[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1793 Engrossed in Senate (ES)]
111th CONGRESS
1st Session
S. 1793
_______________________________________________________________________
AN ACT
To amend title XXVI of the Public Health Service Act to revise and
extend the program for providing life-saving care for those with HIV/
AIDS.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; REFERENCES.
(a) Short Title.--This Act may be cited as the ``Ryan White HIV/
AIDS Treatment Extension Act of 2009''.
(b) References.--Except as otherwise specified, whenever in this
Act an amendment is expressed in terms of an amendment to a section or
other provision, the reference shall be considered to be made to a
section or other provision of the Public Health Service Act (42 U.S.C.
201 et seq.).
SEC. 2. REAUTHORIZATION OF HIV HEALTH CARE SERVICES PROGRAM.
(a) Elimination of Sunset Provision.--
(1) In general.--The Ryan White HIV/AIDS Treatment
Modernization Act of 2006 (Public Law 109-415; 120 Stat. 2767)
is amended by striking section 703.
(2) Effective date.--Paragraph (1) shall take effect as if
enacted on September 30, 2009.
(3) Contingency provisions.--Notwithstanding section 703 of
the Ryan White HIV/AIDS Treatment Modernization Act of 2006
(Public Law 109-415; 120 Stat. 2767) and section 139 of the
Continuing Appropriations Resolution, 2010--
(A) the provisions of title XXVI of the Public
Health Service Act (42 U.S.C. 300ff et seq.), as in
effect on September 30, 2009, are hereby revived; and
(B) the amendments made by this Act to title XXVI
of the Public Health Service Act (42 U.S.C. 300ff et
seq.) shall apply to such title as so revived and shall
take effect as if enacted on September 30, 2009.
(b) Part A Grants.--Section 2610(a) (42 U.S.C. 300ff-20(a)) is
amended by striking ``and $649,500,000 for fiscal year 2009'' and
inserting ``$649,500,000 for fiscal year 2009, $681,975,000 for fiscal
year 2010, $716,074,000 for fiscal year 2011, $751,877,000 for fiscal
year 2012, and $789,471,000 for fiscal year 2013''.
(c) Part B Grants.--Section 2623(a) (42 U.S.C. 300ff-32(a)) is
amended by striking ``and $1,285,200,000 for fiscal year 2009'' and
inserting ``$1,285,200,000 for fiscal year 2009, $1,349,460,000 for
fiscal year 2010, $1,416,933,000 for fiscal year 2011, $1,487,780,000
for fiscal year 2012, and $1,562,169,000 for fiscal year 2013''.
(d) Part C Grants.--Section 2655 (42 U.S.C. 300ff-55) is amended by
striking ``and $235,100,000 for fiscal year 2009'' and inserting
``$235,100,000 for fiscal year 2009, $246,855,000 for fiscal year 2010,
$259,198,000 for fiscal year 2011, $272,158,000 for fiscal year 2012,
and $285,766,000 for fiscal year 2013''.
(e) Part D Grants.--Section 2671(i) (42 U.S.C. 300ff-71(i)) is
amended by inserting before the period at the end ``, $75,390,000 for
fiscal year 2010, $79,160,000 for fiscal year 2011, $83,117,000 for
fiscal year 2012, and $87,273,000 for fiscal year 2013''.
(f) Demonstration and Training Grants Under Part F.--
(1) HIV/AIDS communities, schools, and centers.--Section
2692(c) (42 U.S.C. 300ff-111(c)) is amended--
(A) in paragraph (1)--
(i) by striking ``is authorized'' and
inserting ``are authorized''; and
(ii) by inserting before the period at the
end ``, $36,535,000 for fiscal year 2010,
$38,257,000 for fiscal year 2011, $40,170,000
for fiscal year 2012, and $42,178,000 for
fiscal year 2013'' ; and
(B) in paragraph (2)--
(i) by striking ``is authorized'' and
inserting ``are authorized''; and
(ii) by inserting before the period at the
end ``, $13,650,000 for fiscal year 2010,
$14,333,000 for fiscal year 2011, $15,049,000
for fiscal year 2012, and $15,802,000 for
fiscal year 2013''.
(2) Minority aids initiative.--Section 2693 (42 U.S.C.
300ff-121) is amended--
(A) in subsection (a), by striking ``and
$139,100,000 for fiscal year 2009.'' and inserting
``$139,100,000 for fiscal year 2009, $146,055,000 for
fiscal year 2010, $153,358,000 for fiscal year 2011,
$161,026,000 for fiscal year 2012, and $169,077,000 for
fiscal year 2013. The Secretary shall develop a formula
for the awarding of grants under subsections (b)(1)(A)
and (b)(1)(B) that ensures that funding is provided
based on the distribution of populations
disproportionately impacted by HIV/AIDS.'';
(B) in subsection (b)(2)--
(i) in subparagraph (A)--
(I) in the matter preceding clause
(i), by striking ``competitive,''; and
(II) by adding at the end the
following:
``(iv) For fiscal year 2010, $46,738,000.
``(v) For fiscal year 2011, $49,075,000.
``(vi) For fiscal year 2012, $51,528,000.
``(vii) For fiscal year 2013,
$54,105,000.'';
(ii) in subparagraph (B)--
(I) in the matter preceding clause
(i), by striking ``competitive''; and
(II) by adding at the end the
following:
``(iv) For fiscal year 2010, $8,763,000.
``(v) For fiscal year 2011, $9,202,000.
``(vi) For fiscal year 2012, $9,662,000.
``(vii) For fiscal year 2013,
$10,145,000.'';
(iii) in subparagraph (C), by adding at the
end the following:
``(iv) For fiscal year 2010, $61,343,000.
``(v) For fiscal year 2011, $64,410,000.
``(vi) For fiscal year 2012, $67,631,000.
