SUBCHAPTER XXIV—HIV HEALTH CARE SERVICES PROGRAM
Subchapter Referred to in Other Sections
This subchapter is referred to in
§300ff. Purpose
It is the purpose of this Act to provide emergency assistance to localities that are disproportionately affected by the Human Immunodeficiency Virus epidemic and to make financial assistance available to States and other public or private nonprofit entities to provide for the development, organization, coordination and operation of more effective and cost efficient systems for the delivery of essential services to individuals and families with HIV disease.
(
References in Text
This Act, referred to in text, is
Codification
Section was enacted as part of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, and not as part of the Public Health Service Act which comprises this chapter.
§300ff–1. Prohibition on use of funds
None of the funds made available under this Act, or an amendment made by this Act, shall be used to provide individuals with hypodermic needles or syringes so that such individuals may use illegal drugs.
(
References in Text
This Act, referred to in text, is
Codification
Section was enacted as part of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, and not as part of the Public Health Service Act which comprises this chapter.
Part A—Emergency Relief for Areas With Substantial Need for Services
Part Referred to in Other Sections
This part is referred to in
§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) of this section, make grants in accordance with
(b) Requirement regarding confirmation of cases
The Secretary may not make a grant under subsection (a) of this section 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.
(July 1, 1944, ch. 373, title XXVI, §2601, as added
Prior Provisions
A prior section 2601 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Amendments
1996—Subsec. (a).
"(1) there has been reported to and confirmed by the Director of the Centers for Disease Control and Prevention a cumulative total of more than 2,000 cases of acquired immune deficiency syndrome; or
"(2) the per capita incidence of cumulative cases of such syndrome (computed on the basis of the most recently available data on the population of the area) is not less than 0.0025."
Subsecs. (c), (d).
1992—Subsecs. (a)(1), (b).
Effective Date of 1996 Amendment
Section 13 of
"(a)
"(b)
Study Regarding HIV Disease in Rural Areas
Section 403 of
"(a)
"(1) conduct a study for the purpose of estimating the incidence and prevalence in rural areas of cases of acquired immune deficiency syndrome and cases of infection with the etiologic agent for such syndrome; and
"(2) in carrying out such study, determine the adequacy in rural areas of services for diagnosing such cases and providing treatment for such cases that are in the early stages of infection.
"(b)
"(c)
Section Referred to in Other Sections
This section is referred to in
§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
(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) of this section.
(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
(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) of this section shall establish or designate an HIV health services planning council that shall reflect in its composition the demographics of the epidemic 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;
(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 or AIDS 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) of this subchapter;
(J) grantees under subpart II of part C of this subchapter;
(K) grantees under
(L) grantees under other Federal HIV programs.
(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
(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
(C) Chairperson
A planning council may not be chaired solely by an employee of the grantee.
(4) Duties
The planning council established or designated under paragraph (1) shall—
(A) 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) documented needs of the HIV-infected population;
(ii) cost and outcome effectiveness of proposed strategies and interventions, to the extent that such data are reasonably available (either demonstrated or probable);
(iii) priorities of the HIV-infected communities for whom the services are intended; and
(iv) availability of other governmental and nongovernmental resources;
(B) develop a comprehensive plan for the organization and delivery of health services described in
(C) 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;
(D) 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 of this subchapter; and
(E) establish methods for obtaining input on community needs and priorities which may include public meetings, conducting focus groups, and convening ad-hoc panels.
(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
(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
(6) Grievance procedures
A planning council under paragraph (1) 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) of this section.
(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) of this section 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.
(July 1, 1944, ch. 373, title XXVI, §2602, as added
Prior Provisions
A prior section 2602 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Amendments
1996—Subsec. (b)(1).
"(A) health care providers;
"(B) community-based and AIDS service organizations;
"(C) social service providers;
"(D) mental health care providers;
"(E) local public health agencies;
"(F) hospital planning agencies or health care planning agencies;
"(G) affected communities, including individuals with HIV disease;
"(H) non-elected community leaders;
"(I) State government;
"(J) grantees under subpart II of part C of this subchapter; and
"(K) the lead agency of any Health Resources and Services Administration adult and pediatric HIV-related care demonstration project operating in the area to be served."
Subsec. (b)(2).
Subsec. (b)(2)(C).
Subsec. (b)(3).
Subsec. (b)(3)(A).
Subsec. (b)(3)(B).
Subsec. (b)(3)(C).
Subsec. (b)(3)(D), (E).
Subsec. (b)(4).
Subsec. (b)(5), (6).
Subsec. (c).
1992—Subsec. (a)(1).
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
§300ff–13. Type and distribution of grants
(a) Grants based on relative need of area
(1) In general
In carrying out
(2) Expedited distribution
Not later than 60 days after an appropriation becomes available to carry out this part for each of the fiscal years 1996 through 2000, the Secretary shall, except in the case of waivers granted under section 300ff–15(c) 1 of this title, disburse 50 percent of the amount appropriated under
(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; 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. The first such update shall occur prior to the determination of grant awards under this part for fiscal year 1998.
(D) 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) Increase in grant
With respect to an eligible area under
(A) with respect to fiscal year 1996, 100 percent;
(B) with respect to fiscal year 1997, 99 percent;
(C) with respect to fiscal year 1998, 98 percent;
(D) with respect to fiscal year 1999, 96.5 percent; and
(E) with respect to fiscal year 2000, 95 percent;
of the amount allocated for fiscal year 1995 to such entity under this subsection.
(b) Supplemental grants
(1) In general
Not later than 150 days after the date on which appropriations are made under
(A) contains a report concerning the dissemination of emergency relief funds under subsection (a) of this section 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, 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) Definition
(A) 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; and
(iii) homelessness.
(B) Prevalence
In determining the impact of the factors described in subparagraph (A), the Secretary shall, to the extent practicable, use national, quantitative incidence data that are available for each eligible area. Not later than 2 years after May 20, 1996, the Secretary shall develop a mechanism to utilize such data. In the absence of such data, the Secretary may consider a detailed description and qualitative analysis of severe need, as determined under subparagraph (A), including any local prevalence data gathered and analyzed by the eligible area.
(C) Priority
Subsequent to the development of the quantitative mechanism described in subparagraph (B), 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 subsection (a)(2) of this section as a result of—
(A) the failure of any eligible area to submit an application under section 300ff–15(c) 2 of this title; 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) Amount of grant
The amount of each grant made for purposes of this subsection shall be determined by the Secretary based on the application submitted by the eligible area under
(5) Failure to submit
(A) In general
The failure of an eligible area to submit an application for an expedited grant under subsection (a)(2) of this section shall not result in such area being ineligible for a grant under this subsection.
(B) Application
The application of an eligible area submitted under
(c) Compliance with priorities of HIV planning council
Notwithstanding any other provision of this part, the Secretary, in carrying out
(July 1, 1944, ch. 373, title XXVI, §2603, as added
References in Text
Prior Provisions
A prior section 2603 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Amendments
1996—Subsec. (a)(2).
"(A) 90 days after an appropriation becomes available to carry out this part for fiscal year 1991; and
"(B) 60 days after an appropriation becomes available to carry out this part for each of fiscal years 1992 through 1995;
the Secretary shall".
Subsec. (a)(3).
Subsec. (a)(4).
Subsec. (b)(1).
Subsec. (b)(1)(F), (G).
Subsec. (b)(2) to (4).
Subsec. (b)(5).
Subsec. (b)(5)(B).
Subsec. (c).
1992—Subsec. (a)(3)(B)(i).
1990—Subsec. (a)(3).
"(A)
"(i) an amount determined in accordance with subparagraph (B); and
"(ii) an amount determined in accordance with subparagraph (C).
"(B)
"(i) an amount equal to 75 percent of the amounts available for distribution under paragraph (2) for the fiscal year involved; and
"(ii) a percentage equal to the quotient of—
"(I) the cumulative number of cases of acquired immune deficiency syndrome in the eligible area involved, as indicated by the number of such cases reported to and confirmed by the Director of the Centers for Disease Control on the applicable date described in
"(II) the sum of the cumulative number of such cases in all eligible areas for which an application for a grant under paragraph (1) has been approved.
