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Public Law 109-415 - Dec.
19, 2006
109th Congress
An Act
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To amend title XXVI of the
Public Health Service Act to revise
and extend the program for providing
life-saving care for those with HIV/AIDS.
Be it enacted by the Senate
and House of Representatives of the
United States of America in Congress
assembled,
SECTION 1. SHORT
TITLE; TABLE OF CONTENTS.
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Dec. 19, 2006
[H.R. 6143]
Ryan White HIV/ AIDS
Treatment Modernization Act of 2006.
42 USC 201 note.
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| (a)
SHORT TITLE.—This Act may be cited
as the "Ryan White HIV/AIDS Treatment
Modernization Act of 2006"
(b) TABLE OF CONTENTS.—The
table of contents of this Act
is as follows:
Sec. 1. Short title; table
of contents.
TITLE I—EMERGENCY RELIEF
FOR ELIGIBLE AREAS
Sec. 101. Establishment of
program; general eligibility for grants.
Sec.
102. Type and distribution of grants;
formula grants.
Sec.
103. Type and distribution of grants;
supplemental grants.
Sec.
104. Timeframe for obligation and
expenditure of grant funds.
Sec.
105. Use of amounts.
Sec.
106. Additional amendments to part
A.
Sec.
107. New program in part A; transitional
grants for certain areas ineligible
under section 2601.
Sec.
108. Authorization of appropriations
for part A.
TITLE II—CARE GRANTS
Sec. 201. General use of
grants.
Sec. 202. AIDS Drug Assistance Program.
Sec. 203. Distribution of funds.
Sec. 204. Additional amendments to
subpart I of part B.
Sec. 205. Supplemental grants on basis
of demonstrated need.
Sec. 206. Emerging communities.
Sec. 207. Timeframe for obligation
and expenditure of grant funds.
Sec. 208. Authorization of appropriations
for subpart I of part B.
Sec. 209. Early diagnosis grant program.
Sec. 210. Certain partner notification
programs; authorization of appropriations.
TITLE III—EARLY INTERVENTION
SERVICES
Sec. 301. Establishment of
program; core medical services.
Sec. 302. Eligible entities; preferences;
planning and development grants.
Sec. 303. Authorization of appropriations.
Sec. 304. Confidentiality and informed
consent.
Sec. 305. Provision of certain counseling
services.
Sec. 306. General provisions.
TITLE IV—WOMEN, INFANTS,
CHILDREN, AND YOUTH
Sec. 401. Women, infants,
children, and youth.
Sec. 402. GAO Report.
TITLE V—GENERAL PROVISIONS
Sec. 501. General provisions.
TITLE VI—DEMONSTRATION
AND TRAINING
Sec. 601. Demonstration and
training.
Sec.
602. AIDS education and training centers.
Sec. 603. Codification of minority
AIDS initiative.
TITLE VII—MISCELLANEOUS
PROVISIONS
Sec. 701. Hepatitis; use
of funds.
Sec. 702. Certain references.
Sec. 703. Repeal.
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TITLE I—EMERGENCY RELIEF
FOR ELIGIBLE AREAS
SEC. 101. ESTABLISHMENT OF
PROGRAM; GENERAL ELIGIBILITY FOR GRANTS.
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(a) In General.—Section 2601
of the Public Health Service Act (42
U.S.C. 300ff-11) is amended by striking
subsections (b) through (d) and inserting
the following:
"(b) Continued Status as Eligible
Area.—Notwithstanding any other
provision of this section, a metropolitan
area that is an eligible area for a
fiscal year continues to be an eligible
area until the metropolitan area fails,
for three consecutive fiscal years—
"(1) to meet the requirements of
subsection (a); and
"(2) to have a cumulative total
of 3,000 or more living cases of AIDS
(reported to and confirmed by the Director
of the Centers for Disease Control and
Prevention) as of December 31 of the
most recent calendar year for which
such data is available.
"(c) Boundaries.—For
purposes of determining eligibility
under this part—
"(1) with respect to a metropolitan
area that received funding under this
part in fiscal year 2006, the boundaries
of such metropolitan area shall be
the boundaries that were in effect
for such area for fiscal year 1994;
or
"(2) with respect to a metropolitan
area that becomes eligible to receive
funding under this part in any fiscal
year after fiscal year 2006, the boundaries
of such metropolitan area shall be
the boundaries that are in effect
for such area when such area initially
receives funding under this part.''.
