FORMULA GRANTS TO STATES.

SEC. 221. FORMULA GRANTS TO STATES. The Public Health Service Act (42 U.S.C. 201 et seq.), as amended by section 211, is further amended by inserting after title XXIV the following new title: “TITLE XV—PREVENTION OF ACQUIRED IMMUNE DEFICIENCY SYNDROME “SEC. 2500. USE OF FUNDS. “(a) In General.—The purpose of this part is to provide for the establishment of education and information programs to prevent and reduce exposure to, and the transmission of, the etiologic agent for acquired immune deficiency syndrome. “(b) Contents of Programs.—All programs of education and information receiving funds under this title shall include information about the harmful effects of promiscuous sexual activity and intravenous substance abuse, and the benefits of abstaining from such activities. “(c) Limitation.—None of the funds appropriated to carry out this title may be used to provide education or information designed to promote or encourage, directly, homosexual or heterosexual sexual activity or intravenous substance abuse. “(d) Construction.—Subsection (c) may not be construed to re-strict the ability of an education program that includes the information required in subsection (b) to provide accurate information about various means to reduce an individual’s risk of exposure to, or the transmission of, the etiologic agent for acquired immune deficiency syndrome, provided that any informational materials used are not obscene. “Part A—Formula Grants to States “SEC. 2501. ESTABLISHMENT OF PROGRAM. “(a) Allotments for States.—For the purpose described in subsection (b), the Secretary shall for each of the fiscal years 1989 through 1991 make an allotment for each State in an amount determined in accordance with section 2507. The Secretary shall 102 STAT. 3094make payments each such fiscal year to each State from the allotment for the State if the Secretary approves for the fiscal year involved an application submitted by the State pursuant to section 2503. “(b) Purpose of Grants.—The Secretary may not make payments under subsection (a) for a fiscal year unless the State involved agrees to expend the payments only for the purpose of carrying out, in accordance with section 2502, public information activities with respect to acquired immune deficiency syndrome. “SEC. 2502. PROVISIONS WITH RESPECT TO CARRYING OUT PURPOSE OF GRANTS. “A State may expend payments received under section 2501(a)— “(1) to develop, establish, and conduct public information activities relating to the prevention and diagnosis of acquired immune deficiency syndrome for those populations or communities in the State in which there are a significant number of individuals at risk of infection with the etiologic agent for such syndrome; “(2) to develop, establish, and conduct such public information activities for the general public relating to the prevention and diagnosis of such syndrome; “(3) to develop, establish, and conduct activities to reduce risks relating to such syndrome, including research into the prevention of such syndrome; “(4) to conduct demonstration projects for the prevention of such syndrome; “(5) to provide technical assistance to public entities, to non-profit private entities concerned with such syndrome, to schools, and to employers, for the purpose of developing information programs relating to such syndrome; “(6) with respect to education and training programs for the prevention of such syndrome, to conduct such programs for health professionals (including allied health professionals), public safety workers (including emergency response employees), teachers, school administrators, and other appropriate education personnel; “(7) to conduct appropriate programs for educating school-aged children with respect to such syndrome, after consulting with local school boards; “(8) to make available to physicians and dentists in the State information with respect to acquired immune deficiency syndrome, including measures for the prevention of exposure to, and the transmission of, the etiologic agent for such syndrome (which information is updated not less than annually with the most recently available scientific date relating to such syndrome); “(9) to carry out the initial implementation of recommendations contained in the guidelines and the model curriculum developed under section 2525; and “(10) to make grants to public entities, and to nonprofit private entities concerned with acquired immune deficiency syndrome, for the purpose of the development, establishment, and expansion of programs for education directed toward individuals at increased risk of infection with the etiologic agent for such syndrome and activities to reduce the risks of exposure to such etiologic agent, with preference to programs directed 102 STAT. 3095toward populations in which there is significant evidence of such infection. “SEC. 2503. REQUIREMENT OF SUBMISSION OF APPLICATION CONTAINING CERTAIN AGREEMENTS AND ASSURANCES. “(a) In General.