HIV AIDS Resource Guide/HIV-AIDS Resource Guide.iso/STAT/FEDERAL/RYANW.ASC

Text File | 1994-01-14 | 80KB | 1,753 lines

/* The Ryan White Act, 42 USC 300ff, a comprehensive set of
federal grants for the treatment of HIV which provide
several important protections for: (1) confidential testing;
(2) medical personnel such as EMT's or other emergency
personnel follows. This is one of the most significant laws
related to federal funding for HIV and is contained in two
sections. */
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.

(Aug. 18, 1990, P. L. 101-381, 104 Stat. 576.)


     References in text:
     "This Act", referred to in this section, is Act Aug.
18, 1990, P. L. 101-381, 104 Stat. 576, which is popularly
known as the "Ryan White Comprehensive AIDS Resources
Emergency Act of 1990."
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.

/* A last second amendment when it was noted that several
state governments or cities were instituting needle
exchange/dispensing programs. See in the case law section of
the program the controversy surrounding the state of
Washington's needle sharing. Note that this is not a federal
law which prevents states from instituting needle
exchange/dispensing laws, just a prohibition on the use of
the federal funds for such programs. */

(Aug. 18, 1990, P. L. 101-381, Title IV, Subtitle C, 422,
104 Stat. 628.)

EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR
SERVICES


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 subsection (b), make
grants in accordance with section 2603 [42 USC 300ff-13] for
the purpose of assisting in the provision of the services
specified in 2604 [42 USC 300ff-14] in any metropolitan area
for which, as of June 30, 1990, in the case of grants for
fiscal year 1991, and as of March 31 of the most recent
fiscal year for which such data is available in the case of
a grant for any subsequent fiscal year:

     (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.

(b) Requirement regarding confirmation of cases. The
Secretary may not make a grant under subsection (a) for a
metropolitan area unless, before making any payments under
the grant, the cases of acquired immune deficiency syndrome
reported for purposes of such subsection have been confirmed
by the Secretary, acting through the Director of the Centers
for Disease Control and Prevention.

(July 1, 1944, ch 373, Title XXVI, Part A, 2601, as added
Aug. 18, 1990, P. L. 101-381, Title I, 101(3), 104 Stat.
576.)
(As amended Oct. 27, 1992, P. L. 102-531, Title III,
312(d)(25), 106 Stat. 3505.)

     Other provisions:
     Study regarding HIV disease in rural areas. Act Aug.
18, 1990, P. L. 101-381, Title IV, Subtitle A, 403, 104
Stat. 622, provides:
     "(a) In general. The Secretary of Health and Human
Services, after consultation with the Director of the Office
of Rural Health Policy, shall:
          "(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) Report. Not later than 1 year after the date of
the enactment of this Act, the Secretary of Health and Human
Services shall complete the study required under subsection
(a) and prepare and submit, to the appropriate committees of
Congress a report describing the findings made as a result
of such study. "(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.".
300ff-12.  Administration and planning council
(a) Administration. (1) In general. Assistance made
available under grants awarded under this part [42 USC 300ff-
11 et seq.] shall be directed to the chief elected official
of the city or urban county that administers the public
health agency that provides outpatient and ambulatory
services to the greatest number of individuals with AIDS, as
reported to and confirmed by the  Centers for Disease
Control and Prevention, in the eligible area that is awarded
such a grant.
     (2) Requirements.(A) In general. To receive assistance
under section 2601(a) [42 USC 300ff-11(a)], the chief
elected official of the eligible area involved shall:
               (i) establish, through intergovernmental
agreements with the chief elected officials of the political
subdivisions described in subparagraph (B), an
administrative
mechanism to allocate funds and services based on:
                    (I) the number of AIDS cases in such
subdivisions;
                    (II) the severity of need for outpatient
and ambulatory care services in such subdivisions; and
                    (III) the health and support services
personnel needs of such subdivisions; and
               (ii) establish an HIV health services
planning council in accordance with subsection (b).
          (B) Local political subdivision. The political
subdivisions referred to in subparagraph (A) are those
political subdivisions in the eligible area:
               (i) that provide HIV-related health services;
and
               (ii) for which the number of cases reported
for purposes of section 2601(a) [42 USC 300ff-11(a)]
constitutes not less than 10 percent of the number of such
cases reported for the eligible area.
(b) HIV health services planning council. (1) Establishment.
To be eligible for assistance under this part [42 USC 300ff-
11 et seq.], the chief elected official described in
subsection (a)(1) shall establish or designate an HIV health
services planning council that shall include representatives
of:
          (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 [42 USC
300ff51 et seq.]; 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.

     (2) Method of providing for council. (A) In general. In
providing for a council for purposes of paragraph (1), a chief
elected official receiving a grant under section 2601(a) [42
USC 300ff-11(a)] may establish the council directly or
designate an existing entity to serve as the council, subject
to subparagraph (B).

          (B) Consideration regarding designation of council.
In making a determination of whether to establish or designate
a
council under subparagraph (A), a chief elected official
receiving a grant under section 2601(a) [42 USC 300ff-11(a)]
shall give priority to the designation of an existing entity
that has demonstrated experience in planning for the HIV health
care service needs within the eligible area and in the
implementation of such plans in addressing those needs. Any
existing entity so designated shall be expanded to include a
broad representation of the full range of entities that provide
such services within the geographic area to be served.

     (3) Duties. The planning council established or designated
under paragraph (1) shall:

          (A) establish priorities for the allocation of funds
within the eligible area;

          (B) develop a comprehensive plan for the organization
and delivery of health services described in section 2604 [42
USC 300ff-14] that is compatible with any existing State or
local plan regarding the provision of health services to
individuals with HIV disease; and

        (C) assess the efficiency of the administrative
mechanism in rapidly allocating funds to the areas of greatest
need within the eligible area.

