Ryan White Comprehensive AIDS Resources Emergency Act

Document Text

An Act

To amend the Public Health Service Act to provide grants to improve the quality and availability of care for individuals and families with HIV disease, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SEC 1. SHORT TITLE.

This Act may be cited as the “Ryan White Comprehensive AIDS Resources Emergency Act of 1990.”

SEC. 2. 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 direct financial assistance available to States 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 in urban and rural areas.

TITLE I—HIV EMERGENCY RELIEF GRANT PROGRAM

SEC. 101. HIV EMERGENCY RELIEF GRANT PROGRAM.

Title XXV of the Public Health Service Act (42 U.S.C. 300ee et seq.) is amended by adding at the end thereof the following new part:

“Part C—Emergency Relief and Care Access Grants

“Subpart 1—Emergency Relief Program

“SEC. 2531. GRANTS TO ELIGIBLE METROPOLITAN STATISTICAL AREAS.

“The Secretary shall award emergency relief grants to any metropolitan area as reported in the HIV/AIDS Surveillance Report of the Centers for Disease Control, that, as of March 31, 1990, 1991, 1992, 1993 or 1994, has reported more than 2,000 AIDS cases (hereinafter referred to in this subpart as the 'eligible area'), and that otherwise meets the requirements of this subpart.

“SEC. 2532. ADMINISTRATION AND PLANNING COUNCIL.

“(a) ADMINISTRATION—

“(1) IN GENERAL—Assistance made available under grants awarded under this subpart shall be directed to the chief elected official of the city or urban county that administers the public health agency serving the greatest number of individuals with AIDS, as reported to the Centers for Disease Control, in the eligible area that is awarded such a grant.

“(2) REQUIREMENTS—To receive assistance under paragraph (1), the administering local political subdivision shall—

“(A) establish, through intergovernmental agreement with the chief elected officials of all local political subdivisions that have in excess of 10 percent of all individuals with AIDS, as reported to the Centers for Disease Control, in such subdivision within the eligible area, an administrative mechanism to allocate funds based on the number of AIDS cases and severity of need of such subdivisions; and

“(B) establish an HIV health services planning council.

“(b) HIV HEALTH SERVICES PLANNING COUNCIL—

“(1) ESTABLISHMENT—To be eligible for assistance under this subpart, 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 providers;

“(E) local public health agencies;

“(F) hospital or health care planning agencies;

“(G) affected communities;

“(H) non-elected community leaders; and

“(I) State government.

“(2) PRIORITY—In designating a planning council under paragraph (1), priority shall be provided to any existing entity that has demonstrated experience in assessing and planning for HIV health care service needs within the eligible area, except that such existing entity shall include representatives of the full range of service providing agencies and institutions within such eligible area.

“(3) DUTIES—The planning council established or designated under paragraph (1) shall—

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

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

“SEC. 2533. TYPE AND DISTRIBUTION OF GRANTS.

“(a) GRANTS BASED ON RELATIVE NEED OF AREA—

“(1) IN GENERAL—Not later than 60 days after an appropriation becomes available to carry out this subpart, the Secretary, acting through the Health Resources and Services Administration, shall use 50 percent of the amount appropriated under section 2536 for such fiscal year, to make grants to eligible areas under section 2531.

“(2) AMOUNT OF GRANT—

“(A) GENERAL RULE—The Secretary shall make a grant to each eligible area under paragraph (1) in an amount that bears the same ratio to the amount available under paragraph (1) as the sum of—

“(i) the relative cases per area factor for such area as multiplied by three; and

“(ii) the relative cases per area factor for such area as multiplied by the relative per capita factor for such area; divided by

“(iii) four;

bears to 100.

“(B) RELATIVE CASES PER AREA FACTOR—As used in this paragraph, the term 'relative cases per area factor' means the ratio of the number of individuals with AIDS in an eligible area, as reported to the Centers for Disease Control, to the number of such individuals in all eligible areas.

“(C) RELATIVE PER CAPITA FACTOR—As used in this paragraph, the term 'relative per capita factor' means the ratio of the per capita incidence of individuals with AIDS in an eligible area, as reported to the Centers for Disease Control, to the per capita incidence of such individuals in all eligible areas.

