GRANTS FOR PROVISION OF SERVICES.

SEC. 301. GRANTS FOR PROVISION OF SERVICES. (a) In General.— Title XXVI of the Public Health Service Act (as amended by section 201) is further amended by adding at the end the following new part: “Part C— Early Intervention Services “Subpart I— Formula Grants for States “SEC. 2641. 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 in consultation with the Administrator of the Health Resources and Services Administration, shall 104 STAT. 598for each of the fiscal years 1991 through 1995 make an allotment for each State in an amount determined in accordance with section 2649. 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. “(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; “(B) testing individuals with respect to such disease, including tests to confirm the presence of the disease, tests to diagnose the extent of the deficiency in the immune system, and tests to provide information on appropriate therapeutic measures for preventing and treating the deterioration of the immune system and for preventing and treating conditions arising from the disease; “(C) referrals described in paragraph (3); “(D) other clinical and diagnostic services with respect to HIV disease, and periodic medical evaluations of individuals with the disease; and “(E) providing the therapeutic measures described in subparagraph (B). “(3) Referrals.— The services referred to in paragraph (2)(C) are referrals of individuals with HIV disease to appropriate providers of health and support services, including, as appropriate— “(A) to entities receiving amounts under part A or B for the provision of such services; “(B) to biomedical research facilities of institutions of higher education that offer experimental treatment for such disease, or to community-based organizations or other entities that provide such treatment; or “(C) to grantees under section 2671, in the case of 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— 104 STAT. 599 “(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 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 sub-paragraphs (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 sub-paragraphs (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 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). “SEC. 2642. PROVISION OF SERVICES THROUGH MEDICAID PROVIDERS. “(a) In General.— Subject to subsection (b), the Secretary may not make a grant under section 2641 to a State unless, in the case of any service described in subsection (b) of such section that is available 104 STAT. 600pursuant to the State plan approved under title XIX of the Social Security Act for the State— “(1) the State will provide the service through a State entity, and the State entity has entered into a participation agreement under the State plan and is qualified to receive payments under such plan; or “(2) the State will enter into an agreement with a public or nonprofit private entity under which the entity will provide the service, and the entity has entered into such a participation agreement and is qualified to receive such payments. “(b) Waiver Regarding Certain Secondary Agreements.— “(1) In general.— In the case of an entity making an agreement pursuant to subsection (a)(2) regarding the provision of services, the requirement established in such subsection regarding a participation agreement shall be waived by the Secretary if the entity does not, in providing health care services, impose a charge or accept reimbursement available from any third-party payor, including reimbursement under any insurance policy or under any Federal or State health benefits program. “(2) Acceptance of voluntary donations.— A determination by the Secretary of whether an entity referred to in paragraph (1) meets the criteria for a waiver under such subparagraph shall be made without regard to whether the entity accepts voluntary donations for the purpose of providing services to the public. “SEC. 2643. 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 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% 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 33⅓ per-cent 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.— 104 STAT. 601 “(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) 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 for the State for the period described in subparagraph (B) constitutes more than 1 percent of the number of such cases reported to and confirmed by the Director for the United States for such period. “(B) The period referred to in subparagraph (A) is the 2-year period preceding the fiscal year for which the State involved is applying to receive a grant under section 2641. “(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. “(a) 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, except that the Secretary in providing Federal funds under the grant shall provide such funds (in accordance with the ratios prescribed in paragraph (1)) only with respect to the amount of funds contributed by such State. “SEC. 2644. OFFERING AND ENCOURAGING EARLY INTERVENTION SERVICES. “(a) In General.— The Secretary may not make a grant under section 2641 unless, in the case of entities to which the State provides amounts from the grant for the provision of early intervention services, the State involved agrees that— “(1) if the entity is a health care provider that regularly provides treatment for sexually transmitted diseases, the entity will offer and encourage such services with respect to individuals to whom the entity provides such treatment; “(2) if the entity is a health care provider that regularly provides treatment for intravenous substance abuse, the entity will offer and encourage such services with respect to individuals to whom the entity provides such treatment; “(3) if the entity is a family planning clinic, the entity will offer and encourage such services with respect to individuals to whom the entity provides family planning services and whom the entity has reason to believe has HIV disease; and 104 STAT. 602 “(4) if the entity is a health care provider that provides treatment for tuberculosis, the entity will offer and encourage such services with respect to individuals to whom the entity provides such treatment. “(b) Sufficiency of Amount of Grant.