"(C)
"(i) an amount equal to 25 percent of the amounts available for distribution under paragraph (2) for the fiscal year involved; and
"(ii) a percentage developed by the Secretary through consideration of the ratio of—
"(I) the per capita incidence of cumulative cases of acquired immune deficiency syndrome in the eligible area involved (computed on the basis of the most recently available data on the population of the area); to
"(II) the per capita incidence of such cumulative cases in all eligible areas for which an application for a grant under paragraph (1) has been approved (computed on the basis of the most recently available data on the population of such areas)."
Effective Date of 1996 Amendment
Amendment by sections 3(b)(2), (3), 4, 6(c)(1)(B), and 12(c)(2) of
Section Referred to in Other Sections
This section is referred to in
1 See References in Text note below.
2 See References in Text note below.
§300ff–14. Use of amounts
(a) Requirements
The Secretary may not make a grant under
(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 300ff–12(b)(3)(A) 1 of this title, by the HIV health services planning council that serves such eligible area; and
(2) funds provided under
(b) Primary purposes
(1) In general
The chief elected official shall use amounts received under a grant under
(A) outpatient and ambulatory health and support services, including case management, substance abuse treatment and 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; and
(B) inpatient case management services that prevent unnecessary hospitalization or that expedite discharge, as medically appropriate, from inpatient facilities.
(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,,2 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) Priority for women, infants and children
For the purpose of providing health and support services to infants, children, 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 use, from the grants made for the area under
(c) 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
(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
(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.
(d) Requirement of status as medicaid provider
(1) Provision of service
Subject to paragraph (2), the Secretary may not make a grant under
(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.
(e) 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,.3 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 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 subchapter; and
(C) other types of program support such as quality assurance, quality control, and related activities.
(f) 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.
(July 1, 1944, ch. 373, title XXVI, §2604, as added
References in Text
The Social Security Act, referred to in subsec. (d)(1), is act Aug. 14, 1935, ch. 531,
Prior Provisions
A prior section 2604 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Amendments
1996—Subsec. (b)(1)(A).
Subsec. (b)(2)(A).
Subsec. (b)(3).
Subsec. (e).
1994—Subsec. (b)(2)(A).
Change of Name
Reference to Veterans Administration deemed to refer to Department of Veterans Affairs pursuant to section 10 of
Effective Date of 1996 Amendment
Amendment by
Reference to Community, Migrant, Public Housing, or Homeless Health Center Considered Reference to Health Center
Reference to community health center, migrant health center, public housing health center, or homeless health center considered reference to health center, see section 4(c) of
Section Referred to in Other Sections
This section is referred to in
1 See References in Text note below.
3 So in original. The comma probably should not appear.
§300ff–15. Application
(a) In general
To be eligible to receive a grant under
(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 to individuals with HIV disease;
(B) that the political subdivisions within the eligible area will maintain the level of expenditures by such political subdivisions for HIV-related services for individuals with HIV disease 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
(3) that entities within the eligible area that will receive funds under a grant provided under
(4) 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;
(5) 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; and
(6) 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 of this subchapter, and ensure that the services provided under the comprehensive plan are consistent with the statewide coordinated statement of need.
(b) Application
An eligible area that desires to receive a grant under
(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
(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
(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) of this section 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 2 300ff–11(a) of this title.
(e) Requirements regarding imposition of charges for services
(1) In general
The Secretary may not make a grant under
(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
(4) Waiver regarding secondary agreements
The requirements established in paragraphs (1) through (3) shall be waived in accordance with
(July 1, 1944, ch. 373, title XXVI, §2605, as added
References in Text
Prior Provisions
A prior section 2605 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Amendments
1996—Subsec. (a).
Subsec. (a)(1)(B).
Subsec. (a)(6).
Subsec. (b).
Subsec. (c).
Subsec. (d).
Subsec. (d)(1).
Subsec. (e).
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
1 See References in Text note below.
2 So in original. Probably should be followed by "section".
§300ff–16. Technical assistance
The Administrator of the Health Resources and Services Administration shall, beginning on August 18, 1990, provide technical assistance, including assistance from other grantees, contractors or subcontractors under this subchapter 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
(July 1, 1944, ch. 373, title XXVI, §2606, as added
Prior Provisions
A prior section 2606 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Amendments
1996—
Effective Date of 1996 Amendment
Amendment by
§300ff–17. Definitions
For purposes of this part:
(1) Eligible area
The term "eligible area" means a metropolitan area meeting the requirements of
(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.
(July 1, 1944, ch. 373, title XXVI, §2607, as added
Prior Provisions
A prior section 2607 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Amendments
1996—Par. (1).
1992—Par. (2).
1990—Par. (1).
Effective Date of 1996 Amendment
Amendment by
§300ff–18. Repealed. Pub. L. 104–146, §6(b), May 20, 1996, 110 Stat. 1367
Section, act July 1, 1944, ch. 373, title XXVI, §2608, as added Aug. 18, 1990,
Effective Date of Repeal
Repeal effective Oct. 1, 1996, see section 13 of
Part B—Care Grant Program
Part Referred to in Other Sections
This part is referred to in
subpart i—general grant provisions
Amendments
1996—
§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 this part is subject to
(b) Priority for women, infants, and children
For the purpose of providing health and support services to infants, children, and women with HIV disease, including treatment measures to prevent the perinatal transmission of HIV, a State shall 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 in the State of infants, children, and women with acquired immune deficiency syndrome to the general population in the State of individuals with such syndrome.
(July 1, 1944, ch. 373, title XXVI, §2611, as added
Prior Provisions
A prior section 2611 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Amendments
1996—
Subsec. (a).
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
§300ff–22. General use of grants
A State may use amounts provided under grants made under this part—
(1) to provide the services described in
(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
(3) to provide home- and community-based care services for individuals with HIV disease in accordance with
(4) to provide assistance to assure the continuity of health insurance coverage for individuals with HIV disease in accordance with
(5) to provide therapeutics to treat HIV disease to individuals with HIV disease in accordance with
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.
(July 1, 1944, ch. 373, title XXVI, §2612, as added
Codification
Another section 3(c)(2) of
Prior Provisions
A prior section 2612 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Amendments
1996—
Subsec. (b).
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
§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 300ff–22(a)(1) 1 of this title to an entity that—
(1) is an association of one or more public, and one or more nonprofit private,2 (or private for-profit providers or organizations if such entities are the only available providers of quality HIV care in the area) 2 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 subchapter as a "consortium" or "consortia".
(b) Assurances
(1) Requirement
To receive assistance from a State under subsection (a) of this section, 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;
(B) the service plan established under subsection (c)(2) of this section by such consortium 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) of this section, 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; and
(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.
(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; and
(C) grantees under
The organization to be consulted under subparagraph (B) shall be at the discretion of the applicant consortium.
(d) "Family centered care" defined
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) of this section, 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.
(July 1, 1944, ch. 373, title XXVI, §2613, as added
References in Text
Codification
Another section 3(c)(2) of
Prior Provisions
A prior section 2613 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Amendments
1996—Subsec. (a)(1).
Subsec. (a)(2)(A).
Subsec. (c)(1)(C).
Subsec. (c)(2)(C).
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
1 See References in Text note below.
2 So in original. The comma probably should follow parenthetical phrase.
§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 300ff–22(a)(2) 1 of this title 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) of this section, 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) "Home- and community-based health services" defined
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.
(July 1, 1944, ch. 373, title XXVI, §2614, as added
References in Text
Prior Provisions
A prior section 2614 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see
Section Referred to in Other Sections
This section is referred to in
1 See References in Text note below.
§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 300ff–22(a)(3) 1 of this title 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) of this section—
(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 [
(July 1, 1944, ch. 373, title XXVI, §2615, as added
References in Text
The Social Security Act, referred to in subsec. (b)(2), is act Aug. 14, 1935, ch. 531,
Section Referred to in Other Sections
This section is referred to in
1 See References in Text note below.
§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 300ff–22(a)(5) 1 of this title 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; and
(5) document the progress made in making therapeutics described in subsection (a) of this section available to individuals eligible for assistance under this section.
(d) Duties of Secretary
In carrying out this section, the Secretary shall review the current status of State drug reimbursement programs established under
(July 1, 1944, ch. 373, title XXVI, §2616, as added
Amendments
1996—Subsec. (a).
Subsec. (c)(5).
Subsec. (d).
