[House Report 111-305]
[From the U.S. Government Publishing Office]
111th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 111-305
======================================================================
RYAN WHITE HIV/AIDS TREATMENT EXTENSION ACT OF 2009
_______
October 20, 2009.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Waxman, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 3792) 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, having considered the
same, report favorably thereon without amendment and recommend
that the bill do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Legislative History.............................................. 2
Committee Consideration.......................................... 3
Committee Votes.................................................. 3
Committee Oversight Findings and Recommendations................. 3
New Budget Authority, Entitlement Authority, and Tax Expenditures 3
Statement of General Performance Goals and Objectives............ 3
Constitutional Authority Statement............................... 3
Earmarks and Tax and Tariff Benefits............................. 4
Advisory Committee Statement..................................... 4
Applicability of Law to Legislative Branch....................... 4
Federal Mandates Statement....................................... 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 4
Section-by-Section Analysis of the Legislation................... 5
Changes in Existing Law Made by the Bill, as Reported............ 10
Amendment
There were no amendments to H.R. 3792 offered or adopted
during Committee consideration of the bill.
Purpose and Summary
H.R. 3792, the ``Ryan White HIV/AIDS Treatment Extension
Act of 2009'', is a bill to reauthorize programs providing
comprehensive care, treatment, and support services for
Americans living with HIV/AIDS.
Background and Need for Legislation
Since 1981, when the first cases of AIDS were reported to
the Centers for Disease Control and Prevention (CDC), the
epidemic has continued to expand and, as a result, it is one of
the largest public health challenges in this country. According
to the most recent surveillance report released by the CDC, a
cumulative total of 1,030,832 AIDS cases were reported in the
United States from the beginning of the epidemic through 2007.
The CDC estimates that 583,298 people died of HIV/AIDS over the
same time period. For 2006, the most recent year that data are
available, CDC estimated that approximately 56,300 people were
newly infected with HIV. More than half (57%) of these new
infections occurred in gay and bisexual men. In addition, the
incidence rate for African American men and women was estimated
to be 7 times as high as the incidence rate among whites. It is
clear from these statistics that despite the significant
advances in testing, treatment and prevention, the impact of
HIV/AIDS on people in the United States has been and continues
to be substantial.
The Ryan White HIV/AIDS Program was established by Congress
in 1990 (P.L. 101-381) to provide assistance in health care and
support services for individuals and families affected by HIV/
AIDS. The Ryan White program has been reauthorized and amended
by Congress three times: in 1996 (P.L. 104-146), 2000 (P.L.
106-345), and 2006 (P.L. 109-415). The 2006 reauthorization
contained a ``sunset'' provision that would have eliminated the
entire title, but a provision in the October 1, 2009,
Continuing Resolution (P.L. 111-68) extended the program
through the end of October 2009.
Legislative History
H.R. 3792 was introduced on October 13, 2009, by
Subcommittee Chairman Pallone, Ranking Member Deal, Committee
Chairman Waxman, and Ranking Member Barton. The bill was
referred to the Committee on Energy and Commerce, and
subsequently to the Subcommittee on Health.
Prior to the bill's introduction, the Subcommittee on
Health held a legislative hearing entitled ```Ryan White CARE
Act Amendments of 2009' Discussion Draft Legislation'' on
September 9, 2009. The hearing examined a discussion draft of
legislation to extend the Ryan White program for three
additional years. The Subcommittee received testimony from Mary
Wakefield, Ph.D., R.N., Administrator, Health Resources and
Services Administration; Marcia Crosse, Ph.D., Healthcare
Director, Government Accountability Office; Julie Scofield,
Executive Director, National Alliance of State and Territorial
AIDS Directors; and Donna Elaine Sweet, M.D., M.A.C.P.,
A.A.H.I.V.S., Professor, Department of Internal Medicine,
University of Kentucky, School of Medicine, and Board Chair,
American Academy of HIV Medicine.
The language reported by the Committee was developed in
bipartisan negotiations with the Senate.
Committee Consideration
H.R. 3792 was considered in open markup session by the
Subcommittee on Health on Wednesday, October 14, 2009, and was
forwarded favorably to the full Committee without amendment. On
Thursday, October 15, 2009, the full Committee met in open
markup session and considered H.R 3792, as approved by the
Subcommittee on Health. Subsequently, the Committee ordered
H.R. 3792 favorably reported to the House, without amendment,
by a voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto. A
motion by Mr. Pallone to order H.R. 3792 favorably reported to
the House, without amendment, was adopted by a voice vote.
There were no amendments offered to H.R. 3792 during the
Committee's consideration and no recorded votes were requested
on the bill.
Committee Oversight Findings and Recommendations
In compliance with clause 3(c)(1) of rule XIII of the Rules
of the House of Representatives, the findings and
recommendations of the Committee are reflected in the
descriptive portions of this report.
New Budget Authority, Entitlement Authority, and Tax Expenditures
Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives, the Committee finds that H.R. 3792
would result in no new budget authority, entitlement authority,
or tax expenditures or revenues.
Statement of General Performance Goals and Objectives
The goal of H.R. 3792, the Ryan White HIV/AIDS Treatment
Extension Act of 2009, is to provide HIV-related health
services to address unmet needs.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
constitutional authority for H.R. 3792 is provided in Article
I, section 8, clauses 1, 3, and 18.
Earmarks and Tax and Tariff Benefits
H.R. 3792 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9 of rule XXI of the Rules of the House of
Representatives.
Advisory Committee Statement
No advisory committees were created by H.R. 3792 within the
meaning of section 5 U.S.C. App., 5(b) of the Federal Advisory
Committee Act.
Applicability of Law to the Legislative Branch
The Committee finds that H.R. 3792 does not relate to the
terms and conditions of employment or access to public services
or accommodations within the meaning of section 102(b)(3) of
the Congressional Accountability Act of 1985.
Federal Mandates Statement
The Committee adopts as its own the estimates of federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandate Reform
Act.
Committee Cost Estimate
Pursuant to clause 3(d) of rule XIII of the Rules of the
House of Representatives, the Committee will adopt as its own
the cost estimate on H.R. 3792 prepared by the Director of the
Congressional Budget Office (CBO) pursuant to section 402 of
the Congressional Budget Act.
