[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1793 Enrolled Bill (ENR)]
S.1793
One Hundred Eleventh Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Tuesday,
the sixth day of January, two thousand and nine
An Act
To amend title XXVI of the Public Health Service Act to revise and
extend the program for providing life-saving care for those with HIV/
AIDS.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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(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.).

8689a5acc9aa72b5056dbc78b3455c4b748ef0b6a0f3f6a5708d35b7b5f5f335

(a) Elimination of Sunset Provision.--
(1) In general.--The Ryan White HIV/AIDS Treatment
Modernization Act of 2006 (Public Law 109-415; 120 Stat. 2767) is
amended by striking section 703.
(2) Effective date.--Paragraph (1) shall take effect as if
enacted on September 30, 2009.
(3) Contingency provisions.--Notwithstanding section 703 of the
Ryan White HIV/AIDS Treatment Modernization Act of 2006 (Public Law
109-415; 120 Stat. 2767) and section 139 of the Continuing
Appropriations Resolution, 2010--
(A) the provisions of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff et seq.), as in effect on
September 30, 2009, are hereby revived; and
(B) the amendments made by this Act to title XXVI of the
Public Health Service Act (42 U.S.C. 300ff et seq.) shall apply
to such title as so revived and shall take effect as if enacted
on September 30, 2009.
(b) Part A Grants.--Section 2610(a) (42 U.S.C. 300ff-20(a)) is
amended by striking ``and $649,500,000 for fiscal year 2009'' and
inserting ``$649,500,000 for fiscal year 2009, $681,975,000 for fiscal
year 2010, $716,074,000 for fiscal year 2011, $751,877,000 for fiscal
year 2012, and $789,471,000 for fiscal year 2013''.
(c) Part B Grants.--Section 2623(a) (42 U.S.C. 300ff-32(a)) is
amended by striking ``and $1,285,200,000 for fiscal year 2009'' and
inserting ``$1,285,200,000 for fiscal year 2009, $1,349,460,000 for
fiscal year 2010, $1,416,933,000 for fiscal year 2011, $1,487,780,000
for fiscal year 2012, and $1,562,169,000 for fiscal year 2013''.
(d) Part C Grants.--Section 2655 (42 U.S.C. 300ff-55) is amended by
striking ``and $235,100,000 for fiscal year 2009'' and inserting
``$235,100,000 for fiscal year 2009, $246,855,000 for fiscal year 2010,
$259,198,000 for fiscal year 2011, $272,158,000 for fiscal year 2012,
and $285,766,000 for fiscal year 2013''.
(e) Part D Grants.--Section 2671(i) (42 U.S.C. 300ff-71(i)) is
amended by inserting before the period at the end ``, $75,390,000 for
fiscal year 2010, $79,160,000 for fiscal year 2011, $83,117,000 for
fiscal year 2012, and $87,273,000 for fiscal year 2013''.
(f) Demonstration and Training Grants Under Part F.--
(1) HIV/AIDS communities, schools, and centers.--Section
2692(c) (42 U.S.C. 300ff-111(c)) is amended--
(A) in paragraph (1)--
(i) by striking ``is authorized'' and inserting ``are
authorized''; and
(ii) by inserting before the period at the end ``,
$36,535,000 for fiscal year 2010, $38,257,000 for fiscal
year 2011, $40,170,000 for fiscal year 2012, and
$42,178,000 for fiscal year 2013''; and
(B) in paragraph (2)--
(i) by striking ``is authorized'' and inserting ``are
authorized''; and
(ii) by inserting before the period at the end ``,
$13,650,000 for fiscal year 2010, $14,333,000 for fiscal
year 2011, $15,049,000 for fiscal year 2012, and
$15,802,000 for fiscal year 2013''.
(2) Minority aids initiative.--Section 2693 (42 U.S.C. 300ff-
121) is amended--
(A) in subsection (a), by striking ``and $139,100,000 for
fiscal year 2009.'' and inserting ``$139,100,000 for fiscal
year 2009, $146,055,000 for fiscal year 2010, $153,358,000 for
fiscal year 2011, $161,026,000 for fiscal year 2012, and
$169,077,000 for fiscal year 2013. The Secretary shall develop
a formula for the awarding of grants under subsections
(b)(1)(A) and (b)(1)(B) that ensures that funding is provided
based on the distribution of populations disproportionately
impacted by HIV/AIDS.'';
(B) in subsection (b)(2)--
(i) in subparagraph (A)--
(I) in the matter preceding clause (i), by striking
``competitive,''; and
