---
kind: "section"
citation: "42 U.S.C. § 300ff–14"
title: "42"
title_heading: "The Public Health and Welfare"
number: "300ff–14"
heading: "Use of amounts"
release: "119-102"
url: "https://uscodex.org/usc/42/300ff-14"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter XXIV — Hiv Health Care Services Program"
  - "Part A — Emergency Relief for Areas With Substantial Need for Services"
  - "Subpart i — general grant provisions"
---

# §300ff–14. Use of amounts

- (a) **Requirements—** The [Secretary](/usc/42/201.md?p=c) may not make a grant under [section 300ff–11(a) of this title](/usc/42/300ff–11.md?p=a) to the chief elected official of an [eligible area](/usc/42/300ff–17.md?p=1) unless such political subdivision agrees that—
  - (1) subject to [paragraph (2)](#a-2), the [allocation](/usc/42/2021b.md?p=2) of [funds](/usc/42/12854.md?p=3) and [services](/usc/42/201.md?p=a) within the [eligible area](/usc/42/300ff–17.md?p=1) will be made in accordance with the priorities established, pursuant to [section 300ff–12(b)(4)(C) of this title](/usc/42/300ff–12.md?p=b-4-C), by the [HIV](/usc/42/300ff–88.md?p=6) health [services](/usc/42/201.md?p=a) planning [council](/usc/42/300f.md?p=9) that serves such [eligible area](/usc/42/300ff–17.md?p=1);
  - (2) [funds](/usc/42/12854.md?p=3) provided under [section 300ff–11 of this title](/usc/42/300ff–11.md) will be expended only for—
    - (A) core medical services described in [subsection (c)](#c);
    - (B) [support services](#d-1) described in [subsection (d)](#d); and
    - (C) administrative expenses described in [subsection (h)](#h); and
  - (3) the use of such [funds](/usc/42/12854.md?p=3) will comply with the requirements of this section.
- (b) **Direct financial assistance to appropriate entities—**
  - (1) **In general—** The chief elected official of an [eligible area](/usc/42/300ff–17.md?p=1) shall use amounts from a grant under [section 300ff–11 of this title](/usc/42/300ff–11.md) to provide direct financial assistance to entities described in [paragraph (2)](#b-2) for the purpose of providing core medical services and [support services](#d-1).
  - (2) **Appropriate entities—** Direct financial assistance may be provided under [paragraph (1)](#b-1) to public or nonprofit [private entities](/usc/42/12181.md?p=6), or private for-profit entities if such entities are the only available provider of quality [HIV](/usc/42/300ff–88.md?p=6) care in the area.
- (c) **Required funding for core medical services—**
  - (1) **In general—** With respect to a grant under [section 300ff–11 of this title](/usc/42/300ff–11.md) for an [eligible area](/usc/42/300ff–17.md?p=1) for a grant year, the chief elected official of the area shall, of the portion of the grant remaining after reserving amounts for purposes of paragraphs [(1)](#h-1) and [(5)(B)(i)](#h-5-B-i) of subsection (h), use not less than 75 percent to provide [core medical services](#c-3) that are needed in the [eligible area](/usc/42/300ff–17.md?p=1) for individuals with [HIV/AIDS](/usc/42/300ff–88.md?p=7-A) who are identified and eligible under this subchapter (including [services](/usc/42/201.md?p=a) regarding the [co-occurring conditions](/usc/42/300ff–88.md?p=2) of the individuals).
  - (2) **Waiver—**
    - (A) **In general—** The [Secretary](/usc/42/201.md?p=c) shall waive the application of [paragraph (1)](#c-1) with respect to a chief elected official for a grant year if the [Secretary](/usc/42/201.md?p=c) determines that, within the [eligible area](/usc/42/300ff–17.md?p=1) involved—
      - (i) there are no waiting lists for [AIDS](/usc/42/300ff–88.md?p=1) [Drug](/usc/42/282.md?p=j-1-A-vii) Assistance [Program](/usc/42/274l–1.md?p=4) [services](/usc/42/201.md?p=a) under [section 300ff–26 of this title](/usc/42/300ff–26.md); and
      - (ii) [core medical services](#c-3) are available to all individuals with [HIV/AIDS](/usc/42/300ff–88.md?p=7-A) identified and eligible under this subchapter.
    - (B) **Notification of waiver status—** When informing the chief elected official of an [eligible area](/usc/42/300ff–17.md?p=1) that a grant under [section 300ff–11 of this title](/usc/42/300ff–11.md) is being made for the area for a grant year, the [Secretary](/usc/42/201.md?p=c) shall inform the official whether a waiver under [subparagraph (A)](#c-2-A) is in effect for such year.