“(D) ADJUSTMENTS—The Secretary shall make such proportionate adjustments in amounts allocated for grants to eligible areas as shall be necessary to ensure that total amount of such grants are neither more or less than the amount available for grants under this subsection.

“(b) SUPPLEMENTAL GRANTS—

“(1) IN GENERAL—Not later than 150 days after the first day of each fiscal year, the Secretary shall use the remainder of the amounts made available under section 2536 for such fiscal year, to make grants under section 2531 to eligible areas that submit an application to the Secretary that—

“(A) contains a report concerning the dissemination of emergency relief funds under section 2533(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 commitment of the local resources of the area, both financial and in-kind, to combatting the HIV epidemic;

“(D) demonstrates the ability of the area to utilize such supplemental financial resources in a way 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 funds for services for infants, children, women, and families with HIV disease.

“(2) AMOUNT OF GRANT—The amount of each grant made by the Secretary under paragraph (1) shall be determined by the Secretary based on the application submitted by the eligible area.

“SEC. 2534. USE OF AMOUNTS.

“(a) GRANTS TO INSTITUTIONS—

“(1) IN GENERAL—Amounts received under a grant awarded under this subpart may be used by the grantee to provide direct financial assistance to any public or not-for-profit private hospital, clinic, nursing home, sub-acute care facility, or community health center, that demonstrates that such entity—

“(A) is providing care or services to a disproportionate share of low income individuals and families with HIV disease; and

“(B) is expending resources in the provision of services to such low income individuals and families which exceed reimbursement;

“(2) USE OF FUNDS BY INSTITUTIONS—An institution that receives assistance under paragraph (1) shall use such amounts to—

“(A) enhance the quality of services, care, and treatment to low-income individuals and families with HIV disease; and

“(B) deliver outpatient and ambulatory care services including case management to such individuals and families, including comprehensive treatment and support services.

“(3) PRIORITY—In allocating assistance received under a grant awarded under section 2531, the grantee shall give priority to those eligible institutions under paragraph (1) that—

“(A) have established a plan to evaluate the utilization of services provided in the care of individuals and families with HIV disease; and

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

“(b) GRANTS TO AGENCIES—Amounts received under a grant awarded under this subpart may be used by the grantee to provide direct financial assistance to any public or non-profit agency, clinic, community based organization, or community health center that has the capacity to provide case managed outpatient health and support services to individuals and families with HIV disease that are critical to—

“(1) prevent unnecessary in-patient hospitalization; and

“(2) expedite the discharge of the individual to the most medically appropriate level of service.

“(c) ADDITIONAL USES—

“(1) RENOVATION OR REHABILITATION—In addition to the use specified in subsection (a), amounts received under a grant awarded under this subpart may be used by the grantee to renovate or rehabilitate congregate care housing units, long-term care facilities, transitional care facilities, and sub-acute care facilities for the treatment of individuals with HIV disease, if the grantee demonstrates that—

“(A) an adequate number of—

“(i) congregate care residential units; or

“(ii) long term care or sub acute care nursing beds

are not available within the grantee eligible area for occupancy by individuals with HIV disease;

“(B) it has made a good faith effort to identify and eliminate local regulatory barriers that have impeded the creation, and utilization by individuals with HIV disease, of such facilities; and

“(C) it has exercised its authority to insure that individuals with HIV disease have access to such facilities.

“(2) MATCHING REQUIREMENT—The Secretary shall not permit a grantee to use amounts received under a grant awarded under section 2531 for renovation or rehabilitation under paragraph (1) unless the local political subdivision with jurisdiction over the grantee area provides the grantee with local or State funds in an amount equal to the amount of the grant that is used under paragraph (1). Such local or State contribution to such renovation or rehabilitation program may be in the form of in kind services, goods or real property.

“(3) ADMINISTRATION AND PLANNING—Not more than 5 percent of amounts received under a grant awarded under this subpart shall be utilized to carry out the administrative and planning activities described under section 2532.

“SEC. 2535. APPLICATION.