(b) Technical and Conforming Amendments.—Section
2601(a) of the Public Health Service
Act (42 U.S.C. 300ff-11(a)) is amended—
(1) by striking "through (d)''
and inserting "through (c)'';
and
(2) by inserting "and confirmed
by'' after "reported to''.
(c) Definition of Metropolitan Area.—Section
2607(2) of the Public
Health Service Act (42 U.S.C. 300ff-17(2))
is amended—
(1) by striking "area referred''
and inserting "area that is referred'';
and
(2) by inserting before the period
the following: ", and that has
a population of 50,000 or more individuals''.
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| SEC.
102. TYPE AND DISTRIBUTION OF GRANTS;
FORMULA GRANTS. |
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(a) Distribution Percentages.—Section 2603(a)(2) of the Public Health Service
Act (42 U.S.C. 300ff-13(a)(2)) is
amended—
(1) in the first sentence—
(A) by striking "50 percent of
the amount appropriated under section
2677'' and inserting "662/
3 percent of the amount made
available under section 2610(b) for
carrying out this subpart''; and
(B) by striking "paragraph (3)''
and inserting "paragraphs (3)
and (4)''.
(2) by striking the last sentence.
(b) Distribution Based on Living Cases
of HIV/AIDS.—Section 2603(a)(3)
of the Public Health Service Act (42
U.S.C. 300ff-13(a)(3)) is amended—
(1) in subparagraph (B), by striking
"estimated living cases of acquired
immune deficiency syndrome'' and inserting
"living cases of HIV/AIDS (reported
to and confirmed by the Director of
the Centers for Disease Control and
Prevention)''; and
(2) by striking subparagraphs (C)
through (E) and inserting the following:
"(C) LIVING CASES OF HIV/AIDS.—
"(i) REQUIREMENT OF NAMES-BASED
REPORTING.—
Except as provided in clause (ii),
the number determined under this subparagraph
for an eligible area for a fiscal
year for purposes of subparagraph
(B) is the number of living names-
based cases of HIV/AIDS that, as of
December 31 of the most recent calendar
year for which such data is available,
have been reported to and confirmed
by the Director of the Centers for
Disease Control and Prevention.
"(ii) TRANSITION PERIOD; EXEMPTION
REGARDING NON-AIDS CASES.—For
each of the fiscal years 2007 through
2009, an eligible area is, subject
to clauses (iii) through (v), exempt
from the requirement under clause
(i) that living names- based non-AIDS
cases of HIV be reported unless—
"(I) a system was in operation
as of December 31, 2005, that provides
sufficiently accurate and reliable
names-based reporting of such cases
throughout the State in which the
area is located, subject to clause
(viii); or
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| "(II) no later than
the beginning of fiscal year 2008 or
2009, the Secretary, in consultation
with the chief executive of the State
in which the area is located, determines
that a system has become operational
in the State that provides sufficiently
accurate and reliable names-based reporting
of such cases throughout the State. |
Deadline |
"(iii) REQUIREMENTS
FOR EXEMPTION FOR FISCAL YEAR 2007.—For
fiscal year 2007, an exemption under
clause (ii) for an eligible area applies
only if, by October 1, 2006—
"(I)(aa) the State in which the
area is located had submitted to the
Secretary a plan for making the transition
to sufficiently accurate and reliable
names-based reporting of living non-AIDS
cases of HIV; or
"(bb) all statutory changes necessary
to provide for sufficiently accurate
and reliable reporting of such cases
had been made; and
"(II) the State had agreed that,
by April 1, 2008, the State will begin
accurate and reliable names-based reporting
of such cases, except that such agreement
is not required to provide that, as
of such date, the system for such reporting
be fully sufficient with respect to
accuracy and reliability throughout
the area. |
Applicability.
Deadline. |
"(iv)REQUIREMENT
FOR EXEMPTION AS OF FISCAL YEAR 2008.—For
each of the fiscal years 2008 through
2010, an exemption under clause (ii)
for an eligible area applies only if,
as of April 1, 2008, the State in which
the area is located is substantially
in compliance with the agreement under
clause (iii)(II).
"(v) PROGRESS TOWARD NAMES-BASED
REPORTING.— For fiscal year 2009,
the Secretary may terminate an exemption
under clause (ii) for an eligible area
if the State in which the area is located
submitted a plan under clause (iii)(I)(aa)
and the Secretary determines that the
State is not substantially following
the plan.