  - (3) **Core medical services—** For purposes of this subsection, the term “core medical services”, with respect to an individual with [HIV/AIDS](/usc/42/300ff–88.md?p=7-A) (including the [co-occurring conditions](/usc/42/300ff–88.md?p=2) of the individual), means the following [services](/usc/42/201.md?p=a):
    - (A) Outpatient and ambulatory health [services](/usc/42/201.md?p=a).
    - (B) [AIDS](/usc/42/300ff–88.md?p=1) [Drug](/usc/42/282.md?p=j-1-A-vii) Assistance [Program](/usc/42/274l–1.md?p=4) [treatments](/usc/42/11851.md?p=11) in accordance with [section 300ff–26 of this title](/usc/42/300ff–26.md).
    - (C) [AIDS](/usc/42/300ff–88.md?p=1) pharmaceutical assistance.
    - (D) Oral health care.
    - (E) [Early intervention services](#e-1) described in [subsection (e)](#e).
    - (F) Health insurance premium and cost sharing assistance for low-[income](/usc/42/292s.md?p=c-4) individuals in accordance with [section 300ff–25 of this title](/usc/42/300ff–25.md).
    - (G) Home health care.
    - (H) Medical nutrition therapy.
    - (I) Hospice [services](/usc/42/201.md?p=a).
    - (J) Home and community-based health [services](/usc/42/201.md?p=a) as defined under [section 300ff–24(c) of this title](/usc/42/300ff–24.md?p=c).
    - (K) Mental health [services](/usc/42/201.md?p=a).
    - (L) Substance abuse outpatient care.
    - (M) Medical case management, including [treatment](/usc/42/11851.md?p=11) adherence [services](/usc/42/201.md?p=a).
- (d) **Support services—**
  - (1) **In general—** For purposes of this section, the term “support services” means [services](/usc/42/201.md?p=a), subject to the approval of the [Secretary](/usc/42/201.md?p=c), that are needed for individuals with [HIV/AIDS](/usc/42/300ff–88.md?p=7-A) to achieve their [medical outcomes](#d-2) (such as respite care for [persons](/usc/42/300ff–88.md?p=10) caring for individuals with [HIV/AIDS](/usc/42/300ff–88.md?p=7-A), outreach [services](/usc/42/201.md?p=a), medical transportation, linguistic [services](/usc/42/201.md?p=a), and referrals for health care and support services).
  - (2) **Medical outcomes—** In this subsection, the term “medical outcomes” means those outcomes affecting the [HIV](/usc/42/300ff–88.md?p=6)-related clinical status of an individual with [HIV/AIDS](/usc/42/300ff–88.md?p=7-A).
- (e) **Early intervention services—**
  - (1) **In general—** For purposes of this section, the term “early intervention services” means [HIV/AIDS](/usc/42/300ff–88.md?p=7-A) early intervention services described in [section 300ff–51(e) of this title](/usc/42/300ff–51.md?p=e), with follow-up referral provided for the purpose of facilitating the access of individuals receiving the [services](/usc/42/201.md?p=a) to [HIV](/usc/42/300ff–88.md?p=6)-related health [services](/usc/42/201.md?p=a). The entities through which such [services](/usc/42/201.md?p=a) may be provided under the grant include public health departments, emergency rooms, substance abuse and mental health [treatment](/usc/42/11851.md?p=11) [programs](/usc/42/274l–1.md?p=4), detoxification centers, detention [facilities](/usc/42/11049.md?p=4), clinics regarding sexually transmitted diseases, homeless shelters, [HIV/AIDS](/usc/42/300ff–88.md?p=7-A) [counseling](/usc/42/300ff–88.md?p=3) and testing sites, health care points of entry specified by [eligible areas](/usc/42/300ff–17.md?p=1), [federally qualified health centers](/usc/42/254c.md?p=b-2), and entities described in [section 300ff–52(a) of this title](/usc/42/300ff–52.md?p=a) that constitute a point of access to [services](/usc/42/201.md?p=a) by maintaining referral relationships.
  - (2) **Conditions—** With respect to an entity that proposes to provide [early intervention services](#e-1) under [paragraph (1)](#e-1), such paragraph shall apply only if the entity demonstrates to the satisfaction of the chief elected official for the [eligible area](/usc/42/300ff–17.md?p=1) involved that—
    - (A) Federal, [State](/usc/42/300ff–88.md?p=11-A), or local [funds](/usc/42/12854.md?p=3) are otherwise inadequate for the [early intervention services](#e-1) the entity proposes to provide; and
    - (B) the entity will expend [funds](/usc/42/12854.md?p=3) pursuant to such paragraph to supplement and not supplant other [funds](/usc/42/12854.md?p=3) available to the entity for the provision of [early intervention services](#e-1) for the fiscal year involved.