— With respect to compliance with the agreement made under subsection (a), an entity to which subsection (a) applies may be required to offer, encourage, and provide early intervention services only to the extent that the amount of the grant is sufficient to pay the costs of offering, encouraging, and providing the services. “(c) Criteria for Offering and Encouraging— Subject to section 2641(b)(4), an entity to which subsection (a) applies is, for purposes of such subsection, offering and encouraging early intervention services with respect to the individuals involved if the entity— “(1) offers such services to the individuals, and encourages the individuals to receive the services, as a regular practice in the course of providing the health care involved; and “(2) provides the early intervention services only with the consent of the individuals. “SEC. 2645. NOTIFICATION OF CERTAIN INDIVIDUALS RECEIVING BLOOD TRANSFUSIONS. “(a) In General.— The Secretary may not make a grant under section 2641 unless the State involved provides assurances satisfactory to the Secretary that, with respect to individuals in the State receiving, between January 1, 1978, and April 1, 1985 (inclusive), a transfusion of whole blood or a blood-clotting factor, the State will provide public education and information for the purpose of— “(1) encouraging the population of such individuals to receive early intervention services; and “(2) informing such population of any health facilities in the geographic area involved that provide such services. “(b) Rule of Construction.— An agreement made under subsection (a) may not be construed to require that, in carrying out the activities described in such subsection, a State receiving a grant under section 2641 provide individual notifications to the individuals described in such subsection. “SEC. 2646. REPORTING AND PARTNER NOTIFICATION. “(a) Reporting.— The Secretary may not make a grant under section 2641 unless, with respect to testing for HIV disease, the State involved provides assurances satisfactory to the Secretary that the State will require that any entity carrying out such testing confidentially report to the State public health officer information sufficient— “(1) to perform statistical and epidemiological analyses of the incidence in the State of cases of such disease; “(2) to perform statistical and epidemiological analyses of the demographic characteristics of the population of individuals in the State who have the disease; and “(3) to assess the adequacy of early intervention services in the State. “(b) Partner Notification.— The Secretary may not make a grant under section 2641 unless the State involved provides assurances satisfactory to the Secretary that the State will require that the public health officer of the State, to the extent appropriate in 104 STAT. 603the determination of the officer, carry out a program of partner notification regarding cases of HIV disease. “(c) Rules of Construction.— An agreement made under this section may not be construed— “(1) to require or prohibit any State from providing that identifying information concerning individuals with HIV disease is required to be submitted to the State; or “(2) to require any State to establish a requirement that entities other than the public health officer of the State are required to make the notifications referred to in subsection (b). “SEC. 2647. REQUIREMENT OF STATE LAW PROTECTION AGAINST INTENTIONAL TRANSMISSION. “(a) In General.— The Secretary may not make a grant under section 2641 to a State unless the chief executive officer determines that the criminal laws of the State are adequate to prosecute any HIV infected individual, subject to the condition described in subsection (b), who— “(1) makes a donation of blood, semen, or breast milk, if the individual knows that he or she is infected with HIV and intends, through such donation, to expose another HIV in the event that the donation is utilized; “(2) engages in sexual activity if the individual knows that he or she is infected with HIV and intends, through such sexual activity, to expose another to HIV; and “(3) injects himself or herself with a hypodermic needle and subsequently provides the needle to another person for purposes of hypodermic injection, if the individual knows that he or she is infected and intends, through the provision of the needle, to expose another to such etiologic agent in the event that the needle is utilized. “(b) Consent to Risk of Transmission.— The State laws described in subsection (a) need not apply to circumstances under which the conduct described in paragraphs (1) through (3) of subsection (a) if the individual who is subjected to the behavior involved knows that the other individual is infected and provides prior informed consent to the activity. “(c) State Certification With Respect to Required Laws.— With respect to complying with subsection (a) as a condition of receiving a grant under section 2601, the Secretary may not require a State to enact any statute, or to issue any regulation, if the chief executive officer of the State are adequate. The existence of a criminal law of general application, which can be applied to the conduct described in paragraphs (1) through (3) of subsection (a) is sufficient for compliance with this section. “(d) Time Limitations With Respect to Required Laws.— With respect to receiving a grant under section 2601, if a State is unable to certify compliance with subsection (a), the Secretary may make a grant to a State under such section if— “(1) for each of the fiscal years 1991 and 1992, the State provides assurances satisfactory to the Secretary that by not later than October 1, 1992, the State has in place or will establish the prohibitions described in subsection (a); and “(2) for fiscal year 1993 and subsequent fiscal years, the State has established such prohibitions. 104 STAT. 604 “SEC. 2649. DETERMINATION OF AMOUNT OF ALLOTMENTS. “(a) Minimum Allotment.