``(vii) For fiscal year 2013,
$71,012,000.'';
(iv) in subparagraph (D), by striking
``$18,500,000'' and all that follows through
the period and inserting the following: ``the
following, as applicable:
``(i) For fiscal year 2010, $20,448,000.
``(ii) For fiscal year 2011, $21,470,000.
``(iii) For fiscal year 2012, $22,543,000.
``(iv) For fiscal year 2013,
$23,671,000.''; and
(v) in subparagraph (E), by striking
``$8,500,000'' and all that follows through the
period and inserting the following: ``the
following, as applicable:
``(i) For fiscal year 2010, $8,763,000.
``(ii) For fiscal year 2011, $9,201,000.
``(iii) For fiscal year 2012, $9,662,000.
``(iv) For fiscal year 2013,
$10,144,000.''; and
(C) by adding at the end the following:
``(d) Synchronization of Minority AIDS Initiative.--For fiscal year
2010 and each subsequent fiscal year, the Secretary shall incorporate
and synchronize the schedule of application submissions and funding
availability under this section with the schedule of application
submissions and funding availability under the corresponding provisions
of this title XXVI as follows:
``(1) The schedule for carrying out subsection (b)(1)(A)
shall be the same as the schedule applicable to emergency
assistance under part A.
``(2) The schedule for carrying out subsection (b)(1)(B)
shall be the same as the schedule applicable to care grants
under part B.
``(3) The schedule for carrying out subsection (b)(1)(C)
shall be the same as the schedule applicable to grants for
early intervention services under part C.
``(4) The schedule for carrying out subsection (b)(1)(D)
shall be the same as the schedule applicable to grants for
services through projects for HIV-related care under part D.
``(5) The schedule for carrying out subsection (b)(1)(E)
shall be the same as the schedule applicable to grants and
contracts for activities through education and training centers
under section 2692.''.
(3) HHS report.--Not later than 6 months after the
publication of the Government Accountability Office Report on
the Minority Aids Initiative described in section 2686, the
Secretary of Health and Human Services shall submit to the
appropriate committees of Congress a Departmental plan for
using funding under section 2693 of the Public Health Service
Act (42 U.S.C. 300ff-93) in all relevant agencies to build
capacity, taking into consideration the best practices included
in such Report.
(g) GAO Report.--Section 2686 (42 U.S.C. 300ff-86) is amended to
read as follows:
``SEC. 2686. GAO REPORT.
``The Comptroller General of the Government Accountability Office
shall, not less than 1 year after the date of enactment of the Ryan
White HIV/AIDS Treatment Extension Act of 2009, submit to the
appropriate committees of Congress a report describing Minority AIDS
Initiative activities across the Department of Health and Human
Services, including programs under this title and programs at the
Centers for Disease Control and Prevention, the Substance Abuse and
Mental Health Services Administration, and other departmental agencies.
Such report shall include a history of program activities within each
relevant agency and a description of activities conducted, people
served and types of grantees funded, and shall collect and describe
best practices in community outreach and capacity-building of community
based organizations serving the communities that are disproportionately
affected by HIV/AIDS.''.
SEC. 3. EXTENDED EXEMPTION PERIOD FOR NAMES-BASED REPORTING.
(a) Part A Grants.--Section 2603(a)(3) (42 U.S.C. 300ff-13(a)(3))
is amended--
(1) in subparagraph (C)--
(A) in clause (ii)--
(i) in the matter preceding subclause (I),
by striking ``2009'' and inserting ``2012'';
and
(ii) in subclause (II), by striking ``or
2009'' and inserting ``or a subsequent fiscal
year through fiscal year 2012'';
(B) in clause (iv), by striking ``2010'' and
inserting ``2012'';
(C) in clause (v), by inserting ``or a subsequent
fiscal year'' after ``2009'';
(D) in clause (vi)(II), by inserting after ``5
percent'' the following: ``for fiscal years before
fiscal year 2012 (and 6 percent for fiscal year
2012)'';
(E) in clause (ix)(II)--
(i) by striking ``2010'' and inserting
``2013''; and
(ii) by striking ``2009'' and inserting
``2012''; and
(F) by adding at the end the following:
``(xi) Future fiscal years.--For fiscal
years beginning with fiscal year 2013,
determinations under this paragraph shall be
based only on living names-based cases of HIV/
AIDS with respect to the area involved.''; and
(2) in subparagraph (D)--
(A) in clause (i)--
(i) in the matter preceding subclause (I),
by striking ``2009'' and inserting ``2012'';
and
(ii) in subclause (II), by striking ``and
2009'' and inserting ``through 2012''; and
(B) in clause (ii), by striking ``2009'' and
inserting ``2012''.
(b) Part B Grants.--Section 2618(a)(2) (42 U.S.C. 300ff-28(a)(2))
is amended--
(1) in subparagraph (D)--
(A) in clause (ii)--
(i) in the matter preceding subclause (I),
by striking ``2009'' and inserting ``2012'';
and
(ii) in subclause (II), by striking ``or
2009'' and inserting ``or a subsequent fiscal
year through fiscal year 2012'';
(B) in clause (iv), by striking ``2010'' and
inserting ``2012'';
(C) in clause (v), by inserting ``or a subsequent
fiscal year'' after ``2009'';
(D) in clause (vi)(II), by inserting after ``5
percent'' the following: ``for fiscal years before
fiscal year 2012 (and 6 percent for fiscal year
2012)'';
(E) in clause (viii)(II)--
(i) by striking ``2010'' and inserting
``2013''; and
(ii) by striking ``2009'' and inserting
``2012''; and
(F) by adding at the end the following:
``(x) Future fiscal years.--For fiscal
years beginning with fiscal year 2013,
determinations under this paragraph shall be
based only on living names-based cases of HIV/
AIDS with respect to the State involved.''; and
(2) in subparagraph (E), by striking ``2009'' each place it
appears and inserting ``2012''.
SEC. 4. EXTENSION OF TRANSITIONAL GRANT AREA STATUS.