“(a) IN GENERAL—To be eligible to receive a grant under this subpart, 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) that funds received under a grant awarded under this subpart will be used to supplement not supplant State and local funds currently utilized to provide health and support services to individuals with HIV disease;

“(2) that the eligible area has an HIV planning council, pursuant to section 2532, and has developed or will develop a comprehensive plan for the organization and delivery of HIV services that is compatible with any existing State or local HIV care plans; and

“(3) that agencies and institutions within the eligible area that will receive funds under a grant provided under this subpart shall participate in any established HIV community based continuum of care.

“(b) ADDITIONAL APPLICATION—An eligible area that desires to receive a grant under section 2533(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.

“SEC. 2536. AUTHORIZATION OF APPROPRIATIONS.

“There are authorized to be appropriated to make grants under this subpart, $300,000,000 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.”

TITLE II—HIV CARE GRANTS

SEC. 201. HIV CARE GRANTS.

Part C of title XXV of the Public Health Service Act (as added by section 101) is amended by adding at the end thereof the following new subpart:

“Subpart 2—Care Grant Program

“SEC. 2540. GRANTS.

“The Secretary shall make grants to States to enable such States to improve the quality, availability and organization of care, treatment and support services for individuals and families with HIV disease in urban and rural areas.

“SEC. 2541. GENERAL USE OF GRANTS.

“(a) IN GENERAL—A State shall use amounts provided under grants made under this subpart—

“(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 2542;

“(2) to provide home- and community-based care services for individuals with HIV disease in accordance with section 2543;

“(3) to develop and provide assistance to mechanisms that assure the continuity of health insurance coverage for individuals with HIV disease in accordance with section 2544;

“(4) to provide therapeutic treatments, that have been determined to prolong life or prevent serious deterioration of health, to low-income individuals with HIV disease in accordance with section 2545; or

“(5) to integrate early diagnosis and early intervention services for individuals with HIV disease with primary health care and support services provided in existing health care settings, in accordance with section 2546.

“(b) INFANTS AND WOMEN, ETC—A State shall use not less than 15 percent of funds allocated under this subpart to provide health and support services to infants, children, women, and families with HIV disease.

“SEC. 2542. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

“(a) CONSORTIA—To be eligible to receive a grant under section 2541(1), an applicant shall—

“(1) be a consortia of public and nonprofit private health care and support service providers and community based organizations; and

“(2) agree to use funds received under such a grant for the planning, development and delivery of comprehensive outpatient and support services for individuals with HIV disease, including—

“(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, nutrition services, child welfare and family services (including foster care and adoption services), housing services, benefits advocacy, and legal services.

“(b) ASSURANCES—

“(1) REQUIREMENT—To receive a grant under section 2541(1), an applicant consortium shall provide assurances that—

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

“(B) the service plan developed by such applicant consortium addresses the special care and service needs of the populations and subpopulations identified under subparagraph (A); and

“(C) when practicable, within each locality served by such applicant consortium, a single coordinating entity will be established that shall be capable of integrating the delivery of services to the populations and subpopulations identified under subparagraph (A).

“(2) EXCEPTION—Subparagraph (C) of paragraph (1) shall not apply to any applicant consortium that will operate in a community or locality in which it has been demonstrated by the State, by the locality, or 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—To receive a grant from the State under section 2542(1), a consortium shall prepare and submit, to the State, an application that—

“(1) demonstrates that the consortium includes those agencies and community-based organizations—

“(A) with a record of service to populations and subpopulations with HIV disease requiring care within the community to be served; and

“(B) located in and representative of populations and subpopulations reflecting the local incidence of HIV;

“(2) demonstrates that the consortium has carried out an assessment of service needs within the geographic area to be served and has established a plan to insure the delivery of services to meet such identified needs, including—

“(A) assurances that service needs will be addressed through the coordination and expansion of existing services before new services are created;

“(B) 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;

“(C) assurances that, in the case of service for individuals residing in rural areas, the applicant consortium shall be capable of delivering case management services that link available community support services to specialized regional medical services; and

“(D) assurances that the assessment of service needs and the delivery of services will include participation by affected populations.