(II) by adding at the end the following:
``(iv) For fiscal year 2010, $46,738,000.
``(v) For fiscal year 2011, $49,075,000.
``(vi) For fiscal year 2012, $51,528,000.
``(vii) For fiscal year 2013, $54,105,000.'';
(ii) in subparagraph (B)--
(I) in the matter preceding clause (i), by striking
``competitive''; and
(II) by adding at the end the following:
``(iv) For fiscal year 2010, $8,763,000.
``(v) For fiscal year 2011, $9,202,000.
``(vi) For fiscal year 2012, $9,662,000.
``(vii) For fiscal year 2013, $10,145,000.'';
(iii) in subparagraph (C), by adding at the end the
following:
``(iv) For fiscal year 2010, $61,343,000.
``(v) For fiscal year 2011, $64,410,000.
``(vi) For fiscal year 2012, $67,631,000.
``(vii) For fiscal year 2013, $71,012,000.'';
(iv) in subparagraph (D), by striking ``$18,500,000''
and all that follows through the period and inserting the
following: ``the following, as applicable:
``(i) For fiscal year 2010, $20,448,000.
``(ii) For fiscal year 2011, $21,470,000.
``(iii) For fiscal year 2012, $22,543,000.
``(iv) For fiscal year 2013, $23,671,000.''; and
(v) in subparagraph (E), by striking ``$8,500,000'' and
all that follows through the period and inserting the
following: ``the following, as applicable:
``(i) For fiscal year 2010, $8,763,000.
``(ii) For fiscal year 2011, $9,201,000.
``(iii) For fiscal year 2012, $9,662,000.
``(iv) For fiscal year 2013, $10,144,000.''; and
(C) by adding at the end the following:
``(d) Synchronization of Minority AIDS Initiative.--For fiscal year
2010 and each subsequent fiscal year, the Secretary shall incorporate
and synchronize the schedule of application submissions and funding
availability under this section with the schedule of application
submissions and funding availability under the corresponding provisions
of this title XXVI as follows:
``(1) The schedule for carrying out subsection (b)(1)(A) shall
be the same as the schedule applicable to emergency assistance
under part A.
``(2) The schedule for carrying out subsection (b)(1)(B) shall
be the same as the schedule applicable to care grants under part B.
``(3) The schedule for carrying out subsection (b)(1)(C) shall
be the same as the schedule applicable to grants for early
intervention services under part C.
``(4) The schedule for carrying out subsection (b)(1)(D) shall
be the same as the schedule applicable to grants for services
through projects for HIV-related care under part D.
``(5) The schedule for carrying out subsection (b)(1)(E) shall
be the same as the schedule applicable to grants and contracts for
activities through education and training centers under section
2692.''.
(3) HHS report.--Not later than 6 months after the publication
of the Government Accountability Office Report on the Minority Aids
Initiative described in section 2686, the Secretary of Health and
Human Services shall submit to the appropriate committees of
Congress a Departmental plan for using funding under section 2693
of the Public Health Service Act (42 U.S.C. 300ff-93) in all
relevant agencies to build capacity, taking into consideration the
best practices included in such Report.
(g) GAO Report.--Section 2686 (42 U.S.C. 300ff-86) is amended to
read as follows:
``SEC. 2686. GAO REPORT.
``The Comptroller General of the Government Accountability Office
shall, not less than 1 year after the date of enactment of the Ryan
White HIV/AIDS Treatment Extension Act of 2009, submit to the
appropriate committees of Congress a report describing Minority AIDS
Initiative activities across the Department of Health and Human
Services, including programs under this title and programs at the
Centers for Disease Control and Prevention, the Substance Abuse and
Mental Health Services Administration, and other departmental agencies.
Such report shall include a history of program activities within each
relevant agency and a description of activities conducted, people
served and types of grantees funded, and shall collect and describe
best practices in community outreach and capacity-building of community
based organizations serving the communities that are disproportionately
affected by HIV/AIDS.''.