"(vi) COUNTING OF CASES IN AREAS
WITH EXEMPTIONS.—
"(I)IN GENERAL.—With respect to
an eligible area that is under a reporting
system for living non-AIDS cases of
HIV that is not names-based (referred
to in this subparagraph as `code-based
reporting'), the Secretary shall, for
purposes of this subparagraph, modify
the number of such cases reported for
the eligible area in order to adjust
for duplicative reporting in and among
systems that use code-based reporting.
"(II) ADJUSTMENT RATE.—The adjustment
rate under subclause (I) for an eligible
area shall be a reduction of 5 percent
in the number of living non- AIDS cases
of HIV reported for the area.
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Applicability.
Deadline. |
"(vii) MULTIPLE POLITICAL
JURISDICTIONS.—With respect to living
non-AIDS cases of HIV, if an eligible
area is not entirely within one political
jurisdiction and as a result is subject
to more than one reporting system for
purposes of this subparagraph:
"(I) Names-based reporting under
clause (i) applies in a jurisdictional
portion of the area, or an exemption
under clause (ii) applies in such portion
(subject to applicable provisions of
this subparagraph), according to whether
names-based reporting or code-based
reporting is used in such portion.
"(II) If under subclause (I) both
names-based reporting and code-based
reporting apply in the area, the number
of code-based cases shall be reduced
under clause (vi).
"(viii) LIST OF ELIGIBLE AREAS
MEETING STANDARD REGARDING DECEMBER
31, 2005.—
"(I)IN GENERAL..—If an eligible
area or portion thereof is in a State
specified in subclause (II), the eligible
area or portion shall be considered
to meet the standard described in clause
(ii)(I). No other eligible area or portion
thereof may be considered to meet such
standard.
"(II) RELEVANT STATES.—For purposes
of subclause (I), the States specified
in this subclause are the following:
Alaska, Alabama, Arkansas, Arizona,
Colorado, Florida, Indiana, Iowa, Idaho,
Kansas, Louisiana, Michigan, Minnesota,
Missouri, Mississippi, North Carolina,
North Dakota, Nebraska, New Jersey,
New Mexico, New York, Nevada, Ohio,
Oklahoma, South Carolina, South Dakota,
Tennessee, Texas, Utah, Virginia, Wisconsin,
West Virginia, Wyoming, Guam, and the
Virgin Islands.
"(ix) RULES OF CONSTRUCTION REGARDING
ACCEPTANCE OF REPORTS..—
"(I) Cases of AIDS.—With
respect to an eligible area that is
subject to
the requirement under clause (i) and
is not in compliance with the requirement
for names-based reporting of living
non- AIDS cases of HIV, the Secretary
shall, notwithstanding such noncompliance,
accept reports of living cases of AIDS
that are in accordance with such clause.
"(II) APPLICABILITY OF EXEMPTION
REQUIREMENTS.—The provisions of
clauses (ii) through (viii) may not
be construed as having any legal effect
for fiscal year 2010 or any subsequent
fiscal year, and accordingly, the status
of a State for purposes of such clauses
may not be considered after fiscal year
2009.
"(x) PROGRAM FOR DETECTING INACCURATE
OR FRAUDULENT COUNTING.—The Secretary
shall carry out a program to monitor
the reporting of names- based cases
for purposes of this subparagraph and
to detect instances of inaccurate reporting,
including fraudulent reporting.''.
(c) CODE-BASED AREAS; LIMITATION
ON INCREASE IN GRANT.—
Section 2603(a)(3) of the Public Health
Service Act (42 U.S.C. 300ff-13(a)),
as amended by subsection (b)(2) of
this section, is amended by adding
at the end the following subparagraph:
"(D) CODE-BASED AREAS; LIMITATION
ON INCREASE IN
GRANT.—
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Applicability |
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"(i) IN GENERAL.—
For each of the fiscal years 2007
through 2009, if code-based reporting
(within the meaning of subparagraph
(C)(vi)) applies in an eligible area
or any portion thereof as of the beginning
of the fiscal year involved, then
notwithstanding any other provision
of this paragraph, the amount of the
grant pursuant to this paragraph for
such area for such fiscal year may
not—
"(I) for fiscal year 2007, exceed
by more than 5 percent the amount
of the grant for the area that would
have been made pursuant to this paragraph
and paragraph (4) for fiscal year
2006 (as such paragraphs were in effect
for such fiscal year) if paragraph
(2) (as so in effect) had been applied
by substituting `662/3
percent' for `50 percent'; and
"(II) for each of the fiscal years
2008 and 2009, exceed by more than
5 percent the amount of the grant
pursuant to this paragraph and paragraph
(4) for the area for the preceding
fiscal year.
