HIV CARE GRANTS.

SEC. 201. HIV CARE GRANTS. Title XXVI of the Public Health Service Act (as added by section 101) is amended by adding at the end thereof the following new part: “Part B— Care Grant Program “SEC. 2611. GRANTS. “The Secretary shall, subject to the availability of appropriations, make grants to States to enable such States to improve the quality, availability and organization of health care and support services for individuals and families with HIV disease. “SEC. 2612. GENERAL USE OF GRANTS. “(a) In General.— A State may use amounts provided under grants made under this part— “(1) to establish and operate HIV care consortia within areas most affected by HIV disease that shall be designed to provide a comprehensive continuum of care to individuals and families with HIV disease in accordance with section 2613; “(2) to provide home-and community-based care services for individuals with HIV disease in accordance with section 2614; “(3) to provide assistance to assure the continuity of health insurance coverage for individuals with HIV disease in accordance with section 2615; and “(4) to provide treatments, that have been determined to prolong life or prevent serious deterioration of health, to individuals with HIV disease in accordance with section 2616. “(b) Infants and Women, Etc.— A State shall use not less than 15 percent of funds allocated under this part to provide health and support services to infants, children, women, and families with HIV disease. “SEC. 2613. GRANTS TO ESTABLISH HIV CARE CONSORTIA. “(a) Consortia.— A State may use amounts provided under a grant awarded under this part to provide assistance under section 2612(a)(1) to an entity that— “(1) is an association of one or more public, and one or more nonprofit private, health care and support service providers and community based organizations operating within areas determined by the State to be most affected by HIV disease; and “(2) agrees to use such assistance for the planning, development and delivery, through the direct provision of services or 104 STAT. 587through entering into agreements with other entities for the provision of such services, of comprehensive outpatient health and support services for individuals with HIV disease, that may include— “(A) essential health services such as case management services, medical, nursing, and dental care, diagnostics, monitoring, and medical follow-up services, mental health, developmental, and rehabilitation services, home health and hospice care; and “(B) essential support services such as transportation services, attendant care, homemaker services, day or respite care, benefits advocacy, advocacy services provided through public and nonprofit private entities, and services that are incidental to the provision of health care services for individuals with HIV disease including nutrition services, housing referral services, and child welfare and family services (including foster care and adoption services). An entity or entities of the type described in this subsection shall hereinafter be referred to in this title as a ‘consortium’ or ‘consortia’. “(b) Assurances.— “(1) Requirement.— To receive assistance from a State under subsection (a), an applicant consortium shall provide the State with assurances that— “(A) within any locality in which such consortium is to operate, the populations and subpopulations of individuals and families with HIV disease have been identified by the consortium; “(B) the service plan established under subsection (c)(2) by such consortium addresses the special care and service needs of the populations and subpopulations identified under subparagraph (A); and “(C) except as provided in paragraph (2), the consortium will be a single coordinating entity that will integrate the delivery of services among the populations and subpopulations identified under subparagraph (A). “(2) Exception.— Subparagraph (C) of paragraph (1) shall not apply to any applicant consortium that the State determines will operate in a community or locality in which it has been demonstrated by the applicant consortium that— “(A) subpopulations exist within the community to be served that have unique service requirements; and “(B) such unique service requirements cannot be adequately and efficiently addressed by a single consortium serving the entire community or locality. “(c) Application.— “(1) In general.— To receive assistance from the State under subsection (a), a consortium shall prepare and submit to the State, an application that— “(A) demonstrates that the consortium includes agencies and community-based organizations— “(i) with a record of service to populations and subpopulations with HIV disease requiring care within the community to be served; and “(ii) that are representative of populations and subpopulations reflecting the local incidence of HIV 104 STAT. 588and that are located in areas in which such populations reside; “(B) demonstrates that the consortium has carried out an assessment of service needs within the geographic area to be served and, after consultation with the entities described in paragraph (2), has established a plan to ensure the delivery of services to meet such identified needs that shall include— “(i) assurances that service