(a) Eligibility.--Section 2609 (42 U.S.C. 300ff-19) is amended--
(1) in subsection (c)(1)--
(A) in the heading, by striking ``2007'' and
inserting ``2011''; and
(B) by striking ``2007'' each place it appears and
inserting ``2011''; and
(C) by striking ``2006'' and inserting ``2010'';
(2) in subsection (c)(2)--
(A) in subparagraph (A)(ii), by striking ``to have
a'' and inserting ``subject to subparagraphs (B) and
(C), to have a'';
(B) by redesignating subparagraph (B) as
subparagraph (C);
(C) by inserting after subparagraph (A) the
following:
``(B) Permitting margin of error applicable to
certain metropolitan areas.--In applying subparagraph
(A)(ii) for a fiscal year after fiscal year 2008, in
the case of a metropolitan area that has a cumulative
total of at least 1,400 (and fewer than 1,500) living
cases of AIDS as of December 31 of the most recent
calendar year for which such data is available, such
area shall be treated as having met the criteria of
such subparagraph if not more than 5 percent of the
total from grants awarded to such area under this part
is unobligated as of the end of the most recent fiscal
year for which such data is available.''; and
(D) in subparagraph (C), as so redesignated, by
striking ``Subparagraph (A) does not apply'' and
inserting ``Subparagraphs (A) and (B) do not apply'';
and
(3) in subsection (d)(1)(B), strike ``2009'' and insert
``2013''.
(b) Transfer of Amounts Due to Change in Status as Transitional
Area.--Subparagraph (B) of section 2610(c)(2) (42 U.S.C. 300ff-
20(c)(2)) is amended--
(1) by striking ``(B)'' and inserting ``(B)(i) subject to
clause (ii),'';
(2) by striking the period at the end and inserting ``;
and''; and
(3) by adding at the end the following:
``(ii) for each of fiscal years 2010 through 2013,
notwithstanding subsection (a)--
``(I) there shall be transferred to the
State containing the metropolitan area, for
purposes described in section 2612(a), an
amount (which shall not be taken into account
in applying section 2618(a)(2)(H)) equal to--
``(aa) for the first fiscal year of
the metropolitan area not being a
transitional area, 75 percent of the
amount described in subparagraph (A)(i)
for such area;
``(bb) for the second fiscal year
of the metropolitan area not being a
transitional area, 50 percent of such
amount; and
``(cc) for the third fiscal year of
the metropolitan area not being a
transitional area, 25 percent of such
amount; and
``(II) there shall be transferred and made
available for grants pursuant to section
2618(a)(1) for the fiscal year, in addition to
amounts available for such grants under section
2623, an amount equal to the total amount of
the reduction for such fiscal year under
subparagraph (A), less the amount transferred
for such fiscal year under subclause (I).''.
SEC. 5. HOLD HARMLESS.
(a) Part A Grants.--Section 2603(a)(4) (42 U.S.C. 300ff-13(a)(4))
is amended--
(1) in the matter preceding clause (i) in subparagraph
(A)--
(A) by striking ``2006'' and inserting ``2009'';
and
(B) by striking ``2007 through 2009'' and inserting
``2010 through 2013'';
(2) by striking clauses (i) and (ii) in subparagraph (A)
and inserting the following:
``(i) For fiscal year 2010, an amount equal
to 95 percent of the sum of the amount of the
grant made pursuant to paragraph (3) and this
paragraph for fiscal year 2009.
``(ii) For each of the fiscal years 2011
and 2012, an amount equal to 100 percent of the
amount of the grant made pursuant to paragraph
(3) and this paragraph for fiscal year 2010.
``(iii) For fiscal year 2013, an amount
equal to 92.5 percent of the amount of the
grant made pursuant to paragraph (3) and this
paragraph for fiscal year 2012.''; and
(3) in subparagraph (C), by striking ``2009'' and inserting
``2013''.
(b) Part B Grants.--Section 2618(a)(2)(H) (42 U.S.C. 300ff-
28(a)(2)(H)) is amended--
(1) in clause (i)(I)--
(A) by striking ``2007'' and inserting ``2010'';
and
(B) by striking ``2006'' and inserting ``2009'';
(2) by striking clause (ii) and redesignating clause (iii)
as clause (ii);
(3) in clause (ii), as so redesignated--
(A) in the heading, by striking ``2008 and 2009''
and inserting ``2011 and 2012'';
(B) by striking ``2008 and 2009'' and inserting
``2011 and 2012''; and
(C) by striking ``2007'' and inserting ``2010'';
(4) by inserting after clause (ii), as so redesignated, the
following new clause:
``(iii) Fiscal year 2013.--For fiscal year
2013, the Secretary shall ensure that the total
for a State of the grant pursuant to paragraph
(1) and the grant pursuant to subparagraph (F)
is not less than 92.5 percent of such total for
the State for fiscal year 2012.''; and
(5) in clause (v), by striking ``2009'' and inserting
``2013''.
(c) Technical Corrections.--Title XXVI (42 U.S.C. 300ff-11 et seq.)
is amended--
(1) in subparagraphs (A)(i) and (H) of section 2618(a)(2),
by striking the term ``subparagraph (G)'' each place it appears
and inserting ``subparagraph (F)'';
(2) in sections 2620(a)(2), 2622(c)(1), and 2622(c)(4)(A),
by striking ``2618(a)(2)(G)(i)'' and inserting
``2618(a)(2)(F)(i)'';
(3) in sections 2622(a) and 2623(b)(2)(A), by striking
``2618(a)(2)(G)'' and inserting ``2618(a)(2)(F)''; and
(4) in section 2622(b), by striking ``2618(a)(2)(G)(ii)''
and inserting ``2618(a)(2)(F)(ii)''.
SEC. 6. AMENDMENTS TO THE GENERAL GRANT PROVISIONS.