- (f) **Priority for women, infants, children, and youth—**
  - (1) **In general—** For the purpose of providing health and [support services](#d-1) to infants, [children](/usc/42/256e.md?p=g-2), youth, and women with [HIV/AIDS](/usc/42/300ff–88.md?p=7-A), including [treatment](/usc/42/11851.md?p=11) measures to prevent the perinatal transmission of [HIV](/usc/42/300ff–88.md?p=6), the chief elected official of an [eligible area](/usc/42/300ff–17.md?p=1), in accordance with the established priorities of the planning [council](/usc/42/300f.md?p=9), shall for each of such populations in the [eligible area](/usc/42/300ff–17.md?p=1) use, from the grants made for the area under [section 300ff–11(a) of this title](/usc/42/300ff–11.md?p=a) for a fiscal year, not less than the percentage constituted by the ratio of the population involved (infants, [children](/usc/42/256e.md?p=g-2), youth, or women in such area) with [HIV/AIDS](/usc/42/300ff–88.md?p=7-A) to the general population in such area of individuals with [HIV/AIDS](/usc/42/300ff–88.md?p=7-A).
  - (2) **Waiver—** With respect to the population involved, the [Secretary](/usc/42/201.md?p=c) may provide to the chief elected official of an [eligible area](/usc/42/300ff–17.md?p=1) a waiver of the requirement of [paragraph (1)](#f-1) if such official demonstrates to the satisfaction of the [Secretary](/usc/42/201.md?p=c) that the population is receiving [HIV](/usc/42/300ff–88.md?p=6)-related health [services](/usc/42/201.md?p=a) through the [State](/usc/42/300ff–88.md?p=11-A) medicaid [program](/usc/42/274l–1.md?p=4) under title XIX of the Social Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.], the [State](/usc/42/300ff–88.md?p=11-A) [children](/usc/42/256e.md?p=g-2)’s health insurance [program](/usc/42/274l–1.md?p=4) under title XXI of such Act [[42 U.S.C. 1397aa](/usc/42/1397aa.md) et seq.], or other Federal or [State](/usc/42/300ff–88.md?p=11-A) [programs](/usc/42/274l–1.md?p=4).
- (g) **Requirement of status as medicaid provider—**
  - (1) **Provision of service—** Subject to [paragraph (2)](#g-2), the [Secretary](/usc/42/201.md?p=c) may not make a grant under [section 300ff–11(a) of this title](/usc/42/300ff–11.md?p=a) for the provision of [services](/usc/42/201.md?p=a) under this section in a [State](/usc/42/300ff–88.md?p=11-A) unless, in the case of any such [service](/usc/42/201.md?p=a) that is available pursuant to the [State](/usc/42/300ff–88.md?p=11-A) plan approved under title XIX of the Social Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.] for the [State](/usc/42/300ff–88.md?p=11-A)—
    - (A) the political subdivision involved will provide the [service](/usc/42/201.md?p=a) directly, and the political subdivision has entered into a participation [agreement](/usc/42/1320b–8.md?p=a-3-A) under the [State](/usc/42/300ff–88.md?p=11-A) plan and is qualified to receive payments under such plan; or
    - (B) the political subdivision will enter into an [agreement](/usc/42/1320b–8.md?p=a-3-A) with a public or nonprofit [private entity](/usc/42/12181.md?p=6) under which the entity will provide the [service](/usc/42/201.md?p=a), and the entity has entered into such a participation [agreement](/usc/42/1320b–8.md?p=a-3-A) and is qualified to receive such payments.
  - (2) **Waiver—**
    - (A) **In general—** In the case of an entity making an [agreement](/usc/42/1320b–8.md?p=a-3-A) pursuant to [paragraph (1)(B)](#g-1-B) regarding the provision of [services](/usc/42/201.md?p=a), the requirement established in such paragraph shall be waived by the [HIV](/usc/42/300ff–88.md?p=6) health [services](/usc/42/201.md?p=a) planning [council](/usc/42/300f.md?p=9) for the [eligible area](/usc/42/300ff–17.md?p=1) if the entity does not, in providing health care [services](/usc/42/201.md?p=a), impose a charge or accept reimbursement available from any third-party payor, including reimbursement under any insurance policy or under any Federal or [State](/usc/42/300ff–88.md?p=11-A) health benefits [program](/usc/42/274l–1.md?p=4).
    - (B) **Determination—** A determination by the [HIV](/usc/42/300ff–88.md?p=6) health [services](/usc/42/201.md?p=a) planning [council](/usc/42/300f.md?p=9) of whether an entity referred to in [subparagraph (A)](#g-2-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](/usc/42/201.md?p=a) to the public.
- (h) **Administration—**