18a70160013ed7d6df81cb04d8fbbc5ce217b7691e1c413bad26ea158028f6ee

(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''.

8928fb33cacdb3b5e10289ea3c950f184b991e65b7d7550d4b68c9249d21f355

(a) Eligibility.--Section 2609 (42 U.S.C. 300ff-19) is amended--
(1) in subsection (c)(1)--
(A) in the heading, by striking ``2007'' and inserting
``2011''; and
(B) by striking ``2007'' each place it appears and
inserting ``2011''; and
(C) by striking ``2006'' and inserting ``2010'';
(2) in subsection (c)(2)--
(A) in subparagraph (A)(ii), by striking ``to have a'' and
inserting ``subject to subparagraphs (B) and (C), to have a'';
(B) by redesignating subparagraph (B) as subparagraph (C);
(C) by inserting after subparagraph (A) the following:
``(B) Permitting margin of error applicable to certain
metropolitan areas.--In applying subparagraph (A)(ii) for a
fiscal year after fiscal year 2008, in the case of a
metropolitan area that has a cumulative total of at least 1,400
(and fewer than 1,500) living cases of AIDS as of December 31
of the most recent calendar year for which such data is
available, such area shall be treated as having met the
criteria of such subparagraph if not more than 5 percent of the
total from grants awarded to such area under this part is
unobligated as of the end of the most recent fiscal year for
which such data is available.''; and
(D) in subparagraph (C), as so redesignated, by striking
``Subparagraph (A) does not apply'' and inserting
``Subparagraphs (A) and (B) do not apply''; and
(3) in subsection (d)(1)(B), strike ``2009'' and insert
``2013''.
(b) Transfer of Amounts Due to Change in Status as Transitional
Area.--Subparagraph (B) of section 2610(c)(2) (42 U.S.C. 300ff-
20(c)(2)) is amended--
(1) by striking ``(B)'' and inserting ``(B)(i) subject to
clause (ii),'';
(2) by striking the period at the end and inserting ``; and'';
and
(3) by adding at the end the following:
``(ii) for each of fiscal years 2010 through 2013,
notwithstanding subsection (a)--
``(I) there shall be transferred to the State
containing the metropolitan area, for purposes described in
section 2612(a), an amount (which shall not be taken into
account in applying section 2618(a)(2)(H)) equal to--
``(aa) for the first fiscal year of the
metropolitan area not being a transitional area, 75
percent of the amount described in subparagraph (A)(i)
for such area;
``(bb) for the second fiscal year of the
metropolitan area not being a transitional area, 50
percent of such amount; and
``(cc) for the third fiscal year of the
metropolitan area not being a transitional area, 25
percent of such amount; and
``(II) there shall be transferred and made available
for grants pursuant to section 2618(a)(1) for the fiscal
year, in addition to amounts available for such grants
under section 2623, an amount equal to the total amount of
the reduction for such fiscal year under subparagraph (A),
less the amount transferred for such fiscal year under
subclause (I).''.

4e401f85b3b54c662d65eae53a00aea405ddf09796b92a1780d64732ba6345c9

(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)''.

7efa22784af488383c71d93d92f5625e1d9992d6c7374fc71ced6702948a7c06

(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.