(a) Administration and Planning Council.--Section 2602(b)(4) (42
U.S.C. 300ff-12(b)(4)) is amended--
(1) in subparagraph (A), by inserting ``, as well as the
size and demographics of the estimated population of
individuals with HIV/AIDS who are unaware of their HIV status''
after ``HIV/AIDS'';
(2) in subparagraph (B)--
(A) in clause (i), by striking ``and'' at the end
after the semicolon;
(B) in clause (ii), by inserting ``and'' after the
semicolon; and
(C) by adding at the end the following:
``(iii) individuals with HIV/AIDS who do
not know their HIV status;''; and
(3) in subparagraph (D)--
(A) in clause (ii), by striking ``and'' at the end
after the semicolon;
(B) in clause (iii), by inserting ``and'' after the
semicolon; and
(C) by adding at the end the following:
``(iv) includes a strategy, coordinated as
appropriate with other community strategies and
efforts, including discrete goals, a timetable,
and appropriate funding, for identifying
individuals with HIV/AIDS who do not know their
HIV status, making such individuals aware of
such status, and enabling such individuals to
use the health and support services described
in section 2604, with particular attention to
reducing barriers to routine testing and
disparities in access and services among
affected subpopulations and historically
underserved communities;''.
(b) Type and Distribution of Grants.--Section 2603(b) (42 U.S.C.
300ff-13(b)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (G), by striking ``and'' at the
end after the semicolon;
(B) in subparagraph (H), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following:
``(I) demonstrates success in identifying
individuals with HIV/AIDS as described in clauses (i)
through (iii) of paragraph (2)(A).''; and
(2) in paragraph (2)(A), by striking the period and
inserting: ``, and demonstrated success in identifying
individuals with HIV/AIDS who do not know their HIV status and
making them aware of such status counting one-third. In making
such determination, the Secretary shall consider--
``(i) the number of individuals who have
been tested for HIV/AIDS;
``(ii) of those individuals described in
clause (i), the number of individuals who
tested for HIV/AIDS who are made aware of their
status, including the number who test positive;
and
``(iii) of those individuals described in
clause (ii), the number who have been referred
to appropriate treatment and care.''.
(c) Application.--Section 2605(b)(1) (42 U.S.C. 300ff-15(b)(1)) is
amended by inserting ``, including the identification of individuals
with HIV/AIDS as described in clauses (i) through (iii) of section
2603(b)(2)(A)'' before the semicolon at the end.
SEC. 7. INCREASE IN ADJUSTMENT FOR NAMES-BASED REPORTING.
(a) Part A Grants.--
(1) Formula grants.--Section 2603(a)(3)(C)(vi) (42 U.S.C.
300ff-13(a)(3)(C)(vi)) is amended by adding at the end the
following:
``(III) Increased adjustment for
certain areas previously using code-
based reporting.--For purposes of this
subparagraph for each of fiscal years
2010 through 2012, the Secretary shall
deem the applicable number of living
cases of HIV/AIDS in an area that were
reported to and confirmed by the
Centers for Disease Control and
Prevention to be 3 percent higher than
the actual number if--
``(aa) for fiscal year
2007, such area was a
transitional area;
``(bb) fiscal year 2007 was
the first year in which the
count of living non-AIDS cases
of HIV in such area, for
purposes of this section, was
based on a names-based
reporting system; and
``(cc) the amount of
funding that such area received
under this part for fiscal year
2007 was less than 70 percent
of the amount of funding
(exclusive of funds that were
identified as being for
purposes of the Minority AIDS
Initiative) that such area
received under such part for
fiscal year 2006.''.
(2) Supplemental grants.--Section 2603(b)(2) (42 U.S.C.
300ff-13(b)(2)) is amended by adding at the end the following:
``(D) Increased adjustment for certain areas
previously using code-based reporting.--For purposes of
this subsection for each of fiscal years 2010 through
2012, the Secretary shall deem the applicable number of
living cases of HIV/AIDS in an area that were reported
to and confirmed by the Centers for Disease Control and
Prevention to be 3 percent higher than the actual
number if the conditions described in items (aa)
through (cc) of subsection (a)(3)(C)(vi)(III) are all
satisfied.''.
(b) Part B Grants.--Section 2618(a)(2)(D)(vi) (42 U.S.C. 300ff-
28(a)(2)(D)(vi)) is amended by adding at the end the following:
``(III) Increased adjustment for
certain states previously using code-
based reporting.--For purposes of this
subparagraph for each of fiscal years
2010 through 2012, the Secretary shall
deem the applicable number of living
cases of HIV/AIDS in a State that were
reported to and confirmed by the
Centers for Disease Control and
Prevention to be 3 percent higher than
the actual number if--
``(aa) there is an area in
such State that satisfies all
of the conditions described in
items (aa) through (cc) of
section 2603(a)(3)(C)(vi)(III);
or
``(bb)(AA) fiscal year 2007
was the first year in which the
count of living non-AIDS cases
of HIV in such area, for
purposes of this part, was
based on a names-based
reporting system; and
``(BB) the amount of
funding that such State
received under this part for
fiscal year 2007 was less than
70 percent of the amount of
funding that such State
received under such part for
fiscal year 2006.''.
SEC. 8. TREATMENT OF UNOBLIGATED FUNDS.
(a) Eligibility for Supplemental Grants.--Title XXVI (42 U.S.C.
300ff-11 et seq.) is amended--
(1) in section 2603(b)(1)(H) (42 U.S.C. 300ff-13(b)(1)(H)),
by striking ``2 percent'' and inserting ``5 percent''; and
(2) in section 2620(a)(2) (42 U.S.C. 300ff-29a(a)(2)), by
striking ``2 percent'' and inserting ``5 percent''.