— Subject to the extent of amounts made available in appropriations Acts, the amount of an allotment under section 2641(a) for a State for a fiscal year shall be the greater of— “(1) $100,000 for each of the several States, the District of Columbia, and the Commonwealth of Puerto Rico, and $50,000 for each of the territories of the United States other than the Commonwealth of Puerto Rico; and “(2) an amount determined under subsection (b). “(b) Determination Under Formula.— The amount referred to in subsection (a)(2) is the product of— “(1) an amount equal to the amount appropriated under subsection (a) of section 2650 for the fiscal year involved; and “(2) a percentage equal to the quotient of— “(A) an amount equal to the number of cases of acquired immune deficiency syndrome reported to and confirmed by the Director of the Centers for Disease Control for the State involved for the most recent fiscal year for which such data is available; divided by “(B) an amount equal to the number of cases of acquired immune deficiency syndrome reported to and confirmed by the Director of the Centers for Disease Control for the United States for the most recent fiscal year for which such data is available. “(c) Certain Allocations by Secretary.— After determining the amount of an allotment under this subsection (a) for a fiscal year, the Secretary shall reduce the amount of the allotment of each State by 10 percent. From the amounts available as a result of such reductions, the Secretary shall, on a discretionary basis, make grants to States receiving allotments for the fiscal year involved. Such grants shall be made subject to each of the agreements and assurances required as a condition of receiving grants under section 2641. “(d) Disposition of Certain Funds Appropriated for Allotments.— “(1) In general.— Any amounts available pursuant to paragraph (2) shall, in accordance with paragraph (3), be allotted by the Secretary each fiscal year to States receiving payments under section 2641(a) for the fiscal year (other than any State referred to in paragraph (2)(C)). The Secretary shall make payments, as grants, to each such State from any such allotment for the State for the fiscal year involved. “(2) Specification of amounts.— The amounts referred to in paragraph (1) are any amounts that are not paid to States under section 2641(a) as a result of— “(A) the failure of any State to submit an application under section 2651; “(B) the failure, in the determination of the Secretary, of any State to prepare the application in compliance with such section or to submit the application within a reasonable period of time; or “(C) any State informing the Secretary that the State does not intend to expend the full amount of the allotment made to the State. 104 STAT. 605 “(3) Amount of allotment.— The amount of an allotment under paragraph (1) for a State for a fiscal year shall be an amount equal to the product of— “(A) an amount equal to the amount available pursuant to paragraph (2) for the fiscal year involved; and “(B) the percentage determined under subsection (b)(2) for the State. “(e) Transition Rules.— “(1) For the fiscal years 1991 through 1993, the amount of an allotment under section 2641 shall be the greater of the amount determined under subsection (a) and an amount equal to the amount applicable under paragraph (2) for the fiscal year involved. “(2) For purposes of paragraph (1)— “(A) the amount applicable for fiscal year 1991 is an amount equal to the amount received by the State involved from the Secretary, acting through the Director of the Centers for Disease Control, for fiscal year 1990 for the provision of counseling and testing services with respect to HIV; “(B) the amount applicable for fiscal year 1992 is 85 percent of the amount specified in subparagraph (A); and “(C) the amount applicable for fiscal year 1993 is 70 percent of the amount specified in subparagraph (A). “SEC. 2649A. MISCELLANEOUS PROVISIONS. The Secretary may not make a grant under section 2641 unless— “(1) the State involved submits to the Secretary a comprehensive plan for the organization and delivery of the early intervention services to be funded with the grant that includes a description of the purposes for which the State intends to use such assistance, including— “(A) the services and activities to be provided and an explanation of the manner in which the elements of the program to be implemented by the State with the grant will maximize the quality of early intervention services available to individuals with HIV disease throughout the State; and “(B) a description of the manner in which services funded with the grant will be coordinated with other available related services for individuals with HIV disease; and “(2) the State agrees that— “(A) the public health agency administering the grant will conduct public hearings regarding the proposed use and distribution of the grant; “(B) to the maximum extent practicable, early intervention services delivered pursuant to the grant will be provided without regard to the ability of the individual to pay for such services and without regard to the current or past health condition of the individual with HIV disease; “(C) early intervention services under the grant will be provided in settings accessible to low-income individuals with HIV disease; and “(D) outreach to low-income individuals with HIV disease will be provided to inform such individuals of the services available pursuant to the grant. 104 STAT. 606 “SEC. 2650. AUTHORIZATION OF APPROPRIATIONS. “For the purpose of making grants under section 2641, there are authorized to be appropriated $230,000,000 for fiscal year 1991, and such sums as may be necessary for each of the fiscal years 1992 through 1995. “Subpart II— Categorical Grants “SEC. 2651. ESTABLISHMENT OF PROGRAM. “(a) In General.— For the purposes described in subsection (b), the Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to public and nonprofit private entities specified in section 2652(a)(1). “(b) Purposes of Grants.— “(1) In general.— The Secretary may not make a grant under subsection (a) unless the applicant for the grant agrees to expend the grant for the purposes of providing, on an outpatient basis, each of the early intervention services specified in paragraph (2) with respect to HIV disease. “(2) Specification of early intervention services.