(July 1, 1944, ch 373, Title XXVI, Part A, 2602, as added Aug.
18, 1990, P. L. 101-381, Title I, 101(3), 104 Stat. 577.)
(As amended Oct. 27, 1992, P. L. 102-531, Title III,
312(d)(26), 106 Stat. 3505.)

300ff-13.  Type and distribution of grants

(a) Grants based on relative need of area.(1) In general. In
carrying out section 2601(a) [42 USC 300ff-11(a)], the
Secretary shall make a grant for each eligible area for which
an application under section 2605(a) [42 USC 300ff-15(a)] has
been approved. Each such grant shall be made in an amount
determined in accordance with paragraph (3).

     (2) Expedited distribution. Not later than:

          (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, except in the case of waivers
granted under section 2605(c) [42 USC 300ff-15(c)], disburse 50
percent of the amount appropriated under section 2608 [42 USC
300ff-18] for such fiscal year through grants to eligible areas
under section 2601(a) [42 USC 300ff-11(a)].

     (3) Amount of grant. (A) In general. (i) 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.

               (ii) For purposes of clause (i)(II), the term
"distribution factor" means the sum of--
                    (I) an amount equal to the product of 3 and
the amount determined under subparagraph (B) for the eligible
area involved; and
                    (II) an amount equal to the product of the
amount determined under subparagraph (B) for the eligible area
and the amount determined under subparagraph (C) for the area.

          (B) Amount relating to cumulative number of cases.
The amount determined in this subparagraph is an amount equal
to the ratio of--

               (i) an amount equal to 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 and Prevention by the applicable date specified
in section 2601(a) [42 USC 300ff-11(a)]; to

               (ii) an amount equal to the sum of the
respective amounts determined under clause (i) for each
eligible area for which an application for a grant for purposes
of this paragraph has been approved.

          (C) Amount relating to per capita incidence of cases.
The amount determined in this subparagraph is an amount equal
to 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 cumulative such
cases in all eligible areas for which applications for grants
for purposes of this paragraph have been approved (computed on
the basis of the most recently available data on the population
of the areas).

(b) Supplemental grants.(1) In general. Not later than 150 days
after the date on which appropriations are made under section
2608 [42 USC 300ff-18] for a fiscal year, the Secretary shall
disburse the remainder of amounts not disbursed under section
2603(a)(2) [subsec. (a)(2) of this section] for such fiscal
year for the purpose of making grants under section 2601(a) [42
USC 300ff-11(a)] to eligible areas whose application under
section 2605(b) [42 USC 300ff-15(b)]:

          (A) contains a report concerning the dissemination of
emergency relief funds under subsection (a) and the plan for
utilization of such funds;

          (B) demonstrates the severe need in such area for
supplemental financial assistance to combat the HIV epidemic;

          (C) demonstrates the existing commitment of local
resources of the area, both financial and in-kind, to combating
the HIV epidemic;

          (D) demonstrates the ability of the area to utilize
such supplemental financial resources in a manner that is
immediately responsive and cost effective; and

          (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.
     (2) Remainder of amounts. In determining the amount of
funds to be obligated under paragraph (1), the Secretary shall
include amounts that are not paid to the eligible areas under
expedited procedures under section 2603(a)(2) [subsec. (a)(2)
of this section] as a result of:
          (A) the failure of any eligible area to submit an
application under section 2605(c) [42 USC 300ff-15(c)]; or
          (B) any eligible area informing the Secretary that
such eligible area does not intend to expend the full amount of
its grant under such section.
     (3) 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 section 2605(b) [42 USC 300ff-15(b)].
    (4) Failure to submit.(A) In general. The failure of an
eligible area to submit an application for an expedited grant
under section 2603(a)(2) [subsec. (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 section 2605(b) [42 USC 300ff-15(b)] shall
contain the assurances required under subsection (a) of such
section if such eligible area fails to submit an application
for an expedited grants [grant] under section 2603(a)(2)
[subsec. (a)(2) of this section].

(July 1, 1944, ch 373, Title XXVI, Part A, 2603, as added Aug.
18, 1990. P. L. 101-381, Title I, 101(3), 104 Stat. 578); Nov.
3, 1990, P. L. 101-502, 6(a), 104 Stat. 1289.)
(As amended Oct. 27, 1992, P. L. 102-531, Title III,
312(d)(27), 106 Stat. 3506.)

300ff-14.  Use of amounts

(a) Requirements. The Secretary may not make a grant under
section 2601(a) [42 USC 300ff-11(a)] to the chief elected
official of an eligible area unless such political subdivision
agrees that:
     (1) subject to paragraph (2), the allocation of funds and
services within the eligible area will be made in accordance
with the priorities established, pursuant to section
2602(b)(3)(A) [42 USC 300ff-12(b)(3)(A)], by the HIV health
services planning council that serves such eligible area; and

     (2) funds provided under section 2601 [42 USC 300ff-11]
will be expended only for the purposes described in subsections
(b) and (c).

(b) Primary purposes. (1) In general. The chief elected
official shall use amounts received under a grant under section
2601 [42 USC 300ff-11] to provide direct financial assistance
to entities described in paragraph (2) for the purpose of
delivering or enhancing HIV-related:

          (A) outpatient and ambulatory health and support
services, including case management and comprehensive treatment
services, 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,
including hospitals (which may include Veterans Administration
[Department of Veterans Affairs]  facilities), community-based
organizations, hospices, ambulatory care facilities, community
health centers, migrant health centers, and homeless health
centers.

