Ryan White Comprehensive AIDS Resources Emergency Act of 1990
PL 101-381 (S.2240), enacted 08/18/1990

104 STAT. 576 
PUBLIC LAW 101-381—AUG. 18, 1990 
Public Law 101-381 
101st Congress 
An Act 
Aug. 18, 1990 
[S. 2240] 
Ryan White 
Comprehensive 
AIDS Resources 
Emergency Act 
of 1990. 
42 u s e 201 note. 
42 u s e SOOff. 
42USC300aaa— 
300aaa-13. 
To amend the Public Health Service Act to provide grants to improve the quality and 
availability of care for individuals and families with HIV disease, and for other 
purposes. 
Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the "Ryan White Comprehensive AIDS 
Resources Emergency Act of 1990". 
SEC. 2. PURPOSE. 
It is the purpose of this Act to provide emergency assistance to 
locaUties that are disproportionately affected by the Human 
Immunodeficiency Virus epidemic and to make financial assistance 
available to States and other public or private nonprofit entities to 
provide for the development, organization, coordination and oper-
ation of more effective and cost efficient systems for the delivery of 
essential services to individuals and families with HIV disease. 
TITLE I—HIV EMERGENCY RELIEF 
GRANT PROGRAM 
SEC. 101. HIV EMERGENCY RELIEF GRANT PROGRAM. 
The Public Health Service Act is amended— 
(1) by redesignating title XXVI as title XXVII; 
(2) by redesignating sections 2601 through 2614 as sections 
2701 through 2714, respectively; and 
(3) by inserting after title XXV (42 U.S.C. 300ee et seq.) the 
following new title: 
"TITLE XXVI—HIV HEALTH CARE 
SERVICES PROGRAM 
"PART A—EMERGENCY REUEF FOR AREAS WITH SUBSTANTIAL NEED 
FOR 
S E R V I C E S 
42 u s e 300ff-ll. 
"SEC. 2601. ESTABLISHMENT OF PROGRAM OF GRANTS. 
"(a) ELIGIBLE AREAS.—The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration, shall, 
subject to subsection (b), make grants in accordance with section 
2603 for the purpose of assisting in the provision of the services 
specified in 2604 in any metropolitan area for which, as of June 30, 
1990, in the case of grants for fiscal year 1991, and as of March 31 of 
the most recent fiscal year for which such data is available in the 
case of a grant for any subsequent fiscal year— 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 577 
"(1) there has been reported to and confirmed by the Director 
of the Centers for Disease Control a cumulative total of more 
than 2,000 cases of acquired immune deficiency sjoidrome; or 
"(2) the per capita incidence of cumulative cases of such 
syndrome (computed on the basis of the most recently available 
data on the population of the area) is not less than 0.0025, 
"O3) REQUIREMENT REGARDING CONFIRMATION OF CASES.—The Sec-
retary may not make a grant under subsection (a) for a metropolitan 
area unless, before making any payments under the grant, the cases 
of acquired immune deficiency syndrome reported for purposes of 
such subsection have been confirmed by the Secretary, acting 
through the Director of the Centers for Disease Control. 
"SEC. 2602. ADMINISTRATION AND PLANNING COUNCIL. 
42 USC 300ff-12. 
"(a) ADMINISTRATION.— 
"(1) IN GENERAL.—Assistance made available under grants 
awarded under this part shall be directed to the chief elected 
official of the city or urban county that administers the public 
health agency that provides outpatient and ambulatory services 
to the greatest number of individuals with AIDS, as reported to 
and confirmed by the Centers for Disease Control, in the eligible 
area that is awarded such a grant. 
"(2) REQUIREMENTS.— 
"(A) IN GENERAL.—To receive assistance under section 
2601(a), the chief elected official of the eligible area in-
volved shall— 
"(i) establish, through intergovernmental agreements 
Contracts. 
with the chief elected officials of the political subdivi-
sions described in subparagraph (B), an administrative 
mechanism to allocate funds and services based on— 
"(I) the number of AIDS cases in such subdivi-
sions; 
"(II) the severity of need for outpatient and 
ambulatory care services in such subdivisions; and 
"(III) the health and support services personnel 
needs of such subdivisions; and 
"(ii) establish an HIV health services planning coun-
cil in accordance with subsection (b). 
"(B) LOCAL POUTICAL SUBDIVISION.—The political subdivi-
sions referred to in subparagraph (A) are those political 
subdivisions in the eligible area— 
"(i) that provide HIV-related health services; and 
"(ii) for which the number of cases reported for pur-
poses of section 2601(a) constitutes not less than 10 
percent of the number of such cases reported for the 
eligible area. 
"(b) HIV HEALTH SERVICES PLANNING COUNCIL.— 
"(1) EsTABUSHMENT.—To be eligible for assistance under this 
part, the chief elected official described in subsection (a)(1) shall 
establish or designate an HIV health services planning council 
that shall include representatives of— 
"(A) health care providers; 
"(B) community-based and AIDS service organizations; 
"(C) social service providers; 
"(D) mental health care providers; 
"(E) local public health agencies; 
104 STAT. 578 
PUBLIC LAW 101-381—AUG. 18, 1990 
"(F) hospital planning agencies or health care planning 
agencies; 
"(G) affected communities, including individuals with 
HIV disease; 
"(H) non-elected community leaders; 
"(I) State government; 
"(J) grantees under subpart II of part C; and 
"(K) the lead agency of any Health Resources and Serv-
ices Administration adult and pediatric HIV-related care 
demonstration project operating in the area to be served. 
"(2) METHOD OF PROVIDING FOR COUNCIL.— 
"(A) IN GENERAL.—In providing for a council for purposes 
of paragraph (1), a chief elected official receiving a grant 
under section 2601(a) may establish the council directly or 
designate an existing entity to serve as the council, subject 
to subparagraph (B), 
"(B) 
CONSIDERATION REGARDING DESIGNATION OF COUN-
CIL.—In making a determination of whether to establish or 
designate a council under subparagraph (A), a chief elected 
official receiving a grant under section 2601(a) shall give 
priority to the designation of an existing entity that has 
demonstrated experience in planning for the HIV health 
care service needs within the eligible area and in the 
implementation of such plans in addressing those needs. 
Any existing entity so designated shall be expanded to 
include a broad representation of the full range of entities 
that provide such services within the geographic area to be 
served. 
"(3) DUTIES.—The planning council established or designated 
under paragraph (1) shall— 
"(A) establish priorities for the allocation of funds within 
the eligible area; 
"(B) develop a comprehensive plan for the organization 
and delivery of health services described in section 2604 
that is compatible with any existing State or local plan 
regarding the provision of health services to individuals 
with HIV disease; and 
"(C) assess the efficiency of the administrative mecha-
nism in rapidly allocating funds to the areas of greatest 
need within the eligible area. 
42 use 300fr-13. 
"SEC. 2603. TYPE AND DISTRIBUTION OF GRANTS. 
"(a) GRANTS BASED ON RELATIVE NEED OF AREA.— 
"(1) IN GENERAL.—In carrying out section 2601(a), the Sec-
retary shall make a grant for each eligible area for which an 
application under section 2605(a) has been approved. Each such 
grant shall be made in an amount determined in accordance 
with paragraph (3). 
"(2) EXPEDITED DISTRIBUTION.—Not later than— 
"(A) 90 days after an appropriation becomes available to 
carry out this part for fiscal year 1991; and 
"(B) 60 days after an appropriation becomes available to 
carry out this part for each of fiscal years 1992 through 
1995; 
the Secretary shall, except in the case of waivers granted under 
section 2605(c), disburse 50 percent of the amount appropriated 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 579 
under section 2608 for such fiscal year through grants to eligible 
areas under section 2601(a). 
"(3) AMOUNT OF GRANT.— 
"(A) IN GENERAL.—Subject to the extent of amounts made 
available in appropriations Acts, a grant made for purposes 
of this paragraph for an eligible area shall be made in an 
amount equal to the sum of— 
"(i) an amount determined in accordance with 
subparsigraph (B); and 
"(ii) an amount determined in accordance with 
subparagraph (C). 
"(B) 
AMOUNT RELATING TO CUMULATIVE NUMBER OF 
CASES.—The amount referred to in clause (i) of subpara-
graph (A) is an amount equal to the product of— 
"(i) an amount equal to 75 percent of the amounts 
available for distribution under paragraph (2) for the 
fiscal year involved; and 
"(ii) a percentage equal to the quotient of— 
"(I) the cumulative number of cases of acquired 
immune deficiency syndrome in the eligible area 
involved, as indicated by the number of such cases 
reported to and confirmed by the Director of the 
Centers for Disease Control on the applicable date 
described in section 2601(a); divided by 
"(II) the sum of the cumulative number of such 
cases in all eligible areas for which an application 
for a grant under paragraph (1) has been approved. 
"(C) 
AMOUNT RELATING TO PER CAPITA INCIDENCE OF 
CASES.—The amount referred to in clause (ii) of subpara-
graph (A) is an amount equal to the product of— 
"(i) an amount equal to 25 percent of the amounts 
available for distribution under paragraph (2) for the 
fiscal year involved; and 
"(ii) a percentage developed by the Secretary through 
consideration of the ratio o
f
— 
"(I) the per capita incidence of cumulative cases 
of acquired immune deficiency S3nidrome in the 
eligible area involved (computed on the basis of the 
most recently available data on the population of 
the area); to 
"(II) the per capita incidence of such cumulative 
cases in all eligible areas for which an application 
V 
for a grant under paragraph (1) has been approved 
(computed on the basis of the most recently avail-
able data on the population of such areas). 
"
O
t
>
) SUPPLEMENTAL GRANTS.— 
"(1) IN GENERAL.—Not later than 150 days after the date on 
which appropriations are made under section 2608 for a fiscal 
year, the Secretary shall disburse the remainder of amounts not 
disbursed under section 2603(aX2) for such fiscal year for the 
purpose of making grants under section 2601(a) to eligible areas 
whose application under section 2605(b)— 
"(A) contains a report concerning the dissemination of 
emergency relief funds under subsection (a) and the plan 
for utilization of such funds; 
104 STAT. 580 
PUBLIC LAW 101-381—AUG. 18, 1990 
"(B) demonstrates the severe need in such area for 
supplemental financial assistance to combat the HIV epi-
demic; 
"(C) demonstrates the existing commitment of local re-
sources of the area, both financial and in-kind, to combating 
the HIV epidemic; 
"(D) demonstrates the ability of the area to utilize such 
supplemental financial resources in a manner that is imme-
diately responsive and cost effective; and 
Children and 
"(E) demonstrates that resources will be allocated in 
y?"<^h 
accordance with the local demographic incidence of AIDS 
Women. 
including appropriate allocations for services for infants, 
children, women, and families with HIV disease. 
"(2) REMAINDER OF AMOUNTS.—In determining the amount of 
funds to be obligated under paragraph (1), the Secretary shall 
include amounts that are not paid to the eligible areas under 
expedited procedures under section 2603(a)(2) as a result of— 
"(A) the failure of any eligible area to submit an applica-
tion under section 2605(c); or 
"(B) any eligible area informing the Secretary that such 
eligible area does not intend to expend the full amount of 
its grant under such section. 
"(3) AMOUNT OF GRANT.—The amount of each grant made for 
purposes of this subsection shall be determined by the Secretary 
based on the application submitted by the eligible area under 
section 260503). 
"(4) FAILURE T
O SUBMIT.— 
"(A) IN GENERAL.—The failure of an eligible area to 
submit an application for an expedited grant under section 
2603(a)(2) shall not result in such area being ineligible for a 
grant under this subsection. 
"(B) APPLICATION.—The application of an eligible area 
submitted under section 2605(b) shall contain the assur-
ances required under subsection (a) of such section if such 
eligible area fails to submit an application for an expedited 
grants under section 2603(a)(2). 
42 use 300fF-14. "SEC. 2604. USE OF AMOUNTS. 
"(a) REQUIREMENTS.—The Secretary may not make a grant under 
section 2601(a) to the chief elected official of an eligible area unless 
such political subdivision agrees that— 
"(1) subject to paragraph (2), the allocation of funds and 
services within the eligible area will be made in accordance 
with the priorities established, pursuant to section 2602(b)(3XA), 
by the HIV health services planning council that serves such 
eligible area; and 
"(2) funds provided under section 2601 will be expended only 
for the purposes described in subsections (b) and (c). 
"(b) PRIMARY PURPOSES.— 
"(1) IN GENERAL.—The chief elected official shall use amounts 
received under a grant under section 2601 to provide direct 
financial assistance to entities described in paragraph (2) for the 
purpose of delivering or enhancing HIV-related— 
"(A) outpatient and ambulatory health and support serv-
ices, including case management and comprehensive treat-
ment services, for individuals and families Avith HIV 
disease; and 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 581 
"(B) inpatient case management services that prevent 
unnecessary hospitalization or that expedite discharge, as 
medically appropriate, from inpatient facilities. 
"(2) APPROPRIATE ENTITIES.— 
"(A) IN GENERAL.—Subject to subparagraph (B), direct 
financial assistance may be provided under paragraph (1) to 
public or nonprofit private entities, including hospitals 
(which may include Veterans Administration facilities), 
community-based organizations, hospices, ambulatory care 
facilities, community health centers, migrant health cen-
ters, and homeless health centers. 
"(B) PRIORITY.—In providing direct financial assistance 
under paragraph (1) the chief elected official shall give 
priority to entities that are currently participating in 
Health Resources and Services Administration HIV health 
care demonstration projects. 
"(c) LIMITED EXPENDITURES FOR PERSONNEL NEEDS.— 
"(1) IN GENERAL.—A chief elected official, in accordance with 
paragraph (3), may use not to exceed 10 percent of amounts 
received under a grant under section 2601 to provide financial 
assistance or services, for the purposes described in paragraph 
(2), to any public or nonprofit private entity, including hospitals 
(which may include Veterans Administration facilities), nursing 
homes, subacute and transitional care facilities, and hospices 
that— 
"(A) provide HlV-related care or services to a dispropor-
tionate share of low-income individuals and families with 
HIV disease; 
"(B) incur uncompensated costs in the provision of such 
care or services to such individuals and families; 
"(C) have established, and agree to implement, a plan to 
evaluate the utilization of services provided in the care of 
individuals and families with HIV disease; and 
"(D) have established a system designed to ensure that 
such individuals and families are referred to the most 
medically appropriate level of care as soon as such referral 
is medically indicated. 
"(2) USE.—A chief elected official may use amounts referred 
to in paragraph (1) to— 
"(A) provide direct financial assistance to institutions and 
entities of the type referred to in such pareigraph to assist 
such institutions and entities in recruiting or training and 
pa3dng compensation to qualified personnel determined, 
under paragraph (3), to be necessary by the HIV health 
services planning council, specifically for the care of 
individuals with HIV disease; or 
"(B) in lieu of providing direct financial assistance, make 
arrangements for the provision of the services of such 
qualified personnel to such institutions and entities. 
"(3) REQUIREMENT OF DETERMINATION BY COUNCIL.—A chief 
elected official shall not use any of the amounts received under 
a grant under section 2601(a) to provide assistance or services 
under parsigraph (2) unless the HIV health services planning 
council of the eligible area has made a determination that, with 
respect to the care of individuals with HIV disease— 
104 STAT. 582 
PUBLIC LAW 101-381—AUG. 18, 1990 
"(A) a shortage of specific health, mental health or sup-
port service personnel exists within specific institutions or 
entities in the eligible area; 
"(B) the shortage of such personnel has resulted in the 
inappropriate utilization of inpatient services within the 
area; and 
"(C) assistance or services provided to an institution or 
entity under paragraph (2), will not be used to supplant the 
existing resources devoted by such institution or entity to 
the uses described in such paragraph. 
"(d) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.— 
"(1) PROVISION OF SERVICE.—Subject to paragraph (2), the 
Secretary may not make a grant under section 2601(a) for the 
provision of services under this section in a State unless, in 
the case of any such service that is available pursuant to the 
State plan approved under title XIX of the Social Security Act 
for the State— 
"(A) the political subdivision involved will provide the 
service directly, and the political subdivision has entered 
into a participation agreement under the State plan and is 
qualified to receive pajonents under such plan; or 
"(B) the political subdivision will enter into an agreement 
with a public or nonprofit private entity under which the 
entity will provide the service, and the entity has entered 
into such a participation agreement and is qualified to 
receive such payments. 