— The early intervention services referred to in paragraph (1) are— “(A) counseling individuals with respect to HIV disease in accordance with section 2662; “(B) testing individuals with respect to such disease, including tests to confirm the presence of the disease, tests to diagnose the extent of the deficiency in the immune system, and tests to provide information on appropriate therapeutic measures for preventing and treating the deterioration of the immune system and for preventing and treating conditions arising from the disease; “(C) referrals described in paragraph (3); “(D) other clinical and diagnostic services regarding HIV disease, and periodic medical evaluations of individuals with the disease; “(E) providing the therapeutic measures described in subparagraph (B). “(3) Referrals.— The services referred to in paragraph (2)(C) are referrals of individuals with HIV disease to appropriate providers of health and support services, including, as appropriate— “(A) to entities receiving amounts under part A or B for the provision of such services; “(B) to biomedical research facility of institutions of higher education that offer experimental treatment for such disease, or to community-based organizations or other entities that provide such treatment; or “(C) to grantees under section 2671, in the case of a pregnant woman. “(4) Requirement of availability of all early intervention services through each grantee.— The Secretary may not make a grant under subsection (a) unless the applicant for the grant agrees that each of the early intervention services specified in paragraph (2) will be available through the grantee. With respect to compliance with such agreement, such a grantee may expend the grant to provide the early intervention services directly, and may expend the grant to enter into agreements 104 STAT. 607with public or nonprofit private entities under which the entities provide the services. “(5) Optional services.— A grantee under subsection (a)— “(A) may expend the grant to provide outreach services to individuals who may have HIV disease or may be at risk of the disease, and who may be unaware of the availability and potential benefits of early treatment of the disease, and to provide outreach services to health care professionals who may be unaware of such availability and potential benefits; and “(B) may, in the case of individuals who seek early intervention services from the grantee, expend the grant— “(i) for case management to provide coordination in the provision of health care services to the individuals and to review the extent of utilization of the services by the individuals; and “(ii) to provide assistance to the individuals regarding establishing the eligibility of the individuals for financial assistance and services under Federal, State, or local programs providing for health services, mental health services, social services, or other appropriate services. “(c) Participation in Certain Consortium.— The Secretary may not make a grant under subsection (a) unless the applicant for the grant agrees to make reasonable efforts to participate in a consortium established with a grant under section 2612(a)(1) regarding comprehensive services to individuals with HIV disease, if such a consortium exist in the geographic area with respect to which the applicant is applying to receive such a grant. “SEC. 2652. MINIMUM QUALIFICATIONS OF GRANTEES. “(a) In General.— The entities referred to in subsection (b) are public entities and nonprofit private entities that are— “(A) migrant health centers under section 329 or community health centers under section 330; “(B) grantees under section 340 (regarding health services for the homeless); “(C) grantees under section 1001 (regarding family planning) other than States; “(D) comprehensive hemophilia diagnostic and treatment centers; “(E) Federally-qualified health centers under section 1905(1)(2)(B) of the Social Security Act; or “(F) a nonprofit private entity that provides comprehensive primary care services to populations at risk of HIV disease. “(b) Status as Medicaid Provider.— “(1) In general.— Subject to paragraph (2), the Secretary may not make a grant under section 2651 for the provision of services described in subsection (b) of such section in a State unless, in the case of any such service that is available pursuant to the State plan approved under title XIX of the Social Security Act for the State— “(A) the applicant for the grant will provide the service directly, and the applicant has entered into a participation agreement under the State plan and is qualified to receive payments under such plan; or 104 STAT. 608 “(B) the applicant for the grant 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 regarding certain secondary agreements.— “(A) In the case of an entity making an agreement pursuant to paragraph (1)(B) regarding the provision of services, the requirement established in such paragraph regarding a participation agreement shall be waived by the Secretary if the entity does not, in providing health care services, impose a charge or accept reimbursement available from any third-party payor, including reimbursement under any insurance policy or under any Federal or State health benefits program. “(B) A determination by the Secretary of whether an entity referred to in subparagraph (A) meets the criteria for a waiver under such subparagraph shall be made without regard to whether the entity accepts voluntary donations regarding the provision of services to the public. “SEC. 2653. PREFERENCES IN MAKING GRANTS. “(a) In General.— In making grants under section 2651, the Secretary shall give preference to any qualified applicant experiencing an increase in the burden of providing services regarding HIV disease, as indicated by the factors specified in subsection (b). “(b) Specification of Factors.— “(1) In general.