"(ii) USE OF AMOUNTS INVOLVED.—For
each of the fiscal years 2007 through
2009, amounts available as a result
of the limitation under clause (i)
shall be made available by the Secretary
as additional amounts for grants pursuant
to subsection (b) for the fiscal year
involved, subject to paragraph (4)
and section 2610(d)(2).''.
(d) Hold Harmless.—Section 2603(a)
of the Public Health Service Act (42
U.S.C. 300ff-13(a)) is amended—
(1) in paragraph (3)(A)—
(A) in clause (ii), by striking the
period at the end and inserting a
semicolon; and
(B) by inserting after and below clause
(ii) the following:
"which product shall then, as applicable,
be increased under paragraph (4).''.
(2) by amending paragraph
(4) to read as follows:
"(4) Increases in grant.—
"(A) In general.—For each eligible
area that received a grant pursuant
to this subsection for fiscal year
2006, the Secretary shall, for each
of the fiscal years 2007 through 2009,
increase the amount of the grant made
pursuant to paragraph (3) for the
area to ensure that the amount of
the grant for the fiscal year involved
is not less than the following amount,
as applicable to such fiscal year:
"(i) For fiscal year 2007, an amount
equal to 95 percent of the amount
of the grant that would have been
made pursuant to paragraph (3) and
this paragraph for fiscal year 2006
(as such paragraphs were in effect
for such fiscal year) if paragraph
(2) (as so in effect) had been applied
by substituting `662/3
percent' for `50 percent'.
"(ii) For each of the fiscal years
2008 and 2009, an amount equal to
100 percent of the amount of the grant
made pursuant to paragraph (3) and
this paragraph for fiscal year 2007.
"(B) SOURCE OF FUNDS FOR INCREASE.—
"(i) In general.—From the amounts
available for carrying out the single
program referred to in section 2609(d)(2)(C)
for a fiscal year (relating to supplemental
grants), the Secretary shall make
available such amounts as may be necessary
to comply with subparagraph (A), subject
to section 2610(d)(2).
"(ii) Pro rata reduction.—If the amounts
referred to in clause (i) for a fiscal
year are insufficient to fully comply
with subparagraph (A) for the year,
the Secretary, in order to provide
the additional funds necessary for
such compliance, shall reduce on a
pro rata basis the amount of each
grant pursuant to this subsection
for the fiscal year, other than grants
for eligible areas for which increases
under subparagraph (A) apply. A reduction
under the preceding sentence may not
be made in an amount that would result
in the eligible area involved becoming
eligible for such an increase.
"(C) Limitation.—This paragraph may
not be construed as having any applicability
after fiscal year 2009.''.
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Applicability. |
| SEC.
103. TYPE AND DISTRIBUTION OF GRANTS;
SUPPLEMENTAL GRANTS. |
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Section 2603(b) of the Public Health Service Act (42 U.S.C. 300ff- 13(b)) is
amended—
(1) in paragraph (1)—
(A) in the matter preceding subparagraph
(A), by striking "Not later than''
and all that follows through "the
Secretary shall'' and inserting the
following: "Subject to subsection
(a)(4)(B)(i) and section 2610(d),
the Secretary shall'';
(B) in subparagraph (B), by striking
"demonstrates the severe need
in such area'' and inserting "demonstrates
the need in such area, on an objective
and quantified basis,'';
(C) by striking subparagraph (F) and
inserting the following:
"(F) demonstrates the inclusiveness
of affected communities and individuals
with HIV/AIDS;'';
(D) in subparagraph (G), by striking
the period and inserting "; and'';
and
(E) by adding at the end the following:
"(H) demonstrates the ability
of the applicant to expend funds efficiently
by not having had, for the most recent
grant year under subsection (a) for
which data is available, more than
2 percent of grant funds under such
subsection canceled or covered by
any waivers under subsection (c)(3).'';
and
(2) in paragraph (2)—
(A) in subparagraph (A), by striking
"severe need'' and inserting
"demonstrated need''; (B) by
striking subparagraph
(B) and inserting the following:
"(B) DEMONSTRATED NEED.—The
factors considered by the Secretary
in determining whether an eligible
area has a demonstrated need for purposes
of paragraph (1)(B) may include any
or all of the following:
"(i) The unmet need for such
services, as determined under section
2602(b)(4) or other community input
process as defined under section 2609(d)(1)(A).