3ecc86bcd37ada16108f8beca984b642c54aa54a8c6d407822c171b9041821d5

(a) Part A Grants.--
(1) Formula grants.--Section 2603(a)(3)(C)(vi) (42 U.S.C.
300ff-13(a)(3)(C)(vi)) is amended by adding at the end the
following:
``(III) Increased adjustment for certain areas
previously using code-based reporting.--For purposes of
this subparagraph for each of fiscal years 2010 through
2012, the Secretary shall deem the applicable number of
living cases of HIV/AIDS in an area that were reported
to and confirmed by the Centers for Disease Control and
Prevention to be 3 percent higher than the actual
number if--
``(aa) for fiscal year 2007, such area was a
transitional area;
``(bb) fiscal year 2007 was the first year in
which the count of living non-AIDS cases of HIV in
such area, for purposes of this section, was based
on a names-based reporting system; and
``(cc) the amount of funding that such area
received under this part for fiscal year 2007 was
less than 70 percent of the amount of funding
(exclusive of funds that were identified as being
for purposes of the Minority AIDS Initiative) that
such area received under such part for fiscal year
2006.''.
(2) Supplemental grants.--Section 2603(b)(2) (42 U.S.C. 300ff-
13(b)(2)) is amended by adding at the end the following:
``(D) Increased adjustment for certain areas previously
using code-based reporting.--For purposes of this subsection
for each of fiscal years 2010 through 2012, the Secretary shall
deem the applicable number of living cases of HIV/AIDS in an
area that were reported to and confirmed by the Centers for
Disease Control and Prevention to be 3 percent higher than the
actual number if the conditions described in items (aa) through
(cc) of subsection (a)(3)(C)(vi)(III) are all satisfied.''.
(b) Part B Grants.--Section 2618(a)(2)(D)(vi) (42 U.S.C. 300ff-
28(a)(2)(D)(vi)) is amended by adding at the end the following:
``(III) Increased adjustment for certain states
previously using code-based reporting.--For purposes of
this subparagraph for each of fiscal years 2010 through
2012, the Secretary shall deem the applicable number of
living cases of HIV/AIDS in a State that were reported
to and confirmed by the Centers for Disease Control and
Prevention to be 3 percent higher than the actual
number if--
``(aa) there is an area in such State that
satisfies all of the conditions described in items
(aa) through (cc) of section
2603(a)(3)(C)(vi)(III); or
``(bb)(AA) fiscal year 2007 was the first year
in which the count of living non-AIDS cases of HIV
in such area, for purposes of this part, was based
on a names-based reporting system; and
``(BB) the amount of funding that such State
received under this part for fiscal year 2007 was
less than 70 percent of the amount of funding that
such State received under such part for fiscal year
2006.''.

ad80228e45e5c4c475d516f6a5d9a224cdea948d53dbd3052f66e586ec87a72e

(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))''.

452112c879f58d17a2e0b2f09467c1c751fc618c09d3d5e5e58306e7fbd3f07b

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.''.

0e8802e4da8c99c2535e94b3f97d96d2b35d97af59bbe7b03d4e7becf1a52915

(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)''.

94afe7424a14677169b39c33838cb1a7ec0545bc3687c2dd0047916651e94a0d

(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)''.