"(2) WAIVER.— 
"(A) IN GENERAL.—In the case of an entity making an 
agreement pursuant to paragraph (IXB) regarding the 
provision of services, the requirement established in such 
paragraph shall be waived by the HIV health services 
planning council for the eligible area if the entity does not, 
in providing health care services, impose a charge or accept 
reimbursement available from any third-party payor, 
including reimbursement under any insurance policy or 
under any Federal or State health benefits program. 
"(B) DETERMINATION.—A determination by the HIV 
health services planning council of whether an entity re-
ferred to in subparagraph (A) meets the criteria for a 
waiver under such subparagraph shall be made without 
regard to whether the entity accepts voluntary donations 
for the purpose of providing services to the public. 
"(e) ADMINISTRATION AND PLANNING.—The chief executive officer 
of an eligible area shall not use in excess of 5 percent of amounts 
received under a grant awarded under this part for administration, 
accounting, reporting, and program oversight functions. 
"(f) CONSTRUCTION.—A State may not use amounts received under 
a grant awarded under this part to purchase or improve land, or to 
purchase, construct, or permanently improve (other than minor 
remodeling) any building or other facility, or to make cash payments 
to intended recipients of services. 
42 u s e 300ff-15. 
"SEC. 2605. APPLICATION. 
"(a) IN GENERAL.—To be eligible to receive a grant under section 
2601, an eligible area shall prepare and submit to the Secretary an 
application at such time, in such form, and containing such informa-
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 583 
tion as the Secretary shall require, including assurances adequate to 
ensure— 
"(IXA) that funds received under a grant awarded under this 
part will be utilized to supplement not supplant State funds 
made available in the year for which the grant is awarded to 
provide HIV-related services to individuals with HIV disease; 
"(B) that the political subdivisions within the eligible area 
will maintain the level of expenditures by such political subdivi-
sions for HIV-related services for individuals with HIV disease 
at a level that is equal to the level of such expenditures by such 
political subdivisions for the 1-year period preceding the first 
fiscal year for which a grant is received by the eligible area; and 
"(C) that political subdivisions within the eligible area will 
not use funds received under a grant awarded under this part in 
maintaining the level of expenditures for HIV-related services 
as required in subparagraph (B); 
"(2) that the eligible area has an HIV health services plan-
ning council and has entered into intergovernmental agree-
ments pursuant to section 2602, and has developed or will 
develop the comprehensive plan in accordance with section 
2602(b)(3)(B); 
"(3) that entities within the eligible area that will receive 
funds under a grant provided under section 2601(a) shall partici-
pate in an established HIV community-based continuum of care 
if such continuum exists within the eligible area; 
"(4) that funds received under a grant awarded under this 
part will not be utilized to make pajnnents for any item or 
service to the extent that payment has been made, or can 
reasonably be expected to be made, with respect to that item or 
service— 
"(A) under any State compensation program, under an 
insurance policy, or under any Federal or State health 
benefits program; or 
"(B) by an entity that provides health services on a 
prepaid basis; and 
"(5) to the maximum extent practicable, that— 
Disadvantaged 
"(A) HIV health care and support services provided with 
persons, 
assistance made available under this part will be provided 
without regard— 
"(i) to the ability of the individual to pay for such 
services; and 
"(ii) to the current or past health condition of the 
individual to be served; 
"(B) such services will be provided in a setting that is 
accessible to low-income individuals with HIV-disease; and 
"(C) a program of outreach will be provided to low-income 
individuals with HIV-disease to inform such individuals of 
such services. 
"(b) ADDITIONAL APPUCATION.—An eligible area that desires to 
receive a grant under section 2603(b) shall prepare and submit to the 
Secretary an additional application at such time, in such form, and 
containing such information as the Secretary shall require, includ-
ing 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; 
"(2) demographic data on the population of such individuals; 
104 STAT. 584 
PUBLIC LAW 101-381—AUG. 18, 1990 
"(3) the average cost of providing each category of HIV-
related health services and the extent to which such cost is paid 
by third-party payors; and 
"(4) the aggregate amounts expended for each such category 
of services, 
"(c) DATE CERTAIN FOR SUBMISSION.— 
"(1) REQUIREMENT.—Except as provided in paragraph (2), to 
be eligible to receive a grant under section 2601(a) for a fiscal 
year, an application under subsection (a) shall be submitted not 
later thsin 45 days after the date on which appropriations are 
made under section 2608 for the fiscal year. 
"(2) EXCEPTION.—The Secretary may extend the time for the 
submission of an application under paragraph (1) for a period of 
not to exceed 60 days if the Secretary determines that the 
eligible area has made a good faith effort to comply with the 
requirement of such paragraph but has otherwise been unable 
to submit its application. 
"(3) DISTRIBUTION BY SECRETARY.—Not later than 45 days 
after receiving an application that meets the requirements of 
subsection (a) from an eligible area, the Secretary shall distrib-
ute to such eligible area the amounts awarded under the grant 
for which the application was submitted. 
"(4) REDISTRIBUTION.—Any amounts appropriated in any 
fiscal year under this part and not obligated to an eligible entity 
as a result of the failure of such entity to submit an application 
shall be redistributed by the Secretary to other eligible entities 
in proportion to the original grants made to such eligible areas 
under 2601(a). 
"(d) REQUIREMENTS REGARDING IMPOSITION OF CHARGES FOR SERV-
ICES.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
section 2601 to an eligible area unless the eligible area provides 
assurances that in the provision of services with assistance 
provided under the grant— 
"(A) in the case of individuals with an income less than or 
equal to 100 percent of the official poverty line, the provider 
will not impose charges on any such individual for the 
provision of services under the grant; 
"(B) in the case of individuals with an income greater 
than 100 percent of the official poverty line, the provider— 
"(i) will impose a charge on each such individual for 
the provision of such services; and 
"(ii) will impose the charge according to a schedule of 
charges that is made available to the public; 
"(C) in the case of individuals with an income greater 
than 100 percent of the official poverty line and not exceed-
ing 200 percent of such poverty line, the provider will not, 
for any calendar year, impose charges in an amount exceed-
ing 5 percent of the annual gross income of the individual 
involved; 
"(D) in the case of individuals with an income greater 
than 200 percent of the official poverty line and not exceed-
ing 300 percent of such poverty line, the provider will not, 
for any calendar year, impose charges in an amount exceed-
ing 7 percent of the annual gross income of the individual 
involved; and 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 585 
"(E) in the case of individuals with an income greater 
than 300 percent of the official poverty line, the provider 
will not, for any calendar year, impose charges in an 
amount exceeding 10 percent of the annual gross income of 
the individual involved. 
"(2) ASSESSMENT OF CHARGE.—With respect to compliance 
with the assurance made under paragraph (1), a grantee or 
entity receiving assistance under this part may, in the case of 
individuals subject to a charge for purposes of such parsigraph— 
"(A) assess the amount of the charge in the discretion of 
the grantee, including imposing only a nominal charge for 
the provision of services, subject to the provisions of such 
paragraph regarding public schedules and regarding limita-
tions on the maximum amount of charges; and 
"(B) take into consideration the medical expenses of 
individuals in assessing the amount of the charge, subject to 
such provisions. 
"(3) APPLICABIUTY OF LIMITATION ON AMOUNT OF CHARGE.— 
The Secretary may not make a grant under section 2601 to an 
eligible area unless the eligible area agrees that the limitations 
established in subparagraphs (C), (D) and (E) of parsigraph (1) 
regarding the imposition of charges for services applies to the 
annual aggregate of charges imposed for such services, without 
regard to whether they are characterized as enrollment fees, 
premiums, deductibles, cost sharing, copayments, coinsurance, 
or other charges. 
"(4) 
WAIVER 
REGARDING 
SECONDARY 
AGREEMENTS.—The 
requirements established in paragraphs (1) through (3) shall 
be waived in accordance with section 2604(d)(2). 
"SEC. 2606. TECHNICAL ASSISTANCE. 
42 USC 300ff-16. 
"The Administrator of the Health Resources and Services 
Administration may, beginning on the date of enactment of this 
title, provide technical assistance to assist entities in complying with 
the requirements of this part in order to make such entities eligible 
to receive a grant under this part. 
"SEC. 2607. DEFINITIONS. 
42 USC 300ff-17. 
"For purposes of this part: 
"(1) EuGiBLE AREA.—The term 'eligible area' means a metro-
politan area described in section 2601(a)(1). 
"(2) METROPOUTAN AREA.—The term 'metropolitan area' 
meems an area referred to in the HIV/AIDS Surveillance 
Report of the Centers for Disease Control as a metropolitan 
area. 
"SEC. 2608. AUTHORIZATION OF APPROPRIATIONS. 
42 USC 300ff-18. 
"There are authorized to be appropriated to make grants under 
this part, $275,000,000 in each of the fiscal years 1991 and 1992, and 
such sums as may be necessary in each of the fiscal years 1993 
through 1995.". 
SEC. 102. TECHNICAL AND CONFORMING AMENDMENTS. 
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended— 
(1) in section 406(a)(2), by striking "2101" and inserting 
42 USC 284a. 
"2701"; 
(2) in section 465(f), by striking "2601" and inserting "2701"; 42 USC 286. 
104 STAT. 586 
PUBLIC LAW 101-381—AUG. 18, 1990 
42 use 287a. 
42 u s e 287C-2. 
42 u s e 289f. 
42 u s e 
290aa-3a. 
42 use 299C-5. 
(3) in section 480(a)(2), by striking "2101" and inserting 
"2701"; 
(4) in section 485(a)(2), by striking "2101" and inserting 
"2701"; 
(5) in section 497, by striking "2601" and inserting "2701"; 
and 
(6) in section 505(a)(2), by striking "2101" and inserting 
"2701"; and 
(7) in section 926(b) (as added by section 6103(c)(1) of Public 
Law 101-239), by striking "2611" each place such term appears 
and inserting "2711". 
TITLE II—HIV CARE GRANTS 
State and local 
governments. 
42 use 300ff-21. 
SEC. 201. HIV CARE GRANTS. 
Title XXVI of the Public Health Service Act (as added by section 
101) is amended by adding at the end thereof the following new part: 
"PART B—CARE GRANT PROGRAM 
"SEC. 2611. GRANTS. 
"The Secretary shall, subject to the availability of appropriations, 
make grants to States to enable such States to improve the quality, 
availability and organization of health care and support services for 
individuals and families with HIV disease. 
42 u s e 300ff-22. 
"SEC. 2612. GENERAL USE OF GRANTS. 
"(a) IN GENERAL.—A State may use amounts provided under 
grants made under this part— 
"(1) to establish and operate HIV care consortia within areas 
most affected by HIV disease that shall be designed to provide a 
comprehensive continuum of care to individuals and families 
with HIV disease in accordance with section 2613; 
"(2) to provide home- and community-based care services for 
individuals with HIV disease in accordance with section 2614; 
"(3) to provide assistance to assure the continuity of health 
insurance coverage for individuals with HIV disease in accord-
ance with section 2615; and 
"(4) to provide treatments, that have been determined to 
prolong life or prevent serious deterioration of health, to 
individuals with HIV disease in accordance with section 2616. 
"(b) INFANTS AND WOMEN, ETC.—A State shall use not less than 15 
percent of funds allocated under this part to provide health and 
support services to infants, children, women, and families with HIV 
disease. 
42 use 300ff-23. 
"SEC. 2613. GRANTS TO ESTABLISH HIV CARE CONSORTIA. 
"(a) CONSORTIA.—A State may use amounts provided under a 
grant awarded under this part to provide assistance under section 
2612(a)(1) to an entity that— 
"(1) is an association of one or more public, ^ d one or more 
nonprofit private, health care and support service providers and 
community based organizations operating within areas deter-
mined by the State to be most affected by HIV disease; and 
"(2) agrees to use such assistance for the planning, develop-
ment and delivery, through the direct provision of services or 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 587 
through entering into agreements with other entities for the 
provision of such services, of comprehensive outpatient health 
and support services for individueils with HIV disease, that 
may include— 
"(A) essential health services such as case management 
services, medical, nursing, and dental care, diagnostics, 
monitoring, and medical follow-up services, mental health, 
developmental, and rehabilitation services, home health 
and hospice care; and 
"(B) essential support services such as transportation 
services, attendant care, homemaker services, day or res-
pite care, benefits advocacy, advocacy services provided 
through public and nonprofit private entities, and services 
that are incidental to the provision of health care services 
for individuals with HIV disease including nutrition serv-
ices, housing referral services, and child welfare and family 
services (including foster care and adoption services). 
An entity or entities of the tjrpe described in this subsection shall 
hereinafter be referred to in this title as a 'consortium' or 'consor-
tia'. 
"(b) ASSURANCES.— 
"(1) REQUIREMENT.—To receive assistance from a State under 
subsection (a), an applicant consortium shall provide the State 
with assurances that— 
"(A) within any locality in which such consortium is to 
operate, the populations and subpopulations of individuals 
and families with HIV disease have been identified by the 
consortium; 
"(B) the service plan established under subsection (c)(2) by 
such consortium addresses the special care and service 
needs of the populations and subpopulations identified 
under subparagraph (A); and 
"(C) except as provided in paragraph (2), the consortium 
will be a single coordinating entity that will integrate the 
delivery 
of 
services 
among 
the 
populations 
and 
subpopulations identified under subparagraph (A). 
"(2) EXCEPTION.—Subparagraph (C) of paragraph (1) shall not 
apply to any applicant consortium that the State determines 
will operate in a community or locality in which it has been 
demonstrated by the applicant consortium that— 
"(A) subpopulations exist within the community to be 
served that have unique service requirements; and 
"(B) such unique service requirements cannot be ade-
quately and efficiently addressed by a single consortium 
serving the entire community or locality. 
"(c) APPUCATION.— 
"(1) IN GENERAL.—To receive assistance from the State under 
subsection (a), a consortium shall prepare and submit to the 
State, an application that— 
"(A) demonstrates that the consortium includes agencies 
and community-based organizations— 
"(i) with a record of service to populations and 
subpopulations with HIV disease requiring care within 
the community to be served; and 
"(ii) that are representative of populations and 
subpopulations reflecting the local incidence of HIV 
104 STAT. 588 
PUBLIC LAW 101-381—AUG. 18, 1990 
Urban areas. 
Suburban areas. 
Rural areas. 
and that are located in areas in which such populations 
reside; 
"(B) demonstrates that the consortium has carried out an 
assessment of service needs within the geographic area to 
be served and, after consultation with the entities described 
in paragraph (2), has established a plan to ensure the 
delivery of services to meet such identified needs that shall 
include— 
"(i) assurances that service needs will be addressed 
through the coordination and expansion of existing 
programs before new programs are created; 
"(ii) assurances that, in metropolitan areas, the geo-
graphic area to be served by the consortium cor-
responds to the geographic boundaries of local health 
and support services delivery systems to the extent 
practicable; 
"(iii) assurances that, in the case of services for 
individuals residing in rural areas, the applicant 
consortium shall deliver case management services 
that link available community support services to 
appropriate specialized medical services; and 
'(iv) assurances that the assessment of service needs 
and the planning of the delivery of services will include 
participation by individuals with HIV disease; 
"(C) demonstrates that adequate planning has occurred to 
meet the special needs of families with HIV disease, includ-
ing family centered care; 
'(D) demonstrates that the consortium has created a 
mechanism to evaluate periodically— 
"(i) the success of the consortium in responding to 
identified needs; and 
"(ii) the cost-effectiveness of the mechanisms em-
ployed by the consortium to deliver comprehensive 
care; and 
"(E) demonstrates that the consortium will report to the 
State the results of the evaluations described in subpara-
graph (D) and shall make available to the State or the 
Secretary, on request, such data and information on the 
program methodology that may be required to perform an 
independent evaluation. 
"(2) CONSULTATION.—In establishing the plan required under 
paragraph (IXB), the consortium shall consult with— 
"(AXi) the public health sigency that provides or supports 
ambulatory and outpatient HlV-related health care serv-
ices within the geographic area to be served; or 
"(ii) in the case of a public health agency that does not 
directly provide such HIV-related health care services such 
agency shall consult with an entity or entities that directly 
provide ambulatory and outpatient HIV-related health care 
services within the geographic area to be served; and 
"(B) not less than one community-based organization that 
is organized solely for the purpose of providing HIV-related 
support services to individuals with HIV disease. 
The organization to be consulted under subparagraph (B) shall 
be at the discretion of the applicant consortium. 
"(d) DEFINITION.—As used in this part, the term 'family centered 
care' means the system of services described in this section that is 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 589 
targeted specifically to the special needs of infants, children, women, 
and families. Family centered care shall be based on a partnership 
between parents, professionals, and the community designed to 
ensure an integrated, coordinated, culturally sensitive, and commu-
nity-based continuum of care for children, women, and families with 
HIV disesise. 