— In the case of the geographic area with respect to which the entity involved is applying for a grant under section 2651, the factors referred to in subsection (a), as determined for the period specified in paragraph (2), are— “(A) the number of cases of acquired immune deficiency syndrome; “(B) the rate of increase in such cases; “(C) the lack of availability of early intervention services; “(D) the number of other cases of sexually transmitted diseases, and the number of cases of tuberculosis and of drug abuse; “(E) the rate of increase in each of the cases specified in subparagraph (D); “(F) the lack of availability of primary health services from providers other than such applicant; and “(G) the distance between such area and the nearest community that has an adequate level of availability of appropriate HIV-related services, and the length of time required to travel such distance. “(2) Relevant period of time.— The period referred to in paragraph (1) is the 2-year period preceding the fiscal year for which the entity involved is applying to receive a grant under section 2651. “(c) Equitable Allocations.— In providing preferences for purposes of subsection (b), the Secretary shall equitably allocate the preferences among urban and rural areas. “SEC. 2654. MISCELLANEOUS PROVISIONS. “(a) Services for Individuals With Hemophilia.— In making grants under section 2651, the Secretary shall ensure that any such 104 STAT. 609grants made regarding the provision of early intervention services to individuals with hemophilia are made through the network of comprehensive hemophilia diagnostic and treatment centers. “(b) Technical Assistance.— The Secretary may, directly or through grants or contracts, provide technical assistance to non-profit private entities regarding the process of submitting to the Secretary applications for grants under section 2651, and may provide technical assistance with respect to the planning, development, and operation of any program or service carried out pursuant to such section. “SEC. 2655. AUTHORIZATION OF APPROPRIATIONS. “For the purpose of making grants under section 2651, there are authorized to be appropriated $75,000,000 for fiscal years 1991, and such sums as may be necessary for each of the fiscal years 1992 through 1995. “Subpart III— General Provisions “SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT. “(a) Confidentiality — The Secretary may not make a grant under this part unless— “(1) in the case of any State applying for a grant under section 2641, the State agrees to ensure that information regarding the receipt of early intervention services is maintained confidentially pursuant to law or regulations in a manner not inconsistent with applicable law; and “(2) in the case of any entity applying for a grant under section 2651, the entity agrees to ensure that information regarding the receipt of early intervention services pursuant to the grant is maintained confidentially in a manner not inconsistent with applicable law. “(b) Informed Consent.— “(1) In general.— The Secretary may not make a grant under this part unless the applicant for the grant agrees that, in testing an individual for HIV disease, the applicant will test an individual only after obtaining from the individual a statement, made in writing and signed by the individual, declaring that the individual has undergone the counseling described in section 2662(a) and that the decision of the individual with respect to undergoing such testing is voluntarily made. “(2) Provisions regarding anonymous testing.— “(A) If, pursuant to section 2664(b), an individual will undergo testing pursuant to this part through the use of a pseudonym, a grantee under such section shall be considered to be in compliance with the agreement made under paragraph (1) if the individual signs the statement described in such subsection using the pseudonym. “(B) If, pursuant to section 2664(b), an individual will undergo testing pursuant to this part without providing any information relating to the identity of the individual, a grantee under such section shall be considered to be in compliance with the agreement made under paragraph (1) if the individual orally provides the declaration described in such paragraph. 104 STAT. 610 “SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES. “(a) Counseling Before Testing.— The Secretary may not make a grant under this part unless the applicant for the grant agrees that, before testing an individual for HIV disease, the applicant will provide to the individual appropriate counseling regarding the disease (based on the most recently available scientific data), including counseling on— “(1) measures for the prevention of exposure to, and the transmission of, HIV; “(2) the accuracy and reliability of the results of testing for HIV disease; “(3) the significance of the results of such testing, including the potential for developing acquired immune deficiency syndrome; “(4) encouraging the individual, as appropriate, to undergo such testing; “(5) the benefits of such testing, including the medical benefits of diagnosing HIV disease in the early stages and the medical benefits of receiving early intervention services during such stages; “(6) provisions of law relating to the confidentiality of the process of receiving such services, including information regarding any disclosures that may be authorized under applicable law and information regarding the availability of anonymous counseling and testing pursuant to section 2664(b); and “(7) provisions of applicable law relating to discrimination against individuals with HIV disease. “(b) Counseling of Individuals With Negative Test Results.— The Secretary may not make a grant under this part unless the applicant for the grant agrees that, if the results of testing conducted for HIV disease indicate that an individual does not have the disease, the applicant will review for the individual the information provided pursuant to subsection (a), including— “(1) the information described in paragraphs (1) through (3) of such subsection; and “(2) the appropriateness of further counseling, testing, and education of the individual regarding such disease. “(c) Counseling of Individuals With Positive Test Results.