—The Secretary may not make payments under section 2501(a) for a fiscal year unless— “(1) the State involved submits to the Secretary a description of the purposes for which the State intends to expend the payments for the fiscal year; “(2) the description identifies the populations, areas, and localities in the State with a need for the services for which amounts may be provided by the State under this part; “(3) the description provides information relating to the programs and activities to be supported and services to be provided, including a description of the manner in which such programs and activities will be coordinated with any similar programs and activities of public and private entities; and “(4) the State submits to the Secretary an application for the payments containing agreements in accordance with this part; “(5) the agreements are made through certification from the chief executive officer of the State; “(6) with respect to such agreements, the application provides assurances of compliance satisfactory to the Secretary; and “(7) 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. “(b) Opportunity for Public Comment.—The Secretary may not make payments under section 2501(a) for a fiscal year unless the State involved agrees that, in developing and carrying out the description required in subsection (a), the State will provide public notice with respect to the description (including any revisions) and will facilitate comments from interested persons. “SEC. 2504. RESTRICTIONS ON USE OF GRANT. “(a) In General.—The Secretary may not make payments under section 2501(a) for a fiscal year unless the State involved agrees that the payments will not be expended— “(1) to provide inpatient services; “(2) to make cash payments to intended recipients of services; “(3) to purchase or improve real property (other than minor remodeling of existing improvements to real property) or to purchase major medical equipment; or “(4) to satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funds. “(b) Limitation on Administrative Expenses.—The Secretary may not make payments under section 2501(a) for a fiscal year unless the State involved agrees that the State will not expend more than 5 percent of the payments for administrative expenses with respect to carrying out the purpose described in section 2501(b). “SEC. 2505. REQUIREMENT OF REPORTS AND AUDITS BY STATES. “(a) Reports.—The Secretary may not make payments under section 2501(a) for a fiscal year unless the State involved agrees to prepare and submit to the Secretary an annual report in such form 102 STAT. 3096and containing such information as the Secretary determines to be necessary for— “(1) securing a record and a description of the purposes for which payments received by the State pursuant to such section were expended and of the recipients of such payments; “(2) determining whether the payments were expended in accordance with the needs within the State required to be identified pursuant to section 2503(aX2); “(3) determining whether the payments were expended in accordance with the purpose described in section 2501(b); and “(4) determining the percentage of payments received pursuant to such section that were expended by the State for administrative expenses during the preceding fiscal year. “(b) Audits.— “(1) The Secretary may not payments under section 2501(a) for a fiscal year unless the State involved agrees to establish such fiscal control and fund accounting procedures as may be necessary to ensure the proper disbursal of, and accounting for, amounts received by the State under such section. “(2) The Secretary may not payments under section 2501(a) for a fiscal year unless the State involved agrees that— “(A) the State will provide for— “(i) a financial and compliance audit of such payments; or “(ii) a single financial and compliance audit of each entity administering such payments; “(B) the audit will be performed biennially and will cover expenditures in each fiscal year; and “(C) the audit will be conducted in accordance with standards established by the Comptroller General of the United States for the audit of governmental organizations, programs, activities, and functions. “(3) The Secretary may not make payments under section 2501(a) for a fiscal year unless the State involved agrees that, not later than 30 days after the completion of an audit under paragraph (2), the State will provide a copy of the audit report to the State legislature. “(4) For purposes of paragraph (2), the term ‘financial and compliance audit’ means an audit to determine whether the financial statements of an audited entity present fairly the financial position, and the results of financial operations, of the entity in accordance with generally accepted accounting principles, and whether the entity has complied with laws and regulations that may have a material effect upon the financial statements. “(c) Availability to Public.