          (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.

(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 section 2601 [42 USC 300ff-11] to provide financial
assistance or services, for the purposes described in paragraph
(2), to any public or nonprofit private entity, including
hospitals (which may include Veterans Administration
facilities), nursing homes, subacute and transitional care
facilities, and hospices that:

         (A) provide HIV-related care or services to a
disproportionate share of low-income individuals and families
with HIV disease;

          (B) incur uncompensated costs in the provision of
such care or services to such individuals and families;
          (C) have established, and agree to implement, a plan
to evaluate the utilization of services provided in the care of
individuals and families with HIV disease; and

          (D) have established a system designed to ensure that
such individuals and families are referred to the most
medically appropriate level of care as soon as such referral is
medically indicated.

     (2) Use. A chief elected official may use amounts referred
to in paragraph (1) to:

          (A) provide direct financial assistance to
institutions and entities of the type referred to in such
paragraph to assist such institutions and entities in
recruiting or training and paying compensation to qualified
personnel determined, under paragraph (3), to be necessary by
the HIV health services planning council, specifically for the
care of individuals with HIV disease; or

          (B) in lieu of providing direct financial assistance,
make arrangements for the provision of the services of such
qualified personnel to such institutions and entities.

     (3) Requirement of determination by council. A chief
elected official shall not use any of the amounts received
under a grant under section 2601(a) [42 USC 300ff-11(a)] to
provide assistance or services under paragraph (2) unless the
HIV health services planning council of the eligible area has
made a determination that, with respect to the care of
individuals with HIV disease:

          (A) a shortage of specific health, mental health or
support service personnel exists within specific institutions
or entities in the eligible area;

          (B) the shortage of such personnel has resulted in
the inappropriate utilization of inpatient services within the
area; and

          (C) assistance or services provided to an institution
or entity under paragraph (2), will not be used to supplant the
existing resources devoted by such institution or entity to the
uses described in such paragraph.

(d) 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) [42 USC 300ff-11(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
[42 USC 1396 et seq.] for the State:

          (A) the political subdivision involved will provide
the service directly, and the political subdivision has entered
into a participation agreement under the State plan and is
qualified to receive payments under such plan; or

          (B) the political subdivision will enter into an
agreement with a public or nonprofit private entity under which
the entity will provide the service, and the entity has entered
into such a participation agreement and is qualified to receive
such payments.

     (2) Waiver. (A) In general. In the case of an entity
making an agreement pursuant to paragraph (1)(B) regarding the
provision of services, the requirement established in such
paragraph shall be waived by the HIV health services planning
council for the eligible area if the entity does not, in
providing health care services, impose a charge or accept
reimbursement available from any third-party payor, including
reimbursement under any insurance policy or under any Federal
or State health benefits program.

          (B) Determination. A determination by the HIV health
services planning council of whether an entity referred to in
subparagraph (A) meets the criteria for a waiver under such
subparagraph shall be made without regard to whether the entity
accepts voluntary donations for the purpose of providing
services to the public.

(e) Administration and planning. 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 [42 USC
300ff-11 et seq.] for administration, accounting, reporting,
and program oversight functions.

(f) Construction. A State may not use amounts received under a
grant awarded under this part [42 USC 300ff-11 et seq.] 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, Part A, 2604, as added Aug.
18, 1990, P. L. 101-381, Title I, 101(3), 104 Stat. 580.)


300ff-15.  Application

(a) In general. To be eligible to receive a grant under section
2601 [42 USC 300ff-11], an eligible area shall prepare and
submit to the Secretary an application at such time, in such
form, and containing such information as the Secretary shall
require, including assurances adequate to ensure:

     (1) (A) that funds received under a grant awarded under
this part [42 USC 300ff-11 et seq.] 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 1-year
period preceding the first fiscal year for which a grant is
received by the eligible area; and
          (C) that political subdivisions within the eligible
area will not use funds received under a grant awarded under
this part [42 USC 300ff-11 et seq.] in maintaining the level of
expenditures for HIV-related services as required in
subparagraph (B);
     (2) that the eligible area has an HIV health services
planning council and has entered into intergovernmental
agreements pursuant to section 2602 [42 USC 300ff-12], and has
developed or will develop the comprehensive plan in accordance
with section 2602(b)(3)(B) [42 USC 300ff-12(b)(3)(B)];

     (3) that entities within the eligible area that will
receive funds under a grant provided under section 2601(a) [42
USC 300ff11(a)] shall participate in an established HIV
community-based continuum of care if such continuum exists
within the eligible area;

   (4) that funds received under a grant awarded under this
part [42 USC 300ff-11 et seq.] 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; and

     (5) to the maximum extent practicable, that:

     (A) HIV health care and support services provided with
assistance made available under this part [42 USC 300ff-11 et
seq.] 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.

(b) Additional application. An eligible area that desires to
receive a grant under section 2603(b) [42 USC 300ff-13(b)]
shall prepare and submit to the Secretary an additional
application at such time, in such form, and containing such
information as the Secretary shall require, including the
information required under such subsection and information
concerning:

     (1) the number of individuals to be served within the
eligible area with assistance provided under the grant;

     (2) demographic data on the population of such
individuals;

     (3) the average cost of providing each category of HIV
related health services and the extent to which such cost is
paid by third-party payors; and

     (4) the aggregate amounts expended for each such category
of services.