(b) Corresponding Reduction in Future Grant.--
(1) In general.--Title XXVI (42 U.S.C. 300ff-11 et seq.) is
amended--
(A) in section 2603(c)(3)(D)(i)(42 U.S.C. 300ff-
13(c)(3)(D)(i)), in the matter following subclause
(II), by striking ``2 percent'' and inserting ``5
percent''; and
(B) in section 2622(c)(4)(A) (42 U.S.C. 300ff-
31a(c)(4)(A)), in the matter following clause (ii), by
striking ``2 percent'' and inserting ``5 percent''.
(2) Authority regarding administration of provision.--Title
XXVI (42 U.S.C. 300ff-11 et seq.) is amended--
(A) in section 2603(c) (42 U.S.C. 300ff-13(c)), by
adding at the end the following:
``(4) Authority regarding administration of provisions.--In
administering paragraphs (2) and (3) with respect to the
unobligated balance of an eligible area, the Secretary may
elect to reduce the amount of future grants to the area under
subsection (a) or (b), as applicable, by the amount of any such
unobligated balance in lieu of cancelling such amount as
provided for in paragraph (2) or (3)(A). In such case, the
Secretary may permit the area to use such unobligated balance
for purposes of any such future grant. An amount equal to such
reduction shall be available for use as additional amounts for
grants pursuant to subsection (b), subject to subsection (a)(4)
and section 2610(d)(2). Nothing in this paragraph shall be
construed to affect the authority of the Secretary under
paragraphs (2) and (3), including the authority to grant
waivers under paragraph (3)(A). The reduction in future grants
authorized under this paragraph shall be notwithstanding the
penalty required under paragraph (3)(D) with respect to
unobligated funds.'';
(B) in section 2622 (42 U.S.C. 300ff-31a), by
adding at the end the following:
``(e) Authority Regarding Administration of Provisions.--In
administering subsections (b) and (c) with respect to the unobligated
balance of a State, the Secretary may elect to reduce the amount of
future grants to the State under section 2618, 2620, or 2621, as
applicable, by the amount of any such unobligated balance in lieu of
cancelling such amount as provided for in subsection (b) or (c)(1). In
such case, the Secretary may permit the State to use such unobligated
balance for purposes of any such future grant. An amount equal to such
reduction shall be available for use as additional amounts for grants
pursuant to section 2620, subject to section 2618(a)(2)(H). Nothing in
this paragraph shall be construed to affect the authority of the
Secretary under subsections (b) and (c), including the authority to
grant waivers under subsection (c)(1). The reduction in future grants
authorized under this subsection shall be notwithstanding the penalty
required under subsection (c)(4) with respect to unobligated funds.'';
(C) in section 2603(b)(1)(H) (42 U.S.C. 300ff-
13(b)(1)(H)), by striking ``canceled'' and inserting
``canceled, offset under subsection (c)(4),''; and
(D) in section 2620(a)(2) (42 U.S.C. 300ff-
29a(a)(2)), by striking ``canceled'' and inserting
``canceled, offset under section 2622(e),''.
(c) Consideration of Waiver Amounts in Determining Unobligated
Balances.--
(1) Part a grants.--Section 2603(c)(3)(D)(i)(I) (42 U.S.C.
300ff-14(c)(3)(D)(i)(I)) is amended by inserting after
``unobligated balance'' the following: ``(less any amount of
such balance that is the subject of a waiver of cancellation
under subparagraph (A))''.
(2) Part b grants.--Section 2622(c)(4)(A)(i) (42 U.S.C.
300ff--31a(c)(4)(A)(i)) is amended by inserting after
``unobligated balance'' the following: ``(less any amount of
such balance that is the subject of a waiver of cancellation
under paragraph (1))''.
SEC. 9. APPLICATIONS BY STATES.
Section 2617(b) (42 U.S.C. Section 300ff-27(b)) is amended--
(1) in paragraph (6), by striking ``and'' at the end;
(2) in paragraph (7), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(8) a comprehensive plan--
``(A) containing an identification of individuals
with HIV/AIDS as described in clauses (i) through (iii)
of section 2603(b)(2)(A) and the strategy required
under section 2602(b)(4)(D)(iv);
``(B) describing the estimated number of
individuals within the State with HIV/AIDS who do not
know their status;
``(C) describing activities undertaken by the State
to find the individuals described in subparagraph (A)
and to make such individuals aware of their status;
``(D) describing the manner in which the State will
provide undiagnosed individuals who are made aware of
their status with access to medical treatment for their
HIV/AIDS; and
``(E) describing efforts to remove legal barriers,
including State laws and regulations, to routine
testing.''.
SEC. 10. ADAP REBATE FUNDS.
(a) Use of Unobligated Funds.--Section 2622(d) (42 U.S.C. 300ff-
31a(d)) is amended by adding at the end the following: ``If an
expenditure of ADAP rebate funds would trigger a penalty under this
section or a higher penalty than would otherwise have applied, the
State may request that for purposes of this section, the Secretary deem
the State's unobligated balance to be reduced by the amount of rebate
funds in the proposed expenditure. Notwithstanding 2618(a)(2)(F), any
unobligated amount under section 2618(a)(2)(F)(ii)(V) that is returned
to the Secretary for reallocation shall be used by the Secretary for--
``(1) the ADAP supplemental program if the Secretary
determines appropriate; or
``(2) for additional amounts for grants pursuant to section
2620.''.
(b) Technical Correction.--Subclause (V) of section
2618(a)(2)(F)(ii) (42 U.S.C. 300ff-28(a)(2)(F)(ii)) is amended by
striking ``, subject to subclause (VI)''.
SEC. 11. APPLICATION TO PRIMARY CARE SERVICES.
(a) In General.--Section 2671 (42 U.S.C. 300ff-71), as amended, is
amended--
(1) by redesignating subsection (i) as subsection (j);
(2) in subsection (g), by striking ``subsection (i)'' and
inserting ``subsection (j)''; and
(3) by inserting after subsection (h) the following:
``(i) Application to Primary Care Services.--Nothing in this part
shall be construed as requiring funds under this part to be used for
primary care services when payments are available for such services
from other sources (including under titles XVIII, XIX, and XXI of the
Social Security Act).''.