—The Secretary may not make payments under section 2501(a) for a fiscal year unless the State involved agrees to make copies of the reports and audits described in this section available for public inspection. “(d) Evaluations by Comptroller General.—The Comptroller General of the United States shall, from time to time, evaluate the expenditures by States of payments received under section 2501(a) in order to ensure that expenditures are consistent with the provisions of this part. 102 STAT. 3097 “SEC. 2506. ADDITIONAL REQUIRED AGREEMENTS. “The Secretary may not, except as provided in subsection (b), make payments under section 2501(a) for a fiscal year unless the State involved agrees that— “(1) all programs conducted or supported by the State with such payments will establish objectives for the program and will determine the extent to which the objectives are met; “(2) information provided under this part will be scientifically accurate and factually correct; “(3) in carrying out section 2501(b), the State will give priority to programs described in section 2502(10) for individuals described in such section; “(4) with respect to a State in which there is a substantial number of individuals who are intravenous substance abusers, the State will place priority on activities under this part directed at such substance abusers; “(5) with respect to a State in which there is a significant incidence of reported cases of acquired immune deficiency syndrome, the State will— “(A) for the purpose described in subsection (b) of section 2501, expend not less than 50 percent of payments received under subsection (a) of such section for a fiscal year— “(i) to make grants to public entities, to migrant health centers (as defined in section 329(a)), to community health centers (as defined in section 330(a)), and to nonprofit private entities concerned with acquired immune deficiency syndrome; or “(ii) to enter into contracts with public and private entities; and “(B) of the amounts reserved for a fiscal year by the State for expenditures required in subparagraph (A), expend not less than 50 percent to carry out section 2502(10) through grants to nonprofit private entities, including minority entities, concerned with acquired immune deficiency syndrome located in and representative of communities and subpopulations reflecting the local incidence of such syndrome; (For purposes of this section, the term ‘significant percentage’ means at least a percentage of 1 percent of the number of reported cases of such syndrome in the United States); “(6) with respect to programs carried out pursuant to section 2502(10), the State will ensure that any applicant for a grant under such section agrees— “(A) that any educational or informational materials developed with a grant pursuant to such section will contain material, and be presented in a manner, that is specifically directed toward the group for which such materials are intended; “(B) to provide a description of the manner in which the applicant has planned the program in consultation with, and of the manner in which such applicant will consult during the conduct of the program with— “(i) appropriate local officials and community groups for the area to be served by the program; 102 STAT. 3098 “(ii) organizations comprised or, and representing, the specific population to which the education or prevention effort is to be directed; and “(iii) individuals having expertise in health education and in the needs of the population to be served; “(C) to provide information demonstrating that the applicant has continuing relationships, or will establish continuing relationships, with a portion of the population in the service area that is at risk of infection with the etiologic agent for acquired immune deficiency syndrome and with public and private entities in such area that provide health or other support services to individuals with such infection; “(D) to provide a description of— “(i) the objectives established by the applicant for the conduct of the program; and “(ii) the methods the applicant will use to evaluate the activities conducted under the program to determine if such objectives are met; and “(E) such other information as the Secretary may prescribe; “(7) with respect to programs carried out pursuant to section 2502(10), the State will give preference to any applicant for a grant pursuant to such section that is located in, has a history of service in, and will serve under the program, any geographic area in which— “(A) there is a significant incidence of acquired immune deficiency syndrome; “(B) there has been a significant increase in the incidence of such syndrome; or “(C) there is a significant risk of becoming infected with the etiologic agent for such syndrome; “(8) the State will establish reasonable criteria to evaluate the effective performance of entities that receive funds from to payments made to the State under section 2501(a) and will establish procedures for procedural and substantive independent State review of the failure by the State to provide funds for any such entity; and “(9) the State will permit and cooperate with Federal investigations undertaken in accordance with section 2509(e); “(10) the State will maintain State expenditures for services provided pursuant to section 2501 at a level equal to not less than the average level of such expenditures maintained by the State for the 2-year period preceding the fiscal year for which the State is applying to receive payments. “SEC. 2507. DETERMINATION OF AMOUNT OF ALLOTMENTS FOR STATES. “(a) Minimum Allotment.