(c) Date certain for submission. (1) Requirement. Except as
provided in paragraph (2), to be eligible to receive a grant
under section 2601(a) [42 USC 300ff-11(a)] for a fiscal year,
an application under subsection (a) shall be submitted not
later than 45 days after the date on which appropriations are
made under section 2608 [42 USC 300ff-18] for the fiscal year.

     (2) Exception. The Secretary may extend the time for the
submission of an application under paragraph (1) for a period
of not to exceed 60 days if the Secretary determines that the
eligible area has made a good faith effort to comply with the
requirement of such paragraph but has otherwise been unable to
submit its application.

     (3) Distribution by Secretary. Not later than 45 days
after receiving an application that meets the requirements of
subsection (a) from an eligible area, the Secretary shall
distribute to such eligible area the amounts awarded under the
grant for which the application was submitted.

     (4) Redistribution. Any amounts appropriated in any fiscal
year under this part [42 USC 300ff-11 et seq.] 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 2601(a) [42
USC 300ff-11(a)]. (d) Requirements regarding imposition of
charges for services. (1) In general. The Secretary may not
make a grant under section 2601 [42 USC 300ff-11] to an
eligible area unless the eligible area provides assurances that
in the provision of services with assistance provided under the
grant:

          (A) in the case of individuals with an income less
than or equal to 100 percent of the official poverty line, the
provider will not impose charges on any such individual for the
provision of services under the grant;

          (B) in the case of individuals with an income greater
than 100 percent of the official poverty line, the provider:

               (i) will impose a charge on each such individual
for the provision of such services; and

               (ii) will impose the charge according to a
schedule of charges that is made available to the public;

          (C) in the case of individuals with an income greater
than 100 percent of the official poverty line and not exceeding
200 percent of such poverty line, the provider will not, for
any calendar year, impose charges in an amount exceeding 5
percent of the annual gross income of the individual involved;

          (D) in the case of individuals with an income greater
than 200 percent of the official poverty line and not exceeding
300 percent of such poverty line, the provider will not, for
any calendar year, impose charges in an amount exceeding 7
percent of the annual gross income of the individual involved;
and

          (E) in the case of individuals with an income greater
than 300 percent of the official poverty line, the provider
will not for any calendar year, impose charges in an amount
exceeding 10 percent of the annual gross income of the
individual involved.

   (2) Assessment of charge. With respect to compliance with
the assurance made under paragraph (1), a grantee or entity
receiving assistance under this part [42 USC 300ff-11 et seq.]
may, in the case of individuals subject to a charge for
purposes of such paragraph:

          (A) assess the amount of the charge in the discretion
of the grantee, including imposing only a nominal charge for
the provision of services, subject to the provisions of such
paragraph regarding public schedules and regarding limitations
on the maximum amount of charges; and

          (B) take into consideration the medical expenses of
individuals in assessing the amount of the charge, subject to
such provisions.
     (3) Applicability of limitation on amount of charge. The
Secretary may not make a grant under section 2601 [42 USC 300ff
11] to an eligible area unless the eligible area agrees that
the limitations established in subparagraphs (C), (D) and (E)
of paragraph (1) regarding the imposition of charges for
services applies to the annual aggregate of charges imposed for
such services, without regard to whether they are characterized
as enrollment fees, premiums, deductibles, cost sharing,
copayments, coinsurance, or other charges.

     (4) Waiver regarding secondary agreements. The
requirements established in paragraphs (1) through (3) shall be
waived in accordance with section 2604(d)(2) [42 USC 300ff-
14(d)(2)].

(July 1, 1944, ch 373, Title XXVI, Part A, 2605, as added Aug.
18, 1990, P. L. 101-381, Title I, 101(3), 104 Stat. 582.)

300ff-16.  Technical assistance

The Administrator of the Health Resources and Services
Administration may, beginning on the date of enactment of this
title [enacted Aug. 18, 1990], provide technical assistance to
assist entities in complying with the requirements of this part
[42 USC 300ff-11 et seq.] in order to make such entities
eligible to receive a grant under this part [42 USC 300ff-11 et
seq.].

(July 1, 1944, ch 373, Title XXVI, Part A, 2606, as added Aug.
18, 1990, P. L. 101-381, Title I, 101(3), 104 Stat. 585.)


300ff-17.  Definitions

For purposes of this part [42 USC 300ff-11 et seq.]:

     (1) Eligible area. The term "eligible area" means a
metropolitan area described in section 2601(a) [42 USC 300ff
11(a)].
     (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, Part A, 2607, as added Aug.
18, 1990, P. L. 101-381, Title I, 101(3), 104 Stat. 585; Nov.
15, 1990, P. L. 101-557, Title IV, 401(b)(1), 104 Stat. 2771.)
(As amended Oct. 27, 1992, P. L. 102-531, Title III,
312(d)(28), 106 Stat. 3506.)

     Amendments:

     1990. Act Nov. 15, 1990, in para. (1), substituted
"2601(a)" for "2601(a)(1)".
300ff-18.  Authorization of appropriations


There are authorized to be appropriated to make grants under
this part [42 USC 300ff-11 et seq.], $275,000,000 in each of
the fiscal years 1991 and 1992, and such sums as may be
necessary in each of the fiscal years 1993 through 1995.

(July 1, 1944, ch 373, Title XXVI, Part A, 2608, as added Aug.
18, 1990, P. L. 101-381, Title I, 101(3), 104 Stat. 585.)


                             CARE GRANT PROGRAM
300ff-21.  Grants

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.

(July 1, 1944, ch 373, Title XXVI, Part B, 2611, as added Aug.
18, 1990, P. L. 101-381, Title II, 201, 104 Stat. 586.)

