101st CONGRESS
2d Session
S. 2240
AMENDMENTS
S 2240 EAH
In the House of Representatives, U. S.,
June 13, 1990.
Resolved, That the bill from the Senate (S. 2240) entitled `An Act to amend
the Public Health Service Act to provide grants to improve the quality
and availability of care for individuals and families with HIV disease,
and for other purposes', do pass with the following
AMENDMENTS:
Strike out all after the enacting clause and insert:

4228ebca9d20fd3bf7c0d496058c913a3dd4dd09385c7206dbab75bd3aaf9d06

This Act may be cited as the `AIDS Prevention Act of 1990'.
SYNDROME

fb0284a54aeda11f261531ada221e1b62fb225f7e14ffa883017ef296de67c17

9bf366d6da69560a85f2efcf9c1a8d866ed680d67c2d12073221c1f4a26af296

TITLE I

-PREVENTIVE HEALTH SERVICES WITH RESPECT TO ACQUIRED IMMUNE DEFICIENCY

Title XXVI of the Public Health Service Act, as added by section 101(3)
of this Act, is amended by adding at the end the following new part:
`Part B--Emergency Relief for Areas With Substantial Need for Services
`SEC. 2621. ESTABLISHMENT OF PROGRAM OF GRANTS.
`(a) ESTABLISHMENT-
`(1) ELIGIBLE GEOGRAPHIC AREAS- The Secretary, acting through the
Administrator of the Health Resources and Services Administration, shall,
subject to paragraph (2), make grants in accordance with section 2623 for
the purpose of assisting in the provision of the services specified in
subsection (c) in any metropolitan statistical area for which, as of June
30, 1990, in the case of grants for fiscal year 1991, and as of March 31
of the most recent fiscal year for which such data is available in the
case of a grant for any subsequent fiscal year--
`(A) there has been reported to the Director of the Centers for Disease
Control a cumulative total of more than 2,000 cases of acquired immune
deficiency syndrome; or
`(B) the per capita incidence of cumulative cases of such syndrome (computed
on the basis of the most recently available data on the population of the
geographic area) is not less than 0.0025.
`(2) REQUIREMENT REGARDING CONFIRMATION OF CASES- The Secretary may not make
a grant under paragraph (1) for a metropolitan statistical area unless,
before making any payments under the grant, the cases of acquired immune
deficiency syndrome reported for purposes of such paragraph have been
confirmed by the Secretary, acting through the Director of the Centers
for Disease Control.
`(b) DESIGNATION OF POLITICAL SUBDIVISION TO RECEIVE GRANT- The Secretary
may make grants under subsection (a) only to the chief elected official of
the city, urban county, or other political subdivision that administers the
public health agency serving the greatest proportion of cases of acquired
immune deficiency syndrome in the eligible geographic area involved,
as indicated by the number of such cases reported to the Director of the
Centers for Disease Control.
`(c) SPECIFICATION OF HEALTH AND OTHER COMMUNITY-BASED SERVICES- The
services referred to in subsection (a) are community-based services--
`(1) to enhance the quality of outpatient and ambulatory care services
provided to low-income individuals and families with HIV disease;
`(2) to deliver outpatient and ambulatory care services including case
management to such individuals and families, including comprehensive
treatment and support services;
`(3) to prevent unnecessary inpatient hospitalization; and
`(4) to expedite the provision of services to individuals in the most
medically appropriate level of service.
`(d) PROVISIONS REGARDING SERVICE PROVIDERS-
`(1) CERTAIN MINIMUM QUALIFICATIONS- The Secretary may not make a grant
under subsection (a) unless the political subdivision involved agrees that,
in expending the grant, the services specified in subsection (c) will be
provided only through public or nonprofit private clinics, sub-acute care
facilities, community health centers, community mental health centers,
hospices, ambulatory care facilities, or other public or nonprofit private
entities, that--
`(A) provide health care to a disproportionate share of low-income
individuals and families with HIV disease; and
`(B) incur uncompensated costs in providing health care to such individuals
and families.
`(2) REQUIREMENT OF STATUS AS MEDICAID PROVIDER-
`(A) Subject to subparagraph (B), the Secretary may not make a grant
under subsection (a) for the provision of health services under subsection
(c) in a State unless, in the case of any such service that is available
pursuant to the State plan approved under title XIX of the Social Security
Act for the State--
`(i) the political subdivision involved will provide the health service
directly, and the political subdivision has entered into a participation
