ESTABLISHMENT OF BLOCK GRANT PROGRAM.

SEC. 408. ESTABLISHMENT OF BLOCK GRANT PROGRAM. (a) In General.—Title XIX of the Public Health Service Act (42 U.S.C. 300w et seq.) is amended by adding at the end thereof the following new part: 102 STAT. 3117 “Part D—Immunosuppressive Drug Therapy Block Grant “SEC. 1931. DEFINITIONS. “For purposes of this part: “(1) Eligible patient.—The term ‘eligible patient’ means an organ transplant patient who is not eligible to receive reimbursement for the cost of immunosuppressive drug therapy under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), under the State’s medicaid plan under title XIX of such Act (42 U.S.C. 1396 et seq.), or under private insurance. “(2) Immunosuppressive drug therapy.—The term ‘immunosuppressive drug therapy’ means drugs and biologicals that are to be used for the purpose of preventing the rejection of trans-planted organs and tissues and that can be administered by the transplant patient. “(3) Transplant center.—The term ‘transplant center’ means a transplant center that is a member of the Organ Procurement and Transplantation Network established under section 372. “SEC. 1932. AUTHORIZATION OF APPROPRIATIONS. “For the purpose of making allotments to States to carry out this part, there are authorized to be appropriated $5,000,000 for each of the fiscal years 1988 through 1990. “SEC. 1933. ALLOTMENTS. “(a) Amount.— “(1) In general.—From amounts appropriated under section 1932 for each of the fiscal years 1988 through 1990, the Secretary shall allot to each State an amount that bears the same ratio to the total amount appropriated under such section for such fiscal year as the total number of eligible patients in the State bears to the total number of eligible patients in the United States. “(2) Minimum allotment.—Notwithstanding paragraph (1), the allotment of any State in any fiscal year under this subsection shall not be less than $50,000. If, under paragraph (1), the allotment of any State in any fiscal year will be less than $50,000, the Secretary shall increase the allotment of such State to $50,000 and shall proportionately reduce the allotments of all other States whose allotment exceeds $50,000 in a manner that will insure that the allotment of each State in such fiscal year is at least $50,000. “(b) Unallotted Funds.— “(1) In general.— Subject to paragraph (2), to the extent that all the funds appropriated under section 1932 for a fiscal year and available for allotment in such fiscal year are not otherwise allotted to States because— “(A) one or more States have not submitted an application or description of activities in accordance with section 1936 for such fiscal year; “(B) one or more States have notified the Secretary that they do not intend to use the full amount of their allotment; or “(C) some State allotments are offset or repaid under section 1906(b)(3) (as such section applies to this part pursuant to section 1936(d)); 102 STAT. 3118such excess shall be allotted among each of the remaining States in proportion to the amount otherwise allotted to such States for such fiscal year without regard to this subsection. “(2) Organ transplant centers.— “(A) Application.—If a State does not submit an application for an allotment or description of activities in accordance with section 1936 for a fiscal year or notifies the Secretary that the State does not intend to use the full amount of the allotment of the State, an organ transplant center in the State may submit an application in accordance with section 1936 for the amount of the allotment not allocated to the State. “(B) Allotment.—Subject to subparagraph (C), if an applicant center complies with the requirements imposed on the State by this part, the Secretary shall provide to the center the amount of the allotment not allocated to the State. “(C) Multiple applicants.—If two or more applicant centers in a State meet the requirements of subparagraph (B), the Secretary shall divide among the eligible applicant centers in an equitable manner the amount of the allotment not allocated to the State. “(D) Distribution to other states.—If one or more centers in a State receive an allotment under this paragraph for a fiscal year, the allotment shall not be made available to remaining States under paragraph (I). “SEC. 1934. PAYMENTS UNDER ALLOTMENTS TO STATES. “(a) In General.—For each fiscal year, the Secretary shall make payments, as provided by section 6503(a) of title 31, United States Code, to each State from its allotments under section 1933 from amounts appropriated for that fiscal year. “(b) Carryover Funds.—Any amount paid to a State for a fiscal year and remaining unobligated at the end of such year shall remain available for the next fiscal year to such State for the purposes for which it was made. “SEC. 1935. USE OF ALLOTMENTS. “(a) In General.— “(1) Use.—Except as provided in subsections (b) and (c), amounts paid to a State under section 1934 from its allotment under section 1933 for any fiscal year shall be used by the State to provide immunosuppressive drug therapy for eligible patients. “(2) Methods.—A State may use amounts paid to the State under section 1934 from its allotment under section 1933 to provide immunosuppressive drug therapy for eligible patients— “(A) by purchasing the drugs and biologicals for such therapy and distributing such drugs and biologicals to transplant centers or eligible patients; “(B) by certifying that an individual is an eligible patient for purposes of this part and by reimbursing a transplant center for the costs of immunosuppressive drug therapy provided by such center to such individual; “(C) by any other method prescribed by the Secretary by regulation (other than the method described in subsection (b)(1). 