300ff-22.  General use of grants

(a) In general. A State may use amounts provided under grants
made under this part:

     (1) to establish and operate HIV care consortia within
areas most affected by HIV disease that shall be designed to
provide a comprehensive continuum of care to individuals and
families with HIV disease in accordance with section 2613 [42
USC 300ff-23];

     (2) to provide home- and community-based care services for
individuals with HIV disease in accordance with section 2614
[42 USC 300ff-24];

     (3) to provide assistance to assure the continuity of
health insurance coverage for individuals with HIV disease in
accordance
with section 2615 [42 USC 300ff-25]; and
    (4) to provide treatments, that have been determined to
prolong life or prevent serious deterioration of health, to
individuals with HIV disease in accordance with section 2616
[42 USC 300ff-26].

(b) Infants and women, etc. A State shall use not less than 15
percent of funds allocated under this part to provide health
and support services to infants, children, women, and families
with HIV disease.
(July 1, 1944, ch 373, Title XXVI, Part B, 2612, as added Aug.
18, 1990, P. L. 101-381, Title II, 201, 104 Stat. 586.)

 300ff-23.  Grants to establish HIV care consortia

(a) Consortia. A State may use amounts provided under a grant
awarded under this part to provide assistance under section
2612(a)(1) [42 USC 300ff-22(a)(1)] to an entity that:

     (1) is an association of one or more public, and one or
more nonprofit private, 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, and dental care, diagnostics,
monitoring, and medical follow-up services, mental health,
developmental, and rehabilitation services, home health and
hospice care; and
          (B) essential support services such as transportation
services, attendant care, homemaker services, day or respite
care, benefits advocacy, advocacy services provided through
public and nonprofit private entities, and services that are
incidental to the provision of health care services for
individuals with HIV disease including nutrition services,
housing referral services, and child welfare and family
services (including foster care and adoption services).
An entity or entities of the type described in this subsection
shall hereinafter be referred to in this title [42 USC 300ff-11
et seq.] as a "consortium" or "consortia".

(b) Assurances. (1) Requirement. To receive assistance from a
State under subsection (a), an applicant consortium shall
provide the State with assurances that:

          (A) within any locality in which such consortium is
to operate, the populations and subpopulations of individuals
and families with HIV disease have been identified by the
consortium;

          (B) the service plan established under subsection
(c)(2) 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), 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 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; and

          (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. The
organization to be consulted under subparagraph (B) shall be at
the discretion of the applicant consortium.

(d) Definition. As used in this part, the term "family centered
care" means the system of services described in this section
that is targeted specifically to the special needs of infants,
children, women, and families. Family centered care shall be
based on a partnership between parents, professionals, and the
community designed to ensure an integrated, coordinated,
culturally sensitive, and community-based continuum of care for
children, women, and families with HIV disease.

(e) Priority. In providing assistance under subsection (a), the
State shall, among applicants that meet the requirements of
this section, give priority:
   (1) first to consortia that are receiving assistance from
the Health Resources and Services Administration for adult and
pediatric HIV-related care demonstration projects; and then

     (2) to any other existing HIV care consortia.

(July 1, 1944, ch 373, Title XXVI, Part B, 2613, as added Aug.
18, 1990, P. L. 101-381, Title II, 201, 104 Stat. 586.)

 300ff-24.  Grants for home- and community-based care

(a) Uses. A State may use amounts provided under a grant
awarded under this part to make grants under section 2612(a)(2)
[42 USC 300ff-22(a)(2)] to entities to:

   (1) provide home- and community-based health services for
individuals with HIV disease pursuant to written plans of care
prepared by a case management team, that shall include
appropriate health care professionals, in such State for
providing such services to such individuals;

     (2) provide outreach services to individuals with HIV
disease, including those individuals in rural areas; and

     (3) provide for the coordination of the provision of
services under this section with the provision of HIV-related
health services provided by public and private entities.

(b) Priority. In awarding grants under subsection (a), a State
shall give priority to entities that provide assurances to the
State that:

     (1) such entities will participate in HIV care consortia
if such consortia exist within the State; and

     (2) such entities will utilize amounts provided under such
grants for the provision of home- and community-based services
to low-income individuals with HIV disease.

(c) Definition. As used in this part, the term "home- and
community-based health services":

     (1) means, with respect to an individual with HIV disease,
skilled health services furnished to the individual in the
individual's home pursuant to a written plan of care
established by a case management team, that shall include
appropriate health care professionals, for the provision of
such services and items described in paragraph (2);

     (2) includes:

          (A) durable medical equipment;

          (B) homemaker or home health aide services and
personal care services furnished in the home of the individual;
          (C) day treatment or other partial hospitalization
services;

          (D) home intravenous and aerosolized drug therapy
(including prescription drugs administered as part of such
therapy);

          (E) routine diagnostic testing administered in the
home of the individual; and

          (F) appropriate mental health, developmental, and

rehabilitation services; and

     (3) does not include:

          (A) inpatient hospital services; and

          (B) nursing home and other long term care facilities.
(July 1, 1944, ch 373, Title XXVI, Part B, 2614, as added Aug.
18, 1990, P. L. 101-381, Title II, 201, 104 Stat. 589.)


300ff-25.  Continuum of health insurance coverage


(a) In general. A State may use amounts received under a grant
awarded under this part to establish a program of financial
assistance under section 2612(a)(3) [42 USC 300ff-22(a)(3)] to
assist eligible low-income individuals with HIV disease in:


     (1) maintaining a continuity of health insurance; or


    (2) receiving medical benefits under a health insurance
program, including risk-pools.