"(e) PRIORITY.—In providing assistance under subsection (a), the 
State shall, among applicants that meet the requirements of this 
section, give priority— 
"(1) first to consortia that are receiving assistance from the 
Health Resources and Services Administration for adult and 
pediatric HlV-related care demonstration projects; and then 
"(2) to any other existing HIV care consortia. 
"SEC. 2614. GRANTS FOR HOME- AND COMMUNITY-BASED CARE. 
42 USC 300ff-24. 
"(a) USES.—A State may use amounts provided under a grant 
awarded under this part to make grants under section 2612(aX2) to 
entities to— 
"(1) provide home- and community-based health services for 
individuals with HIV disease pursuant to written plans of care 
prepared by a case management team, that shall include appro-
priate health care professionals, in such State for providing 
such services to such individuals; 
"(2) provide outreach services to individuals with HIV disease, 
including those individuals in rural areas; and 
"(3) provide for the coordination of the provision of services 
under this section with the provision of HIV-related health 
services provided by public and private entities. 
"(b) PRIORITY.—In awarding grants under subsection (a), a State 
shall give priority to entities that provide assurances to the State 
that— 
"(1) such entities will participate in HIV care consortia if such 
consortia exist within the State; and 
"(2) such entities will utilize amounts provided under such Disadvantaged 
grants for the provision of home- and community-based services persons, 
to low-income individuals with HIV disease. 
"(c) DEFINITION.—As used in this part, the term 'home- and 
community-based health services'— 
"(1) means, with respect to an individual with HIV disease, 
skilled health services furnished to the individual in the individ-
ual's home pursuant to a written plan of care established by a 
case management team, that shall include appropriate hesdth 
care professionals, for the provision of such services and items 
described in paragraph (2); 
"(2) includes— 
"(A) durable medical equipment; 
"(B) homemaker or home health aide services and per-
sonal care services furnished in the home of the individual; 
"(C) day treatment or other partial hospitalization serv-
ices; 
"(D) home intravenous and aerosolized drug therapy 
(including prescription drugs administered as part of such 
therapy); 
"(E) routine diagnostic testing administered in the home 
of the individual; and 
"(F) appropriate mental health, developmental, and re-
habilitation services; and 
104 STAT. 590 
PUBLIC LAW 101-381—AUG. 18, 1990 
"(3) does not include— 
"(A) inpatient hospital services; and 
"(B) nursing home and other long term care facilities. 
42 use 300ff-25. 
"SEC. 2615. CONTINUUM OF HEALTH INSURANCE COVERAGE. 
"(a) IN GENERAL.—A State may use amounts received under a 
grant awarded under this part to establish a program of financial 
assistance under section 2612(a)(3) to assist eligible low-income 
individuals with HIV disease in— 
"(1) maintaining a continuity of health insurance; or 
"(2) receiving medical benefits under a health insurance pro-
gram, including risk-pools. 
"(b) LIMITATIONS.—Assistance shall not be utilized under subsec-
tion (a)— 
"(1) to pay any costs associated with the creation, capitaliza-
tion, or administration of a liability risk pool (other than those 
costs paid on behalf of individuals as part of premium contribu-
tions to existing liability risk pools); and 
"(2) to pay any amount expended by a State under title XIX of 
the Social Security Act. 
42 u s e 300ff-26. 
"SEC. 2616. PROVISION OF TREATMENTS. 
"(a) IN GENERAL.—A State may use amounts provided under a 
grant awarded under this part to establish a program under section 
2612(a)(4) to provide treatments that have been determined to pro-
long life or prevent the serious deterioration of health arising from 
HIV disease in eligible individuals. 
"(b) ELIGIBLE INDIVIDUAL.—To be eligible to receive assistance 
from a State under this section an individual shall— 
"(1) have a medical diagnosis of HIV disease; and 
Disadvantaged 
"(2) be a low-income individual, as defined by the State-
persons, 
"(j.) STATE DUTIES.—In carrying out this section the State shall— 
"(1) determine, in accordance with guidelines issued by the 
Secretary, which treatments are eligible to be included under 
the program established under this section; 
"(2) provide assistance for the purchase of treatments deter-
mined to be eligible under paragraph (1), and the provision of 
such ancillary devices that are essential to administer such 
treatments; 
"(3) provide outreach to individuals with HIV disease, and as 
appropriate to the families of such individuals; and 
"(4) facilitate access to treatments for such individuals. 
42 use 300ff-27. 
"SEC. 2617. STATE APPLICATION. 
"(a) IN GENERAL.—The Secretary shall not make a grant to a State 
under this part for a fiscal year unless the State prepares and 
submits, to the Secretary, an application at such time, in such form, 
and containing such agreements, assurances, and information as the 
Secretary determines to be necessary to carry out this part. 
"(b) DESCRIPTION OF INTENDED USES AND AGREEMENTS.—The ap-
plication submitted under subsection (a) shall contain— 
"(1) a detailed description of the HIV-related services pro-
vided in the State to individuals and families with HIV disease 
during the year preceding the year for which the grant is 
requested, and the number of individuals and families receiving 
such services, that shall include— 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 591 
"(A) a description of the types of programs operated or 
funded by the State for the provision of HIV-related serv-
ices during the year preceding the year for which the grant 
is requested and the methods utilized by the State to fi-
nance such programs; 
"(B) an accounting of the amount of funds that the State 
has expended for such services and programs during the 
year preceding the year for which the grant is requested; 
and 
"(C) information concerning— 
"(i) the number of individuals to be served with 
assistance provided under the grant; 
"(ii) demographic data on the population of the 
individuals to be served; 
"(iii) the average cost of providing each category of 
HIV-related health services and the extent to which 
such cost is paid by third-party payors; and 
"(iv) the aggregate amounts expended for each such 
category of services; 
"(2) a comprehensive plan for the organization and delivery of 
HIV health care and support services to be funded with assist-
ance received under this part that shall include a description of 
the purposes for which the State intends to use such assistance, 
including— 
"(A) the services and activities to be provided and an 
explanation of the manner in which the elements of the 
progrgun to be implemented by the State with such assist-
ance will maximize the quality of health and support serv-
ices available to individuals with HIV disease throughout 
the State; and 
"(B) a description of the manner in which services funded 
with assistance provided under this part will be coordinated 
with other available related services for individuals with 
HIV disease; and 
"(3) an assurance by the State that— 
"(A) the public health agency that is administering the 
grant for the State will conduct public hearings concerning 
the proposed use and distribution of the assistance to be 
received under this part; 
"(B) the State will— 
Disadvantaged 
"(i) to the maximum extent practicable, ensure that persons. 
HIV-related health care and support services delivered 
pursuant to a program established with assistance pro-
vided under this part will be provided without regard 
to the ability of the individual to pay for such services 
and without regard to the current or past health condi-
tion of the individual with HIV disease; 
"(ii) ensure that such services will be provided in a 
setting that is accessible to low-income individuals with 
HIV disease; 
"(iii) provide outreach to low-income individuals with 
HIV disease to inform such individuals of the services 
available under this part; and 
"(iv) in the case of a State that intends to use 
amounts provided under the grant for purposes de-
scribed in 2615, submit a plan to the Secretary that 
104 STAT. 592 
PUBLIC LAW 101-381—AUG. 18, 1990 
Public 
information. 
Public 
information. 
demonstrates that the State has established a program 
that assures that— 
"(I) such amounts will be targeted to individuals 
who would not otherwise be able to afford health 
insurance coverage; and 
"(ID income, asset, and medical expense criteria 
will be established and applied by the State to 
identify those individuals who qualify for assist-
ance 
under 
such 
program, 
and 
information 
concerning such criteria shall be made available to 
the public; 
"(C) the State will provide for periodic independent peer 
review to assess the quality and appropriateness of health 
and support services provided by entities that receive funds 
from the State under this part; 
"(D) the State will permit and cooperate with any Federal 
investigations undertaken regarding programs conducted 
under this part; 
"(E) the State will maintain HIV-related activities at a 
level that is equal to not less than the level of such expendi-
tures by the State for the 1-year period preceding the fiscal 
year for which the State is applying to receive a grant 
under this part; and 
"(F) the State will ensure that grant funds are not uti-
lized to make payments for any item or service to the 
extent that payment has been made, or can reasonably be 
expected to be made, with respect to that item or service— 
"(i) under any State compensation program, under an 
insurance policy, or under any Federal or State health 
benefits program; or 
"(ii) by an entity that provides health services on a 
prepaid basis. 
"(c) REQUIREMENTS REGARDING IMPOSITION OF CHARGES FOR SERV-
ICES.— 
"(1) IN GENERAL.—The Secretary may not make a grant 
under section 2611 to a State unless the State provides assur-
ances that in the provision of services with assistance provided 
under the grant— 
"(A) in the case of individuals with an income less than or 
equal to 100 percent of the official poverty line, the provider 
will not impose charges on any such individual for the 
provision of services under the grant; 
"(B) in the case of individuals with an income greater 
than 100 percent of the official poverty line, the provider— 
"(i) will impose charges on each such individual for 
the provision of such services; and 
"(ii) will impose charges according to a schedule of 
charges that is made available to the public; 
"(C) in the case of individuals with an income greater 
than 100 percent of the official poverty line and not exceed-
ing 200 percent of such poverty line, the provider will not, 
for any calendar year, impose charges in an amount exceed-
ing 5 percent of the annual gross income of the individ-
ual involved; 
"(D) in the case of individuals with an income greater 
than 200 percent of the official poverty line and not exceed-
ing 300 percent of such poverty line, the provider will not. 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 593 
for any calendar year, impose charges in an amount exceed-
ing 7 percent of the annual gross income of the individual 
involved; and 
"(E) in the case of individuals with an income greater 
than 800 percent of the official poverty line, the provider 
will not, for any calendar year, impose charges in an 
amount exceeding 10 percent of the annual gross income of 
the individual involved. 
"(2) ASSESSMENT OF CHARGE.—With respect to compliance 
with the assurance made under paragraph (1), a grantee under 
this part may, in the case of individuals subject to a charge for 
purposes of such paragraph— 
"(A) assess the amount of the charge in the discretion of 
the grantee, including imposing only a nominal charge for 
the provision of services, subject to the provisions of such 
paragraph regarding public schedules regarding limitation 
on the maximum amount of charges; and 
"(B) take into consideration the medical expenses of 
individuals in sissessing the amount of the charge, subject 
to such provisions. 
"(3) APPUCABILITY OF UMITATION ON AMOUNT OF CHARGE.— 
The Secretary may not make a grant under section 2611 unless 
the applicant of the grant agrees that the limitations estab-
lished in subparagraphs (C), (D), and (E) of paragraph (1) regard-
ing the imposition of charges for services applies to the annual 
aggregate of charges imposed for such services, without regard 
to whether they are characterized as enrollment fees, pre-
miums, deductibles, cost sharing, copajrments, coinsurance, or 
other charges. 
"(4) WAIVER.— 
"(A) IN GENERAL.—The State shall waive the require-
ments established in paragraphs (1) through (3) in the case 
of an entity that does not, in providing health care services, 
impose a charge or accept reimbursement from any third-
party payor, including reimbursement under any insurance 
policy or under any Federal or State health benefits pro-
gram. 
"(B) DETERMINATION.—A determination by the State of 
whether an entity referred to in subparagraph (A) meets 
the criteria for a waiver under such subparagraph shall be 
made without regard to whether the entity accepts vol-
untary donations regarding the provision of services to the 
public. 
"(d) REQUIREMENT OF MATCHING FUNDS REGARDING STATE ALLOT-
MENTS.— 
"(1) IN GENERAL.—In the case of any State to which the 
criterion described in paragraph (3) applies, the Secretary may 
not make a grant under this part unless the State agrees that, 
with respect to the costs to be incurred by the State in carr3dng 
out the program for which the grant was awarded, the State 
will, subject to subsection (bX2), make available (directly or 
through donations from public or private entities) non-Federal 
contributions toward such costs in an amount equal to— 
"(A) for the first fiscal year of pajmients under the grsint, 
not less than 16% percent of such costs ($1 for each $5 of 
Federal funds provided in the grant); 
104 STAT. 594 
PUBLIC LAW 101-381—AUG. 18, 1990 
"(B) for any second fiscal year of such pa3anents, not less 
than 20 percent of such costs ($1 for each $4 of Federal 
funds provided in the grant); 
"(C) for any third fiscal year of such pajmo^ents, not less 
than 25 percent of such costs ($1 for each $3 of Federal 
funds provided in the grant); 
"(D) for any fourth fiscal year of such payments, not less 
than 33 V
s percent of such costs ($1 for each $2 of Federal 
funds provided in the grant); and 
"(E) for any subsequent fiscal year of such payments, not 
less than 33 V
s percent of such costs ($1 for each $2 of 
Federal funds provided in the grant). 
"(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-
TION.— 
"(A) IN GENERAL.—Non-Federal contributions required in 
paragraph (1) may be in cash or in kind, fairly evaluated, 
including plant, equipment, or services. Amounts provided 
by the Federal Government, and any portion of any service 
subsidized by the Federal Government, may not be included 
in determining the amount of such non-Federal contribu-
tions. 
"(B) INCLUSION OF CERTAIN AMOUNTS.— 
"(i) In making a determination of the amount of non-
Federal contributions made by a State for purposes of 
paragraph (1), the Secretary shall, subject to clause (ii), 
include any non-Federal contributions provided by the 
State for HIV-related services, without regard to 
whether the contributions are made for programs 
established pursuant to this title; 
"(ii) In making a determination for purposes of 
clause (i), the Secretary may not include any non-
Federal contributions provided by the State as a condi-
tion of receiving Federal funds under any program 
under this title (except for the program established in 
this part) or under other provisions of law. 
"(3) APPLICABIUTY OF REQUIREMENT.— 
"(A) NUMBER OF CASES.—A State referred to in paragraph 
(1) is any State for which the number of cases of acquired 
immune deficiency syndrome reported to and confirmed by 
the Director of the Centers for Disease Control for the 
period described in subparagraph (B) constitutes in excess 
of 1 percent of the aggregate number of such cases reported 
to and confirmed by the Director for such period for the 
United States. 
"(B) PERIOD OF TIME.—The period referred to in subpara-
graph (A) is the 2-year period preceding the fiscal year for 
which the State involved is applying to receive a grant 
under subsection (a). 
"(C) PUERTO RICO.—For purposes of paragraph (1), the 
number of cases of acquired immune deficiency s3nidrome 
reported and confirmed for the Commonwealth of Puerto 
Rico for any fiscal year shall be deemed to be less than 1 
percent. 
"(4) DIMINISHED STATE CONTRIBUTION.—With respect to a State 
that does not make available the entire amount of the non-
Federal contribution referred to in paragraph (1), the State 
shall continue to be eligible to receive Federal funds under a 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 595 
grant under this part, except that the Secretary in providing 
Federal funds under the grant shall provide such funds (in 
accordance with the ratios prescribed in paragraph (1)) only 
with respect to the amount of funds contributed by such State. 
'SEC. 2618. DISTRIBUTION OF FUNDS. 
42 USC 300ff-28. 
"(a) SPECIAL PROJECTS OF A NATIONAL SIGNIFICANCE.— 
"(1) IN GENERAL.—Of the amount appropriated under section 
2620 for each fiscal year, the Secretary shall use not to exceed 
10 percent of such amount to establish and administer a special 
projects of national significance program to award direct grants 
to public and nonprofit private entities including community-
based organizations to fund special programs for the care and 
treatment of individuals with HIV disease. 
"(2) GRANTS.—The Secretary shall award grants under subsec-
tion (a) based on— 
"(A) the need to assess the effectiveness of a particular 
model for the care and treatment of individuals with HIV 
disease; 
"(B) the innovative nature of the proposed activity; and 
"(C) the potential replicability of the proposed activity in 
other similar localities or nationally. 