Congressional Budget Office Estimate
With respect to the requirement of clause 3(c)(3) of rule
XIII of the Rules of the House of Representatives, a complete
cost estimate on H.R. 3792 by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of 1974
was not available when the Committee filed this report. CBO
has, however, determined that the bill would not impact direct
spending, as discussed in the letter that follows:
U.S. Congress,
Congressional Budget Office,
Washington, DC, October 19, 2009.
Hon. Henry A. Waxman,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
reviewed H.R. 3792, the Ryan White HIV/AIDS Treatment Extension
Act of 2009, as ordered reported by the Committee on Energy and
Commerce on October 15, 2009, and determined that the bill
would have no impact on direct spending or revenues. The bill
would reauthorize the Ryan White program in title XXVI of the
Public Health Service Act and would authorize appropriations
for purposes specified in the bill. CBO has not completed an
estimate of the legislation's impact on spending subject to
appropriation.
H.R. 3792 would impose intergovernmental and private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
because it would require public and private medical facilities
to comply with new procedures for notifying emergency response
employees of possible exposures to an infectious disease. CBO
estimates that the costs of the mandates would fall below the
annual thresholds established in UMRA for both
intergovernmental and private-sector mandates ($69 million and
$139 million in 2009, respectively, adjusted annually for
inflation). In general, funds authorized in the bill would
benefit state, local, and tribal governments that participate
in medical and other support programs for individuals with HIV/
AIDS.
If you wish further details, we will be pleased to provide
them. The CBO staff contact is Lisa Ramirez-Branum.
Sincerely,
Douglas W. Elmendorf,
Director.
Enclosure.
Section-by-Section Analysis of the Legislation
Section 1. Short title; references
Section 1 establishes the short title of the Act as the
``Ryan White HIV/AIDS Treatment Extension Act of 2009''.
Section 2. Reauthorization of HIV health care services program
Section 2 re-establishes the provisions of the Act,
retroactive to September 30, 2009, and repeals all prior sunset
provisions. It provides a 5% increase over fiscal year 2009
authorization levels across Parts A through D and Part F for
each of fiscal years 2010 through 2013.
Section 2 contains several provisions that pertain to the
Minority AIDS Initiative (MAI), which addresses HIV/AIDS among
racial and ethnic minorities, who as a whole, face
disproportionate incidence and prevalence rates of the disease,
as well as heightened barriers to care and treatment. It
synchronizes the MAI application schedules across Ryan White
Parts A through D and Part F to streamline the MAI application
process.
Section 2 also reverts competitive funding under MAI Parts
A and Part B to formula funding. Prior to the 2006 Ryan White
HIV/AIDS Treatment Modernization Act (RWHATMA), Part A and Part
B MAI funding was allocated to cities and states based on their
share of total AIDS cases among racial and ethnic minorities.
RWHATMA shifted MAI funding to a competitive process. According
to the Government Accountability Office (GAO), this created a
large administrative burden, and resulted in a number of
jurisdictions receiving no funding; no improvements in program
performance were reported. Therefore, this section shifts MAI
funding for Part A and Part B to a formula basis. It is the
Committee's intent that the Secretary distribute MAI funding
for Part A and Part B based on the distribution of HIV/AIDS
cases among racial and ethnic minorities.
In addition, the section requires the GAO to report on MAI
activities across the Department of Health and Human Services
(HHS) departmental agencies, including a description of best
practices in capacity-building, particularly for minority
community-based organizations. The section also requires the
Secretary of HHS to prepare a plan for the use of MAI funds for
capacity-building, taking into consideration the findings of
the GAO report.
The legislation retains the existing requirement that 75%
of funding be spent on ``core medical services''. The Committee
encourages grantees and subgrantees to maximize flexibility in
the use of support services in support of medical outcomes,
including finding methods of reducing costs. Grantees may seek
to adopt systems that reasonably ensure the ability of clients
to attain support services that minimize cost or accounting
burden wherever possible. Examples that have come to the
Committee's attention include the use of monthly bus or subway
passes and weekly or monthly gas cards or vouchers that may
allow incidental non-Ryan White Program travel but are cheaper
overall than individual bus passes or taxi vouchers.
The Committee is concerned about the prevalence of HIV in
the nation's prison system. Disparities in the epidemic are
exacerbated by the lack of access to adequate health and
support services for inmates while incarcerated and upon their
return to the community. The Committee notes that the Health
Research and Services Administration (HRSA) has developed
guidance on the permitted use of Ryan White dollars for pre-
and post-release programs for HIV-positive inmates being
released back to the community, and believes that HRSA should
encourage Part B grantees to develop and implement such
programs as appropriate.
More than 30% of HIV-infected persons in the United States
are chronically infected with the hepatitis C virus (HCV). Ryan
White grantees require additional assistance in addressing the
complex needs of co-infected clients, particularly in large
urban areas where the majority of HIV/HCV co-infected patients
live and receive services. The Committee encourages the HRSA to
increase the capacity of Ryan White grantees to deliver medical
management, treatment, and support services for clients co-
infected with HIV and HCV by implementing training and
technical assistance initiatives, so that Ryan White funded
programs are able to increase HCV education, testing, medical
management, case management, and treatment services to meet the
needs of their respective communities. While not all co-
infected patients are appropriate candidates for treatment, the
low uptake in hepatitis treatment despite availability of
medications on ADAP formularies is troubling. The Committee
encourages HRSA to address this concern through the creation of
best practices from successful efforts in the field, increased
provider education, case manager capacity building and creation
of educational materials for clients.
Numerous studies and reports, including the National
Healthcare Disparities Report and Unequal Treatment, the 2002
Institute of Medicine Report, document extensive health
disparities across the country. These studies have found that,
on average, racial and ethnic minorities are disproportionately
afflicted with chronic and acute conditions--such as cancer,
diabetes, and hypertension--as well as communicable diseases
likes HIV/AIDS, and suffer worse health outcomes, worse health
status, and higher mortality rates than the general population.
The Ryan White Act provides the best opportunity for
individuals affected by HIV/AIDS to access health care.