(b) Limitations. Assistance shall not be utilized under
subsection (a):

     (1) to pay any costs associated with the creation,
capitalization, or administration of a liability risk pool
(other
than those costs paid on behalf of individuals as part of
premium contributions to existing liability risk pools); and

     (2) to pay any amount expended by a State under title XIX
of the Social Security Act [42 USC 1396 et seq.].

(July 1, 1944, ch 373, Title XXVI, Part B, 2615, as added Aug.
18, 1990, P. L. 101-381, Title II, 201, 104 Stat. 590.)

 300ff-26.  Provision of treatments

(a) In general. A State may use amounts provided under a grant
awarded under this part to establish a program under section
2612(a)(4) [42 USC 300ff-22(a)(4)] to provide treatments that
have been determined to prolong life or prevent the serious
deterioration of health arising from HIV disease in eligible
individuals.

(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; and

   (4) facilitate access to treatments for such individuals.

(July 1, 1944, ch 373, Title XXVI, Part B, 2616, as added Aug.
18, 1990, P. L. 101-381, Title II, 201, 104 Stat. 590.)

 300ff-27.  State application


(a) In general. The Secretary shall not make a grant to a State
under this part for a fiscal year unless the State prepares and
submits, to the Secretary, an application at such time, in such
form, and containing such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this part.

(b) Description of intended uses and agreements. The
application submitted under subsection (a) shall contain:

    (1) a detailed description of the HIV-related services
provided in the State to individuals and families with HIV
disease during the year preceding the year for which the grant
is requested, and the number of individuals and families
receiving such services, that shall include:

          (A) a description of the types of programs operated
or funded by the State for the provision of HIV-related
services during the year preceding the year for which the grant
is requested and the methods utilized by the State to finance
such programs;

          (B) an accounting of the amount of funds that the
State has expended for such services and programs during the
year preceding the year for which the grant is requested; and
          (C) information concerning:
               (i) the number of individuals to be served with
assistance provided under the grant;
               (ii) demographic data on the population of the
individuals to be served;
               (iii) the average cost of providing each
category of HIV-related health services and the extent to which
such cost is paid by third-party payors; and
               (iv) the aggregate amounts expended for each
such category of services;
     (2) a 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; and
          (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
     (3) 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 2615
[42 USC 300ff-25], submit a plan to the Secretary that
demonstrates that the State has established a program that
assures that:

               (I) such amounts will be targeted to individuals
who would not otherwise be able to afford health insurance
coverage; and
                    (II) income, asset, and medical expense
criteria will be established and applied by the State to
identify those individuals who qualify for assistance under
such program, and information concerning such criteria shall be
made available to the public;
          (C) the State will provide for periodic independent
peer review to assess the quality and appropriateness of health
and support services provided by entities that receive funds
from the State under this part;
          (D) the State will permit and cooperate with any
Federal investigations undertaken regarding programs conducted
under this part;
          (E) the State will maintain HIV-related activities at
a level that is equal to not less than the level of such
expenditures by the State for the 1-year period preceding the
fiscal year for which the State is applying to receive a grant
under this part; 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 section 2611 [42 USC 300ff-21] to a State unless the
State provides assurances that in the provision of services
with assistance provided under the grant:
     (A) in the case of individuals with an income less than or
equal to 100 percent of the official poverty line, the provider
will not impose charges on any such individual for the
provision of services under the grant;
          (B) in the case of individuals with an income greater
than 100 percent of the official poverty line, the provider--
               (i) will impose charges on each such individual
for the provision of such services; and
               (ii) will impose charges according to a schedule
of charges that is made available to the public;
          (C) in the case of individuals with an income greater
than 100 percent of the official poverty line and not exceeding
200 percent of such poverty line, the provider will not, for
any calendar year, impose charges in an amount exceeding 5
percent of the annual gross income of the individual involved;
          (D) in the case of individuals with an income greater
than 200 percent of the official poverty line and not exceeding
300 percent of such poverty line, the provider will not, for
any calendar year, impose charges in an amount exceeding 7
percent of the annual gross income of the individual involved;
and

          (E) in the case of individuals with an income greater
than 300 percent of the official poverty line, the provider
will not, for any calendar year, impose charges in an amount
exceeding 10 percent of the annual gross income of the
individual involved.

     (2) Assessment of charge. With respect to compliance with
the assurance made under paragraph (1), a grantee under this
part may, in the case of individuals subject to a charge for
purposes of such paragraph--

          (A) assess the amount of the charge in the discretion
of the grantee, including imposing only a nominal charge for
the provision of services, subject to the provisions of such
paragraph regarding public schedules regarding limitation on
the maximum amount of charges; and

          (B) take into consideration the medical expenses of
individuals in assessing the amount of the charge, subject to
such provisions.

     (3) Applicability of limitation on amount of charge. The
Secretary may not make a grant under section 2611 [42 USC 300ff
21] unless the applicant of the grant agrees that the
limitations established in subparagraphs (C), (D), and (E) of
paragraph (1) regarding the imposition of charges for services
applies to the annual aggregate of charges imposed for such
services, without regard to whether they are characterized as
enrollment fees, premiums, deductibles, cost sharing,
copayments, coinsurance, or other charges.

     (4) Waiver. (A) In general. The State shall waive the
requirements established in paragraphs (1) through (3) in the
case of an entity that does not, in providing health care
services, impose a charge or accept reimbursement from any
thirdparty payor, including reimbursement under any insurance
policy or under any Federal or State health benefits program.