— The Secretary may not make a grant under this part unless the applicant for the grant agrees that, if the results of testing for HIV disease indicate that the individual has the disease, the applicant will provide to the individual appropriate counseling regarding such disease, including— “(1) reviewing the information described in paragraphs (1) through (3) of subsection (a); “(2) reviewing the appropriateness of further counseling, testing, and education of the individual regarding such disease; and “(3) providing counseling on— “(A) the availability, through the applicant, of early intervention services; “(B) the availability in the geographic area of appropriate health care, mental health care, and social and support services, including providing referrals for such services, as appropriate; “(C) the benefits of locating and counseling any individual by whom the infected individual may have been ex-104 STAT. 611posed to HIV and any individual whom the infected individual may have exposed to HIV; and “(D) the availability of the services of public health authorities with respect to locating and counseling any individual described in subparagraph (C). “(d) Additional Requirements Regarding Appropriate Counseling.— The Secretary may not make a grant under this part unless the applicant for the grant agrees that, in counseling individuals with respect to HIV disease, the applicant will ensure that the counseling is provided under conditions appropriate to the needs of the individuals. “(e) Counseling of Emergency Response Employees.— The Secretary may not make a grant under this part to a State unless the State agrees that, in counseling individuals with respect to HIV disease, the State will ensure that, in the case of emergency response employees, the counseling is provided to such employees under conditions appropriate to the needs of the employees regarding the counseling. “(f) Rule of Construction Regarding Counseling Without Testing.— Agreements made pursuant to this section may not be construed to prohibit any grantee under this part from expending the grant for the purpose of providing counseling services described in this section to an individual who does not undergo testing for HIV disease as a result of the grantee or the individual determining that such testing of the individual is not appropriate. “SEC. 2663. APPLICABILITY OF REQUIREMENTS REGARDING CONFIDENTIALITY, INFORMED CONSENT, AND COUNSELING. “The Secretary may not make a grant under this part unless the applicant for the grant agrees that, with respect to testing for HIV disease, any such testing carried out by the applicant will, without regard to whether such testing is carried out with Federal funds, be carried out in accordance with conditions described in sections 2661 and 2662. “SEC. 2664. ADDITIONAL REQUIRED AGREEMENTS. “(a) Reports to Secretary.— The Secretary may not make a grant under this part unless— “(1) the applicant submits to the Secretary— “(A) a specification of the expenditures made by the applicant for early intervention services for the fiscal year preceding the fiscal year for which the applicant is applying to receive the grant; and “(B) an estimate of the number of individuals to whom the applicant has provided such services for such fiscal year; and “(2) the applicant agrees to submit to the Secretary a report providing— “(A) the number of individuals to whom the applicant provides early intervention services pursuant to the grant; “(B) epidemiological and demographic data on the population of such individuals; “(C) the extent to which the costs of HIV-related health care for such individuals are paid by third-party payors; “(D) the average costs of providing each category of early intervention service; and 104 STAT. 612 “(E) the aggregate amounts expended for each such category. “(b) Provision of Opportunities for Anonymous Counseling and Testing.— The Secretary may not make a grant under this part unless the applicant for the grant agrees that, to the extent permitted under State law, regulation or rule, the applicant will offer substantial opportunities for an individual— “(1) to undergo counseling and testing regarding HIV disease without being required to provide any information relating to the identity of the individual; and “(2) to undergo such counseling and testing through the use of a pseudonym. “(c) Prohibition Against Requiring Testing as Condition of Receiving Other Health Services.— The Secretary may not make a grant under this part unless the applicant for the grant agrees that, with respect to an individual seeking health services from the applicant, the applicant will not require the individual to undergo testing for HIV as a condition of receiving any health services unless such testing is medically indicated in the provision of the health services sought by the individual. “(d) Maintenance of Support.— The Secretary may not make a grant under this part unless the applicant for the grant agrees to maintain the expenditures of the applicant for early intervention services at a level equal to not less than the level of such expenditures maintained by the State for the fiscal year preceding the fiscal year for which the applicant is applying to receive the grant. “(e) Requirements Regarding Imposition of Charges for Services.— “(1) In general.— The Secretary may not make a grant under this part unless, subject to paragraph (5), the applicant for the grant agrees that— “(A) in the case of individuals with an income less than or equal to 100 percent of the official poverty line, the applicant will not impose a charge on any such individual for the provision of early intervention services under the grant; “(B) in the case of individuals with an income greater than 100 percent of the official poverty line, the applicant— “(i) will impose a charge on each such individual for the provision of such services; and “(ii) will impose the charge according to a schedule of charges that is made available to the public. “(2) Limitation on charges regarding individuals subject to charges.— With respect to the imposition of a charge for purposes of paragraph (1)(B)(ii), the Secretary may not make a grant under this part unless, subject to paragraph (5), the applicant for the grant agrees that— “(A) in the case of individuals with an income greater than 100 percent of the official poverty line and not exceeding 200 percent of such poverty line, the applicant will not, for any calendar year, impose charges in an amount exceeding 5 percent of the annual gross income of the individual involved; “(B) in the case of individuals with an income greater than 200 percent of the official poverty line and not exceeding 300 percent of such poverty line, the applicant will not, for any calendar year, impose charges in an 104 STAT. 613amount exceeding 7 percent of the annual gross income of the individual involved; and “(C) in the case of individuals with an income greater than 300 percent of the official poverty line, the applicant will not, for any calendar year, impose charges in an amount exceeding 10 percent of the annual gross income of the individual involved. “(3) Assessment of charge.