"(3) SPECIAL PROJECTS.—Special projects of a national signifi-
cance may include those that are designed to— 
"(A) establish a system designed to increase the number 
of health care facilities willing and able to serve low-income 
individuals and families with HIV disease; 
"(B) deliver drug abuse treatment and HIV health care 
services at a single location, through either an outpatient or 
residential facility; 
"(C) provide support and respite care for participants in 
family-based care networks critical to the delivery of com-
prehensive HIV care in the minority community; 
"(D) deliver an enhanced spectrum of comprehensive 
health care and support services to underserved hemophilia 
populations, including minorities and those in rural and 
underserved areas, utilizing established networks of hemo-
philia diagnostic and treatment centers and community-
based outreach systems; 
"(E) deliver HIV health care £ind support services to 
Indians with HIV disease and their families; 
"(F) improve the provision of HIV health care and sup-
port services to individuals and families with HIV disease 
located in rural areas; 
"(G) deliver HIV health care and support services to 
homeless individuals and families with HIV disease; and 
"(H) deliver HIV health care and support services to 
individuals with HIV diseeise who are incarcerated. 
"(b) AMOUNT OF GRANT TO STATE.— 
"(1) MINIMUM ALLOTMENT.—Subject to the extent of amounts 
made available under section 2620, the amount of a greuit to be 
made under this part for— 
"(A) each of the several States and the District of Colum- 
District of 
bia for a fiscal year shall be the greater o
f
— 
Columbia, 
"(i) $100,000, and 
"(ii) an amount determined under paragraph (2); and 
104 STAT. 596 
PUBLIC LAW 101-381—AUG. 18, 1990 
Territories, U.S. 
"(B) each territory of the United States, as defined in 
paragraph 3, shall be an amount determined under para-
graph (2). 
"(2) DETERMINATION.— 
"(A) FORMULA.—The amount referred to in paragraph 
(l)(AXii) for a State and paragraph (1)(B) for a territory of 
the United States shall be the product o
f
— 
"(i) an amount equal to the amount appropriated 
under section 2620 for the fiscal year involved; and 
"(ii) the ratio of the distribution factor for the State 
or territory to the sum of the distribution factors for all 
the States or territories. 
"(B) DISTRIBUTION FACTOR.—As used in subparagraph 
(A)(ii), the term 'distribution factor' means— 
"(i) in the case of a State, the product o
f
— 
"(I) the number of cases of acquired immune 
deficiency syndrome in the State, as indicated by 
the number of cases reported to and confirmed by 
the Secretary for the 2 most recent fiscal years for 
which such data are available; and 
"(11) the cube root of the ratio (based on the most 
recent available data) of^ 
"(aa) the average per capita income of 
individuals in the United States (including the 
territories); to 
"(bb) the average per capita income of 
individuals in the State; and 
"(ii) in the case of a territory of the United States the 
number of additional cases of such syndrome in the 
specific territory, as indicated by the number of cases 
reported to and confirmed by the Secretary for the 2 
most recent fiscal years for which such data is avail-
able. 
"(3) DEFINITIONS.—As used in this subsection— 
"(A) the term 'State' means each of the 50 States, the 
District of Columbia and the Commonwealth of Puerto 
Rico; and 
"(B) the term 'territory of the United States' means the 
Virgin Islands, Guam, American Samoa, the Common-
wealth of the Northern Mariana Islands, and the Republic 
of the Marshall Islands. 
"(c) ALLOCATION OF ASSISTANCE BY STATES.— 
"(1) CONSORTIA.—In a State that has reported 1 percent or 
more of all AIDS cases reported to and confirmed by the Centers 
for Disease Control in all States, not less than 50 percent of the 
amount received by the State under a grant awarded under this 
part shall be utilized for the creation and operation of commu-
nity-based comprehensive care consortia under section 2613, in 
those areas within the State in which the largest number of 
individuals with HIV disease reside. 
"(2) ALLOWANCES.—Prior to allocating assistance under this 
subsection, a State shall consider the unmet needs of those 
areas that have not received financial gissistance under part A. 
"(3) PLANNING AND EVALUATIONS.—A State may not use in 
excess of 5 percent of amounts received under a grant awarded 
under this part for planning and evaluation activities. 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 597 
"(4) ADMINISTRATION.—A State may not use in excess of 5 
percent of amounts received under a grant awarded under this 
part for administration, accounting, reporting, and program 
oversight functions. 
"(5) CONSTRUCTION.—A State may not use amounts received 
under a grant awarded under this part to purcheise or improve 
land, or to purchase, construct, or permanently improve (other 
than minor remodeling) any building or other facility, or to 
make cash pajnnents to intended recipients of services. 
"(d) EXPEDITED DISTRIBUTION.— 
"(1) IN GENERAL.—Not less than 75 percent of the amounts 
received under a grant awarded to a State under this part shall 
be obligated to specific programs and projects and made avail-
able for expenditure not later than— 
"(A) in the case of the first fiscal year for which amounts 
are received, 150 days after the receipt of such amounts by 
the State; and 
"(B) in the case of succeeding fiscal years, 120 days after 
the receipt of such amounts by the State. 
"(2) PuBUC COMMENT.—Within the time periods referred to in 
paragraph (1), the State shall invite and receive public comment 
concerning methods for the utilization of such amounts. 
"(e) REALLOCATION.—Any amounts appropriated in any fiscal year 
and made available to a State under this part that have not been 
obligated as described in subsection (d) shall be repaid to the Sec-
retary £md reallotted to other States in proportion to the original 
grants made to such States. 
"SEC. 2619. TECHNICAL ASSISTANCE. 
42 USC 300ff-29. 
"The Secretary may provide technical assistance in administering 
and coordinating the activities authorized under section 2612. 
"SEC. 2620. AUTHORIZATION OF APPROPRIATIONS. 
42 USC 300ff-30. 
"There are authorized to be appropriated to make grants under 
this part, $275,000,000 in each of the fiscal years 1991 and 1992, and 
such sums as may be necessary in each of the fiscal years 1993 
through 1995.". 
TITLE III—EARLY INTERVENTION 
SERVICES 
SEC. 301. GRANTS FOR PROVISION OF SERVICES. 
Contracts. 
(a) IN GENERAL.—Title XXVI of the Public Health Service Act (as 
amended by section 201) is further emiended by adding at the end 
the following new part: 
"PART C—EARLY INTERVENTION SERVICES 
"Subpart I—Formula Grants for States 
"SEC. 2641. ESTABLISHMENT OF PROGRAM. 
42 uSC 300ff-41. 
"(a) ALLOTMENTS FOR STATES.—For the purposes described in 
subsection (b), the Secretary, acting through the Director of the 
Centers for Disease Control and in consultation with the Adminis-
trator of the Health Resources and Services Administration, shall 
104 STAT. 598 
PUBLIC LAW 101-381—AUG. 18, 1990 
for each of the fiscal years 1991 through 1995 make an allotment for 
each State in an amount determined in accordance with section 
2649. The Secretary shall make payments, as grants, to each State 
from the allotment for the State for the fiscal year involved if the 
Secretary approves for the fiscal year an application submitted by 
the State pursuant to section 2665. 
"(b) PURPOSES OF GRANTS.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
subsection (a) unless the State involved agrees to expend the 
grant for the purposes of providing, on an outpatient basis, each 
of the early intervention services specified in paragraph (2) with 
respect to HIV disease. 
"(2) 
SPECIFICATION OF EARLY INTERVENTION SERVICES.—The 
early intervention services referred to in paragraph (1) are— 
"(A) counseling individuals with respect to HIV disease in 
accordance with section 2662; 
"(B) testing individuals with respect to such disease, 
including tests to confirm the presence of the disease, tests 
to diagnose the extent of the deficiency in the immune 
system, and tests to provide information on appropriate 
therapeutic measures for preventing and treating the de-
terioration of the immune system and for preventing and 
treating conditions arising from the disease; 
"(C) referrals described in paragraph (3); 
"(D) other clinical and diagnostic services with respect to 
HIV disease, and periodic medical evaluations of individ-
uals with the disease; and 
"(E) providing the therapeutic measures described in 
subparagraph (B). 
"(3) REFERRALS.—The services referred to in paragraph (2XC) 
are referrals of individuals with HIV disease to appropriate 
providers of health and support services, including, as appro-
priate— 
"(A) to entities receiving amounts under part A or B for 
the provision of such services; 
"(B) to biomedical research facilities of institutions of 
higher education that offer experimental treatment for 
such disease, or to community-based organizations or other 
entities that provide such treatment; or 
"(C) to grantees under section 2671, in the case of preg-
nant women. 
"(4) REQUIREMENT OF AVAILABILITY OF ALL EARLY INTERVEN-
TION SERVICES THROUGH EACH GRANTEE.—The Secretary may not 
make a grant under subsection (a) unless the State involved 
agrees that each of the early intervention services specified in 
paragraph (2) will be available through the State. With respect 
to compliance with such agreement, a State may expend the 
grant to provide the early intervention services directly, and 
may expend the grant to enter into agreements with public or 
nonprofit private entities under which the entities provide the 
services. 
"(5) OPTIONAL SERVICES.—A State receiving a grant under 
subsection (a)— 
"(A) may expend not more than 5 percent of the grant to 
provide early intervention services through making grants 
to hospitals that— 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 599 
"(i) for the most recent fiscal year for which the data 
is available, have admitted— 
"(I) not fewer than 250 individuals with acquired 
immune deficiency syndrome; or 
"(11) a number of such individuals constituting 20 
percent of the number of inpatients of the hospital 
admitted during such period; 
"(ii) £igree to offer and encourage such services with 
respect to inpatients of the hospitals; and 
"(iii) agree that subsections (c) and (d) of section 2644 
will apply to the hospitals to the same extent and in 
the same manner as such subsections apply to entities 
described in such section; 
"(B) may expend the grant to provide outreach services to 
individuals who may have HIV diseeise, or may be at risk of 
the disease, and who may be unaware of the availability 
and potential benefits of early treatment of the disease, and 
to provide outreach services to health care professionals 
who may be unaware of such availability and potential 
benefits; and 
"(C) may, in the case of individuals who seek early inter-
vention services from the grantee, expend the grant— 
"(i) for case management to provide coordination in 
the provision of health care services to the individuals 
and to review the extent of utilization of the services by 
the individuals; and 
"(ii) to provide assistance to the individuals regard-
ing establishing the eligibility of the individuals for 
financial assistance £ind services under Federal, State, 
or local programs providing for health services, mental 
health services, social services, or other appropriate 
services. 
"(6) ALLOCATIONS.— 
"(A) Subject to subparagraphs (B) £ind (C), the Secretary 
may not make a grant under subsection (a) unless the State 
involved agrees— 
"(i) to expend not less than 35 percent of the grant to 
provide the early intervention services specified in sub-
paragraphs (A) through (C) of paragraph (2); and 
"(ii) to expend not less than 35 percent of the grant to 
provide the early intervention services specified in sub-
paragraphs (D) and (E) of such parsigraph. 
"(B) With respect to compliance with the agreement 
under subparagraph (A), amounts reserved by a State for 
fiscal year 1991 for purposes of clauses (i) and (ii) of such 
subparagraph may be expended to provide the services 
specified in paragraph (5). 
"(C) The Secretary shall ensure that, of the amounts 
appropriated under section 2650 for fiscal year 1991, an 
amount equal to $130,000,000 is expended to provide the 
early intervention services specified in subparagraphs (A) 
through (C) of pargigraph (2). 
"SEC. 2642. PROVISION OF SERVICES THROUGH MEDICAID PROVIDERS. 
42 USC 300ff-42. 
"(a) IN GENERAL.—Subject to subsection (b), the Secretary may not 
make a grant under section 2641 to a State unless, in the case of any 
service described in subsection (b) of such section that is available 
104 STAT. 600 
PUBLIC LAW 101-381—AUG. 18, 1990 
pursuant to the State plan approved under title XIX of the Social 
Security Act for the State— 
"(1) the State will provide the service through a State entity, 
and the State entity has entered into a participation agreement 
under the State plan and is qualified to receive pajonents under 
such plan; or 
"(2) the State will enter into an agreement with a public or 
nonprofit private entity under which the entity will provide the 
service, and the entity has entered into such a participation 
agreement and is qualified to receive such pajmients. 
"(b) WAIVER REGARDING CERTAIN SECONDARY AGREEMENTS.— 
"(1) IN GENERAL.—In the case of an entity making an sigree-
ment pursuant to subsection (aX2) regarding the provision of 
services, the requirement established in such subsection regard-
ing a participation agreement shall be waived by the Secretary 
if the entity does not, in providing health care services, impose a 
charge or accept reimbursement available from any third-party 
payor, including reimbursement under any insurance policy or 
under any Federal or State health benefits program. 
"(2) ACCEPTANCE OF VOLUNTARY DONATIONS.—A determination 
by the Secretary of whether an entity referred to in paragraph 
(1) meets the criteria for a waiver under such subparagraph 
shall be made without regard to whether the entity accepts 
voluntary donations for the purpose of providing services to the 
public. 
42 use 300ff-43. 
"SEC. 2643. REQUIREMENT OF MATCHING FUNDS. 
"(a) IN GENERAL.—In the case of any State to which the criterion 
described in subsection (c) applies, the Secretary may not make a 
grant under section 2641 unless the State agrees that, with respect 
to the costs to be incurred by the State in carrying out the purpose 
referred to in such subsection, the State will, subject to subsection 
(bX2), make available (directly or through donations from public or 
private entities) non-Federal contributions toward such costs in an 
amount equal to— 
"(1) for the first fiscal year for which such criterion applies to 
the State, not less than 16% percent of such costs ($1 for each 
$5 of Federal funds provided in the grant); 
"(2) for any second such fiscal year, not less than 20 percent of 
such costs ($1 for each $4 of Federal funds provided in the 
grant); 
"(3) for any third such fiscal year, not less than 25 percent of 
such costs ($1 for each $3 of Federal funds provided in the 
grant); and 
"(4) for any subsequent fiscal year, not less than 33 V
b per-
cent of such costs ($1 for each $2 of Federal funds provided in 
the grant). 
"(b) 
DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-
TION.— 
"(1) IN GENERAL.—Non-Federal contributions required in 
subsection (a) may be in cash or in kind, fairly evaluated, 
including plant, equipment, or services. Amounts provided by 
the Federal Government, and any portion of any service sub-
sidized by the Federal Government, may not be included in 
determining the amount of such non-Federal contributions. 
"(2) INCLUSION OF CERTAIN AMOUNTS.— 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 601 
"(A) In making a determination of the amount of non-
Federal contributions made by a State for purposes of 
subsection (a), the Secretary shall, subject to subparagraph 
(B), include £iny non-Federal contributions provided by the 
State for HIV-related services, without regard to whether 
the contributions are made for programs established pursu-
ant to this title. 
"(B) In making a determination for purposes of subpara-
graph (A), the Secretary may not include any non-Federal 
contributions provided by the State as a condition of receiv-
ing Federal funds under any program under this title 
(except for the program established in section 2641) or 
under other provisions of law. 
"(c) APPLICABIUTY OF MATCHING REQUIREMENT.— 
"(1) PERCENTAGE OF NATIONAL NUMBER OF CASES.— 
"(A) The criterion referred to in subsection (a) is, with 
respect to a State, that the number of cases of acquired 
immune deficiency syndrome reported to and confirmed by 
the Director of the Centers for Disease Control for the State 
for the period described in subparagraph (B) constitutes 
more than 1 percent of the number of such cases reported to 
and confirmed by the Director for the United States for 
such period. 
"(B) The period referred to in subparagraph (A) is the 2-
year period preceding the fiscal year for which the State 
involved is applying to receive a grant under section 2641. 
"(2) EXEMPTION.—For purposes of paragraph (1), the number 
Puerto Rico, 
of cases of acquired immune deficiency syndrome reported and 
confirmed for the Commonwealth of Puerto Rico for any fiscal 
year shall be deemed to be less than 1 percent. 
"(d) DIMINISHED STATE CONTRIBUTION.—With respect to a State 
that does not make available the entire gmiount of the non-Federal 
contribution referred to in subsection (a), the State shall continue to 
be eligible to receive Federal funds under a grant under section 
2641, except that the Secretary in providing Federal funds under the 
grant shall provide such funds (in accordance with the ratios pre-
scribed in paragraph (1)) only with respect to the amount of funds 
contributed by such State. 
"SEC. 2644. OFFERING AND ENCOURAGING EARLY INTERVENTION SERV- 
42 USC 300ff-44. 
ICES. 