Comorbidities such as hepatitis C have a substantial impact on
health-related quality for patients with HIV/AIDS. By ensuring
patients with comorbidities have access to care, the Ryan White
Act is taking a small but necessary step in reducing the
serious health disparities that disproportionately affect
racial and ethnic minorities.
Most low-income HIV-positive individuals co-infected with
HBV or HCV can obtain services through the Ryan White Program,
but coverage for HBV and HCV treatment and viral load testing,
which is crucial for diagnosis and monitoring response to
treatment, is limited. Unfortunately, coverage for diagnostics,
monitoring, treatment and vaccination against viral hepatitis
is not uniformly available through state AIDS Drug Assistance
Programs (ADAPs), due to funding shortfalls. The Committee
believes resources under the Ryan White Program are urgently
needed for care, treatment, diagnostics, hepatitis vaccine,
case management, and support services for patients undergoing
hepatitis treatment, as well as to improve provider education
on HBV and HCV medical management and treatment.
The Committee recognizes that despite the progress made to
treat individuals with HIV/AIDS, including through the Ryan
White Act, that there is still significant progress that needs
to be made to prevent HIV transmission. From 2004 to 2007, the
estimated number of newly diagnosed HIV/AIDS cases increased
among all races and ethnicities, and increased 18% among males
and 8% among females during that time period. In recognition of
this trend, the Committee supports the development of an HIV
vaccine as a solution for ending the HIV pandemic. Of the more
than 80 HIV/AIDS vaccine candidates that have undergone Phase I
clinical trials, 2 have entered phase III trials. The
development and testing of HIV vaccines should be encouraged by
the public and private sector, along with other promising
science that seeks to eradicate HIV/AIDS in the United States.
Section 3. Extended exemption period for names-based reporting
Section 3 maintains the code-based protections established
under the 2006 reauthorization for states and jurisdictions
with maturing names-based HIV case data during the first three
years of the reauthorization period. For the first two years,
jurisdictions that report code-based data to HRSA will continue
to incur a 5% penalty against their count of living cases of
HIV and will still be subject to a 5% cap on increases in the
HIV case count. In 2012, the penalty will be increased to 6%.
Beginning in fiscal year 2013, code-based protections will be
eliminated and all states will be required to report cases
using a names-based system.
Section 4. Extension of transitional grant area status
Section 4 extends current rules for transitional grant area
(TGA) status. It adds a provision that if a metropolitan area
receiving Part A funding has between 1400 and 1500 cumulative
living AIDS cases and did not have more than 5% of its total
grants unobligated at the end of the grant period for the prior
fiscal year, it will be treated as having met the criteria for
continued eligibility as a TGA.
Section 4 also modifies the transfer of amounts from TGAs
that lose their eligibility during the reauthorization period.
Under current law, when a TGA loses its status, $500,000 is
transferred to the overall Part B pool for states, along with
the state's most recent formula grant award. Section 4 provides
transitional funding as the clients of a former TGA are
absorbed by the overall state program. In the first year after
a TGA loses eligibility for Part A funding, the state in which
the TGA is located will retain 75% of the TGA formula funding.
The amount will decline to 50% in the second year and 25% in
the third. By the fourth year, all of the former TGAs funding
will be part of the overall Part B pool.
Section 5. Hold harmless
Section 5 continues the hold harmless pattern established
in 2006 for the first three years of the reauthorization
period. States and EMAs will receive no less than 95% of fiscal
year 2009 formula award amounts in 2010 and 100% of fiscal year
2010 formula award amounts for each of the fiscal years 2011
and 2012. For fiscal year 2013, states and EMAs may not receive
less than 92.5% of the previous fiscal year's grant.
Section 6. Amendments to the general grant provisions
Section 6 encourages early identification of individuals
infected with HIV. It requires the planning councils for Part A
grant recipients to develop a strategy, in coordination with
other appropriate community strategies or activities, to
identify and diagnose individuals with HIV/AIDS who are unaware
of their status and link them with the appropriate care and
treatment.
For the purposes of allocating competitive Part A
supplemental grants, one-third of the criteria on which
allocations are made will be based on demonstrated success in
identifying undiagnosed individuals with HIV/AIDS, making them
aware of their status, and linking them to appropriate care.
Section 7. Increase in adjustment for names-based reporting
Section 7 adds an adjustment for Part A and B jurisdictions
that switched to names-based reporting early in 2007 and
received a decrease in total funding of at least 30% from year
2006 as a result of determinations based on the new reporting
system. For those jurisdictions, the Secretary shall base
awards on living HIV/AIDS cases plus an adjustment of 3%.
Section 8. Treatment of unobligated funds
Under current law, if a Part A or Part B grantee has
unobligated formula funding at the end of the grant year, it
can request a waiver to carry over the funding. If the waiver
is not granted or if the funds remain unspent by the end of the
carryover year, the funds return to the Secretary and become
available for supplemental grants.
If the unobligated formula balance is 2% or more of the
total award, certain penalties apply, whether or not the
jurisdiction receives a carryover waiver. For formula funds,
future formula funding will be reduced by the amount of the
unobligated balance, beginning in the year following the
report. In addition, the jurisdiction will not be eligible for
supplemental funding in the year following the report.
Because of multiple factors (such as statewide budget
problems and hiring freezes) it has at times been difficult for
all Part A and Part B grantees to obligate 98% of their funds
by the end of the year. Nine states experienced a reduction in
their fiscal year 2009 grants due to unobligated balances in
fiscal year 2007.
Section 7 increases the unobligated penalty threshold from
2% of the total award to 5%. It retains the provision that a
jurisdiction with more than 5% of its funds unobligated will be
ineligible for supplemental funding in the following year. For
formula funds, if the unobligated amount is more than the 5%
threshold, the next year's formula funding will be reduced by
the amount of unobligated balance, but the reduction amount
will not include any unobligated balance that was approved for
carryover by HRSA.
Section 9. Application by States
Section 9 requires states, as part of their planning
process for Ryan White funding, to establish a comprehensive
strategy to identify and diagnose individuals with HIV/AIDS who
are unaware of their status and link them with the appropriate
care and treatment.