agreements under the State plan and are qualified to receive payments
under such plan; or
`(ii) the political subdivision has entered into an agreement with a public
or nonprofit private entity under which the entity will provide the health
service, and the entity has entered into such a participation agreement
and is qualified to receive such payments.
`(B)(i) In the case of an entity making an agreement pursuant to subparagraph
(A)(ii) regarding the provision of health services, the requirement
established in such subparagraph shall be waived by the Secretary if
the entity does not, in providing health care services, impose a charge
or accept reimbursement available from any third-party payor, including
reimbursement under any insurance policy or under any Federal or State
health benefits program.
`(ii) A determination by the Secretary of whether an entity referred to in
clause (i) meets the criteria for a waiver under such clause shall be made
without regard to whether the entity accepts voluntary donations regarding
the provision of services to the public.
`(3) PRIORITIES- The Secretary may not make a grant under subsection (a)
unless the political subdivision involved agrees that, with respect to
health care providers described in paragraph (1), the political subdivision
will give priority to providing the services specified in subsection (c)
through such providers that--
`(A) have established, and agree to implement, a plan to evaluate the
utilization of services provided in the care of individuals and families
with HIV disease;
`(B) have established a system designed to ensure that such individuals
and families are referred to the most medically appropriate level of care
as soon as such referral is medically indicated; and
`(C) have provided such services to a significant number of individuals
with acquired immune deficiency syndrome.
`(e) DEFINITIONS- For purposes of this part:
`(1) The term `eligible geographic area' means a metropolitan statisical
area described in subsection (a)(1).
`(2) The term `metropolitan statisical area' means such areas as specified
by the Secretary.
`(f) Requirements Regarding Imposition of Fees for Services-
`(1) IN GENERAL- The Secretary may not make a grant under subsection (a)
unless, subject to paragraph (3), the applicant for the grant agrees that--
`(A) in the case of individuals with an income equal to or less than
100 percent of the official poverty line, the applicant will not impose
a charge on any such individual for the provision of preventive health
services under the grant;
`(B) in the case of individuals with an income greater than 100 percent
of the official poverty line, the applicant--
`(i) will impose a charge on each such individual for the provision of
such services; and
`(ii) will impose the charge according to a schedule of charges that is
made available to the public;
`(C) in the case of individuals with an income greater than 100 percent
of the official poverty line and not exceeding 200 percent of such poverty
line, the applicant will not, for any calendar year, impose the charge in
an amount exceeding 5 percent of the annual gross income of the individual
involved; and
`(D) in the case of individuals with an income greater than 200 percent of
the official poverty line, the applicant will not, for any calendar year,
impose the charge in an amount exceeding 10 percent of the annual gross
income of the individual involved.
`(2) APPLICABILITY OF LIMITATION ON AMOUNT OF CHARGE- The Secretary may not
make a grant under subsection (a) unless the applicant for the grant agrees
that the limitations established in subparagraphs (C) and (D) of paragraph
(1) regarding the imposition of charges for services applies to the single
annual aggregate of charges imposed for such services, without regard
to whether such charges are characterized as enrollment fees, premiums,
deductions, cost sharing, copayments, or similar items.
`(3) WAIVER REGARDING CERTAIN SECONDARY AGREEMENTS- The requirement
established in paragraph (1)(B)(i) shall be waived by the Secretary in
the case of any entity for whom the Secretary has granted a waiver under
subsection (f)(2)(B).
`SEC. 2622. ADMINISTRATION OF GRANTS.
`(a) IN GENERAL- To receive a grant under section 2621(a), the administering
local political subdivision shall, subject to subparagraph (B)--
`(1) establish, through intergovernmental agreement with the chief elected
officials of all local political subdivisions that have in excess of 10
percent of all individuals with acquired immune deficiency syndrome, as
reported to the Centers for Disease Control, in such subdivision within
