[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[Senate]
[Pages 25095-25101]
[From the U.S. Government Publishing Office, www.gpo.gov]




          RYAN WHITE HIV/AIDS TREATMENT EXTENSION ACT OF 2009

  Mr. BROWN. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of Calender No. 182, S. 1793.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 1793) 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.

  There being no objection, the Senate proceeded to consider the bill.
  Mr. HARKIN. Mr. President, today marks an important milestone in our 
ongoing national effort to combat HIV and AIDS. Twenty-eight years ago, 
the Centers for Disease Control and Prevention issued its first warning 
about the disease we now know as AIDS. Today, we are approving the 
fourth extension of the Ryan White CARE Act, comprehensive legislation 
first enacted in 1990 for the prevention and treatment of HIV and AIDS.
  In those early days, the Nation failed on all levels to fully 
recognize the dangers posed by this disease. Its victims suffered in 
silence and stigma. Shamefully, those who had the power to help did 
nothing.
  Then, belatedly, in the mid 1990s, a young boy's courage opened the 
Nation's eyes to the tragedy of AIDS. A disease that had seemed distant 
was suddenly a potential threat to any of us. We realized that it is a 
deadly virus that does not discriminate based on color, religion, 
political affiliation, or income status. I have no doubt that Ryan 
White would be proud of the bipartisan effort that, after months of 
negotiation and compromise, has produced the bill before us today.
  In 1987, bipartisan legislation was first introduced calling for a 
comprehensive national strategy focusing on education, prevention, and 
research to halt the spread of AIDS. We summoned government, the public 
health community, and the media all to do their part raise public 
awareness and combat the AIDS epidemic across America.
  Yet, today, more than two decades later, the battle continues. We 
mourn the more than 500,000 Americans who have been lost to the AIDS 
virus. However, we take heart from the fact that AIDS is no longer a 
death sentence. Through testing and treatment, people are living long, 
full, productive lives with HIV. We are identifying victims earlier in 
the progression of the disease, and keeping them healthier longer.
  However, we still have a long way to go. Many who live with HIV and 
AIDS do not have insurance to pay for costly treatments. As a result, 
heavy demands are placed on community-based organizations, as well as 
on State and local governments. For most of these citizens, the Ryan 
White CARE Act continues to provide the only means to obtain the care 
and treatment they need.
  The Ryan White CARE Act began as an emergency response to the HIV/
AIDS crisis in urban America, but today it has been broadened into a 
national strategy to provide care and support for people living with 
HIV and AIDS anywhere in America.
  This bill builds on a consensus among States, cities, community-based 
organizations, hospitals and health providers, and persons living with 
HIV and AIDS their families and advocates: It maintains access to life-
saving medications, quality health care, and support services for 
persons living with HIV and AIDS who have come to depend on publicly 
funded systems, it extends this system of quality care to persons with 
HIV and AIDS who have faced long waiting lists for medications and 
severe limits on their access to specialty health care; it bolsters 
governmental and community-based institutions charged with providing 
this care, all of whom face growing case loads and the greater 
challenges of an evolving population of persons with HIV/AIDS; it 
balances the needs of high-prevalence cities and States with those 
facing rapidly growing epidemics; it assures those who have been 
relying on their local system of care that it will continue to be there 
for them; and it reassures persons seeking tests for HIV that 
comprehensive care and support will be available.
  At its best, the United States has the finest HIV/AIDS care system, 
truly the gold standard for the rest of the world to emulate. Our goal 
in this legislation is to make the U.S. HIV/AIDS care system also the 
fairest in the world, with equal access for all, high quality 
standards, and guaranteed continuity of care--regardless of 
geographical location.

[[Page 25096]]

