PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2767

Public Law 109–415

109th Congress

An Act

To amend title XXVI of the Public Health Service Act to revise and extend the

program for providing life-saving care for those with HIV/AIDS.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) SHORT TITLE.—This Act may be cited as the ‘‘Ryan White

HIV/AIDS Treatment Modernization Act of 2006’’.

(b) TABLE OF CONTENTS.—The table of contents of this Act

is as follows:

Sec. 1. Short title; table of contents.

TITLE I—EMERGENCY RELIEF FOR ELIGIBLE AREAS

Sec. 101. Establishment of program; general eligibility for grants.

Sec. 102. Type and distribution of grants; formula grants.

Sec. 103. Type and distribution of grants; supplemental grants.

Sec. 104. Timeframe for obligation and expenditure of grant funds.

Sec. 105. Use of amounts.

Sec. 106. Additional amendments to part A.

Sec. 107. New program in part A; transitional grants for certain areas ineligible

under section 2601.

Sec. 108. Authorization of appropriations for part A.

TITLE II—CARE GRANTS

Sec. 201. General use of grants.

Sec. 202. AIDS Drug Assistance Program.

Sec. 203. Distribution of funds.

Sec. 204. Additional amendments to subpart I of part B.

Sec. 205. Supplemental grants on basis of demonstrated need.

Sec. 206. Emerging communities.

Sec. 207. Timeframe for obligation and expenditure of grant funds.

Sec. 208. Authorization of appropriations for subpart I of part B.

Sec. 209. Early diagnosis grant program.

Sec. 210. Certain partner notification programs; authorization of appropriations.

TITLE III—EARLY INTERVENTION SERVICES

Sec. 301. Establishment of program; core medical services.

Sec. 302. Eligible entities; preferences; planning and development grants.

Sec. 303. Authorization of appropriations.

Sec. 304. Confidentiality and informed consent.

Sec. 305. Provision of certain counseling services.

Sec. 306. General provisions.

TITLE IV—WOMEN, INFANTS, CHILDREN, AND YOUTH

Sec. 401. Women, infants, children, and youth.

Sec. 402. GAO Report.

TITLE V—GENERAL PROVISIONS

Sec. 501. General provisions.

TITLE VI—DEMONSTRATION AND TRAINING

Sec. 601. Demonstration and training.

42 USC 201 note.

Ryan White HIV/

AIDS Treatment

Modernization

Act of 2006.

Dec. 19, 2006

[H.R. 6143]

120 STAT. 2768 PUBLIC LAW 109–415—DEC. 19, 2006

Sec. 602. AIDS education and training centers.

Sec. 603. Codification of minority AIDS initiative.

TITLE VII—MISCELLANEOUS PROVISIONS

Sec. 701. Hepatitis; use of funds.

Sec. 702. Certain references.

Sec. 703. Repeal.

TITLE I—EMERGENCY RELIEF FOR

ELIGIBLE AREAS

SEC. 101. ESTABLISHMENT OF PROGRAM; GENERAL ELIGIBILITY FOR

GRANTS.

(a) IN GENERAL.—Section 2601 of the Public Health Service

Act (42 U.S.C. 300ff–11) is amended by striking subsections (b)

through (d) and inserting the following:

‘‘(b) CONTINUED STATUS AS ELIGIBLE AREA.—Notwithstanding

any other provision of this section, a metropolitan area that is

an eligible area for a fiscal year continues to be an eligible area

until the metropolitan area fails, for three consecutive fiscal years—

‘‘(1) to meet the requirements of subsection (a); and

‘‘(2) to have a cumulative total of 3,000 or more living

cases of AIDS (reported to and confirmed by the Director of

the Centers for Disease Control and Prevention) as of December

31 of the most recent calendar year for which such data is

available.

‘‘(c) BOUNDARIES.—For purposes of determining eligibility under

this part—

‘‘(1) with respect to a metropolitan area that received

funding under this part in fiscal year 2006, the boundaries

of such metropolitan area shall be the boundaries that were

in effect for such area for fiscal year 1994; or

‘‘(2) with respect to a metropolitan area that becomes

eligible to receive funding under this part in any fiscal year

after fiscal year 2006, the boundaries of such metropolitan

area shall be the boundaries that are in effect for such area

when such area initially receives funding under this part.’’.

(b) TECHNICAL AND CONFORMING AMENDMENTS.—Section

2601(a) of the Public Health Service Act (42 U.S.C. 300ff–11(a))

is amended—

(1) by striking ‘‘through (d)’’ and inserting ‘‘through (c)’’;

and

(2) by inserting ‘‘and confirmed by’’ after ‘‘reported to’’.

(c) DEFINITION OF METROPOLITAN AREA.—Section 2607(2) of

the Public Health Service Act (42 U.S.C. 300ff–17(2)) is amended—

(1) by striking ‘‘area referred’’ and inserting ‘‘area that

is referred’’; and

(2) by inserting before the period the following: ‘‘, and

that has a population of 50,000 or more individuals’’.

SEC. 102. TYPE AND DISTRIBUTION OF GRANTS; FORMULA GRANTS.

(a) DISTRIBUTION PERCENTAGES.—Section 2603(a)(2) of the

Public Health Service Act (42 U.S.C. 300ff–13(a)(2)) is amended—

(1) in the first sentence—

(A) by striking ‘‘50 percent of the amount appropriated

under section 2677’’ and inserting ‘‘662⁄3 percent of the

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2769

amount made available under section 2610(b) for carrying

out this subpart’’; and

(B) by striking ‘‘paragraph (3)’’ and inserting ‘‘paragraphs (3) and (4)’’.

(2) by striking the last sentence.

(b) DISTRIBUTION BASED ON LIVING CASES OF HIV/AIDS.—Section 2603(a)(3) of the Public Health Service Act (42 U.S.C. 300ff–

13(a)(3)) is amended—

(1) in subparagraph (B), by striking ‘‘estimated living cases

of acquired immune deficiency syndrome’’ and inserting ‘‘living

cases of HIV/AIDS (reported to and confirmed by the Director

of the Centers for Disease Control and Prevention)’’; and

(2) by striking subparagraphs (C) through (E) and inserting

the following:

‘‘(C) LIVING CASES OF HIV/AIDS.— ‘‘(i) REQUIREMENT OF NAMES-BASED REPORTING.— Except as provided in clause (ii), the number determined under this subparagraph for an eligible area

for a fiscal year for purposes of subparagraph (B) is

the number of living names-based cases of HIV/AIDS

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 2009, an eligible area is, subject to clauses

(iii) through (v), exempt from the requirement under

clause (i) that living names-based non-AIDS 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 in which the area is located,

subject to clause (viii); or

‘‘(II) no later than the beginning of fiscal year

2008 or 2009, the Secretary, in consultation with

the chief executive of the State in which the area

is located, 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 an eligible area applies only if, by October

1, 2006—

‘‘(I)(aa) the State in which the area is located

had submitted to the Secretary a plan for making

the transition to sufficiently accurate and reliable

names-based reporting of living non-AIDS cases

of HIV; or

‘‘(bb) all statutory changes necessary to provide for sufficiently accurate and reliable reporting

of such cases had been made; and

‘‘(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

Applicability.

Deadline.

Deadline.

120 STAT. 2770 PUBLIC LAW 109–415—DEC. 19, 2006

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

2010, an exemption under clause (ii) for an eligible

area applies only if, as of April 1, 2008, the State

in which the area is located is substantially in compliance with the agreement under clause (iii)(II).

‘‘(v) PROGRESS TOWARD NAMES-BASED REPORTING.— For fiscal year 2009, the Secretary may terminate an

exemption under clause (ii) for an eligible area if the

State in which the area is located 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 an eligible

area 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 eligible area 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 an eligible area shall be

a reduction of 5 percent in the number of living

non-AIDS cases of HIV reported for the area.

‘‘(vii) MULTIPLE POLITICAL JURISDICTIONS.—With

respect to living non-AIDS cases of HIV, if an eligible

area is not entirely within one political jurisdiction

and as a result is subject to more than one reporting

system for purposes of this subparagraph:

‘‘(I) Names-based reporting under clause (i)

applies in a jurisdictional portion of the area, or

an exemption under clause (ii) applies in such

portion (subject to applicable provisions of this

subparagraph), according to whether names-based

reporting or code-based reporting is used in such

portion.

‘‘(II) If under subclause (I) both names-based

reporting and code-based reporting apply in the

area, the number of code-based cases shall be

reduced under clause (vi).

‘‘(viii) LIST OF ELIGIBLE AREAS MEETING STANDARD

REGARDING DECEMBER 31, 2005.—

‘‘(I) IN GENERAL.—If an eligible area or portion

thereof is in a State specified in subclause (II),

the eligible area or portion shall be considered

to meet the standard described in clause (ii)(I).

No other eligible area or portion thereof may be

considered to meet such standard.

‘‘(II) RELEVANT STATES.—For purposes of subclause (I), the States specified in this subclause

Applicability.

Applicability.

Deadline.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2771

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.

‘‘(ix) RULES OF CONSTRUCTION REGARDING ACCEPTANCE OF REPORTS.—

‘‘(I) CASES OF AIDS.—With respect to an eligible

area 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 (viii)

may not be construed as having any legal effect

for fiscal year 2010 or any subsequent fiscal year,

and accordingly, the status of a State for purposes

of such clauses may not be considered after fiscal

year 2009.

‘‘(x) PROGRAM FOR DETECTING INACCURATE OR

FRAUDULENT COUNTING.—The Secretary shall carry out

a program to monitor the reporting of names-based

cases for purposes of this subparagraph and to detect

instances of inaccurate reporting, including fraudulent

reporting.’’.

(c) CODE-BASED AREAS; LIMITATION ON INCREASE IN GRANT.—

Section 2603(a)(3) of the Public Health Service Act (42 U.S.C.

300ff–13(a)), as amended by subsection (b)(2) of this section, is

amended by adding at the end the following subparagraph:

‘‘(D) CODE-BASED AREAS; LIMITATION ON INCREASE IN

GRANT .—

‘‘(i) IN GENERAL.—For each of the fiscal years 2007

through 2009, if code-based reporting (within the

meaning of subparagraph (C)(vi)) applies in an eligible

area or any portion thereof as of the beginning of

the fiscal year involved, then notwithstanding any

other provision of this paragraph, the amount of the

grant pursuant to this paragraph for such area for

such fiscal year may not—

‘‘(I) for fiscal year 2007, exceed by more than

5 percent the amount of the grant for the area

that would have been made pursuant to this paragraph and paragraph (4) for fiscal year 2006 (as

such paragraphs were in effect for such fiscal year)

if paragraph (2) (as so in effect) had been applied

by substituting ‘662⁄3 percent’ for ‘50 percent’; and

‘‘(II) for each of the fiscal years 2008 and 2009,

exceed by more than 5 percent the amount of

the grant pursuant to this paragraph and paragraph (4) for the area for the preceding fiscal year.

Applicability.

120 STAT. 2772 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(ii) USE OF AMOUNTS INVOLVED.—For each of the

fiscal years 2007 through 2009, 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 subsection (b) for the fiscal

year involved, subject to paragraph (4) and section

2610(d)(2).’’.

(d) HOLD HARMLESS.—Section 2603(a) of the Public Health

Service Act (42 U.S.C. 300ff–13(a)) is amended—

(1) in paragraph (3)(A)—

(A) in clause (ii), by striking the period at the end

and inserting a semicolon; and

(B) by inserting after and below clause (ii) the following:

‘‘which product shall then, as applicable, be increased under

paragraph (4).’’.

(2) by amending paragraph (4) to read as follows:

‘‘(4) INCREASES IN GRANT.—

‘‘(A) IN GENERAL.—For each eligible area that received

a grant pursuant to this subsection for fiscal year 2006,

the Secretary shall, for each of the fiscal years 2007 through

2009, increase the amount of the grant made pursuant

to paragraph (3) for the area to ensure that the amount

of the grant for the fiscal year involved is not less than

the following amount, as applicable to such fiscal year:

‘‘(i) For fiscal year 2007, an amount equal to 95

percent of the amount of the grant that would have

been made pursuant to paragraph (3) and this paragraph for fiscal year 2006 (as such paragraphs were

in effect for such fiscal year) if paragraph (2) (as so

in effect) had been applied by substituting ‘662⁄3 percent’ for ‘50 percent’.

‘‘(ii) For each of the fiscal years 2008 and 2009,

an amount equal to 100 percent of the amount of

the grant made pursuant to paragraph (3) and this

paragraph for fiscal year 2007.

‘‘(B) SOURCE OF FUNDS FOR INCREASE.—

‘‘(i) IN GENERAL.—From the amounts available for

carrying out the single program referred to in section

2609(d)(2)(C) for a fiscal year (relating to supplemental

grants), the Secretary shall make available such

amounts as may be necessary to comply with subparagraph (A), subject to section 2610(d)(2).

‘‘(ii) PRO RATA REDUCTION.—If the amounts

referred to in clause (i) for a fiscal year are insufficient

to fully comply with subparagraph (A) 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 this

subsection for the fiscal year, other than grants for

eligible areas for which increases under subparagraph

(A) apply. A reduction under the preceding sentence

may not be made in an amount that would result

in the eligible area involved becoming eligible for such

an increase.

‘‘(C) LIMITATION.—This paragraph may not be construed as having any applicability after fiscal year 2009.’’.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2773

SEC. 103. TYPE AND DISTRIBUTION OF GRANTS; SUPPLEMENTAL

GRANTS.

Section 2603(b) of the Public Health Service Act (42 U.S.C.

300ff–13(b)) is amended—

(1) in paragraph (1)—

(A) in the matter preceding subparagraph (A), by

striking ‘‘Not later than’’ and all that follows through ‘‘the

Secretary shall’’ and inserting the following: ‘‘Subject to

subsection (a)(4)(B)(i) and section 2610(d), the Secretary

shall’’;

(B) in subparagraph (B), by striking ‘‘demonstrates

the severe need in such area’’ and inserting ‘‘demonstrates

the need in such area, on an objective and quantified

basis,’’;

(C) by striking subparagraph (F) and inserting the

following:

‘‘(F) demonstrates the inclusiveness of affected communities and individuals with HIV/AIDS;’’;

(D) in subparagraph (G), by striking the period and

inserting ‘‘; and’’; and

(E) by adding at the end the following:

‘‘(H) demonstrates the ability of the applicant to expend

funds efficiently by not having had, for the most recent

grant year under subsection (a) for which data is available,

more than 2 percent of grant funds under such subsection

canceled or covered by any waivers under subsection

(c)(3).’’; and

(2) in paragraph (2)—

(A) in subparagraph (A), by striking ‘‘severe need’’ and

inserting ‘‘demonstrated need’’;

(B) by striking subparagraph (B) and inserting the

following:

‘‘(B) DEMONSTRATED NEED.—The factors considered by

the Secretary in determining whether an eligible area has

a demonstrated need for purposes of paragraph (1)(B) may

include any or all of the following:

‘‘(i) The unmet need for such services, as determined under section 2602(b)(4) or other community

input process as defined under section 2609(d)(1)(A).

‘‘(ii) An increasing need for HIV/AIDS-related services, including relative rates of increase in the number

of cases of HIV/AIDS.

‘‘(iii) The relative rates of increase in the number

of cases of HIV/AIDS within new or emerging subpopulations.

‘‘(iv) The current prevalence of HIV/AIDS.

‘‘(v) Relevant factors related to the cost and complexity of delivering health care to individuals with

HIV/AIDS in the eligible area.

‘‘(vi) The impact of co-morbid factors, including

co-occurring conditions, determined relevant by the

Secretary.

‘‘(vii) The prevalence of homelessness.

‘‘(viii) The prevalence of individuals described

under section 2602(b)(2)(M).

120 STAT. 2774 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(ix) The relevant factors that limit access to health

care, including geographic variation, adequacy of

health insurance coverage, and language barriers.