0d1ac1c8c09172911963957edd95742d21d0497d401070d4fc5ab33adc751584

Part E of title XXVI (42 U.S.C. 300ff-81 et seq.) is amended--
(1) by redesignating section 2688 as section 2689; and
(2) by inserting after section 2687 the following:
``SEC. 2688. NATIONAL HIV/AIDS TESTING GOAL.
``(a) In General.--Not later than January 1, 2010, the Secretary
shall establish a national HIV/AIDS testing goal of 5,000,000 tests for
HIV/AIDS annually through federally-supported HIV/AIDS prevention,
treatment, and care programs, including programs under this title and
other programs administered by the Centers for Disease Control and
Prevention.
``(b) Annual Report.--Not later than January 1, 2011, and annually
thereafter, the Secretary, acting through the Director of the Centers
for Disease Control and Prevention, shall submit to Congress a report
describing, with regard to the preceding 12-month reporting period--
``(1) whether the testing goal described in subsection (a) has
been met;
``(2) the total number of individuals tested through federally-
supported and other HIV/AIDS prevention, treatment, and care
programs in each State;
``(3) the number of individuals who--
``(A) prior to such 12-month period, were unaware of their
HIV status; and
``(B) through federally-supported and other HIV/AIDS
prevention, treatment, and care programs, were diagnosed and
referred into treatment and care during such period;
``(4) any barriers, including State laws and regulations, that
the Secretary determines to be a barrier to meeting the testing
goal described in subsection (a);
``(5) the amount of funding the Secretary determines necessary
to meet the annual testing goal in the following 12 months and the
amount of Federal funding expended to meet the testing goal in the
prior 12-month period; and
``(6) the most cost-effective strategies for identifying and
diagnosing individuals who were unaware of their HIV status,
including voluntary testing with pre-test counseling, routine
screening including opt-out testing, partner counseling and
referral services, and mass media campaigns.
``(c) Review of Program Effectiveness.--Not later than 1 year after
the date of enactment of this section, the Secretary, in consultation
with the Director of the Centers for Disease Control and Prevention,
shall submit a report to Congress based on a comprehensive review of
each of the programs and activities conducted by the Centers for
Disease Control and Prevention as part of the Domestic HIV/AIDS
Prevention Activities, including the following:
``(1) The amount of funding provided for each program or
activity.
``(2) The primary purpose of each program or activity.
``(3) The annual goals for each program or activity.
``(4) The relative effectiveness of each program or activity
with relation to the other programs and activities conducted by the
Centers for Disease Control and Prevention, based on the--
``(A) number of previously undiagnosed individuals with
HIV/AIDS made aware of their status and referred into the
appropriate treatment;
``(B) amount of funding provided for each program or
activity compared to the number of undiagnosed individuals with
HIV/AIDS made aware of their status;
``(C) program's contribution to the National HIV/AIDS
testing goal; and
``(D) progress made toward the goals described in paragraph
(3).
``(5) Recommendations if any to Congress on ways to allocate
funding for domestic HIV/AIDS prevention activities and programs in
order to achieve the National HIV/AIDS testing goal.
``(d) Coordination With Other Federal Activities.--In pursuing the
National HIV/AIDS testing goal, the Secretary, where appropriate, shall
consider and coordinate with other national strategies conducted by the
Federal Government to address HIV/AIDS.''.