Section 10. ADAP rebate funds
The unobligated balances requirement addressed in section 8
intersects with the treatment of rebate dollars under the AIDS
Drug Assistance Program (ADAP). Under current law, many states
purchase ADAP drugs directly from the manufacturer and receive
substantial rebates in return. These rebates must be put back
into the program and, as a general requirement, states must
spend rebate dollars before grant dollars. The amount and
timing of rebate dollars, however, is unpredictable. For
example, a state may receive a significant rebate late in the
award year. Since rebates must be spent before program funds,
the state could end the year with more than the permitted
threshold of unobligated program funds.
Section 10 of the bill provides that if an expenditure of
ADAP rebate funds would trigger a penalty or a higher penalty
than would otherwise have applied, the Secretary shall deem the
state's unobligated balance to be reduced by the amount of
rebate funds in the proposed expenditure.
Section 10 also specifies that any unobligated ADAP grant
amounts that are returned to the Secretary shall go to the
state ADAP program, if the Secretary deems appropriate, or to
Part B supplemental fund.
Section 11. Application to primary care services
Part D of Ryan White provides grants to entities serving
women, infants, children, and youths living with HIV/AIDS.
Programs provide for outpatient medical care and offer case
management, referrals, and other services to enable
participation in the program, including outreach efforts to
youth with HIV.
Section 11 clarifies that Part D should be the payer of
last resort and specifies memoranda of understanding as
vehicles for Part D providers to ensure access to primary care.
Section 12. National HIV/AIDS testing goal
Section 12 requires the Secretary to establish a national
HIV/AIDS testing goal of 5 million HIV tests provided through
all federally-supported HIV/AIDS programs.
Also, Section 12 requires the Secretary to report to
Congress each year on the progress made toward achieving the
goal. The Secretary is required to review each domestic HIV/
AIDS prevention program to determine its effectiveness based on
the program's stated purposes and on its contributions toward
the testing goal.
Section 13. Notification of possible exposure to infectious diseases
Section 13 establishes requirements to ensure that
emergency responders are notified if exposed to potentially
life-threatening infectious diseases, while preserving
confidentiality requirements. A nearly identical section was in
statute prior to the 2006 reauthorization. The legislation
makes minor changes to the original language, including
permitting the Secretary to suspend the requirements in a
federal public health emergency. Because states and many
localities have their own requirements for infectious disease
surveillance, prevention, investigation, and control, the
Committee expects that in developing the disease list under
this section, the Secretary will consult as appropriate with
state and local governmental public health authorities, and
work to optimize efficiency and coordination with state and
local procedures.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
RYAN WHITE HIV/AIDS TREATMENT MODERNIZATION ACT OF 2006
* * * * * * *
TITLE VII--MISCELLANEOUS PROVISIONS
* * * * * * *
[SEC. 703. REPEAL.
[Effective on October 1, 2009, title XXVI of the Public
Health Service Act (42 U.S.C. 300ff et seq.) is repealed.]
----------
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE XXVI--HIV HEALTH CARE SERVICES PROGRAM
Part A--Emergency Relief for Areas With Substantial Need for Services
Subpart I--General Grant Provisions
* * * * * * *
SEC. 2602. ADMINISTRATION AND PLANNING COUNCIL.
(a) * * *
(b) HIV Health Services Planning Council.--
(1) * * *
* * * * * * *
(4) Duties.--The planning council established or
designated under paragraph (1) shall--
(A) determine the size and demographics of
the population of individuals with HIV/AIDS, as
well as the size and demographics of the
estimated population of individuals with HIV/
AIDS who are unaware of their HIV status;
(B) determine the needs of such population,
with particular attention to--
(i) individuals with HIV/AIDS who
know their HIV status and are not
receiving HIV-related services; [and]
(ii) disparities in access and
services among affected subpopulations
and historically underserved
communities; and
(iii) individuals with HIV/AIDS who
do not know their HIV status;
* * * * * * *
(D) develop a comprehensive plan for the
organization and delivery of health and support
services described in section 2604 that--
(i) * * *
(ii) includes a strategy to
coordinate the provision of such
services with programs for HIV
prevention (including outreach and
early intervention) and for the
prevention and treatment of substance
abuse (including programs that provide
comprehensive treatment services for
such abuse); [and]
(iii) is compatible with any State or
local plan for the provision of
services to individuals with HIV/AIDS;
and
(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;
* * * * * * *
SEC. 2603. TYPE AND DISTRIBUTION OF GRANTS.
(a) Grants Based on Relative Need of Area.--
(1) * * *
* * * * * * *
(3) Amount of grant.--
(A) * * *
* * * * * * *
(C) Living cases of hiv/aids.--
(i) * * *
(ii) Transition period; exemption
regarding non-aids cases.--For each of
the fiscal years 2007 through [2009]
2012, an eligible area is, subject to
clauses (iii) through (v), exempt from
the requirement under clause (i) that
living names-based non-AIDS cases of
HIV be reported unless--
(I) * * *
(II) no later than the
beginning of fiscal year 2008
[or 2009] or a subsequent
fiscal year through fiscal year
2012, the Secretary, in
consultation with the chief
executive of the State in which
the area is located, determines
that a system has become
operational in the State that
provides sufficiently accurate
and reliable names-based
reporting of such cases
throughout the State.
* * * * * * *
(iv) Requirement for exemption as of
fiscal year 2008.--For each of the
fiscal years 2008 through [2010] 2012,
an exemption under clause (ii) for an
eligible area applies only if, as of
April 1, 2008, the State in which the
area is located is substantially in
compliance with the agreement under
clause (iii)(II).
(v) Progress toward names-based
reporting.--For fiscal year 2009 or a
subsequent fiscal year, the Secretary
may terminate an exemption under clause
(ii) for an eligible area if the State
in which the area is located submitted
a plan under clause (iii)(I)(aa) and
the Secretary determines that the State
is not substantially following the
plan.
(vi) Counting of cases in areas with
exemptions.--
(I) * * *
(II) Adjustment rate.--The
adjustment rate under subclause
(I) for an eligible area shall
be a reduction of 5 percent for
fiscal years before fiscal year
2012 (and 6 percent for fiscal
year 2012) in the number of
living non-AIDS cases of HIV
reported for the area.
(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.