“(3) demonstrates that adequate planning has occurred to meet the special needs of families with AIDS, including family centered care for infants, children, women, and families;

“(4) demonstrates that the consortium has created a mechanism to periodically evaluate—

“(A) the success of the consortium in responding to such identified needs; and

“(B) the cost-effectiveness of the mechanisms employed by the consortium to deliver comprehensive care; and

“(5) demonstrates that the consortium will report to the state the results of the evaluations described in subsection (d).

“(d) DEFINITION—As used in this subpart, the term 'family centered care' means the system of services described in section 2542 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 diseases.

“(e) PRIORITY—In awarding grants under section 2541(1), the State shall give priority to existing HIV care consortia so that such consortia may build on existing systems and experience and avoid duplication of efforts.

“SEC. 2543. GRANTS FOR HOME- AND COMMUNITY-BASED CARE.

“(a) USES—A State may use amounts provided under a grant awarded under this subpart to make grants under section 2541(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 health care professionals in such State for providing such services to such individuals;

“(2) provide for the identification, location, and provision of outreach services to individuals with HIV disease, including those in rural areas;

“(3) provide for the coordination of the provision of services under this subpart with the provision of similar or related services provided by public and private entities; and

“(4) give priority to the provision of outreach and home and community-based services to individuals with HIV disease who are low-income individuals.

“(b) DEFINITION—As used in this subpart, 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 health care professional 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 intravenously as part of such therapy);

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

“(F) mental health, developmental, and rehabilitation services; and

“(3) does not include—

“(A) inpatient hospital services; and

“(B) nursing home and other long term care facilities.

“SEC. 2544. CONTINUUM OF HEALTH INSURANCE COVERAGE.

“A State may use amounts received under a grant awarded under this subpart to establish a program of financial assistance under section 2541(3) to assist eligible low income individuals with HIV disease in—

“(1) maintaining a continuity of private health insurance; or

“(2) receiving medical benefits under a health insurance program established by the State.

“SEC. 2545. PROVISION OF THERAPEUTICS.

“(a) IN GENERAL—A State may use amounts provided under a grant awarded under this subpart to establish a program under section 2541(4) to provide therapeutic care that has been determined to prolong life or prevent the serious deterioration of health arising from AIDS or 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 AIDS or HIV disease; and

“(2) be a low income individual, as defined by the State.

“(c) STATE DUTIES—In providing assistance under this section the State shall—

“(1) determine, in accordance with guidelines issued by the Secretary, which therapies are eligible to be included under the program established under this section;

“(2) permit assistance to be made available under the program established under this section to purchase the therapies determined to be eligible under paragraph (1), and provide such ancillary devices that are essential to administer such therapies; and

“(3) provide outreach to individuals and families with HIV disease in rural areas and establish a distribution system that facilitates access to therapeutics for such individuals.

“SEC. 2546. PROGRAMS FOR EARLY INTERVENTION.

“A State may use amounts provided under a grant awarded under this subpart to establish a program under section 2541(5) to integrate early diagnosis and early intervention services with primary health care and support services, including drug treatment services, that are delivered in existing public health and medical care facilities for the purpose of—

“(1) providing outreach services to individuals with HIV disease and health care professionals who are unaware of the availability and potential benefits of early treatment of HIV infection, including those in rural areas;

“(2) offering clinical, diagnostic, and periodic medical monitoring services to such individuals; and

“(3) providing appropriate therapeutics that have been determined to prolong life or prevent serious deterioration of health in individuals with HIV disease.

“SEC. 2547. STATE APPLICATION.

“(a) IN GENERAL—The Secretary shall not make a grant to a State under this subpart 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 subpart.

