II 

109TH CONGRESS 

2D SESSION S. 2339 

To reauthorize the HIV Health Care Services Program under title 26 of 

the Public Health Service Act. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 28, 2006 

Mr. COBURN introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To reauthorize the HIV Health Care Services Program under 

title 26 of the Public Health Service Act. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Ryan White CARE 

5 Act Amendments of 2006’’. 

6 SEC. 2. REAUTHORIZATION OF APPROPRIATIONS. 

7 Title XXVI of the Public Health Service Act (42 

8 U.S.C. 300ff–11 et seq.) is amended— 

9 (1) in section 2677— 
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1 (A) in subsection (a), by striking ‘‘2001 

2 through 2005’’ and inserting ‘‘2006 through 

3 2010’’; and 

4 (B) in subsection (b), by striking ‘‘2001 

5 through 2005’’ and inserting ‘‘2006 through 

6 2010’’; 

7 (2) in section 2625(c)(2)(A), by striking ‘‘2001 

8 through 2005’’ and inserting ‘‘2006 through 2010’’; 

9 (3) in section 2631(d), by striking ‘‘2005’’ and 

10 inserting ‘‘2010’’; 

11 (4) in section 2655, by striking ‘‘2001 through 

12 2005’’ and inserting ‘‘2006 through 2010’’; 

13 (5) in section 2671(l), as redesignated by sec14 tion 4(d)(1) of this Act, by striking ‘‘for each of’’ 

15 and all that follows through the period and inserting 

16 ‘‘for each of the fiscal years 2006 through 2010.’’; 

17 and 

18 (6) in section 2692(c)— 

19 (A) in paragraph (1), by striking ‘‘2001 

20 through 2005’’ and inserting ‘‘2006 through 

21 2010’’; and 

22 (B) in paragraph (2)— 

23 (i) in subparagraph (A), by striking 

24 ‘‘2001 through 2005’’ and inserting ‘‘2006 

25 through 2010’’; and 
3 

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1 (ii) in subparagraph (B), by striking 

2 ‘‘2001 through 2005’’ and inserting ‘‘2006 

3 through 2010’’. 

4 SEC. 3. DEFINITIONS. 

5 Section 2676 of the Public Health Service Act (42 

6 U.S.C. 300ff–76) is amended— 

7 (1) by redesignating paragraphs (11) and (12), 

8 as paragraphs (12) and (15), respectively; 

9 (2) by inserting after paragraph (10) the fol10 lowing: 

11 ‘‘(11) PARTNER NOTIFICATION.—The term 

12 ‘partner notification’ means the process by which— 

13 ‘‘(A) an HIV-positive individual provides 

14 the names of such individual’s sex and needle15 sharing partners to health care providers or 

16 other health workers, who then confidentially 

17 notify the partners directly of the partners’ ex18 posure to HIV; and 

19 ‘‘(B) current and past partners of an HIV20 positive individual (index person) are confiden21 tially notified of the partners’ exposure to HIV, 

22 counseled about the partners’ exposure, and of23 fered services, including testing, referrals for 

24 treatment, and notification of the partners’ sex 

25 and needle-sharing partners.’’; and 
4 

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1 (3) by inserting after paragraph (12) (as redes2 ignated by paragraph (1)) the following: 

3 ‘‘(13) PRIMARY MEDICAL CARE.—The term 

4 ‘primary medical care’ means medical care that con5 sists of medication, prescription drugs, diagnostic 

6 tests, visits with physicians and medically 

7 credentialed health care providers, treatment for oral 

8 health, treatment for psychiatric conditions, and 

9 treatment for other health care conditions directly 

10 related to HIV/AIDS infection, as well as the cost 

11 of health insurance premiums, co-payments, and 

12 deductibles. Such term does not include case man13 agement for non-medical services or short-term tran14 sitional housing. 

15 ‘‘(14) ROUTINE TESTING.—The term ‘routine 

16 testing’ means HIV testing— 

17 ‘‘(A) that is administered automatically to 

18 those accessing health care services for any rea19 son; and 

20 ‘‘(B) in which— 

21 ‘‘(i) pre-test counseling is not required 

22 but the subject is notified that the subject 

23 will receive an HIV test and the subject 

24 may opt out of such testing; and 
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1 ‘‘(ii) for those individuals with a posi2 tive test result, post-test counseling, in3 cluding referrals to care, is provided and 

4 confidentiality is protected.’’. 

5 SEC. 4. FUNDING FOR PRIMARY MEDICAL CARE. 

6 (a) PART A.—Section 2604 of the Public Health 

7 Service Act (42 U.S.C. 300ff–14) is amended by adding 

8 at the end the following: 

9 ‘‘(h) REQUIRED FUNDING FOR PRIMARY MEDICAL

10 CARE.—Notwithstanding any other provision of law, a 

11 grantee under this part shall expend not less than 75 per12 cent of the funds received under the grant on primary 

13 medical care.’’. 