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
1 So in original. Probably should be a reference to
§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) of this section 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 comprehensive plan for 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, including—
(A) 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;
(B) 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
(C) 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 subchapter; and 1
(3) an assurance that the public health agency administering the grant for the State will periodically convene a meeting of individuals with HIV, representatives of grantees under each part under this subchapter, providers, and public agency representatives for the purpose of developing a statewide coordinated statement of need; and
(4) an assurance by the State that—
(A) the public health agency that is administering the grant for the State will conduct public hearings concerning the proposed use and distribution of the assistance to be received under this part;
(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
(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; and
(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.
(c) Requirements regarding imposition of charges for services
(1) In general
The Secretary may not make a grant under
(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
(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) of this section, 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 162/3 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 subchapter;
(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 subchapter (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) of this section.
(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.
(July 1, 1944, ch. 373, title XXVI, §2617, as added
Amendments
1996—Subsec. (b)(2)(C).
Subsec. (b)(3).
Subsec. (b)(4).
Subsec. (b)(4)(B)(iv).
1992—Subsec. (d)(3)(A).
Effective Date of 1996 Amendment
Amendment by
1 So in original. The word "and" probably should not appear.
§300ff–27a. Spousal notification
(a) In general
The Secretary of Health and Human Services shall not make a grant under part B of title XXVI of the Public Health Service Act (
(b) Definitions
For purposes of this section:
(1) Spouse
The term "spouse" means any individual who is the marriage partner of an HIV-infected patient, or who has been the marriage partner of that patient at any time within the 10-year period prior to the diagnosis of HIV infection.
(2) HIV-infected patient
The term "HIV-infected patient" means any individual who has been diagnosed to be infected with the human immunodeficiency virus.
(3) State
The term "State" means any of the 50 States, the District of Columbia, or any territory of the United States.
(
References in Text
The Public Health Service Act, referred to in subsec. (a), is act July 1, 1944, ch. 373,
Codification
Section was enacted as part of the Ryan White CARE Act Amendments of 1996, and not as part of the Public Health Service Act which comprises this chapter.
Effective Date
Section effective Oct. 1, 1996, see section 13 of
§300ff–28. Distribution of funds
(a) Repealed. Pub. L. 104–146, §3(g)(2), May 20, 1996, 110 Stat. 1363
(b) Amount of grant to State
(1) Minimum allotment
Subject to the extent of amounts made available under
(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), $100,000; 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), $250,000;
(ii) an amount determined under paragraph (2); and
(B) each territory of the United States, as defined in paragraph (3), shall be 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
(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 1 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 of this subchapter).
(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; and
(ii) with respect to each of the first through the tenth year during such period, the amount referred to in
(E) 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.
(F) 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.
(G) Limitation
(i) In general
The Secretary shall ensure that the amount of a grant awarded to a State or territory for a fiscal year under this part is equal to not less than—
(I) with respect to fiscal year 1996, 100 percent;
(II) with respect to fiscal year 1997, 99 percent;
(III) with respect to fiscal year 1998, 98 percent;
(IV) with respect to fiscal year 1999, 96.5 percent; and
(V) with respect to fiscal year 2000, 95 percent;
of the amount such State or territory received for fiscal year 1995 under this part. In administering this subparagraph, the Secretary shall, with respect to States that will receive grants in amounts that exceed the amounts that such States received under this part in fiscal year 1995, 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 1995.
(ii) Ratable reduction
If the amount appropriated under
(H) Appropriations for treatment drug program
With respect to the fiscal year involved, if under
(i) 100 percent of such amount; 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.
(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,2 American Samoa, the Commonwealth of the Northern Mariana Islands, and the Republic of the Marshall Islands.
(c) Allocation of assistance by States
(1) Repealed. Pub. L. 104–146, §3(c)(5)(A), May 20, 1996, 110 Stat. 1355
(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 of this subchapter.
(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
(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 subchapter; 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) of this section 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.
(d) 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.
(e) 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) of this section shall be repaid to the Secretary and reallotted to other States in proportion to the original grants made to such States.
(July 1, 1944, ch. 373, title XXVI, §2618, as added
Amendments
1998—Subsec. (b)(3)(A).
Subsec. (b)(3)(B).
1996—Subsec. (a).
Subsec. (a)(1).
Subsec. (b)(1).
"(A) each of the several States and the District of Columbia for a fiscal year shall be the greater of—
"(i) $100,000, and
"(ii) an amount determined under paragraph (2); and
"(B) each territory of the United States, as defined in paragraph 3, shall be an amount determined under paragraph (2)."
Subsec. (b)(2).
Subsec. (c)(1).
Subsec. (c)(3), (4).
"(3)
"(4)
Subsec. (c)(5) to (7).
1992—Subsec. (c)(1).
Effective Date of 1996 Amendment
Amendment by sections 3(c)(5), (g)(2) and 6(c)(3)(A) of
1 So in original. Probably should be " 'non-EMA".
2 So in original. The comma probably should not appear.
§300ff–29. Technical assistance
The Secretary shall provide technical assistance in administering and coordinating the activities authorized under
(July 1, 1944, ch. 373, title XXVI, §2619, as added
Amendments
1996—
Effective Date of 1996 Amendment
Amendment by
§300ff–30. Repealed. Pub. L. 104–146, §6(b), May 20, 1996, 110 Stat. 1367
Section, act July 1, 1944, ch. 373, title XXVI, §2620, as added Aug. 18, 1990,
Effective Date of Repeal
Repeal effective Oct. 1, 1996, see section 13 of
§300ff–31. Coordination
The Secretary shall ensure that the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration coordinate the planning and implementation of Federal HIV programs in order to facilitate the local development of a complete continuum of HIV-related services for individuals with HIV disease and those at risk of such disease. Not later than October 1, 1996, and biennially thereafter, the Secretary shall submit to the appropriate committees of the Congress a report concerning coordination efforts under this subchapter at the Federal, State, and local levels, including a statement of whether and to what extent there exist Federal barriers to integrating HIV-related programs.
(July 1, 1944, ch. 373, title XXVI, §2621, as added
Effective Date
Section effective Oct. 1, 1996, see section 13 of
subpart ii—provisions concerning pregnancy and perinatal transmission of hiv
§300ff–33. CDC guidelines for pregnant women
(a) Requirement
Notwithstanding any other provision of law, a State shall, not later than 120 days after May 20, 1996, 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) of this section 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) of this section and is receiving funds under this part 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
(E) Offsetting State costs associated with the implementation of mandatory newborn testing in accordance with this subchapter or at an earlier date than is required by this subchapter.
(2) Funding
For purposes of carrying out this subsection, there are authorized to be appropriated $10,000,000 for each of the fiscal years 1996 through 2000. Amounts made available under
(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.
(July 1, 1944, ch. 373, title XXVI, §2625, as added
Effective Date
Section effective Oct. 1, 1996, see section 13 of
Perinatal Transmission of HIV Disease; Congressional Findings
Section 7(a) of
"(1) Research studies and statewide clinical experiences have demonstrated that administration of anti-retroviral medication during pregnancy can significantly reduce the transmission of the human immunodeficiency virus (commonly known as HIV) from an infected mother to her baby.
"(2) The Centers for Disease Control and Prevention have recommended that all pregnant women receive HIV counseling; voluntary, confidential HIV testing; and appropriate medical treatment (including anti-retroviral therapy) and support services.
"(3) The provision of such testing without access to such counseling, treatment, and services will not improve the health of the woman or the child.
"(4) The provision of such counseling, testing, treatment, and services can reduce the number of pediatric cases of acquired immune deficiency syndrome, can improve access to and provision of medical care for the woman, and can provide opportunities for counseling to reduce transmission among adults, and from mother to child.
"(5) The provision of such counseling, testing, treatment, and services can reduce the overall cost of pediatric cases of acquired immune deficiency syndrome.
"(6) The cancellation or limitation of health insurance or other health coverage on the basis of HIV status should be impermissible under applicable law. Such cancellation or limitation could result in disincentives for appropriate counseling, testing, treatment, and services.
"(7) For the reasons specified in paragraphs (1) through (6)—
"(A) routine HIV counseling and voluntary testing of pregnant women should become the standard of care; and
"(B) the relevant medical organizations as well as public health officials should issue guidelines making such counseling and testing the standard of care."
Section Referred to in Other Sections
This section is referred to in
§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) of this section, 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 May 20, 1996, 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) of this section. The Director shall issue guidelines to ensure that the data collected is statistically valid.
