HIV EMERGENCY RELIEF GRANT PROGRAM.

SEC. 101. HIV EMERGENCY RELIEF GRANT PROGRAM. The Public Health Service Act is amended— (1) by redesignating title XXVI as title XXVII; (2) by redesignating sections 2601 through 2614 as sections 2701 through 2714, respectively; and (3) by inserting after title XXV (42 U.S.C. 300ee et seq.) the following new title: “TITLE XXVI— HIV HEALTH CARE SERVICES PROGRAM “Part A— Emergency Relief for Areas With Substantial Need for Services “SEC. 2601. ESTABLISHMENT OF PROGRAM OF GRANTS. “(a) Eligible Areas.— The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall, subject to subsection (b), make grants in accordance with section 2603 for the purpose of assisting in the provision of the services specified in 2604 in any metropolitan area for which, as of June 30, 1990, in the case of grants for fiscal year 1991, and as of March 31 of the most recent fiscal year for which such data is available in the case of a grant for any subsequent fiscal year— 104 STAT. 577 “(1) there has been reported to and confirmed by the Director of the Centers for Disease Control a cumulative total of more than 2,000 cases of acquired immune deficiency syndrome; or “(2) the per capita incidence of cumulative cases of such syndrome (computed on the basis of the most recently available data on the population of the area) is not less than 0.0025. “(b) Requirement Regarding Confirmation of Cases.— The Secretary may not make a grant under subsection (a) for a metropolitan area unless, before making any payments under the grant, the cases of acquired immune deficiency syndrome reported for purposes of such subsection have been confirmed by the Secretary, acting through the Director of the Centers for Disease Control. “SEC. 2602. ADMINISTRATION AND PLANNING COUNCIL. “(a) Administration.— “(1) In general.— Assistance made available under grants awarded under this part shall be directed to the chief elected official of the city or urban county that administers the public health agency that provides outpatient and ambulatory services to the greatest number of individuals with AIDS, as reported to and confirmed by the Centers for Disease Control, in the eligible area that is awarded such a grant. “(2) Requirements.— “(A) In general.— To receive assistance under section 2601(a), the chief elected official of the eligible area involved shall— “(i) establish, through intergovernmental agreements with the chief elected officials of the political subdivisions described in subparagraph (B), an administrative mechanism to allocate funds and services based on— “(I) the number of AIDS cases in such subdivisions; “(II) the severity of need for outpatient and ambulatory care services in such subdivisions; and “(III) the health and support services personnel needs of such subdivisions; and “(ii) establish an HIV health services planning council in accordance with subsection (b). “(B) Local political subdivision.— The political subdivisions referred to in subparagraph (A) are those political subdivisions in the eligible area— “(i) that provide HIV-related health services; and “(ii) for which the number of cases reported for purposes of section 2601(a) constitutes not less than 10 percent of the number of such cases reported for the eligible area. “(b) HIV Health Services Planning Council.— “(1) Establishment.— To be eligible for assistance under this part, the chief elected official described in subsection (a)(1) shall establish or designate an HIV health services planning council that shall include representatives of— “(A) health care providers; “(B) community-based and AIDS service organizations; “(C) social service providers; “(D) mental health care providers; “(E) local public health agencies; 104 STAT. 578 “(F) hospital planning agencies or health care planning agencies; “(G) affected communities, including individuals with HIV disease; “(H) non-elected community leaders; “(I) State government; “(J) grantees under subpart II of part C; and “(K) the lead agency of any Health Resources and Services Administration adult and pediatric HIV-related care demonstration project operating in the area to be served. “(2) Method of providing for council.— “(A) In general.— In providing for a council for purposes of paragraph (1), a chief elected official receiving a grant under section 2601(a) may establish the council directly or designate an existing entity to serve as the council, subject to subparagraph (B). “(B) Consideration regarding designation of council.— In making a determination of whether to establish or designate a council under subparagraph (A), a chief elected official receiving a grant under section 2601(a) shall give priority to the designation of an existing entity that has demonstrated experience in planning for the HIV health care service needs within the eligible area and in the implementation of such plans in addressing those needs. Any existing entity so designated shall be expanded to include a broad representation of the full range of entities that provide such services within the geographic area to be served. “(3) Duties.