"(ii) An increasing need for
HIV/AIDS-related services, including
relative rates of increase in the
number of cases of HIV/AIDS.
"(iii) The relative rates of
increase in the number of cases of
HIV/AIDS within new or emerging subpopulations.
"(iv) The current prevalence
of HIV/AIDS.
"(v) Relevant factors related
to the cost and complexity of delivering
health care to individuals with HIV/AIDS
in the eligible area.
"(vi) The impact of co-morbid
factors, including co-occurring conditions,
determined relevant by the Secretary.
"(vii) The prevalence of homelessness.
"(viii) The prevalence of individuals
described under section 2602(b)(2)(M).
"(ix) The relevant factors that
limit access to health care, including
geographic variation, adequacy of
health insurance coverage, and language
barriers.
"(x) The impact of a decline
in the amount received pursuant to
subsection (a) on services available
to all individuals with HIV/AIDS identified
and eligible under this title.'';
and
(C) by striking subparagraphs (C)
and (D) and inserting the following:
"(C) Priority in making grants.—The
Secretary shall provide funds under
this subsection to an eligible area
to address the decline or disruption
of all EMA- provided services related
to the decline in the amounts received
pursuant to subsection (a) consistent
with the grant award for the eligible
area for fiscal year 2006, to the
extent that the factor under subparagraph
(B)(x) (relating to a decline in funding)
applies to the eligible area.''.
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| SEC.
104. TIMEFRAME FOR OBLIGATION AND EXPENDITURE
OF GRANT FUNDS. |
Section 2603 of the Public Health Service
Act (42 U.S.C. 300ff-13) is amended—
(1) by redesignating subsection (c)
as subsection (d);
(2) by inserting after subsection (b)
the following: |
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"(c) Timeframe for Obligation
and Expenditure of Grant Funds.—
"(1) Obligation by end of grant
year.—Effective for fiscal year
2007 and subsequent fiscal years, funds
from a grant award made pursuant to
subsection (a) or (b) for a fiscal year
are available for obligation by the
eligible area involved through the end
of the one-year period beginning on
the date in such fiscal year on which
funds from the award first become available
to the area (referred to in this subsection
as the `grant year for the award'),
except as provided in paragraph (3)(A).
"(2) Supplemental grants; cancellation
of unobligated balance of grant award.—Effective
for fiscal year 2007 and subsequent
fiscal years, if a grant award made
pursuant to subsection (b) for an eligible
area for a fiscal year has an unobligated
balance as of the end of the grant year
for the award—
"(A) the Secretary shall cancel
that unobligated balance of the award,
and shall require the eligible area
to return any amounts from such balance
that have been disbursed to the area;
and
"(B) the funds involved shall be
made available by the Secretary as additional
amounts for grants pursuant to subsection
(b) for the first fiscal year beginning
after the fiscal year in which the Secretary
obtains the information necessary for
determining that the balance is required
under subparagraph (A) to be canceled,
except that the availability of the
funds for such grants is subject to
subsection (a)(4) and section 2610(d)(2)
as applied for such year.
"(3) Formula grants; cancellation
of unobligated balance of grant award;
waiver permitting carryover.—
"(A) In general.—Effective
for fiscal year 2007 and subsequent
fiscal years, if a grant award made
pursuant to subsection (a) for an
eligible area for a fiscal year has
an unobligated balance as of the end
of the grant year for the award, the
Secretary shall cancel that unobligated
balance of the award, and shall require
the eligible area to return any amounts
from such balance that have been disbursed
to the area, unless—
"(i) before the end of the grant
year, the chief elected official of
the area submits to the Secretary
a written application for a waiver
of the cancellation, which application
includes a description of the purposes
for which the area intends to expend
the funds involved; and "(ii)
the Secretary approves the waiver.
"(B) Expenditure by end of carryover
year.—With respect to a waiver under
subparagraph (A) that is approved
for a balance that is unobligated
as of the end of a grant year for
an award:
"(i) The unobligated funds are
available for expenditure by the eligible
area involved for the one-year period
beginning upon the expiration of the
grant year (referred to in this subsection
as the `carryover year').
"(ii) If the funds are not expended
by the end of the carryover year,
the Secretary shall cancel that unexpended
balance of the award, and shall require
the eligible area to return any amounts
from such balance that have been disbursed
to the area.