(d) Determination by Secretary
Not later than 180 days after the expiration of the 18-month period beginning on the date on which the system is implemented under subsection (c) of this section, the Secretary shall publish in the Federal Register a determination of whether it has become a routine practice in the provision of health care in the United States to carry out each of the activities described in paragraphs (1) through (4) of
(e) Contingent applicability
(1) In general
If the determination published in the Federal Register under subsection (d) of this section is that (for purposes of such subsection) the activities involved have become routine practices, paragraph (2) shall apply on and after the expiration of the 18-month period beginning on the date on which the determination is so published.
(2) Requirement
Subject to subsection (f) of this section, the Secretary shall not make a grant under this part to a State unless the State meets not less than one of the following requirements:
(A) A 50 percent reduction (or a comparable measure for States with less than 10 cases) in the rate of new cases of AIDS (recognizing that AIDS is a suboptimal proxy for tracking HIV in infants and was selected because such data is universally available) as a result of perinatal transmission as compared to the rate of such cases reported in 1993 (a State may use HIV data if such data is available).
(B) At least 95 percent of women in the State who have received at least two prenatal visits (consultations) prior to 34 weeks gestation with a health care provider or provider group have been tested for the human immunodeficiency virus.
(C) The State has in effect, in statute or through regulations, the requirements specified in paragraphs (1) through (5) of
(f) Limitation regarding availability of funds
With respect to an activity described in any of paragraphs (1) through (4) of
(1) Federal funds provided to the State in grants under this part or under
(2) Funds that the State or private entities have elected to provide, including through entering into contracts under which health benefits are provided. This section does not require any entity to expend non-Federal funds.
(July 1, 1944, ch. 373, title XXVI, §2626, as added
Amendments
1996—Subsec. (d).
Subsec. (f).
Effective Date
Section effective May 20, 1996, see section 13(b) of
Section Referred to in Other Sections
This section is referred to in
§300ff–35. Testing of pregnant women and newborn infants
An activity or requirement described in this section is any of the following:
(1) In the case of newborn infants who are born in the State and whose biological mothers have not undergone prenatal testing for HIV disease, that each such infant undergo testing for such disease.
(2) That the results of such testing of a newborn infant be promptly disclosed in accordance with the following, as applicable to the infant involved:
(A) To the biological mother of the infant (without regard to whether she is the legal guardian of the infant).
(B) If the State is the legal guardian of the infant:
(i) To the appropriate official of the State agency with responsibility for the care of the infant.
(ii) To the appropriate official of each authorized agency providing assistance in the placement of the infant.
(iii) If the authorized agency is giving significant consideration to approving an individual as a foster parent of the infant, to the prospective foster parent.
(iv) If the authorized agency is giving significant consideration to approving an individual as an adoptive parent of the infant, to the prospective adoptive parent.
(C) If neither the biological mother nor the State is the legal guardian of the infant, to another legal guardian of the infant.
(D) To the child's health care provider.
(3) That, in the case of prenatal testing for HIV disease that is conducted in the State, the results of such testing be promptly disclosed to the pregnant woman involved.
(4) That, in disclosing the test results to an individual under paragraph (2) or (3), appropriate counseling on the human immunodeficiency virus be made available to the individual (except in the case of a disclosure to an official of a State or an authorized agency).
(5) With respect to State insurance laws, that such laws require—
(A) that, if health insurance is in effect for an individual, the insurer involved may not (without the consent of the individual) discontinue the insurance, or alter the terms of the insurance (except as provided in subparagraph (C)), solely on the basis that the individual is infected with HIV disease or solely on the basis that the individual has been tested for the disease or its manifestation;
(B) that subparagraph (A) does not apply to an individual who, in applying for the health insurance involved, knowingly misrepresented the HIV status of the individual; and
(C) that subparagraph (A) does not apply to any reasonable alteration in the terms of health insurance for an individual with HIV disease that would have been made if the individual had a serious disease other than HIV disease.
For purposes of this subparagraph, a statute or regulation shall be deemed to regulate insurance for purposes of this paragraph only to the extent that such statute or regulation is treated as regulating insurance for purposes of
(July 1, 1944, ch. 373, title XXVI, §2627, as added
Effective Date
Section effective Oct. 1, 1996, see section 13 of
Section Referred to in Other Sections
This section is referred to in
§300ff–36. Report by Institute of Medicine
(a) In general
The Secretary shall request that the Institute of Medicine of the National Academy of Sciences conduct an evaluation of the extent to which State efforts have been effective in reducing the perinatal transmission of the human immunodeficiency virus, and an analysis of the existing barriers to the further reduction in such transmission.
(b) Report to Congress
The Secretary shall ensure that, not later than 2 years after May 20, 1996, the evaluation and analysis described in subsection (a) of this section is completed and a report summarizing the results of such evaluation and analysis is prepared by the Institute of Medicine and submitted to the appropriate committees of Congress together with the recommendations of the Institute.
(July 1, 1944, ch. 373, title XXVI, §2628, as added
Effective Date
Section effective Oct. 1, 1996, see section 13 of
§300ff–37. State HIV testing programs established prior to or after May 20, 1996
Nothing in this subpart shall be construed to disqualify a State from receiving grants under this subchapter if such State has established at any time prior to or after May 20, 1996, a program of mandatory HIV testing.
(July 1, 1944, ch. 373, title XXVI, §2629, as added
Effective Date
Section effective Oct. 1, 1996, see section 13 of
Part C—Early Intervention Services
Part Referred to in Other Sections
This part is referred to in
subpart i—formula grants for states
§300ff–41. Establishment of program
(a) Allotments for States
For the purposes described in subsection (b) of this section, the Secretary, acting through the Director of the Centers for Disease Control and Prevention and in consultation with the Administrator of the Health Resources and Services Administration, shall for each of the fiscal years 1991 through 1995 make an allotment for each State in an amount determined in accordance with
(b) Purposes of grants
(1) In general
The Secretary may not make a grant under subsection (a) of this section unless the State involved 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.
(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
(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 with respect to HIV disease, and periodic medical evaluations of individuals with the disease; and
(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 of this subchapter 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
(4) Requirement of availability of all early intervention services through each grantee
The Secretary may not make a grant under subsection (a) of this section unless the State involved agrees that each of the early intervention services specified in paragraph (2) will be available through the State. With respect to compliance with such agreement, a State 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 under which the entities provide the services.
(5) Optional services
A State receiving a grant under subsection (a) of this section—
(A) may expend not more than 5 percent of the grant to provide early intervention services through making grants to hospitals that—
(i) for the most recent fiscal year for which the data is available, have admitted—
(I) not fewer than 250 individuals with acquired immune deficiency syndrome; or
(II) a number of such individuals constituting 20 percent of the number of inpatients of the hospital admitted during such period;
(ii) agree to offer and encourage such services with respect to inpatients of the hospitals; and
(iii) agree that subsections (c) and (d) of
(B) 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
(C) 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.
(6) Allocations
(A) Subject to subparagraphs (B) and (C), the Secretary may not make a grant under subsection (a) of this section unless the State involved agrees—
(i) to expend not less than 35 percent of the grant to provide the early intervention services specified in subparagraphs (A) through (C) of paragraph (2); and
(ii) to expend not less than 35 percent of the grant to provide the early intervention services specified in subparagraphs (D) and (E) of such paragraph.
(B) With respect to compliance with the agreement under subparagraph (A), amounts reserved by a State for fiscal year 1991 for purposes of clauses (i) and (ii) of such subparagraph may be expended to provide the services specified in paragraph (5).
(C) The Secretary shall ensure that, of the amounts appropriated under
(July 1, 1944, ch. 373, title XXVI, §2641, as added
Amendments
1992—Subsec. (a).
Section Referred to in Other Sections
This section is referred to in
§300ff–42. Provision of services through medicaid providers
(a) In general
Subject to subsection (b) of this section, the Secretary may not make a grant under
(1) the State will provide the service through a State entity, and the State entity has entered into a participation agreement under the State plan and is qualified to receive payments under such plan; or
(2) the State 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.
(b) Waiver regarding certain secondary agreements
(1) In general
In the case of an entity making an agreement pursuant to subsection (a)(2) of this section regarding the provision of services, the requirement established in such subsection 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.
(2) Acceptance of voluntary donations
A determination by the Secretary of whether an entity referred to in paragraph (1) 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.
