§ 300ff-28. Distribution of funds
(a)
Amount of grant to State
(1)
Minimum allotment
Subject to the extent of amounts made available under section
300ff–31b of this title, the amount of a grant to be made under section
300ff–21 of this title for—
(A)
each of the 50 States, the District of Columbia, Guam, and the Virgin Islands (referred to in this paragraph as a “covered State”) for a fiscal year shall be the greater of—
(2)
Determination
(A)
Formula
For purposes of paragraph (1), the amount referred to in this paragraph for a State (including a territory) for a fiscal year is, subject to subparagraphs (E) and (F)—
(i)
an amount equal to the amount made available under section
300ff–31b of this title for the fiscal year involved for grants pursuant to paragraph (1), subject to subparagraph (F); and
(ii)
the percentage constituted by the sum of—
(I)
the product of 0.75 and the ratio of the State distribution factor for the State or territory (as determined under subsection (B)) to the sum of the respective State distribution factors for all States or territories;
(II)
the product of .20 and the ratio of the non-EMA distribution factor for the State or territory (as determined under subparagraph (C)) to the sum of the respective non-EMA distribution factors for all States or territories; and
(III)
if the State does not for such fiscal year contain any area that is an eligible area under subpart I of part A or any area that is a transitional area under section
300ff–19 of this title (referred to in this subclause as a “no-EMA State”), the product of 0.05 and the ratio of the number of cases that applies for the State under subparagraph (D) to the sum of the respective numbers of cases that so apply for all no-EMA States.
(B)
State distribution factor
For purposes of subparagraph (A)(ii)(I), the term “State distribution factor” means an amount equal to the number of living cases of HIV/AIDS in the State involved, as determined under subparagraph (D).
(C)
Non-EMA distribution factor
For purposes of subparagraph (A)(ii)(II), the term “non-ema [1] distribution factor” means an amount equal to the sum of—
(i)
the number of living cases of HIV/AIDS in the State involved, as determined under subparagraph (D); less
(ii)
a number equal to the sum of—
(I)
the total number of living cases of HIV/AIDS that are within areas in such State that are eligible areas under subpart I of part A for the fiscal year involved, which individual number for an area is the number that applies under section
300ff–11 of this title for the area for such fiscal year; and
(II)
the total number of such cases that are within areas in such State that are transitional areas under section
300ff–19 of this title for such fiscal year, which individual number for an area is the number that applies under such section for the fiscal year.
(D)
Living cases of HIV/AIDS
(i)
Requirement of names-based reporting
Except as provided in clause (ii), the number determined under this subparagraph for a State for a fiscal year for purposes of subparagraph (B) is the number of living names-based cases of HIV/AIDS in the State that, as of December 31 of the most recent calendar year for which such data is available, have been reported to and confirmed by the Director of the Centers for Disease Control and Prevention.
(ii)
Transition period; exemption regarding non-AIDS cases
For each of the fiscal years 2007 through 2012, a State is, subject to clauses (iii) through (v), exempt from the requirement under clause (i) that living non-AIDS names-based cases of HIV be reported unless—
(I)
a system was in operation as of December 31, 2005, that provides sufficiently accurate and reliable names-based reporting of such cases throughout the State, subject to clause (vii); or
(II)
no later than the beginning of fiscal year 2008 or a subsequent fiscal year through fiscal year 2012, the Secretary, after consultation with the chief executive of the State, determines that a system has become operational in the State that provides sufficiently accurate and reliable names-based reporting of such cases throughout the State.
(iii)
Requirements for exemption for fiscal year 2007
For fiscal year 2007, an exemption under clause (ii) for a State applies only if, by October 1, 2006—
(I)
(II)
the State had agreed that, by April 1, 2008, the State will begin accurate and reliable names-based reporting of such cases, except that such agreement is not required to provide that, as of such date, the system for such reporting be fully sufficient with respect to accuracy and reliability throughout the area.
(iv)
Requirement for exemption as of fiscal year 2008
For each of the fiscal years 2008 through 2012, an exemption under clause (ii) for a State applies only if, as of April 1, 2008, the State is substantially in compliance with the agreement under clause (iii)(II).
(v)
Progress toward names-based reporting
For fiscal year 2009 or a subsequent fiscal year, the Secretary may terminate an exemption under clause (ii) for a State if the State submitted a plan under clause (iii)(I)(aa) and the Secretary determines that the State is not substantially following the plan.
(vi)
Counting of cases in areas with exemptions
(I)
In general
With respect to a State that is under a reporting system for living non-AIDS cases of HIV that is not names-based (referred to in this subparagraph as “code-based reporting”), the Secretary shall, for purposes of this subparagraph, modify the number of such cases reported for the State in order to adjust for duplicative reporting in and among systems that use code-based reporting.
(II)
Adjustment rate
The adjustment rate under subclause (I) for a State shall be a reduction of 5 percent for fiscal years before fiscal year 2012 (and 6 percent for fiscal year 2012) in the number of living non-AIDS cases of HIV reported for the State.