needs will be addressed through the coordination and expansion of existing programs before new programs are created; “(ii) assurances that, in metropolitan areas, the geographic area to be served by the consortium corresponds to the geographic boundaries of local health and support services delivery systems to the extent practicable; “(iii) assurances that, in the case of services for individuals residing in rural areas, the applicant consortium shall deliver case management services that link available community support services to appropriate specialized medical services; and “(iv) assurances that the assessment of service needs and the planning of the delivery of services will include participation by individuals with HIV disease; “(C) demonstrates that adequate planning has occurred to meet the special needs of families with HIV disease, including family centered care; “(D) demonstrates that the consortium has created a mechanism to evaluate periodically— “(i) the success of the consortium in responding to identified needs; and “(ii) the cost-effectiveness of the mechanisms employed by the consortium to deliver comprehensive care; and “(E) demonstrates that the consortium will report to the State the results of the evaluations described in subparagraph (D) and shall make available to the State or the Secretary, on request, such data and information on the program methodology that may be required to perform an independent evaluation. “(2) Consultation.— In establishing the plan required under paragraph (1)(B), the consortium shall consult with— “(A) (i) the public health agency that provides or supports ambulatory and outpatient HIV-related health care services within the geographic area to be served; or “(ii) in the case of a public health agency that does not directly provide such HIV-related health care services such agency shall consult with an entity or entities that directly provide ambulatory and outpatient HIV-related health care services within the geographic area to be served; and “(B) not less than one community-based organization that is organized solely for the purpose of providing HIV-related support services to individuals with HIV disease. The organization to be consulted under subparagraph (B) shall be at the discretion of the applicant consortium. “(d) Definition.— As used in this part, the term ‘family centered care’ means the system of services described in this section that is 104 STAT. 589targeted specifically to the special needs of infants, children, women, and families. Family centered care shall be based on a partnership between parents, professionals, and the community designed to ensure an integrated, coordinated, culturally sensitive, and community-based continuum of care for children, women, and families with HIV disease. “(e) Priority.— In providing assistance under subsection (a), the State shall, among applicants that meet the requirements of this section, give priority— “(1) first to consortia that are receiving assistance from the Health Resources and Services Administration for adult and pediatric HIV-related care demonstration projects; and then “(2) to any other existing HIV care consortia. “SEC. 2614. GRANTS FOR HOME-AND COMMUNITY-BASED CARE. “(a) Uses.— A State may use amounts provided under a grant awarded under this part to make grants under section 2612(a)(2) to entities to— “(1) provide home- and community-based health services for individuals with HIV disease pursuant to written plans of care prepared by a case management team, that shall include appropriate health care professionals, in such State for providing such services to such individuals; “(2) provide outreach services to individuals with HIV disease, including those individuals in rural areas; and “(3) provide for the coordination of the provision of services under this section with the provision of HIV-related health services provided by public and private entities. “(b) Priority.— In awarding grants under subsection (a), a State shall give priority to entities that provide assurances to the State that— “(1) such entities will participate in HIV care consortia if such consortia exist within the State; and “(2) such entities will utilize amounts provided under such grants for the provision of home- and community-based services to low-income individuals with HIV disease. “(c) Definition.— As used in this part, the term ‘home- and community-based health services’— “(1) means, with respect to an individual with HIV disease, skilled health services furnished to the individual in the individual’s home pursuant to a written plan of care established by a case management team, that shall include appropriate health care professionals, for the provision of such services and items described in paragraph (2); “(2) includes— “(A) durable medical equipment; “(B) homemaker or home health aide services and personal care services furnished in the home of the individual; “(C) day treatment or other partial hospitalization services; “(D) home intravenous and aerosolized drug therapy (including prescription drugs administered as part of such therapy); “(E) routine diagnostic testing administered in the home of the individual; and “(F) appropriate mental health, developmental, and rehabilitation services; and 104 STAT. 590 “(3) does not include— “(A) inpatient hospital services; and “(B) nursing home and other long term care facilities. “SEC. 2615. CONTINUUM OF HEALTH INSURANCE COVERAGE. “(a) In General.