(July 1, 1944, ch. 373, title XXVI, §2642, as added
References in Text
The Social Security Act, referred to in subsec. (a), is act Aug. 14, 1935, ch. 531,
Section Referred to in Other Sections
This section is referred to in
§300ff–43. Requirement of matching funds
(a) In general
In the case of any State to which the criterion described in subsection (c) of this section applies, the Secretary may not make a grant under
(1) for the first fiscal year for which such criterion applies to the State, not less than 162/3 percent of such costs ($1 for each $5 of Federal funds provided in the grant);
(2) for any second such fiscal year, not less than 20 percent of such costs ($1 for each $4 of Federal funds provided in the grant);
(3) for any third such fiscal year, not less than 25 percent of such costs ($1 for each $3 of Federal funds provided in the grant); and
(4) for any subsequent fiscal year, not less than 331/3 percent of such costs ($1 for each $2 of Federal funds provided in the grant).
(b) Determination of amount of non-Federal contribution
(1) In general
Non-Federal contributions required in subsection (a) of this section 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.
(2) Inclusion of certain amounts
(A) In making a determination of the amount of non-Federal contributions made by a State for purposes of subsection (a) of this section, the Secretary shall, subject to subparagraph (B), 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 subchapter.
(B) In making a determination for purposes of subparagraph (A), 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 subchapter (except for the program established in
(c) Applicability of matching requirement
(1) Percentage of national number of cases
(A) The criterion referred to in subsection (a) of this section is, with respect to a State, that 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 State for the period described in subparagraph (B) constitutes more than 1 percent of the number of such cases reported to and confirmed by the Director for the United States for such period.
(B) 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
(2) Exemption
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.
(d) Diminished State contribution
With respect to a State that does not make available the entire amount of the non-Federal contribution referred to in subsection (a) of this section, the State shall continue to be eligible to receive Federal funds under a grant under
(July 1, 1944, ch. 373, title XXVI, §2643, as added
Amendments
1992—Subsec. (c)(1)(A).
§300ff–44. Offering and encouraging early intervention services
(a) In general
The Secretary may not make a grant under
(1) if the entity is a health care provider that regularly provides treatment for sexually transmitted diseases, the entity will offer and encourage such services with respect to individuals to whom the entity provides such treatment;
(2) if the entity is a health care provider that regularly provides treatment for intravenous substance abuse, the entity will offer and encourage such services with respect to individuals to whom the entity provides such treatment;
(3) if the entity is a family planning clinic, the entity will offer and encourage such services with respect to individuals to whom the entity provides family planning services and whom the entity has reason to believe has HIV disease; and
(4) if the entity is a health care provider that provides treatment for tuberculosis, the entity will offer and encourage such services with respect to individuals to whom the entity provides such treatment.
(b) Sufficiency of amount of grant
With respect to compliance with the agreement made under subsection (a) of this section, an entity to which subsection (a) of this section applies may be required to offer, encourage, and provide early intervention services only to the extent that the amount of the grant is sufficient to pay the costs of offering, encouraging, and providing the services.
(c) Criteria for offering and encouraging
Subject to
(1) offers such services to the individuals, and encourages the individuals to receive the services, as a regular practice in the course of providing the health care involved; and
(2) provides the early intervention services only with the consent of the individuals.
(July 1, 1944, ch. 373, title XXVI, §2644, as added
Section Referred to in Other Sections
This section is referred to in
§300ff–45. Notification of certain individuals receiving blood transfusions
(a) In general
The Secretary may not make a grant under
(1) encouraging the population of such individuals to receive early intervention services; and
(2) informing such population of any health facilities in the geographic area involved that provide such services.
(b) Rule of construction
An agreement made under subsection (a) of this section may not be construed to require that, in carrying out the activities described in such subsection, a State receiving a grant under
(July 1, 1944, ch. 373, title XXVI, §2645, as added
§300ff–46. Reporting and partner notification
(a) Reporting
The Secretary may not make a grant under
(1) to perform statistical and epidemiological analyses of the incidence in the State of cases of such disease;
(2) to perform statistical and epidemiological analyses of the demographic characteristics of the population of individuals in the State who have the disease; and
(3) to assess the adequacy of early intervention services in the State.
(b) Partner notification
The Secretary may not make a grant under
(c) Rules of construction
An agreement made under this section may not be construed—
(1) to require or prohibit any State from providing that identifying information concerning individuals with HIV disease is required to be submitted to the State; or
(2) to require any State to establish a requirement that entities other than the public health officer of the State are required to make the notifications referred to in subsection (b) of this section.
(July 1, 1944, ch. 373, title XXVI, §2646, as added
Study Regarding Partner Notification
Section 402 of
"(a)
"(1) in the case of individuals who have been notified under such programs, the percentage of such individuals who undergo counseling and testing regarding HIV disease;
"(2) in the case of such individuals who have undergone HIV testing, the number of such individuals determined through such tests to have HIV disease;
"(3) the extent to which such programs have, in the case of such individuals, resulted in behavioral changes that are effective regarding the prevention of exposure to, and the transmission of, HIV disease; and
"(4) the extent to which such programs represent a cost effective use of available HIV-related resources.
"(b)
§300ff–47. Requirement of State law protection against intentional transmission
(a) In general
The Secretary may not make a grant under
(1) makes a donation of blood, semen, or breast milk, if the individual knows that he or she is infected with HIV and intends, through such donation, to expose another to HIV in the event that the donation is utilized;
(2) engages in sexual activity if the individual knows that he or she is infected with HIV and intends, through such sexual activity, to expose another to HIV; and
(3) injects himself or herself with a hypodermic needle and subsequently provides the needle to another person for purposes of hypodermic injection, if the individual knows that he or she is infected and intends, through the provision of the needle, to expose another to such etiologic agent in the event that the needle is utilized.
(b) Consent to risk of transmission
The State laws described in subsection (a) of this section need not apply to circumstances under which the conduct described in paragraphs (1) through (3) of subsection (a) of this section if the individual who is subjected to the behavior involved knows that the other individual is infected and provides prior informed consent to the activity.
(c) State certification with respect to required laws
With respect to complying with subsection (a) of this section as a condition of receiving a grant under
(d) Time limitations with respect to required laws
With respect to receiving a grant under
(1) for each of the fiscal years 1991 and 1992, the State provides assurances satisfactory to the Secretary that by not later than October 1, 1992, the State will have in place or will establish the prohibitions described in subsection (a) of this section; and
(2) for fiscal year 1993 and subsequent fiscal years, the State has established such prohibitions.
(July 1, 1944, ch. 373, title XXVI, §2647, as added
Amendments
1996—Subsec. (a)(1).
Subsec. (c).
Subsec. (d).
Subsec. (d)(1).
1990—Subsec. (c).
Effective Date of 1996 Amendment
Amendment by
§300ff–48. Testing and other early intervention services for State prisoners
(a) In general
In addition to grants under
(1) the services be provided to such individuals; and
(2) each such individual be informed of the requirements of subsection (c) of this section regarding testing and be informed of the results of such testing of the individual.
(b) Requirement of matching funds
(1) In general
The Secretary may not make a grant under subsection (a) of this section unless the State involved agrees that, with respect to the costs to be incurred by the State in carrying out the purpose described in such subsection, the State will 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 $1 for each $2 of Federal funds provided in the grant; and
(B) for any subsequent fiscal year of such payments, not less than $1 for each $1 of Federal funds provided in the grant.
(2) Determination of amount of non-Federal contribution
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 services (or portions of services) subsidized by the Federal Government, may not be included in determining the amount of such non-Federal contributions.
(c) Testing
The Secretary may not make a grant under subsection (a) of this section unless—
(1) the State involved requires that, subject to subsection (d) of this section, any individual sentenced by the State to a term of imprisonment be tested for HIV disease—
(A) upon entering the State penal system; and
(B) during the 30-day period preceding the date on which the individual is released from such system;
(2) with respect to informing employees of the penal system of the results of such testing of the individual, the State—
(A) upon the request of any such employee, provides the results to the employee in any case in which the medical officer of the prison determines that there is a reasonable basis for believing that the employee has been exposed by the individual to such disease; and
(B) informs the employees of the availability to the employees of such results under the conditions described in subparagraph (A);
(3) with respect to informing the spouse of the individual of the results of such testing of the individual, the State—
(A) upon the request of the spouse, provides such results to the spouse prior to any conjugal visit and provides such results to the spouse during the period described in paragraph (1)(B); and
(B) informs the spouse of the availability to the spouse of such results under the conditions described in subparagraph (A);
(4) with respect to such testing upon entering the State penal system of such an individual who has been convicted of rape or aggravated sexual assault, the State—
(A) upon the request of the victim of the rape or assault, provides such results to the victim; and
(B) informs the victim of the availability to the victim of such results; and
(5) the State, except as provided in any of paragraphs (2) through (4), maintains the confidentiality of the results of testing for HIV disease in each prison operated by the State or with amounts provided by the State, and makes disclosures of such results only as medically necessary.