(III)
Increased adjustment for certain States previously using code-based reporting
For purposes of this subparagraph for each of fiscal years 2010 through 2012, the Secretary shall deem the applicable number of living cases of HIV/AIDS in a State that were reported to and confirmed by the Centers for Disease Control and Prevention to be 3 percent higher than the actual number if—
(aa)
there is an area in such State that satisfies all of the conditions described in items (aa) through (cc) of section
300ff–13
(a)(3)(C)(vi)(III) of this title; or
(AA)
fiscal year 2007 was the first year in which the count of living non-AIDS cases of HIV in such area, for purposes of this part, was based on a names-based reporting system; and
(BB)
the amount of funding that such State received under this part for fiscal year 2007 was less than 70 percent of the amount of funding that such State received under such part for fiscal year 2006.
(vii)
List of States meeting standard regarding December 31, 2005
(I)
In general
If a State is specified in subclause (II), the State shall be considered to meet the standard described in clause (ii)(I). No other State may be considered to meet such standard.
(II)
Relevant States
For purposes of subclause (I), the States specified in this subclause are the following: Alaska, Alabama, Arkansas, Arizona, Colorado, Florida, Indiana, Iowa, Idaho, Kansas, Louisiana, Michigan, Minnesota, Missouri, Mississippi, North Carolina, North Dakota, Nebraska, New Jersey, New Mexico, New York, Nevada, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, West Virginia, Wyoming, Guam, and the Virgin Islands.
(viii)
Rules of construction regarding acceptance of reports
(I)
Cases of AIDS
With respect to a State that is subject to the requirement under clause (i) and is not in compliance with the requirement for names-based reporting of living non-AIDS cases of HIV, the Secretary shall, notwithstanding such noncompliance, accept reports of living cases of AIDS that are in accordance with such clause.
(II)
Applicability of exemption requirements
The provisions of clauses (ii) through (vii) may not be construed as having any legal effect for fiscal year 2013 or any subsequent fiscal year, and accordingly, the status of a State for purposes of such clauses may not be considered after fiscal year 2012.
(E)
Code-based States; limitation on increase in grant
(i)
In general
For each of the fiscal years 2007 through 2012, if code-based reporting (within the meaning of subparagraph (D)(vi)) applies in a State as of the beginning of the fiscal year involved, then notwithstanding any other provision of this paragraph, the amount of the grant pursuant to paragraph (1) for the State may not for the fiscal year involved exceed by more than 5 percent the amount of the grant pursuant to this paragraph for the State for the preceding fiscal year, except that the limitation under this clause may not result in a grant pursuant to paragraph (1) for a fiscal year that is less than the minimum amount that applies to the State under such paragraph for such fiscal year.
(ii)
Use of amounts involved
For each of the fiscal years 2007 through 2012, amounts available as a result of the limitation under clause (i) shall be made available by the Secretary as additional amounts for grants pursuant to section
300ff–29a of this title, subject to subparagraph (H).
(F)
Appropriations for treatment drug program
(i)
Formula grants
With respect to the fiscal year involved, if under section
300ff–31b of this title an appropriations Act provides an amount exclusively for carrying out section
300ff–26 of this title, the portion of such amount allocated to a State shall be the product of—
(II)
the percentage constituted by the ratio of the State distribution factor for the State (as determined under subparagraph (B)) to the sum of the State distribution factors for all States;
which product shall then, as applicable, be increased under subparagraph (H).
(ii)
Supplemental treatment drug grants
(I)
In general
From amounts made available under subclause (V), the Secretary shall award supplemental grants to States described in subclause (II) to enable such States to purchase and distribute to eligible individuals under section
300ff–26
(b) of this title pharmaceutical therapeutics described under subsections (c)(2) and (e) of such section.
(II)
Eligible States
For purposes of subclause (I), a State shall be an eligible State if the State did not have unobligated funds subject to reallocation under subsection (d) in the previous fiscal year and, in accordance with criteria established by the Secretary, demonstrates a severe need for a grant under this clause. For purposes of determining severe need, the Secretary shall consider eligibility standards, formulary composition, the number of eligible individuals to whom a State is unable to provide therapeutics described in section
300ff–26
(a) of this title, and an unanticipated increase of eligible individuals with HIV/AIDS.
(III)
State requirements
The Secretary may not make a grant to a State under this clause unless the State agrees that the State will make available (directly or through donations of public or private entities) non-Federal contributions toward the activities to be carried out under the grant in an amount equal to $1 for each $4 of Federal funds provided in the grant, except that the Secretary may waive this subclause if the State has otherwise fully complied with section
300ff–27
(d) of this title with respect to the grant year involved. The provisions of this subclause shall apply to States that are not required to comply with such section
300ff–27
(d) of this title.
(IV)
Use and coordination
Amounts made available under a grant under this clause shall only be used by the State to provide HIV/AIDS-related medications. The State shall coordinate the use of such amounts with the amounts otherwise provided under section
300ff–26
(a) of this title in order to maximize drug coverage.