9f051c40c53134264d88df058045ad618b114555f6649283074de37a2a719638

Title XXVI (42 U.S.C. 300ff-11 et seq.) is amended by adding at the
end the following:
``PART G--NOTIFICATION OF POSSIBLE EXPOSURE TO INFECTIOUS DISEASES
``SEC. 2695. INFECTIOUS DISEASES AND CIRCUMSTANCES RELEVANT TO
NOTIFICATION REQUIREMENTS.
``(a) In General.--Not later than 180 days after the date of the
enactment of this part, the Secretary shall complete the development
of--
``(1) a list of potentially life-threatening infectious
diseases, including emerging infectious diseases, to which
emergency response employees may be exposed in responding to
emergencies;
``(2) guidelines describing the circumstances in which such
employees may be exposed to such diseases, taking into account the
conditions under which emergency response is provided; and
``(3) guidelines describing the manner in which medical
facilities should make determinations for purposes of section
2695B(d).
``(b) Specification of Airborne Infectious Diseases.--The list
developed by the Secretary under subsection (a)(1) shall include a
specification of those infectious diseases on the list that are
routinely transmitted through airborne or aerosolized means.
``(c) Dissemination.--The Secretary shall--
``(1) transmit to State public health officers copies of the
list and guidelines developed by the Secretary under subsection (a)
with the request that the officers disseminate such copies as
appropriate throughout the States; and
``(2) make such copies available to the public.
``SEC. 2695A. ROUTINE NOTIFICATIONS WITH RESPECT TO AIRBORNE INFECTIOUS
DISEASES IN VICTIMS ASSISTED.
``(a) Routine Notification of Designated Officer.--
``(1) Determination by treating facility.--If a victim of an
emergency is transported by emergency response employees to a
medical facility and the medical facility makes a determination
that the victim has an airborne infectious disease, the medical
facility shall notify the designated officer of the emergency
response employees who transported the victim to the medical
facility of the determination.
``(2) Determination by facility ascertaining cause of death.--
If a victim of an emergency is transported by emergency response
employees to a medical facility and the victim dies at or before
reaching the medical facility, the medical facility ascertaining
the cause of death shall notify the designated officer of the
emergency response employees who transported the victim to the
initial medical facility of any determination by the medical
facility that the victim had an airborne infectious disease.
``(b) Requirement of Prompt Notification.--With respect to a
determination described in paragraph (1) or (2) of subsection (a), the
notification required in each of such paragraphs shall be made as soon
as is practicable, but not later than 48 hours after the determination
is made.
``SEC. 2695B. REQUEST FOR NOTIFICATION WITH RESPECT TO VICTIMS
ASSISTED.
``(a) Initiation of Process by Employee.--If an emergency response
employee believes that the employee may have been exposed to an
infectious disease by a victim of an emergency who was transported to a
medical facility as a result of the emergency, and if the employee
attended, treated, assisted, or transported the victim pursuant to the
emergency, then the designated officer of the employee shall, upon the
request of the employee, carry out the duties described in subsection
(b) regarding a determination of whether the employee may have been
exposed to an infectious disease by the victim.
``(b) Initial Determination by Designated Officer.--The duties
referred to in subsection (a) are that--
``(1) the designated officer involved collect the facts
relating to the circumstances under which, for purposes of
subsection (a), the employee involved may have been exposed to an
infectious disease; and
``(2) the designated officer evaluate such facts and make a
determination of whether, if the victim involved had any infectious
disease included on the list issued under paragraph (1) of section
2695(a), the employee would have been exposed to the disease under
such facts, as indicated by the guidelines issued under paragraph
(2) of such section.
``(c) Submission of Request to Medical Facility.--
``(1) In general.--If a designated officer makes a
determination under subsection (b)(2) that an emergency response
employee may have been exposed to an infectious disease, the
designated officer shall submit to the medical facility to which
the victim involved was transported a request for a response under
subsection (d) regarding the victim of the emergency involved.
``(2) Form of request.--A request under paragraph (1) shall be
in writing and be signed by the designated officer involved, and
shall contain a statement of the facts collected pursuant to
subsection (b)(1).
``(d) Evaluation and Response Regarding Request to Medical
Facility.--
``(1) In general.--If a medical facility receives a request
under subsection (c), the medical facility shall evaluate the facts
submitted in the request and make a determination of whether, on
the basis of the medical information possessed by the facility
regarding the victim involved, the emergency response employee was
exposed to an infectious disease included on the list issued under
paragraph (1) of section 2695(a), as indicated by the guidelines
issued under paragraph (2) of such section.
``(2) Notification of exposure.--If a medical facility makes a
determination under paragraph (1) that the emergency response
employee involved has been exposed to an infectious disease, the
medical facility shall, in writing, notify the designated officer