          (B) Determination. A determination by the State of
whether an entity referred to in subparagraph (A) meets the
criteria for a waiver under such subparagraph shall be made
without regard to whether the entity accepts voluntary
donations regarding the provision of services to the public.

(d) Requirement of matching funds regarding State
allotments.(1) In general. In the case of any State to which
the criterion described in paragraph (3) applies, the Secretary
may not make a grant under this part unless the State agrees
that, with respect to the costs to be incurred by the State in
carrying out the program for which the grant was awarded, the
State will, subject to subsection (b)(2), make available
(directly or through donations from public or private entities)
non-Federal contributions toward such costs in an amount equal
to:

          (A) for the first fiscal year of payments under the
grant, not less than 16 2/3 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 33 1/3 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 33 1/3 percent of such costs ($1 for each $2 of
Federal funds provided in the grant).
     (2) Determination of amount of non-Federal
contribution.(A) In general. Non-Federal contributions required
in paragraph (1) may be in cash or in kind, fairly evaluated,
including plant, equipment, or services. Amounts provided by
the Federal Government, and any portion of any service
subsidized by the Federal Government, may not be included in
determining the amount of such non-Federal contributions.
          (B) Inclusion of certain amounts.(i) In making a
determination of the amount of non-Federal contributions made
by a State for purposes of paragraph (1), the Secretary shall,
subject to clause (ii), include any non-Federal contributions
provided by the State for HIV-related services, without regard
to whether the contributions are made for programs established
pursuant to this title;
               (ii) In making a determination for purposes of
clause (i), the Secretary may not include any non-Federal
contributions provided by the State as a condition of receiving
Federal funds under any program under this title (except for
the program established in this part) or under other provisions
of law.
    (3) Applicability of requirement.(A) Number of cases. A
State referred to in paragraph (1) is any State for which the
number of cases of acquired immune deficiency syndrome reported
to and confirmed by the Director of the  Centers for Disease
Control and Prevention for the period described in subparagraph
(B) constitutes in excess of 1 percent of the aggregate number
of such cases reported to and confirmed by the Director for
such period for the United States.

          (B) Period of time. The period referred to in
subparagraph (A) is the 2-year period preceding the fiscal year
for which the State involved is applying to receive a grant
under subsection (a).

          (C) Puerto Rico. For purposes of paragraph (1), the
number of cases of acquired immune deficiency syndrome reported
and confirmed for the Commonwealth of Puerto Rico for any
fiscal year shall be deemed to be less than 1 percent.

     (4) Diminished State contribution. With respect to a State
that does not make available the entire amount of the non-
Federal contribution referred to in paragraph (1), the State
shall continue to be eligible to receive Federal funds under a
grant under this part, except that the Secretary in providing
Federal funds under the grant shall provide such funds (in
accordance with the ratios prescribed in paragraph (1)) only
with respect to the amount of funds contributed by such State.

(July 1, 1944, ch 373, Title XXVI, Part B, 2617, as added Aug.
18, 1990, P. L. 101-381, Title II, 201, 104 Stat. 590.)
(As amended Oct. 27, 1992, P. L. 102-531, Title III,
312(d)(29), 106 Stat. 3506.)

300ff-28.  Distribution of funds

(a) Special projects of a national significance. (1) In
general. Of the amount appropriated under section 2620 [42 USC
300ff-30] for each fiscal year, the Secretary shall use not to
exceed 10 percent of such amount to establish and administer a
special projects of national significance program to award
direct grants to public and nonprofit private entities
including communitybased organizations to fund special programs
for the care and treatment of individuals with HIV disease.

      (2) Grants. The Secretary shall award grants under
subsection (a) based on:
          (A) the need to assess the effectiveness of a
particular model for the care and treatment of individuals with
HIV disease;

          (B) the innovative nature of the proposed activity;
and

        (C) the potential replicability of the proposed
activity in other similar localities or nationally.

     (3) Special projects. Special projects of a national
significance may include those that are designed to:

          (A) establish a system designed to increase the
number of health care facilities willing and able to serve low-
income individuals and families with HIV disease;

          (B) deliver drug abuse treatment and HIV health care
services at a single location, through either an outpatient or
residential facility;

          (C) provide support and respite care for participants
in family-based care networks critical to the delivery of
comprehensive HIV care in the minority community;

          (D) deliver an enhanced spectrum of comprehensive
health care and support services to underserved hemophilia
populations, including minorities and those in rural and
underserved areas, utilizing established networks of hemophilia
diagnostic and treatment centers and community-based outreach
systems;

          (E) deliver HIV health care and support services to
Indians with HIV disease and their families;

          (F) improve the provision of HIV health care and
support services to individuals and families with HIV disease
located in rural areas;

          (G) deliver HIV health care and support services to
homeless individuals and families with HIV disease; and

          (H) deliver HIV health care and support services to
individuals with HIV disease who are incarcerated.

(b) Amount of grant to State. (1) Minimum allotment. Subject to
the extent of amounts made available under section 2620 [42 USC
300ff-30], the amount of a grant to be made under this part
for:

          (A) each of the several States and the District of
Columbia for a fiscal year shall be the greater of:

               (i) $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).
   (2) Determination. (A) Formula. The amount referred to in
paragraph (1)(A)(ii) for a State and paragraph (1)(B) for a
territory of the United States shall be the product of:

               (i) an amount equal to the amount appropriated
under section 2620 [42 USC 300ff-30] for the fiscal year
involved; and

               (ii) the ratio of the distribution factor for
the State or territory to the sum of the distribution factors
for all the States or territories.