(V)
Funding
For the purpose of making grants under this clause, the Secretary shall each fiscal year reserve 5 percent of the amount referred to in clause (i) with respect to section
300ff–26 of this title.
(iii)
Code-based States; limitation on increase in formula grant
The limitation under subparagraph (E)(i) applies to grants pursuant to clause (i) of this subparagraph to the same extent and in the same manner as such limitation applies to grants pursuant to paragraph (1), except that the reference to minimum grants does not apply for purposes of this clause. Amounts available as a result of the limitation under the preceding sentence shall be made available by the Secretary as additional amounts for grants under clause (ii) of this subparagraph.
(H)
Increase in formula grants
(i)
Assurance of amount
(ii)
Fiscal years 2011 and 2012
For each of the fiscal years 2011 and 2012, the Secretary shall ensure that the total for a State of the grant pursuant to paragraph (1) and the grant pursuant to subparagraph (F) is not less than 100 percent of such total for the State for fiscal year 2010.
(iii)
Fiscal year 2013
For fiscal year 2013, the Secretary shall ensure that the total for a State of the grant pursuant to paragraph (1) and the grant pursuant to subparagraph (F) is not less than 92.5 percent of such total for the State for fiscal year 2012.
(iv)
Source of funds for increase
(I)
In general
From the amount reserved under section
300ff–31b
(b)(2) of this title for a fiscal year, and from amounts available for such section pursuant to subsection (d) of this section, the Secretary shall make available such amounts as may be necessary to comply with clause (i).
(II)
Pro rata reduction
If the amounts referred to in subclause (I) for a fiscal year are insufficient to fully comply with clause (i) for the year, the Secretary, in order to provide the additional funds necessary for such compliance, shall reduce on a pro rata basis the amount of each grant pursuant to paragraph (1) for the fiscal year, other than grants for States for which increases under clause (i) apply and other than States described in paragraph (1)(A)(i)(I). A reduction under the preceding sentence may not be made in an amount that would result in the State involved becoming eligible for such an increase.
(b)
Allocation of assistance by States
(1)
Allowances
Prior to allocating assistance under this subsection, a State shall consider the unmet needs of those areas that have not received financial assistance under part A of this subchapter.
(2)
Planning and evaluations
Subject to paragraph (4) and except as provided in paragraph (5), a State may not use more than 10 percent of amounts received under a grant awarded under section
300ff–21 of this title for planning and evaluation activities.
(3)
Administration
(A)
In general
Subject to paragraph (4), and except as provided in paragraph (5), a State may not use more than 10 percent of amounts received under a grant awarded under section
300ff–21 of this title for administration.
(B)
Allocations
In the case of entities and subcontractors to which a State allocates amounts received by the State under a grant under section
300ff–21 of this title, the State shall ensure that, of the aggregate amount so allocated, the total of the expenditures by such entities for administrative expenses does not exceed 10 percent (without regard to whether particular entities expend more than 10 percent for such expenses).
(C)
Administrative activities
For the purposes of subparagraph (A), amounts may be used for administrative activities that include routine grant administration and monitoring activities, including a clinical quality management program under subparagraph (E).
(D)
Subcontractor administrative costs
For the purposes of this paragraph, subcontractor administrative activities include—
(E)
Clinical quality management
(i)
Requirement
Each State that receives a grant under section
300ff–21 of this title shall provide for the establishment of a clinical quality management program to assess the extent to which HIV health services provided to patients under the grant are consistent with the most recent Public Health Service guidelines for the treatment of HIV/AIDS and related opportunistic infection, and as applicable, to develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV health services.
(ii)
Use of funds
(I)
In general
From amounts received under a grant awarded under section
300ff–21 of this title for a fiscal year, a State may use for activities associated with the clinical quality management program required in clause (i) not to exceed the lesser of—
(4)
Limitation on use of funds
Except as provided in paragraph (5), a State may not use more than a total of 15 percent of amounts received under a grant awarded under section
300ff–21 of this title for the purposes described in paragraphs (2) and (3).
(5)
Exception
With respect to a State that receives the minimum allotment under subsection (a)(1) of this section for a fiscal year, such State, from the amounts received under a grant awarded under section
300ff–21 of this title for such fiscal year for the activities described in paragraphs (2) and (3), may, notwithstanding paragraphs (2) through (4), use not more than that amount required to support one full-time-equivalent employee.
(6)
Construction
A State may not use amounts received under a grant awarded under section
300ff–21 of this title 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.
(c)
Expedited distribution
(1)
In general
Not less than 75 percent of the amounts received under a grant awarded to a State under section
300ff–21 of this title shall be obligated to specific programs and projects and made available for expenditure not later than—
(d)
Reallocation
Any portion of a grant made to a State under section
300ff–21 of this title for a fiscal year that has not been obligated as described in subsection (c) ceases to be available to the State and shall be made available by the Secretary for grants under section
300ff–29a of this title, in addition to amounts made available for such grants under section
300ff–31b
(b)(2) of this title.
[1] So in original. Probably should be “ ‘non-EMA”.