the eligible geographic area, an administrative mechanism to allocate
funds and services based on the proportion of cases of such syndrome and
severity of need of such subdivisions; and
`(2) establish a council in accordance with subsection (c).
`(b) PRIORITIES IN ALLOCATION OF FUNDS- Allocation of funds and services
under subsection (a) for an eligible geographic area shall be made in
accordance with the priorities established, pursuant to subsection (c)(2),
by the council that serves the eligible geographic area pursuant to such
subsection.
`(c) HIV HEALTH SERVICES PLANNING COUNCIL-
`(1) IN GENERAL- To be eligible for assistance under this part, the chief
elected official described in subsection (a)(1) shall agree to provide
for an HIV health services planning council not later than 30 days after
the date on which such assistance is first received by the official. Such
a council shall include representatives of--
`(A) health care service providers;
`(B) community-based service organizations;
`(C) social service providers;
`(D) mental health providers;
`(E) local public health agencies;
`(F) hospital planning agencies or health care planning agencies;
`(G) affected communities;
`(H) community leaders;
`(I) State government;
`(J) grantees under section 2601; and
`(K) individuals who are infected with the human immunodeficiency virus.
`(2) DUTIES- The planning council provided for under paragraph (1) shall--
`(A) develop a comprehensive plan for the organization and delivery of
health services described in section 2621(c) that is compatible with any
existing State or local plan regarding the provision of health services
to individuals with HIV disease;
`(B) establish priorities for the allocation of funds within the eligible
geographic area; and
`(C) assess the efficiency of the administrative mechanism in rapidly
allocating funds to the areas of greatest need within the eligible
geographic area.
`(3) METHOD OF PROVIDING FOR COUNCIL-
`(A) IN GENERAL- In providing for a council for purposes of paragraph (1), a
chief elected official receiving a grant under section 2621(a) may establish
the council directly or designate an existing entity to serve as the council.
`(B) CONSIDERATION REGARDING DESIGNATION OF COUNCIL- In making a
determination of whether to establish or designate a council under
subparagraph (A), a chief elected official receiving a grant under
section 2621(a) shall consider whether the purpose of the council can
most effectively be carried out by designating as the council an existing
entity that has demonstrated experience in assessing and planning, within
the eligible geographic area, health care service needs regarding acquired
immune deficiency syndrome.
`(C) PRIORITY IN DESIGNATIONS- If a chief elected official receiving a
grant under section 2621(a) makes a determination that, in providing for
a council under paragraph (1), an existing entity should be designated to
serve as the council, the chief elected official shall give priority to
designating an entity described in subparagraph (B).
`(d) ADMINISTRATION AND PLANNING- Not to exceed 5 percent of amounts
received under a grant awarded under section 2621(a) may be utilized for
the administration of the grant.
`SEC. 2623. TYPE AND DISTRIBUTION OF GRANTS.
`(a) GRANTS BASED ON RELATIVE NEED OF AREA-
`(1) IN GENERAL- In carrying out section 2621(a), the Secretary shall make
a grant for each eligible geographic area for which an application under
section 2624(a) has been approved. Each such grant shall be made in an
amount determined in accordance with paragraph (3).
`(2) EXPENDITURES OF APPROPRIATIONS- Of the amounts appropriated under
section 2625 for a fiscal year, the Secretary shall reserve 50 percent for
making grants under paragraph (1). Not later than 90 days after the date
on which appropriations under such section are made for a fiscal year,
the Secretary shall obligate all of the amounts so reserved.
`(3) AMOUNT OF GRANT-
`(A) IN GENERAL- Subject to the extent of amounts made available in
appropriations Acts, a grant under paragraph (1) for an eligible geographic
area shall be made in an amount equal to the sum of--
`(i) an amount determined in accordance with subparagraph (B); and
`(ii) an amount determined in accordance with subparagraph (C).
`(B) AMOUNT RELATING TO CUMULATIVE NUMBER OF CASES- The amount referred
to in clause (i) of subparagraph (A) is an amount equal to the product of--
`(i) an amount equal to 75 percent of the amounts reserved under paragraph
(2) for the fiscal year involved; and
`(ii) a percentage equal to the quotient of--