who submitted the request under subsection (c) of the
determination.
``(3) Finding of no exposure.--If a medical facility makes a
determination under paragraph (1) that the emergency response
employee involved has not been exposed to an infectious disease,
the medical facility shall, in writing, inform the designated
officer who submitted the request under subsection (c) of the
determination.
``(4) Insufficient information.--
``(A) If a medical facility finds in evaluating facts for
purposes of paragraph (1) that the facts are insufficient to
make the determination described in such paragraph, the medical
facility shall, in writing, inform the designated officer who
submitted the request under subsection (c) of the insufficiency
of the facts.
``(B)(i) If a medical facility finds in making a
determination under paragraph (1) that the facility possesses
no information on whether the victim involved has an infectious
disease included on the list under section 2695(a), the medical
facility shall, in writing, inform the designated officer who
submitted the request under subsection (c) of the insufficiency
of such medical information.
``(ii) If after making a response under clause (i) a
medical facility determines that the victim involved has an
infectious disease, the medical facility shall make the
determination described in paragraph (1) and provide the
applicable response specified in this subsection.
``(e) Time for Making Response.--After receiving a request under
subsection (c) (including any such request resubmitted under subsection
(g)(2)), a medical facility shall make the applicable response
specified in subsection (d) as soon as is practicable, but not later
than 48 hours after receiving the request.
``(f) Death of Victim of Emergency.--
``(1) Facility ascertaining cause of death.--If a victim
described in subsection (a) dies at or before reaching the medical
facility involved, and the medical facility receives a request
under subsection (c), the medical facility shall provide a copy of
the request to the medical facility ascertaining the cause of death
of the victim, if such facility is a different medical facility
than the facility that received the original request.
``(2) Responsibility of facility.--Upon the receipt of a copy
of a request for purposes of paragraph (1), the duties otherwise
established in this part regarding medical facilities shall apply
to the medical facility ascertaining the cause of death of the
victim in the same manner and to the same extent as such duties
apply to the medical facility originally receiving the request.
``(g) Assistance of Public Health Officer.--
``(1) Evaluation of response of medical facility regarding
insufficient facts.--
``(A) In the case of a request under subsection (c) to
which a medical facility has made the response specified in
subsection (d)(4)(A) regarding the insufficiency of facts, the
public health officer for the community in which the medical
facility is located shall evaluate the request and the
response, if the designated officer involved submits such
documents to the officer with the request that the officer make
such an evaluation.
``(B) As soon as is practicable after a public health
officer receives a request under subparagraph (A), but not
later than 48 hours after receipt of the request, the public
health officer shall complete the evaluation required in such
paragraph and inform the designated officer of the results of
the evaluation.
``(2) Findings of evaluation.--
``(A) If an evaluation under paragraph (1)(A) indicates
that the facts provided to the medical facility pursuant to
subsection (c) were sufficient for purposes of determinations
under subsection (d)(1)--
``(i) the public health officer shall, on behalf of the
designated officer involved, resubmit the request to the
medical facility; and
``(ii) the medical facility shall provide to the
designated officer the applicable response specified in
subsection (d).
``(B) If an evaluation under paragraph (1)(A) indicates
that the facts provided in the request to the medical facility
were insufficient for purposes of determinations specified in
subsection (c)--
``(i) the public health officer shall provide advice to
the designated officer regarding the collection and
description of appropriate facts; and
``(ii) if sufficient facts are obtained by the
designated officer--
``(I) the public health officer shall, on behalf of
the designated officer involved, resubmit the request
to the medical facility; and
``(II) the medical facility shall provide to the
designated officer the appropriate response under
subsection (c).
``SEC. 2695C. PROCEDURES FOR NOTIFICATION OF EXPOSURE.
``(a) Contents of Notification to Officer.--In making a
notification required under section 2695A or section 2695B(d)(2), a
medical facility shall provide--
``(1) the name of the infectious disease involved; and
``(2) the date on which the victim of the emergency involved
was transported by emergency response employees to the medical
facility involved.
``(b) Manner of Notification.--If a notification under section
2695A or section 2695B(d)(2) is mailed or otherwise indirectly made--
``(1) the medical facility sending the notification shall, upon
sending the notification, inform the designated officer to whom the
notification is sent of the fact that the notification has been
sent; and
``(2) such designated officer shall, not later than 10 days
after being informed by the medical facility that the notification
has been sent, inform such medical facility whether the designated
officer has received the notification.
``SEC. 2695D. NOTIFICATION OF EMPLOYEE.