‘‘(x) The impact of a decline in the amount received

pursuant to subsection (a) on services available to all

individuals with HIV/AIDS identified and eligible

under this title.’’; and

(C) by striking subparagraphs (C) and (D) and inserting

the following:

‘‘(C) PRIORITY IN MAKING GRANTS.—The Secretary shall

provide funds under this subsection to an eligible area

to address the decline or disruption of all EMA-provided

services related to the decline in the amounts received

pursuant to subsection (a) consistent with the grant award

for the eligible area for fiscal year 2006, to the extent

that the factor under subparagraph (B)(x) (relating to a

decline in funding) applies to the eligible area.’’.

SEC. 104. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT

FUNDS.

Section 2603 of the Public Health Service Act (42 U.S.C. 300ff–

13) is amended—

(1) by redesignating subsection (c) as subsection (d);

(2) by inserting after subsection (b) the following:

‘‘(c) TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT

FUNDS.—

‘‘(1) OBLIGATION BY END OF GRANT YEAR.—Effective for

fiscal year 2007 and subsequent fiscal years, funds from a

grant award made pursuant to subsection (a) or (b) for a fiscal

year are available for obligation by the eligible area involved

through the end of the one-year period beginning on the date

in such fiscal year on which funds from the award first become

available to the area (referred to in this subsection as the

‘grant year for the award’), except as provided in paragraph

(3)(A).

‘‘(2) SUPPLEMENTAL GRANTS; CANCELLATION OF UNOBLIGATED BALANCE OF GRANT AWARD.—Effective for fiscal year

2007 and subsequent fiscal years, if a grant award made pursuant to subsection (b) for an eligible area for a fiscal year

has an unobligated balance as of the end of the grant year

for the award—

‘‘(A) the Secretary shall cancel that unobligated balance

of the award, and shall require the eligible area to return

any amounts from such balance that have been disbursed

to the area; and

‘‘(B) the funds involved shall be made available by

the Secretary as additional amounts for grants pursuant

to subsection (b) for the first fiscal year beginning after

the fiscal year in which the Secretary obtains the information necessary for determining that the balance is required

under subparagraph (A) to be canceled, except that the

availability of the funds for such grants is subject to subsection (a)(4) and section 2610(d)(2) as applied for such

year.

‘‘(3) FORMULA GRANTS; CANCELLATION OF UNOBLIGATED BALANCE OF GRANT AWARD; WAIVER PERMITTING CARRYOVER.—

Effective dates.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2775

‘‘(A) IN GENERAL.—Effective for fiscal year 2007 and

subsequent fiscal years, if a grant award made pursuant

to subsection (a) for an eligible area for a fiscal year has

an unobligated balance as of the end of the grant year

for the award, the Secretary shall cancel that unobligated

balance of the award, and shall require the eligible area

to return any amounts from such balance that have been

disbursed to the area, unless—

‘‘(i) before the end of the grant year, the chief

elected official of the area submits to the Secretary

a written application for a waiver of the cancellation,

which application includes a description of the purposes

for which the area intends to expend the funds

involved; and

‘‘(ii) the Secretary approves the waiver.

‘‘(B) EXPENDITURE BY END OF CARRYOVER YEAR.—With

respect to a waiver under subparagraph (A) that is

approved for a balance that is unobligated as of the end

of a grant year for an award:

‘‘(i) The unobligated funds are available for

expenditure by the eligible area involved for the oneyear period beginning upon the expiration of the grant

year (referred to in this subsection as the ‘carryover

year’).

‘‘(ii) If the funds are not expended by the end

of the carryover year, the Secretary shall cancel that

unexpended balance of the award, and shall require

the eligible area to return any amounts from such

balance that have been disbursed to the area.

‘‘(C) USE OF CANCELLED BALANCES.—In the case of

any balance of a grant award that is cancelled under

subparagraph (A) or (B)(ii), the grant funds involved shall

be made available by the Secretary as additional amounts

for grants pursuant to subsection (b) for the first fiscal

year beginning after the fiscal year in which the Secretary

obtains the information necessary for determining that the

balance is required under such subparagraph to be canceled, except that the availability of the funds for such

grants is subject to subsection (a)(4) and section 2610(d)(2)

as applied for such year.

‘‘(D) CORRESPONDING REDUCTION IN FUTURE GRANT.—

‘‘(i) IN GENERAL.—In the case of an eligible area

for which a balance from a grant award under subsection (a) is unobligated as of the end of the grant

year for the award—

‘‘(I) the Secretary shall reduce, by the same

amount as such unobligated balance, the amount

of the grant under such subsection for the first

fiscal year beginning after the fiscal year in which

the Secretary obtains the information necessary

for determining that such balance was unobligated

as of the end of the grant year (which requirement

for a reduction applies without regard to whether

a waiver under subparagraph (A) has been

approved with respect to such balance); and

120 STAT. 2776 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(II) the grant funds involved in such reduction

shall be made available by the Secretary as additional funds for grants pursuant to subsection (b)

for such first fiscal year, subject to subsection (a)(4)

and section 2610(d)(2);

except that this clause does not apply to the eligible

area if the amount of the unobligated balance was

2 percent or less.

‘‘(ii) RELATION TO INCREASES IN GRANT.—A reduction under clause (i) for an eligible area for a fiscal

year may not be taken into account in applying subsection (a)(4) with respect to the area for the subsequent fiscal year.’’; and

(3) by adding at the end the following:

‘‘(e) REPORT ON THE AWARDING OF SUPPLEMENTAL FUNDS.— Not later than 45 days after the awarding of supplemental funds

under this section, the Secretary shall submit to Congress a report

concerning such funds. Such report shall include information

detailing—

‘‘(1) the total amount of supplemental funds available under

this section for the year involved;

‘‘(2) the amount of supplemental funds used in accordance

with the hold harmless provisions of subsection (a)(4);

‘‘(3) the amount of supplemental funds disbursed pursuant

to subsection (b)(2)(C);

‘‘(4) the disbursement of the remainder of the supplemental

funds after taking into account the uses described in paragraphs

(2) and (3); and

‘‘(5) the rationale used for the amount of funds disbursed

as described under paragraphs (2), (3), and (4).’’.

SEC. 105. USE OF AMOUNTS.

Section 2604 of the Public Health Service Act (42 U.S.C. 300ff–

14) is amended to read as follows:

‘‘SEC. 2604. USE OF AMOUNTS.

‘‘(a) REQUIREMENTS.—The Secretary may not make a grant

under section 2601(a) to the chief elected official of an eligible

area unless such political subdivision agrees that—

‘‘(1) subject to paragraph (2), the allocation of funds and

services within the eligible area will be made in accordance

with the priorities established, pursuant to section

2602(b)(4)(C), by the HIV health services planning council that

serves such eligible area;

‘‘(2) funds provided under section 2601 will be expended

only for—

‘‘(A) core medical services described in subsection (c);

‘‘(B) support services described in subsection (d); and

‘‘(C) administrative expenses described in subsection

(h); and

‘‘(3) the use of such funds 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 shall use amounts from a grant under section 2601 to

provide direct financial assistance to entities described in paragraph (2) for the purpose of providing core medical services

and support services.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2777

‘‘(2) APPROPRIATE ENTITIES.—Direct financial assistance

may be provided under paragraph (1) to public or nonprofit

private entities, or private for-profit entities if such entities

are the only available provider of quality HIV care in the

area.

‘‘(c) REQUIRED FUNDING FOR CORE MEDICAL SERVICES.— ‘‘(1) IN GENERAL.—With respect to a grant under section

2601 for an eligible area 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) and

(5)(B)(i) of subsection (h), use not less than 75 percent to

provide core medical services that are needed in the eligible

area for individuals with HIV/AIDS who are identified and

eligible under this title (including services regarding the cooccurring conditions of the individuals).

‘‘(2) WAIVER.— ‘‘(A) IN GENERAL.—The Secretary shall waive the

application of paragraph (1) with respect to a chief elected

official for a grant year if the Secretary determines that,

within the eligible area involved—

‘‘(i) there are no waiting lists for AIDS Drug Assistance Program services under section 2616; and

‘‘(ii) core medical services are available to all

individuals with HIV/AIDS identified and eligible

under this title.

‘‘(B) NOTIFICATION OF WAIVER STATUS.—When

informing the chief elected official of an eligible area that

a grant under section 2601 is being made for the area

for a grant year, the Secretary shall inform the official

whether a waiver under subparagraph (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 (including the co-occurring conditions

of the individual), means the following services:

‘‘(A) Outpatient and ambulatory health services.

‘‘(B) AIDS Drug Assistance Program treatments in

accordance with section 2616.

‘‘(C) AIDS pharmaceutical assistance.

‘‘(D) Oral health care.

‘‘(E) Early intervention services described in subsection

(e).

‘‘(F) Health insurance premium and cost sharing assistance for low-income individuals in accordance with section

2615.

‘‘(G) Home health care.

‘‘(H) Medical nutrition therapy.

‘‘(I) Hospice services.

‘‘(J) Home and community-based health services as

defined under section 2614(c).

‘‘(K) Mental health services.

‘‘(L) Substance abuse outpatient care.

‘‘(M) Medical case management, including treatment

adherence services.

‘‘(d) SUPPORT SERVICES.— ‘‘(1) IN GENERAL.—For purposes of this section, the term

‘support services’ means services, subject to the approval of

120 STAT. 2778 PUBLIC LAW 109–415—DEC. 19, 2006

the Secretary, that are needed for individuals with HIV/AIDS

to achieve their medical outcomes (such as respite care for

persons caring for individuals with HIV/AIDS, outreach services, medical transportation, linguistic services, and referrals

for health care and support services).

‘‘(2) MEDICAL OUTCOMES.—In this subsection, the term

‘medical outcomes’ means those outcomes affecting the HIVrelated clinical status of an individual with HIV/AIDS.

‘‘(e) EARLY INTERVENTION SERVICES.— ‘‘(1) IN GENERAL.—For purposes of this section, the term

‘early intervention services’ means HIV/AIDS early intervention

services described in section 2651(e), with follow-up referral

provided for the purpose of facilitating the access of individuals

receiving the services to HIV-related health services. The entities through which such services may be provided under the

grant include public health departments, emergency rooms,

substance abuse and mental health treatment programs, detoxification centers, detention facilities, clinics regarding sexually

transmitted diseases, homeless shelters, HIV/AIDS counseling

and testing sites, health care points of entry specified by eligible

areas, federally qualified health centers, and entities described

in section 2652(a) that constitute a point of access to services

by maintaining referral relationships.

‘‘(2) CONDITIONS.—With respect to an entity that proposes

to provide early intervention services under paragraph (1), such

paragraph shall apply only if the entity demonstrates to the

satisfaction of the chief elected official for the eligible area

involved that—

‘‘(A) Federal, State, or local funds are otherwise inadequate for the early intervention services the entity proposes to provide; and

‘‘(B) the entity will expend funds pursuant to such

paragraph to supplement and not supplant other funds

available to the entity for the provision of early intervention

services 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 to infants, children, youth, and women with

HIV/AIDS, 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 for each of such populations in

the eligible area use, from the grants made for the area under

section 2601(a) for a fiscal year, not less than the percentage

constituted by the ratio of the population involved (infants,

children, youth, or women in such area) with HIV/AIDS to

the general population in such area of individuals with HIV/

AIDS.

‘‘(2) WAIVER.—With respect to the population involved, the

Secretary may provide to the chief elected official of an eligible

area a waiver of the requirement of paragraph (1) if such

official demonstrates to the satisfaction of the Secretary that

the population is receiving HIV-related health services through

the State medicaid program under title XIX of the Social Security Act, the State children’s health insurance program under

title XXI of such Act, or other Federal or State programs.

‘‘(g) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.—

Applicability.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2779

‘‘(1) PROVISION OF SERVICE.—Subject to paragraph (2), the

Secretary may not make a grant under section 2601(a) for

the provision of services under this section in a State unless,

in the case of any such service that is available pursuant

to the State plan approved under title XIX of the Social Security

Act for the State—

‘‘(A) the political subdivision involved will provide the

service directly, and the political subdivision has entered

into a participation agreement under the State plan and

is qualified to receive payments under such plan; or

‘‘(B) the political subdivision will enter into an agreement with a public or nonprofit private entity under which

the entity will provide the service, and the entity has

entered into such a participation agreement and is qualified

to receive such payments.

‘‘(2) WAIVER.— ‘‘(A) IN GENERAL.—In the case of an entity making

an agreement pursuant to paragraph (1)(B) regarding the

provision of services, the requirement established in such

paragraph shall be waived by the HIV health services

planning council for the eligible area if the entity does

not, in providing health care services, impose a charge

or accept reimbursement available from any third-party

payor, including reimbursement under any insurance policy

or under any Federal or State health benefits program.

‘‘(B) DETERMINATION.—A determination by the HIV

health services planning council of whether an entity

referred to in subparagraph (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 to the public.

‘‘(h) ADMINISTRATION.—

‘‘(1) LIMITATION.—The chief elected official of an eligible

area shall not use in excess of 10 percent of amounts received

under a grant under this part 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 allocates amounts received by the official

under a grant under this part, 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), 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, the receipt and disbursal of program funds,

the development and establishment of reimbursement and

accounting systems, the development of a clinical quality

management program as described in paragraph (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

Contracts.

120 STAT. 2780 PUBLIC LAW 109–415—DEC. 19, 2006

the HIV health services planning council as established

under section 2602(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 funded

under this title; and

‘‘(C) other types of program support such as quality

assurance, quality control, and related activities.

‘‘(5) CLINICAL QUALITY MANAGEMENT.— ‘‘(A) REQUIREMENT.—The chief elected official of an

eligible area that receives a grant under this part 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.

‘‘(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 may use

for activities associated with the clinical quality

management program required in subparagraph (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 under subparagraph (A) may not be considered administrative expenses for purposes of the limitation established in paragraph (1).

‘‘(i) CONSTRUCTION.—A chief elected official may not use

amounts received under a grant awarded under this part 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.’’.

SEC. 106. ADDITIONAL AMENDMENTS TO PART A.

(a) REPORTING OF CASES.—Section 2601(a) of the Public Health

Service Act (42 U.S.C. 300ff–11(a)) is amended by striking ‘‘for

the most recent period’’ and inserting ‘‘during the most recent

period’’.

(b) PLANNING COUNCIL REPRESENTATION.—Section

2602(b)(2)(G) of the Public Health Service Act (42 U.S.C. 300ff–

12(b)(2)(G)) is amended by inserting ‘‘, members of a Federally

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2781

recognized Indian tribe as represented in the population, individuals

co-infected with hepatitis B or C’’ after ‘‘disease’’.

(c) APPLICATION FOR GRANT.—

(1) PAYER OF LAST RESORT.—Section 2605(a)(6)(A) of the

Public Health Service Act (42 U.S.C. 300ff–15(a)(6)(A)) is

amended by inserting ‘‘(except for a program administered by

or providing the services of the Indian Health Service)’’ before

the semicolon.

(2) AUDITS.—Section 2605(a) of the Public Health Service

Act (42 U.S.C. 300ff–15(a)) is amended—

(A) in paragraph (8), by striking ‘‘and’’ at the end;

(B) in paragraph (9), by striking the period and

inserting ‘‘; and’’; and

(C) by adding at the end the following:

‘‘(10) that the chief elected official will submit to the lead

State agency under section 2617(b)(4), audits, consistent with

Office of Management and Budget circular A133, regarding

funds expended in accordance with this part every 2 years

and shall include necessary client-based data to compile unmet

need calculations and Statewide coordinated statements of need

process.’’.