  This bill is a great example of the good and important things we can 
accomplish in this body when we work together with bipartisanship, 
goodwill, and a spirit of compromise. This is also complex legislation, 
and all our committee staff members, Democratic and Republican alike, 
deserve great credit for their expertise, and for their diligence in 
bringing us to this day. I want to recognize Connie Garner and Jenelle 
Krishnamoorthy from my staff, Hayden Rhudy from Senator Enzi's staff, 
Tamar Magarik Haro from Senator Dodd's staff, and Evan Feinberg from 
Senator Coburn's staff for their dedication and hard work on this 
legislation.
  To say the least, this legislation is extremely important to 
Americans living with HIV and AIDS. For them, it is a lifeline. It 
offers hope for an active, productive, dignified life. This legislation 
shows America at its very best: compassionate, generous, extending a 
hand up to those in great need. Mr. President, I thank my colleagues 
for coming together to support this important, bipartisan bill.
  Mr. ENZI. Mr. President, I rise today to express my great 
appreciation to Senators Harkin, Dodd, and Coburn for working in a 
bipartisan manner to reauthorize the Ryan White HIV/AIDS program. I am 
also thankful to all of the members on the HELP Committee for their 
efforts to ensure that we passed this bill in a timely manner so that 
individuals receiving care under the Ryan White program would not see 
an interruption in their services.
  This bill continues policies that seek to accomplish the goal of 
ensuring that Ryan White funding follows the patient. The bill, which 
will pass by unanimous consent, updates funding formulas and requires 
more accurate and reliable data reporting from the States, which will 
ensure that funds are allocated to the areas with the greatest need. It 
encourages aggressive testing strategies and establishes a national 
HIV/AIDS testing goal of 5 million tests per year. The bill also 
provides more flexibility to allow grantees to spend funds effectively.
  Over the years we have seen a dramatic change in the geographic 
location of the HIV/AIDS epidemic from northern, metropolitan areas, to 
southern--and in many instances--rural areas. Today, more persons 
living with AIDS reside in the South than in any other area of the 
country. Of the 26,347 new HIV cases, 51.2 percent were diagnosed in 
the 17 Southern States and of the top 20 metropolitan areas with the 
highest AIDS case rates, 14 were in the South. Thanks to the bipartisan 
efforts of the HELP Committee this reauthorization will ensure that 
funding is distributed in an equitable manner, reaching individuals 
with the greatest need.
  The Ryan White program provides care for millions of Americans in 
need of medical care. Unfortunately we have also seen abuses, where 
these funds are misspent and patients do not receive the care they 
need. As the ranking member of the HELP Committee, I will continue to 
work to prevent these abuses and guarantee that funding is distributed 
to legitimate organizations that provide real services. It is a 
travesty that so many millions of dollars have been wasted due to poor 
oversight and corruption.
  As Congress continues to authorize and provide funding for services 
under the Ryan White program, we must also commit to conduct proper 
oversight, so that these dollars actually reach the patients who need 
assistance, rather than being pocketed by criminals.
  I close by again expressing my great appreciation to my colleagues 
for their hours of hard work and dedication to extend the Ryan White 
HIV/AIDS program. I also thank the HIV/AIDS community for their 
tireless efforts to provide care to individuals with HIV/AIDS. Many 
Americans with HIV/AIDS will continue to receive access to vital care 
because of the compassion and dedication of HIV/AIDS organizations 
receiving Ryan White dollars. Finally, I also thank my staff members 
Greg Dean, Chuck Clapton and Hayden Rhudy, as well as the staff members 
of Senator Harkin's office, Connie Gardner and Jenelle Krishnamoorthy, 
for their hard work on this important bill.
  Mr. BROWN. Mr. President, this is the Ryan White HIV Act, which is 
particularly important legislation. I join millions of people in the 
country in supporting it.
  I ask unanimous consent that a Harkin amendment, which is at the 
desk, be agreed to; that the bill, as amended, be read the third time 
and passed; that the motions to reconsider be laid upon the table, with 
no intervening action or debate, and that any statements related to the 
bill be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 2692) was agreed to, as follows:


                           amendment no. 2692

       On page 5, line 14, strike ``In'' and insert ``in''.
       On page 7, line 12, add ``and'' at the end.
       On page 7, line 24, strike ``(vi)'' and insert ``(C)'' and 
     realign the margin accordingly.
       On page 8, line 1, strike ``(g)'' and insert ``(d)''.
       On page 26, line 5, insert ``section'' after ``in''.
       On page 26, line 6, strike ``(c)(A)'' and insert 
     ``(c)(4)(A)''.
       On page 26, line 13, strike ``(c)'' and insert ``(c))''.
       On page 31, line 24, strike ``(a)'' and insert ``(1)'' and 
     realign the margin accordingly.
       On page 31, line 26, strike ``(b)'' and insert ``(2)'' and 
     realign the margin accordingly.
       On page 42, line 13, strike ``subpart'' and insert 
     ``part''.
       On page 46, line 24, strike ``subpart'' and insert 
     ``part''.
       On page 47, line 10, strike ``subpart'' and insert 
     ``part''.
       On page 48, strike lines 1 through 8, and insert the 
     following:
       ``(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.''.
       On page 48, line 9, strike ``subpart'' and insert ``part''.
       On page 48, line 13, strike ``subpart'' and insert 
     ``part''.
       On page 48, line 20, strike ``subpart'' and insert 
     ``part''.
       On page 49, line 18, strike ``subpart'' and insert 
     ``part''.
       On page 49, line 23, strike ``subpart'' and insert 
     ``part''.
       On page 50, line 1, strike ``SUBPART'' and insert ``PART''.
       On page 50, line 2, strike ``subpart'' and insert ``part''.
       On page 50, line 5, strike ``subpart'' and insert ``part''.

  The bill (S. 1793) was ordered to be engrossed for a third reading, 
was read the third time, and passed, as follows:

                                S. 1793

       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

[[Page 25097]]

     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

[[Page 25098]]

     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

[[Page 25099]]

     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.

[[Page 25100]]

       ``(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.

[[Page 25101]]

       ``(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.''.

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