(d) Determination of prisons subject to requirement
(1) In general
The Secretary may not make a grant under subsection (a) of this section unless the State involved agrees that the requirement established in such subsection regarding the provision of early intervention services to inmates will apply only to inmates who are incarcerated in prisons with respect to which the State public health officer, after consultation with the chief State correctional officer, has, on the basis of the criteria described in paragraph (2), determined that the provision of such services is appropriate with respect to the public health and safety.
(2) Description of criteria
The criteria to be considered for purposes of paragraph (1) are—
(A) with respect to the geographic areas in which inmates of the prison involved resided before incarceration in the prison—
(i) the severity of the epidemic of HIV disease in the areas during the period in which the inmates resided in the areas; and
(ii) the incidence, in the areas during such period, of behavior that places individuals at significant risk of developing HIV disease; and
(B) the extent to which medical examinations conducted by the State for inmates of the prison involved indicate that the inmates have engaged in such behavior.
(e) Applicability of provisions regarding informed consent, counseling, and other matters
The Secretary may not make a grant under subsection (a) of this section unless the State involved agrees that
(f) Requirement of application
The Secretary may not make a grant under subsection (a) of this section 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.
(g) Rule of construction
With respect to testing inmates of State prisons for HIV disease without the consent of the inmates, the agreements made under this section may not be construed to authorize, prohibit, or require any State to conduct such testing, except as provided in subparagraphs (A) and (B) of subsection (c)(1) of this section.
(h) Authorization of appropriations
To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 1988 through 1995.
(July 1, 1944, ch. 373, title XXVI, §2648, formerly
Codification
Section was formerly classified to
Amendments
1996—
Subsecs. (g), (h).
1990—
Subsecs. (a) to (f).
Subsec. (g).
1988—Subsecs. (c), (d)(3)(B)(i).
Effective Date of 1996 Amendment
Amendment by
Effective Date of 1988 Amendment
Amendment by
Effective Date
Section 904 of title IX of
Short Title
Section 901 of title IX of
Study by Attorney General; Report to Congress
Section 903 of title IX of
§300ff–49. Determination of amount of allotments
(a) Minimum allotment
Subject to the extent of amounts made available in appropriations Acts, the amount of an allotment under
(1) $100,000 for each of the several States, the District of Columbia, and the Commonwealth of Puerto Rico, and $50,000 for each of the territories of the United States other than the Commonwealth of Puerto Rico; and
(2) an amount determined under subsection (b) of this section.
(b) Determination under formula
The amount referred to in subsection (a)(2) of this section is the product of—
(1) an amount equal to the amount appropriated under
(2) a percentage equal to the quotient of—
(A) an amount equal to 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 State involved for the most recent fiscal year for which such data is available; divided by
(B) an amount equal to 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 United States for the most recent fiscal year for which such data is available.
(c) Certain allocations by Secretary
(1) Discretionary grants to certain States
After determining the amount of an allotment under subsection (a) of this section for a fiscal year, the Secretary shall reduce the amount of the allotment of each State by 10 percent. From the amounts available as a result of such reductions, the Secretary shall, on a discretionary basis, make grants to States receiving allotments for the fiscal year involved. Such grants shall be made subject to each of the agreements and assurances required as a condition of receiving grants under
(2) Grants to certain political subdivisions
(A)(i) In the case of a State containing any political subdivision described in clause (ii), the Secretary shall, subject to subparagraph (B), make a reduction in the amount of the allotment under subsection (a) of this section for the State for each fiscal year in an amount necessary for carrying out subparagraphs (B) and (C) with respect to the political subdivision. Any such reduction shall be in addition to the reduction required in paragraph (1) for the fiscal year involved.
(ii) The political subdivision referred to in clause (i) is any political subdivision that received a cooperative agreement from the Secretary, acting through the Director of the Centers for Disease Control and Prevention, for fiscal year 1990 for programs to provide counseling and testing with respect to acquired immune deficiency syndrome.
(B) In the case of a State described in subparagraph (A), the Secretary shall, from the amounts made available as a result of reductions under such subparagraph, make a grant each fiscal year to each political subdivision described in such subparagraph that exists in the State if the political subdivision involved agrees that the provisions of subparts II and III will apply to the political subdivision to the same extent and in the same manner as such subparts apply to entities receiving grants under
(C) Grants under subparagraph (B) for a fiscal year for a political subdivision shall be provided in an amount equal to the amount received by the political subdivision in fiscal year 1990 under the cooperative agreement described in subparagraph (A).
(d) Disposition of certain funds appropriated for allotments
(1) In general
Any amounts available pursuant to paragraph (2) shall, in accordance with paragraph (3), be allotted by the Secretary each fiscal year to States receiving payments under
(2) Specification of amounts
The amounts referred to in paragraph (1) are any amounts that are not paid to States under
(A) the failure of any State to submit an application under
(B) the failure, in the determination of the Secretary, of any State to prepare the application in compliance with such section or to submit the application within a reasonable period of time; or
(C) any State informing the Secretary that the State does not intend to expend the full amount of the allotment made to the State.
(3) Amount of allotment
The amount of an allotment under paragraph (1) for a State for a fiscal year shall be an amount equal to the product of—
(A) an amount equal to the amount available pursuant to paragraph (2) for the fiscal year involved; and
(B) the percentage determined under subsection (b)(2) of this section for the State.
(e) Transition rules
(1) For the fiscal years 1991 through 1993, the amount of an allotment under
(2) For purposes of paragraph (1)—
(A) the amount applicable for fiscal year 1991 is an amount equal to the amount received by the State involved from the Secretary, acting through the Director of the Centers for Disease Control and Prevention, for fiscal year 1990 for the provision of counseling and testing services with respect to HIV;
(B) the amount applicable for fiscal year 1992 is 85 percent of the amount specified in subparagraph (A); and
(C) the amount applicable for fiscal year 1993 is 70 percent of the amount specified in subparagraph (A).
(July 1, 1944, ch. 373, title XXVI, §2649, as added
Amendments
1996—Subsec. (b)(1).
Subsec. (c)(1).
1992—Subsecs. (b)(2), (c)(2)(A)(ii), (e)(2)(A).
1990—Subsec. (c).
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
§300ff–49a. Miscellaneous provisions
The Secretary may not make a grant under
(1) the State involved submits to the Secretary a comprehensive plan for the organization and delivery of the early intervention services to be funded with the grant that includes a description of the purposes for which the State intends to use such assistance, including—
(A) 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 the grant will maximize the quality of early intervention services available to individuals with HIV disease throughout the State; and
(B) a description of the manner in which services funded with the grant will be coordinated with other available related services for individuals with HIV disease; and
(2) the State agrees that—
(A) the public health agency administering the grant will conduct public hearings regarding the proposed use and distribution of the grant;
(B) to the maximum extent practicable, early intervention services delivered pursuant to the grant 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;
(C) early intervention services under the grant will be provided in settings accessible to low-income individuals with HIV disease; and
(D) outreach to low-income individuals with HIV disease will be provided to inform such individuals of the services available pursuant to the grant.
(July 1, 1944, ch. 373, title XXVI, §2649A, as added
§300ff–50. Authorization of appropriations
For the purpose of making grants under
(July 1, 1944, ch. 373, title XXVI, §2650, as added
Section Referred to in Other Sections
This section is referred to in
subpart ii—categorical grants
Subpart Referred to in Other Sections
This subpart is referred to in
§300ff–51. Establishment of program
(a) In general
For the purposes described in subsection (b) of this section, the Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to public and nonprofit private entities specified in
(b) Purposes of grants
(1) In general
The Secretary may not make a grant under subsection (a) of this section 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
(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 of this subchapter 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
(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) of this section 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
(ii) paragraphs (3) and (4) of
(5) Optional services
A grantee under subsection (a) of this section—
(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) of this section unless the applicant for the grant agrees to make reasonable efforts to participate in a consortium established with a grant under section 300ff–22(a)(1) 1 of this title 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.