"(a) IN GENERAL.—The Secretary may not make a grant under 
section 2641 unless, in the C£ise of entities to which the State 
provides amounts from the grant for the provision of early interven-
tion services, the State involved gigrees that— 
"(1) if the entity is a health care provider that regularly 
provides treatment for sexually transmitted diseases, the entity 
will offer and encourage such services with respect to individ-
uals to whom the entity provides such treatment; 
"(2) if the entity is a health care provider that regularly 
provides treatment for intravenous substance abuse, the entity 
will offer and encourage such services with respect to individ-
uals to whom the entity provides such treatment; 
"(3) if the entity is a family planning clinic, the entity will 
offer and encourage such services with respect to individuals to 
whom the entity provides family planning services and whom 
the entity has reason to believe has HIV disease; and 
104 STAT. 602 
PUBLIC LAW 101-381—AUG. 18, 1990 
"(4) if the entity is a health care provider that provides 
treatment for tuberculosis, the entity will offer and encourage 
such services with respect to individuals to whom the entity 
provides such treatment. 
"(b) SUFFICIENCY OF AMOUNT OF GRANT.—With respect to compli-
ance with the agreement made under subsection (a), an entity to 
which subsection (a) applies may be required to offer, encourage, 
and provide early intervention services only to the extent that the 
amount of the grant is sufficient to pay the costs of offering, 
encouraging, and providing the services. 
"(c) CRITERIA FOR OFFERING AND ENCOURAGING.—Subject to sec-
lion 2641(b)(4), an entity to which subsection (a) applies is, for 
purposes of such subsection, offering and encouraging early inter-
vention services with respect to the individuals involved if the 
- entity— 
"(1) offers such services to the individuals, and encourages the 
individuals to receive the services, as a regular practice in the 
course of providing the health care involved; and 
"(2) provides the early intervention services only with the 
consent of the individuals. 
42 use 300ff-45. "SEC. 2645. NOTIFICATION OF CERTAIN INDIVIDUALS RECEIVING BLOOD 
TRANSFUSIONS. 
"(a) IN GENERAL.—The Secretary may not make a grant under 
section 2641 unless the State involved provides assurances satisfac-
tory to the Secretary that, with respect to individuals in the State 
receiving, between January 1, 1978, and April 1, 1985 (inclusive), a 
transfusion of whole blood or a blood-clotting factor, the State will 
provide public education and information for the purpose of^ 
"(1) encouraging the population of such individuals to receive 
early intervention services; and 
"(2) informing such population of any health facilities in the 
geographic area involved that provide such services. 
"(b) RULE OF CONSTRUCTION.—An agreement made under subsec-
tion (a) may not be construed to require that, in carrying out the 
activities described in such subsection, a State receiving a grant 
under section 2641 provide individual notifications to the individ-
uals described in such subsection. 
42 use 300ff-46. 
"SEC. 2646. REPORTING AND PARTNER NOTIFICATION. 
Classified 
"(a) REPORTING.—The Secretary may not make a grant under 
information. 
section 2641 unless, with respect to testing for HIV disease, the 
State involved provides assurances satisfactory to the Secretary that 
the State will require that any entity carrying out such testing 
confidentially report to the State public health officer information 
sufficient— 
"(1) to perform statistical and epidemiological analyses of the 
incidence in the State of cases of such disease; 
"(2) to perform statistical and epidemiological analyses of the 
demographic characteristics of the population of individuals in 
the State who have the disease; and 
"(3) to assess the adequacy of early intervention services in 
the State. 
"(b) PARTNER NOTIFICATION.—The Secretary may not make a 
grant under section 2641 unless the State involved provides assur-
ances satisfactory to the Secretary that the State will require that 
the public health officer of the State, to the extent appropriate in 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 603 
the determination of the officer, carry out a program of partner 
notification regarding cases of HIV disease. 
"(c) RULES OF CONSTRUCTION.—An agreement made under this 
section may not be construed— 
"(1) to require or prohibit any State from providing that 
identifying information concerning individuals with HIV dis-
ease is required to be submitted to the State; or 
"(2) to require any State to estabhsh a requirement that 
entities other than the public health officer of the State are 
required to make the notifications referred to in subsection (b). 
"SEC. 2647. REQUIREMENT OF STATE LAW PROTECTION AGAINST INTEN- 
42 USC 300ff-47. 
TIONAL TRANSMISSION. 
"(a) IN GENERAL.—The Secretary may not make a grant under 
section 2641 to a State unless the chief executive officer determines 
that the criminal laws of the State are adequate to prosecute any 
HIV infected individual, subject to the condition described in subsec-
tion (b), who— 
"(1) makes a donation of blood, semen, or breast milk, if the 
individual knows that he or she is infected with HIV and 
intends, through such donation, to expose another HIV in the 
event that the donation is utilized; 
"(2) engages in sexual activity if the individual knows that he 
or she is infected with HIV and intends, through such sexual 
activity, to expose another to HIV; and 
"(3) injects himself or herself with a hypodermic needle and 
subsequently provides the needle to another person for purposes 
of hypodermic injection, if the individual knows that he or she 
is infected and intends, through the provision of the needle, to 
expose another to such etiologic agent in the event that the 
needle is utilized. 
"(b) CONSENT TO RISK OF TRANSMISSION.—The State laws described 
in subsection (a) need not apply to circumstances under which the 
conduct described in paragraphs (1) through (3) of subsection (a) if 
the individual who is subjected to the behavior involved knows that 
the other individual is infected and provides prior informed consent 
to the activity. 
"(c) STATE CERTIFICATION WITH RESPECT TO REQUIRED LAWS.— 
With respect to complying with subsection (a) as a condition of 
receiving a grant under section 2601, the Secretary may not require 
a State to enact any statute, or to issue any regulation, if the chief 
executive officer of the State are adequate. The existence of a 
criminal law of general application, which can be applied to the 
conduct described in pareigraphs (1) through (3) of subsection (a) is 
sufficient for compliance with this section. 
"(d) TIME LIMITATIONS WITH RESPECT TO REQUIRED LAWS.—With 
respect to receiving a grant under section 2601, if a State is unable 
to certify compliance with subsection (a), the Secretary may make a 
grant to a State under such section i
f
— 
"(1) for each of the fiscal years 1991 and 1992, the State 
provides assurances satisfactory to the Secretary that by not 
later than October 1, 1992, the State has in place or will 
establish the prohibitions described in subsection (a); and 
"(2) for fiscal year 1993 and subsequent fiscal years, the State 
has established such prohibitions. 
104 STAT. 604 
PUBLIC LAW 101-381—AUG. 18, 1990 
District of 
Columbia. 
Puerto Rico. 
Territories, U.S. 
42 u s e 300ff-49. 
"SEC. 2649. DETERMINATION OF AMOUNT OF ALLOTMENTS. 
"(a) MINIMUM ALLOTMENT.—Subject to the extent of amounts 
made available in appropriations Acts, the amount of an allotment 
under section 2641(a) for a State for a fiscal year shall be the greater 
of— 
"(1) $100,000 for each of the several States, the District of 
Columbia, and the Commonwealth of Puerto Rico, and $50,000 
for each of the territories of the United States other than the 
Commonwealth of Puerto Rico; and 
"(2) an amount determined under subsection (b). 
"(h) DETERMINATION UNDER FORMULA.—The amount referred to in 
subsection (a)(2) is the product of— 
"(1) an amount equal to the amount appropriated under 
subsection (a) of section 2650 for the fiscal year involved; and 
"(2) a percentage equal to the quotient of— 
"(A) an amount equal to the number of cases of acquired 
immune deficiency sjmdrome reported to and confirmed by 
the Director of the Centers for Disease Control for the State 
involved for the most recent fiscal year for which such data 
is available; divided by 
"(B) an amount equal to the number of cases of acquired 
immune deficiency syndrome reported to and confirmed by 
the Director of the Centers for Disease Control for the 
United States for the most recent fiscal year for which such 
data is available. 
"(c) CERTAIN ALLOCATIONS BY SECRETARY.—After determining the 
amount of an allotment under this subsection (a) for a fiscal year, 
the Secretary shall reduce the amount of the allotment of each State 
by 10 percent. From the amounts available as a result of such 
reductions, the Secretary shall, on a discretionary basis, make 
grants to States receiving allotments for the fiscal year involved. 
Such grants shall be made subject to each of the agreements and 
assurances required as a condition of receiving grants under section 
2641. 
"(d) DISPOSITION OF CERTAIN FUNDS APPROPRIATED FOR ALLOT-
MENTS.— 
"(1) IN GENERAL.—Any amounts available pursuant to para-
graph (2) shall, in accordance with paragraph (3), be allotted by 
the Secretary each fiscal year to States receiving payments 
under section 2641(a) for the fiscal year (other than any State 
referred to in paragraph (2)(C)). The Secretary shall make pay-
ments, as grants, to each such State from any such allotment 
for the State for the fiscal year involved. 
"(2) SPECIFICATION OF AMOUNTS.—The amounts referred to in 
paragraph (1) are any amounts that are not paid to States under 
section 2641(a) as a result o
f
— 
"(A) the failure of any State to submit an application 
under section 2651; 
"(B) the failure, in the determination of the Secretary, of 
any State to prepare the application in compliance with 
such section or to submit the application within a reason-
able period of time; or 
"(C) any State informing the Secretary that the State 
does not intend to expend the full amount of the allotment 
made to the State. 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 605 
"(3) AMOUNT OF ALLOTMENT,—The amount of an allotment 
under paragraph (1) for a State for a fiscal year shall be an 
amount equal to the product of— 
"(A) an amount equal to the amount available pursuant 
to paragraph (2) for the fiscal year involved; and 
"(B) the percentage determined under subsection (bX2) for 
the State. 
"(e) TRANSITION RULES.— 
"(1) For the fiscal years 1991 through 1993, the amount of an 
allotment under section 2641 shall be the greater of the amount 
determined under subsection (a) and an amount equal to the 
amount applicable under paragraph (2) for the fiscal year in-
volved. 
"(2) For purposes of paragraph (1)— 
"(A) the amount applicable for fiscal year 1991 is an 
amount equal to the amount received by the State involved 
from the Secretary, acting through the Director of the 
Centers for Disease Control, for fiscal year 1990 for the 
provision of counseling and testing services with respect to 
HIV; 
"(B) the amount applicable for fiscal year 1992 is 85 
percent of the amount specified in subparagraph (A); and 
"(C) the amount applicable for fiscal year 1993 is 70 
percent of the amount specified in subparagraph (A). 
•SEC. 2649A. MISCELLANEOUS PROVISIONS. 
The Secretary may not make a grant under section 2641 unless— 
"(1) the State involved submits to the Secretary a comprehen-
sive plan for the organization and delivery of the early 
intervention services to be funded with the grant that includes 
a description of the purposes for which the State intends to use 
* such assistance, including— 
"(A) the services and activities to be provided and an 
explanation of the manner in which the elements of the 
. 
program to be implemented by the State with the grant will 
maximize the quality of early intervention services avail-
able to individuals with HIV disease throughout the State; 
and 
"(B) a description of the manner in which services funded 
with the grant will be coordinated with other available 
related services for individuals with HIV disease; and 
"(2) the State agrees that— 
"(A) the public health agency administering the grant 
will conduct public hearings regarding the proposed use 
and distribution of the grant; 
"(B) to the maximum extent practicable, early interven-
tion services delivered pursuant to the grgmt will be pro-
vided without regard to the ability of the individual to pay 
for such services and without regard to the current or past 
health condition of the individual with HIV disease; 
"(C) early intervention services under the grant will be 
provided in settings accessible to low-income individuals 
with HIV disease; and 
"(D) outreach to low-income individuals with HIV disease 
will be provided to inform such individuals of the services 
available pursuant to the grant. 
42 use 
300ff-49a. 
Disadvantaged 
persons. 
104 STAT. 606 
PUBLIC LAW 101-381—AUG. 18, 1990 
42 use 300ff-50. 
"SEC. 2650. AUTHORIZATION OF APPROPRIATIONS. 
"For the purpose of making grants under section 2641, there are 
authorized to be appropriated $230,000,000 for fiscal year 1991, and 
such sums as may be necessary for each of the fiscal years 1992 
through 1995. 
"Subpart II—Categorical Grants 
42 use 300ff-51. 
"SEC. 2651. ESTABLISHMENT OF PROGRAM. 
"(a) IN GENERAL.—For the purposes described in subsection (b), 
the Secretary, acting through the Administrator of the Health 
Resources and Services Administration, may make grants to public 
and nonprofit private entities specified in section 2652(a)(1). 
"(b) PURPOSES OF GRANTS.— 
Contracts. 
"(1) IN GENERAL.—The Secretary may not make a grant under 
subsection (a) unless the applicant for the grant agrees to 
expend the grant for the purposes of providing, on an outpatient 
basis, each of the early intervention services specified in para-
graph (2) with respect to HIV disease. 
"(2) 
SPECIFICATION OF EARLY INTERVENTION SERVICES.—The 
early intervention services referred to in paragraph (1) are— 
"(A) counseling individuals with respect to HIV disease in 
accordance with section 2662; 
"(B) testing individuals with respect to such disease, 
including tests to confirm the presence of the disease, tests 
to diagnose the extent of the deficiency in the immune 
system, and tests to provide information on appropriate 
therapeutic measures for preventing and treating the de-
terioration of the immune system and for preventing and 
treating conditions arising from the disease; 
"(C) referrals described in paragraph (3); 
"(D) other clinical and diagnostic services regarding HIV 
disease, and periodic medical evaluations of individuals with the 
disease; 
"(E) providing the therapeutic measures described in 
subparagraph (B). 
"(3) REFERRALS.—The services referred to in paragraph (2)(C) 
are referrals of individuals with HIV disease to appropriate 
providers of health and support services, including, as appro-
priate— 
"(A) to entities receiving amounts under part A or B for 
the provision of such services; 
"(B) to biomedical research facility of institutions of 
higher education that offer experimental treatment for 
such disease, or to community-based organizations or other 
entities that provide such treatment; or 
"(C) to grantees under section 2671, in the case of a 
pregnant woman. 
Contracts. 
"(4) REQUIREMENT OF AVAILABILITY OF ALL EARLY INTERVEN-
TION SERVICES THROUGH EACH GRANTEE.—The Secretary may not 
make a grant under subsection (a) unless the applicant for the 
grant agrees that each of the early intervention services speci-
fied in paragraph (2) will be available through the grantee. With 
respect to compliance with such agreement, such a grantee may 
expend the grant to provide the early intervention services 
directly, and may expend the grant to enter into agreements 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 607 
with public or nonprofit private entities under which the enti-
ties provide the services. 
"(5) OPTIONAL SERVICES.—A grantee under subsection (a)— 
"(A) may expend the grant to provide outreach services to 
individuals who may have HIV disease or may be at risk of 
the disease, and who may be unaware of the availability 
and potential benefits of early treatment of the disease, and 
to provide outreach services to health care professionals 
who may be unaware of such availability and potential 
benefits; and 
"(B) may, in the case of individuals who seek early inter-
vention services from the grantee, expend the grant— 
"(i) for case management to provide coordination in 
the provision of health care services to the individuals 
and to review the extent of utilization of the services by 
the individuals; and 
"(ii) to provide assistance to the individuals regard-
ing establishing the eligibility of the individuals for 
financial assistance and services under Federal, State, 
or local programs providing for health services, mental 
health services, social services, or other appropriate 
services. 
"(c) PARTICIPATION IN CERTAIN CONSORTIUM.—The Secretary may 
not make a grant under subsection (a) unless the applicant for the 
grant agrees to make reasonable efforts to participate in a consor-
tium established with a grant under section 2612(a)(1) regarding 
comprehensive services to individuals with HIV disease, if such a 
consortium exist in the geographic area with respect to which the 
applicant is applying to receive such a grant. 
"SEC. 2652. MINIMUM QUALIFICATIONS OF GRANTEES. 
42 USC 300ff-52. 
"(a) IN GENERAL.—The entities referred to in subsection (b) are 
public entities and nonprofit private entities that are— 
"(A) migrant health centers under section 329 or community 
health centers under section 330; 
"(B) grantees under section 340 (regarding health services for 
the homeless); 
"(C) grantees under section 1001 (regarding family planning) 
other than States; 
"(D) comprehensive hemophilia diagnostic and treatment cen-
ters; 
"(E) 
Federally-qualified 
health 
centers 
under 
section 
1905(1)(2)(B) of the Social Security Act; or 
"(F) a nonprofit private entity that provides comprehensive 
primary care services to populations at risk of HIV disease. 
"0)) STATUS AS MEDICAID PROVIDER.— 
Contracts. 