(3) COORDINATION.—Section 2605(b) of the Public Health

Service Act (42 U.S.C. 300ff–15(b)) is amended—

(A) in paragraph (3), by striking ‘‘and’’ at the end;

(B) in paragraph (4), by striking the period and

inserting a semicolon; and

(C) by adding at the end the following:

‘‘(5) the manner in which the expected expenditures are

related to the planning process for States that receive funding

under part B (including the planning process described in section 2617(b)); and

‘‘(6) the expected expenditures and how those expenditures

will improve overall client outcomes, as described under the

State plan under section 2617(b), and through additional outcomes measures as identified by the HIV health services planning council under section 2602(b).’’.

SEC. 107. NEW PROGRAM IN PART A; TRANSITIONAL GRANTS FOR CERTAIN AREAS INELIGIBLE UNDER SECTION 2601.

(a) IN GENERAL.—Part A of title XXVI of the Public Health

Service Act (42 U.S.C. 300ff–11) is amended—

(1) by inserting after the part heading the following:

‘‘Subpart I—General Grant Provisions’’; and

(2) by adding at the end the following:

‘‘Subpart II—Transitional Grants

‘‘SEC. 2609. ESTABLISHMENT OF PROGRAM.

‘‘(a) IN GENERAL.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall

make grants for the purpose of providing services described in

section 2604 in transitional areas, subject to the same provisions

regarding the allocation of grant funds as apply under subsection

(c) of such section.

42 USC 300ff–19.

120 STAT. 2782 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(b) TRANSITIONAL AREAS.—For purposes of this section, the

term ‘transitional area’ means, subject to subsection (c), a metropolitan area for which there has been reported to and confirmed by

the Director of the Centers for Disease Control and Prevention

a cumulative total of at least 1,000, but fewer than 2,000, cases

of AIDS during the most recent period of 5 calendar years for

which such data are available.

‘‘(c) CERTAIN ELIGIBILITY RULES.—

‘‘(1) FISCAL YEAR 2007.—With respect to grants under subsection (a) for fiscal year 2007, a metropolitan area that received

funding under subpart I for fiscal year 2006 but does not

for fiscal year 2007 qualify under such subpart as an eligible

area and does not qualify under subsection (b) as a transitional

area shall, notwithstanding subsection (b), be considered a

transitional area.

‘‘(2) CONTINUED STATUS AS TRANSITIONAL AREA.—

‘‘(A) IN GENERAL.—Notwithstanding subsection (b), a

metropolitan area that is a transitional area for a fiscal

year continues, except as provided in subparagraph (B),

to be a transitional area until the metropolitan area fails,

for three consecutive fiscal years—

‘‘(i) to qualify under such subsection as a transitional area; and

‘‘(ii) to have a cumulative total of 1,500 or more

living cases of AIDS (reported to and confirmed by

the Director of the Centers for Disease Control and

Prevention) as of December 31 of the most recent calendar year for which such data is available.

‘‘(B) EXCEPTION REGARDING STATUS AS ELIGIBLE AREA.—

Subparagraph (A) does not apply for a fiscal year if the

metropolitan area involved qualifies under subpart I as

an eligible area.

‘‘(d) APPLICATION OF CERTAIN PROVISIONS OF SUBPART I.—

‘‘(1) ADMINISTRATION; PLANNING COUNCIL.—

‘‘(A) IN GENERAL.—The provisions of section 2602 apply

with respect to a grant under subsection (a) for a transitional area to the same extent and in the same manner

as such provisions apply with respect to a grant under

subpart I for an eligible area, except that, subject to

subparagraph (B), the chief elected official of the transitional area may elect not to comply with the provisions

of section 2602(b) if the official provides documentation

to the Secretary that details the process used to obtain

community input (particularly from those with HIV) in

the transitional area for formulating the overall plan for

priority setting and allocating funds from the grant under

subsection (a).

‘‘(B) EXCEPTION.—For each of the fiscal years 2007

through 2009, the exception described in subparagraph

(A) does not apply if the transitional area involved received

funding under subpart I for fiscal year 2006.

‘‘(2) TYPE AND DISTRIBUTION OF GRANTS; TIMEFRAME FOR

OBLIGATION AND EXPENDITURE OF GRANT FUNDS.—

‘‘(A) FORMULA GRANTS; SUPPLEMENTAL GRANTS.—The

provisions of section 2603 apply with respect to grants

under subsection (a) to the same extent and in the same

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2783

manner as such provisions apply with respect to grants

under subpart I, subject to subparagraphs (B) and (C).

‘‘(B) FORMULA GRANTS; INCREASE IN GRANT.—For purposes of subparagraph (A), section 2603(a)(4) does not

apply.

‘‘(C) SUPPLEMENTAL GRANTS; SINGLE PROGRAM WITH

SUBPART I PROGRAM.—With respect to section 2603(b) as

applied for purposes of subparagraph (A):

‘‘(i) The Secretary shall combine amounts available

pursuant to such subparagraph with amounts available

for carrying out section 2603(b) and shall administer

the two programs as a single program.

‘‘(ii) In the single program, the Secretary has

discretion in allocating amounts between eligible areas

under subpart I and transitional areas under this section, subject to the eligibility criteria that apply under

such section, and subject to section 2603(b)(2)(C)

(relating to priority in making grants).

‘‘(iii) Pursuant to section 2603(b)(1), amounts for

the single program are subject to use under sections

2603(a)(4) and 2610(d)(1).

‘‘(3) APPLICATION; TECHNICAL ASSISTANCE; DEFINITIONS.—

The provisions of sections 2605, 2606, and 2607 apply with

respect to grants under subsection (a) to the same extent and

in the same manner as such provisions apply with respect

to grants under subpart I.’’.

(b) CONFORMING AMENDMENTS.—Subpart I of part A of title

XXVI of the Public Health Service Act, as designated by subsection

(a)(1) of this section, is amended by striking ‘‘this part’’ each place

such term appears and inserting ‘‘this subpart’’.

SEC. 108. AUTHORIZATION OF APPROPRIATIONS FOR PART A.

Part A of title XXVI of the Public Health Service Act, as

amended by section 106(a), is amended by adding at the end the

following:

‘‘Subpart III—General Provisions

‘‘SEC. 2610. AUTHORIZATION OF APPROPRIATIONS.

‘‘(a) IN GENERAL.—For the purpose of carrying out this part,

there are authorized to be appropriated $604,000,000 for fiscal

year 2007, $626,300,000 for fiscal year 2008, and $649,500,000

for fiscal year 2009. Amounts appropriated under the preceding

sentence for a fiscal year are available for obligation by the Secretary until the end of the second succeeding fiscal year.

‘‘(b) RESERVATION OF AMOUNTS.—

‘‘(1) FISCAL YEAR 2007.—Of the amount appropriated under

subsection (a) for fiscal year 2007, the Secretary shall reserve—

‘‘(A) $458,310,000 for grants under subpart I; and

‘‘(B) $145,690,000 for grants under section 2609.

‘‘(2) SUBSEQUENT FISCAL YEARS.—Of the amount appropriated under subsection (a) for fiscal year 2008 and each

subsequent fiscal year—

‘‘(A) the Secretary shall reserve an amount for grants

under subpart I; and

‘‘(B) the Secretary shall reserve an amount for grants

under section 2609.

42 USC 300ff–20.

42 USC

300ff–11 et seq.

120 STAT. 2784 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(c) TRANSFER OF CERTAIN AMOUNTS; CHANGE IN STATUS AS

ELIGIBLE AREA OR TRANSITIONAL AREA.—Notwithstanding subsection (b):

‘‘(1) If a metropolitan area is an eligible area under subpart

I for a fiscal year, but for a subsequent fiscal year ceases

to be an eligible area by reason of section 2601(b)—

‘‘(A)(i) the amount reserved under paragraph (1)(A)

or (2)(A) of subsection (b) of this section for the first such

subsequent year of not being an eligible area is deemed

to be reduced by an amount equal to the amount of the

grant made pursuant to section 2603(a) for the metropolitan area for the preceding fiscal year; and

‘‘(ii)(I) if the metropolitan area qualifies for such first

subsequent fiscal year as a transitional area under 2609,

the amount reserved under paragraph (1)(B) or (2)(B) of

subsection (b) for such fiscal year is deemed to be increased

by an amount equal to the amount of the reduction under

subparagraph (A) for such year; or

‘‘(II) if the metropolitan area does not qualify for such

first subsequent fiscal year as a transitional area under

2609, an amount equal to the amount of such reduction

is, notwithstanding subsection (a), transferred and made

available for grants pursuant to section 2618(a)(1), in addition to amounts available for such grants under section

2623; and

‘‘(B) if a transfer under subparagraph (A)(ii)(II) is made

with respect to the metropolitan area for such first subsequent fiscal year, then—

‘‘(i) the amount reserved under paragraph (1)(A)

or (2)(A) of subsection (b) of this section for such year

is deemed to be reduced by an additional $500,000;

and

‘‘(ii) an amount equal to the amount of such additional reduction is, notwithstanding subsection (a),

transferred and made available for grants pursuant

to section 2618(a)(1), in addition to amounts available

for such grants under section 2623.

‘‘(2) If a metropolitan area is a transitional area under

section 2609 for a fiscal year, but for a subsequent fiscal year

ceases to be a transitional area by reason of section 2609(c)(2)

(and does not qualify for such subsequent fiscal year as an

eligible area under subpart I)—

‘‘(A) the amount reserved under subsection (b)(2)(B)

of this section for the first such subsequent fiscal year

of not being a transitional area is deemed to be reduced

by an amount equal to the total of—

‘‘(i) the amount of the grant that, pursuant to

section 2603(a), was made under section 2609(d)(2)(A)

for the metropolitan area for the preceding fiscal year;

and

‘‘(ii) $500,000; and

‘‘(B) an amount equal to the amount of the reduction

under subparagraph (A) for such year is, notwithstanding

subsection (a), transferred and made available for grants

pursuant to section 2618(a)(1), in addition to amounts available for such grants under section 2623.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2785

‘‘(3) If a metropolitan area is a transitional area under

section 2609 for a fiscal year, but for a subsequent fiscal year

qualifies as an eligible area under subpart I—

‘‘(A) the amount reserved under subsection (b)(2)(B)

of this section for the first such subsequent fiscal year

of becoming an eligible area is deemed to be reduced by

an amount equal to the amount of the grant that, pursuant

to section 2603(a), was made under section 2609(d)(2)(A)

for the metropolitan area for the preceding fiscal year;

and

‘‘(B) the amount reserved under subsection (b)(2)(A)

for such fiscal year is deemed to be increased by an amount

equal to the amount of the reduction under subparagraph

(A) for such year.

‘‘(d) CERTAIN TRANSFERS; ALLOCATIONS BETWEEN PROGRAMS

UNDER SUBPART I.—With respect to paragraphs (1)(B)(i) and

(2)(A)(ii) of subsection (c), the Secretary shall administer any reductions under such paragraphs for a fiscal year in accordance with

the following:

‘‘(1) The reductions shall be made from amounts available

for the single program referred to in section 2609(d)(2)(C)

(relating to supplemental grants).

‘‘(2) The reductions shall be made before the amounts

referred to in paragraph (1) are used for purposes of section

2603(a)(4).

‘‘(3) If the amounts referred to in paragraph (1) are not

sufficient for making all the reductions, the reductions shall

be reduced until the total amount of the reductions equals

the total of the amounts referred to in such paragraph.

‘‘(e) RULES OF CONSTRUCTION REGARDING FIRST SUBSEQUENT

FISCAL YEAR.—Paragraphs (1) and (2) of subsection (c) apply with

respect to each series of fiscal years during which a metropolitan

area is an eligible area under subpart I or a transitional area

under section 2609 for a fiscal year and then for a subsequent

fiscal year ceases to be such an area by reason of section 2601(b)

or 2609(c)(2), respectively, rather than applying to a single such

series. Paragraph (3) of subsection (c) applies with respect to each

series of fiscal years during which a metropolitan area is a transitional area under section 2609 for a fiscal year and then for a

subsequent fiscal year becomes an eligible area under subpart I,

rather than applying to a single such series.’’.

TITLE II—CARE GRANTS

SEC. 201. GENERAL USE OF GRANTS.

(a) IN GENERAL.—Section 2612 of the Public Health Service

Act (42 U.S.C. 300ff–22) is amended to read as follows:

‘‘SEC. 2612. GENERAL USE OF GRANTS.

‘‘(a) IN GENERAL.—A State may use amounts provided under

grants made under section 2611 for—

‘‘(1) core medical services described in subsection (b);

‘‘(2) support services described in subsection (c); and

‘‘(3) administrative expenses described in section 2618(b)(3).

‘‘(b) REQUIRED FUNDING FOR CORE MEDICAL SERVICES.—

Applicability.

120 STAT. 2786 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(1) IN GENERAL.—With respect to a grant under section

2611 for a State for a grant year, the State shall, of the

portion of the grant remaining after reserving amounts for

purposes of subparagraphs (A) and (E)(ii)(I) of section

2618(b)(3), use not less than 75 percent to provide core medical

services that are needed in the State for individuals with HIV/

AIDS who are identified and eligible under this title (including

services regarding the co-occurring conditions of the individuals).

‘‘(2) WAIVER.—

‘‘(A) IN GENERAL.—The Secretary shall waive the

application of paragraph (1) with respect to a State for

a grant year if the Secretary determines that, within the

State—

‘‘(i) there are no waiting lists for AIDS Drug Assistance Program services under section 2616; and

‘‘(ii) core medical services are available to all

individuals with HIV/AIDS identified and eligible

under this title.

‘‘(B) NOTIFICATION OF WAIVER STATUS.—When

informing a State that a grant under section 2611 is being

made to the State for a fiscal year, the Secretary shall

inform the State whether a waiver under subparagraph

(A) is in effect for the fiscal year.

‘‘(3) CORE MEDICAL SERVICES.—For purposes of this subsection, the term ‘core medical services’, with respect to an

individual infected with HIV/AIDS (including the co-occurring

conditions of the individual) means the following services:

‘‘(A) Outpatient and ambulatory health services.

‘‘(B) AIDS Drug Assistance Program treatments in

accordance with section 2616.

‘‘(C) AIDS pharmaceutical assistance.

‘‘(D) Oral health care.

‘‘(E) Early intervention services described in subsection

(d).

‘‘(F) Health insurance premium and cost sharing assistance for low-income individuals in accordance with section

2615.

‘‘(G) Home health care.

‘‘(H) Medical nutrition therapy.

‘‘(I) Hospice services.

‘‘(J) Home and community-based health services as

defined under section 2614(c).

‘‘(K) Mental health services.

‘‘(L) Substance abuse outpatient care.

‘‘(M) Medical case management, including treatment

adherence services.

‘‘(c) SUPPORT SERVICES.—

‘‘(1) IN GENERAL.—For purposes of this subsection, the term

‘support services’ means services, subject to the approval of

the Secretary, that are needed for individuals with HIV/AIDS

to achieve their medical outcomes (such as respite care for

persons caring for individuals with HIV/AIDS, outreach services, medical transportation, linguistic services, and referrals

for health care and support services).

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2787

‘‘(2) DEFINITION OF MEDICAL OUTCOMES.—In this subsection,

the term ‘medical outcomes’ means those outcomes affecting

the HIV-related clinical status of an individual with HIV/AIDS.

‘‘(d) EARLY INTERVENTION SERVICES.—

‘‘(1) IN GENERAL.—For purposes of this section, the term

‘early intervention services’ means HIV/AIDS early intervention

services described in section 2651(e), with follow-up referral

provided for the purpose of facilitating the access of individuals

receiving the services to HIV-related health services. The entities through which such services may be provided under the

grant include public health departments, emergency rooms,

substance abuse and mental health treatment programs, detoxification centers, detention facilities, clinics regarding sexually

transmitted diseases, homeless shelters, HIV/AIDS counseling

and testing sites, health care points of entry specified by States,

federally qualified health centers, and entities described in

section 2652(a) that constitute a point of access to services

by maintaining referral relationships.

