42 U.S.C. § 300ff–64 — Additional required agreements

(a) Reports to Secretary — Before getting a grant, an applicant must give the Secretary: what it spent on early intervention services the year before; an estimate of how many people it served; how the grant's planned spending fits the Part A and Part B planning processes (including the section 300ff–12 and 300ff–27(b) processes); and how the expected spending will improve overall client outcomes as described in the State plan. The applicant must also agree to later report: the number of people it serves with early intervention services under the grant; epidemiological and demographic data on that population; how much of their HIV-related care costs are covered by third-party payors; the average cost of each category of early intervention service; and the total amounts spent per category. It must also agree to provide documentation on how it gathered community input on the grant's design and implementation, and to send the State's lead agency (under section 300ff–27(b)(4)) audits every two years, following Office of Management and Budget circular A-133, including client-level data needed for unmet-need calculations and the statewide coordinated statement of need process. (b) Provision of opportunities for anonymous counseling and testing — Where State law allows, a grantee must agree to offer substantial opportunities for someone to get HIV/AIDS counseling and testing without providing any identifying information, including through use of a pseudonym. (c) Prohibition against requiring testing as condition of receiving other health services — A grantee must agree not to require someone seeking other health services to undergo HIV testing first, unless the test is medically indicated for the health services being sought. (d) Maintenance of support — A grantee must agree to keep its own spending on early intervention services at a level at least equal to what it spent the year before. (e) Requirements regarding imposition of charges for services — A grantee must agree not to charge anyone with income at or below the federal poverty line for early intervention services under the grant. For people above the poverty line, the grantee must charge them, using a fee schedule made available to the public, but the charges are capped: no more than 5 percent of a person's annual gross income in a calendar year for those between 100 and 200 percent of the poverty line; no more than 7 percent for those between 200 and 300 percent; and no more than 10 percent for those above 300 percent. Within those caps, the grantee may set the actual amount charged itself — even just a nominal charge — and may take a patient's medical expenses into account. These caps apply to the total of all charges in a year, regardless of whether they are called enrollment fees, premiums, deductibles, copayments, coinsurance, or similar charges. This whole charging requirement is waived for any entity already granted a waiver under section 300ff–52(b)(2) — those that do not bill anyone. (f) Relationship to items and services under other programs — A grantee, and any entity it funds to provide early intervention services, generally cannot use the grant to pay for a service if payment for it already has been, or reasonably can be expected to be, made under a State compensation program, an insurance policy, a federal or state health benefits program (other than an Indian Health Service program), or a prepaid health plan. This rule does not apply to an entity the Secretary has waived under section 300ff–52(b)(2). (g) Administration of grant — A grantee must agree to: spend the money only for the purposes of the subpart the grant was made under; keep fiscal-control and accounting procedures adequate to ensure proper disbursement and accounting; keep administrative spending, including planning and evaluation, under 10 percent of the grant — not counting the clinical quality management program described below; show that its program is consistent with the statewide coordinated statement of need and take part in updating that statement; and run a clinical quality management program that assesses whether the medical services it funds match the most recent federal HIV/AIDS treatment guidelines, works to fix any gaps, and helps improve access to and quality of HIV health services.