89–006 

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 


tjames on DSKG8SOYB1PROD with HEARING
2 

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 OfVerDate Nov 24 2008 05:44 Oct 21, 2009 Jkt 089006 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR305.XXX HR305

tjames on DSKG8SOYB1PROD with HEARING
3 

fice; 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. 


tjames on DSKG8SOYB1PROD with HEARING
4 

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. 


tjames on DSKG8SOYB1PROD with HEARING
5 

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 pracVerDate Nov 24 2008 05:44 Oct 21, 2009 Jkt 089006 PO 00000 Frm 00005 Fmt 6659 Sfmt 6602 E:\HR\OC\HR305.XXX HR305

tjames on DSKG8SOYB1PROD with HEARING
6 

tices in capacity-building, particularly for minority communitybased 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. 


tjames on DSKG8SOYB1PROD with HEARING
7 

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, codebased 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. 


tjames on DSKG8SOYB1PROD with HEARING
8 

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 jurisdicVerDate Nov 24 2008 05:44 Oct 21, 2009 Jkt 089006 PO 00000 Frm 00008 Fmt 6659 Sfmt 6602 E:\HR\OC\HR305.XXX HR305

tjames on DSKG8SOYB1PROD with HEARING
9 

tion 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. 


tjames on DSKG8SOYB1PROD with HEARING
10 

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 

* * * * * * * 

øSEC. 703. REPEAL. 

øEffective 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 

* * * * * * * 


tjames on DSKG8SOYB1PROD with HEARING
11 

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; 

øand¿ 

(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); øand¿ 

(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 


tjames on DSKG8SOYB1PROD with HEARING
12 

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 NONAIDS CASES.—For each of the fiscal years 2007 through 

ø2009¿ 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 øor 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 namesbased reporting of such cases throughout the 

State. 

* * * * * * * 

(iv) REQUIREMENT FOR EXEMPTION AS OF FISCAL

YEAR 2008.—For each of the fiscal years 2008 through 

ø2010¿ 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. 


tjames on DSKG8SOYB1PROD with HEARING
13 

(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 REQUIRE- MENTS.—The provisions of clauses (ii) through 

(viii) may not be construed as having any legal effect for fiscal year ø2010¿ 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 ø2009¿ 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 ø2009¿ 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 øand 2009¿ 

through 2012, exceed by more than 5 percent the 

amount of the grant pursuant to this paragraph 


tjames on DSKG8SOYB1PROD with HEARING
14 

and paragraph (4) for the area for the preceding 

fiscal year. 

(ii) USE OF AMOUNTS INVOLVED.—For each of the fiscal years 2007 through ø2009¿ 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 ø2006¿ 

2009, the Secretary shall, for each of the fiscal years ø2007 

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: 

ø(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 ‘‘662⁄3 percent’’ for 

‘‘50 percent’’. 

ø(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 ø2009¿ 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; øand¿ 


tjames on DSKG8SOYB1PROD with HEARING
15 

(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 ø2 percent¿ 5 percent of grant funds under such 

subsection øcanceled¿ canceled, offset under subsection 

(c)(4), or covered by any waivers under subsection (c)(3)ø.¿; 

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-thirdø.¿, 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— 


tjames on DSKG8SOYB1PROD with HEARING
16 

(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 ø2 

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); 

* * * * * * * 


tjames on DSKG8SOYB1PROD with HEARING
17 

Subpart II—Transitional Grants 

SEC. 2609. ESTABLISHMENT OF PROGRAM. 

(a) * * * 

* * * * * * * 

(c) CERTAIN ELIGIBILITY RULES.— 

(1) FISCAL YEAR ø2007¿ 2011.—With respect to grants under 

subsection (a) for fiscal year ø2007¿ 2011, a metropolitan area 

that received funding under subpart I for fiscal year ø2006¿ 

2010 but does not for fiscal year ø2007¿ 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) øto 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. 

ø(B)¿ (C) EXCEPTION REGARDING STATUS AS ELIGIBLE

AREA.—øSubparagraph (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 ø2009¿ 2013, the exception described in subparagraph (A) does not apply if the transitional area involved 

received funding under subpart I for fiscal year 2006. 

* * * * * * * 


tjames on DSKG8SOYB1PROD with HEARING
18 

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, øand $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 2623ø.¿; 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). 

* * * * * * * 


tjames on DSKG8SOYB1PROD with HEARING
19 

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; øand¿ 

(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 careø.¿; 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. 