"(1) IN GENERAL.—Subject to paragraph (2), the Secretary may 
not make a grant under section 2651 for the provision of serv-
ices described in subsection (b) of such section in a State unless, 
in the case of any such service that is available pursuant to the 
State plan approved under title XIX of the Social Security Act 
for the State— 
"(A) the applicant for the grant will provide the service 
directly, and the applicant has entered into a participation 
agreement under the State plan and is qualified to receive 
payments under such plan; or 
89-194 O - 91 - 21: QL 3 Part 1 
104 STAT. 608 
PUBLIC LAW 101-381—AUG. 18, 1990 
"(B) the applicant for the grant will enter into an agree-
ment with a public or nonprofit private entity under which 
the entity will provide the service, and the entity has 
entered into such a participation agreement and is qualified 
to receive such pa3anents. 
"(2) WAIVER REGARDING CERTAIN SECONDARY AGREEMENTS.— 
"(A) In the case of an entity making an agreement pursu-
ant to paragraph (1)(B) regarding the provision of services, 
the requirement established in such paragraph regarding a 
participation agreement shall be waived by the Secretary if 
the entity does not, in providing health care services, 
impose a charge or accept reimbursement available from 
any third-party payor, including reimbursement under any 
insurance policy or under any Federal or State health 
benefits program. 
"(B) A determination by the Secretary of whether an 
entity referred to in subparagraph (A) meets the criteria for 
a waiver under such subparagraph shall be made without 
regard to whether the entity accepts voluntary donations 
regarding the provision of services to the public. 
42 use 300ff-53. 
"SEC. 2653. PREFERENCES IN MAKING GRANTS. 
"(a) IN GENERAL.—In making grants under section 2651, the 
Secretary shall give preference to any qualified applicant experienc-
ing an increase in the burden of providing services regarding HIV 
disease, as indicated by the factors specified in subsection (b). 
"(b) SPECIFICATION OF FACTORS.— 
"(1) IN GENERAL.—In the case of the geographic area with 
respect to which the entity involved is appl5dng for a grant 
under section 2651, the factors referred to in subsection (a), as 
determined for the period specified in paragraph (2), are— 
"(A) the number of cases of acquired immune deficiency 
syndrome; 
"(B) the rate of increase in such cases; 
"(C) the lack of availability of early intervention services; 
"(D) the number of other cases of sexually transmitted 
diseases, and the number of cases of tuberculosis and of 
drug abuse; 
"(E) the rate of increase in each of the cases specified in 
subparagraph (D); 
"(F) the lack of availability of primary health services 
from providers other than such applicant; and 
"(G) the distance between such area and the nearest 
community that has an adequate level of availability of 
appropriate HIV-related services, and the length of time 
required to travel such distance. 
"(2) RELEVANT PERIOD OF TIME.—The period referred to in 
paragraph (1) is the 2-year period preceding the fiscal year for 
which the entity involved is applying to receive a grant under 
section 2651. 
Urban areas. 
"(c) EQUITABLE ALLOCATIONS.—In providing preferences for pur-
Rural areas. 
poses of subsection (b), the Secretary shall equitably allocate the 
preferences among urban and rural areas. 
42 u s e 300ff-54. 
"SEC. 2654. MISCELLANEOUS PROVISIONS. 
"(a) SERVICES FOR INDIVIDUALS WITH HEMOPHIUA.—In making 
grants under section 2651, the Secretary shall ensure that any such 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 609 
grants made regarding the provision of early intervention services 
to individuals with hemophilia are made through the network of 
comprehensive hemophilia diagnostic and treatment centers. 
"(b) TECHNICAL ASSISTANCE.—The Secretary may, directly or 
through grants or contracts, provide technical assistance to non-
profit private entities regarding the process of submitting to the 
Secretary applications for grants under section 2651, and may pro-
vide technical assistance with respect to the planning, development, 
and operation of any program or service carried out pursuant to 
such section. 
"SEC. 2655. AUTHORIZATION OF APPROPRIATIONS. 
42 USC 300ff-55. 
"For the purpose of making grants under section 2651, there are 
authorized to be appropriated $75,000,000 for fiscal years 1991, and 
such sums as may be necessary for each of the fiscal years 1992 
through 1995. 
"Subpart III—General Provisions 
"SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT. 
42 USC 300ff-61. 
"(a) CoNFiDENTiAUTY.—The Secretary may not make a grant 
under this part unless— 
"(1) in the case of any State appljdng for a grant under section 
2641, the State agrees to ensure that information regarding the 
receipt of early intervention services is maintained confiden-
tially pursuant to law or regulations in a manner not inconsist-
ent with applicable law; and 
"(2) in the case of any entity applying for a grant under 
section 2651, the entity agrees to ensure that information 
regarding the receipt of early intervention services pursuant to 
the grant is maintained confidentially in a manner not 
inconsistent with applicable law. 
"G)) INFORMED CONSENT.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
this part unless the applicant for the grant agrees that, in 
testing an individual for HIV disease, the applicant will test an 
individual only after obtaining from the individual a statement, 
made in writing and signed by the individual, declaring that the 
individual has undergone the counseling described in section 
2662(a) and that the decision of the individual with respect to 
undergoing such testing is voluntarily made. 
"(2) PROVISIONS REGARDING ANONYMOUS TESTING.— 
"(A) If, pursuant to section 2664(b), an individual will 
undergo testing pursuant to this part through the use of a 
pseudon3an, a grantee under such section shall be consid-
ered to be in compliance with the agreement made under 
paragraph (1) if the individual signs the statement de-
scribed in such subsection using the pseudonym. 
"(B) If, pursuant to section 2664(b), an individual will 
undergo testing pursuant to this part without providing any 
information relating to the identity of the individual, a 
grantee under such section shall be considered to be in 
compliance with the agreement made under paragraph (1) 
if the individual orally provides the declaration described in 
such paragraph. 
104 STAT. 610 
PUBLIC LAW 101-381—AUG. 18, 1990 
42 use 300ff-62. 
"SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES. 
"(a) COUNSELING BEFORE TESTING.—The Secretary may not make 
a grant under this part unless the appUcant for the grant agrees 
that, before testing an individual for HIV disease, the applicant will 
provide to the individual appropriate counseling regarding the dis-
ease (based on the most recently available scientific data), including 
counseling on— 
"(1) measures for the prevention of exposure to, and the 
transmission of, HIV; 
"(2) the accuracy and reliability of the results of testing for 
HIV disease; 
"(3) the significance of the results of such testing, including 
the potential for developing acquired immune deficiency syn-
drome; 
"(4) encouraging the individual, as appropriate, to undergo 
such testing; 
"(5) the benefits of such testing, including the medical bene-
fits of diagnosing HIV disease in the early stages and the 
medical benefits of receiving early intervention services during 
such stages; 
"(6) provisions of law relating to the confidentiality of the 
process of receiving such services, including information regard-
ing any disclosures that may be authorized under applicable law 
and information regarding the availability of anonymous coun-
seling and testing pursuant to section 2664(b); and 
"(7) provisions of applicable law relating to discrimination 
against individuals with HIV disease. 
"(b) COUNSEUNG OF INDIVIDUALS WITH NEGATIVE TEST RESULTS.— 
The Secretary may not make a grant under this part unless the 
applicant for the grant agrees that, if the results of testing con-
ducted for HIV disease indicate that an individual does not have the 
disease, the applicant will review for the individual the information 
provided pursuant to subsection (a), including— 
"(1) the information described in paragraphs (1) through (3) of 
such subsection; and 
"(2) the appropriateness of further counseling, testing, and 
education of the individual regarding such disease. 
"(c) COUNSEUNG OF INDIVIDUALS WITH POSITIVE TEST RESULTS.— 
The Secretary may not make a grant under this part unless the 
applicant for the grant agrees that, if the results of testing for HIV 
disease indicate that the individual has the disease, the applicant 
will provide to the individual appropriate counseling regarding such 
disease, including— 
"(1) reviewing the information described in paragraphs (1) 
through (3) of subsection (a); 
"(2) reviewing the appropriateness of further counseling, test-
ing, and education of the individual regarding such disease; and 
"(3) providing counseling on— 
"(A) the availability, through the applicant, of early 
intervention services; 
"(B) the availability in the geographic area of appropriate 
health care, mental health care, and social and support 
services, including providing referrals for such services, as 
appropriate; 
"(C) the benefits of locating and counseling any individ-
ual by whom the infected individual may have been ex-
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 611 
posed to HIV and any individual whom the infected individ-
ual may have exposed to HIV; and 
"(D) the availability of the services of public health 
authorities with respect to locating and counseling any 
individual described in subparagraph (C). 
"(d) ADDITIONAL REQUIREMENTS REGARDING APPROPRIATE COUN-
SEUNG.—The Secretary may not make a grant under this part 
unless the applicant for the grant agrees that, in counseling individ-
uals with respect to HIV disease, the applicant will ensure that the 
counseling is provided under conditions appropriate to the needs of 
the individuals. 
"(e) CouNSEUNG OF EMERGENCY RESPONSE EMPLOYEES.—The Sec-
retary may not make a grant under this part to a State unless the 
State agrees that, in counseling individuals with respect to HIV 
disease, the State will ensure that, in the case of emergency re-
sponse employees, the counseling is provided to such employees 
under conditions appropriate to the needs of the employees regard-
ing the counseling. 
"(f) RULE OF CONSTRUCTION REGARDING COUNSELING WITHOUT 
TESTING.—Agreements made pursuant to this section may not be 
construed to prohibit any grantee under this part from expending 
the grant for the purpose of providing counseling services described 
in this section to an individual who does not undergo testing for HIV 
disease as a result of the grantee or the individual determining that 
such testing of the individual is not appropriate. 
"SEC. 2663. APPLICABILITY OF REQUIREMENTS REGARDING CONFIDEN- 42 USC 300ff-63. 
TIALITY, INFORMED CONSENT, AND COUNSELING. 
"The Secretary may not make a grant under this part unless the 
applicant for the grant agrees that, with respect to testing for HIV 
disease, any such testing carried out by the applicant will, without 
regard to whether such testing is carried out with Federal funds, be 
carried out in accordance with conditions described in sections 2661 
and 2662. 
"SEC. 2664. ADDITIONAL REQUIRED AGREEMENTS. 
42 USC 300ff-64. 
"(a) REPORTS TO SECRETARY.—The Secretary may not make a grant 
under this part unless— 
"(1) the applicant submits to the Secretary— 
"(A) a specification of the expenditures made by the 
applicant for early intervention services for the fiscal year 
preceding the fiscal year for which the applicant is applying 
to receive the grant; and 
"(B) an estimate of the number of individuals to whom 
the applicant has provided such services for such fiscal 
year; and 
"(2) the applicant agrees to submit to the Secretary a report 
Reports, 
providing— 
"(A) the number of individuals to whom the applicant 
provides early intervention services pursuant to the grant; 
"(B) epidemiological and demographic data on the popu-
lation of such individuals; 
"(C) the extent to which the costs of HIV-related health 
care for such individuals are paid by third-party payors; 
"(D) the average costs of providing each category of early 
intervention service; and 
104 STAT. 612 
PUBLIC LAW 101-381—AUG. 18, 1990 
"(E) the aggregate amounts expended for each such cat-
egory. 
"(b) PROVISION OF OPPORTUNITIES FOR ANONYMOUS C!OUNSEUNG 
AND TESTING.—The Secretary may not make a grant under this part 
unless the applicant for the grant agrees that, to the extent per-
mitted under State law, regulation or rule, the applicant will offer 
substantial opportunities for an individual— 
"(1) to undergo counseling and testing regarding HIV disease 
without being required to provide any information relating to 
the identity of the individual; and 
"(2) to undergo such counseling and testing through the use of 
a pseudonym. 
"(c) PROHIBITION AGAINST REQUIRING TESTING AS CONDITION OF 
RECEIVING OTHER HEALTH SERVICES.—The Secretary may not make 
a grant under this part unless the applicant for the grant agrees 
that, with respect to an individual seeking health services from the 
applicant, the applicant will not require the individual to undergo 
testing for HIV as a condition of receiving any health services unless 
such testing is medically indicated in the provision of the health 
services sought by the individual. 
"(d) MAINTENANCE OF SUPPORT.—The Secretary may not make a 
grant under this part unless the applicant for the grant agrees to 
maintain the expenditures of the applicant for early intervention 
services at a level equal to not less than the level of such expendi-
tures maintained by the State for the fiscal year preceding the fiscal 
year for which the applicant is applying to receive the grant. 
"(e) REQUIREMENTS REGARDING IMPOSITION OF CHARGES FOR SERV-
ICES.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
this part unless, subject to paragraph (5), the applicant for the 
grant agrees that— 
"(A) in the case of individuals with an income less than or 
equal to 100 percent of the official poverty line, the ap-
plicant will not impose a charge on any such individual for 
the provision of early intervention services under the grant; 
"(B) in the case of individuals with an income greater 
than 100 percent of the official poverty line, the applicant— 
"(i) will impose a charge on each such individual for 
the provision of such services; and 
"(ii) will impose the charge according to a schedule of 
charges that is made available to the public. 
"(2) LIMITATION ON CHARGES REGARDING INDIVIDUALS SUBJECT 
T
O CHARGES.—With respect to the imposition of a charge for 
purposes of paragraph (l)(B)(ii), the Secretary may not make a 
grant under this part unless, subject to paragraph (5), the 
applicant for the grant agrees that— 
"(A) in the case of individuals with an income greater 
than 100 percent of the official poverty line and not 
exceeding 200 percent of such poverty line, the applicant 
will not, for any calendar year, impose charges in an 
amount exceeding 5 percent of the annual gross income of 
the individual involved; 
"(B) in the C£ise of individuals with an income greater 
than 200 percent of the official poverty line and not 
exceeding 300 percent of such poverty line, the applicant 
will not, for any calendar year, impose charges in an 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 613 
amount exceeding 7 percent of the annual gross income of 
the individual involved; and 
"(C) in the case of individuals with an income greater 
than 300 percent of the official poverty line, the applicant 
will not, for any calendar year, impose charges in an 
amount exceeding 10 percent of the annual gross income of 
the individual involved. 
"(3) ASSESSMENT OF CHARGE.—With respect to compliance 
with the agreement made under paragraph (1), a grantee under 
this part may, in the case of individuals subject to a charge for 
purposes of such paragraph— 
"(A) assess the amount of the charge in the discretion of 
the grantee, including imposing only a nominal charge for 
the provision of services, subject to the provisions of such 
paragraph regarding public schedules and of paragraph (2) 
regarding limitations on the maximum amount of charges; 
and 
"(B) take into consideration the medical expenses of 
individuals in assessing the amount of the charge, subject to 
such provisions. 
"(4) APPUCABIUTY OF LIMITATION ON AMOUNT OF CHARGE.— 
The Secretary may not make a grant under this part unless the 
applicant for the grant agrees that the limitations established 
in paragraph (2) regarding the imposition of charges for services 
applies to the annual aggregate of charges imposed for such 
services, without regard to whether they are characterized as 
enrollment 
fees, 
premiums, 
deductibles, 
cost 
sharing, 
copayments, coinsurance, or similar charges. 
(5) WAIVER REGARDING CERTAIN SECONDARY AGREEMENTS.— 
The requirement established in paragraph (l)(B)(i) shall be 
waived by the Secretary in the case of any entity for whom the 
Secretary has granted a waiver under section 26420t)) or 
2652(b)(2). 
"(f) 
RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER PRO-
GRAMS.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
this part unless the applicant for the grant agrees that, subject 
to paragraph (2), the grant will not be expended by the ap-
plicant, or by any entity receiving amounts from the applicant 
for the provision of early intervention services, to make pay-
ment for any such service to the extent that payment has been 
made, or can reasonably be expected to be made, with respect to 
such service— 
"(A) under any State compensation program, under an 
insurance policy, or under any Federal or State health 
benefits program; or 
"(B) by an entity that provides health services on a 
prepaid basis. 
"(2) APPLICABILITY TO CERTAIN SECONDARY AGREEMENTS FOR 
PROVISION OF SERVICES.—An agreement made under paragraph 
(1) shall not apply in the case of an entity through which a 
grantee under this part provides early intervention services if 
the Secretary has provided a waiver under section 2642(b) or 
2652(b)(2) regarding the entity. 
"(g) ADMINISTRATION OF GRANT.—The Secretary may not make a 
grant under this part unless the applicant for the grant agrees 
that— 
104 STAT. 614 
PUBLIC LAW 101-381—AUG. 18, 1990 
42 u s e 300ff-65. 
42 u s e 300ff-66. 
42 u s e 300ff-67. 
Public 
information. 
Sexual 
activities. 
Drugs and drug 
abuse. 