‘‘(2) CONDITIONS.—With respect to an entity that proposes

to provide early intervention services under paragraph (1), such

paragraph shall apply only if the entity demonstrates to the

satisfaction of the chief elected official for the State involved

that—

‘‘(A) Federal, State, or local funds are otherwise inadequate for the early intervention services the entity proposes to provide; and

‘‘(B) the entity will expend funds pursuant to such

subparagraph to supplement and not supplant other funds

available to the entity for the provision of early intervention

services for the fiscal year involved.

‘‘(e) PRIORITY FOR WOMEN, INFANTS, CHILDREN, AND YOUTH.—

‘‘(1) IN GENERAL.—For the purpose of providing health and

support services to infants, children, youth, and women with

HIV/AIDS, including treatment measures to prevent the

perinatal transmission of HIV, a State shall for each of such

populations in the eligible area use, from the grants made

for the area under section 2601(a) for a fiscal year, not less

than the percentage constituted by the ratio of the population

involved (infants, children, youth, or women in such area) with

HIV/AIDS to the general population in such area of individuals

with HIV/AIDS.

‘‘(2) WAIVER.—With respect to the population involved, the

Secretary may provide to a State a waiver of the requirement

of paragraph (1) if such State demonstrates to the satisfaction

of the Secretary that the population is receiving HIV-related

health services through the State medicaid program under title

XIX of the Social Security Act, the State children’s health

insurance program under title XXI of such Act, or other Federal

or State programs.

‘‘(f) CONSTRUCTION.—A State may not use amounts received

under a grant awarded under section 2611 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.’’.

(b) HIV CARE CONSORTIA.—Section 2613 of the Public Health

Service Act (42 U.S.C. 300ff–23) is amended—

120 STAT. 2788 PUBLIC LAW 109–415—DEC. 19, 2006

(1) in subsection (a), in the matter preceding paragraph

(1)—

(A) by striking ‘‘may use’’ and inserting ‘‘may, subject

to subsection (f), use’’; and

(B) by striking ‘‘section 2612(a)(1)’’ and inserting ‘‘section 2612(a)’’; and

(2) by adding at the end the following subsection:

‘‘(f) ALLOCATION OF FUNDS; TREATMENT AS SUPPORT SERVICES.—For purposes of the requirement of section 2612(b)(1),

expenditures of grants under section 2611 for or through consortia

under this section are deemed to be support services, not core

medical services. The preceding sentence may not be construed

as having any legal effect on the provisions of subsection (a) that

relate to authorized expenditures of the grant.’’.

(c) TECHNICAL AMENDMENTS.—Part B of title XXVI of the Public

Health Service Act (42 U.S.C. 300ff–21 et seq.) is amended—

(1) in section 2611—

(A) in subsection (a), by striking the subsection designation and heading; and

(B) by striking subsection (b);

(2) in section 2614—

(A) in subsection (a), in the matter preceding paragraph

(1), by striking ‘‘section 2612(a)(2)’’ and inserting ‘‘section

2612(b)(3)(J)’’; and

(B) in subsection (c)(2)(B), by striking ‘‘homemaker or’’;

(3) in section 2615(a) by striking ‘‘section 2612(a)(3)’’ and

inserting ‘‘section 2612(b)(3)(F)’’; and

(4) in section 2616(a) by striking ‘‘section 2612(a)(5)’’ and

inserting ‘‘section 2612(b)(3)(B)’’.

SEC. 202. AIDS DRUG ASSISTANCE PROGRAM.

(a) REQUIREMENT OF MINIMUM DRUG LIST.—Section 2616 of

the Public Health Service Act (42 U.S.C. 300ff–26) is amended—

(1) in subsection (c), by striking paragraph (1) and inserting

the following:

‘‘(1) ensure that the therapeutics included on the list of

classes of core antiretroviral therapeutics established by the

Secretary under subsection (e) are, at a minimum, the treatments provided by the State pursuant to this section;’’;

(2) by redesignating subsection (e) as subsection (f); and

(3) by inserting after subsection (d) the following:

‘‘(e) LIST OF CLASSES OF CORE ANTIRETROVIRAL THERAPEUTICS.—For purposes of subsection (c)(1), the Secretary shall

develop and maintain a list of classes of core antiretroviral therapeutics, which list shall be based on the therapeutics included

in the guidelines of the Secretary known as the Clinical Practice

Guidelines for Use of HIV/AIDS Drugs, relating to drugs needed

to manage symptoms associated with HIV. The preceding sentence

does not affect the authority of the Secretary to modify such Guidelines.’’.

(b) DRUG REBATE PROGRAM.—Section 2616 of the Public Health

Service Act, as amended by subsection (a)(2) of this section, is

amended by adding at the end the following:

‘‘(g) DRUG REBATE PROGRAM.—A State shall ensure that any

drug rebates received on drugs purchased from funds provided

pursuant to this section are applied to activities supported under

42 USC 300ff–26.

42 USC 300ff–25.

42 USC 300ff–24.

42 USC 300ff–21.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2789

this subpart, with priority given to activities described under this

section.’’.

SEC. 203. DISTRIBUTION OF FUNDS.

(a) DISTRIBUTION BASED ON LIVING CASES OF HIV/AIDS.—

(1) STATE DISTRIBUTION FACTOR.—Section 2618(a)(2) of the

Public Health Service Act (42 U.S.C. 300ff–28(a)(2)) is

amended—

(A) in subparagraph (B), by striking ‘‘estimated number

of living cases of acquired immune deficiency syndrome

in the eligible area involved’’ and inserting ‘‘number of

living cases of HIV/AIDS in the State involved’’; and

(B) by amending subparagraph (D) to read as follows:

‘‘(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 2009, 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 2009, 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)(aa) the State had submitted to the Secretary a plan for making the transition to sufficiently accurate and reliable names-based

reporting of living non-AIDS cases of HIV; or

‘‘(bb) all statutory changes necessary to provide for sufficiently accurate and reliable reporting

of such cases had been made; and

‘‘(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

Applicability.

Deadline.

Deadline.

120 STAT. 2790 PUBLIC LAW 109–415—DEC. 19, 2006

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

2010, 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, 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 EXEMP- TIONS.—‘‘(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 codebased reporting.

‘‘(II) ADJUSTMENT RATE.—The adjustment rate

under subclause (I) for a State shall be a reduction

of 5 percent in the number of living non-AIDS

cases of HIV reported for the State.

‘‘(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 REQUIRE- MENTS.—The provisions of clauses (ii) through (vii)

Applicability.

Deadline.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2791

may not be construed as having any legal effect

for fiscal year 2010 or any subsequent fiscal year,

and accordingly, the status of a State for purposes

of such clauses may not be considered after fiscal

year 2009.

‘‘(ix) PROGRAM FOR DETECTING INACCURATE OR

FRAUDULENT COUNTING.—The Secretary shall carry out

a program to monitor the reporting of names-based

cases for purposes of this subparagraph and to detect

instances of inaccurate reporting, including fraudulent

reporting.’’.

(2) NON-EMA DISTRIBUTION FACTOR.—Section 2618(a)(2)(C)

of the Public Health Service Act (42 U.S.C. 300ff–28(a)(2)(C))

is amended—

(A) in clause (i), by striking ‘‘estimated number of

living cases of acquired immune deficiency syndrome’’ each

place such term appears and inserting ‘‘number of living

cases of HIV/AIDS’’; and

(B) in clause (ii), by amending such clause to read

as follows:

‘‘(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 2601 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 2609 for such fiscal year, which

individual number for an area is the number that

applies under such section for the fiscal year.’’.

(b) FORMULA AMENDMENTS GENERALLY.—Section 2618(a)(2) of

the Public Health Service Act (42 U.S.C. 300ff–28(a)(2)) is

amended—

(1) in subparagraph (A)—

(A) by striking ‘‘The amount referred to’’ in the matter

preceding clause (i) and all that follows through the end

of clause (i) and inserting the following: ‘‘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 2623 for the fiscal year involved for

grants pursuant to paragraph (1), subject to subparagraph (G); and’’; and

(B) in clause (ii)—

(i) in subclause (I)—

(I) by striking ‘‘.80’’ and inserting ‘‘0.75’’; and

(II) by striking ‘‘and’’ at the end;

(ii) in subclause (II)—

(I) by inserting ‘‘non-EMA’’ after ‘‘respective’’;

and

(II) by striking the period and inserting ‘‘;

and’’; and

(iii) by adding at the end the following:

120 STAT. 2792 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(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 2609 (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.’’;

(2) by striking subparagraphs (E) through (H);

(3) by inserting after subparagraph (D) the following subparagraphs:

‘‘(E) CODE-BASED STATES; LIMITATION ON INCREASE IN

GRANT.—‘‘(i) IN GENERAL.—For each of the fiscal years 2007

through 2009, 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 2009, 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 2620, subject to subparagraph (H).’’; and

(4) by redesignating subparagraph (I) as subparagraph (F).

(c) SEPARATE ADAP GRANTS.—Section 2618(a)(2)(G) of the

Public Health Service Act (42 U.S.C. 300ff–28(a)(2)(G)), as redesignated by subsection (b)(4) of this section, is amended—

(1) in clause (i)—

(A) in the matter preceding subclause (I), by striking

‘‘section 2677’’ and inserting ‘‘section 2623’’;

(B) in subclause (II), by striking the period at the

end and inserting a semicolon; and

(C) by adding after and below subclause (II) the following:

‘‘which product shall then, as applicable, be increased

under subparagraph (H).’’;

(2) in clause (ii)—

(A) by striking subclauses (I) through (III) and

inserting the following:

‘‘(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

2616(b) pharmaceutical therapeutics described

under subsections (c)(2) and (e) of such section.

Applicability.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2793

‘‘(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 section 2618(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 2616(a), 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 2617(d)

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

2617(d).’’.

(B) in subclause (IV), by moving the subclause two

ems to the left;

(C) in subclause (V), by striking ‘‘3 percent’’ and

inserting ‘‘5 percent’’; and

(D) by striking subclause (VI); and

(3) by adding at the end the following clause:

‘‘(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.’’.

(d) HOLD HARMLESS.—Section 2618(a)(2) of the Public Health

Service Act (42 U.S.C. 300ff–28(a)(2)), as amended by subsection

(b)(4) of this section, is amended by adding at the end the following

subparagraph:

‘‘(H) INCREASE IN FORMULA GRANTS.—

‘‘(i) ASSURANCE OF AMOUNT.—

‘‘(I) GENERAL RULE.—For fiscal year 2007, the

Secretary shall ensure, subject to clauses (ii)

through (iv), that the total for a State of the grant

pursuant to paragraph (1) and the grant pursuant

to subparagraph (G) is not less than 95 percent

of such total for the State for fiscal year 2006.

Applicability.

120 STAT. 2794 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(II) RULE OF CONSTRUCTION.—With respect

to the application of subclause (I), the 95 percent

requirement under such subclause shall apply with

respect to each grant awarded under paragraph

(1) and with respect to each grant awarded under

subparagraph (G).

‘‘(ii) FISCAL YEAR 2007.—For purposes of clause

(i) as applied for fiscal year 2007, the references in

such clause to subparagraph (G) are deemed to be

references to subparagraph (I) as such subparagraph

was in effect for fiscal year 2006.

‘‘(iii) FISCAL YEARS 2008 AND 2009.—For each of

the fiscal years 2008 and 2009, the Secretary shall

ensure that the total for a State of the grant pursuant

to paragraph (1) and the grant pursuant to subparagraph (G) is not less than 100 percent of such total

for the State for fiscal year 2007.

‘‘(iv) SOURCE OF FUNDS FOR INCREASE.—

‘‘(I) IN GENERAL.—From the amount reserved

under section 2623(b)(2) 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.

‘‘(v) APPLICABILITY.—This paragraph may not be

construed as having any applicability after fiscal year

2009.’’.

(e) ADMINISTRATIVE EXPENSES; CLINICAL QUALITY MANAGEMENT.—Section 2618(b) of the Public Health Service Act (42 U.S.C.

300ff–28(b)) is amended—

(1) by redesignating paragraphs (2) through (7) as paragraphs (1) through (6);

(2) in paragraph (2) (as so redesignated)—

(A) by striking ‘‘paragraph (5)’’ and inserting ‘‘paragraph (4)’’; and

(B) by striking ‘‘paragraph (6)’’ and inserting ‘‘paragraph (5)’’;

(3) in paragraph (3) (as so redesignated)—

(A) by amending subparagraph (A) to read as follows:

‘‘(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 2611 for administration.’’;

Applicability.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2795

(B) by redesignating subparagraphs (B) and (C) as

subparagraphs (C) and (D), respectively;

(C) by inserting after subparagraph (A) the following:

‘‘(B) ALLOCATIONS.—In the case of entities and subcontractors to which a State allocates amounts received

by the State under a grant under section 2611, 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).’’;

(D) in subparagraph (C) (as so redesignated), by

inserting before the period the following: ‘‘, including a

clinical quality management program under subparagraph

(E)’’; and

(E) by adding at the end the following:

‘‘(E) CLINICAL QUALITY MANAGEMENT.—

‘‘(i) REQUIREMENT.—Each State that receives a

grant under section 2611 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 2611 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—

‘‘(aa) 5 percent of amounts received under

the grant; or

‘‘(bb) $3,000,000.

‘‘(II) RELATION TO LIMITATION ON ADMINISTRATIVE EXPENSES.—The costs of a clinical quality

management program under clause (i) may not

be considered administrative expenses for purposes

of the limitation established in subparagraph (A).’’;

(4) in paragraph (4) (as so redesignated)—

(A) by striking ‘‘paragraph (6)’’ and inserting ‘‘paragraph (5)’’; and

(B) by striking ‘‘paragraphs (3) and (4)’’ and inserting

‘‘paragraphs (2) and (3)’’; and

(5) in paragraph (5) (as so redesignated), by striking ‘‘paragraphs (3)’’ and all that follows through ‘‘(5),’’ and inserting

the following: ‘‘paragraphs (2) and (3), may, notwithstanding

paragraphs (2) through (4),’’.

(f) REALLOCATION FOR SUPPLEMENTAL GRANTS.—Section

2618(d) of the Public Health Service Act (42 U.S.C. 300ff–28(d))

is amended to read as follows:

‘‘(d) REALLOCATION.—Any portion of a grant made to a State

under section 2611 for a fiscal year that has not been obligated

120 STAT. 2796 PUBLIC LAW 109–415—DEC. 19, 2006

as described in subsection (c) ceases to be available to the State

and shall be made available by the Secretary for grants under

section 2620, in addition to amounts made available for such grants

under section 2623(b)(2).’’.

(g) DEFINITIONS; OTHER TECHNICAL AMENDMENTS.—Section

2618(a) of the Public Health Service Act (42 U.S.C. 300ff–28(a))

is amended—

(1) in paragraph (1), in the matter preceding subparagraph

(A), by striking ‘‘section 2677’’ and inserting ‘‘section 2623’’;

(2) in paragraph (1)(A)—

(A) in the matter preceding clause (i), by striking ‘‘each

of the several States and the District of Columbia’’ and

inserting ‘‘each of the 50 States, the District of Columbia,

Guam, and the Virgin Islands (referred to in this paragraph

as a ‘covered State’)’’; and

(B) in clause (i)—

(i) in subclause (I), by striking ‘‘State or District’’

and inserting ‘‘covered State’’; and

(ii) in subclause (II)—

(I) by striking ‘‘State or District’’ and inserting

‘‘covered State’’; and

(II) by inserting ‘‘and’’ after the semicolon;

and

(3) in paragraph (1)(B), by striking ‘‘each territory of the

United States, as defined in paragraph (3),’’ and inserting ‘‘each

territory other than Guam and the Virgin Islands’’;

(4) in paragraph (2)(C)(i), by striking ‘‘or territory’’; and

(5) by striking paragraph (3).

SEC. 204. ADDITIONAL AMENDMENTS TO SUBPART I OF PART B.

(a) REFERENCES TO PART B.—Subpart I of part B of title XXVI

of the Public Health Service Act (42 U.S.C. 300ff–21 et seq.) is

amended by striking ‘‘this part’’ each place such term appears

and inserting ‘‘section 2611’’.