— A State may use amounts received under a grant awarded under this part to establish a program of financial assistance under section 2612(a)(3) to assist eligible low-income individuals with HIV disease in— “(1) maintaining a continuity of health insurance; or “(2) receiving medical benefits under a health insurance program, including risk-pools. “(b) Limitations.— Assistance shall not be utilized under subsection (a)— “(1) to pay any costs associated with the creation, capitalization, or administration of a liability risk pool (other than those costs paid on behalf of individuals as part of premium contributions to existing liability risk pools); and “(2) to pay any amount expended by a State under title XIX of the Social Security Act. “SEC. 2616. PROVISION OF TREATMENTS. “(a) In General.— A State may use amounts provided under a grant awarded under this part to establish a program under section 2612(a)(4) to provide treatments that have been determined to pro-long life or prevent the serious deterioration of health arising from HIV disease in eligible individuals. “(b) Eligible Individual.— To be eligible to receive assistance from a State under this section an individual shall— “(1) have a medical diagnosis of HIV disease; and “(2) be a low-income individual, as defined by the State. “(c) State Duties.— In carrying out this section the State shall— “(1) determine, in accordance with guidelines issued by the Secretary, which treatments are eligible to be included under the program established under this section; “(2) provide assistance for the purchase of treatments determined to be eligible under paragraph (1), and the provision of. such ancillary devices that are essential to administer such treatments; “(3) provide outreach to individuals with HIV disease, and as appropriate to the families of such individuals; and “(4) facilitate access to treatments for such individuals. “SEC. 2617. STATE APPLICATION. “(a) In General.— The Secretary shall not make a grant to a State under this part for a fiscal year unless the State prepares and submits, to the Secretary, an application at such time, in such form, and containing such agreements, assurances, and information as the Secretary determines to be necessary to carry out this part. “(b) Description of Intended Uses and Agreements.— The application submitted under subsection (a) shall contain— “(1) a detailed description of the HIV-related services provided in the State to individuals and families with HIV disease during the year preceding the year for which the grant is requested, and the number of individuals and families receiving such services, that shall include— 104 STAT. 591 “(A) a description of the types of programs operated or funded by the State for the provision of HIV-related services during the year preceding the year for which the grant is requested and the methods utilized by the State to finance such programs; “(B) an accounting of the amount of funds that the State has expended for such services and programs during the year preceding the year for which the grant is requested; and “(C) information concerning— “(i) the number of individuals to be served with assistance provided under the grant; “(ii) demographic data on the population of the individuals to be served; “(iii) the average cost of providing each category of HIV-related health services and the extent to which such cost is paid by third-party payors; and “(iv) the aggregate amounts expended for each such category of services; “(2) a comprehensive plan for the organization and delivery of HIV health care and support services to be funded with assistance received under this part that shall include a description of the purposes for which the State intends to use such assistance, including— “(A) the services and activities to be provided and an explanation of the manner in which the elements of the program to be implemented by the State with such assistance will maximize the quality of health and support services available to individuals with HIV disease throughout the State; and “(B) a description of the manner in which services funded with assistance provided under this part will be coordinated with other available related services for individuals with HIV disease; and “(3) an assurance by the State that— “(A) the public health agency that is administering the grant for the State will conduct public hearings concerning the proposed use and distribution of the assistance to be received under this part; “(B) the State will— “(i) to the maximum extent practicable, ensure that HIV-related health care and support services delivered pursuant to a program established with assistance provided under this part will be provided without regard to the ability of the individual to pay for such services and without regard to the current or past health condition of the individual with HIV disease; “(ii) ensure that such services will be provided in a setting that is accessible to low-income individuals with HIV disease; “(iii) provide outreach to low-income individuals with HIV