* * * * * * *
(ix) Rules of construction regarding
acceptance of reports.--
(I) * * *
(II) Applicability of
exemption requirements.--The
provisions of clauses (ii)
through (viii) may not be
construed as having any legal
effect for fiscal year [2010]
2013 or any subsequent fiscal
year, and accordingly, the
status of a State for purposes
of such clauses may not be
considered after fiscal year
[2009] 2012.
* * * * * * *
(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.
(D) Code-based areas; limitation on increase
in grant.--
(i) In general.--For each of the
fiscal years 2007 through [2009] 2012,
if code-based reporting (within the
meaning of subparagraph (C)(vi))
applies in an eligible area or any
portion thereof as of the beginning of
the fiscal year involved, then
notwithstanding any other provision of
this paragraph, the amount of the grant
pursuant to this paragraph for such
area for such fiscal year may not--
(I) * * *
(II) for each of the fiscal
years 2008 [and 2009] through
2012, exceed by more than 5
percent the amount of the grant
pursuant to this paragraph and
paragraph (4) for the area for
the preceding fiscal year.
(ii) Use of amounts involved.--For
each of the fiscal years 2007 through
[2009] 2012, amounts available as a
result of the limitation under clause
(i) shall be made available by the
Secretary as additional amounts for
grants pursuant to subsection (b) for
the fiscal year involved, subject to
paragraph (4) and section 2610(d)(2).
(4) Increases in grant.--
(A) In general.--For each eligible area that
received a grant pursuant to this subsection
for fiscal year [2006] 2009, the Secretary
shall, for each of the fiscal years [2007
through 2009] 2010 through 2013, increase the
amount of the grant made pursuant to paragraph
(3) for the area to ensure that the amount of
the grant for the fiscal year involved is not
less than the following amount, as applicable
to such fiscal year:
[(i) For fiscal year 2007, an amount
equal to 95 percent of the amount of
the grant that would have been made
pursuant to paragraph (3) and this
paragraph for fiscal year 2009 (as such
paragraphs were in effect for such
fiscal year) if paragraph (2) (as so in
effect) had been applied by
substituting ``66\2/3\ percent'' for
``50 percent''.
[(ii) For each of the fiscal years
2008 and 2009, an amount equal to 100
percent of the amount of the grant made
pursuant to paragraph (3) and this
paragraph for fiscal year 2007.]
(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.
* * * * * * *
(C) Limitation.--This paragraph may not be
construed as having any applicability after
fiscal year [2009] 2013.
(b) Supplemental Grants.--
(1) In general.--Subject to subsection (a)(4)(B)(i)
and section 2610(d), the Secretary shall disburse the
remainder of amounts not disbursed under section
2603(a)(2) for such fiscal year for the purpose of
making grants under section 2601(a) to eligible areas
whose application under section 2605(b)--
(A) * * *
* * * * * * *
(G) demonstrates the manner in which the
proposed services are consistent with the local
needs assessment and the statewide coordinated
statement of need; [and]
(H) demonstrates the ability of the applicant
to expend funds efficiently by not having had,
for the most recent grant year under subsection
(a) for which data is available, more than [2
percent] 5 percent of grant funds under such
subsection [canceled] canceled, offset under
subsection (c)(4), or covered by any waivers
under subsection (c)(3)[.]; and
(I) demonstrates success in identifying
individuals with HIV/AIDS as described in
clauses (i) through (iii) of paragraph (2)(A).
(2) Amount of grant.--
(A) In general.--The amount of each grant
made for purposes of this subsection shall be
determined by the Secretary based on a
weighting of factors under paragraph (1), with
demonstrated need under subparagraph (B) of
such paragraph counting one-third[.], 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.
* * * * * * *
(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.
* * * * * * *
(c) Timeframe for Obligation and Expenditure of Grant
Funds.--
(1) * * *
* * * * * * *
(3) Formula grants; cancellation of unobligated
balance of grant award; waiver permitting carryover.--
(A) * * *
* * * * * * *
(D) Corresponding reduction in future
grant.--
(i) In general.--In the case of an
eligible area for which a balance from
a grant award under subsection (a) is
unobligated as of the end of the grant
year for the award--
(I) the Secretary shall
reduce, by the same amount as
such unobligated balance (less
any amount of such balance that
is the subject of a waiver of
cancellation under subparagraph
(A)), the amount of the grant
under such subsection for the
first fiscal year beginning
after the fiscal year in which
the Secretary obtains the
information necessary for
determining that such balance
was unobligated as of the end
of the grant year (which
requirement for a reduction
applies without regard to
whether a waiver under
subparagraph (A) has been
approved with respect to such
balance); and
* * * * * * *
except that this clause does not apply
to the eligible area if the amount of
the unobligated balance was [2 percent]
5 percent or less.
* * * * * * *
(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.
* * * * * * *
SEC. 2605. APPLICATION.
(a) * * *
(b) Application.--An eligible area that desires to receive a
grant under section 2603(b) shall prepare and submit to the
Secretary an application, in accordance with subsection (c)
regarding a single application and grant award, at such time,
in such form, and containing such information as the Secretary
shall require, including the information required under such
subsection and information concerning--
(1) the number of individuals to be served within the
eligible area with assistance provided under the grant,
including the identification of individuals with HIV/
AIDS as described in clauses (i) through (iii) of
section 2603(b)(2)(A);
* * * * * * *
Subpart II--Transitional Grants
SEC. 2609. ESTABLISHMENT OF PROGRAM.
(a) * * *
* * * * * * *
(c) Certain Eligibility Rules.--
(1) Fiscal year [2007] 2011.--With respect to grants
under subsection (a) for fiscal year [2007] 2011, a
metropolitan area that received funding under subpart I
for fiscal year [2006] 2010 but does not for fiscal
year [2007] 2011 qualify under such subpart as an
eligible area and does not qualify under subsection (b)
as a transitional area shall, notwithstanding
subsection (b), be considered a transitional area.
(2) Continued status as transitional area.--
(A) In general.--Notwithstanding subsection
(b), a metropolitan area that is a transitional
area for a fiscal year continues, except as
provided in subparagraph (B), to be a
transitional area until the metropolitan area
fails, for three consecutive fiscal years--
(i) * * *
(ii) [to have a] subject to
subparagraphs (B) and (C), to have a
cumulative total of 1,500 or more
living cases of AIDS (reported to and
confirmed by the Director of the
Centers for Disease Control and
Prevention) as of December 31 of the
most recent calendar year for which
such data is available.
