42 U.S.C. § 300ff–14 — Use of amounts

(a) Requirements. The Secretary^* can't give a grant under section 300ff–11(a) to an eligible area's chief elected official unless that official agrees to three things. First, funds and services must be given out following the priorities the area's HIV^* health services planning council sets, as required by section 300ff–12(b)(4)(C), except where paragraph (2) applies. Second, grant funds can only pay for three things: core medical services (subsection (c)), support services (subsection (d)), and administrative expenses (subsection (h)). Third, all use of the funds must follow the rest of this section's rules.

(b) Direct financial assistance to appropriate entities. (1) The chief elected official must use grant money to give direct financial help to certain entities, so those entities can provide core medical services and support services. (2) That direct help can go to public or nonprofit private organizations. It can also go to for-profit private organizations, but only if they're the only provider of quality HIV care available in the area.

(c) Required funding for core medical services. (1) After setting aside money for two specific administrative purposes (under subsection (h)(1) and (h)(5)(B)(i)), the official must spend at least 75 percent of what's left on core medical services needed by people with HIV/AIDS^* who qualify under this subchapter, including care for related conditions. (2) Waiver: the Secretary must excuse an area from this 75-percent rule for a grant year if the Secretary finds that, in that area, there's no waiting list for AIDS^* Drug^* Assistance Program services (section 300ff–26), and core medical services are available to everyone who qualifies. When telling an official that a grant has been awarded, the Secretary must also say whether this waiver applies. (3) "Core medical services" means: outpatient and ambulatory health care; AIDS Drug Assistance Program treatments; AIDS pharmaceutical assistance; oral health care; early intervention services (defined in subsection (e)); help paying health insurance premiums and cost-sharing^* for low-income people (section 300ff–25); home health care; medical nutrition therapy; hospice care; home and community-based health services (defined in section 300ff–24(c)); mental health services; outpatient substance abuse care; and medical case management, including help staying on treatment^*.

(d) Support services. (1) "Support services" means services the Secretary approves that help people with HIV/AIDS reach good medical outcomes -- for example, respite care for caregivers, outreach, medical transportation, translation and interpreting, and referrals to health care and other support. (2) "Medical outcomes" means results that affect a person's HIV-related health status.

(e) Early intervention services. (1) "Early intervention services" means the HIV/AIDS early intervention services described in section 300ff–51(e), plus follow-up referrals to help people reach HIV-related health care. These services can be offered through places like public health departments, emergency rooms, substance abuse and mental health programs, detox centers, jails, STD clinics, homeless shelters, HIV testing sites, health centers the area chooses, federally qualified health centers, and other referral-network entities under section 300ff–52(a). (2) An entity can only offer these services under paragraph (1) if it proves to the chief elected official that: (A) other federal, state^*, or local funding isn't enough to cover the early intervention services it wants to provide; and (B) it will use this grant money to add to, not replace, its other funding for early intervention services that year.

(f) Priority for women, infants, children, and youth. (1) The chief elected official must spend a minimum share of the area's grant money on health and support services -- including care to prevent mothers from passing HIV to their babies -- for infants, children, youth, and women with HIV/AIDS. That minimum share must follow the planning council's priorities, and for each group, must be at least equal to that group's share of all people with HIV/AIDS in the area. (2) Waiver: the Secretary can excuse an official from this requirement for a given group if the official shows that the group is already getting HIV-related care through Medicaid, the Children's Health Insurance Program, or other federal or state programs.

(g) Requirement of status as medicaid provider. (1) Unless paragraph (2)'s waiver applies, the Secretary can't fund services under this section in a state if those services are covered by the state's Medicaid plan, unless: (A) the political subdivision provides the service^* itself and has its own Medicaid provider agreement; or (B) the subdivision arranges for a public or nonprofit entity to provide the service, and that entity has its own Medicaid provider agreement. (2) Waiver: the local HIV health services planning council must waive this requirement for an entity under (1)(B) if the entity doesn't charge patients or accept payment from any third-party payer, including insurance or federal/state health programs. Whether the entity accepts voluntary donations from the public doesn't affect this determination.

(h) Administration. (1) The chief elected official can't spend more than 10 percent of the grant on administrative costs. (2) When the official passes money on to other entities and subcontractors, the official must make sure that, overall, those entities don't spend more than 10 percent combined on administration -- even though some individual entities might spend more than 10 percent. (3) Allowed administrative activities include: (A) routine grant management -- applying for funds, receiving and paying out money, building accounting systems, running the clinical quality program in paragraph (5), writing required reports, and meeting audit rules; and (B) contracting activities -- running the planning council under section 300ff–12(b), writing requests for proposals, reviewing bids, negotiating and awarding contracts, monitoring contracts, reporting on them, and reallocating funds. (4) For subcontractors, administrative activities include: (A) normal overhead, using an agency's standard indirect cost rate; (B) overseeing specific funded programs; and (C) other program support like quality assurance and quality control. (5) Clinical quality management: (A) the official must set up a program to check whether the HIV care funded by the grant follows the latest Public Health Service treatment guidelines, and to improve care where it falls short. (B) The official can spend on this program up to the lesser of 5 percent of the grant or $3,000,000 -- and this spending doesn't count toward the 10-percent administrative cap in paragraph (1).

(i) Construction. Grant money can't be used to buy or improve land; to buy, build, or substantially remodel any building (minor remodeling is okay); or to make cash payments directly to people receiving services.