"(C) Use of cancelled balances.—In
the case of any balance of a grant
award that is cancelled under subparagraph
(A) or (B)(ii), the grant funds involved
shall be made available by the Secretary
as additional amounts for grants pursuant
to subsection (b) for the first fiscal
year beginning after the fiscal year
in which the Secretary obtains the
information necessary for determining
that the balance is required under
such subparagraph to be canceled,
except that the availability of the
funds for such grants is subject to
subsection (a)(4) and section 2610(d)(2)
as applied for such year. "(D)
Corresponding reduction in future
grant.—
"(i) In general.—In the case
of an eligible area for which a balance
from a grant award under subsection
(a) is unobligated as of the end of
the grant year for the award—
"(I) the Secretary shall reduce,
by the same amount as such unobligated
balance, the amount of the grant under
such subsection for the first fiscal
year beginning after the fiscal year
in which the Secretary obtains the
information necessary for determining
that such balance was unobligated
as of the end of the grant year (which
requirement for a reduction applies
without regard to whether a waiver
under subparagraph (A) has been approved
with respect to such balance); and
"(II) the grant funds involved
in such reduction shall be made available
by the Secretary as additional funds
for grants pursuant to subsection
(b) for such first fiscal year, subject
to subsection (a)(4) and section 2610(d)(2);
except that this clause does not apply
to the eligible area if the amount
of the unobligated balance was 2 percent
or less.
"(ii) Relation to increases in
grant.—A reduction under clause (i)
for an eligible area for a fiscal
year may not be taken into account
in applying subsection (a)(4) with
respect to the area for the subsequent
fiscal year.''; and (3) by adding
at the end the following:
"(e) Report on the Awarding of
Supplemental Funds.—Not later than
45 days after the awarding of supplemental
funds under this section, the Secretary
shall submit to Congress a report
concerning such funds. Such report
shall include information detailing—
"(1) the total amount of supplemental
funds available under this section
for the year involved;
"(2) the amount of supplemental
funds used in accordance with the
hold harmless provisions of subsection
(a)(4);
"(3) the amount of supplemental
funds disbursed pursuant to subsection
(b)(2)(C);
"(4) the disbursement of the
remainder of the supplemental funds
after taking into account the uses
described in paragraphs (2) and (3);
and
"(5) the rationale used for the
amount of funds disbursed as described
under paragraphs (2), (3), and (4).''.
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Effective
dates. |
| SEC.
105. USE OF AMOUNTS. |
|
Section 2604 of the Public Health Service Act (42 U.S.C. 300ff-14) is amended
to read as follows:
"SEC. 2604. USE OF AMOUNTS.
"(a) Requirements.—The
Secretary may not make a grant under
section 2601(a) to the chief elected
official of an eligible area unless
such political subdivision agrees
that—
"(1) subject to paragraph (2),
the allocation of funds and services
within the eligible area will be made
in accordance with the priorities
established, pursuant to section
2602(b)(4)(C), by the HIV health services
planning council that serves such
eligible area;
"(2) funds provided under section
2601 will be expended only for—
"(A) core medical services described
in subsection (c);
"(B) support services described
in subsection (d);
and
"(C) administrative expenses
described in subsection (h); and
"(3) the use of such funds will
comply with the requirements of this
section.
"(b) Direct Financial Assistance
to Appropriate Entities.—
"(1) In general.—The chief
elected official of an eligible area
shall use amounts from a grant under
section 2601 to provide direct financial
assistance to entities described in
paragraph (2) for the purpose of providing
core medical services and support
services.
"(2) Appropriate entities.—Direct
financial assistance may be provided
under paragraph (1) to public or nonprofit
private entities, or private for-profit
entities if such entities are the
only available provider of quality
HIV care in the area.
"(c) Required Funding for Core
Medical Services.—
"(1) In general.—With respect
to a grant under section 2601 for
an eligible area for a grant year,
the chief elected official of the
area shall, of the portion of the
grant remaining after reserving amounts
for purposes of paragraphs (1) and
(5)(B)(i) of subsection (h), use not
less than 75 percent to provide core
medical services that are needed in
the eligible area for individuals
with HIV/AIDS who are identified and
eligible under this title (including
services regarding the co- occurring
conditions of the individuals).
"(2) Waiver.—
"(A) In general.—The Secretary
shall waive the application of paragraph
(1) with respect to a chief elected
official for a grant year if the Secretary
determines that, within the eligible
area involved—
"(i) there are no waiting lists
for AIDS Drug Assistance Program services
under section 2616; and
"(ii) core medical services are
available to all individuals with
HIV/AIDS identified and eligible under
this title.