``(a) In General.--After receiving a notification for purposes of
section 2695A or 2695B(d)(2), a designated officer of emergency
response employees shall, to the extent practicable, immediately notify
each of such employees who--
``(1) responded to the emergency involved; and
``(2) as indicated by guidelines developed by the Secretary,
may have been exposed to an infectious disease.
``(b) Certain Contents of Notification to Employee.--A notification
under this subsection to an emergency response employee shall inform
the employee of--
``(1) the fact that the employee may have been exposed to an
infectious disease and the name of the disease involved;
``(2) any action by the employee that, as indicated by
guidelines developed by the Secretary, is medically appropriate;
and
``(3) if medically appropriate under such criteria, the date of
such emergency.
``(c) Responses Other Than Notification of Exposure.--After
receiving a response under paragraph (3) or (4) of subsection (d) of
section 2695B, or a response under subsection (g)(1) of such section,
the designated officer for the employee shall, to the extent
practicable, immediately inform the employee of the response.
``SEC. 2695E. SELECTION OF DESIGNATED OFFICERS.
``(a) In General.--For the purposes of receiving notifications and
responses and making requests under this part on behalf of emergency
response employees, the public health officer of each State shall
designate 1 official or officer of each employer of emergency response
employees in the State.
``(b) Preference in Making Designations.--In making the
designations required in subsection (a), a public health officer shall
give preference to individuals who are trained in the provision of
health care or in the control of infectious diseases.
``SEC. 2695F. LIMITATION WITH RESPECT TO DUTIES OF MEDICAL FACILITIES.
``The duties established in this part for a medical facility--
``(1) shall apply only to medical information possessed by the
facility during the period in which the facility is treating the
victim for conditions arising from the emergency, or during the 60-
day period beginning on the date on which the victim is transported
by emergency response employees to the facility, whichever period
expires first; and
``(2) shall not apply to any extent after the expiration of the
30-day period beginning on the expiration of the applicable period
referred to in paragraph (1), except that such duties shall apply
with respect to any request under section 2695B(c) received by a
medical facility before the expiration of such 30-day period.
``SEC. 2695G. MISCELLANEOUS PROVISIONS.
``(a) Liability of Medical Facilities, Designated Officers, Public
Health Officers, and Governing Entities.--This part may not be
construed to authorize any cause of action for damages or any civil
penalty against any medical facility, any designated officer, any other
public health officer, or any governing entity of such facility or
officer for failure to comply with the duties established in this part.
``(b) Testing.--This part may not, with respect to victims of
emergencies, be construed to authorize or require a medical facility to
test any such victim for any infectious disease.
``(c) Confidentiality.--This part may not be construed to authorize
or require any medical facility, any designated officer of emergency
response employees, or any such employee, to disclose identifying
information with respect to a victim of an emergency or with respect to
an emergency response employee.
``(d) Failure To Provide Emergency Services.--This part may not be
construed to authorize any emergency response employee to fail to
respond, or to deny services, to any victim of an emergency.
``(e) Notification and Reporting Deadlines.--In any case in which
the Secretary determines that, wholly or partially as a result of a
public health emergency that has been determined pursuant to section
319(a), individuals or public or private entities are unable to comply
with the requirements of this part, the Secretary may, notwithstanding
any other provision of law, temporarily suspend, in whole or in part,
the requirements of this part as the circumstances reasonably require.
Before or promptly after such a suspension, the Secretary shall notify
the Congress of such action and publish in the Federal Register a
notice of the suspension.
``(f) Continued Application of State and Local Law.--Nothing in
this part shall be construed to limit the application of State or local
laws that require the provision of data to public health authorities.
``SEC. 2695H. INJUNCTIONS REGARDING VIOLATION OF PROHIBITION.
``(a) In General.--The Secretary may, in any court of competent
jurisdiction, commence a civil action for the purpose of obtaining
temporary or permanent injunctive relief with respect to any violation
of this part.
``(b) Facilitation of Information on Violations.--The Secretary
shall establish an administrative process for encouraging emergency
response employees to provide information to the Secretary regarding
violations of this part. As appropriate, the Secretary shall
investigate alleged such violations and seek appropriate injunctive
relief.
``SEC. 2695I. APPLICABILITY OF PART.
``This part shall not apply in a State if the chief executive
officer of the State certifies to the Secretary that the law of the
State is substantially consistent with this part.''.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.

5aa5d9b1295ef881fdef2bd3248ace07a6e01a5bcc1218a1eb9d3f47a57c26df

Ryan White HIV/AIDS Treatment Extension Act of 2009 — S. 1793

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