(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 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.
[(B)] (C) Exception regarding status as
eligible area.--[Subparagraph (A) does not
apply] Subparagraphs (A) and (B) do not apply
for a fiscal year if the metropolitan area
involved qualifies under subpart I as an
eligible area.
(d) Application of Certain Provisions of Subpart I.--
(1) Administration; planning council.--
(A) * * *
(B) Exception.--For each of the fiscal years
2007 through [2009] 2013, the exception
described in subparagraph (A) does not apply if
the transitional area involved received funding
under subpart I for fiscal year 2006.
* * * * * * *
Subpart III--General Provisions
SEC. 2610. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--For the purpose of carrying out this part,
there are authorized to be appropriated $604,000,000 for fiscal
year 2007, $626,300,000 for fiscal year 2008, [and $649,500,000
for fiscal year 2009] $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. Amounts appropriated under the preceding
sentence for a fiscal year are available for obligation by the
Secretary until the end of the second succeeding fiscal year.
* * * * * * *
(c) Transfer of Certain Amounts; Change in Status as Eligible
Area or Transitional Area.--Notwithstanding subsection (b):
(1) * * *
(2) If a metropolitan area is a transitional area
under section 2609 for a fiscal year, but for a
subsequent fiscal year ceases to be a transitional area
by reason of section 2609(c)(2) (and does not qualify
for such subsequent fiscal year as an eligible area
under subpart I)--
(A) * * *
(B)(i) subject to clause (ii), an amount
equal to the amount of the reduction under
subparagraph (A) for such year is,
notwithstanding subsection (a), transferred and
made available for grants pursuant to section
2618(a)(1), in addition to amounts available
for such grants under section 2623[.]; and
(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).
* * * * * * *
Part B--Care Grant Program
Subpart I--General Grant Provisions
* * * * * * *
SEC. 2617. STATE APPLICATION.
(a) * * *
(b) Description of Intended Uses and Agreements.--The
application submitted under subsection (a) shall contain--
(1) * * *
* * * * * * *
(6) an assurance that the public health agency
administering the grant for the State will periodically
convene a meeting of individuals with HIV/AIDS, members
of a Federally recognized Indian tribe as represented
in the State, representatives of grantees under each
part under this title, providers, and public agency
representatives for the purpose of developing a
statewide coordinated statement of need; [and]
(7) an assurance by the State that--
(A) * * *
* * * * * * *
(G) entities within areas in which activities
under the grant are carried out will maintain
appropriate relationships with entities in the
area served that constitute key points of
access to the health care system for
individuals with HIV/AIDS (including emergency
rooms, substance abuse treatment programs,
detoxification centers, adult and juvenile
detention facilities, sexually transmitted
disease clinics, HIV counseling and testing
sites, mental health programs, and homeless
shelters), and other entities under section
2612(c) and 2652(a), for the purpose of
facilitating early intervention for individuals
newly diagnosed with HIV/AIDS and individuals
knowledgeable of their HIV status but not in
care[.]; and
(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. 2618. DISTRIBUTION OF FUNDS.
(a) Amount of Grant to State.--
(1) * * *
(2) Determination.--
(A) Formula.--For purposes of paragraph (1),
the amount referred to in this paragraph for a
State (including a territory) for a fiscal year
is, subject to subparagraphs (E) and (F)--
(i) an amount equal to the amount
made available under section 2623 for
the fiscal year involved for grants
pursuant to paragraph (1), subject to
[subparagraph (G)] subparagraph (F);
and
* * * * * * *
(D) Living cases of hiv/aids.--
(i) * * *
(ii) Transition period; exemption
regarding non-aids cases.--For each of
the fiscal years 2007 through [2009]
2012, a State is, subject to clauses
(iii) through (v), exempt from the
requirement under clause (i) that
living non-AIDS names-based cases of
HIV be reported unless--
(I) * * *
(II) no later than the
beginning of fiscal year 2008
[or 2009] or a subsequent
fiscal year through fiscal year
2012, the Secretary, after
consultation with the chief
executive of the State,
determines that a system has
become operational in the State
that provides sufficiently
accurate and reliable names-
based reporting of such cases
throughout the State.
* * * * * * *
(iv) Requirement for exemption as of
fiscal year 2008.--For each of the
fiscal years 2008 through [2010] 2012,
an exemption under clause (ii) for a
State applies only if, as of April 1,
2008, the State is substantially in
compliance with the agreement under
clause (iii)(II).
(v) Progress toward names-based
reporting.--For fiscal year 2009 or a
subsequent fiscal year, the Secretary
may terminate an exemption under clause
(ii) for a State if the State submitted
a plan under clause (iii)(I)(aa) and
the Secretary determines that the State
is not substantially following the
plan.
(vi) Counting of cases in areas with
exemptions.--
(I) * * *
(II) Adjustment rate.--The
adjustment rate under subclause
(I) for a State shall be a
reduction of 5 percent for
fiscal years before fiscal year
2012 (and 6 percent for fiscal
year 2012) in the number of
living non-AIDS cases of HIV
reported for the State.
(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.
* * * * * * *
(viii) Rules of construction
regarding acceptance of reports.--
(I) * * *
(II) Applicability of
exemption requirements.--The
provisions of clauses (ii)
through (vii) may not be
construed as having any legal
effect for fiscal year [2010]
2013 or any subsequent fiscal
year, and accordingly, the
status of a State for purposes
of such clauses may not be
considered after fiscal year
[2009] 2012.
* * * * * * *
(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.
(E) Code-based states; limitation on increase
in grant.--
(i) In general.--For each of the
fiscal years 2007 through [2009] 2012,
if code-based reporting (within the
meaning of subparagraph (D)(vi))
applies in a State as of the beginning
of the fiscal year involved, then
notwithstanding any other provision of
this paragraph, the amount of the grant
pursuant to paragraph (1) for the State
may not for the fiscal year involved
exceed by more than 5 percent the
amount of the grant pursuant to this
paragraph for the State for the
preceding fiscal year, except that the
limitation under this clause may not
result in a grant pursuant to paragraph
(1) for a fiscal year that is less than
the minimum amount that applies to the
State under such paragraph for such
fiscal year.