— The planning council established or designated under paragraph (1) shall— “(A) establish priorities for the allocation of funds within the eligible area; “(B) develop a comprehensive plan for the organization and delivery of health services described in section 2604 that is compatible with any existing State or local plan regarding the provision of health services to individuals with HIV disease; and “(C) assess the efficiency of the administrative mechanism in rapidly allocating funds to the areas of greatest need within the eligible area. “SEC. 2603. TYPE AND DISTRIBUTION OF GRANTS. “(a) Grants Based on Relative Need of Area.— “(1) In general.— In carrying out section 2601(a), the Secretary shall make a grant for each eligible area for which an application under section 2605(a) has been approved. Each such grant shall be made in an amount determined in accordance with paragraph (3). “(2) Expedited distribution.— Not later than— “(A) 90 days after an appropriation becomes available to carry out this part for fiscal year 1991; and “(B) 60 days after an appropriation becomes available to carry out this part for each of fiscal years 1992 through 1995; the Secretary shall, except in the case of waivers granted under section 2605(c), disburse 50 percent of the amount appropriated 104 STAT. 579under section 2608 for such fiscal year through grants to eligible areas under section 2601(a). “(3) Amount of grant.— “(A) In general.— Subject to the extent of amounts made available in appropriations Acts, a grant made for purposes of this paragraph for an eligible area shall be made in an amount equal to the sum of— “(i) an amount determined in accordance with subparagraph (B); and “(ii) an amount determined in accordance with subparagraph (C). “(B) Amount relating to cumulative number of cases.— The amount referred to in clause (i) of subparagraph (A) is an amount equal to the product of— “(i) an amount equal to 75 percent of the amounts available for distribution under paragraph (2) for the fiscal year involved; and “(ii) a percentage equal to the quotient of— “(I) the cumulative number of cases of acquired immune deficiency syndrome in the eligible area involved, as indicated by the number of such cases reported to and confirmed by the Director of the Centers for Disease Control on the applicable date described in section 2601(a); divided by “(II) the sum of the cumulative number of such cases in all eligible areas for which an application for a grant under paragraph (1) has been approved. “(C) Amount relating to per capita incidence of cases.— The amount referred to in clause (ii) of subparagraph (A) is an amount equal to the product of— “(i) an amount equal to 25 percent of the amounts available for distribution under paragraph (2) for the fiscal year involved; and “(ii) a percentage developed by the Secretary through consideration of the ratio of— “(I) the per capita incidence of cumulative cases of acquired immune deficiency syndrome in the eligible area involved (computed on the basis of the most recently available data on the population of the area); to “(II) the per capita incidence of such cumulative cases in all eligible areas for which an application for a grant under paragraph (1) has been approved (computed on the basis of the most recently available data on the population of such areas). “(b) Supplemental Grants.— “(1) In general.— Not later than 150 days after the date on which appropriations are made under section 2608 for a fiscal year, the Secretary shall disburse the remainder of amounts not disbursed under section 2603(a)(2) for such fiscal year for the purpose of making grants under section 2601(a) to eligible areas whose application under section 2605(b)— “(A) contains a report concerning the dissemination of emergency relief funds under subsection (a) and the plan for utilization of such funds; 104 STAT. 580 “(B) demonstrates the severe need in such area for supplemental financial assistance to combat the HIV epidemic; “(C) demonstrates the existing commitment of local resources of the area, both financial and in-kind, to combating the HIV epidemic; “(D) demonstrates the ability of the area to utilize such supplemental financial resources in a manner that is immediately responsive and cost effective; and “(E) demonstrates that resources will be allocated in accordance with the local demographic incidence of AIDS including appropriate allocations for services for infants, children, women, and families with HIV disease. “(2) Remainder of amounts.— In determining the amount of funds to be obligated under paragraph (1), the Secretary shall include amounts that are not paid to the eligible areas under expedited procedures under section 2603(a)(2) as a result of— “(A) the failure of any eligible area to submit an application under section 2605(c); or “(B) any eligible area informing the Secretary that such eligible area does not intend to expend the full amount of its grant under such section. “(3) Amount of grant.— The amount of each grant made for purposes of this subsection shall be determined by the Secretary based on the application submitted by the eligible area under section 2605(b). “(4) Failure to submit.