`(I) the cumulative number of cases of acquired immune deficiency syndrome
in the eligible geographic area involved, as indicated by the number of such
cases reported to the Director of the Centers for Disease Control; divided by
`(II) the sum of the cumulative number of such cases in all eligible
geographic areas for which an application for a grant under paragraph (1)
has been approved.
`(C) AMOUNT RELATING TO PER CAPITA INCIDENCE OF CASES- The amount referred
to in clause (ii) of subparagraph (A) is an amount equal to the product of--
`(i) an amount equal to 25 percent of the amounts reserved under paragraph
(2) for the fiscal year involved; and
`(ii) a percentage developed by the Secretary through consideration of
the ratio of--
`(I) the per capita incidence of cumulative cases of acquired immune
deficiency syndrome in the eligible geographic area involved (computed
on the basis of the most recently available data on the population of the
geographic area); to
`(II) the per capita incidence of such cumulative cases in all eligible
geographic areas for which an application for a grant under paragraph (1)
has been approved (computed on the basis of the most recently available
data on the population of such geographic areas).
`(b) SUPPLEMENTAL GRANTS-
`(1) IN GENERAL- Not later than 150 days after the date on which
appropriations are made under section 2625 for a fiscal year, the Secretary
shall obligate 50 percent of the amounts appropriated under such section
for the fiscal year for the purpose of making grants under section 2621(a)
to eligible geographic areas whose application under section 2624(c)--
`(A) contains a report concerning the dissemination of emergency relief
funds under subsection (a) and the plan for utilization of such funds;
`(B) demonstrates the severe need in such area for supplemental financial
assistance to combat the HIV epidemic;
`(C) demonstrates the commitment of the local resources of the area,
both financial and in-kind, to combating the HIV epidemic;
`(D) demonstrates the ability of the area to utilize such supplemental
financial resources in a way that is immediately responsive and cost
effective; and
`(E) demonstrates that resources will be allocated in accordance with
the local demographic incidence of AIDS including funds for services for
infants, children, women, and families with HIV disease.
`(2) AMOUNT OF GRANT- The amount of each grant made by the Secretary under
paragraph (1) shall be determined by the Secretary based on the application
submitted by the eligible geographic area.
`SEC. 2624. APPLICATION.
`(a) IN GENERAL- To be eligible to receive a grant under section 2621,
an eligible geographic area shall prepare and submit to the Secretary an
application in such form, and containing such information as the Secretary
shall require, including assurances adequate to ensure--
`(1) that, if the applicant for the grant has, during the fiscal year
preceding the fiscal year for which the applicant is first applying to
receive such a grant, carried out with non-Federal funds a program of
providing services for the prevention or treatment of cases of infection
with the etiologic agent for acquired immune deficiency syndrome, or social
services regarding such cases, then the applicant will, for each fiscal
year for which such a grant is made to the applicant, expend the grant
only for the purpose of significantly increasing the availability of such
services provided by the applicant above the average level of availability
provided under the program during such period; and
`(2) that agencies and institutions within the eligible geographic area
that will receive funds under a grant provided under this part shall be
participants in an established HIV community-based continuum of care.
`(b) DATE CERTAIN FOR SUBMISSION- To be eligible to receive a grant under
section 2621(a) for a fiscal year, an application under subsection (a) shall
be submitted not later than 45 days after the date on which appropriations
are made under section 2625 for the fiscal year.
`(c) ADDITIONAL APPLICATION- An eligible geographic area that desires
to receive a grant under section 2623(b) shall prepare and submit, to
the Secretary, an additional application at such time, in such form, and
containing such information as the Secretary shall require, including the
information required under such subsection.
`SEC. 2625. AUTHORIZATION OF APPROPRIATIONS.
`For the purpose of making grants under section 2621(a), there are
authorized to be appropriated $275,000,000 for each of the fiscal years
1991 and 1992, and such sums as may be necessary for each of the fiscal
years 1993 through 1995.'.