disease to inform such individuals of the services available under this part; and “(iv) in the case of a State that intends to use amounts provided under the grant for purposes described in 2615, submit a plan to the Secretary that 104 STAT. 592demonstrates that the State has established a program that assures that— “(I) such amounts will be targeted to individuals who would not otherwise be able to afford health insurance coverage; and “(II) income, asset, and medical expense criteria will be established and applied by the State to identify those individuals who qualify for assistance under such program, and information concerning such criteria shall be made available to the public; “(C) the State will provide for periodic independent peer review to assess the quality and appropriateness of health and support services provided by entities that receive funds from the State under this part; “(D) the State will permit and cooperate with any Federal investigations undertaken regarding programs conducted under this part; “(E) the State will maintain HIV-related activities at a level that is equal to not less than the level of such expenditures by the State for the 1 year period preceding the fiscal year for which the State is applying to receive a grant under this part; and “(F) the State will ensure that grant funds are not utilized to make payments for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service— “(i) under any State compensation program, under an insurance policy, or under any Federal or State health benefits program; or “(ii) by an entity that provides health services on a prepaid basis. “(c) Requirements Regarding Imposition of Charges for Services.— “(1) In General.— The Secretary may not make a grant under section 2611 to a State unless the State provides assurances that in the provision of services with assistance provided under the grant— “(A) in the case of individuals with an income less than or equal to 100 percent of the official poverty line, the provider will not impose charges on any such individual for the provision of services under the grant; “(B) in the case of individuals with an income greater than 100 percent of the official poverty line, the provider— “(i) will impose charges on each such individual for the provision of such services; and “(ii) will impose charges according to a schedule of charges that is made available to the public; “(C) in the case of individuals with an income greater than 100 percent of the official poverty line and not exceeding 200 percent of such poverty line, the provider will not, for any calendar year, impose charges in an amount exceeding 5 percent of the annual gross income of the individual involved; “(D) in the case of individuals with an income greater than 200 percent of the official poverty line and not exceeding 300 percent of such poverty line, the provider will not, 104 STAT. 593for any calendar year, impose charges in an amount exceeding 7 percent of the annual gross income of the individual involved; and “(E) in the case of individuals with an income greater than 300 percent of the official poverty line, the provider will not, for any calendar year, impose charges in an amount exceeding 10 percent of the annual gross income of the individual involved. “(2) Assessment of charge.— With respect to compliance with the assurance made under paragraph (1), a grantee under this part may, in the case of individuals subject to a charge for purposes of such paragraph— “(A) assess the amount of the charge in the discretion of the grantee, including imposing only a nominal charge for the provision of services, subject to the provisions of such paragraph regarding public schedules regarding limitation on the maximum amount of charges; and “(B) take into consideration the medical expenses of individuals in assessing the amount of the charge, subject to such provisions. “(3) Applicability of limitation on amount of charge.— The Secretary may not make a grant under section 2611 unless the applicant of the grant agrees that the limitations established in subparagraphs (C), CD), and (E) of paragraph (1) regarding the imposition of charges for services applies to the annual aggregate of charges imposed for such services, without regard to whether they are characterized as enrollment fees, premiums, deductibles, cost sharing, copayments, coinsurance, or other charges. “(4) Waiver.— “(A) In general.— The State shall waive the requirements established in paragraphs (1) through (3) in the case of an entity that does not, in providing health care services, impose a charge or accept reimbursement from any third-party payor, including reimbursement under any insurance policy or under any Federal or State health benefits program. “(B) Determination.— A determination by the State of whether an entity referred to in subparagraph (A) meets the criteria for a waiver under such subparagraph shall be made without regard to whether the entity accepts voluntary donations regarding the provision of services to the public. “(d) Requirement of Matching Funds Regarding State Allotments.— “(1) In general.