"(B) Notification of waiver status.—When
informing the chief elected official
of an eligible area that a grant under
section 2601 is being made for the
area for a grant year, the Secretary
shall inform the official whether
a waiver under subparagraph (A) is
in effect for such year.
"(3) Core medical services.—For
purposes of this subsection, the term
`core medical services', with respect
to an individual with HIV/AIDS (including
the co-occurring conditions of the
individual), means the following services:
"(A) Outpatient and ambulatory
health services.
"(B) AIDS Drug Assistance Program
treatments in accordance with section
2616.
"(C) AIDS pharmaceutical assistance.
"(D) Oral health care.
"(E) Early intervention services
described in subsection (e).
"(F) Health insurance premium
and cost sharing assistance for low-income
individuals in accordance with section
2615.
"(G) Home health care.
"(H) Medical nutrition therapy.
"(I) Hospice services.
"(J) Home and community-based
health services as defined under section
2614(c).
"(K) Mental health services.
"(L) Substance abuse outpatient
care.
"(M) Medical case management,
including treatment adherence services.
"(d) Support Services.—
"(1) In general.—For purposes
of this section, the term `support
services' means services, subject
to the approval of the Secretary,
that are needed for individuals with
HIV/AIDS to achieve their medical
outcomes (such as respite care for
persons caring for individuals with
HIV/AIDS, outreach services, medical
transportation, linguistic services,
and referrals for health care and
support services).
"(2) Medical outcomes.—In
this subsection, the term `medical
outcomes' means those outcomes affecting
the HIV- related clinical status of
an individual with HIV/AIDS.
"(e) Early Intervention Services.—
"(1) In general.—For purposes
of this section, the term `early intervention
services' means HIV/AIDS early intervention
services described in section 2651(e),
with follow-up referral provided for
the purpose of facilitating the access
of individuals receiving the services
to HIV-related health services. The
entities through which such services
may be provided under the grant include
public health departments, emergency
rooms, substance abuse and mental
health treatment programs, detoxification
centers, detention facilities, clinics
regarding sexually transmitted diseases,
homeless shelters, HIV/ AIDS counseling
and testing sites, health care points
of entry specified by eligible areas,
federally qualified health centers,
and entities described in section
2652(a) that constitute a point of
access to services by maintaining
referral relationships.
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"(2) Conditions.—With
respect to an entity that proposes to
provide early intervention services
under paragraph (1), such paragraph
shall apply only if the entity demonstrates
to the satisfaction of the chief elected
official for the eligible area involved
that—
"(A) Federal, State, or local funds
are otherwise inadequate for the early
intervention services the entity proposes
to provide; and
"(B) the entity will expend funds
pursuant to such paragraph to supplement
and not supplant other funds available
to the entity for the provision of early
intervention services for the fiscal
year involved.
"(f) Priority for Women, Infants,
Children, and Youth.—
"(1) In general.—For the
purpose of providing health and support
services to infants, children, youth,
and women with HIV/AIDS, including
treatment measures to prevent the
perinatal transmission of HIV, the
chief elected official of an eligible
area, in accordance with the established
priorities of the planning council,
shall for each of such populations
in the eligible area use, from the
grants made for the area under section
2601(a) for a fiscal year, not less
than the percentage constituted by
the ratio of the population involved
(infants,
children, youth, or women in such
area) with HIV/AIDS to the general
population in such area of individuals
with HIV/AIDS.
"(2) Waiver.—With respect
to the population involved, the Secretary
may provide to the chief elected official
of an eligible area a waiver of the
requirement of paragraph (1) if such
official demonstrates to the satisfaction
of the Secretary that the population
is receiving HIV-related health services
through the State medicaid program
under title XIX of the Social Security
Act, the State children's health insurance
program under title XXI of such Act,
or other Federal or State programs.
"(g) Requirement of Status
as Medicaid Provider.—
"(1) Provision of service.—Subject
to paragraph (2), the Secretary may
not make a grant under section 2601(a)
for the provision of services under
this section in a State unless, in
the case of any such service that
is available pursuant to the State
plan approved under title XIX of the
Social Security Act for the State—
"(A) the political subdivision
involved will provide the service
directly, and the political subdivision
has entered into a participation agreement
under the State plan and is qualified
to receive payments under such plan;
or
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Applicability. |
"(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.