(July 1, 1944, ch. 373, title XXVI, §2651, as added
References in Text
Amendments
1996—Subsec. (b)(1).
Subsec. (b)(3)(B).
Subsec. (b)(4).
Subsec. (c).
1990—Subsec. (a).
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
1 See References in Text note below.
§300ff–52. Minimum qualifications of grantees
(a) In general
The entities referred to in
(1) migrant health centers under section 254b 1 of this title or community health centers under section 254c 1 of this title;
(2) grantees under section 256 1 of this title (regarding health services for the homeless);
(3) grantees under
(4) comprehensive hemophilia diagnostic and treatment centers;
(5) Federally-qualified health centers under section 1905(l)(2)(B) of the Social Security Act [
(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
(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.
(July 1, 1944, ch. 373, title XXVI, §2652, as added
References in Text
The Social Security Act, referred to in subsec. (b)(1), is act Aug. 14, 1935, ch. 531,
Amendments
1996—Subsec. (b)(1)(B).
1990—Subsec. (a).
Effective Date of 1996 Amendment
Amendment by
Reference to Community, Migrant, Public Housing, or Homeless Health Center Considered Reference to Health Center
Reference to community health center, migrant health center, public housing health center, or homeless health center considered reference to health center, see section 4(c) of
Section Referred to in Other Sections
This section is referred to in
1 See References in Text note below.
§300ff–53. Preferences in making grants
(a) In general
In making grants under
(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
(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
(c) Equitable allocations
In providing preferences for purposes of subsection (b) of this section, the Secretary shall equitably allocate the preferences among urban and rural areas.
(July 1, 1944, ch. 373, title XXVI, §2653, as added
§300ff–54. Miscellaneous provisions
(a) Services for individuals with hemophilia
In making grants under
(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
(c) Planning and development grants
(1) In general
The Secretary may provide planning grants, in an amount not to exceed $50,000 for each such grant, to public and nonprofit private entities for the purpose of enabling such entities to provide HIV early intervention services.
(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
(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) Limitation
Not to exceed 1 percent of the amount appropriated for a fiscal year under
(July 1, 1944, ch. 373, title XXVI, §2654, as added
Amendments
1996—Subsec. (c).
Effective Date of 1996 Amendment
Amendment by
§300ff–55. Authorization of appropriations
For the purpose of making grants under
(July 1, 1944, ch. 373, title XXVI, §2655, as added
Amendments
1996—
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
subpart iii—general provisions
Subpart Referred to in Other Sections
This subpart is referred to in
§300ff–61. Confidentiality and informed consent
(a) Confidentiality
The Secretary may not make a grant under this part unless—
(1) in the case of any State applying for a grant under
(2) in the case of any entity applying for a grant under
(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
(2) Provisions regarding anonymous testing
(A) If, pursuant to
(B) If, pursuant to
(July 1, 1944, ch. 373, title XXVI, §2661, as added
Section Referred to in Other Sections
This section is referred to in
§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
(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) of this section, 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) of this section;
(2) reviewing the appropriateness of further counseling, testing, and education of the individual regarding such disease; and
(3) providing counseling on—
(A) the availability, through the applicant, of early intervention services;
(B) 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) 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
(D) 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.
(July 1, 1944, ch. 373, title XXVI, §2662, as added
Section Referred to in Other Sections
This section is referred to in
§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
(July 1, 1944, ch. 373, title XXVI, §2663, as added
§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
(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
(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 7.5 percent including planning and evaluation of the grant for administrative expenses with respect to the grant; and
(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.
(h) Construction
A State may not use amounts received under a grant awarded under
(July 1, 1944, ch. 373, title XXVI, §2664, as added
Amendments
1996—Subsec. (g)(3).
Subsec. (g)(4).
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
§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
(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.
(July 1, 1944, ch. 373, title XXVI, §2665, as added
Section Referred to in Other Sections
This section is referred to in
§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) of this section, 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) of this section, 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.
(July 1, 1944, ch. 373, title XXVI, §2666, as added
§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.
(July 1, 1944, ch. 373, title XXVI, §2667, as added
Part D—General Provisions
Part Referred to in Other Sections
This part is referred to in
§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) of this section.
(b) Provisions regarding participation in research
(1) In general
With respect to the projects of research with which an applicant under subsection (a) of this section 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) of this section.
(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) of this section, 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) For the first and second fiscal years for which grants under subsection (a) of this section are to be made to the applicant, the applicant agrees that, not later than the end of the second fiscal year of receiving such a grant, a significant number of women, infants, children, and youth who are patients of the applicant will be participating in the projects of research.
(D) Except as provided in paragraph (3) (and paragraph (4), as applicable), for the third and subsequent fiscal years for which such grants are to be made to the applicant, the Secretary has determined that a significant number of such individuals are participating in the projects.
(2) Prohibition
Receipt of services by a patient shall not be conditioned upon the consent of the patient to participate in research.
(3) Significant participation; consideration by Secretary of certain circumstances
In administering the requirement of paragraph (1)(D), the Secretary shall take into account circumstances in which a grantee under subsection (a) of this section is temporarily unable to comply with the requirement for reasons beyond the control of the grantee, and shall in such circumstances provide to the grantee a reasonable period of opportunity in which to reestablish compliance with the requirement.
(4) Significant participation; temporary waiver for original grantees
(A) In general
In the case of an applicant under subsection (a) of this section who received a grant under such subsection for fiscal year 1995, the Secretary may, subject to subparagraph (B), provide to the applicant a waiver of the requirement of paragraph (1)(D) if the Secretary determines that the applicant is making reasonable progress toward meeting the requirement.
(B) Termination of authority for waivers
The Secretary may not provide any waiver under subparagraph (A) on or after October 1, 1998. Any such waiver provided prior to such date terminates on such date, or on such earlier date as the Secretary may specify.
(c) Provisions regarding conduct of research
(1) In general
With respect to eligibility for a grant under subsection (a) of this section:
(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) of this section (including the functions specified in subsection (b)(1) of this section).
(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 chapter 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) of this section. 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) of this section and recipients of such services.
(B) Discretion of Secretary
The Secretary may authorize the use, for purposes of subsection (a)(1) of this section, 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) of this section 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.
(e) Coordination with other entities
A grant under subsection (a) of this section 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 chapter, and under title V of the Social Security Act [
(2) The applicant will participate in the statewide coordinated statement of need under part B of this subchapter (where it has been initiated by the public health agency responsible for administering grants under part B of this subchapter) and in revisions of such statement.
(f) Application
A grant under subsection (a) of this section 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.
(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) of this section, 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.
(h) Annual review of programs; evaluations
(1) Review regarding access to and participation in programs
With respect to a grant under subsection (a) of this section 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) of this section 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) of this section.
(i) Training and technical assistance
Of the amounts appropriated under subsection (j) of this section 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) of this section), training and technical assistance to assist applicants and grantees under subsection (a) of this section in complying with the requirements of this section.
(j) 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.
(July 1, 1944, ch. 373, title XXVI, §2671, as added
References in Text
The Social Security Act, referred to in subsec. (e)(1), is act Aug. 14, 1935, ch. 531,
Amendments
1996—
Effective Date of 1996 Amendment
Amendment by
Section Referred to in Other Sections
This section is referred to in
§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) of this section.
(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.
(July 1, 1944, ch. 373, title XXVI, §2672, as added
§300ff–73. Research, evaluation, and assessment program
(a) Establishment
The Secretary, acting through 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 August 18, 1990, 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) of this section.
(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.
(July 1, 1944, ch. 373, title XXVI, §2673, as added
Amendments
1999—Subsec. (a).
Change of Name
Committee on Energy and Commerce of House of Representatives treated as referring to Committee on Commerce of House of Representatives by section 1(a) of
§300ff–74. Evaluations and reports
(a) Evaluations
The Secretary shall, directly or through grants and contracts, evaluate programs carried out under this subchapter.
(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 subchapter; and
(2) making such recommendations for administrative and legislative initiatives with respect to this subchapter 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 1991 through 1995.