"(1) the applicant will not expend amounts received pursuant 
to this part for any purpose other than the purposes described 
in the subpart under which the grant involved is made; 
"(2) the applicant will establish such procedures for fiscal 
control and fund accounting as may be necessary to ensure 
proper disbursement and accounting with respect to the grant; 
and 
"(3) the applicant will not expend more than 5 percent of the 
grant for administrative expenses with respect to the grant. 
"(h) CONSTRUCTION.—A State may not use amounts received under 
a grant awarded under section 2641 to purchase or improve land, or 
to purchase, construct, or permanently improve (other than minor 
remodeling) any building or other facility, or to make cash payments 
to intended recipients of services. 
"SEC. 2665. REQUIREMENT OF SUBMISSION OF APPLICATION CONTAINING 
CERTAIN AGREEMENTS AND ASSURANCES. 
"The Secretary may not make a grant under this part unless— 
"(1) an application for the grant is submitted to the Secretary 
containing agreements and assurances in accordance with this 
part and containing the information specified in section 
2664(a)(1); 
"(2) with respect to such agreements, the application pro-
vides assurances of compliance satisfactory to the Secretary; 
and 
"(3) the application otherwise is in such form, is made in such 
manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to 
carry out this part. 
"SEC. 2666. PROVISION BY SECRETARY OF SUPPLIES AND SERVICES IN 
LIEU OF GRANT FUNDS. 
"(a) IN GENERAL.—Upon the request of a grantee under this part, 
the Secretary may, subject to subsection (b), provide supplies, equip-
ment, and services for the purpose of aiding the grantee in providing 
early intervention services and, for such purpose, may detail to the 
State any officer or employee of the Department of Health and 
Human Services. 
"(b) LIMITATION.—With respect to a request described in subsec-
tion (a), the Secretary shall reduce the amount of payments under 
the grant involved by an amount equal to the costs of detailing 
personnel and the fair market value of any supplies, equipment, or 
services provided by the Secretary. The Secretary shall, for the 
payment of expenses incurred in complying with such request, 
expend the amounts withheld. 
"SEC. 2667. USE OF FUNDS. 
"Counseling programs carried out under this part— 
"(1) shall not be designed to promote or encourage, directly, 
intravenous drug abuse or sexual activity, homosexual or 
heterosexual; 
"(2) shall be designed to reduce exposure to and transmission 
of HIV disease by providing accurate information; and 
"(3) shall provide information on the health risks of promis-
cuous sexual activity and intravenous drug abuse.".. 
(b) REVISION, EXTENSION, AND TRANSFER OF PROGRAM OF PRISON 
TESTING ACT OF 1988.— 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 615 
42 use 300ee-6, 
300ff-48. 
42 use 300ff-48. 
(1) TRANSFER OF PROGRAM.—Section 902 of Public Law 100-
607— 
(A) is transferred to part C of title XXVI of the Public 
Health Service Act, as added by subsection (a) of this Act; 
(B) is redesignated as section 2648; and 
(C) is inserted after section 2647 of such part C. 
(2) EXTENSION OF AUTHORIZATION OF APPROPRIATIONS FOR PRO-
GRAM.—Section 2648(g) of the Public Health Service Act, as 
transferred and added by paragraph (1) of this subsection, is 
amended by striking "1990" and inserting "1995". 
(3) REVISION OF PROGRAM.—Section 2648 of the Public Health Prisoners. 
Service Act, as transferred and added by paragraph (1) of this 
subsection, is amended by striking subsections (a) through (f) 
and inserting the following: 
"(a) IN GENERAL.—In addition to grants under section 2641, the 
Secretary may make grants to States for the purpose of assisting the 
States in providing early intervention services to individuals sen-
tenced by the State to a term of imprisonment. The Secretary may 
make such a grant only if the State involved requires, subject to 
subsection (d), that— 
"(1) the services be provided to such individuals; and 
"(2) each such individual be informed of the requirements of 
subsection (c) regarding testing and be informed of the results of 
such testing of the individual. 
"(b) REQUIREMENT OF MATCHING FUNDS.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
subsection (a) unless the State involved agrees that, with respect 
to the costs to be incurred by the State in carrying out the 
purpose described in such subsection, the State will make avail-
able (directly or through donations from public or private enti-
ties) non-Federal contributions toward such costs in an amount 
equal to— 
"(A) for the first fiscal year of payments under the grant, 
not less than $1 for each $2 of Federal funds provided in the 
grant; and 
"(B) for any subsequent fiscal year of such payments, not 
less than $1 for each $1 of Federal funds provided in the 
grant. 
"(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-
TION.—Non-Federal contributions required in parajgraph (1) 
may be in cash or in kind, fairly evaluated, including plant, 
equipment, or services. Amounts provided by the Federal 
Government, and services (or portions of services) subsidized by 
the Federal Government, may not be included in determining 
the amount of such non-Federal contributions. 
"(c) TESTING.—The Secretary may not make a grant under subsec-
tion (a) unless— 
"(1) the State involved requires that, subject to subsection (d), 
any individual sentenced by the State to a term of imprison-
ment be tested for HIV disease— 
"(A) upon entering the State penal system; and 
"(B) during the 30-day period preceding the date on which 
the individual is released from such system; 
"(2) with respect to informing employees of the penal system 
of the results of such testing of the individual, the State— 
"(A) upon the request of any such employee, provides the 
results to the employee in any case in which the medical 
104 STAT. 616 
PUBLIC LAW 101-381—AUG. 18, 1990 
officer of the prison determines that there is a reasonable 
basis for believing that the employee has been exposed by 
the individual to such disease; and 
"(B) informs the employees of the availability to the 
employees of such results under the conditions described in 
subparagraph (A); 
"(3) with respect to informing the spouse of the individual of 
the results of such testing of the individual, the State— 
"(A) upon the request of the spouse, provides such results 
to the spouse prior to any conjugal visit and provides such 
results to the spouse during the period described in para-
graph (1)(B); and 
"(B) informs the spouse of the availability to the spouse of 
such results under the conditions described in subpara-
graph (A); 
"(4) with respect to such testing upon entering the State penal 
system of such an individual who has been convicted of rape or 
aggravated sexual assault, the State— 
"(A) upon the request of the victim of the rape or assault, 
provides such results to the victim; and 
"(B) informs the victim of the availability to the victim of 
such results; and 
Classified 
"(5) the State, except £is provided in any of paragraphs (2) 
information. 
through (4), maintains the confidentiality of the results of test-
ing for HIV disease in each prison operated by the State or with 
amounts provided by the State, and makes disclosures of such 
results only as medically necessary. 
"(d) DETERMINATION OF PRISONS SUBJECT TO REQUIREMENT.— 
"(1) IN GENERAL.—The Secretary may not make a grant under 
subsection (a) unless the State involved agrees that the require-
ment established in such subsection regarding the provision of 
early intervention services to inmates will apply only to in-
mates who are incarcerated in prisons with respect to which the 
State public health officer, after consultation with the chief 
State correctional officer, has, on the basis of the criteria de-
scribed in paragraph (2), determined that the provision of such 
services is appropriate with respect to the public health and 
safety. 
"(2) DESCRIPTION OF CRITERIA.—The criteria to be considered 
for purposes of paragraph (1) are— 
' (A) with respect to the geographic areas in which in-
mates of the prison involved resided before incarceration 
in the prison— 
(i) the severity of the epidemic of HIV disease in the 
areas during the period in which the inmates resided in 
the areas; and 
"(ii) the incidence, in the areas during such period, of 
behavior that places individuals at significant risk of 
developing HIV disease; and 
"(B) the extent to which medical examinations conducted 
by the State for inmates of the prison involved indicate 
that the inmates have engaged in such behavior. 
"(e) 
APPLICABILITY OF PROVISIONS REGARDING INFORMED CON-
SENT, COUNSELING, AND OTHER MATTERS.—The Secretary may 
not 
make a grant under subsection (a) unless the State involved sigrees 
that sections 2641(b)(4), 2662, and 2664(c) will apply to the provision 
of early intervention services pursuant to the grant in the same 
PUBLIC LAW 101-381—AUG. 18, 1990 
manner and to the same extent as such sections apply to the 
provision of such services by grantees under section 2641. 
"(f) REQUIREMENT OF APPUCATION.—The Secretary may not make 
a grant under subsection (a) unless an application for the grant is 
submitted to the Secretary and the application is in such form, is 
made in such manner, and contains such agreements, assurances, 
and information as the Secretary determines to be necessary to 
carry out this section. 
"(g) RULE OF CONSTRUCTION.—With respect to testing inmates of 
State prisons for HIV disease without the consent of the inmates, 
the agreements made under this section may not be construed to 
authorize, prohibit, or require any State to conduct such testing, 
except as provided in subparagraphs (A) and (B) of subsection (c)(1).". 
(4) TECHNICAL AMENDMENTS.—Section 2648 of the Public 
Health Service Act, as transferred and added by paragraph (1) 
of this subsection, is amended by striking the heading and 
inserting the following: "TESTING AND OTHER EARLY 
INTERVENTION SERVICES FOR STATE PRISONERS.". 
TITLE IV—GENERAL PROVISIONS, 
REPORTS AND EVALUATIONS 
Subtitle A—General Provisions 
SEC. 401. GENERAL PROVISIONS. 
Title XXVI of the Public Health Service Act (as added by section 
101 and amended by sections 201 and 301) is further amended by 
adding at the end thereof the following new part: 
"PART D—GENERAL PROVISIONS 
104 STAT. 617 
"SEC. 2671. DEMONSTRATION GRANTS FOR RESEARCH AND SERVICES FOR 
42 USC 300ff-71. 
PEDIATRIC PATIENTS REGARDING ACQUIRED IMMUNE 
DEFICIENCY SYNDROME. 
"(a) IN GENERAL.—The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration and the 
Director of the National Institutes of Health, shall make demonstra-
tion grants to community health centers, and other appropriate 
public or nonprofit private entities that provide primary health care 
to the public, for the purpose o
f
— 
"(1) conducting, at the health facilities of such entities, clini-
cal research on therapies for pediatric patients with HIV dis-
ease as well as pregnant women with HIV disease; and 
"(2) with respect to the pediatric patients who participate in 
such research, providing health care on an outpatient basis to 
such patients and the families of such patients. 
"(b) MINIMUM QUALIFICATIONS OF GRANTEES.—The Secretary may 
not make a grant under subsection (a) unless the health facility 
operated by the applicant for the grant serves a significant number 
of pediatric patients and pregnant women with HIV disease. 
"(c) COOPERATION WITH BIOMEDICAL INSTITUTIONS.— 
"(1) DESIGN OF RESEARCH PROTOCOL.—The Secretary may not 
make a grant under subsection (a) unless the applicant for the 
grant— 
Health care 
facilities. 
Women. 
Women. 
104 STAT. 618 
PUBLIC LAW 101-381—AUG. 18, 1990 
Contracts. 
42 use 300ff-72. 
Safety. 
"(A) has entered into a cooperative agreement or contract 
with an appropriately qualified entity with expertise in 
biomedical research under which the entity will assist the 
applicant in designing and conducting a protocol for the 
research to be conducted pursuant to the grant; and 
"(B) agrees to provide the clinical data developed in the 
research to the Director of the National Institutes of 
Health. 
"(2) 
ANALYSIS AND EVALUATION.—The Secretary, acting 
through the Director of the National Institutes of Health— 
"(A) may assist grantees under subsection (a) in designing 
and conducting protocols described in subparagraph (A) of 
paragraph (1); and 
"(B) shall analyze and evaluate the data submitted to the 
Director pursuant to subparagraph (B) of such paragraph. 
"(d) CASE MANAGEMENT.—The Secretary may not make a grant 
under subsection (a) unless the applicant for the grant agrees to 
provide for the case management of the pediatric patient involved 
and the family of the patient. 
"(e) REFERRALS FOR ADDITIONAL SERVICES.—The Secretary may not 
make a grant under subsection (a) unless the applicant for the grant 
agrees to provide for the pediatric patient involved and the family of 
the patient— 
"(1) referrals for inpatient hospital services, treatment for 
substance abuse, and mental health services; and 
"(2) referrals for other social and support services, as appro-
priate. 
"(f) INCIDENTAL SERVICES.—The Secretary may not make a grant 
under subsection (a) unless the applicant for the grant agrees to 
provide the family of the pediatric patient involved with such 
transportation, child care, and other incidental services as may be 
necessary to enable the pediatric patient and the family of the 
patient to participate in the program established by the applicant 
pursuant to such subsection. 
"(g) APPLICATION.—The Secretary may not make a grant under 
subsection (a) unless an application for the grant is submitted to the 
Secretary and the application is in such form, is made in such 
manner, and contains such agreements, assurances, and information 
as the Secretary determines to be necessary to carry out this section. 
"(h) EVALUATIONS.—The Secretary shall, directly or through con-
tracts with public and private entities, provide for evaluations of 
programs carried out pursuant to subsection (a). 
"(i) DEFINITION.—For purposes of this section, the term 'commu-
nity health center' has the meaning given such term in section 
330(a). 
"(j) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carry-
ing out this section, there are authorized to be appropriated 
$20,000,000 for fiscal year 1991, and such sums as may be necessary 
for each of the fiscal years 1992 through 1995. 
"SEC. 2672. PROVISIONS RELATING TO BLOOD BANKS. 
"(a) INFORMATIONAL AND TRAINING PROGRAMS.—The Secretary 
shall— 
"(1) develop and make available to technical and supervisory 
personnel employed at blood banks and facilities that produce 
blood products, materials and information concerning measures 
that may be implemented to protect the safety of the blood 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 619 
supply with respect to the activities of such personnel, includ-
ing— 
"(A) state-of-the-art diagnostic and testing procedures 
relating to pathogens in the blood supply; and 
"(B) quality assurance procedures relating to the safety of 
the blood supply and of blood products; and 
"(2) develop and implement a training program that is de-
signed to increase the number of employees of the Department 
of Health and Human Services who are qualified to conduct 
inspections of blood banks and facilities that produce blood 
products. 
"(b) UPDATES.—The Secretary shall periodically review and 
update the materials and information made available under 
informational or training programs conducted under subsection (a). 
"(c) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to 
be appropriated to carry out this section, $1,500,000 for fiscal year 
1991, and such sums as may be necessary in each of the fiscal years 
1992 through 1995. 
"SEC. 2673. RESEARCH, EVALUATION, AND ASSESSMENT PROGRAM. 
42 USC 300ff-73. 
"(a) ESTABLISHMENT.—The Secretary, acting through the Agency 
for Health Care Policy and Research, shall establish a program to 
enable independent research to be conducted by individuals and 
organizations with appropriate expertise in the fields of health, 
health policy, and economics (particularly health care economics) to 
develop— 
"(1) a comparative assessment of the impact and cost-
effectiveness of major models for organizing and delivering 
HIV-related health care, mental health care, early intervention, 
and support services, that shall include a report concerning 
patient outcomes, satisfaction, perceived quality of care, and 
total cumulative cost, and a review of the appropriateness of 
such models for the delivery of health and support services to 
infants, children, women, and families with HIV disease; 
"(2) through a review of private sector financing mechanisms 
for the delivery of HIV-related health and support services, an 
assessment of strategies for maintaining private health benefits 
for individuals with HIV disease and an assessment of specific 
business practices or regulatory barriers that could serve to 
reduce access to private sector benefit programs; 
"(3) an assessment of the manner in which different points-of-
entry to the health care system affect the cost, quality, and 
outcome of the care and treatment of individuals and families 
with HIV disease; and 
"(4) a summary report concerning the major and continuing 
Reports, 
unmet needs in health care, mental health care, early interven-
tion, and support services for individuals and families with HIV 
disease in urban and rural areas. 
"(b) REPORT.—Not later than 2 years after the date of enactment 
of this title, and periodically thereafter, the Secretary shall prepare 
and submit, to the Committee on Energy and Commerce of the 
House of Representatives and the Committee on Labor £ind Human 
Resources of the Senate, a progress report that contains the findings 
and assessments developed under subsection (a). 
"(c) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to 
be appropriated to carry out this section, such sums as may be 
necessary for each of the fiscal years 1991 through 1995. 
104 STAT. 620 
PUBLIC LAW 101-381—AUG. 18, 1990 
42 use 300ff-74. 
"SEC. 2674. EVALUATIONS AND REPORTS. 
Contracts. 
"(a) EVALUATIONS.—The Secretary shall, directly or through 
grants and contracts, evaluate programs carried out under this title. 