(b) HEPATITIS.—Section 2614(a)(3) of the Public Health Service

Act (42 U.S.C. 300ff–24(a)(3)) is amended by inserting ‘‘, including

specialty care and vaccinations for hepatitis co-infection,’’ after

‘‘health services’’.

(c) APPLICATION FOR GRANT.—

(1) COORDINATION.—Section 2617(b) of the Public Health

Service Act (42 U.S.C. 300ff–27(b)) is amended—

(A) by redesignating paragraphs (4) through (6) as

paragraphs (5) through (7), respectively;

(B) by inserting after paragraph (3), the following:

‘‘(4) the designation of a lead State agency that shall—

‘‘(A) administer all assistance received under this part;

‘‘(B) conduct the needs assessment and prepare the

State plan under paragraph (3);

‘‘(C) prepare all applications for assistance under this

part;

‘‘(D) receive notices with respect to programs under

this title;

‘‘(E) every 2 years, collect and submit to the Secretary

all audits, consistent with Office of Management and

Budget circular A133, from grantees within the State,

including audits regarding funds expended in accordance

with this part; and

Deadline.

Audits.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2797

‘‘(F) carry out any other duties determined appropriate

by the Secretary to facilitate the coordination of programs

under this title.’’;

(C) in paragraph (5) (as so redesignated)—

(i) in subparagraph (E), by striking ‘‘and’’ at the

end; and

(ii) by inserting after subparagraph (F) the following:

‘‘(G) includes key outcomes to be measured by all entities in the State receiving assistance under this title; and’’;

and

(D) in paragraph (7) (as so redesignated), in subparagraph (A)—

(i) by striking ‘‘paragraph (5)’’ and inserting ‘‘paragraph (6)’’; and

(ii) by striking ‘‘paragraph (4)’’ and inserting ‘‘paragraph (5)’’.

(2) NATIVE AMERICAN REPRESENTATION.—Section 2617(b)(6)

of the Public Health Service Act, as redesignated by paragraph

(1)(A) of this subsection, is amended by inserting before ‘‘representatives of grantees’’ the following: ‘‘members of a Federally

recognized Indian tribe as represented in the State,’’.

(3) PAYER OF LAST RESORT.—Section 2617(b)(7)(F)(ii) of the

Public Health Service Act, as redesignated by paragraph (1)(A)

of this subsection, is amended by inserting before the semicolon

the following: ‘‘(except for a program administered by or providing the services of the Indian Health Service)’’.

(d) MATCHING FUNDS; APPLICABILITY OF REQUIREMENT.—Section 2617(d)(3) of the Public Health Service Act (42 U.S.C. 300ff–

27(d)(3)) is amended—

(1) in subparagraph (A), by striking ‘‘acquired immune

deficiency syndrome’’ and inserting ‘‘HIV/AIDS’’; and

(2) in subparagraph (C), by striking ‘‘acquired immune

deficiency syndrome’’ and inserting ‘‘HIV/AIDS’’.

SEC. 205. SUPPLEMENTAL GRANTS ON BASIS OF DEMONSTRATED

NEED.

Subpart I of part B of title XXVI of the Public Health Service

Act (42 U.S.C. 300ff–21 et seq.) is amended—

(1) by redesignating section 2620 as section 2621; and

(2) by inserting after section 2619 the following:

‘‘SEC. 2620. SUPPLEMENTAL GRANTS.

‘‘(a) IN GENERAL.—For the purpose of providing services

described in section 2612(a), the Secretary shall make grants to

States—

‘‘(1) whose applications under section 2617 have demonstrated the need in the State, on an objective and quantified

basis, for supplemental financial assistance to provide such

services; and

‘‘(2) that did not, for the most recent grant year pursuant

to section 2618(a)(1) or 2618(a)(2)(G)(i) for which data is available, have more than 2 percent of grant funds under such

sections canceled or covered by any waivers under section

2622(c).

‘‘(b) DEMONSTRATED NEED.—The factors considered by the Secretary in determining whether an eligible area has a demonstrated

42 USC

300ff–29a.

42 USC 300ff–30.

120 STAT. 2798 PUBLIC LAW 109–415—DEC. 19, 2006

need for purposes of subsection (a)(1) may include any or all of

the following:

‘‘(1) The unmet need for such services, as determined under

section 2617(b).

‘‘(2) An increasing need for HIV/AIDS-related services,

including relative rates of increase in the number of cases

of HIV/AIDS.

‘‘(3) The relative rates of increase in the number of cases

of HIV/AIDS within new or emerging subpopulations.

‘‘(4) The current prevalence of HIV/AIDS.

‘‘(5) Relevant factors related to the cost and complexity

of delivering health care to individuals with HIV/AIDS in the

eligible area.

‘‘(6) The impact of co-morbid factors, including co-occurring

conditions, determined relevant by the Secretary.

‘‘(7) The prevalence of homelessness.

‘‘(8) The prevalence of individuals described under section

2602(b)(2)(M).

‘‘(9) The relevant factors that limit access to health care,

including geographic variation, adequacy of health insurance

coverage, and language barriers.

‘‘(10) The impact of a decline in the amount received pursuant to section 2618 on services available to all individuals

with HIV/AIDS identified and eligible under this title.

‘‘(c) PRIORITY IN MAKING GRANTS.—The Secretary shall provide

funds under this section to a State to address the decline in services

related to the decline in the amounts received pursuant to section

2618 consistent with the grant award to the State for fiscal year

2006, to the extent that the factor under subsection (b)(10) (relating

to a decline in funding) applies to the State.

‘‘(d) REPORT ON THE AWARDING OF SUPPLEMENTAL FUNDS.—

Not later than 45 days after the awarding of supplemental funds

under this section, the Secretary shall submit to Congress a report

concerning such funds. Such report shall include information

detailing—

‘‘(1) the total amount of supplemental funds available under

this section for the year involved;

‘‘(2) the amount of supplemental funds used in accordance

with the hold harmless provisions of section 2618(a)(2);

‘‘(3) the amount of supplemental funds disbursed pursuant

to subsection (c);

‘‘(4) the disbursement of the remainder of the supplemental

funds after taking into account the uses described in paragraphs

(2) and (3); and

‘‘(5) the rationale used for the amount of funds disbursed

as described under paragraphs (2), (3), and (4).

‘‘(e) CORE MEDICAL SERVICES.—The provisions of section 2612(b)

apply with respect to a grant under this section to the same extent

and in the same manner as such provisions apply with respect

to a grant made pursuant to section 2618(a)(1).

‘‘(f) APPLICABILITY OF GRANT AUTHORITY.—The authority to

make grants under this section applies beginning with the first

fiscal year for which amounts are made available for such grants

under section 2623(b)(1).’’.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2799

SEC. 206. EMERGING COMMUNITIES.

Section 2621 of the Public Health Service Act, as redesignated

by section 205(1) of this Act, is amended—

(1) in the heading for the section, by striking ‘‘SUPPLEMENTAL GRANTS’’ and inserting ‘‘EMERGING COMMUNITIES’’;

(2) in subsection (b)—

(A) in paragraph (2), by striking ‘‘and’’ at the end;

(B) by redesignating paragraph (3) as paragraph (4);

and

(C) by inserting after paragraph (2) the following:

‘‘(3) agree that the grant will be used to provide funds

directly to emerging communities in the State, separately from

other funds under this title that are provided by the State

to such communities; and’’.

(3) by striking subsections (d) and (e) and inserting the

following:

‘‘(d) DEFINITIONS OF EMERGING COMMUNITY.—For purposes of

this section, the term ‘emerging community’ means a metropolitan

area (as defined in section 2607) for which there has been reported

to and confirmed by the Director of the Centers for Disease Control

and Prevention a cumulative total of at least 500, but fewer than

1,000, cases of AIDS during the most recent period of 5 calendar

years for which such data are available.

‘‘(e) CONTINUED STATUS AS EMERGING COMMUNITY.—Notwithstanding any other provision of this section, a metropolitan area

that is an emerging community for a fiscal year continues to be

an emerging community until the metropolitan area fails, for three

consecutive fiscal years—

‘‘(1) to meet the requirements of subsection (d); and

‘‘(2) to have a cumulative total of 750 or more living cases

of AIDS (reported to and confirmed by the Director of the

Centers for Disease Control and Prevention) as of December

31 of the most recent calendar year for which such data is

available.

‘‘(f) DISTRIBUTION.—The amount of a grant under subsection

(a) for a State for a fiscal year shall be an amount equal to

the product of—

‘‘(1) the amount available under section 2623(b)(1) for the

fiscal year; and

‘‘(2) a percentage equal to the ratio constituted by the

number of living cases of HIV/AIDS in emerging communities

in the State to the sum of the respective numbers of such

cases in such communities for all States.’’.

SEC. 207. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT

FUNDS.

Subpart I of part B of title XXVI of the Public Health Service

Act (42 U.S.C. 300ff–21 et seq.), as amended by section 205, is

further amended by adding at the end the following:

‘‘SEC. 2622. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF

GRANT FUNDS.

‘‘(a) OBLIGATION BY END OF GRANT YEAR.—Effective for fiscal

year 2007 and subsequent fiscal years, funds from a grant award

made to a State for a fiscal year pursuant to section 2618(a)(1)

or 2618(a)(2)(G), or under section 2620 or 2621, are available for

obligation by the State through the end of the one-year period

Effective date.

42 USC

300ff–31a.

120 STAT. 2800 PUBLIC LAW 109–415—DEC. 19, 2006

beginning on the date in such fiscal year on which funds from

the award first become available to the State (referred to in this

section as the ‘grant year for the award’), except as provided in

subsection (c)(1).

‘‘(b) SUPPLEMENTAL GRANTS; CANCELLATION OF UNOBLIGATED

BALANCE OF GRANT AWARD.—Effective for fiscal year 2007 and

subsequent fiscal years, if a grant award made to a State for

a fiscal year pursuant to section 2618(a)(2)(G)(ii), or under section

2620 or 2621, has an unobligated balance as of the end of the

grant year for the award—

‘‘(1) the Secretary shall cancel that unobligated balance

of the award, and shall require the State to return any amounts

from such balance that have been disbursed to the State; and

‘‘(2) the funds involved shall be made available by the

Secretary as additional amounts for grants pursuant to section

2620 for the first fiscal year beginning after the fiscal year

in which the Secretary obtains the information necessary for

determining that the balance is required under paragraph (1)

to be canceled, except that the availability of the funds for

such grants is subject to section 2618(a)(2)(H) as applied for

such year.

‘‘(c) FORMULA GRANTS; CANCELLATION OF UNOBLIGATED BALANCE OF GRANT AWARD; WAIVER PERMITTING CARRYOVER.—

‘‘(1) IN GENERAL.—Effective for fiscal year 2007 and subsequent fiscal years, if a grant award made to a State for a

fiscal year pursuant to section 2618(a)(1) or 2618(a)(2)(G)(i)

has an unobligated balance as of the end of the grant year

for the award, the Secretary shall cancel that unobligated balance of the award, and shall require the State to return any

amounts from such balance that have been disbursed to the

State, unless—

‘‘(A) before the end of the grant year, the State submits

to the Secretary a written application for a waiver of the

cancellation, which application includes a description of

the purposes for which the State intends to expend the

funds involved; and

‘‘(B) the Secretary approves the waiver.

‘‘(2) EXPENDITURE BY END OF CARRYOVER YEAR.—With

respect to a waiver under paragraph (1) that is approved for

a balance that is unobligated as of the end of a grant year

for an award:

‘‘(A) The unobligated funds are available for expenditure by the State involved for the one-year period beginning

upon the expiration of the grant year (referred to in this

section as the ‘carryover year’).

‘‘(B) If the funds are not expended by the end of the

carryover year, the Secretary shall cancel that unexpended

balance of the award, and shall require the State to return

any amounts from such balance that have been disbursed

to the State.

‘‘(3) USE OF CANCELLED BALANCES.—In the case of any

balance of a grant award that is cancelled under paragraph

(1) or (2)(B), the grant funds involved shall be made available

by the Secretary as additional amounts for grants under section

2620 for the first fiscal year beginning after the fiscal year

in which the Secretary obtains the information necessary for

determining that the balance is required under such paragraph

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2801

to be canceled, except that the availability of the funds for

such grants is subject to section 2618(a)(2)(H) as applied for

such year.

‘‘(4) CORRESPONDING REDUCTION IN FUTURE GRANT.— ‘‘(A) IN GENERAL.—In the case of a State for which

a balance from a grant award made pursuant to section

2618(a)(1) or 2618(a)(2)(G)(i) is unobligated as of the end

of the grant year for the award—

‘‘(i) the Secretary shall reduce, by the same amount

as such unobligated balance, the amount of the grant

under such section for the first fiscal year beginning

after the fiscal year in which the Secretary obtains

the information necessary for determining that such

balance was unobligated as of the end of the grant

year (which requirement for a reduction applies without regard to whether a waiver under paragraph (1)

has been approved with respect to such balance); and

‘‘(ii) the grant funds involved in such reduction

shall be made available by the Secretary as additional

funds for grants under section 2620 for such first fiscal

year, subject to section 2618(a)(2)(H);

except that this subparagraph does not apply to the State

if the amount of the unobligated balance was 2 percent

or less.

‘‘(B) RELATION TO INCREASES IN GRANT.—A reduction

under subparagraph (A) for a State for a fiscal year may

not be taken into account in applying section 2618(a)(2)(H)

with respect to the State for the subsequent fiscal year.

‘‘(d) TREATMENT OF DRUG REBATES.—For purposes of this section, funds that are drug rebates referred to in section 2616(g)

may not be considered part of any grant award referred to in

subsection (a).’’.

SEC. 208. AUTHORIZATION OF APPROPRIATIONS FOR SUBPART I OF

PART B.

Subpart I of part B of title XXVI of the Public Health Service

Act (42 U.S.C. 300ff–21 et seq.), as amended by section 207, is

further amended by adding at the end the following:

‘‘SEC. 2623. AUTHORIZATION OF APPROPRIATIONS.

‘‘(a) IN GENERAL.—For the purpose of carrying out this subpart, there are authorized to be appropriated $1,195,500,000 for fiscal

year 2007, $1,239,500,000 for fiscal year 2008, and $1,285,200,000

for fiscal year 2009. Amounts appropriated under the preceding

sentence for a fiscal year are available for obligation by the Secretary until the end of the second succeeding fiscal year.

‘‘(b) RESERVATION OF AMOUNTS.— ‘‘(1) EMERGING COMMUNITIES.—Of the amount appropriated

under subsection (a) for a fiscal year, the Secretary shall reserve

$5,000,000 for grants under section 2621.

‘‘(2) SUPPLEMENTAL GRANTS.—

‘‘(A) IN GENERAL.—Of the amount appropriated under

subsection (a) for a fiscal year in excess of the 2006 adjusted

amount, the Secretary shall reserve 1⁄3 for grants under

section 2620, except that the availability of the reserved

funds for such grants is subject to section 2618(a)(2)(H)

as applied for such year, and except that any amount

appropriated exclusively for carrying out section 2616 (and,

42 USC

300ff–31b.

120 STAT. 2802 PUBLIC LAW 109–415—DEC. 19, 2006

accordingly, distributed under section 2618(a)(2)(G)) is not

subject to this subparagraph.

‘‘(B) 2006 ADJUSTED AMOUNT.—For purposes of

subparagraph (A), the term ‘2006 adjusted amount’ means

the amount appropriated for fiscal year 2006 under section

2677(b) (as such section was in effect for such fiscal year),

excluding any amount appropriated for such year exclusively for carrying out section 2616 (and, accordingly,

distributed under section 2618(a)(2)(I), as so in effect).’’.

SEC. 209. EARLY DIAGNOSIS GRANT PROGRAM.