“(b) DESCRIPTION OF INTENDED USES AND AGREEMENTS—The application submitted under subsection (a) shall contain—

“(1) a description of the purposes for which the State intends to use the assistance provided to the State under this subpart, including—

“(A) information relating to the services and activities to be provided;

“(B) a description of the manner in which such services and activities will be coordinated with other services and activities of public and private entities to provide a comprehensive continuum of care; and

“(C) information relating to the process for coordinating the various program options provided for in this subpart to maximize the effectiveness of the services provided; and

“(2) an assurance by the State that—

“(A) the legislature of the State will conduct public hearings concerning the proposed use and distribution of the assistance to be received under this subpart;

“(B) the State will, to the maximum extent practicable, ensure that services provided to an individual pursuant to a program established with assistance provided under this subpart 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;

“(C) if any charges are imposed for the provision of services for which assistance is provided under this subpart, such charges—

“(i) will be pursuant to a public schedule of charges;

“(ii) will not be imposed on any eligible individual with an income that does not exceed 200 percent of the official poverty line as determined by the Secretary; and

“(iii) for an eligible individual with an income that exceeds 200 percent of the official poverty line, will be adjusted to reflect the income of such individual;

“(D) 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 subpart;

“(E) the State will permit and cooperate with any Federal investigations undertaken under this subpart;

“(F) the State will maintain State expenditures for health and support services for individuals with AIDS or HIV disease at a level that is equal to not less than the average level of such expenditures maintained by the State for the 2-year period preceding the fiscal year for which the State is applying to receive a grant under this part;

“(G) the State will not make payments from assistance provided under this subpart for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service—

“(i) under any State compensation program, under an insurance policy, or under any Federal or State health benefits program; or

“(ii) by an entity that provides health services on a prepaid basis; and

“(H) the State shall establish a comprehensive plan for the organization and delivery of HIV health care and support services, in urban and rural areas, including provisions for the delivery of services to populations and subpopulations identified through the needs assessment required by section 2542.

“SEC. 2548. DISTRIBUTION OF FUNDS.

“(a) SPECIAL PROJECTS OF A NATIONAL SIGNIFICANCE—

“(1) IN GENERAL—Of the amount appropriated under section 2549, the Secretary shall use not to exceed 10 percent of such amount to—

“(A) provide technical assistance in administering and coordinating the activities authorized under section 2541; and

“(B) establish and administer a Special Projects of National Significance Program to award direct grants to States, localities, or community-based 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 of the applicant to establish a demonstration project 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 of the applicant; and

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

“(3) SPECIAL PROGRAMS—Special programs of a national significance may include those that are designed to—

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

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

“(C) create a structure for the support and respite of informal and family-based care networks in the minority community critical to the delivery of comprehensive care;

“(D) create the capacity to deliver health and support services to individuals and families with HIV disease located in rural areas and Indians (both Reservation and non-Reservation based), and/or deliver;

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

“(F) deliver health and support care 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 2549, the amount of a grant to be made under this subpart 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 2549 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 additional cases of AIDS 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 is 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

“(i) in the case of a territory of the United States the number of additional cases of AIDS 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, the term

'territory of the United States' means the Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands and Puerto Rico.

“(c) ALLOCATION OF ASSISTANCE BY STATES—

“(1) CONSORTIA—In a State that has reported 1 percent or more of all AIDS cases reported to the Centers for Disease Control in all States, not less than 50 percent of the amount received by the State under a grant awarded under this subpart shall be utilized for the creation and operation of community-based comprehensive care consortia under section 2542, in those areas, including rural areas, within the State in which the largest number of individuals with HIV disease reside.

“(2) ALLOWANCES—In allocating assistance under this subsection, a State shall take into account which areas received financial assistance under sub-part 1.

“(3) PLANNING AND EVALUATIONS—A State shall not use in excess of 5 percent of amounts received under a grant awarded under this subpart for planning and evaluation activities.

“(4) ADMINISTRATION—A State shall not use in excess of 5 percent of amounts received under a grant awarded under this subpart for administration, accounting, reporting, and program oversight functions.

“(d) EXPEDITED DISTRIBUTION—Not less than 75 percent of the amounts received under a grant awarded to a State under this subpart shall be obligated to specific programs and projects and made available for expenditure not later than 120 days after the receipt of such amounts by the State. Within such 120 day period, the State shall invite and receive public comment concerning methods for utilizing such amounts.

“(e) REALLOCATION—Any amounts appropriated in any fiscal year and made available to a State under this subpart that have not been obligated as described in section 2548(d) shall be recaptured by the Secretary and reallotted to other States in proportion to the original grants made to such States.

“SEC. 2549. AUTHORIZATION OF APPROPRIATIONS.