(b) Provision of Care Through Memorandum of Understanding.--Section
2671(a) (42 U.S.C. 300ff-71(a)) is amended by striking ``(directly or
through contracts)'' and inserting ``(directly or through contracts or
memoranda of understanding)''.
SEC. 12. NATIONAL HIV/AIDS TESTING GOAL.
Part E of title XXVI (42 U.S.C. 300ff-81 et seq.) is amended--
(1) by redesignating section 2688 as section 2689; and
(2) by inserting after section 2687 the following:
``SEC. 2688. NATIONAL HIV/AIDS TESTING GOAL.
``(a) In General.--Not later than January 1, 2010, the Secretary
shall establish a national HIV/AIDS testing goal of 5,000,000 tests for
HIV/AIDS annually through federally-supported HIV/AIDS prevention,
treatment, and care programs, including programs under this title and
other programs administered by the Centers for Disease Control and
Prevention.
``(b) Annual Report.--Not later than January 1, 2011, and annually
thereafter, the Secretary, acting through the Director of the Centers
for Disease Control and Prevention, shall submit to Congress a report
describing, with regard to the preceding 12-month reporting period--
``(1) whether the testing goal described in subsection (a)
has been met;
``(2) the total number of individuals tested through
federally-supported and other HIV/AIDS prevention, treatment,
and care programs in each State;
``(3) the number of individuals who--
``(A) prior to such 12-month period, were unaware
of their HIV status; and
``(B) through federally-supported and other HIV/
AIDS prevention, treatment, and care programs, were
diagnosed and referred into treatment and care during
such period;
``(4) any barriers, including State laws and regulations,
that the Secretary determines to be a barrier to meeting the
testing goal described in subsection (a);
``(5) the amount of funding the Secretary determines
necessary to meet the annual testing goal in the following 12
months and the amount of Federal funding expended to meet the
testing goal in the prior 12-month period; and
``(6) the most cost-effective strategies for identifying
and diagnosing individuals who were unaware of their HIV
status, including voluntary testing with pre-test counseling,
routine screening including opt-out testing, partner counseling
and referral services, and mass media campaigns.
``(c) Review of Program Effectiveness.--Not later than 1 year after
the date of enactment of this section, the Secretary, in consultation
with the Director of the Centers for Disease Control and Prevention,
shall submit a report to Congress based on a comprehensive review of
each of the programs and activities conducted by the Centers for
Disease Control and Prevention as part of the Domestic HIV/AIDS
Prevention Activities, including the following:
``(1) The amount of funding provided for each program or
activity.
``(2) The primary purpose of each program or activity.
``(3) The annual goals for each program or activity.
``(4) The relative effectiveness of each program or
activity with relation to the other programs and activities
conducted by the Centers for Disease Control and Prevention,
based on the--
``(A) number of previously undiagnosed individuals
with HIV/AIDS made aware of their status and referred
into the appropriate treatment;
``(B) amount of funding provided for each program
or activity compared to the number of undiagnosed
individuals with HIV/AIDS made aware of their status;
``(C) program's contribution to the National HIV/
AIDS testing goal; and
``(D) progress made toward the goals described in
paragraph (3).
``(5) Recommendations if any to Congress on ways to
allocate funding for domestic HIV/AIDS prevention activities
and programs in order to achieve the National HIV/AIDS testing
goal.
``(d) Coordination With Other Federal Activities.--In pursuing the
National HIV/AIDS testing goal, the Secretary, where appropriate, shall
consider and coordinate with other national strategies conducted by the
Federal Government to address HIV/AIDS.''.
SEC. 13. NOTIFICATION OF POSSIBLE EXPOSURE TO INFECTIOUS DISEASES.
Title XXVI (42 U.S.C. 300ff-11 et seq.) is amended by adding at the
end the following:
``PART G--NOTIFICATION OF POSSIBLE EXPOSURE TO INFECTIOUS DISEASES
``SEC. 2695. INFECTIOUS DISEASES AND CIRCUMSTANCES RELEVANT TO
NOTIFICATION REQUIREMENTS.
``(a) In General.--Not later than 180 days after the date of the
enactment of this part, the Secretary shall complete the development
of--
``(1) a list of potentially life-threatening infectious
diseases, including emerging infectious diseases, to which
emergency response employees may be exposed in responding to
emergencies;
``(2) guidelines describing the circumstances in which such
employees may be exposed to such diseases, taking into account
the conditions under which emergency response is provided; and
``(3) guidelines describing the manner in which medical
facilities should make determinations for purposes of section
2695B(d).
``(b) Specification of Airborne Infectious Diseases.--The list
developed by the Secretary under subsection (a)(1) shall include a
specification of those infectious diseases on the list that are
routinely transmitted through airborne or aerosolized means.
``(c) Dissemination.--The Secretary shall--
``(1) transmit to State public health officers copies of
the list and guidelines developed by the Secretary under
subsection (a) with the request that the officers disseminate
such copies as appropriate throughout the States; and
``(2) make such copies available to the public.
``SEC. 2695A. ROUTINE NOTIFICATIONS WITH RESPECT TO AIRBORNE INFECTIOUS
DISEASES IN VICTIMS ASSISTED.
``(a) Routine Notification of Designated Officer.--
``(1) Determination by treating facility.--If a victim of
an emergency is transported by emergency response employees to
a medical facility and the medical facility makes a
determination that the victim has an airborne infectious
disease, the medical facility shall notify the designated
officer of the emergency response employees who transported the
victim to the medical facility of the determination.
``(2) Determination by facility ascertaining cause of
death.--If a victim of an emergency is transported by emergency
response employees to a medical facility and the victim dies at
or before reaching the medical facility, the medical facility
ascertaining the cause of death shall notify the designated
officer of the emergency response employees who transported the
victim to the initial medical facility of any determination by
the medical facility that the victim had an airborne infectious
disease.