—The allotment for a State under section 2501(a) for a fiscal year shall be the greater of— “(1) the amount described in subsection (b); or “(2) the amount determined in accordance with subsection (c). “(b) Determination of Minimum Allotment.— “(1) If the total amount appropriated under section 2516(a) for a fiscal year exceeds $100,000,000, the amount referred to in subsection (a)(1) is $300,000 for the fiscal year. “(2) If the total amount appropriated under section 2514(a) for a fiscal year equals or exceeds $50,000,000, but is less than 102 STAT. 3099$100,000,000, the amount referred to in subsection (a)(1) is $200,000 for the fiscal year. “(3) If the total amount appropriated under section 2514(a) for a fiscal year is less than $50,000,000, the amount referred to in subsection (a)(1) is $100,000 for the fiscal year. “(c) Determination Under Formula.— “(1) The amount referred to in subsection (a)(2) is the sum of— “(A) the amount determined under paragraph (2); and “(B) the amount determined under paragraph (3). “(2) The amount referred to in paragraph (1)(A) is the product of— “(A) an amount equal to 50 percent of the amounts appropriated pursuant to section 2514(a); and “(B) a percentage equal to the quotient of— “(i) the population of the State involved; divided by “(ii) the population of the United States. “(3) The amount referred to in paragraph (1)(B) is the product of— “(A) an amount equal to 50 percent of the amounts appropriated pursuant to section 2514(a); and “(B) a percentage equal to the quotient of— “(i) the number of additional cases of acquired immune deficiency syndrome reported to and con-firmed by the Secretary for the State involved for the most recent fiscal year for which such data is available; divided by “(ii) the number of additional cases of such syndrome reported to and confirmed by the Secretary for the United States for such fiscal year. “(d) Disposition of Certain Funds Appropriated for Allotments.— “(1) Amounts described in paragraph (2) shall be allotted by the Secretary to States receiving payments under section 2501(a) for the fiscal year (other than any State referred to in paragraph (2)(C)). Such amounts shall be allotted according to a formula established by the Secretary. The formula shall be equivalent to the formula described in this section under which the allotment for the State for the fiscal year involved was determined. “(2) The amounts referred to in paragraph (1) are any amounts that are not paid to States under section 2501(a) as a result of— “(A) the failure of any State to submit an application under section 2507; “(B) the failure, in the determination of the Secretary, of any State to prepare within a reasonable period of time such application in compliance with such section; 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. “SEC. 2508. FAILURE TO COMPLY WITH AGREEMENTS. “(a) Repayment of Payments.— “(1) The Secretary may, subject to subsection (c), require a State to repay any payments received by the State under section 2501(a) that the Secretary determines were not expended by the State in accordance with the agreements required to be con-102 STAT. 3100tained in the application submitted by the State pursuant to section 2507. “(2) If a State fails to make a repayment required in paragraph (1), the Secretary may offset the amount of the repayment against the amount of any payment due to be paid to the State under section 2501(a). “(b) Withholding.— “(1) The Secretary may, subject to subsection (c), withhold payments due under section 2501(a) if the Secretary determines that the State involved is not expending amounts received under such section in accordance with the agreements required to be contained in the application submitted by the State pursuant to section 2507. “(2) The Secretary shall cease withholding payments from a State under paragraph (1) if the Secretary determines that there are reasonable assurances that the State will expend amounts received under section 2501(a) in accordance with the agreements referred to in such paragraph. “(3) The Secretary may not withhold funds under paragraph (1) from a State for a minor failure to comply with the agreements referred to in such paragraph. “(c) Opportunity for Hearing.—Before requiring repayment of payments under subsection (a)(1), or withholding payments under subsection (b)(1), the Secretary shall provide to the State an opportunity for a hearing conducted within the State. “(d) Prompt Response to Serious Allegations.