“There are authorized to be appropriated to make grants under this subpart, $300,000,000 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.

“SEC. 2550. DEFINITION.

“As used in this subpart except as otherwise specifically provided, the term 'State' means each of the 50 States, the District of Columbia, the Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands and Puerto Rico.”

TITLE III—TREATMENT AND NOTIFICATION OF INDIVIDUALS WITH HIV DISEASE AND THEIR FAMILIES

SEC. 301. REQUIREMENT OF REPORTING AND PARTNER NOTIFICATION WITH RESPECT TO CASES OF INFECTION.

(a) REPORTING—

(1) IN GENERAL—The Secretary may not make a grant under title II of this Act unless, with respect to testing for infection with the etiologic agent for acquired immune deficiency syndrome, the State involved requires that—

(A) any entity carrying out such testing confidentially report to the State public health officer information sufficient—

(i) to perform statistical and epidemiological analyses of the incidence in the State of cases of such infection; and

(ii) to perform statistical and epidemiological analyses of the demographic characteristics of the population of individuals in the State with such infections; and

(B) the public health officer of such State establishes a system of reporting cases of individuals infected with the etiologic agent for acquired immune deficiency syndrome that is necessary, to the extent appropriate in the determination of such officer, for the State to carry out the notification of unsuspecting persons at risk for exposure to the etiologic agent for acquired immune deficiency syndrome.

(2) PROVISION OF CERTAIN INFORMATION TO CENTERS FOR DISEASE CONTROL—The Secretary may not make a grant under title II of this Act unless the State involved agrees to provide to the Director of the Centers for Disease Control all information received by the State pursuant to the requirement described in clauses (i) and (ii) of paragraph (1)(A).

(b) PARTNER NOTIFICATION—

(1) IN GENERAL—The Secretary may not make a grant under title II of this Act unless—

(A) the State involved requires that the appropriate State or local public health officer (as determined by the State) carry out, to the extent appropriate in the determination of such officer, a program of partner notification with respect to cases of exposure to the etiologic agent acquired immume deficiency syndrome; and

(i) advises all such individuals regarding the benefits to undergo testing for such infection; and

(ii) provides to all such individuals information on the medical benefits of diagnosing such infection in the early stages of infection and of the availability of treatment and support services for individuals and families with HIV disease.

(2) RULE OF CONSTRUCTION WITH RESPECT TO RESPONSIBILITY FOR MAKING NOTIFICATIONS—With respect to compliance with paragraph (1) as a condition of receiving a grant under title II of this Act, such paragraph may not be construed to require that a State establish a requirement that any entity, other than the public health official referred to in such paragraph, make the notifications required under such system.

SEC. 302. EFFECTIVE DATE.

This title shall be effective for all fiscal years beginning after September 30, 1992.

TITLE IV—HIV DISEASE HEALTH SERVICES RESEARCH, EVALUATION, AND ASSESSMENT

SEC. 401. PURPOSE.

It is the purpose of this section to develop, as rapidly as practicable, information concerning the organization, impact, efficacy, and cost effectiveness of various health care service delivery and financing systems for the care of individuals with HIV disease.

SEC. 402. RESEARCH, EVALUATION, AND ASSESSMENT PROGRAM.

(a) ESTABLISHMENT—The Secretary of Health and Human Services, acting through the Agency for Health Care Policy and Research, shall establish a program to enable independent research to be conducted by individuals and organizations with appropriate expertise in the fields of health, health policy, and economics (particularly health care economics) to develop—

(1) a comparative assessment of the impact and cost-effectiveness of major models for organizing and delivering AIDS and HIV health care, mental health, early intervention, and support services, that shall include a report concerning patient outcomes, satisfaction, perceived quality of care, and total cumulative cost;

(2) a review of major health services financing mechanisms, including private health insurance policies, self pay options, health maintenance organization plans financed under the Social Security Act, and State and local government funding options, and the relative contribution of each of such payment options;

(3) an assessment of how point-of-entry procedures for obtaining HIV health care treatment and support services impacts the cost, quality, and outcome of the care and treatment of HIV individuals and families and the extent to which the overall quality, cost, and outcome of such care can be related to the source of payment for treatment;

(4) a comprehensive report of the significant financial, regulatory, organizational, and social barriers that serve to limit the delivery of high quality care services to individuals and families with HIV disease, with special emphasis being placed on the extent to which disadvantaged status impacts such service delivery;

(5) a summary report concerning the major and continuing unmet needs in health care, mental health, early intervention, and support services for individuals and families with HIV disease in urban and rural areas; and

(6) a review and assessment of models for the delivery of health and support services to infants, children, women, and families with HIV disease.