``(b) Requirement of Prompt Notification.--With respect to a
determination described in paragraph (1) or (2) of subsection (a), the
notification required in each of such paragraphs shall be made as soon
as is practicable, but not later than 48 hours after the determination
is made.
``SEC. 2695B. REQUEST FOR NOTIFICATION WITH RESPECT TO VICTIMS
ASSISTED.
``(a) Initiation of Process by Employee.--If an emergency response
employee believes that the employee may have been exposed to an
infectious disease by a victim of an emergency who was transported to a
medical facility as a result of the emergency, and if the employee
attended, treated, assisted, or transported the victim pursuant to the
emergency, then the designated officer of the employee shall, upon the
request of the employee, carry out the duties described in subsection
(b) regarding a determination of whether the employee may have been
exposed to an infectious disease by the victim.
``(b) Initial Determination by Designated Officer.--The duties
referred to in subsection (a) are that--
``(1) the designated officer involved collect the facts
relating to the circumstances under which, for purposes of
subsection (a), the employee involved may have been exposed to
an infectious disease; and
``(2) the designated officer evaluate such facts and make a
determination of whether, if the victim involved had any
infectious disease included on the list issued under paragraph
(1) of section 2695(a), the employee would have been exposed to
the disease under such facts, as indicated by the guidelines
issued under paragraph (2) of such section.
``(c) Submission of Request to Medical Facility.--
``(1) In general.--If a designated officer makes a
determination under subsection (b)(2) that an emergency
response employee may have been exposed to an infectious
disease, the designated officer shall submit to the medical
facility to which the victim involved was transported a request
for a response under subsection (d) regarding the victim of the
emergency involved.
``(2) Form of request.--A request under paragraph (1) shall
be in writing and be signed by the designated officer involved,
and shall contain a statement of the facts collected pursuant
to subsection (b)(1).
``(d) Evaluation and Response Regarding Request to Medical
Facility.--
``(1) In general.--If a medical facility receives a request
under subsection (c), the medical facility shall evaluate the
facts submitted in the request and make a determination of
whether, on the basis of the medical information possessed by
the facility regarding the victim involved, the emergency
response employee was exposed to an infectious disease included
on the list issued under paragraph (1) of section 2695(a), as
indicated by the guidelines issued under paragraph (2) of such
section.
``(2) Notification of exposure.--If a medical facility
makes a determination under paragraph (1) that the emergency
response employee involved has been exposed to an infectious
disease, the medical facility shall, in writing, notify the
designated officer who submitted the request under subsection
(c) of the determination.
``(3) Finding of no exposure.--If a medical facility makes
a determination under paragraph (1) that the emergency response
employee involved has not been exposed to an infectious
disease, the medical facility shall, in writing, inform the
designated officer who submitted the request under subsection
(c) of the determination.
``(4) Insufficient information.--
``(A) If a medical facility finds in evaluating
facts for purposes of paragraph (1) that the facts are
insufficient to make the determination described in
such paragraph, the medical facility shall, in writing,
inform the designated officer who submitted the request
under subsection (c) of the insufficiency of the facts.
``(B)(i) If a medical facility finds in making a
determination under paragraph (1) that the facility
possesses no information on whether the victim involved
has an infectious disease included on the list under
section 2695(a), the medical facility shall, in
writing, inform the designated officer who submitted
the request under subsection (c) of the insufficiency
of such medical information.
``(ii) If after making a response under clause (i)
a medical facility determines that the victim involved
has an infectious disease, the medical facility shall
make the determination described in paragraph (1) and
provide the applicable response specified in this
subsection.
``(e) Time for Making Response.--After receiving a request under
subsection (c) (including any such request resubmitted under subsection
(g)(2)), a medical facility shall make the applicable response
specified in subsection (d) as soon as is practicable, but not later
than 48 hours after receiving the request.
``(f) Death of Victim of Emergency.--
``(1) Facility ascertaining cause of death.--If a victim
described in subsection (a) dies at or before reaching the
medical facility involved, and the medical facility receives a
request under subsection (c), the medical facility shall
provide a copy of the request to the medical facility
ascertaining the cause of death of the victim, if such facility
is a different medical facility than the facility that received
the original request.
``(2) Responsibility of facility.--Upon the receipt of a
copy of a request for purposes of paragraph (1), the duties
otherwise established in this part regarding medical facilities
shall apply to the medical facility ascertaining the cause of
death of the victim in the same manner and to the same extent
as such duties apply to the medical facility originally
receiving the request.
``(g) Assistance of Public Health Officer.--
``(1) Evaluation of response of medical facility regarding
insufficient facts.--
``(A) In the case of a request under subsection (c)
to which a medical facility has made the response
specified in subsection (d)(4)(A) regarding the
insufficiency of facts, the public health officer for
the community in which the medical facility is located
shall evaluate the request and the response, if the
designated officer involved submits such documents to
the officer with the request that the officer make such
an evaluation.
``(B) As soon as is practicable after a public
health officer receives a request under subparagraph
(A), but not later than 48 hours after receipt of the
request, the public health officer shall complete the
evaluation required in such paragraph and inform the
designated officer of the results of the evaluation.
``(2) Findings of evaluation.--
``(A) If an evaluation under paragraph (1)(A)
indicates that the facts provided to the medical
facility pursuant to subsection (c) were sufficient for
purposes of determinations under subsection (d)(1)--
``(i) the public health officer shall, on
behalf of the designated officer involved,
resubmit the request to the medical facility;
and
``(ii) the medical facility shall provide
to the designated officer the applicable
response specified in subsection (d).