(ii) Use of amounts involved.--For
each of the fiscal years 2007 through
[2009] 2012, amounts available as a
result of the limitation under clause
(i) shall be made available by the
Secretary as additional amounts for
grants pursuant to section 2620,
subject to subparagraph (H).
(F) Appropriations for treatment drug
program.--
(i) * * *
(ii) Supplemental treatment drug
grants.--
(I) * * *
* * * * * * *
(V) Funding.--For the purpose
of making grants under this
clause, the Secretary shall
each fiscal year reserve 5
percent of the amount referred
to in clause (i) with respect
to section 2616[, subject to
subclause (VI)].
* * * * * * *
(H) Increase in formula grants.--
(i) Assurance of amount.--
(I) General rule.--For fiscal
year [2007] 2010, the Secretary
shall ensure, subject to
clauses (ii) through (iv), that
the total for a State of the
grant pursuant to paragraph (1)
and the grant pursuant to
[subparagraph (G)] subparagraph
(F) is not less than 95 percent
of such total for the State for
fiscal year [2006] 2009.
(II) Rule of construction.--
With respect to the application
of subclause (I), the 95
percent requirement under such
subclause shall apply with
respect to each grant awarded
under paragraph (1) and with
respect to each grant awarded
under [subparagraph (G)]
subparagraph (F).
[(ii) Fiscal year 2007.--For purposes
of clause (i) as applied for fiscal
year 2007, the references in such
clause to subparagraph (G) are deemed
to be references to subparagraph (I) as
such subparagraph was in effect for
fiscal year 2006.]
[(iii)] (ii) Fiscal years [2008 and
2009] 2011 and 2012.--For each of the
fiscal years [2008 and 2009] 2011 and
2012, the Secretary shall ensure that
the total for a State of the grant
pursuant to paragraph (1) and the grant
pursuant to [subparagraph (G)]
subparagraph (F) is not less than 100
percent of such total for the State for
fiscal year [2007] 2010.
(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.
* * * * * * *
(v) Applicability.--This paragraph
may not be construed as having any
applicability after fiscal year [2009]
2013.
* * * * * * *
SEC. 2620. SUPPLEMENTAL GRANTS.
(a) In General.--For the purpose of providing services
described in section 2612(a), the Secretary shall make grants
to States--
(1) * * *
(2) that did not, for the most recent grant year
pursuant to section 2618(a)(1) or [2618(a)(2)(G)(i)]
2618(a)(2)(F)(i) for which data is available, have more
than [2 percent] 5 percent of grant funds under such
sections [canceled] canceled, offset under section
2622(e), or covered by any waivers under section
2622(c).
* * * * * * *
SEC. 2622. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT FUNDS.
(a) Obligation by End of Grant Year.--Effective for fiscal
year 2007 and subsequent fiscal years, funds from a grant award
made to a State for a fiscal year pursuant to section
2618(a)(1) or [2618(a)(2)(G)] 2618(a)(2)(F), or under section
2620 or 2621, are available for obligation by the State through
the end of the one-year period beginning on the date in such
fiscal year on which funds from the award first become
available to the State (referred to in this section as the
``grant year for the award''), except as provided in subsection
(c)(1).
(b) Supplemental Grants; Cancellation of Unobligated Balance
of Grant Award.--Effective for fiscal year 2007 and subsequent
fiscal years, if a grant award made to a State for a fiscal
year pursuant to section [2618(a)(2)(G)(ii)] 2618(a)(2)(F)(ii),
or under section 2620 or 2621, has an unobligated balance as of
the end of the grant year for the award--
(1) * * *
* * * * * * *
(c) Formula Grants; Cancellation of Unobligated Balance of
Grant Award; Waiver Permitting Carryover.--
(1) In general.--Effective for fiscal year 2007 and
subsequent fiscal years, if a grant award made to a
State for a fiscal year pursuant to section 2618(a)(1)
or [2618(a)(2)(G)(i)] 2618(a)(2)(F)(i) has an
unobligated balance as of the end of the grant year for
the award, the Secretary shall cancel that unobligated
balance of the award, and shall require the State to
return any amounts from such balance that have been
disbursed to the State, unless--
(A) * * *
* * * * * * *
(4) Corresponding reduction in future grant.--
(A) In general.--In the case of a State for
which a balance from a grant award made
pursuant to section 2618(a)(1) or
[2618(a)(2)(G)(i)] 2618(a)(2)(F)(i) is
unobligated as of the end of the grant year for
the award--
(i) the Secretary shall reduce, by
the same amount as such unobligated
balance (less any amount of such
balance that is the subject of a waiver
of cancellation under paragraph (1)),
the amount of the grant under such
section for the first fiscal year
beginning after the fiscal year in
which the Secretary obtains the
information necessary for determining
that such balance was unobligated as of
the end of the grant year (which
requirement for a reduction applies
without regard to whether a waiver
under paragraph (1) has been approved
with respect to such balance); and
* * * * * * *
except that this subparagraph does not apply to
the State if the amount of the unobligated
balance was [2] 5 percent or less.
* * * * * * *
(d) Treatment of Drug Rebates.--For purposes of this section,
funds that are drug rebates referred to in section 2616(g) may
not be considered part of any grant award referred to in
subsection (a). 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.
(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.
SEC. 2623. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--For the purpose of carrying out this
subpart, there are authorized to be appropriated $1,195,500,000
for fiscal year 2007, $1,239,500,000 for fiscal year 2008, [and
$1,285,200,000 for fiscal year 2009] $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. Amounts appropriated under
the preceding sentence for a fiscal year are available for
obligation by the Secretary until the end of the second
succeeding fiscal year.
(b) Reservation of Amounts.--
(1) * * *
(2) Supplemental grants.--
(A) In general.--Of the amount appropriated
under subsection (a) for a fiscal year in
excess of the 2006 adjusted amount, the
Secretary shall reserve \1/3\ for grants under
section 2620, except that the availability of
the reserved funds for such grants is subject
to section 2618(a)(2)(H) as applied for such
year, and except that any amount appropriated
exclusively for carrying out section 2616 (and,
accordingly, distributed under section
[2618(a)(2)(G)] 2618(a)(2)(F)) is not subject
to this subparagraph.