— With respect to compliance with the agreement made under paragraph (1), a grantee under this part may, in the case of individuals subject to a charge for purposes of such paragraph— “(A) assess the amount of the charge in the discretion of the grantee, including imposing only a nominal charge for the provision of services, subject to the provisions of such paragraph regarding public schedules and of paragraph (2) regarding limitations on the maximum amount of charges; and “(B) take into consideration the medical expenses of individuals in assessing the amount of the charge, subject to such provisions. “(4) Applicability of limitation on amount of charge.— The Secretary may not make a grant under this part unless the applicant for the grant agrees that the limitations established in paragraph (2) regarding the imposition of charges for services applies to the annual aggregate of charges imposed for such services, without regard to whether they are characterized as enrollment fees, premiums, deductibles, cost sharing, copayments, coinsurance, or similar charges. (5) Waiver regarding certain secondary agreements.— The requirement established in paragraph (1)(B)(i) shall be waived by the Secretary in the case of any entity for whom the Secretary has granted a waiver under section 2642(b) or 2652(b)(2). “(f) Relationship to Items and Services Under Other Programs.— “(1) In general.— The Secretary may not make a grant under this part unless the applicant for the grant agrees that, subject to paragraph (2), the grant will not be expended by the applicant, or by any entity receiving amounts from the applicant for the provision of early intervention services, to make payment for any such service to the extent that payment has been made, or can reasonably be expected to be made, with respect to such service— “(A) under any State compensation program, under an insurance policy, or under any Federal or State health benefits program; or “(B) by an entity that provides health services on a prepaid basis. “(2) Applicability to certain secondary agreements for provision of services.— An agreement made under paragraph (1) shall not apply in the case of an entity through which a grantee under this part provides early intervention services if the Secretary has provided a waiver under section 2642(b) or 2652(b)(2) regarding the entity. “(g) Administration of Grant.— The Secretary may not make a grant under this part unless the applicant for the grant agrees that— 104 STAT. 614 “(1) the applicant will not expend amounts received pursuant to this part for any purpose other than the purposes described in the subpart under which the grant involved is made; “(2) the applicant will establish such procedures for fiscal control and fund accounting as may be necessary to ensure proper disbursement and accounting with respect to the grant; and “(3) the applicant will not expend more than 5 percent of the grant for administrative expenses with respect to the grant. “(h) Construction.— A State may not use amounts received under a grant awarded under section 2641 to purchase or improve land, or to purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or to make cash payments to intended recipients of services. “SEC. 2665. REQUIREMENT OF SUBMISSION OF APPLICATION CONTAINING CERTAIN AGREEMENTS AND ASSURANCES. “The Secretary may not make a grant under this part unless— “(1) an application for the grant is submitted to the Secretary containing agreements and assurances in accordance with this part and containing the information specified in section 2664(a)(1); “(2) with respect to such agreements, the application provides assurances of compliance satisfactory to the Secretary; and “(3) the application otherwise is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this part. “SEC. 2666. PROVISION BY SECRETARY OF SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS. “(a) In General.— Upon the request of a grantee under this part, the Secretary may, subject to subsection (b), provide supplies, equipment, and services for the purpose of aiding the grantee in providing early intervention services and, for such purpose, may detail to the State any officer or employee of the Department of Health and Human Services. “(b) Limitation.— With respect to a request described in subsection (a), the Secretary shall reduce the amount of payments under the grant involved by an amount equal to the costs of detailing personnel and the fair market value of any supplies, equipment, or services provided by the Secretary. The Secretary shall, for the payment of expenses incurred in complying with such request, expend the amounts withheld. “SEC. 2667. USE OF FUNDS. “Counseling programs carried out under this part— “(1) shall not be designed to promote or encourage, directly, intravenous drug abuse or sexual activity, homosexual or heterosexual; “(2) shall be designed to reduce exposure to and transmission of HIV disease by providing accurate information; and “(3) shall provide information on the health risks of promiscuous sexual activity and intravenous drug abuse.”. (b) Revision, Extension, and Transfer of Program of Prison Testing Act of 1988.— 104 STAT. 615 (1) Transfer of program.— Section 902 of Public Law 100–607— (A) is transferred to part C of title XXVI of the Public Health Service Act, as added by subsection (a) of this Act; (B) is redesignated as section 2648; and (C) is inserted after section 2647 of such part C. (2) Extension of authorization of appropriations for program.— Section 2648(g) of the Public Health Service Act, as transferred and added by paragraph (1) of this subsection, is amended by striking “1990” and inserting “1995”. (3) Revision of program.