Section 2625 of the Public Health Service Act (42 U.S.C. 300ff–

33) is amended to read as follows:

‘‘SEC. 2625. EARLY DIAGNOSIS GRANT PROGRAM.

‘‘(a) IN GENERAL.—In the case of States whose laws or regulations are in accordance with subsection (b), the Secretary, acting

through the Centers for Disease Control and Prevention, shall make

grants to such States for the purposes described in subsection

(c).

‘‘(b) DESCRIPTION OF COMPLIANT STATES.—For purposes of subsection (a), the laws or regulations of a State are in accordance

with this subsection if, under such laws or regulations (including

programs carried out pursuant to the discretion of State officials),

both of the policies described in paragraph (1) are in effect, or

both of the policies described in paragraph (2) are in effect, as

follows:

‘‘(1)(A) Voluntary opt-out testing of pregnant women.

‘‘(B) Universal testing of newborns.

‘‘(2)(A) Voluntary opt-out testing of clients at sexually

transmitted disease clinics.

‘‘(B) Voluntary opt-out testing of clients at substance abuse

treatment centers.

The Secretary shall periodically ensure that the applicable policies

are being carried out and recertify compliance.

‘‘(c) USE OF FUNDS.—A State may use funds provided under

subsection (a) for HIV/AIDS testing (including rapid testing),

prevention counseling, treatment of newborns exposed to HIV/AIDS,

treatment of mothers infected with HIV/AIDS, and costs associated

with linking those diagnosed with HIV/AIDS to care and treatment

for HIV/AIDS.

‘‘(d) APPLICATION.—A State that is eligible for the grant under

subsection (a) shall submit an application to the Secretary, in

such form, in such manner, and containing such information as

the Secretary may require.

‘‘(e) LIMITATION ON AMOUNT OF GRANT.—A grant under subsection (a) to a State for a fiscal year may not be made in an

amount exceeding $10,000,000.

‘‘(f) RULE OF CONSTRUCTION.—Nothing in this section shall

be construed to pre-empt State laws regarding HIV/AIDS counseling

and testing.

‘‘(g) DEFINITIONS.—In this section:

‘‘(1) The term ‘voluntary opt-out testing’ means HIV/AIDS

testing—

‘‘(A) that is administered to an individual seeking other

health care services; and

‘‘(B) in which—

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2803

‘‘(i) pre-test counseling is not required but the individual is informed that the individual will receive an

HIV/AIDS test and the individual may opt out of such

testing; and

‘‘(ii) for those individuals with a positive test result,

post-test counseling (including referrals for care) is

provided and confidentiality is protected.

‘‘(2) The term ‘universal testing of newborns’ means HIV/

AIDS testing that is administered within 48 hours of delivery

to—

‘‘(A) all infants born in the State; or

‘‘(B) all infants born in the State whose mother’s HIV/

AIDS status is unknown at the time of delivery.

‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—Of the funds appropriated annually to the Centers for Disease Control and Prevention

for HIV/AIDS prevention activities, $30,000,000 shall be made available for each of the fiscal years 2007 through 2009 for grants

under subsection (a), of which $20,000,000 shall be made available

for grants to States with the policies described in subsection (b)(1),

and $10,000,000 shall be made available for grants to States with

the policies described in subsection (b)(2). Funds provided under

this section are available until expended.’’.

SEC. 210. CERTAIN PARTNER NOTIFICATION PROGRAMS; AUTHORIZATION OF APPROPRIATIONS.

Section 2631(d) of the Public Health Service Act (42 U.S.C.

300ff–38(d)) is amended by striking ‘‘there are’’ and all that follows

and inserting the following: ‘‘there is authorized to be appropriated

$10,000,000 for each of the fiscal years 2007 through 2009.’’.

TITLE III—EARLY INTERVENTION

SERVICES

SEC. 301. ESTABLISHMENT OF PROGRAM; CORE MEDICAL SERVICES.

(a) IN GENERAL.—Section 2651 of the Public Health Service

Act (42 U.S.C. 300ff–51) is amended to read as follows:

‘‘SEC. 2651. ESTABLISHMENT OF A PROGRAM.

‘‘(a) IN GENERAL.—For the purposes described in subsection

(b), the Secretary, acting through the Administrator of the Health

Resources and Services Administration, may make grants to public

and nonprofit private entities specified in section 2652(a).

‘‘(b) REQUIREMENTS.—

‘‘(1) IN GENERAL.—The Secretary may not make a grant

under subsection (a) unless the applicant for the grant agrees

to expend the grant only for—

‘‘(A) core medical services described in subsection (c);

‘‘(B) support services described in subsection (d); and

‘‘(C) administrative expenses as described in section

2664(g)(3).

‘‘(2) EARLY INTERVENTION SERVICES.—An applicant for a

grant under subsection (a) shall expend not less than 50 percent

of the amount received under the grant for the services

described in subparagraphs (B) through (E) of subsection (e)(1)

for individuals with HIV/AIDS.

‘‘(c) REQUIRED FUNDING FOR CORE MEDICAL SERVICES.—

120 STAT. 2804 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(1) IN GENERAL.—With respect to a grant under subsection

(a) to an applicant for a fiscal year, the applicant shall, of

the portion of the grant remaining after reserving amounts

for purposes of paragraphs (3) and (5) of section 2664(g), use

not less than 75 percent to provide core medical services that

are needed in the area involved for individuals with HIV/

AIDS who are identified and eligible under this title (including

services regarding the co-occurring conditions of the individuals).

‘‘(2) WAIVER.—

‘‘(A) The Secretary shall waive the application of paragraph (1) with respect to an applicant for a grant if the

Secretary determines that, within the service area of the

applicant—

‘‘(i) there are no waiting lists for AIDS Drug Assistance Program services under section 2616; and

‘‘(ii) core medical services are available to all

individuals with HIV/AIDS identified and eligible

under this title.

‘‘(B) NOTIFICATION OF WAIVER STATUS.—When

informing an applicant that a grant under subsection (a)

is being made for a fiscal year, the Secretary shall inform

the applicant whether a waiver under subparagraph (A)

is in effect for the fiscal year.

‘‘(3) CORE MEDICAL SERVICES.—For purposes of this subsection, the term ‘core medical services’, with respect to an

individual with HIV/AIDS (including the co-occurring conditions

of the individual) means the following services:

‘‘(A) Outpatient and ambulatory health services.

‘‘(B) AIDS Drug Assistance Program treatments under

section 2616.

‘‘(C) AIDS pharmaceutical assistance.

‘‘(D) Oral health care.

‘‘(E) Early intervention services described in subsection

(e).

‘‘(F) Health insurance premium and cost sharing assistance for low-income individuals in accordance with section

2615.

‘‘(G) Home health care.

‘‘(H) Medical nutrition therapy.

‘‘(I) Hospice services.

‘‘(J) Home and community-based health services as

defined under section 2614(c).

‘‘(K) Mental health services.

‘‘(L) Substance abuse outpatient care.

‘‘(M) Medical case management, including treatment

adherence services.

‘‘(d) SUPPORT SERVICES.—

‘‘(1) IN GENERAL.—For purposes of this section, the term

‘support services’ means services, subject to the approval of

the Secretary, that are needed for individuals with HIV/AIDS

to achieve their medical outcomes (such as respite care for

persons caring for individuals with HIV/AIDS, outreach services, medical transportation, linguistic services, and referrals

for health care and support services).

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2805

‘‘(2) DEFINITION OF MEDICAL OUTCOMES.—In this section,

the term ‘medical outcomes’ means those outcomes affecting

the HIV-related clinical status of an individual with HIV/AIDS.

‘‘(e) SPECIFICATION OF EARLY INTERVENTION SERVICES.—

‘‘(1) IN GENERAL.—The early intervention services referred

to in this section are—

‘‘(A) counseling individuals with respect to HIV/AIDS

in accordance with section 2662;

‘‘(B) testing individuals with respect to HIV/AIDS,

including tests to confirm the presence of the disease, tests

to diagnose the extent of the deficiency in the immune

system, and tests to provide information on appropriate

therapeutic measures for preventing and treating the

deterioration of the immune system and for preventing

and treating conditions arising from HIV/AIDS;

‘‘(C) referrals described in paragraph (2);

‘‘(D) other clinical and diagnostic services regarding

HIV/AIDS, and periodic medical evaluations of individuals

with HIV/AIDS; and

‘‘(E) providing the therapeutic measures described in

subparagraph (B).

‘‘(2) REFERRALS.—The services referred to in paragraph

(1)(C) are referrals of individuals with HIV/AIDS to appropriate

providers of health and support services, including, as

appropriate—

‘‘(A) to entities receiving amounts under part A or

B for the provision of such services;

‘‘(B) to biomedical research facilities of institutions of

higher education that offer experimental treatment for such

disease, or to community-based organizations or other entities that provide such treatment; or

‘‘(C) to grantees under section 2671, in the case of

a pregnant woman.

‘‘(3) REQUIREMENT OF AVAILABILITY OF ALL EARLY INTERVENTION SERVICES THROUGH EACH GRANTEE.—

‘‘(A) IN GENERAL.—The Secretary may not make a grant

under subsection (a) unless the applicant for the grant

agrees that each of the early intervention services specified

in paragraph (2) will be available through the grantee.

With respect to compliance with such agreement, such

a grantee may expend the grant to provide the early intervention services directly, and may expend the grant to

enter into agreements with public or nonprofit private entities, or private for-profit entities if such entities are the

only available provider of quality HIV care in the area,

under which the entities provide the services.

‘‘(B) OTHER REQUIREMENTS.—Grantees described in—

‘‘(i) subparagraphs (A), (D), (E), and (F) of section

2652(a)(1) shall use not less than 50 percent of the

amount of such a grant to provide the services

described in subparagraphs (A), (B), (D), and (E) of

paragraph (1) directly and on-site or at sites where

other primary care services are rendered; and

‘‘(ii) subparagraphs (B) and (C) of section

2652(a)(1) shall ensure the availability of early intervention services through a system of linkages to

120 STAT. 2806 PUBLIC LAW 109–415—DEC. 19, 2006

community-based primary care providers, and to establish mechanisms for the referrals described in paragraph (1)(C), and for follow-up concerning such referrals.’’.

(b) ADMINISTRATIVE EXPENSES; CLINICAL QUALITY MANAGEMENT

PROGRAM.—Section 2664(g) of the Public Health Service Act (42

U.S.C. 300ff–64(g)) is amended—

(1) in paragraph (3), by amending the paragraph to read

as follows:

‘‘(3) the applicant will not expend more than 10 percent

of the grant for administrative expenses with respect to the

grant, including planning and evaluation, except that the costs

of a clinical quality management program under paragraph

(5) may not be considered administrative expenses for purposes

of such limitation;’’; and

(2) in paragraph (5), by inserting ‘‘clinical’’ before ‘‘quality

management’’.

SEC. 302. ELIGIBLE ENTITIES; PREFERENCES; PLANNING AND

DEVELOPMENT GRANTS.

(a) MINIMUM QUALIFICATION OF GRANTEES.—Section 2652(a)

of the Public Health Service Act (42 U.S.C. 300ff–52(a)) is amended

to read as follows:

‘‘(a) ELIGIBLE ENTITIES.—

‘‘(1) IN GENERAL.—The entities referred to in section 2651(a)

are public entities and nonprofit private entities that are—

‘‘(A) federally-qualified health centers under section

1905(l)(2)(B) of the Social Security Act;

‘‘(B) grantees under section 1001 (regarding family

planning) other than States;

‘‘(C) comprehensive hemophilia diagnostic and treatment centers;

‘‘(D) rural health clinics;

‘‘(E) health facilities operated by or pursuant to a contract with the Indian Health Service;

‘‘(F) community-based organizations, clinics, hospitals

and other health facilities that provide early intervention

services to those persons infected with HIV/AIDS through

intravenous drug use; or

‘‘(G) nonprofit private entities that provide comprehensive primary care services to populations at risk of HIV/

AIDS, including faith-based and community-based

organizations.

‘‘(2) UNDERSERVED POPULATIONS.—Entities described in

paragraph (1) shall serve underserved populations which may

include minority populations and Native American populations,

ex-offenders, individuals with comorbidities including hepatitis

B or C, mental illness, or substance abuse, low-income populations, inner city populations, and rural populations.’’.

(b) PREFERENCES IN MAKING GRANTS.—Section 2653 of the

Public Health Service Act (42 U.S.C. 300ff–53) is amended—

(1) in subsection (b)(1)—

(A) in subparagraph (A), by striking ‘‘acquired immune

deficiency syndrome’’ and inserting ‘‘HIV/AIDS’’; and

(B) in subparagraph (D), by inserting before the semicolon the following: ‘‘and the number of cases of individuals

co-infected with HIV/AIDS and hepatitis B or C’’; and

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2807

(2) in subsection (d)(2), by striking ‘‘special consideration’’

and inserting ‘‘preference’’.

(c) PLANNING AND DEVELOPMENT GRANTS.—Section 2654(c) of

the Public Health Service Act (42 U.S.C. 300ff–54(c)) is amended—

(1) in paragraph (1)—

(A) in subparagraph (A), by striking ‘‘HIV’’; and

(B) in subparagraph (B), by striking ‘‘HIV’’ and

inserting ‘‘HIV/AIDS’’; and

(2) in paragraph (3), by striking ‘‘or underserved communities’’ and inserting ‘‘areas or to underserved populations’’.

SEC. 303. AUTHORIZATION OF APPROPRIATIONS.

Section 2655 of the Public Health Service Act (42 U.S.C. 300ff–

55) is amended by striking ‘‘such sums’’ and all that follows through

‘‘2005’’ and inserting ‘‘, $218,600,000 for fiscal year 2007,

$226,700,000 for fiscal year 2008, and $235,100,000 for fiscal year

2009’’.

SEC. 304. CONFIDENTIALITY AND INFORMED CONSENT.

Section 2661 of the Public Health Service Act (42 U.S.C. 300ff–

61) is amended to read as follows:

‘‘SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT.

‘‘(a) CONFIDENTIALITY.—The Secretary may not make a grant

under this part unless, in the case of any entity applying for

a grant under section 2651, the entity agrees to ensure that information regarding the receipt of early intervention services pursuant

to the grant is maintained confidentially in a manner not inconsistent with applicable law.

‘‘(b) INFORMED CONSENT.—The Secretary may not make a grant

under this part unless the applicant for the grant agrees that,

in testing an individual for HIV/AIDS, the applicant will test an

individual only after the individual confirms that the decision of

the individual with respect to undergoing such testing is voluntarily

made.’’.

SEC. 305. PROVISION OF CERTAIN COUNSELING SERVICES.

Section 2662 of the Public Health Service Act (42 U.S.C. 300ff–

62) is amended to read as follows:

‘‘SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.

‘‘(a) COUNSELING OF INDIVIDUALS WITH NEGATIVE TEST

RESULTS.—The Secretary may not make a grant under this part

unless the applicant for the grant agrees that, if the results of

testing conducted for HIV/AIDS indicate that an individual does

not have such condition, the applicant will provide the individual

information, including—

‘‘(1) measures for prevention of, exposure to, and transmission of HIV/AIDS, hepatitis B, hepatitis C, and other sexually transmitted diseases;

‘‘(2) the accuracy and reliability of results of testing for

HIV/AIDS, hepatitis B, and hepatitis C;

‘‘(3) the significance of the results of such testing, including

the potential for developing AIDS, hepatitis B, or hepatitis

C;

‘‘(4) the appropriateness of further counseling, testing, and

education of the individual regarding HIV/AIDS and other sexually transmitted diseases;

120 STAT. 2808 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(5) if diagnosed with chronic hepatitis B or hepatitis C

co-infection, the potential of developing hepatitis-related liver

disease and its impact on HIV/AIDS; and

‘‘(6) information regarding the availability of hepatitis B

vaccine and information about hepatitis treatments.