          (B) Distribution factor. As used in subparagraph
(A)(ii), the term "distribution factor" means:

               (i) in the case of a State, the product of:
                    (I) the number of cases of acquired immune
deficiency syndrome in the State, as indicated by the number of
cases reported to and confirmed by the Secretary for the 2 most
recent fiscal years for which such data are available; and
                    (II) the cube root of the ratio (based on
the most recent available data) of:
                         (aa) the average per capita income of
individuals in the United States (including the territories);
to
                         (bb) the average per capita income of
individuals in the State; and
               (ii) in the case of a territory of the United
States the number of additional cases of such syndrome in the
specific territory, as indicated by the number of cases
reported to and confirmed by the Secretary for the 2 most
recent fiscal years for which such data is available.
     (3) Definitions. As used in this subsection:
          (A) the term "State" means each of the 50 States, the
District of Columbia and the Commonwealth of Puerto Rico; and
          (B) the term "territory of the United States" means
the Virgin Islands, Guam, American Samoa, the Commonwealth of
the Northern Mariana Islands, and the Republic of the Marshall
Islands.
(c) Allocation of assistance by States. (1) Consortia. In a
State that has reported 1 percent or more of all AIDS cases
reported to and confirmed by the  Centers for Disease Control
and Prevention in all States, not less than 50 percent of the
amount received by the State under a grant awarded under this
part shall be utilized for the creation and operation of
community-based comprehensive care consortia under section 2613
[42 USC 300ff-23], in those areas within the State in which the
largest number of individuals with HIV disease reside.

     (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
[42 USC 300ff-11 et seq.].

     (3) Planning and evaluations. A State may not use in
excess
of 5 percent of amounts received under a grant awarded under
this part for planning and evaluation activities.
     (4) Administration. A State may not use in excess of 5
percent of amounts received under a grant awarded under this
part for administration, accounting, reporting, and program
oversight functions.
     (5) 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) 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, Part B, 2618, as added Aug.
18, 1990, P. L. 101-381, Title II, 201, 104 Stat. 595.)
(As amended Oct. 27, 1992, P. L. 102-531, Title III,
312(d)(30), 106 Stat. 3506.)

 300ff-29.  Technical assistance

The Secretary may provide technical assistance in administering
and coordinating the activities authorized under section 2612
[42 USC 300ff-22].

(July 1, 1944, ch 373, Title XXVI, Part B, 2619, as added Aug.
18, 1990, P. L. 101-381, Title II, 201, 104 Stat. 597.)

300ff-30.  Authorization of appropriations

There are authorized to be appropriated to make grants under
this part, $275,000,000 in each of the fiscal years 1991 and
1992, and such sums as may be necessary in each of the fiscal
years 1993 through 1995.

(July 1, 1944, ch 373, Title XXVI, Part B, 2620, as added Aug.
18, 1990, P. L. 101-381, Title II, 201, 104 Stat. 597.)

                         EARLY INTERVENTION SERVICES
                          Formula Grants for
States
300ff-41.  Establishment of program

(a) Allotments for States. For the purposes described in
subsection (b), 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 section 2649 [42 USC 300ff-49].
The Secretary shall make payments, as grants, to each State
from the allotment for the State for the fiscal year involved
if the Secretary approves for the fiscal year an application
submitted by the State pursuant to section 2665 [42 USC 300ff-
65].

(b) Purposes of grants.(1) In general. The Secretary may not
make a grant under subsection (a) 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 section 2662 [42 USC 300ff-62];

          (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 [42
USC 300ff-11 et seq.] or B [42 USC 300ff-21 et seq.] for the
provision of such services;

          (B) to biomedical research facilities of institutions
of higher education that offer experimental treatment for such
disease, or to community-based organizations or other entities
that provide such treatment; or

          (C) to grantees under section 2671 [42 USC 300ff-71],
in the case of pregnant women.

     (4) Requirement of availability of all early intervention
services through each grantee. The Secretary may not make a
grant under subsection (a) 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):

          (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
section 2644 [42 USC 300ff-44(c), (d)] will apply to the
hospitals to the same extent and in the same manner as such
subsections apply to entities described in such section;
          (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) 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 section 2650 [42 USC 300ff-50] for fiscal
year 1991, an amount equal to $130,000,000 is expended to
provide the early intervention services specified in
subparagraphs (A) through (C) of paragraph (2).

300ff-43.  Requirement of matching funds

(a) In general. In the case of any State to which the criterion
described in subsection (c) applies, the Secretary may not make
a grant under section 2641 [42 USC 300ff-41] unless the State
agrees that, with respect to the costs to be incurred by the
State in carrying out the purpose referred to in such
subsection, the State will, subject to subsection (b)(2), make
available (directly or through donations from public or private
entities) non-Federal contributions toward such costs in an
amount equal to:

     (1) for the first fiscal year for which such criterion
applies to the State, not less than 16 2/3 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 33 1/3
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)
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), 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 title.

          (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 title (except for
the program established in section 2641 [42 USC 300ff-41]) or
under other provisions of law.

(c) Applicability of matching requirement.(1) Percentage of
national number of cases.(A) The criterion referred to in
subsection (a) 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
2year period preceding the fiscal year for which the State
involved is applying to receive a grant under section 2641 [42
USC 300ff-41].

   (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), the State shall
continue to be eligible to receive Federal funds under a grant
under section 2641 [42 USC 300ff-41], 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, Part C, Subpart I, 2643, as
added Aug. 18, 1990, P. L. 101-381, Title III, 301(a), 104 Stat.
600.)
(As amended Oct. 27, 1992, P. L. 102-531, Title III, 312(d)(32),
106 Stat. 3506.)

/* This statute is continued in part 2. */