  - (1) **Limitation—** The chief elected official of an [eligible area](/usc/42/300ff–17.md?p=1) shall not use in excess of 10 percent of amounts received under a grant under this subpart for administrative expenses.
  - (2) **Allocations by chief elected official—** In the case of entities and subcontractors to which the chief elected official of an [eligible area](/usc/42/300ff–17.md?p=1) allocates amounts received by the official under a grant under this subpart, the official 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).
  - (3) **Administrative activities—** For purposes of [paragraph (1)](#h-1), amounts may be used for administrative activities that include—
    - (A) routine grant administration and monitoring activities, including the development of applications for part A [funds](/usc/42/12854.md?p=3), the receipt and disbursal of [program](/usc/42/274l–1.md?p=4) [funds](/usc/42/12854.md?p=3), the development and establishment of reimbursement and accounting systems, the development of a clinical quality management [program](/usc/42/274l–1.md?p=4) as described in [paragraph (5)](#h-5), the preparation of routine programmatic and financial reports, and compliance with grant conditions and audit requirements; and
    - (B) all activities associated with the grantee’s contract award procedures, including the activities carried out by the [HIV](/usc/42/300ff–88.md?p=6) health [services](/usc/42/201.md?p=a) planning [council](/usc/42/300f.md?p=9) as established under [section 300ff–12(b) of this title](/usc/42/300ff–12.md?p=b), the development of requests for proposals, contract proposal review activities, negotiation and awarding of contracts, monitoring of contracts through telephone consultation, written documentation or onsite visits, reporting on contracts, and funding reallocation activities.
  - (4) **Subcontractor administrative activities—** For the purposes of this subsection, subcontractor administrative activities include—
    - (A) usual and recognized overhead activities, including established indirect rates for agencies;
    - (B) management oversight of specific [programs](/usc/42/274l–1.md?p=4) funded under this subchapter; and
    - (C) other types of [program](/usc/42/274l–1.md?p=4) support such as quality assurance, quality control, and related activities.
  - (5) **Clinical quality management—**
    - (A) **Requirement—** The chief elected official of an [eligible area](/usc/42/300ff–17.md?p=1) that receives a grant under this subpart shall provide for the establishment of a clinical quality management [program](/usc/42/274l–1.md?p=4) to assess the extent to which [HIV](/usc/42/300ff–88.md?p=6) health [services](/usc/42/201.md?p=a) provided to patients under the grant are consistent with the most recent Public Health [Service](/usc/42/201.md?p=a) guidelines for the [treatment](/usc/42/11851.md?p=11) of [HIV/AIDS](/usc/42/300ff–88.md?p=7-A) and related opportunistic infection, and as applicable, to develop strategies for ensuring that such [services](/usc/42/201.md?p=a) are consistent with the guidelines for improvement in the access to and quality of [HIV](/usc/42/300ff–88.md?p=6) health [services](/usc/42/201.md?p=a).
    - (B) **Use of funds—**
      - (i) **In general—** From amounts received under a grant awarded under this subpart for a fiscal year, the chief elected official of an [eligible area](/usc/42/300ff–17.md?p=1) may use for activities associated with the clinical quality management [program](/usc/42/274l–1.md?p=4) required in [subparagraph (A)](#h-5-A) not to exceed the lesser of—
        - (I) 5 percent of amounts received under the grant; or
        - (II) $3,000,000.
      - (ii) **Relation to limitation on administrative expenses—** The costs of a clinical quality management [program](/usc/42/274l–1.md?p=4) under [subparagraph (A)](#h-5-A) may not be considered administrative expenses for purposes of the limitation established in [paragraph (1)](#h-1).
- (i) **Construction—** A chief elected official may not use amounts received under a grant awarded under this subpart to purchase or improve land, or to purchase, construct, or permanently improve (other than minor remodeling) any [building](/usc/42/6881.md?p=i-3) or other [facility](/usc/42/11049.md?p=4), or to make cash payments to intended [recipients](/usc/42/2996a.md?p=6) of [services](/usc/42/201.md?p=a).