‘‘(b) COUNSELING OF INDIVIDUALS WITH POSITIVE TEST

RESULTS.—The Secretary may not make a grant under this part

unless the applicant for the grant agrees that, if the results of

testing for HIV/AIDS indicate that the individual has such condition, the applicant will provide to the individual appropriate counseling regarding the condition, including—

‘‘(1) information regarding—

‘‘(A) measures for prevention of, exposure to, and transmission of HIV/AIDS, hepatitis B, and hepatitis C;

‘‘(B) the accuracy and reliability of results of testing

for HIV/AIDS, hepatitis B, and hepatitis C; and

‘‘(C) the significance of the results of such testing,

including the potential for developing AIDS, hepatitis B,

or hepatitis C;

‘‘(2) reviewing the appropriateness of further counseling,

testing, and education of the individual regarding HIV/AIDS

and other sexually transmitted diseases; and

‘‘(3) providing counseling—

‘‘(A) on the availability, through the applicant, of early

intervention services;

‘‘(B) on the availability in the geographic area of appropriate health care, mental health care, and social and support services, including providing referrals for such services, as appropriate;

‘‘(C)(i) that explains the benefits of locating and counseling any individual by whom the infected individual may

have been exposed to HIV/AIDS, hepatitis B, or hepatitis

C and any individual whom the infected individual may

have exposed to HIV/AIDS, hepatitis B, or hepatitis C;

and

‘‘(ii) that emphasizes it is the duty of infected individuals to disclose their infected status to their sexual partners

and their partners in the sharing of hypodermic needles;

that provides advice to infected individuals on the manner

in which such disclosures can be made; and that emphasizes that it is the continuing duty of the individuals to

avoid any behaviors that will expose others to HIV/AIDS,

hepatitis B, or hepatitis C; and

‘‘(D) on the availability of the services of public health

authorities with respect to locating and counseling any

individual described in subparagraph (C);

‘‘(4) if diagnosed with chronic hepatitis B or hepatitis C

co-infection, the potential of developing hepatitis-related liver

disease and its impact on HIV/AIDS; and

‘‘(5) information regarding the availability of hepatitis B

vaccine.

‘‘(c) ADDITIONAL REQUIREMENTS REGARDING APPROPRIATE

COUNSELING.—The Secretary may not make a grant under this

part unless the applicant for the grant agrees that, in counseling

individuals with respect to HIV/AIDS, the applicant will ensure

that the counseling is provided under conditions appropriate to

the needs of the individuals.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2809

‘‘(d) COUNSELING OF EMERGENCY RESPONSE EMPLOYEES.—The

Secretary may not make a grant under this part to a State unless

the State agrees that, in counseling individuals with respect to

HIV/AIDS, the State will ensure that, in the case of emergency

response employees, the counseling is provided to such employees

under conditions appropriate to the needs of the employees

regarding the counseling.

‘‘(e) RULE OF CONSTRUCTION REGARDING COUNSELING WITHOUT

TESTING.—Agreements made pursuant to this section may not be

construed to prohibit any grantee under this part from expending

the grant for the purpose of providing counseling services described

in this section to an individual who does not undergo testing for

HIV/AIDS as a result of the grantee or the individual determining

that such testing of the individual is not appropriate.’’.

SEC. 306. GENERAL PROVISIONS.

(a) APPLICABILITY OF CERTAIN REQUIREMENTS.—Section 2663

of the Public Health Service Act (42 U.S.C. 300ff–63) is amended

by striking ‘‘will, without’’ and all that follows through ‘‘be carried’’

and inserting ‘‘with funds appropriated through this Act will be

carried’’.

(b) ADDITIONAL REQUIRED AGREEMENTS.—Section 2664(a) of the

Public Health Service Act (42 U.S.C. 300ff–64(a)) is amended—

(1) in paragraph (1)—

(A) in subparagraph (A), by striking ‘‘and’’ at the end;

(B) in subparagraph (B), by striking ‘‘and’’ at the end;

and

(C) by adding at the end the following:

‘‘(C) information regarding how the expected expenditures of the grant are related to the planning process

for localities funded under part A (including the planning

process described in section 2602) and for States funded

under part B (including the planning process described

in section 2617(b)); and

‘‘(D) a specification of the expected expenditures and

how those expenditures will improve overall client outcomes, as described in the State plan under section

2617(b);’’;

(2) in paragraph (2), by striking the period and inserting

a semicolon; and

(3) by adding at the end the following:

‘‘(3) the applicant agrees to provide additional documentation to the Secretary regarding the process used to obtain

community input into the design and implementation of activities related to such grant; and

‘‘(4) the applicant agrees to submit, every 2 years, to the

lead State agency under section 2617(b)(4) audits, consistent

with Office of Management and Budget circular A133, regarding

funds expended in accordance with this title and shall include

necessary client level data to complete unmet need calculations

and Statewide coordinated statements of need process.’’.

(c) PAYER OF LAST RESORT.—Section 2664(f)(1)(A) of the Public

Health Service Act (42 U.S.C. 300ff–64(f)(1)(A)) is amended by

inserting ‘‘(except for a program administered by or providing the

services of the Indian Health Service)’’ before the semicolon.

120 STAT. 2810 PUBLIC LAW 109–415—DEC. 19, 2006

TITLE IV—WOMEN, INFANTS,

CHILDREN, AND YOUTH

SEC. 401. WOMEN, INFANTS, CHILDREN, AND YOUTH.

Part D of title XXVI of the Public Health Service Act (42

U.S.C. 300ff–71 et seq.) is amended to read as follows:

‘‘PART D—WOMEN, INFANTS, CHILDREN, AND

YOUTH

‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO

RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND

YOUTH.

‘‘(a) IN GENERAL.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall

award grants to public and nonprofit private entities (including

a health facility operated by or pursuant to a contract with the

Indian Health Service) for the purpose of providing family-centered

care involving outpatient or ambulatory care (directly or through

contracts) for women, infants, children, and youth with HIV/AIDS.

‘‘(b) ADDITIONAL SERVICES FOR PATIENTS AND FAMILIES.—Funds

provided under grants awarded under subsection (a) may be used

for the following support services:

‘‘(1) Family-centered care including case management.

‘‘(2) Referrals for additional services including—

‘‘(A) referrals for inpatient hospital services, treatment

for substance abuse, and mental health services; and

‘‘(B) referrals for other social and support services,

as appropriate.

‘‘(3) Additional services necessary to enable the patient

and the family to participate in the program established by

the applicant pursuant to such subsection including services

designed to recruit and retain youth with HIV.

‘‘(4) The provision of information and education on

opportunities to participate in HIV/AIDS-related clinical

research.

‘‘(c) COORDINATION WITH OTHER ENTITIES.—A grant awarded

under subsection (a) may be made only if the applicant provides

an agreement that includes the following:

‘‘(1) The applicant will coordinate activities under the grant

with other providers of health care services under this Act,

and under title V of the Social Security Act, including programs

promoting the reduction and elimination of risk of HIV/AIDS

for youth.

‘‘(2) The applicant will participate in the statewide coordinated statement of need under part B (where it has been

initiated by the public health agency responsible for administering grants under part B) and in revisions of such statement.

‘‘(3) The applicant will every 2 years submit to the lead

State agency under section 2617(b)(4) audits regarding funds

expended in accordance with this title and shall include necessary client-level data to complete unmet need calculations

and Statewide coordinated statements of need process.

Deadline.

Audits.

42 USC 300ff–71.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2811

‘‘(d) ADMINISTRATION; APPLICATION.—A grant may only be

awarded to an entity under subsection (a) if an application for

the grant is submitted to the Secretary and the application is

in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines

to be necessary to carry out this section. Such application shall

include the following:

‘‘(1) Information regarding how the expected expenditures

of the grant are related to the planning process for localities

funded under part A (including the planning process outlined

in section 2602) and for States funded under part B (including

the planning process outlined in section 2617(b)).

‘‘(2) A specification of the expected expenditures and how

those expenditures will improve overall patient outcomes, as

outlined as part of the State plan (under section 2617(b)) or

through additional outcome measures.

‘‘(e) ANNUAL REVIEW OF PROGRAMS; EVALUATIONS.—

‘‘(1) REVIEW REGARDING ACCESS TO AND PARTICIPATION IN

PROGRAMS.—With respect to a grant under subsection (a) for

an entity for a fiscal year, the Secretary shall, not later than

180 days after the end of the fiscal year, provide for the conduct

and completion of a review of the operation during the year

of the program carried out under such subsection by the entity.

The purpose of such review shall be the development of recommendations, as appropriate, for improvements in the following:

‘‘(A) Procedures used by the entity to allocate

opportunities and services under subsection (a) among

patients of the entity who are women, infants, children,

or youth.

‘‘(B) Other procedures or policies of the entity regarding

the participation of such individuals in such program.

‘‘(2) EVALUATIONS.——The Secretary shall, directly or

through contracts with public and private entities, provide for

evaluations of programs carried out pursuant to subsection

(a).

‘‘(f) ADMINISTRATIVE EXPENSES.—

‘‘(1) LIMITATION.—A grantee may not use more than 10

percent of amounts received under a grant awarded under

this section for administrative expenses.

‘‘(2) CLINICAL QUALITY MANAGEMENT PROGRAM.—A grantee

under this section shall implement 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.

‘‘(g) TRAINING AND TECHNICAL ASSISTANCE.—From the amounts

appropriated under subsection (i) for a fiscal year, the Secretary

may use not more than 5 percent to provide, directly or through

contracts with public and private entities (which may include

grantees under subsection (a)), training and technical assistance

to assist applicants and grantees under subsection (a) in complying

with the requirements of this section.

‘‘(h) DEFINITIONS.—In this section:

Contracts.

Deadline.

120 STAT. 2812 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(1) ADMINISTRATIVE EXPENSES.—The term ‘administrative

expenses’ means funds that are to be used by grantees for

grant management and monitoring activities, including costs

related to any staff or activity unrelated to services or indirect

costs.

‘‘(2) INDIRECT COSTS.—The term ‘indirect costs’ means costs

included in a Federally negotiated indirect rate.

‘‘(3) SERVICES.—The term ‘services’ means—

‘‘(A) services that are provided to clients to meet the

goals and objectives of the program under this section,

including the provision of professional, diagnostic, and

therapeutic services by a primary care provider or a referral

to and provision of specialty care; and

‘‘(B) services that sustain program activity and contribute to or help improve services under subparagraph

(A).

‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

carrying out this section, there are authorized to be appropriated,

$71,800,000 for each of the fiscal years 2007 through 2009.’’.

SEC. 402. GAO REPORT.

Not later than 24 months after the date of enactment of this

Act, the Comptroller General of the Government Accountability

Office shall conduct an evaluation, and submit to Congress a report,

concerning the funding provided for under part D of title XXVI

of the Public Health Service Act to determine—

(1) how funds are used to provide the administrative

expenses, indirect costs, and services, as defined in section

2671(h) of such title, for individuals with HIV/AIDS;

(2) how funds are used to provide the administrative

expenses, indirect costs, and services, as defined in section

2671(h) of such title, to family members of women, infants,

children, and youth infected with HIV/AIDS;

(3) how funds are used to provide family-centered care

involving outpatient or ambulatory care authorized under section 2671(a) of such title;

(4) how funds are used to provide additional services

authorized under section 2671(b) of such title; and

(5) how funds are used to help identify HIV-positive pregnant women and their children who are exposed to HIV and

connect them with care that can improve their health and

prevent perinatal transmission.

TITLE V—GENERAL PROVISIONS

SEC. 501. GENERAL PROVISIONS.

Part E of title XXVI of the Public Health Service Act (42

U.S.C. 300ff–80 et seq.) is amended to read as follows:

‘‘PART E—GENERAL PROVISIONS

‘‘SEC. 2681. COORDINATION.

‘‘(a) REQUIREMENT.—The Secretary shall ensure that the Health

Resources and Services Administration, the Centers for Disease

Control and Prevention, the Substance Abuse and Mental Health

Services Administration, and the Centers for Medicare & Medicaid

42 USC 300ff–81.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2813

Services coordinate the planning, funding, and implementation of

Federal HIV programs (including all minority AIDS initiatives of

the Public Health Service, including under section 2693) to enhance

the continuity of care and prevention services for individuals with

HIV/AIDS or those at risk of such disease. The Secretary shall

consult with other Federal agencies, including the Department of

Veterans Affairs, as needed and utilize planning information submitted to such agencies by the States and entities eligible for

assistance under this title.

‘‘(b) REPORT.—The Secretary shall biennially prepare and

submit to the appropriate committees of the Congress a report

concerning the coordination efforts at the Federal, State, and local

levels described in this section, including a description of Federal

barriers to HIV program integration and a strategy for eliminating

such barriers and enhancing the continuity of care and prevention

services for individuals with HIV/AIDS or those at risk of such

disease.

‘‘(c) INTEGRATION BY STATE.—As a condition of receipt of funds

under this title, a State shall provide assurances to the Secretary

that health support services funded under this title will be

integrated with other such services, that programs will be coordinated with other available programs (including Medicaid), and that

the continuity of care and prevention services of individuals with

HIV/AIDS is enhanced.

‘‘(d) INTEGRATION BY LOCAL OR PRIVATE ENTITIES.—As a condition of receipt of funds under this title, a local government or

private nonprofit entity shall provide assurances to the Secretary

that services funded under this title will be integrated with other

such services, that programs will be coordinated with other available programs (including Medicaid), and that the continuity of

care and prevention services of individuals with HIV is enhanced.

‘‘SEC. 2682. AUDITS.

‘‘(a) IN GENERAL.—For fiscal year 2009, and each subsequent

fiscal year, the Secretary may reduce the amounts of grants under

this title to a State or political subdivision of a State for a fiscal

year if, with respect to such grants for the second preceding fiscal

year, the State or subdivision fails to prepare audits in accordance

with the procedures of section 7502 of title 31, United States Code.

The Secretary shall annually select representative samples of such

audits, prepare summaries of the selected audits, and submit the

summaries to the Congress.

‘‘(b) POSTING ON THE INTERNET.—All audits that the Secretary

receives from the State lead agency under section 2617(b)(4) shall

be posted, in their entirety, on the Internet website of the Health

Resources and Services Administration.

‘‘SEC. 2683. PUBLIC HEALTH EMERGENCY.

‘‘(a) IN GENERAL.—In an emergency area and during an emergency period, the Secretary shall have the authority to waive such

requirements of this title to improve the health and safety of

those receiving care under this title and the general public, except

that the Secretary may not expend more than 5 percent of the

funds allocated under this title for sections 2620 and section 2603(b).

‘‘(b) EMERGENCY AREA AND EMERGENCY PERIOD.—In this section:

‘‘(1) EMERGENCY AREA.—The term ‘emergency area’ means

a geographic area in which there exists—

42 USC 300ff–83.

Effective date.

42 USC 300ff–82.

120 STAT. 2814 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(A) an emergency or disaster declared by the President

pursuant to the National Emergencies Act or the Robert

T. Stafford Disaster Relief and Emergency Assistance Act;

or

‘‘(B) a public health emergency declared by the Secretary pursuant to section 319.

‘‘(2) EMERGENCY PERIOD.—The term ‘emergency period’

means the period in which there exists—

‘‘(A) an emergency or disaster declared by the President

pursuant to the National Emergencies Act or the Robert

T. Stafford Disaster Relief and Emergency Assistance Act;

or

‘‘(B) a public health emergency declared by the Secretary pursuant to section 319.

‘‘(c) UNOBLIGATED FUNDS.—If funds under a grant under this

section are not expended for an emergency in the fiscal year in

which the emergency is declared, such funds shall be returned

to the Secretary for reallocation under sections 2603(b) and 2620.

‘‘SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

‘‘None of the funds appropriated under this title shall be used

to fund AIDS programs, or to develop materials, designed to promote

or encourage, directly, intravenous drug use or sexual activity,

whether homosexual or heterosexual. Funds authorized under this

title may be used to provide medical treatment and support services

for individuals with HIV.