(d) Allocation of funds
The Secretary shall carry out this section with amounts available under
(July 1, 1944, ch. 373, title XXVI, §2674, as added
Amendments
1996—Subsec. (b).
Subsec. (b)(1).
Subsec. (b)(2) to (4).
"(2) recommending criteria to be used in determining the geographic areas with the most substantial need for HIV-related health services;
"(3) summarizing all of the evaluations carried out pursuant to subsection (a) of this section during the period for which the report under this subsection is prepared; and".
Subsec. (d).
Effective Date of 1996 Amendment
Amendment by
§300ff–75. Coordination
(a) Requirement
The Secretary shall assure that the Health Resources and Services Administration and the Centers for Disease Control and Prevention will coordinate the planning of the funding of programs authorized under this subchapter to assure that health support services for individuals with HIV disease are integrated with each other and that the continuity of care of individuals with HIV disease is enhanced. In coordinating the allocation of funds made available under this subchapter the Health Resources and Services Administration and the Centers for Disease Control and Prevention shall utilize planning information submitted to such agencies by the States and entities eligible for support.
(b) Integration by State
As a condition of receipt of funds under this subchapter, a State shall assure the Secretary that health support services funded under this subchapter will be integrated with each other, that programs will be coordinated with other available programs (including Medicaid) and that the continuity of care of individuals with HIV disease is enhanced.
(c) Integration by local or private entities
As a condition of receipt of funds under this subchapter, a local government or private nonprofit entity shall assure the Secretary that services funded under this subchapter will be integrated with each other, that programs will be coordinated with other available programs (including Medicaid) and that the continuity of care of individuals with HIV is enhanced.
(July 1, 1944, ch. 373, title XXVI, §2675, as added
Amendments
1992—Subsec. (a).
§300ff–76. Definitions
For purposes of this subchapter:
(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
(3) Emergency
The term "emergency" means an emergency involving injury or illness.
(4) Emergency response employees
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
(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.
(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.
(July 1, 1944, ch. 373, title XXVI, §2676, as added
Amendments
1996—Par. (2).
Par. (4).
Par. (10).
Effective Date of 1996 Amendment
Amendment by
§300ff–77. Authorization of appropriations
(a) In general
Subject to subsection (b) of this section, there are authorized to be appropriated to make grants under parts A and B of this subchapter, such sums as may be necessary for each of the fiscal years 1996 through 2000.
(b) Development of methodology
(1) In general
With respect to each of the fiscal years 1997 through 2000, the Secretary shall develop and implement a methodology for adjusting the percentages allocated to part A of this subchapter and part B of this subchapter to account for grants to new eligible areas under part A of this subchapter and other relevant factors. Not later than July 1, 1996, the Secretary shall prepare and submit to the appropriate committees of Congress a report regarding the findings with respect to the methodology developed under this paragraph.
(2) Failure to implement
If the Secretary determines that such a methodology under paragraph (1) cannot be developed, there are authorized to be appropriated—
(A) such sums as may be necessary to carry out part A of this subchapter for each of the fiscal years 1997 through 2000; and
(B) such sums as may be necessary to carry out part B of this subchapter for each of the fiscal years 1997 through 2000.
(July 1, 1944, ch. 373, title XXVI, §2677, as added
Effective Date
Section effective May 20, 1996, see section 13(b) of
Section Referred to in Other Sections
This section is referred to in
§300ff–78. Prohibition on promotion of certain activities
None of the funds authorized under this subchapter 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 subchapter may be used to provide medical treatment and support services for individuals with HIV.
(July 1, 1944, ch. 373, title XXVI, §2678, as added
Effective Date
Section effective Oct. 1, 1996, see section 13 of
Part E—Emergency Response Employees
subpart i—guidelines and model curriculum
Amendments
1996—
§300ff–80. Grants for implementation
(a) In general
With respect to the recommendations contained in the guidelines and the model curriculum developed under
(b) Requirement of application
The Secretary may not make a grant under subsection (a) of this section 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.
(July 1, 1944, ch. 373, title XXVI, §2680, as added
Effective Date
Section 411(b) of
subpart ii—notifications of possible exposure to infectious diseases
Amendments
1996—
§300ff–81. Infectious diseases and circumstances relevant to notification requirements
(a) In general
Not later than 180 days after August 18, 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
(b) Specification of airborne infectious diseases
The list developed by the Secretary under subsection (a)(1) of this section 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) of this section with the request that the officers disseminate such copies as appropriate throughout the States; and
(2) make such copies available to the public.
(July 1, 1944, ch. 373, title XXVI, §2681, as added
Section Referred to in Other Sections
This section is referred to in
§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.
(July 1, 1944, ch. 373, title XXVI, §2682, as added
Section Referred to in Other Sections
This section is referred to in
§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) of this section 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) of this section are that—
(1) the designated officer involved collect the facts relating to the circumstances under which, for purposes of subsection (a) of this section, 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
(c) Submission of request to medical facility
(1) In general
If a designated officer makes a determination under subsection (b)(2) of this section 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) of this section 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) of this section.
(d) Evaluation and response regarding request to medical facility
(1) In general
If a medical facility receives a request under subsection (c) of this section, 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
(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 this section 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 this section 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 this section 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
(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) of this section (including any such request resubmitted under subsection (g)(2) of this section), a medical facility shall make the applicable response specified in subsection (d) of this section 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) of this section dies at or before reaching the medical facility involved, and the medical facility receives a request under subsection (c) of this section, 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) of this section to which a medical facility has made the response specified in subsection (d)(4)(A) of this section 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) of this section were sufficient for purposes of determinations under subsection (d)(1) of this section—
(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) of this section.
(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) of this section—
(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) of this section.
(July 1, 1944, ch. 373, title XXVI, §2683, as added
Section Referred to in Other Sections
This section is referred to in
§300ff–84. Procedures for notification of exposure
(a) Contents of notification to officer
In making a notification required under
(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
(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.
(July 1, 1944, ch. 373, title XXVI, §2684, as added
Amendments
1996—Subsec. (b).
Effective Date of 1996 Amendment
Amendment by
§300ff–85. Notification of employee
(a) In general
After receiving a notification for purposes of
(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
(July 1, 1944, ch. 373, title XXVI, §2685, as added
§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) of this section, 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.
(July 1, 1944, ch. 373, title XXVI, §2686, as added
Section Referred to in Other Sections
This section is referred to in
§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
(July 1, 1944, ch. 373, title XXVI, §2687, as added
§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.
(July 1, 1944, ch. 373, title XXVI, §2688, as added
§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.
(July 1, 1944, ch. 373, title XXVI, §2689, as added
§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.
(July 1, 1944, ch. 373, title XXVI, §2690, as added
Part F—Demonstration and Training
subpart i—special projects of national significance
§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 subchapter 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) of this section 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 subchapter 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 subchapter 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.
(July 1, 1944, ch. 373, title XXVI, §2691, as added
Effective Date
For effective date, see section 13 of
subpart ii—aids education and training centers
§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) training health personnel, including practitioners in programs under this subchapter and other community providers, in the diagnosis, treatment, and prevention of HIV disease, including the prevention of the perinatal transmission of the disease and including measures for the prevention and treatment of opportunistic infections;
(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; and
(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.
(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
The Secretary may make grants to assist dental schools and programs described in section 294o(b)(4)(B) 1 of this title with respect to oral health care to patients with HIV disease.
(2) Application
Each dental school or program described in section 294o(b)(4)(B) 1 of this title 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.
(c) Authorization of appropriations
(1) Schools; centers
For the purpose of grants under subsection (a) of this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 1996 through 2000.
(2) Dental schools
For the purpose of grants under subsection (b) of this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 1996 through 2000.
(July 1, 1944, ch. 373, title XXVI, §2692, formerly title VII, §776, as added
References in Text
Codification
Section was formerly classified to
Amendments
1996—
Subsec. (a)(1)(A).
Subsec. (a)(1)(B).
Subsec. (a)(1)(C), (D).
Subsec. (c).
"(1) The term 'HIV disease' means infection with the human immunodeficiency virus, and includes any condition arising from such infection.
"(2) The term 'human immunodeficiency virus' means the etiologic agent for acquired immune deficiency syndrome."
Subsec. (d).
"(1)
"(2)
1992—Subsec. (a)(3).
Effective Date of 1996 Amendment
Amendment by
Effective Date of 1992 Amendment
Amendment by