—The Secretary shall promptly respond to any complaint of a substantial or serious nature that a State has failed to expend amounts received under section 2501(a) in accordance with the agreements required to be contained in the application submitted by the State pursuant to section 2507. “(e) Investigations.— “(1) The Secretary shall conduct in several States in each fiscal year investigations of the expenditure of payments received by the States under section 2501(a) in order to evaluate compliance with the agreements required to be contained in the applications submitted to the Secretary pursuant to section 2507. “(2) The Comptroller General of the United States may conduct investigations of the expenditure of funds received under section 2501(a) by a State in order to ensure compliance with the agreements referred to in paragraph (1). “(3) Each State, and each entity receiving funds from payments made to a State under section 2501(a), shall make appropriate books, documents, papers, and records available to the Secretary and the Comptroller General of the United States, or any of their duly authorized representatives, for examination, copying, mechanical reproduction on or off the premises of the appropriate entity upon a reasonable request therefor. “(4)(A) In conducting any investigation in a State, the Secretary and the Comptroller General of the United States may not make a request for any information not readily available to the State, or to an entity receiving funds from payments made to the State under section 2501(a), or make an unreasonable request for information to be compiled, collected, or transmitted in any form not readily available. 102 STAT. 3101 “(B) Subparagraph (a) shall not apply to the collection, compilation, or transmittal of data in the course of a judicial proceeding. “SEC. 2509. PROHIBITION AGAINST CERTAIN FALSE STATEMENTS. “(a) In General.— “(1) A person may not knowingly make or cause to be made any false statement or representation of a material fact in connection with the furnishing of items or services for which amounts may be paid by a State from payments received by the State under section 2501(a). “(2) A person with knowledge of the occurrence of any event affecting the right of the person to receive any amounts from payments made to the State under section 2501(a) may not conceal or fail to disclose any such event with the intent of fraudulently securing such amounts. “(b) Criminal Penalty for Violation of Prohibition.—Any person who violates a prohibition established in subsection (a) may for each violation be fined in accordance with title 18, United States Code, or imprisoned for not more than 5 years, or both. “SEC. 2510. TECHNICAL ASSISTANCE AND PROVISION BY SECRETARY OF SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS. “(a) Technical Assistance.—The Secretary may provide training and technical assistance to States with respect to the planning, development, and operation of any program or service carried out pursuant to this part. The Secretary may provide such technical assistance directly or through grants or contracts. “(b) Provision by Secretary of Supplies and Services in Lieu of Grant Funds.— “(1) Upon the request of a State receiving payments under this part, the Secretary may, subject to paragraph (2), provide supplies, equipment, and services for the purpose of aiding the State in carrying out such part and, for such purpose, may detail to the State any officer or employee of the Department of Health and Human Services. “(2) With respect to a request described in paragraph (1), the Secretary shall reduce the amount of payments under the program involved to the State 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. 2511. EVALUATIONS. “The Secretary shall, directly or through grants or contracts, evaluate the services provided and activities carried out with payments to States under this part. “SEC. 2512. REPORT BY SECRETARY. “The Secretary shall annually prepare a report on the activities of the States carried out pursuant to this part. Such report may include any recommendations of the Secretary for appropriate administrative and legislative initiatives. The report shall be submitted to the Congress through inclusion in the comprehensive report required in section 2301. 102 STAT. 3102 “SEC. 2513. DEFINITION. “For purposes of this part, the term ‘infection with the etiologic agent for acquired immune deficiency syndrome’ includes any condition arising from such etiologic agent. “SEC. 2514. FUNDING. “(a) Authorization of Appropriations.—For the purpose of making allotments under section 2501(a), there are authorized to be appropriated $165,000,000 for fiscal year 1989 and such sums as may be necessary for each of the fiscal years 1990 and 1991. “(b) Availability to States.