‘‘SEC. 2685. PRIVACY PROTECTIONS.

‘‘(a) IN GENERAL.—The Secretary shall ensure that any information submitted to, or collected by, the Secretary under this title

excludes any personally identifiable information.

‘‘(b) DEFINITION.—In this section, the term ‘personally identifiable information’ has the meaning given such term under the regulations promulgated under section 264(c) of the Health Insurance

Portability and Accountability Act of 1996.

‘‘SEC. 2686. GAO REPORT.

‘‘The Comptroller General of the Government Accountability

Office shall biennially submit to the appropriate committees of

Congress a report that includes a description of Federal, State,

and local barriers to HIV program integration, particularly for

racial and ethnic minorities, including activities carried out under

subpart III of part F, and recommendations for enhancing the

continuity of care and the provision of prevention services for

individuals with HIV/AIDS or those at risk for such disease. Such

report shall include a demonstration of the manner in which funds

under this subpart are being expended and to what extent the

services provided with such funds increase access to prevention

and care services for individuals with HIV/AIDS and build stronger

community linkages to address HIV prevention and care for racial

and ethnic minority communities.

‘‘SEC. 2687. SEVERITY OF NEED INDEX.

‘‘(a) DEVELOPMENT OF INDEX.—Not later than September 30,

2008, the Secretary shall develop and submit to the appropriate

committees of Congress a severity of need index in accordance

with subsection (c).

Deadline.

42 USC 300ff–87.

42 USC 300ff–86.

42 USC 300ff–85.

42 USC 300ff–84.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2815

‘‘(b) DEFINITION OF SEVERITY OF NEED INDEX.—In this section,

the term ‘severity of need index’ means the index of the relative

needs of individuals within a State or area, as identified by a

number of different factors, and is a factor or set of factors that

is multiplied by the number of living HIV/AIDS cases in a State

or area, providing different weights to those cases based on needs.

Such factors or set of factors may be different for different components of the provisions under this title.

‘‘(c) REQUIREMENTS FOR SECRETARIAL SUBMISSION.—When the

Secretary submits to the appropriate committees of Congress the

severity of need index under subsection (a), the Secretary shall

provide the following:

‘‘(1) Methodology for and rationale behind developing the

severity of need index, including information related to the

field testing of the severity of need index.

‘‘(2) An independent contractor analysis of activities carried

out under paragraph (1).

‘‘(3) Information regarding the process by which the Secretary received community input regarding the application and

development of the severity of need index.

‘‘(d) ANNUAL REPORTS.—If the Secretary fails to submit the

severity of need index under subsection (a) in either of fiscal years

2007 or 2008, the Secretary shall prepare and submit to the appropriate committees of Congress a report for such fiscal year—

‘‘(1) that updates progress toward having client level data;

‘‘(2) that updates the progress toward having a severity

of need index, including information related to the methodology

and process for obtaining community input; and

‘‘(3) that, as applicable, states whether the Secretary could

develop a severity of need index before fiscal year 2009.

‘‘SEC. 2688. DEFINITIONS.

‘‘For purposes of this title:

‘‘(1) AIDS.—The term ‘AIDS’ means acquired immune deficiency syndrome.

‘‘(2) CO-OCCURRING CONDITIONS.—The term ‘co-occurring

conditions’ means one or more adverse health conditions in

an individual with HIV/AIDS, without regard to whether the

individual has AIDS and without regard to whether the conditions arise from HIV.

‘‘(3) COUNSELING.—The term ‘counseling’ means such counseling provided by an individual trained to provide such counseling.

‘‘(4) FAMILY-CENTERED CARE.—The term ‘family-centered

care’ means the system of services described in this title that

is targeted specifically to the special needs of infants, children,

women and families. Family-centered care shall be based on

a partnership between parents, professionals, and the community designed to ensure an integrated, coordinated, culturally

sensitive, and community-based continuum of care for children,

women, and families with HIV/AIDS.

‘‘(5) FAMILIES WITH HIV/AIDS.—The term ‘families with HIV/

AIDS’ means families in which one or more members have

HIV/AIDS.

‘‘(6) HIV.—The term ‘HIV’ means infection with the human

immunodeficiency virus.

‘‘(7) HIV/AIDS.—

42 USC 300ff–88.

120 STAT. 2816 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(A) IN GENERAL.—The term ‘HIV/AIDS’ means HIV,

and includes AIDS and any condition arising from AIDS.

‘‘(B) COUNTING OF CASES.—The term ‘living cases of

HIV/AIDS’, with respect to the counting of cases in a

geographic area during a period of time, means the sum

of—

‘‘(i) the number of living non-AIDS cases of HIV

in the area; and

‘‘(ii) the number of living cases of AIDS in the

area.

‘‘(C) NON-AIDS CASES.—The term ‘non-AIDS’, with

respect to a case of HIV, means that the individual involved

has HIV but does not have AIDS.

‘‘(8) HUMAN IMMUNODEFICIENCY VIRUS.—The term ‘human

immunodeficiency virus’ means the etiologic agent for AIDS.

‘‘(9) OFFICIAL POVERTY LINE.—The term ‘official poverty

line’ means the poverty line established by the Director of

the Office of Management and Budget and revised by the

Secretary in accordance with section 673(2) of the Omnibus

Budget Reconciliation Act of 1981.

‘‘(10) PERSON.—The term ‘person’ includes one or more

individuals, governments (including the Federal Government

and the governments of the States), governmental agencies,

political subdivisions, labor unions, partnerships, associations,

corporations, legal representatives, mutual companies, jointstock companies, trusts, unincorporated organizations,

receivers, trustees, and trustees in cases under title 11, United

States Code.

‘‘(11) STATE.—

‘‘(A) IN GENERAL.—The term ‘State’ means each of the

50 States, the District of Columbia, and each of the territories.

‘‘(B) TERRITORIES.—The term ‘territory’ means each of

American Samoa, Guam, the Commonwealth of Puerto

Rico, the Commonwealth of the Northern Mariana Islands,

the Virgin Islands, the Republic of the Marshall Islands,

the Federated States of Micronesia, and Palau.

‘‘(12) YOUTH WITH HIV.—The term ‘youth with HIV’ means

individuals who are 13 through 24 years old and who have

HIV/AIDS.’’.

TITLE VI—DEMONSTRATION AND

TRAINING

SEC. 601. DEMONSTRATION AND TRAINING.

Subpart I of part F of title XXVI of the Public Health Service

Act (42 U.S.C. 300ff–101 et seq.) is amended to read as follows:

‘‘Subpart I—Special Projects of National

Significance

‘‘SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

‘‘(a) IN GENERAL.—Of the amount appropriated under each

of parts A, B, C, and D for each fiscal year, the Secretary shall

use the greater of $20,000,000 or an amount equal to 3 percent

42 USC

300ff–101.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2817

of such amount appropriated under each such part, but not to

exceed $25,000,000, to administer special projects of national significance to—

‘‘(1) quickly respond to emerging needs of individuals

receiving assistance under this title; and

‘‘(2) to fund special programs to develop a standard electronic client information data system to improve the ability

of grantees under this title to report client-level data to the

Secretary.

‘‘(b) GRANTS.—The Secretary shall award grants under subsection (a) to entities eligible for funding under parts A, B, C,

and D based on—

‘‘(1) whether the funding will promote obtaining client level

data as it relates to the creation of a severity of need index,

including funds to facilitate the purchase and enhance the

utilization of qualified health information technology systems;

‘‘(2) demonstrated ability to create and maintain a qualified

health information technology system;

‘‘(3) the potential replicability of the proposed activity in

other similar localities or nationally;

‘‘(4) the demonstrated reliability of the proposed qualified

health information technology system across a variety of providers, geographic regions, and clients; and

‘‘(5) the demonstrated ability to maintain a safe and secure

qualified health information system; or

‘‘(6) newly emerging needs of individuals receiving assistance under this title.

‘‘(c) COORDINATION.—The Secretary may not make a grant

under this section unless the applicant submits evidence that the

proposed program is consistent with the statewide coordinated

statement of need, and the applicant agrees to participate in the

ongoing revision process of such statement of need.

‘‘(d) PRIVACY PROTECTION.—The Secretary may not make a

grant under this section for the development of a qualified health

information technology system unless the applicant provides assurances to the Secretary that the system will, at a minimum, comply

with the privacy regulations promulgated under section 264(c) of

the Health Insurance Portability and Accountability Act of 1996.

‘‘(e) REPLICATION.—The Secretary shall make information concerning successful models or programs developed under this part

available to grantees under this title for the purpose of coordination,

replication, and integration. To facilitate efforts under this subsection, the Secretary may provide for peer-based technical assistance for grantees funded under this part.’’.

SEC. 602. AIDS EDUCATION AND TRAINING CENTERS.

(a) AMENDMENTS REGARDING SCHOOLS AND CENTERS.—Section

2692(a)(2) of the Public Health Service Act (42 U.S.C. 300ff–

111(a)(2)) is amended—

(1) in subparagraph (A)—

(A) by inserting ‘‘and Native Americans’’ after

‘‘minority individuals’’; and

(B) by striking ‘‘and’’ at the end;

(2) in subparagraph (B), by striking the period and

inserting ‘‘; and’’; and

(3) by adding at the end the following:

120 STAT. 2818 PUBLIC LAW 109–415—DEC. 19, 2006

‘‘(C) train or result in the training of health professionals and allied health professionals to provide treatment

for hepatitis B or C co-infected individuals.’’.

(b) AUTHORIZATIONS OF APPROPRIATIONS FOR SCHOOLS, CEN- TERS, AND DENTAL PROGRAMS.—Section 2692(c) of the Public Health

Service Act (42 U.S.C. 300ff–111(c)) is amended to read as follows:

‘‘(c) AUTHORIZATION OF APPROPRIATIONS.— ‘‘(1) SCHOOLS; CENTERS.—For the purpose of awarding

grants under subsection (a), there is authorized to be appropriated $34,700,000 for each of the fiscal years 2007 through

2009.

‘‘(2) DENTAL SCHOOLS.—For the purpose of awarding grants

under subsection (b), there is authorized to be appropriated

$13,000,000 for each of the fiscal years 2007 through 2009.’’.

SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE.

Part F of title XXVI of the Public Health Service Act (42

U.S.C. 300ff–101 et seq.) is amended by adding at the end the

following:

‘‘Subpart III—Minority AIDS Initiative

‘‘SEC. 2693. MINORITY AIDS INITIATIVE.

‘‘(a) IN GENERAL.—For the purpose of carrying out activities

under this section to evaluate and address the disproportionate

impact of HIV/AIDS on, and the disparities in access, treatment,

care, and outcomes for, racial and ethnic minorities (including African Americans, Alaska Natives, Latinos, American Indians, Asian

Americans, Native Hawaiians, and Pacific Islanders), there are

authorized to be appropriated $131,200,000 for fiscal year 2007,

$135,100,000 for fiscal year 2008, and $139,100,000 for fiscal year

2009.

‘‘(b) CERTAIN ACTIVITIES.—

‘‘(1) IN GENERAL.—In carrying out the purpose described

in subsection (a), the Secretary shall provide for—

‘‘(A) emergency assistance under part A;

‘‘(B) care grants under part B;

‘‘(C) early intervention services under part C;

‘‘(D) services through projects for HIV-related care

under part D; and

‘‘(E) activities through education and training centers

under section 2692.

‘‘(2) ALLOCATIONS AMONG ACTIVITIES.—Activities under

paragraph (1) shall be carried out by the Secretary in accordance with the following:

‘‘(A) For competitive, supplemental grants to improve

HIV-related health outcomes to reduce existing racial and

ethnic health disparities, the Secretary shall, of the amount

appropriated under subsection (a) for a fiscal year, reserve

the following, as applicable:

‘‘(i) For fiscal year 2007, $43,800,000.

‘‘(ii) For fiscal year 2008, $45,400,000.

‘‘(iii) For fiscal year 2009, $47,100,000.

‘‘(B) For competitive grants used for supplemental support education and outreach services to increase the

number of eligible racial and ethnic minorities who have

access to treatment through the program under section

42 USC

300ff–121.

PUBLIC LAW 109–415—DEC. 19, 2006 120 STAT. 2819

2616 for therapeutics, the Secretary shall, of the amount

appropriated for a fiscal year under subsection (a), reserve

the following, as applicable:

‘‘(i) For fiscal year 2007, $7,000,000.

‘‘(ii) For fiscal year 2008, $7,300,000.

‘‘(iii) For fiscal year 2009, $7,500,000.

‘‘(C) For planning grants, capacity-building grants, and

services grants to health care providers who have a history

of providing culturally and linguistically appropriate care

and services to racial and ethnic minorities, the Secretary

shall, of the amount appropriated for a fiscal year under

subsection (a), reserve the following, as applicable:

‘‘(i) For fiscal year 2007, $53,400,000.

‘‘(ii) For fiscal year 2008, $55,400,000.

‘‘(iii) For fiscal year 2009, $57,400,000.

‘‘(D) For eliminating racial and ethnic disparities in

the delivery of comprehensive, culturally and linguistically

appropriate care services for HIV disease for women,

infants, children, and youth, the Secretary shall, of the

amount appropriated under subsection (a), reserve

$18,500,000 for each of the fiscal years 2007 through 2009.

‘‘(E) For increasing the training capacity of centers

to expand the number of health care professionals with

treatment expertise and knowledge about the most appropriate standards of HIV disease-related treatments and

medical care for racial and ethnic minority adults, adolescents, and children with HIV disease, the Secretary shall,

of the amount appropriated under subsection (a), reserve

$8,500,000 for each of the fiscal years 2007 through 2009.

‘‘(c) CONSISTENCY WITH PRIOR PROGRAM.—With respect to the

purpose described in subsection (a), the Secretary shall carry out

this section consistent with the activities carried out under this

title by the Secretary pursuant to the Departments of Labor, Health

and Human Services, and Education, and Related Agencies Appropriations Act, 2002 (Public Law 107–116).’’.

TITLE VII—MISCELLANEOUS

PROVISIONS

SEC. 701. HEPATITIS; USE OF FUNDS.

Section 2667 of the Public Health Service Act (42 U.S.C. 300ff–

67) is amended—

(1) in paragraph (2), by striking ‘‘and’’ at the end;

(2) in paragraph (3), by striking the period and inserting

‘‘; and’’; and

(3) by adding at the end the following:

‘‘(4) shall provide information on the transmission and

prevention of hepatitis A, B, and C, including education about

the availability of hepatitis A and B vaccines and assisting

patients in identifying vaccination sites.’’.

SEC. 702. CERTAIN REFERENCES.

Title XXVI of the Public Health Service Act (42 U.S.C. 300ff

et seq.) is amended—

120 STAT. 2820 PUBLIC LAW 109–415—DEC. 19, 2006

LEGISLATIVE HISTORY—H.R. 6143:

HOUSE REPORTS: No. 109–695 (Comm. on Energy and Commerce).

CONGRESSIONAL RECORD, Vol. 152 (2006):

Sept. 28, considered and passed House.

Dec. 6, considered and passed Senate, amended.

Dec. 8, House concurred in Senate amendment.

Æ

(1) by striking ‘‘acquired immune deficiency syndrome’’ each

place such term appears, other than in section 2687(1) (as

added by section 501 of this Act), and inserting ‘‘AIDS’’;

(2) by striking ‘‘such syndrome’’ and inserting ‘‘AIDS’’; and

(3) by striking ‘‘HIV disease’’ each place such term appears

and inserting ‘‘HIV/AIDS’’.

SEC. 703. REPEAL.

Effective on October 1, 2009, title XXVI of the Public Health

Service Act (42 U.S.C. 300ff et seq.) is repealed.

Approved December 19, 2006.

Effective date.

42 USC 300ff–11

et seq.

42 USC 300ff–12

et seq.

42 USC 300ff–11,

300ff–28.