102 STAT. 3119 “(3) Copayments.—A State may require an eligible patient to whom immunosuppressive drug therapy is provided with amounts paid to the State under this part to make copayments for part of the costs of such therapy, without regard to section 1916 of the Social Security Act (42 U.S.C. 1396o). “(b) Limitations.—A State may not use amounts paid to it under section 1934 to— “(1) make direct payments to organ transplant patients; or “(2) satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funds. “(c) Administrative Costs.—Not more than 10 percent of the total amount paid to any State under section 1934 from its allotment under section 1933 for any fiscal year may be used for administering the funds made available under section 1934. The State will pay from non-Federal sources the remaining costs of administering such funds. “SEC. 1936. APPLICATION AND DESCRIPTION OF ACTIVITIES; REQUIREMENTS. “(a) Application Required.—In order to receive an allotment for a fiscal year under section 1933, each State shall submit an application to the Secretary. Each such application shall be in such form and submitted by such date as the Secretary shall require. Each such application shall contain assurances that the State will meet the requirements of subsection (b). “(b) Requirements.—As part of the annual application required by subsection (a), the chief executive officer of each State shall— “(1) certify that the State agrees to use the funds allotted to the State under section 1933 in accordance with the requirements of this part; “(2) agrees to cooperate with Federal investigations under-taken in accordance with section 1907 (as such section applies to this part pursuant to subsection (d) of this section); and “(3) certify that the State agrees that Federal funds made available under section 1934 for any period will be so used as to supplement and increase the level of State, local, and other non-Federal funds that would in the absence of such Federal funds be made available for the activities for which funds are provided under such section and will in no event supplant such State, local, and other non-Federal funds. “(c) Description of Activities.— “(1) In general.—The chief executive officer of a State shall, as part of the application required by subsection (a), also prepare and furnish the Secretary (in accordance with such form as the Secretary shall provide) with a description of the intended use of the payments the State will receive under section 1934 for the fiscal year for which the application is submitted, including information on the programs and activities to be supported. “(2) Public comment.—The description shall be made public within the State in such manner as to facilitate comment from any person (including any Federal or other public agency) during development of the description and after its transmittal. “(3) Revisions.—The description shall be revised (consistent with this section) throughout the year as may be necessary to reflect substantial changes in the programs and activities assisted by the State under this part. Any revision shall be subject to paragraph (2). 102 STAT. 3120 “(d) Administration.—Unless inconsistent with this part, section 1903(b), section 1906(a), paragraphs (1) through (5) of section 1906(b), and sections 1907, 1908, and 1909 shall apply to this part in the same manner as such provisions apply to part A of this title. “(e) Additional Information.—Each annual report submitted by a State to the Secretary under section 1906(a) (as such section applies to this part pursuant to subsection (d) of this section) with respect to its activities under this part shall contain— “(1) a specification of the number of eligible patients in the State receiving immunosuppressive drug therapy with amounts paid to the State under this part; “(2) a description of the amount of any copayment required by the State under section 1935(a)(3); and “(3) a certification that amounts paid to the State under this part are being used in accordance with this part, “SEC. 1937. TERMINATION DATE. “The amendments made under part D of this Act shall terminate effective January 1, 1991.”. (b) Report.— (1) In general.—Not later than 24 months after the date of enactment of this Act, the Secretary of Health and Human Services shall prepare and transmit to the Congress a report concerning the impact of part D of title XIX of the Public Health Service Act (as added by section 407 of this title). (2) Contents.—The report shall contain— (A) a description of the effect of the program established under such part on organ transplants in the United States; (B) an analysis of the effects of such program on the costs of organ transplants and renal dialysis; (C) an analysis of the extent to which amounts paid to States under such part are used for purposes other than the purposes specified by such part, including an analysis of the extent to which drugs and biologicals purchased with such amounts are provided to individuals who are not eligible patients under such part; and (D) such recommendations as the Secretary considers appropriate, including recommendations as to whether financial assistance under such program should be continued during fiscal years after fiscal year 1990.