— In the case of any State to which the criterion described in paragraph (3) applies, the Secretary may not make a grant under this part unless the State agrees that, with respect to the costs to be incurred by the State in carrying out the program for which the grant was awarded, the State will, subject to subsection (b)(2), make available (directly or through donations from public or private entities) non-Federal contributions toward such costs in an amount equal to— “(A) for the first fiscal year of payments under the grant, not less than 16% percent of such costs ($1 for each $5 of Federal funds provided in the grant); 104 STAT. 594 “(B) for any second fiscal year of such payments, not less than 20 percent of such costs ($1 for each $4 of Federal funds provided in the grant); “(C) for any third fiscal year of such payments, not less than 25 percent of such costs ($1 for each $3 of Federal funds provided in the grant); “(D) for any fourth fiscal year of such payments, not less than 33⅓ percent of such costs ($1 for each $2 of Federal funds provided in the grant); and “(E) for any subsequent fiscal year of such payments, not less than 33⅓ percent of such costs ($1 for each $2 of Federal funds provided in the grant). “(2) Determination of amount of non-federal contribution.— “(A) In general.— Non-Federal contributions required in paragraph (1) may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government, and any portion of any service subsidized by the Federal Government, may not be included in determining the amount of such non-Federal contributions. “(B) Inclusion of certain amounts.— “(i) In making a determination of the amount of non-Federal contributions made by a State for purposes of paragraph (1), the Secretary shall, subject to clause (ii), include any non-Federal contributions provided by the State for HIV-related services, without regard to whether the contributions are made for programs established pursuant to this title; “(ii) In making a determination for purposes of clause (i), the Secretary may not include any non-Federal contributions provided by the State as a condition of receiving Federal funds under any program under this title (except for the program established in this part) or under other provisions of law. “(3) Applicability of requirement.— “(A) Number of cases.— A State referred to in paragraph (1) is any State for which the number of cases of acquired immune deficiency syndrome reported to and confirmed by the Director of the Centers for Disease Control for the period described in subparagraph (B) constitutes in excess of 1 percent of the aggregate number of such cases reported to and confirmed by the Director for such period for the United States. “(B) Period of time.— The period referred to in subparagraph (A) is the 2-year period preceding the fiscal year for which the State involved is applying to receive a grant under subsection (a). “(C) Puerto Rico.— For purposes of paragraph (1), the number of cases of acquired immune deficiency syndrome reported and confirmed for the Commonwealth of Puerto Rico for any fiscal year shall be deemed to be less than 1 percent. “(4) Diminished state contribution.— With respect to a State that does not make available the entire amount of the non-Federal contribution referred to in paragraph (1), the State shall continue to be eligible to receive Federal funds under a 104 STAT. 595grant under this part, except that the Secretary in providing Federal funds under the grant shall provide such funds (in accordance with the ratios prescribed in paragraph (1)) only with respect to the amount of funds contributed by such State. “SEC. 2S18. DISTRIBUTION OF FUNDS. “(a) Special Projects of a National Significance.— “(1) In general.— Of the amount appropriated under section 2620 for each fiscal year, the Secretary shall use not to exceed 10 percent of such amount to establish and administer a special projects of national significance program to award direct grants to public and nonprofit private entities including communitybased organizations to fund special programs for the care and treatment of individuals with HIV disease. “(2) Grants.— The Secretary shall award grants under subsection (a) based on— “(A) the need to assess the effectiveness of a particular model for the care and treatment of individuals with HIV disease; “(B) the innovative nature of the proposed activity; and “(C) the potential replicability of the proposed activity in other similar localities or nationally. “(3) Special projects.— Special projects of a national significance may include those that are designed to— “(A) establish a system designed to increase the number of health care facilities willing and able to serve low-income individuals and families with HIV disease; “(B) deliver drug abuse treatment and HIV health care services at a single location, through either an outpatient or residential facility; “(C) provide support and respite care for participants in family based care networks critical to the delivery of comprehensive HIV care in the minority community; “(D) deliver an enhanced spectrum of comprehensive health care and support services to underserved hemophilia populations, including minorities and those in rural and underserved areas, utilizing established networks of hemophilia diagnostic and treatment centers and communitybased outreach systems; “(E) deliver HIV health care and support services to Indians with HIV disease and their families; “(F) improve the provision of HIV health care and sup-port services to individuals and families with HIV disease located in rural areas; “(G) deliver HIV health care and support services to homeless individuals and families with HIV disease; and “(H) deliver HIV health care and support services to individuals with HIV disease who are incarcerated. “(b) Amount of Grant to State.