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TITLE II

-EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

Title XXVI of the Public Health Service Act, as amended by section 201 of
this Act, is amended by adding at the end the following new part:
`Part C--Emergency Response Employees
`Subpart I--Guidelines and Model Curriculum
`SEC. 2631. GRANTS FOR IMPLEMENTATION.
`(a) IN GENERAL- With respect to the recommendations contained in the
guidelines and the model curriculum developed under section 253 of Public
Law 100-607, the Secretary shall make grants to States and political
subdivisions of States for the purpose of assisting grantees regarding
the initial implementation of such portions of the recommendations as are
applicable to emergency response employees.
`(b) REQUIREMENT OF APPLICATION- The Secretary may not make a grant under
subsection (a) unless an application for the grant is submitted to the
Secretary and the application is in such form, is made in such manner,
and contains such agreements, assurances, and information as the Secretary
determines to be necessary to carry out this section.
`(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
this section, there is authorized to be appropriated $5,000,000 for each
of the fiscal years 1991 through 1995.
`Subpart II--Notifications of Possible Exposure Regarding Acquired Immune
Deficiency Syndrome and Other Infectious Diseases
`SEC. 2641. ESTABLISHMENT OF REQUIREMENT OF NOTIFICATIONS WITH RESPECT TO
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 infectious
disease, the medical facility shall, with respect to the determination,
notify the designated officer of the emergency response employees who
transported the victim to the medical facility.
`(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 the death of the victim
shall, with respect to the designated officer of the emergency response
employees who transported the victim to the initial medical facility,
notify the designated officer of any determination by the medical facility
that the victim had an infectious disease.
`(3) REQUIREMENT OF PROMPT NOTIFICATIONS- With respect to a determination
described in paragraph (1) or (2), 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.
`(b) NOTIFICATION UPON REQUEST OF DESIGNATED OFFICER-
`(1) DETERMINATION BY TREATING FACILITY- If a victim of an emergency
is transported by emergency response employees to a medical facility,
the medical facility shall, upon the request of the designated officer
of any emergency response employees who attended, treated, assisted, or
transported the victim, notify the designated officer of any determination
by the medical facility that the victim has an infectious disease.
`(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 the death of the victim
shall, upon the request of the designated officer of any emergency response
employees who attended, treated, assisted, or transported the victim,
notify the designated officer of any determination by the medical facility
that the victim had an infectious disease.
`(3) REQUIREMENT OF PROMPT NOTIFICATION-
`(A) A medical facility shall make a notification required in paragraph
(1) or (2) as soon as is practicable, but not later than 48 hours, after
receipt of a request pursuant to the paragraph involved if, prior to the
request, a determination described in such paragraph has been made by the
medical facility.
`(B) A medical facility shall make a notification required in paragraph (1)
or (2) as soon as is practicable, but not later than 48 hours, after making
a determination described in the paragraph involved if, after receipt of
a request pursuant to such paragraph, the determination is made.
`(c) PROCEDURES FOR NOTIFICATION OF DESIGNATED OFFICER-
`(1) CONTENTS OF NOTIFICATION TO OFFICER- In making a notification required
under subsection (a) or (b), a medical facility shall provide the date and,
to the extent practicable, the time on which the victim of the emergency
involved was transported by emergency response employees to a medical
facility.
`(2) MANNER OF NOTIFICATION- If a notification under subsection (a) or
(b) is mailed or otherwise indirectly made--
`(A) 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
`(B) 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.
`(d) DESIGNATION OF INDIVIDUALS TO REQUEST AND RECEIVE NOTIFICATIONS FROM
MEDICAL FACILITIES-
`(1) IN GENERAL- The public health officer of each State shall, for the
purpose of requesting and receiving notifications under subsections (a) and
(b), and for the purpose of carrying out subsection (e), designate 1 official
or officer of each employer of emergency response employees in the State.
`(2) PREFERENCE IN MAKING DESIGNATIONS- In making the designations
required in paragraph (1), 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.
`(e) NOTIFICATION OF EMPLOYEE-
`(1) ROUTINE NOTIFICATION OF EMPLOYEE- After receiving a notification
under subsection (a) or (b), a designated officer of emergency response
employees shall, to the extent practicable, immediately notify each of
such employees who--
`(A) responded to the emergency involved; and
`(B) as indicated by guidelines developed by the Secretary, may have been
exposed to an infectious disease.
`(2) NOTIFICATION UPON REQUEST OF EMPLOYEE- A designated officer of
emergency response employees shall, upon request of such an employee--
`(A) determine whether, if a victim of an emergency to which the employee
responded had an infectious disease, the employee might have been exposed
to the disease, as indicated by guidelines developed by the Secretary; and
`(B) make a request described in subsection (b) if, as indicated by a
determination made pursuant to subparagraph (A), the employee might have
been exposed to the disease.
`(3) CONTENTS OF NOTIFICATION TO EMPLOYEE- A notification under this
subsection to an emergency response employee shall inform the employee of--
`(A) the fact that the employee may have been exposed to an infectious
disease and the name of the disease involved;
`(B) any action by the employee that, as indicated by guidelines developed
by the Secretary, is medically appropriate; and
`(C) if medically appropriate under such criteria, the date and time of
such emergency.
`(f) LIMITATION- Subsections (a)(1) and (b)(1) shall not apply to any
determination described in such subsections made with respect to a victim
of an emergency after the expiration of the 60-day period beginning on
the date that the victim is transported by emergency response employees
to a medical facility.
`SEC. 2642. RULES OF CONSTRUCTION.
`(a) TESTING- Section 2641 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.
`(b) CONFIDENTIALITY- Section 2641 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.
`(c) FAILURE TO PROVIDE EMERGENCY SERVICES- Section 2641 may not be
construed to authorize any emergency response employee to fail to respond,
or to deny services, to any victim of an emergency.
`SEC. 2643. 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 preventing a violation of section 2641.
`(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