* * * * * * * 


tjames on DSKG8SOYB1PROD with HEARING
20 

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 øsubparagraph (G)¿ subparagraph (F); and 

* * * * * * * 

(D) LIVING CASES OF HIV/AIDS.— 

(i) * * * 

(ii) TRANSITION PERIOD; EXEMPTION REGARDING NONAIDS CASES.—For each of the fiscal years 2007 through 

ø2009¿ 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 øor 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 

ø2010¿ 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 REPORTVerDate Nov 24 2008 05:44 Oct 21, 2009 Jkt 089006 PO 00000 Frm 00020 Fmt 6659 Sfmt 6603 E:\HR\OC\HR305.XXX HR305

tjames on DSKG8SOYB1PROD with HEARING
21 

ING.—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 ACCEPT- ANCE OF REPORTS.— (I) * * * 

(II) APPLICABILITY OF EXEMPTION REQUIRE- MENTS.—The provisions of clauses (ii) through (vii) 

may not be construed as having any legal effect 

for fiscal year ø2010¿ 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 ø2009¿ 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 ø2009¿ 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. 


tjames on DSKG8SOYB1PROD with HEARING
22 

(ii) USE OF AMOUNTS INVOLVED.—For each of the fiscal years 2007 through ø2009¿ 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 

2616ø, subject to subclause (VI)¿. 

* * * * * * * 

(H) INCREASE IN FORMULA GRANTS.— 

(i) ASSURANCE OF AMOUNT.— 

(I) GENERAL RULE.—For fiscal year ø2007¿ 

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 øsubparagraph (G)¿ subparagraph (F) is not less than 95 percent of such total 

for the State for fiscal year ø2006¿ 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 

øsubparagraph (G)¿ subparagraph (F). 

ø(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.¿ 

ø(iii)¿ (ii) FISCAL YEARS ø2008 AND 2009¿ 2011 AND

2012.—For each of the fiscal years ø2008 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 øsubparagraph (G)¿ subparagraph (F) is not less than 100 percent of such 

total for the State for fiscal year ø2007¿ 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. 

* * * * * * * 


tjames on DSKG8SOYB1PROD with HEARING
23 

(v) APPLICABILITY.—This paragraph may not be construed as having any applicability after fiscal year 

ø2009¿ 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 ø2618(a)(2)(G)(i)¿ 2618(a)(2)(F)(i) for 

which data is available, have more than ø2 percent¿ 5 percent 

of grant funds under such sections øcanceled¿ 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 

ø2618(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 oneyear 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 ø2618(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 ø2618(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 ø2618(a)(2)(G)(i)¿ 2618(a)(2)(F)(i) is unobligated as of the end of the grant year for the award— 


tjames on DSKG8SOYB1PROD with HEARING
24 

(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 ø2¿ 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, øand $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 


tjames on DSKG8SOYB1PROD with HEARING
25 

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 

ø2618(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, øand $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 ø(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 øsubsection (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 asVerDate Nov 24 2008 05:44 Oct 21, 2009 Jkt 089006 PO 00000 Frm 00025 Fmt 6659 Sfmt 6601 E:\HR\OC\HR305.XXX HR305

tjames on DSKG8SOYB1PROD with HEARING
26 

sistance 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). 

ø(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 

* * * * * * * 

øSEC. 2686. GAO REPORT. 

øThe 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 


tjames on DSKG8SOYB1PROD with HEARING
27 

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). 


tjames on DSKG8SOYB1PROD with HEARING
28 

(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. ø2688.¿ 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 øis 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 øis 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, øand $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.— 


tjames on DSKG8SOYB1PROD with HEARING
29 

(1) * * * 

(2) ALLOCATIONS AMONG ACTIVITIES.—Activities under paragraph (1) shall be carried out by the Secretary in accordance 

with the following: 

(A) For øcompetitive,¿ 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 øcompetitive¿ 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 ø$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 treatVerDate Nov 24 2008 05:44 Oct 21, 2009 Jkt 089006 PO 00000 Frm 00029 Fmt 6659 Sfmt 6601 E:\HR\OC\HR305.XXX HR305

tjames on DSKG8SOYB1PROD with HEARING
30 

ment 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 

ø$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). 


tjames on DSKG8SOYB1PROD with HEARING
31 

(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 


tjames on DSKG8SOYB1PROD with HEARING
32 

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 MED- ICAL 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. 


tjames on DSKG8SOYB1PROD with HEARING
33 

(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 REGARD- ING 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 


tjames on DSKG8SOYB1PROD with HEARING
34 

(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 


tjames on DSKG8SOYB1PROD with HEARING
35 

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. 


tjames on DSKG8SOYB1PROD with HEARING
36 

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. 

* * * * * * * 

Æ 


tjames on DSKG8SOYB1PROD with HEARING