"(h) Administration.—
"(1) Limitation.—The chief elected
official of an eligible area shall not
use in excess of 10 percent of amounts
received under a grant under this part
for administrative expenses.
"(2) Allocations by chief elected
official.—In the case of entities and
subcontractors to which the chief elected
official of an eligible area allocates
amounts received by the official under
a grant under this part, the official
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).
"(3) Administrative activities.—For
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 development of a clinical
quality management program as described
in paragraph (5), 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 activities carried out
by the HIV health services planning
council as established under section
2602(b), 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.
"(4) Subcontractor administrative
activities.—For the purposes of this
subsection, subcontractor administrative
activities include—
"(A) usual and recognized overhead
activities, including established indirect
rates for agencies; "(B) management
oversight of specific programs funded
under this title; and "(C) other
types of program support such as quality
assurance, quality control, and related
activities.
"(5) Clinical quality management.—
"(A) Requirement.—The chief elected
official of an eligible area that receives
a grant under this part shall provide
for the establishment of a clinical
quality management program to assess
the extent to which HIV health services
provided to patients under the grant
are consistent with the most recent
Public Health Service guidelines for
the treatment of HIV/AIDS and related
opportunistic infection, and as applicable,
to develop strategies for ensuring that
such services are consistent with the
guidelines for improvement in the access
to and quality of HIV health services.
"(B) Use of funds.—
"(i) In general.—From amounts received
under a grant awarded under this subpart
for a fiscal year, the chief elected
official of an eligible area may use
for activities associated with the clinical
quality management program required
in subparagraph (A) not to exceed the
lesser of—
"(I) 5 percent of amounts received
under the grant; or
"(II) $3,000,000.
"(ii) Relation to limitation on
administrative expenses.—The costs of
a clinical quality management program
under subparagraph (A) may not be considered
administrative expenses for purposes
of the limitation established in paragraph
(1).
"(i) Construction.—A chief elected
official 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.''. |
Contracts |
SEC. 106. ADDITIONAL AMENDMENTS
TO PART A.
- (a)
REPORTING OF CASES.(Section 2601(a) of the
Public Health Service Act (42 U.S.C. 300ff11(a))
is amended by striking ;for the most recent
period; and inserting ;during the most recent
period
- (b)
PLANNING
COUNCIL REPRESENTATION.(Section 2602(b)(2)(G)
of the Public Health Service Act (42 U.S.C.
300ff 12(b)(2)(G)) is amended by inserting
;, members of a Federally
recognized Indian tribe as
represented in the population, individuals
co-infected with hepatitis B or C; after
;disease
- (c)
APPLICATION FOR GRANT.(
- (1)
PAYER OF LAST RESORT.(Section 2605(a)(6)(A)
of the Public Health Service Act (42 U.S.C.
300ff15(a)(6)(A)) is amended by inserting
(except for a program administered by or providing
the services of the Indian Health Service);
before the semicolon.
- (2)
AUDITS.(Section 2605(a) of the Public Health
Service Act (42 U.S.C. 300ff15(a)) is amended(
(A) in paragraph (8), by
striking ;and; at the end;
(B) in paragraph (9), by
striking the period and inserting ; and;
and
(C) by adding at the end
the following:
(10) that the chief elected
official will submit to the lead State agency
under section 2617(b)(4), audits, consistent
with Office of Management and Budget circular
A133, regarding funds expended in accordance
with this part every 2 years and shall include
necessary client-based data to compile unmet
need calculations and Statewide coordinated
statements of need process.
(3) COORDINATION.(Section
2605(b) of the Public Health Service Act
(42 U.S.C. 300ff15(b)) is amended(
(A) in paragraph (3), by
striking ;and; at the end;
(B) in paragraph (4), by
striking the period and inserting a semicolon;
and
(C) by adding at the end
the following:
(5) the manner in which the
expected expenditures are related to the
planning process for States that receive
funding under part B (including the planning
process described in sec tion 2617(b));
and
(6) the expected expenditures
and how those expenditures will improve
overall client outcomes, as described under
the State plan under section 2617(b), and
through additional out comes measures as
identified by the HIV health services plan
ning council under section 2602(b).
SEC. 107. NEW PROGRAM IN
PART A; TRANSITIONAL GRANTS FOR CERTAIN
AREAS INELIGIBLE UNDER SECTION 2601.
(a) IN GENERAL.(Part A of
title XXVI of the Public Health Service
Act (42 U.S.C. 300ff11) is amended(
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