(b) REPORT—Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services shall prepare and submit, to the Committee on Energy and Commerce, and Ways and Means of the House of Representatives and the Committee on Labor and Human Resources, and Finance of the Senate, a report that contains the reports, evaluations and assessments required under subsection (a).

TITLE V—MISCELLANEOUS PROVISIONS

SEC. 501. ADAMHA IV DRUG ABUSE WAIVER.

(a) INTRAVENOUS DRUG USERS—Section 1916(c)(7) of the Public Health Services Act (42 U.S.C. 300x-4(a)(7)) is amended by adding at the end thereof the following new sentence: “The Secretary shall waive the provisions of the preceding sentence for any State which has submitted application for such a waiver to the Secretary prior to September 30, 1989.”

(b) EFFECTIVE DATE—The amendment made by subsection (a) shall be effective as of October 1, 1989.

SEC. 502. 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.

SEC. 503. REQUIREMENT OF STATE LAWS PROTECTING DONATIONS OF BLOOD.

The Secretary of Health and Human Services shall not make a grant to a State under this Act, or an amendment made by this Act, unless the Secretary determines that the criminal laws of the State are adequate to prosecute any individual who knowingly and intentionally donates, or knowingly and intentionally attempts to donate, blood, blood products, semen, tissues, organs, or other bodily fluids if such individual—

(1) has been diagnosed on the basis of laboratory evidence as infected with the human immunodeficiency virus; and

(2) has been informed that he or she is infected with the human immunodeficiency virus and has knowledge of the risk of transmission of such virus, through donated blood, blood products, semen, tissues, organs, or other bodily fluids.

Nothing in this Act shall preclude any State from making it a crime to donate knowingly and intentionally donate, or knowingly and intentionally attempt to donate, blood, blood products, semen, tissues, organs, or other bodily fluids by: (1) an individual who, on or after January 1, 1977, is or has been a user of any intravenous drug, the sale, distribution, or use of which is prohibited under Federal or State law after the time the individual injected the drug or; (2) an individual who has engaged in prostitution on or after January 1, 1977.

SEC. 504. INSPECTION OF BLOOD BANKS AND PRODUCERS OF BLOOD PRODUCTS.

(a) There is authorized an additional 150 full-time equivalent positions to the Food and Drug Administration. The positions established by this authority are to be used for the inspection of blood banks and producers of blood products.

(b) There is also authorized an appropriation of $1,500,000 to carry out this activity in fiscal year 1991 and such sums as may be necessary through fiscal year 1995.

SEC. 505. TECHNICAL CORRECTIONS TO THE PRISON TESTING ACT OF 1988.

Section 902 of the Prison Testing Act of 1988 (42 U.S.C. 300ee-6) is amended—

(1) in subsection (b)(2)—

(A) by striking out “may” in subparagraph (A) and inserting in lieu thereof “will”; and

(B) by striking out subparagraph (B) and inserting in lieu thereof the following new subparagraph:

“(B) victims of aggravated sexual abuse, as described in subsection (c)(2), will be informed of the results of the test, if the person convicted of the aggravated sexual assault tests positive for exposure to the human immunodeficiency virus and if the victim requests to be so informed after the victim is notified of the right of the victim to be informed under this subparagraph.”;

(2) in subsection (c)(2)—

(A) by striking out “99” and inserting in lieu thereof “109A”; and

(B) by striking out “rape” and inserting in lieu thereof “aggravated sexual abuse”; and

(3) in subsection (g), by striking out “1990” and inserting in lieu thereof “1995.”

Passed the Senate May 16 (legislative day, April 18), 1990.