d91a0af446a1ca1e35801ae63e6c0414631cb7470d295b14ac5dc7e21565fac3

TITLE III

-EMERGENCY RESPONSE EMPLOYEES

violations and seek appropriate injunctive relief.'.

0192ef218732b3950c0a71c36b98e4c68714373ee0fc461d3d77043a39bc0d36

Title XXVI of the Public Health Service Act, as amended by section 301 of
this Act, is amended by adding at the end the following new part:
`Part D--Certain Health Care Services
`SEC. 2651. GRANTS FOR DEMONSTRATION PROJECTS FOR COMPREHENSIVE TREATMENT
SERVICES.
`(a) IN GENERAL- The Secretary, acting through the Administrator of the
Health Resources and Services Administration, may make grants to public and
nonprofit entities for the purpose of providing for demonstration projects
to provide comprehensive treatment services for adults and children infected
with the etiologic agent for acquired immune deficiency syndrome.
(b) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
subsection (a), there are authorized to be appropriated $50,000,000 for
fiscal year 1991, and such sums as may be necessary for each of the fiscal
years 1992 through 1995.
`SEC. 2652. GRANTS TO STATES FOR PROVISION OF DRUGS FOR TREATMENT.
`(a) IN GENERAL- The Secretary, acting through the Administrator of the
Health Resources and Services Administration, may make grants to States
for the purpose of assisting States--
`(1) in purchasing drugs approved by the Commissioner of Food and Drugs
for use in the treatment of cases of infection with the etiologic agent
for acquired immune deficiency syndrome (including treating and preventing
conditions arising from such infection); and
`(2) in distributing such drugs as medically appropriate to indigent
individuals in need of the drugs who have no other means by which to
acquire the drugs.
`(b) REQUIREMENT OF MATCHING FUNDS-
`(1) IN GENERAL- The Secretary may not make a grant under subsection (a)
unless the State involved agrees that, with respect to the costs to be
incurred by the State in carrying out the purpose referred to in such
subsection, the State will make available (directly or through donations
from public or private entities) non-Federal contributions toward such
costs in an amount equal to--
`(A) for the first fiscal year of payments under the grant, not less than
$1 each $5 of Federal funds provided in the grant;
`(B) for any second fiscal year of such payments, not less than $1 for
each $4 of Federal funds provided in the grant;
`(C) for any third fiscal year of such payments, not less than $1 for each
$3 of Federal funds provided in the grant;
`(D) for any fourth fiscal year of such payments, not less than $1 for
each $2 of Federal funds provided in the grant; and
`(E) for any subsequent fiscal year of such payments, not less than $1
for each $1 of Federal funds provided in the grant.
`(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION- Non-Federal
contributions required in paragraph (1) may be in cash or in kind, fairly
evaluated, including plant, equipment, or services. Amounts provided by the
Federal Government, or services assisted or subsidized to any significant
extent by the Federal Government, may not be included in determining the
amount of such non-Federal contributions.
`(c) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
subsection (a), there are authorized to be appropriated $30,000,000 for
each of the fiscal years 1991 through 1995.
`SEC. 2653. DEMONSTRATION GRANTS FOR RESEARCH AND SERVICES FOR PEDIATRIC
PATIENTS REGARDING ACQUIRED IMMUNE DEFICIENCY SYNDROME.
`(a) IN GENERAL- The Secretary, acting through the Administrator of the
Health Resources and Services Administration and the Director of the National
Institutes of Health, shall make demonstration grants to community health
