110 STAT. 1370 PUBLIC LAW 104-146—MAY 20, 1996 "(b) CAUSES OF PERINATAL TRANSMISSION.— In determining the rate under subsection (a), a State shall also determine the possible causes of perinatal transmission. Such causes may include— "(1) the inadequate provision within the State of prenatal counseling and testing in accordance with the guidelines issued by the Centers for Disease Control and Prevention; "(2) the inadequate provision or utilization within the State of appropriate therapy or failure of such therapy to reduce perinatal transmission of HIV, including— "(A) that therapy is not available, accessible or offered to mothers; or "(B) that available therapy is offered but not accepted by mothers; or "(3) other factors (which may include the lack of prenatal care) determined relevant by the State. "(c) CDC REPORTING SYSTEM. — Not later than 4 months after the date of enactment of this subpart, the Director of the Centers for Disease Control and Prevention shall develop and implement a system to be used by States to comply with the requirements Gmdelines. of subsections (a) and (b). The Director shall issue guidelines to ensure that the data collected is statistically valid. Federal Register, "(d) DETERMINATION BY SECRETARY.— Not later than 180 days publication. after the expiration of the 18-month period beginning on the date on which the system is implemented under subsection (c), the Secretary shall publish in the Federal Register a determination of whether it has become a routine practice in the provision of health care in the United States to carry out each of the activities described in paragraphs (1) through (5) of section 2627. In making the determination, the Secretary shall consult with the States and with other public or private entities that have knowledge or expertise relevant to the determination. " (e) CONTINGENT APPLICABILITY.— "(1) IN GENERAL.— If the determination published in the Federal Register under subsection (d) is that (for purposes of such subsection) the activities involved have become routine practices, paragraph (2) shall apply on and after the expiration of the 18-month period beginning on the date on which the determination is so published. "(2) REQUIREMENT. — Subject to subsection (f), the Secretary shall not make a grant under part B to a State unless the State meets not less than one of the following requirements: "(A) A 50 percent reduction (or a comparable measure for States with less than 10 cases) in the rate of new cases of AIDS (recognizing that AIDS is a suboptimal proxy for tracking HIV in infants and was selected because such data is universally available) as a result of perinatal transmission as compared to the rate of such cases reported in 1993 (a State may use HIV data if such data is available). "(B) At least 95 percent of women in the State who have received at least two prenatal visits (consultations) prior to 34 weeks gestation with a health care provider or provider group have been tested for the human immunodeficiency virus. "(C) The State has in effect, in statute or through regulations, the requirements specified in paragraphs (1) through (5) of section 2627.