— “(A) In general.— The failure of an eligible area to submit an application for an expedited grant under section 2603(a)(2) shall not result in such area being ineligible for a grant under this subsection. “(B) Application.— The application of an eligible area submitted under section 2605(b) shall contain the assurances required under subsection (a) of such section if such eligible area fails to submit an application for an expedited grants under section 2603(a)(2). “SEC. 2604. USE OF AMOUNTS. “(a) Requirements.— The Secretary may not make a grant under section 2601(a) to the chief elected official of an eligible area unless such political subdivision agrees that— “(1) subject to paragraph (2), the allocation of funds and services within the eligible area will be made in accordance with the priorities established, pursuant to section 2602(b)(3)(A), by the HIV health services planning council that serves such eligible area; and “(2) funds provided under section 2601 will be expended only for the purposes described in subsections (b) and (c). “(b) Primary Purposes.— “(1) In general.— The chief elected official shall use amounts received under a grant under section 2601 to provide direct financial assistance to entities described in paragraph (2) for the purpose of delivering or enhancing HIV-related— “(A) outpatient and ambulatory health and support services, including case management and comprehensive treatment services, for individuals and families with HIV disease; and 104 STAT. 581 “(B) inpatient case management services that prevent unnecessary hospitalization or that expedite discharge, as medically appropriate, from inpatient facilities. “(2) Appropriate entities.— “(A) In general.— Subject to subparagraph (B), direct financial assistance may be provided under paragraph (1) to public or nonprofit private entities, including hospitals (which may include Veterans Administration facilities), community-based organizations, hospices, ambulatory care facilities, community health centers, migrant health centers, and homeless health centers. “(B) Priority.— In providing direct financial assistance under paragraph (1) the chief elected official shall give priority to entities that are currently participating in Health Resources and Services Administration HIV health care demonstration projects. “(c) Limited Expenditures for Personnel Needs.— “(1) In general.— A chief elected official, in accordance with paragraph (3), may use not to exceed 10 percent of amounts received under a grant under section 2601 to provide financial assistance or services, for the purposes described in paragraph (2), to any public or nonprofit private entity, including hospitals (which may include Veterans Administration facilities), nursing homes, subacute and transitional care facilities, and hospices that— “(A) provide HIV-related care or services to a disproportionate share of low-income individuals and families with HIV disease; “(B) incur uncompensated costs in the provision of such care or services to such individuals and families; “(C) have established, and agree to implement, a plan to evaluate the utilization of services provided in the care of individuals and families with HIV disease; and “(D) have established a system designed to ensure that such individuals and families are referred to the most medically appropriate level of care as soon as such referral is medically indicated. “(2) Use.— A chief elected official may use amounts referred to in paragraph (1) to— “(A) provide direct financial assistance to institutions and entities of the type referred to in such paragraph to assist such institutions and entities in recruiting or training and paying compensation to qualified personnel determined, under paragraph (3), to be necessary by the HIV health services planning council, specifically for the care of individuals with HIV disease; or “(B) in lieu of providing direct financial assistance, make arrangements for the provision of the services of such qualified personnel to such institutions and entities. “(3) Requirement of determination by council.— A chief elected official shall not use any of the amounts received under a grant under section 2601(a) to provide assistance or services under paragraph (2) unless the HIV health services planning council of the eligible area has made a determination that, with respect to the care of individuals with HIV disease— 104 STAT. 582 “(A) a shortage of specific health, mental health or sup-port service personnel exists within specific institutions or entities in the eligible area; “(B) the shortage of such personnel has resulted in the inappropriate utilization of inpatient services within the area; and “(C) assistance or services provided to an institution or entity under paragraph (2), will not be used to supplant the existing resources devoted by such institution or entity to the uses described in such paragraph. “(d) Requirement of Status as Medicaid Provider.— “(1) Provision of service.