— Section 2648 of the Public Health Service Act, as transferred and added by paragraph (1) of this subsection, is amended by striking subsections (a) through (f) and inserting the following: “(a) In General.— In addition to grants under section 2641, the Secretary may make grants to States for the purpose of assisting the States in providing early intervention services to individuals sentenced by the State to a term of imprisonment. The Secretary may make such a grant only if the State involved requires, subject to subsection (d), that— “(1) the services be provided to such individuals; and “(2) each such individual be informed of the requirements of subsection (c) regarding testing and be informed of the results of such testing of the individual. “(b) Requirement of Matching Funds.— “(1) In general.— The Secretary may not make a grant under subsection (a) unless the State involved agrees that, with respect to the costs to be incurred by the State in carrying out the purpose described in such subsection, the State will make available (directly or through donations from public or private entities) non-Federal contributions toward such costs in an amount equal to— “(A) for the first fiscal year of payments under the grant, not less than $1 for each $2 of Federal funds provided in the grant; and “(B) for any subsequent fiscal year of such payments, not less than $1 for each $1 of Federal funds provided in the grant. “(2) Determination of amount of non-federal contribution.— Non-Federal contributions required in paragraph (1) may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government, and services (or portions of services) subsidized by the Federal Government, may not be included in determining the amount of such non-Federal contributions. “(c) Testing.— The Secretary may not make a grant under subsection (a) unless— “(1) the State involved requires that, subject to subsection (d), any individual sentenced by the State to a term of imprisonment be tested for HIV disease— “(A) upon entering the State penal system; and “(B) during the 30-day period preceding the date on which the individual is released from such system; “(2) with respect to informing employees of the penal system of the results of such testing of the individual, the State— “(A) upon the request of any such employee, provides the results to the employee in any case in which the medical 104 STAT. 616officer of the prison determines that there is a reasonable basis for believing that the employee has been exposed by the individual to such disease; and “(B) informs the employees of the availability to the employees of such results under the conditions described in subparagraph (A); “(3) with respect to informing the spouse of the individual of the results of such testing of the individual, the State— “(A) upon the request of the spouse, provides such results to the spouse prior to any conjugal visit and provides such results to the spouse during the period described in paragraph (1)(B); and “(B) informs the spouse of the availability to the spouse of such results under the conditions described in subparagraph (A); “(4) with respect to such testing upon entering the State penal system of such an individual who has been convicted of rape or aggravated sexual assault, the State— “(A) upon the request of the victim of the rape or assault, provides such results to the victim; and “(B) informs the victim of the availability to the victim of such results; and “(5) the State, except as provided in any of paragraphs (2) through (4), maintains the confidentiality of the results of testing for HIV disease in each prison operated by the State or with amounts provided by the State, and makes disclosures of such results only as medically necessary. “(d) Determination of Prisons Subject to Requirement.— “(1) In general.— The Secretary may not make a grant under subsection (a) unless the State involved agrees that the requirement established in such subsection regarding the provision of early intervention services to inmates will apply only to in-mates who are incarcerated in prisons with respect to which the State public health officer, after consultation with the chief State correctional officer, has, on the basis of the criteria described in paragraph (2), determined that the provision of such services is appropriate with respect to the public health and safety. “(2) Description of criteria.— The criteria to be considered for purposes of paragraph (1) are— “(A) with respect to the geographic areas in which in-mates of the prison involved resided before incarceration in the prison— “(i) the severity of the epidemic of HIV disease in the areas during the period in which the inmates resided in the areas; and “(ii) the incidence, in the areas during such period, of behavior that places individuals at significant risk of developing HIV disease; and “(B) the extent to which medical examinations conducted by the State for inmates of the prison involved indicate that the inmates have engaged in such behavior. “(e) Applicability of Provisions Regarding Informed consent, Counseling, and Other Matters.— The Secretary may not make a grant under subsection (a) unless the State involved agrees that sections 2641(b)(4), 2662, and 2664(c) will apply to the provision of early intervention services pursuant to the grant in the same 104 STAT. 617manner and to the same extent as such sections apply to the provision of such services by grantees under section 2641. “(f) Requirement of Application.— The Secretary may not make a grant under subsection (a) unless an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section. “(g) Rule of Construction.— With respect to testing inmates of State prisons for HIV disease without the consent of the inmates, the agreements made under this section may not be construed to authorize, prohibit, or require any State to conduct such testing, except as provided in subparagraphs (A) and (B) of subsection (c)(1).”. (4) Technical Amendments.— Section 2648 of the Public Health Service Act, as transferred and added by paragraph (1) of this subsection, is amended by striking the heading and inserting the following: “TESTING AND OTHER EARLY INTERVENTION SERVICES FOR STATE PRISONERS.”.