centers, and other appropriate public or nonprofit private entities that
provide primary health care to the public, for the purpose of--
`(1) conducting, at the health facilities of such entities, clinical
research on therapies for pediatric patients infected with the etiologic
agent for acquired immune deficiency syndrome; and
`(2) with respect to the pediatric patients who participate in such
research, providing health care on an outpatient basis to such patients
and the families of such patients.
`(b) MINIMUM QUALIFICATIONS OF GRANTEES- The Secretary may not make a
grant under subsection (a) unless the health facility operated by the
applicant for the grant serves a significant number of pediatric patients
and pregnant women infected with the etiologic agent for acquired immune
deficiency syndrome.
`(c) COOPERATION WITH BIOMEDICAL INSTITUTIONS-
`(1) DESIGN OF RESEARCH PROTOCOL- The Secretary may not make a grant under
subsection (a) unless the applicant for the grant--
`(A) has entered into a cooperative agreement or contract with an
appropriately qualified entity with expertise in biomedical research under
which the entity will assist the applicant in designing and conducting a
protocol for the research to be conducted pursuant to the grant; and
`(B) agrees to provide the clinical data developed in the research to the
Director of the National Institutes of Health.
`(2) ANALYSIS AND EVALUATION- The Secretary, acting through the Director
of the National Institutes of Health--
`(A) may assist grantees under subsection (a) in designing and conducting
protocols described in subparagraph (A) of paragraph (1); and
`(B) shall analyze and evaluate the data submitted to the Director pursuant
to subparagraph (B) of such paragraph.
`(d) CASE MANAGEMENT- The Secretary may not make a grant under subsection
(a) unless the applicant for the grant agrees to provide for the case
management of the pediatric patient involved and the family of the patient.
`(e) REFERRALS FOR ADDITIONAL SERVICES- The Secretary may not make a grant
under subsection (a) unless the applicant for the grant agrees to provide
for the pediatric patient involved and the family of the patient--
`(1) referrals for inpatient hospital services, treatment for substance
abuse, and mental health services; and
`(2) referrals for other social and support services, as appropriate.
`(f) INCIDENTAL SERVICES- The Secretary may not make a grant under subsection
(a) unless the applicant for the grant agrees to provide the family of the
pediatric patient involved with such transportation, child care, and other
incidental services as may be necessary to enable the the pediatric patient
and the family of the patient to participate in the program established
by the applicant pursuant to such subsection.
`(g) APPLICATION- The Secretary may not make a grant under subsection (a)
unless an application for the grant is submitted to the Secretary and the
application is in such form, is made in such manner, and contains such
agreements, assurances, and information as the Secretary determines to be
necessary to carry out this section.
`(h) EVALUATIONS- The Secretary shall, directly or through contracts with
public and private entities, provide for evaluations of programs carried
out pursuant to subsection (a).
`(i) DEFINITION- For purposes of this section, the term `community health
center' has the meaning given such term in section 330(a).
`(j) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this
section, there are authorized to be appropriated $20,000,000 for fiscal
year 1991, and such sums as may be necessary for each of the fiscal years
1992 through 1995.