## Source credit

(July 1, 1944, ch. 373, title XXVI, § 2604, as added Pub. L. 101–381, title I, § 101(3), Aug. 18, 1990, 104 Stat. 580; amended Pub. L. 103–446, title XII, § 1203(a)(3), Nov. 2, 1994, 108 Stat. 4689; Pub. L. 104–146, § 3(b)(4), May 20, 1996, 110 Stat. 1351; Pub. L. 106–345, title I, § 121, Oct. 20, 2000, 114 Stat. 1326; Pub. L. 109–415, title I, §§ 105, 107(b), title VII, § 703, Dec. 19, 2006, 120 Stat. 2776, 2783, 2820; Pub. L. 111–87, § 2(a)(1), (3)(A), Oct. 30, 2009, 123 Stat. 2885.)

## Notes

### Editorial Notes

### References in Text

The Social Security Act, referred to in subsecs. (f)(2) and (g)(1), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XIX and XXI of the Act are classified generally to subchapters XIX (§ 1396 et seq.) and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

### Prior Provisions

A prior section 2604 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see section 238c of this title.

### Amendments

2009—Pub. L. 111–87 repealed Pub. L. 109–415, § 703, and revived the provisions of this section as in effect on Sept. 30, 2009. See 2006 Amendment note and Effective Date of 2009 Amendment; Revival of Section note below.

2006—Pub. L. 109–415, § 703, which directed repeal of this section effective Oct. 1, 2009, was itself repealed by Pub. L. 111–87, § 2(a)(1), effective Sept. 30, 2009.