—Any amounts paid to a State under section 2501(a) shall remain available to the State until the expiration of the 1-year period beginning on the date on which the State receives such amounts. “Part B—National Information Programs “SEC. 2521. AVAILABILITY OF INFORMATION TO GENERAL PUBLIC. “(a) Comprehensive Information Plan.—The Secretary, acting through the Director of the Centers for Disease Control, shall annually prepare a comprehensive plan, including a budget, for a National Acquired Immune Deficiency Syndrome Information Program. The plan shall contain provisions to implement the provisions of this title. The Director shall submit such plan to the Secretary. The authority established in this subsection may not be construed to be the exclusive authority for the Director to carry out information activities with respect to acquired immune deficiency syndrome. “(b) Clearinghouse.— “(1) The Secretary, acting through the Director of the Centers for Disease Control, may establish a clearinghouse to make information concerning acquired immune deficiency syndrome available to Federal agencies, States, public and private entities, and the general public. “(2) The clearinghouse may conduct or support programs— “(A) to develop and obtain educational materials, model curricula, and methods directed toward reducing the trans-mission of the etiologic agent for acquired immune deficiency syndrome; “(B) to provide instruction and support for individuals who provide instruction in methods and techniques of education relating to the prevention of acquired immune deficiency syndrome and instruction in the use of the materials and curricula described in subparagraph (A); and “(C) to conduct, or to provide for the conduct of, the materials, curricula, and methods described in paragraph (1) and the efficacy of such materials, curricula, and methods in preventing infection with the the etiologic agent for acquired immune deficiency syndrome. “(c) Toll-Free Telephone Communications.—The Secretary shall provide for the establishment and maintenance of toll-free telephone communications to provide information to, and respond to queries from, the public concerning acquired immune deficiency syndrome. Such communications shall be available on a 24-hour basis. 102 STAT. 3103 “SEC. 2522. PUBLIC INFORMATION CAMPAIGNS. “(a) In General.—The Secretary, acting through the Director of the Centers for Disease Control, may make grants to public entities, and to nonprofit private entities concerned with acquired immune deficiency syndrome, and shall enter into contracts with public and private entities, for the development and delivery of public service announcements and paid advertising messages that warn individuals about activities which place them at risk of infection with the etiologic agent for such syndrome. “(b) Requirement of Application.—The Secretary may not provide financial assistance under subsection (a) unless— “(1) an application for such assistance is submitted to the Secretary; “(2) with respect to carrying out the purpose for which the assistance is to be provided, 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 section. “SEC. 2523. PROVISION OF INFORMATION TO UNDERSERVED POPULATIONS. “(a) In General.—The Secretary may make grants to public entities, to migrant health centers (as defined in section 329(a)), to community health centers (as defined in section 330(a)), and to nonprofit private entities concerned with acquired immune deficiency syndrome, for the purpose of assisting grantees in providing services to populations of individuals that are underserved with respect to programs providing information on the prevention of exposure to, and the transmission of, the etiologic agent for acquired immune deficiency syndrome. “(b) Preferences in Making Grants.—In making grants under subsection (a), the Secretary shall give preference to any applicant for such a grant that has the ability to disseminate rapidly the information described in subsection (a) (including any national organization with such ability). “SEC. 2524. AUTHORIZATION OF APPROPRIATIONS. “(a) In General.—For the purpose of carrying out sections 2521 through 2523, there are authorized to be appropriated $105,000,000 for fiscal year 1989 and such sums as may be necessary for each of the fiscal years 1990 and 1991. “(b) Allocations.— “(1) Of the amounts appropriated pursuant to subsection (a), the Secretary shall make available $45,000,000 to carry out section 2522 and $30,000,000 to carry out this part through financial assistance to minority entities for the provision of services to minority populations. “(2) After consultation with the Director of the Office of Minority Health and with the Indian Health Service, the Secretary, acting through the Director of the Centers for Disease Control, shall, not later than 90 days after the date of the enactment of this section, publish guidelines to provide procedures for applications for funding pursuant to paragraph (1) and for public comment.”.