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TITLE IV

-CERTAIN HEALTH CARE SERVICES

Title XXVI of the Public Health Service Act, as amended by section 401 of
this Act, is amended by adding at the end the following new part:
`Part E--General Provisions
`SEC. 2661. DEFINITIONS.
`For purposes of this title:
`(1) The term `counseling with respect to acquired immune deficiency
syndrome' means such counseling provided by an individual trained to
provide such counseling.
`(2) The term `designated officer of emergency response employees' means
an individual designated under section 2641(d) by the public health officer
of the State involved.
`(3) The term `emergency' means an emergency involving injury or illness.
`(4) The term `emergency response employees' means firefighters, law
enforcement officers, paramedics, emergency medical technicians, and
other individuals (including employees of legally organized and recognized
volunteer organizations, without regard to whether such employees receive
nominal compensation) who, in the course of professional duties, respond
to emergencies in the geographic area involved.
`(5) The term `employer of emergency response employees' means an
organization that, in the course of professional duties, responds to
emergencies in the geographic area involved.
`(6) The term `exposed', with respect to acquired immune deficiency syndrome
or any other infectious disease, means to be in circumstances in which
there is a significant risk of becoming infected with the etiologic agent
for the disease involved.
`(7) The term `infection with the etiologic agent for acquired immune
deficiency syndrome' includes any condition arising from such etiologic
agent.
`(8) The term `infectious disease' means hepatitis B, hepatitis non-A/non-B,
pulmonary tuberculosis, meningicoccal meningitis, rubella, infection with
the etiologic agent for acquired immune deficiency syndrome, and any other
disease designated, in accordance with guidelines issued by the Secretary,
as an infectious disease for purposes of part C.
`(9) The term `official poverty line' means the poverty line established
by the Director of the Office of Management and Budget and revised by
the Secretary in accordance with section 673(a) of the Omnibus Budget
Reconciliation Act of 1981.
`(10) The term `person' includes one or more individuals, governments
(including the Federal Government and the governments of the States),
governmental agencies, political subdivisions, labor unions, partnerships,
associations, corporations, legal representatives, mutual companies,
joint-stock companies, trusts, unincorporated organizations, receivers,
trustees, and trustees in cases under title 11, United States Code.
`(11) The term `preventive health services' means the services specified
in section 2601(c)(2).
`(12) The term `State' means each of the several States, the District of
Columbia, and the territories of the United States.
`(13) The term `territories of the United States' means each of the
Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, the
Commonwealth of the Northern Mariana Islands, the Trust Territory of the
Pacific Islands, and any other territory or possession of the United States.
`(14) The term `testing for infection with the etiologic agent for acquired
immune deficiency syndrome' includes any diagnosis of such infection made
by a health care provider licensed to make such a diagnosis under the law
of the State in which the diagnosis is made.'.

64d4e8e4c4a35b3c11ab59aa0c203e99173ba8e384eb13ea53216f1b6a1c81e9

TITLE V

-CERTAIN DEFINITIONS

(a) IN GENERAL- The Secretary of Health and Human Services, after
consultation with the Director of the Office of Rural Health Policy, shall--
(1) conduct a study for the purpose of estimating the incidence and
prevalence in rural areas of cases of acquired immune deficiency syndrome
and cases of infection with the etiologic agent for such syndrome; and
(2) in carrying out the study, determine the adequacy in rural areas of
services for diagnosing such cases and providing treatment for such cases
that are in the early stages of infection.
(b) REPORT- Not later than 1 year after the date of the enactment of this
Act, the Secretary of Health and Human Services shall complete the study
required in subsection (a) and submit to the Congress a report describing
the findings made as a result of the study.

c4f3ce6986883e6fc65f785662193737c806605e1a280c06a88a3111fdf65fff

TITLE VI

-GENERAL PROVISIONS

The Public Health Service Act (42 U.S.C. 201 et seq.) is amended--
(1) in section 406(a)(2), by striking `2101' and inserting `2701';
(2) in section 465(f), by striking `2601' and inserting `2701';
(3) in section 480(a)(2), by striking `2101' and inserting `2701';
(4) in section 485(a)(2), by striking `2101' and inserting `2701';
(5) in section 497, by striking `2601' and inserting `2701'; and
(6) in section 505(a)(2), by striking `2101' and inserting `2701'; and
(7) in section 926(b) (as added by section 6103(c)(1) of Public Law 101-239),
by striking `2611' each place such term appears and inserting `2711'.

edcd78e76b7b8067336f9c475b6c86dfb62bbdd5b054f4d7b3329d85ba1ca42a

Part C of title XXVI of the Public Health Service Act (as added by section
301 of this Act) shall take effect on the expiration of the 60-day period
beginning on the date of the enactment of this Act. Such title shall
otherwise take effect October 1, 1990, or upon the date of the enactment
of this Act, whichever occurs later.
Amend the title so as to read: `An Act to amend the Public Health Service Act
to establish a program of grants to provide preventive health services with
respect to acquired immune deficiency syndrome, and for other purposes.'.
Attest:
Clerk.
S 2240 EAH----2
S 2240 EAH----3
S 2240 EAH----4
S 2240 EAH----5
S 2240 EAH----6
S 2240 EAH----7

d395b71f3b33d9cb73800f089fab969ac0aed1f67348be8649000bd846ed82b2

Ryan White Comprehensive AIDS Resources Emergency Act of 1990

Other Sections