— Subject to paragraph (2), the Secretary may not make a grant under section 2601(a) for the provision of services under this section in a State unless, in the case of any such service that is available pursuant to the State plan approved under title XIX of the Social Security Act for the State— “(A) the political subdivision involved will provide the service directly, and the political subdivision has entered into a participation agreement under the State plan and is qualified to receive payments under such plan; or “(B) the political subdivision will enter into an agreement with a public or nonprofit private entity under which the entity will provide the service, and the entity has entered into such a participation agreement and is qualified to receive such payments. “(2) Waiver.— “(A) In general.— In the case of an entity making an agreement pursuant to paragraph (1)(B) regarding the provision of services, the requirement established in such paragraph shall be waived by the HIV health services planning council for the eligible area if the entity does not, in providing health care services, impose a charge or accept reimbursement available from any third-party payor, including reimbursement under any insurance policy or under any Federal or State health benefits program. “(B) Determination.— A determination by the HIV health services planning council of whether an entity referred to in subparagraph (A) meets the criteria for a waiver under such subparagraph shall be made without regard to whether the entity accepts voluntary donations for the purpose of providing services to the public. “(e) Administration and Planning.— The chief executive officer of an eligible area shall not use in excess of 5 percent of amounts received under a grant awarded under this part for administration, accounting, reporting, and program oversight functions. “(f) 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. “SEC. 2605. APPLICATION. “(a) In General.— To be eligible to receive a grant under section 2601, an eligible area shall prepare and submit to the Secretary an application at such time, in such form, and containing such informa-104 STAT. 583tion as the Secretary shall require, including assurances adequate to ensure— “(1) (A) that funds received under a grant awarded under this part will be utilized to supplement not supplant State funds made available in the year for which the grant is awarded to provide HIV-related services to individuals with HIV disease; “(B) that the political subdivisions within the eligible area will maintain the level of expenditures by such political subdivisions for HIV-related services for individuals with HIV disease at a level that is equal to the level of such expenditures by such political subdivisions for the 1-year period preceding the first fiscal year for which a grant is received by the eligible area; and “(C) that political subdivisions within the eligible area will not use funds received under a grant awarded under this part in maintaining the level of expenditures for HIV-related services as required in subparagraph (B); “(2) that the eligible area has an HIV health services planning council and has entered into intergovernmental agreements pursuant to section 2602, and has developed or will develop the comprehensive plan in accordance with section 2602(b)(3)(B); “(3) that entities within the eligible area that will receive funds under a grant provided under section 2601(a) shall participate in an established HIV community-based continuum of care if such continuum exists within the eligible area; “(4) that funds received under a grant awarded under this part will not be utilized to make payments for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service— “(A) under any State compensation program, under an insurance policy, or under any Federal or State health benefits program; or “(B) by an entity that provides health services on a prepaid basis; and “(5) to the maximum extent practicable, that— “(A) HIV health care and support services provided with assistance made available under this part will be provided without regard— “(i) to the ability of the individual to pay for such services; and “(ii) to the current or past health condition of the individual to be served; “(B) such services will be provided in a setting that is accessible to low-income individuals with HIV-disease; and “(C) a program of outreach will be provided to low-income individuals with HIV-disease to inform such individuals of such services. “(b) Additional Application.— An eligible area that desires to receive a grant under section 2603(b) shall prepare and submit to the Secretary an additional application at such time, in such form, and containing such information as the Secretary shall require, including the information required under such subsection and information concerning— “(1) the number of individuals to be served within the eligible area with assistance provided under the grant; “(2) demographic data on the population of such individuals; 104 STAT. 584 “(3) the average cost of providing each category of HIV-related health services and the extent to which such cost is paid by third-party payors; and “(4) the aggregate amounts expended for each such category of services. “(c) Date Certain for Submission.