"(b) REPORT TO CONGRESS.—The Secretary shsill, not later than 1 
year after the date on which amounts are first appropriated under 
this title, and annually thereafter, prepare and submit to the appro-
priate Committees of Congress a report— 
"(1) summarizing all of the reports that are required to be 
submitted to the Secretary under this title; 
"(2) recommending criteria to be used in determining the 
geographic areas with the most substantial need for HlV-re-
lated health services; 
"(3) summarizing all of the evaluations carried out pursuant 
to subsection (a) during the period for which the report under 
this subsection is prepared; and 
"(4) making such recommendations for administrative and 
legislative initiatives with respect to this title as the Secretary 
determines to be appropriate. 
"(c) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to 
be appropriated to carry out this section, such sums as may be 
necessary for each of the fiscal years 1991 through 1995. 
42 use 300ff-75. "SEC. 2675. COORDINATION. 
"(a) REQUIREMENT.—The Secretary shall assure that the Health 
Resources and Services Administration and the Centers for Disease 
Control will coordinate the planning of the funding of programs 
authorized under this title to assure that health support services for 
individuals with HIV disease are integrated with each other and 
that the continuity of care of individuals with HIV disease is 
enhanced. In coordinating the allocation of funds made available 
under this title the Health Resources and Services Administration 
and the Centers for Disease Control shall utilize planning informa-
tion submitted to such agencies by the States and entities eligible 
for support. 
"(b) INTEGRATION BY STATE.—As a condition of receipt of funds 
under this title, a State shall assure the Secretary that health 
support services funded under this title will be integrated with each 
other, that programs will be coordinated with other available pro-
grams (including Medicaid) and that the continuity of care of 
individuals with HIV disease is enhanced. 
"(c) INTEGRATION BY LOCAL OR PRIVATE ENTITIES.—As a condition 
of receipt of funds under this title, a local government or private 
nonprofit entity shall assure the Secretary that services funded 
under this title will be integrated with each other, that programs 
will be coordinated with other available programs (including Medic-
aid) and that the continuity of care of individuals with HIV is 
enhanced. 
42 use 300ff-76. 
"SEC. 2676. DEFINITIONS. 
"For purposes of this title: 
"(1) COUNSELING.—The term 'counseling' means such counsel-
ing provided by an individual trained to provide such counsel-
ing. 
(2) DESIGNATED OFFICER OF EMERGENCY RESPONSE EMPLOY-
EES.—The term 'designated officer of emergency response 
employees' means an individual designated under section 
26 
by the public health officer of the State involved. 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 621 
"(3) EMERGENCY.—The term 'emergency' means an emer-
gency involving injury or illness. 
"(4) EMERGENCY RESPONSE EMPLOYEE.—The term 'emergency 
response employees' means firefighters, law enforcement offi-
cers, paramedics, emergency medical technicians, and other 
individuals (including employees of legally organized and recog-
nized volunteer organizations, without regard to whether such 
employees receive nominal compensation) who, in the course of 
professional duties, respond to emergencies in the geographic 
area involved. 
"(5) 
EMPLOYER OF EMERGENCY RESPONSE EMPLOYEES.—The 
term 'employer of emergency response employees' means an 
organization that, in the course of professional duties, responds 
to emergencies in the geographic area involved. 
"(6) EXPOSED.—The term 'exposed', with respect to HIV dis-
ease or any other infectious disease, means to be in cir-
cumstances in which there is a significant risk of becoming 
infected with the etiologic agent for the disease involved. 
"(7) FAMILIES WITH HIV DISEASE.—The term 'families with HIV 
disease' means families in which one or more members have 
HIV disease. 
"(8) HIV.—The term 'HIV means infection with the etiologic 
agent for acquired immune deficiency syndrome. 
"(9) HIV DISEASE.—The term 'HIV disease' means infection 
with the etiologic agent for acquired immune deficiency syn-
drome, and includes any condition arising from such syndrome. 
"(10) OFFICIAL POVERTY LINE.—The term 'official poverty line' 
means the poverty line established by the Director of the Office 
of Management and Budget and revised by the Secretary in 
accordance with section 673(a) of the Omnibus Budget Reconcili-
ation Act of 1981. 
"(11) PERSON.—The term 'person' includes one or more 
individuals, governments (including the Federal Government 
and the governments of the States), governmental agencies, 
political subdivisions, labor unions, partnerships, associations, 
corporations, legal representatives, mutual companies, joint-
stock companies, trusts, unincorporated organizations, receiv-
ers, trustees, and trustees in cases under title 11, United States 
Code. 
"(12) STATE.—The term 'State', except as otherwise specifi-
cally provided, means each of the 50 States, the District of 
Columbia, the Virgin Islands, Guam, American Samoa, the 
Commonwealth of the Northern Mariana Islands, Puerto Rico, 
and the Republic of the Marshall Islands.". 
SEC. 402. STUDY REGARDING PARTNER NOTIFICATION. 
42 USC 300ff-46 
(a) IN GENERAL.—The Secretary shall conduct a study of programs "°*®-
of HIV partner notification for the purpose of determining— 
(1) in the case of individuals who have been notified under 
such programs, the percentage of such individuals who undergo 
counseling and testing regarding HIV disease; 
(2) in the case of such individuals who have undergone HIV 
testing, the number of such individuals determined through 
such tests to have HIV disease; 
(3) the extent to which such programs have, in the case of 
such individuals, resulted in behavioral changes that are effec-
104 STAT. 622 
PUBLIC LAW 101-381—AUG. 18, 1990 
tive regarding the prevention of exposure to, and the trans-
mission of, HIV disease; and 
(4) the extent to which such programs represent a cost effec-
tive use of available HIV-related resources. 
(b) REPORT.—Not later than 1 year after the date of enactment of 
this Act, the Secretary of Health and Human Services shall com-
plete the study required under subsection (a) and prepare and 
submit, to the appropriate committees of Congress, a report describ-
ing the findings made as a result of such study. 
42 u s e 300ff-ll 
SEC. 403. STUDY REGARDING HIV DISEASE IN RURAL AREAS. 
^° ®
' 
(a) IN GENERAL.—The Secretary of Health and Human Services, 
after consultation with the Director of the Office of Rural Health 
Policy, shall— 
(1) conduct a study for the purpose of estimating the incidence 
and prevalence in rural areas of cases of acquired immune 
deficiency syndrome and cases of infection with the etiologic 
agent for such syndrome; and 
(2) in carrying out such study, determine the adequacy in 
rural areas of services for diagnosing such cases and providing 
treatment for such cases that are in the early stages of infec-
tion. 
(b) REPORT.—Not later than 1 year after the date of the enactment 
of this Act, the Secretary of Health and Human Services shall 
complete the study required under subsection (a) and prepare and 
submit, to the appropriate committees of Congress a report describ-
ing the findings made as a result of such study. 
(c) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to 
be appropriated to carry out this section, such sums as may be 
necessary for each of the fiscal years 1991 through 1995. 
Subtitle B—Emergency Response Employees 
SEC. 411. ESTABLISHMENT OF PROGRAM. 
(a) IN GENERAL.—Title XXVI of the Public Health Service Act (as 
amended by section 401) is further amended by adding at the end 
the following new part: 
"PART E—EMERGENCY RESPONSE EMPLOYEES 
"SUBPART I—GUIDELINES AND MODEL CURRICULUM 
42 u s e 300ff-80. 
"SEC. 2680. GRANTS FOR IMPLEMENTATION. 
"(a) IN GENERAL.—With respect to the recommendations con-
tained in the guidelines and the model curriculum developed under 
section 253 of Public Law 100-607, the Secretary shall make grants 
to States and political subdivisions of States for the purpose of 
assisting grantees regarding the initial implementation of such 
portions of the recommendations as are applicable to emergency 
response employees. 
Qo) REQUIREMENT OF APPLICATION.—The Secretary may not make 
a grant under subsection (a) unless an application for the grant is 
submitted to the Secretary and the application is in such form, is 
made in such manner, and contains such agreements, assurances, 
and information as the Secretary determines to be necessary to 
carry out this section. 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 623 
"(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$5,000,000 for each of the fiscal years 1991 through 1995. 
"SUBPART II—NOTIFICATIONS OF POSSIBLE EXPOSURE TO INFECTIOUS 
DISEASES 
"SEC. 2681. INFECTIOUS DISEASES AND CIRCUMSTANCES RELEVANT TO 42 USC 300ff-81. 
NOTIFICATION REQUIREMENTS. 
"(a) IN GENERAL.—Not later than 180 days after the date of the 
enactment of the Ryan White Comprehensive AIDS Resources 
Emergency Act of 1990, the Secretary shall complete the develop-
ment of^ 
"(1) a list of potentially life-threatening 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 facili-
ties should make determinations for purposes of section 2683(d). 
"(b) SPECIFICATION OF AIRBORNE INFECTIOUS DISEASES.—The list 
developed by the Secretary under subsection (a)(1) shall include a 
specification of those infectious diseases on the list that are rou-
tinely 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. 
Public 
"SEC. 2682. ROUTINE NOTIFICATIONS WITH RESPECT TO AIRBORNE INFEC- 
42^uS(?300ff-82 
TIOUS 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 hgis 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 FACIUTY ASCERTAINING CAUSE OF 
DEATH.—If a victim of an emergency is transported by emer-
gency 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 des-
ignated officer of the emergency response employees who trans-
ported the victim to the initial medical facility of any deter-
mination 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), 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. 
104 STAT. 624 
PUBLIC LAW 101-381—AUG. 18, 1990 
42 use 300ff-83. "SEC. 2683. REQUEST FOR NOTIFICATIONS WITH RESPECT TO VICTIMS 
ASSISTED. 
"(a) INITIATION OF PROCESS BY EMPLOYEE.—If an emergency 
re-
sponse employee believes that the employee may have been ex-
posed 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 em-
ployee 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 infec-
tious disease included on the list issued under paragraph (1) of 
section 2681(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 FACIUTY.— 
"(1) IN GENERAL.—If a designated officer makes a determina-
tion under subsection (b)(2) that an emergency response em-
ployee may have been exposed to an infectious disesise, 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 pursusmt to 
subsection (b)(1). 
"(d) EVALUATION AND RESPONSE REGARDING REQUEST TO MEDICAL 
FACIUTY.— 
"(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 em-
ployee was exposed to an infectious disease included on the list 
issued under paragraph (1) of section 2681(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 deter-
mination. 
"(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. 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 625 
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 m£iking a determina-
tion under paragraph (1) that the facility possesses no 
information on whether the victim involved has an infec-
tious disease included on the list under section 2681(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 infec-
tious disease, the medical facility shall make the deter-
mination 
described 
in 
paragraph 
(1) and 
provide the 
applicable response specified in this subsection. 
"(e) TIME FOR MAKING RESPONSE.—After receiving a request under 
subsection (c) (including any such request resubmitted under subsec-
tion (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) RESPONSIBIUTY 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 PUBUC HEALTH OFFICER.— 
"(1) EVALUATION OF RESPONSE OF MEDICAL FACILITY REGARDING 
INSUFFICIENT FACTS.— 
"(A) In the case of a request under subsection (c) to which 
a medical facility has made the response specified in subsec-
tion (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 re-
sponse, if the designated officer involved submits such docu-
ments to the officer with the request that the officer make 
such an evaluation. 
1 g- 
"(B) As soon as is practicable after a public health officer 
.g' 
receives a request under paragraph (1), but not later than 
48 hours after receipt of the request, the public health 
officer shall complete the evaluation required in such para- 
, 
104 STAT. 626 
PUBLIC LAW 101-381—AUG. 18, 1990 
graph 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 des-
ignated officer the applicable response specified in 
subsection (d). 
"(B) If an evaluation under paragraph (1)(A) indicates 
that the facts provided in the request to the medical facility 
were insufficient for purposes of determinations specified in 
subsection (c)— 
"(i) the public health officer shall provide advice to 
the designated officer regarding the collection and 
description of appropriate facts; and 
"(ii) if sufficient facts are obtained by the designated 
officer— 
"(I) the public health officer shall, on behalf of 
the designated officer involved, resubmit the re-
quest to the medical facility; and 
"(II) the medical facility shall provide to the 
designated officer the appropriate response under 
subsection (c). 
Health care 
"SEC. 2684. PROCEDURES FOR NOTIFICATION OF EXPOSURE. 
42 use 300ff-84. 
"(^) CONTENTS OF NOTIFICATION TO OFFICER.—In making a notifica-
tion required under section 2682 or section 2683(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 
2682 or section 2682(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. 
42 u s e 300fr-85. 
"SEC. 2685. NOTIFICATION OF EMPLOYEE. 
"(a) IN GENERAL.—After receiving a notification for purposes of 
section 2682 or 2683(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. 
PUBLIC LAW 101-381—AUG. 18, 1990 
104 STAT. 627 
"(b) 
CERTAIN 
CONTENTS OF NOTIFICATION TO EMPLOYEE.—A 
notification under this subsection to an emergency response em-
ployee shall inform the employee o
f
— 
"(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, £is indicated by guide-
lines 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 2683, or a response under subsection (g)(1) of such section, 
the designated officer for the employee shall, to the extent prac-
ticable, immediately inform the employee of the response. 
"SEC. 2686. SELECTION OF DESIGNATED OFFICERS. 
42 USC 300ff-86. 
"(a) IN GENERAL.—For the purposes of receiving notifications and 
responses and making requests under this subpart on behalf of 
emergency response employees, the public health officer of each 
State shall designate 1 official or officer of each employer of emer-
gency response employees in the State. 
"(b) PREFERENCE IN MAKING DESIGNATIONS.—In making the des-
ignations 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. 2687. LIMITATIONS WITH RESPECT TO DUTIES OF MEDICAL FACILI- 
42 USC 300ff-87. 
TIES. 
"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 2683(c) received 
by a medical facility before the expiration of such 30-day period. 
"SEC. 2688. RULES OF CONSTRUCTION. 
42 USC 300ff-88. 
"(a) LIABILITY OF MEDICAL FACILITIES AND DESIGNATED OFFICERS.— 
This subpart may not be construed to authorize any cause of action 
for damages or any civil penalty against any medical facility, or any 
designated 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) CONFIDENTIAUTY.—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. 
104 STAT. 628 
PUBLIC LAW 101-381—AUG. 18, 1990 
"(d) FAILURE TO PROVIDE EMERGENCY SERVICES.—This subpart 
may not be construed to authorize any emergency response em-
ployee to fail to respond, or to deny services, to any victim of an 
emergency. 
42 u s e 300ff-89. 
"SEC. 2689. 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 viola-
tion of this subpart. 
"(b) FACILITATION OF INFORMATION ON VIOLATIONS.—The Sec-
retary shall establish an administrative process for encouraging 
emergency response employees to provide information to the Sec-
retary regarding violations of this subpart. As appropriate, the 
Secretary shall investigate alleged such violations and seek appro-
priate injunctive relief. 
42 u s e 300ff-90. 
"SEC. 2690. 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 in substantial compliance with this subpart.". 
42 use 300ff-80 
(b) EFFECTIVE DATE.—Sections 2680 and 2681 of part E of title 
note. 
XXVI of the Public Health Service Act, as added by subsection (a) of 
this section, shall take effect upon the date of the enactment of this 
Act. Such part shall otherwise take effect upon the expiration of the 
30-day period beginning on the date on which the Secretary issues 
guidelines under section 2681(a). 
Subtitle C—Miscellaneous Provisions 
42 u s e 300X-4 
SEC. 421. ADAMHA IV DRUG ABUSE WAIVER. 
^°*^' 
Any State that received a waiver under section 1916(c)(7) of the 
Public Health Service Act (42 U.S.C. 300x-4(a)(7)) of $100,000 or less 
for fiscal year 1989 shall be granted a waiver under such section for 
fiscal years 1990 and 1991. 
42 u s e 300ff-l. 
SEC. 422. PROHIBITION ON USE OF FUNDS. 
None of the funds made available under this Act, or an amend-
ment made by this Act, shall be used to provide individuals with 
hypodermic needles or syringes so that such individuals may use 
illegal drugs. 
Approved August 18, 1990. 
LEGISLATIVE HISTORY—S. 2240 (H.R. 4785): 
HOUSE REPORTS: No. 101-511 accompanying H.R. 4785 (Comm. on Energy and 
Commerce) and No. 101-652 (Comm. of Conference). 
SENATE REPORTS: No. 101-27^ (Comm. on Labor and Human Resources). 
CONGRESSIONAL RECORD, Vol. 136 (1990): 
May 15, 16, considered and passed Senate. 
June 13, H.R. 4785 considered and passed House; S. 2240, amended, passed in 
lieu. 
Aug. 3, House receded and agreed to conference report. 
Aug. 4, Senate agreed to conference report.