* * * * * * *
Part C--Early Intervention Services
Subpart I--Categorical Grants
* * * * * * *
SEC. 2655. AUTHORIZATION OF APPROPRIATIONS.
For the purpose of making grants under section 2651, there
are authorized to be appropriated, $218,600,000 for fiscal year
2007, $226,700,000 for fiscal year 2008, [and $235,100,000 for
fiscal year 2009] $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.
* * * * * * *
PART D--WOMEN, INFANTS, CHILDREN, AND YOUTH
SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR
WOMEN, INFANTS, CHILDREN, AND YOUTH.
(a) In General.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall award grants to public and nonprofit
private entities (including a health facility operated by or
pursuant to a contract with the Indian Health Service) for the
purpose of providing family-centered care involving outpatient
or ambulatory care [(directly or through contracts)] (directly
or through contracts or memoranda of understanding) for women,
infants, children, and youth with HIV/AIDS.
* * * * * * *
(g) Training and Technical Assistance.--From the amounts
appropriated under [subsection (i)] subsection (j) for a fiscal
year, the Secretary may use not more than 5 percent to provide,
directly or through contracts with public and private entities
(which may include grantees under subsection (a)), training and
technical assistance to assist applicants and grantees under
subsection (a) in complying with the requirements of this
section.
* * * * * * *
(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).
[(i)] (j) Authorization of Appropriations.--For the purpose
of carrying out this section, there are authorized to be
appropriated, $71,800,000 for each of the fiscal years 2007
through 2009, $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.
PART E--GENERAL PROVISIONS
* * * * * * *
[SEC. 2686. GAO REPORT.
[The Comptroller General of the Government Accountability
Office shall biennially submit to the appropriate committees of
Congress a report that includes a description of Federal,
State, and local barriers to HIV program integration,
particularly for racial and ethnic minorities, including
activities carried out under subpart III of part F, and
recommendations for enhancing the continuity of care and the
provision of prevention services for individuals with HIV/AIDS
or those at risk for such disease. Such report shall include a
demonstration of the manner in which funds under this subpart
are being expended and to what extent the services provided
with such funds increase access to prevention and care services
for individuals with HIV/AIDS and build stronger community
linkages to address HIV prevention and care for racial and
ethnic minority communities.]
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. 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. [2688.] 2689. DEFINITIONS.
For purposes of this title:
(1) * * *
* * * * * * *
PART F--DEMONSTRATION AND TRAINING
* * * * * * *
Subpart II--AIDS Education and Training Centers
SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.
(a) * * *
* * * * * * *
(c) Authorization of Appropriations.--
(1) Schools; centers.--For the purpose of awarding
grants under subsection (a), there [is authorized] are
authorized to be appropriated $34,700,000 for each of
the fiscal years 2007 through 2009, $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.
(2) Dental schools.--For the purpose of awarding
grants under subsection (b), there [is authorized] are
authorized to be appropriated $13,000,000 for each of
the fiscal years 2007 through 2009, $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.
Subpart III--Minority AIDS Initiative
SEC. 2693. MINORITY AIDS INITIATIVE.
(a) In General.--For the purpose of carrying out activities
under this section to evaluate and address the disproportionate
impact of HIV/AIDS on, and the disparities in access,
treatment, care, and outcomes for, racial and ethnic minorities
(including African Americans, Alaska Natives, Latinos, American
Indians, Asian Americans, Native Hawaiians, and Pacific
Islanders), there are authorized to be appropriated
$131,200,000 for fiscal year 2007, $135,100,000 for fiscal year
2008, [and $139,100,000 for fiscal year 2009.] $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) Certain Activities.--
(1) * * *
(2) Allocations among activities.--Activities under
paragraph (1) shall be carried out by the Secretary in
accordance with the following:
(A) For [competitive,] supplemental grants to
improve HIV-related health outcomes to reduce
existing racial and ethnic health disparities,
the Secretary shall, of the amount appropriated
under subsection (a) for a fiscal year, reserve
the following, as applicable:
(i) * * *
* * * * * * *
(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.
(B) For [competitive] grants used for
supplemental support education and outreach
services to increase the number of eligible
racial and ethnic minorities who have access to
treatment through the program under section
2616 for therapeutics, the Secretary shall, of
the amount appropriated for a fiscal year under
subsection (a), reserve the following, as
applicable:
(i) * * *
* * * * * * *
(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.
(C) For planning grants, capacity-building
grants, and services grants to health care
providers who have a history of providing
culturally and linguistically appropriate care
and services to racial and ethnic minorities,
the Secretary shall, of the amount appropriated
for a fiscal year under subsection (a), reserve
the following, as applicable:
(i) * * *
* * * * * * *
(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.
(D) For eliminating racial and ethnic
disparities in the delivery of comprehensive,
culturally and linguistically appropriate care
services for HIV disease for women, infants,
children, and youth, the Secretary shall, of
the amount appropriated under subsection (a),
reserve [$18,500,000 for each of the fiscal
years 2007 through 2009.] 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.
(E) For increasing the training capacity of
centers to expand the number of health care
professionals with treatment expertise and
knowledge about the most appropriate standards
of HIV disease-related treatments and medical
care for racial and ethnic minority adults,
adolescents, and children with HIV disease, the
Secretary shall, of the amount appropriated
under subsection (a), reserve [$8,500,000 for
each of the fiscal years 2007 through 2009.]
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.
* * * * * * *
(g) 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.
* * * * * * *
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 subpart 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 subpart 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 subpart 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, and
Public Health Officers.--This subpart may not be construed to
authorize any cause of action for damages or any civil penalty
against any medical facility, any designated officer, or any
other public health officer for failure to comply with the
duties established in this subpart.
(b) Testing.--This subpart 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 subpart 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 subpart 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 subpart.
(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 subpart. As appropriate,
the Secretary shall investigate alleged such violations and
seek appropriate injunctive relief.
SEC. 2695I. APPLICABILITY OF SUBPART.
This subpart 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
subpart.
* * * * * * *