— “(1) Requirement.— Except as provided in paragraph (2), to be eligible to receive a grant under section 2601(a) for a fiscal year, an application under subsection (a) shall be submitted not later than 45 days after the date on which appropriations are made under section 2608 for the fiscal year. “(2) Exception.— The Secretary may extend the time for the submission of an application under paragraph (1) for a period of not to exceed 60 days if the Secretary determines that the eligible area has made a good faith effort to comply with the requirement of such paragraph but has otherwise been unable to submit its application. “(3) Distribution by Secretary.— Not later than 45 days after receiving an application that meets the requirements of subsection (a) from an eligible area, the Secretary shall distribute to such eligible area the amounts awarded under the grant for which the application was submitted. “(4) Redistribution.— Any amounts appropriated in any fiscal year under this part and not obligated to an eligible entity as a result of the failure of such entity to submit an application shall be redistributed by the Secretary to other eligible entities in proportion to the original grants made to such eligible areas under 2601(a). “(d) Requirements Regarding Imposition of Charges for Services.— “(1) In general.— The Secretary may not make a grant under section 2601 to an eligible area unless the eligible area provides assurances that in the provision of services with assistance provided under the grant— “(A) in the case of individuals with an income less than or equal to 100 percent of the official poverty line, the provider will not impose charges on any such individual for the provision of services under the grant; “(B) in the case of individuals with an income greater than 100 percent of the official poverty line, the provider— “(i) will impose a charge on each such individual for the provision of such services; and “(ii) will impose the charge according to a schedule of charges that is made available to the public; “(C) in the case of individuals with an income greater than 100 percent of the official poverty line and not exceeding 200 percent of such poverty line, the provider will not, for any calendar year, impose charges in an amount exceeding 5 percent of the annual gross income of the individual involved; “(D) in the case of individuals with an income greater than 200 percent of the official poverty line and not exceeding 300 percent of such poverty line, the provider will not, for any calendar year, impose charges in an amount exceeding 7 percent of the annual gross income of the individual involved; and 104 STAT. 585 “(E) in the case of individuals with an income greater than 300 percent of the official poverty line, the provider will not, for any calendar year, impose charges in an amount exceeding 10 percent of the annual gross income of the individual involved. “(2) Assessment of charge.— With respect to compliance with the assurance made under paragraph (1), a grantee or entity receiving assistance under this part may, in the case of individuals subject to a charge for purposes of such paragraph— “(A) assess the amount of the charge in the discretion of the grantee, including imposing only a nominal charge for the provision of services, subject to the provisions of such paragraph regarding public schedules and regarding limitations on the maximum amount of charges; and “(B) take into consideration the medical expenses of individuals in assessing the amount of the charge, subject to such provisions. “(3) Applicability of limitation on amount of charge.— The Secretary may not make a grant under section 2601 to an eligible area unless the eligible area agrees that the limitations established in subparagraphs (C), (D) and (E) of paragraph (1) regarding the imposition of charges for services applies to the annual aggregate of charges imposed for such services, without regard to whether they are characterized as enrollment fees, premiums, deductibles, cost sharing, copayments, coinsurance, or other charges. “(4) Waiver regarding secondary agreements.— The requirements established in paragraphs (1) through (3) shall be waived in accordance with section 2604(d)(2). “SEC. 2606. TECHNICAL ASSISTANCE. “The Administrator of the Health Resources and Services Administration may, beginning on the date of enactment of this title, provide technical assistance to assist entities in complying with the requirements of this part in order to make such entities eligible to receive a grant under this part. “SEC. 2607. DEFINITIONS. “For purposes of this part: “(1) Eligible area.— The term ‘eligible area’ means a metropolitan area described in section 2601(a)(1). “(2) Metropolitan area.— The term ‘metropolitan area’ means an area referred to in the HIV/AIDS Surveillance Report of the Centers for Disease Control as a metropolitan area. “SEC. 2608. 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.”.