Pub. L. 109–415, § 105, amended section generally. Prior to amendment, section related to requirements for allocation of funds, purposes for use of amounts, quality management program, expenditures for personnel, status of grantee as medicaid provider, administrative activities and expenses, and prohibited uses of amounts.

Subsecs. (h)(1), (2), (5)(A), (i). Pub. L. 109–415, § 107(b), substituted “this subpart” for “this part”.

2000—Subsec. (b)(1). Pub. L. 106–345, § 121(a)(1), substituted “HIV-related services, as follows:” for “HIV-related—” in introductory provisions.

Subsec. (b)(1)(A). Pub. L. 106–345, § 121(a)(2), substituted “Outpatient and ambulatory health services, including substance abuse treatment,” for “outpatient and ambulatory health and support services, including case management, substance abuse treatment and” and substituted a period for “; and” at end.

Subsec. (b)(1)(B). Pub. L. 106–345, § 121(a)(4), added subpar. (B). Former subpar. (B) redesignated (C).

Subsec. (b)(1)(C). Pub. L. 106–345, § 121(a)(3), redesignated subpar. (B) as (C) and substituted “Inpatient” for “inpatient”.

Subsec. (b)(1)(D). Pub. L. 106–345, § 121(a)(5), added subpar. (D).

Subsec. (b)(3). Pub. L. 106–345, § 121(b)(2), added par. (3). Former par. (3) redesignated (4).

Subsec. (b)(4). Pub. L. 106–345, § 121(b)(1), (c), redesignated par. (3) as (4) and amended heading and text of par. (4) generally. Prior to amendment, text read as follows: “For the purpose of providing health and support services to infants, children, and women with HIV disease, including treatment measures to prevent the perinatal transmission of HIV, the chief elected official of an eligible area, in accordance with the established priorities of the planning council, shall use, from the grants made for the area under section 300ff–11(a) of this title for a fiscal year, not less than the percentage constituted by the ratio of the population in such area of infants, children, and women with acquired immune deficiency syndrome to the general population in such area of individuals with such syndrome.”

Subsecs. (c) to (g). Pub. L. 106–345, § 121(d), added subsec. (c) and redesignated former subsecs. (c) to (f) as (d) to (g), respectively.

1996—Subsec. (b)(1)(A). Pub. L. 104–146, § 3(b)(4)(A), inserted “, substance abuse treatment and mental health treatment,” after “case management” and “which shall include treatment education and prophylactic treatment for opportunistic infections,” after “treatment services,”.

Subsec. (b)(2)(A). Pub. L. 104–146, § 3(b)(4)(B), inserted “, or private for-profit entities if such entities are the only available provider of quality HIV care in the area,” after “nonprofit private entities,” and substituted “homeless health centers, substance abuse treatment programs, and mental health programs” for “and homeless health centers”.

Subsec. (b)(3). Pub. L. 104–146, § 3(b)(4)(C), added par. (3).

Subsec. (e). Pub. L. 104–146, § 3(b)(4)(C), struck out “and planning” after “Administration” in heading, designated existing provisions as par. (1), inserted par. heading, struck out “accounting, reporting, and program oversight functions” after “for administration,”, inserted at end “In the case of entities and subcontractors to which such officer allocates amounts received by the officer under the grant, the officer 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).”, and added pars. (2) and (3).

1994—Subsec. (b)(2)(A). Pub. L. 103–446 substituted “Department of Veterans Affairs facilities” for “Veterans Administration facilities”.

### Statutory Notes and Related Subsidiaries

### Effective Date of 2009 Amendment; Revival of Section

For provisions that repeal by section 2(a)(1) of Pub. L. 111–87 of section 703 of Pub. L. 109–415 be effective Sept. 30, 2009, and that the provisions of this section as in effect on Sept. 30, 2009, be revived, see section 2(a)(2), (3)(A) of Pub. L. 111–87, set out as a note under section 300ff–11 of this title.

### 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.