— “(1) Minimum allotment.— Subject to the extent of amounts made available under section 2620, the amount of a grant to be made under this part for— “(A) each of the several States and the District of Columbia for a fiscal year shall be the greater of— “(i) $100,000, and “(ii) an amount determined under paragraph (2); and 104 STAT. 596 “(B) each territory of the United States, as defined in paragraph 3, shall be an amount determined under paragraph (2). “(2) Determination.— “(A) Formula.— The amount referred to in paragraph (1)(A)(ii) for a State and paragraph (1)(B) for a territory of the United States shall be the product of— “(i) an amount equal to the amount appropriated under section 2620 for the fiscal year involved; and “(ii) the ratio of the distribution factor for the State or territory to the sum of the distribution factors for all the States or territories. “(B) Distribution factor.— As used in subparagraph (A)(ii), the term ‘distribution factor’ means— “(i) in the case of a State, the product of— “(I) the number of cases of acquired immune deficiency syndrome in the State, as indicated by the number of cases reported to and confirmed by the Secretary for the 2 most recent fiscal years for which such data are available; and “(II) the cube root of the ratio (based on the most recent available data) of— “(aa) the average per capita income of individuals in the United States (including the territories); to “(bb) the average per capita income of individuals in the State; and “(ii) in the case of a territory of the United States the number of additional cases of such syndrome in the specific territory, as indicated by the number of cases reported to and confirmed by the Secretary for the 2 most recent fiscal years for which such data is available. “(3) Definitions.— As used in this subsection— “(A) the term ‘State’ means each of the 50 States, the District of Columbia and the Commonwealth of Puerto Rico; and “(B) the term ‘territory of the United States’ means the Virgin Islands, Guam, American Samoa, the Common-wealth of the Northern Mariana Islands, and the Republic of the Marshall Islands. “(c) Allocation of Assistance by States.— “(1) Consortia.— In a State that has reported 1 percent or more of all AIDS cases reported to and confirmed by the Centers for Disease Control in all States, not less than 50 percent of the amount received by the State under a grant awarded under this part shall be utilized for the creation and operation of community-based comprehensive care consortia under section 2613, in those areas within the State in which the largest number of individuals with HIV disease reside. “(2) Allowances.— Prior to allocating assistance under this subsection, a State shall consider the unmet needs of those areas that have not received financial assistance under part A. “(3) Planning and evaluations.— A State may not use in excess of 5 percent of amounts received under a grant awarded under this part for planning and evaluation activities. 104 STAT. 597 “(4) Administration.— A State may not use in excess of 5 percent of amounts received under a grant awarded under this part for administration, accounting, reporting, and program oversight functions. “(5) Construction.— A State may not use amounts received under a grant awarded under this part to purchase or improve land, or to purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or to make cash payments to intended recipients of services. “(d) Expedited Distribution.— “(1) In general.— Not less than 75 percent of the amounts received under a grant awarded to a State under this part shall be obligated to specific programs and projects and made available for expenditure not later than— “(A) in the case of the first fiscal year for which amounts are received, 150 days after the receipt of such amounts by the State; and “(B) in the case of succeeding fiscal years, 120 days after the receipt of such amounts by the State. “(2) Public comment.— Within the time periods referred to in paragraph (1), the State shall invite and receive public comment concerning methods for the utilization of such amounts. “(e) Reallocation.— Any amounts appropriated in any fiscal year and made available to a State under this part that have not been obligated as described in subsection (d) shall be repaid to the Secretary and reallotted to other States in proportion to the original grants made to such States. “SEC. 2619. TECHNICAL ASSISTANCE. “The Secretary may provide technical assistance in administering and coordinating the activities authorized under section 2612. “SEC. 2620. AUTHORIZATION OF APPROPRIATIONS. “There are authorized to be appropriated to make grants under this part, $275,000,000 in each of the fiscal years 1991 and 1992, and such sums as may be necessary in each of the fiscal years 1993 through 1995.”.