``(B) If an evaluation under paragraph (1)(A)
indicates that the facts provided in the request to the
medical facility were insufficient for purposes of
determinations specified in subsection (c)--
``(i) the public health officer shall
provide advice to the designated officer
regarding the collection and description of
appropriate facts; and
``(ii) if sufficient facts are obtained by
the designated officer--
``(I) the public health officer
shall, on behalf of the designated
officer involved, resubmit the request
to the medical facility; and
``(II) the medical facility shall
provide to the designated officer the
appropriate response under subsection
(c).
``SEC. 2695C. PROCEDURES FOR NOTIFICATION OF EXPOSURE.
``(a) Contents of Notification to Officer.--In making a
notification required under section 2695A or section 2695B(d)(2), a
medical facility shall provide--
``(1) the name of the infectious disease involved; and
``(2) the date on which the victim of the emergency
involved was transported by emergency response employees to the
medical facility involved.
``(b) Manner of Notification.--If a notification under section
2695A or section 2695B(d)(2) is mailed or otherwise indirectly made--
``(1) the medical facility sending the notification shall,
upon sending the notification, inform the designated officer to
whom the notification is sent of the fact that the notification
has been sent; and
``(2) such designated officer shall, not later than 10 days
after being informed by the medical facility that the
notification has been sent, inform such medical facility
whether the designated officer has received the notification.
``SEC. 2695D. NOTIFICATION OF EMPLOYEE.
``(a) In General.--After receiving a notification for purposes of
section 2695A or 2695B(d)(2), a designated officer of emergency
response employees shall, to the extent practicable, immediately notify
each of such employees who--
``(1) responded to the emergency involved; and
``(2) as indicated by guidelines developed by the
Secretary, may have been exposed to an infectious disease.
``(b) Certain Contents of Notification to Employee.--A notification
under this subsection to an emergency response employee shall inform
the employee of--
``(1) the fact that the employee may have been exposed to
an infectious disease and the name of the disease involved;
``(2) any action by the employee that, as indicated by
guidelines developed by the Secretary, is medically
appropriate; and
``(3) if medically appropriate under such criteria, the
date of such emergency.
``(c) Responses Other Than Notification of Exposure.--After
receiving a response under paragraph (3) or (4) of subsection (d) of
section 2695B, or a response under subsection (g)(1) of such section,
the designated officer for the employee shall, to the extent
practicable, immediately inform the employee of the response.
``SEC. 2695E. SELECTION OF DESIGNATED OFFICERS.
``(a) In General.--For the purposes of receiving notifications and
responses and making requests under this part on behalf of emergency
response employees, the public health officer of each State shall
designate 1 official or officer of each employer of emergency response
employees in the State.
``(b) Preference in Making Designations.--In making the
designations required in subsection (a), a public health officer shall
give preference to individuals who are trained in the provision of
health care or in the control of infectious diseases.
``SEC. 2695F. LIMITATION WITH RESPECT TO DUTIES OF MEDICAL FACILITIES.
``The duties established in this part for a medical facility--
``(1) shall apply only to medical information possessed by
the facility during the period in which the facility is
treating the victim for conditions arising from the emergency,
or during the 60-day period beginning on the date on which the
victim is transported by emergency response employees to the
facility, whichever period expires first; and
``(2) shall not apply to any extent after the expiration of
the 30-day period beginning on the expiration of the applicable
period referred to in paragraph (1), except that such duties
shall apply with respect to any request under section 2695B(c)
received by a medical facility before the expiration of such
30-day period.
``SEC. 2695G. MISCELLANEOUS PROVISIONS.
``(a) Liability of Medical Facilities, Designated Officers, Public
Health Officers, and Governing Entities.--This part may not be
construed to authorize any cause of action for damages or any civil
penalty against any medical facility, any designated officer, any other
public health officer, or any governing entity of such facility or
officer for failure to comply with the duties established in this part.
``(b) Testing.--This part may not, with respect to victims of
emergencies, be construed to authorize or require a medical facility to
test any such victim for any infectious disease.
``(c) Confidentiality.--This part may not be construed to authorize
or require any medical facility, any designated officer of emergency
response employees, or any such employee, to disclose identifying
information with respect to a victim of an emergency or with respect to
an emergency response employee.
``(d) Failure To Provide Emergency Services.--This part may not be
construed to authorize any emergency response employee to fail to
respond, or to deny services, to any victim of an emergency.
``(e) Notification and Reporting Deadlines.--In any case in which
the Secretary determines that, wholly or partially as a result of a
public health emergency that has been determined pursuant to section
319(a), individuals or public or private entities are unable to comply
with the requirements of this part, the Secretary may, notwithstanding
any other provision of law, temporarily suspend, in whole or in part,
the requirements of this part as the circumstances reasonably require.
Before or promptly after such a suspension, the Secretary shall notify
the Congress of such action and publish in the Federal Register a
notice of the suspension.
``(f) Continued Application of State and Local Law.--Nothing in
this part shall be construed to limit the application of State or local
laws that require the provision of data to public health authorities.
``SEC. 2695H. INJUNCTIONS REGARDING VIOLATION OF PROHIBITION.
``(a) In General.--The Secretary may, in any court of competent
jurisdiction, commence a civil action for the purpose of obtaining
temporary or permanent injunctive relief with respect to any violation
of this part.
``(b) Facilitation of Information on Violations.--The Secretary
shall establish an administrative process for encouraging emergency
response employees to provide information to the Secretary regarding
violations of this part. As appropriate, the Secretary shall
investigate alleged such violations and seek appropriate injunctive
relief.
``SEC. 2695I. APPLICABILITY OF PART.
``This part shall not apply in a State if the chief executive
officer of the State certifies to the Secretary that the law of the
State is substantially consistent with this part.''.
Passed the Senate October 19, 2009.
Attest:
Secretary.
111th CONGRESS
1st Session
S. 1793
_______________________________________________________________________
AN ACT
To amend title XXVI of the Public Health Service Act to revise and
extend the program for providing life-saving care for those with HIV/
AIDS.