
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document affected by Public Law 106-345 Section 205]
[CITE: 42USC300ff-27]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
            SUBCHAPTER XXIV--HIV HEALTH CARE SERVICES PROGRAM
 
                       Part B--Care Grant Program
 
                   subpart i--general grant provisions
 
Sec. 300ff-27. 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 application submitted under subsection (a) of this section shall 
contain--
        (1) a detailed description of the HIV-related services provided 
    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--
            (A) a description of the types of programs operated or 
        funded by the State for the provision of HIV-related services 
        during the year preceding the year for which the grant is 
        requested and the methods utilized by the State to finance 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 assistance 
    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 program 
        to be implemented by the State with such assistance will 
        maximize the quality of health and support services available to 
        individuals with HIV disease throughout the State;
            (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
            (C) a description of how the allocation and utilization of 
        resources are consistent with the statewide coordinated 
        statement of need (including traditionally underserved 
        populations and subpopulations) developed in partnership with 
        other grantees in the State that receive funding under this 
        subchapter; and \1\
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    \1\ So in original. The word ``and'' probably should not appear.

        (3) an assurance that the public health agency administering the 
    grant for the State will periodically convene a meeting of 
    individuals with HIV, representatives of grantees under each part 
    under this subchapter, providers, and public agency representatives 
    for the purpose of developing a statewide coordinated statement of 
    need; and
        (4) 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--
                (i) to the maximum extent practicable, ensure that HIV-
            related health care and support services delivered pursuant 
            to a program established with assistance provided 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 condition 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 described in section 
            300ff-25 of this title, submit a plan to the Secretary that 
            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
                    (II) income, asset, and medical expense criteria 
                will be established and applied by the State to identify 
                those individuals who qualify for assistance 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 
        expenditures 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 utilized 
        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 services

                           (1) In general

        The Secretary may not make a grant under section 300ff-21 of 
    this title to a State unless the State 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 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 exceeding 200 
        percent of such poverty line, the provider will not, for any 
        calendar year, impose charges in an amount exceeding 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 exceeding 300 
        percent of such poverty line, the provider will not, for any 
        calendar year, impose charges in an amount exceeding 7 percent 
        of the annual gross income of the individual involved; and
            (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 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 assessing the amount of the charge, subject to 
        such provisions.

         (3) Applicability of limitation on amount of charge

        The Secretary may not make a grant under section 300ff-21 of 
    this title unless the applicant of the grant agrees that the 
    limitations established in subparagraphs (C), (D), and (E) of 
    paragraph (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

        (A) In general

            The State shall waive the requirements 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 program.

        (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 voluntary donations regarding the provision of 
        services to the public.

(d) Requirement of matching funds regarding State allotments

                           (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 carrying out the program for which the 
    grant was awarded, the State will, subject to subsection (b)(2) of 
    this section, make available (directly or through donations from 
    public or private entities) non-Federal contributions toward such 
    costs in an amount equal to--
            (A) for the first fiscal year of payments under the grant, 
        not less than 16\2/3\ percent of such costs ($1 for each $5 of 
        Federal funds provided in the grant);
            (B) for any second fiscal year of such payments, 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 payments, 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\1/3\ 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\1/3\ percent of such costs ($1 for each $2 of 
        Federal funds provided in the grant).

       (2) Determination of amount of non-Federal contribution

        (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 contributions.

        (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 subchapter;
            (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 condition of receiving Federal funds 
        under any program under this subchapter (except for the program 
        established in this part) or under other provisions of law.

                  (3) Applicability 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 and Prevention 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 subparagraph (A) is the 2-year 
        period preceding the fiscal year for which the State involved is 
        applying to receive a grant under subsection (a) of this 
        section.

        (C) Puerto Rico

            For purposes of paragraph (1), the number 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.

                  (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 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.

(July 1, 1944, ch. 373, title XXVI, Sec. 2617, as added Pub. L. 101-381, 
title II, Sec. 201, Aug. 18, 1990, 104 Stat. 590; amended Pub. L. 102-
531, title III, Sec. 312(d)(29), Oct. 27, 1992, 106 Stat. 3506; Pub. L. 
104-146, Secs. 3(c)(4), 12(c)(3), May 20, 1996, 110 Stat. 1355, 1373.)


                               Amendments

    1996--Subsec. (b)(2)(C). Pub. L. 104-146, Sec. 3(c)(4)(A), added 
subpar. (C).
    Subsec. (b)(3). Pub. L. 104-146, Sec. 3(c)(4)(C), added par. (3). 
Former par. (3) redesignated (4).
    Subsec. (b)(4). Pub. L. 104-146, Sec. 3(c)(4)(B), redesignated par. 
(3) as (4).
    Subsec. (b)(4)(B)(iv). Pub. L. 104-146, Sec. 12(c)(3), which 
directed amendment of par. (3)(B)(iv) by inserting ``section'' before 
``300ff-25'', was executed by making the amendment in par. (4)(B)(iv) to 
reflect the probable intent of Congress and the redesignation of par. 
(3) as (4) by Pub. L. 104-146, Sec. 3(c)(4)(B). See above.
    1992--Subsec. (d)(3)(A). Pub. L. 102-531 substituted ``Centers for 
Disease Control and Prevention'' for ``Centers for Disease Control''.


                    Effective Date of 1996 Amendment

    Amendment by Pub. L. 104-146 effective Oct. 1, 1996, see section 13 
of Pub. L. 104-146, set out as a note under section 300ff-11 of this 
title.