14 (b) PART B.—Section 2612 of the Public Health 

15 Service Act (42 U.S.C. 300ff–22) is amended by adding 

16 at the end the following: 

17 ‘‘(e) REQUIRED FUNDING FOR PRIMARY MEDICAL

18 CARE.—Notwithstanding any other provision of law, a 

19 grantee under this part shall expend not less than 75 per20 cent of the funds received under the grant on primary 

21 medical care.’’. 

22 (c) PART C.—Subpart II of part C of title XXVI of 

23 the Public Health Service Act (42 U.S.C. 300ff–61 et 

24 seq.) is amended by adding at the end the following: 
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1 ‘‘SEC. 2668. REQUIRED FUNDING FOR PRIMARY MEDICAL 

2 CARE. 

3 ‘‘Notwithstanding any other provision of law, a grant4 ee under this part shall expend not less than 75 percent 

5 of the funds received under the grant on primary medical 

6 care. Grant funds expended for the services described in 

7 subparagraphs (B) through (E) of section 2651(b)(2) 

8 shall count as expenditures on primary medical care.’’. 

9 (d) GRANTS FOR COORDINATED SERVICES AND AC10 CESS TO RESEARCH FOR WOMEN, INFANTS, CHILDREN, 

11 AND YOUTH.—Section 2671 of the Public Health Service 

12 Act (42 U.S.C. 300ff–71) is amended— 

13 (1) by redesignating subsection (k) as sub14 section (l); and 

15 (2) by inserting after subsection (j) the fol16 lowing: 

17 ‘‘(k) REQUIRED FUNDING FOR PRIMARY MEDICAL

18 CARE.—Notwithstanding any other provision of law, a 

19 grantee under this section shall expend not less than 75 

20 percent of the funds received under the grant on primary 

21 medical care.’’. 

22 SEC. 5. SUPPLEMENTAL TREATMENT DRUG GRANTS SAFE23 TY NET. 

24 (a) IN GENERAL.—Section 2618(a)(2)(I)(ii) of the 

25 Public Health Service Act (42 U.S.C. 300ff– 
7 

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1 28(a)(2)(I)(ii)) is amended by striking subclauses (V) and 

2 (VI) and inserting the following: 

3 ‘‘(V) FUNDING.— 

4 ‘‘(aa) AUTHORIZATION OF

5 APPROPRIATIONS.—There is au6 thorized to be appropriated to 

7 carry out this clause for a fiscal 

8 year an amount that is not more 

9 than 8 percent of the amount ap10 propriated to carry out section 

11 2616 for such fiscal year. 

12 ‘‘(bb) TRANSFER OF FUNDS

13 WHEN APPROPRIATIONS ARE IN14 SUFFICIENT.— 

15 ‘‘(AA) IN GENERAL.— 

16 For any fiscal year for 

17 which the amount appro18 priated to carry out this 

19 clause and the amount redis20 tributed to carry out this 

21 clause pursuant to section 

22 2679 total less than 5 per23 cent of the amount appro24 priated to carry out section 

25 2616 for such fiscal year, 
8 

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1 the Secretary shall transfer 

2 from funds appropriated to 

3 carry out this part (except 

4 this section) and parts A, C, 

5 D, E, and F, for the fiscal 

6 year and in accordance with 

7 subitem (BB), such amounts 

8 as are necessary to make the 

9 lesser of $35,000,000 or 5 

10 percent of the amount ap11 propriated to carry out sec12 tion 2616 for such fiscal 

13 year, available to carry out 

14 this clause for such fiscal 

15 year. 

16 ‘‘(BB) FORMULA FOR

17 THE TRANSFER OF

18 FUNDS.—In carrying out 

19 subitem (AA) for a fiscal 

20 year, the Secretary shall 

21 transfer from each part 

22 under this title an amount, 

23 from the amount of funds 

24 appropriated for such part 

25 for the fiscal year, that 
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1 bears the same relation to 

2 the total amount required to 

3 be transferred under 

4 subitem (AA) for the fiscal 

5 year, as the amount of funds 

6 appropriated to carry out 

7 such part for the fiscal year 

8 bears to the total amount of 

9 funds appropriated to carry 

10 out this title for such fiscal 

11 year. 

12 ‘‘(CC) ADDITIONAL

13 AMOUNTS FROM HRSA.—In 

14 addition to transferring 

15 funds under subitem (AA), 

16 the Secretary may transfer, 

17 for any fiscal year for which 

18 the amount appropriated to 

19 carry out this clause is less 

20 than $35,000,000, not more 

21 than $5,000,000 from ad22 ministrative funds of the 

23 Health Resources and Serv24 ices Administration of the 

25 Department of Health and 
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1 Human Services to carry out 

2 this clause.’’. 

3 (b) RETURN OF UNOBLIGATED FUNDS.— 

4 (1) IN GENERAL.—Part D of title XXVI of the 

5 Public Health Service Act (42 U.S.C. 300ff–71 et 

6 seq.) is amended by adding at the end the following: 

7 ‘‘SEC. 2679. UNOBLIGATED FUNDS USED FOR SUPPLE8 MENTAL TREATMENT DRUG GRANTS. 

9 ‘‘Notwithstanding any other provision of this title, 

10 any funds received under this title during a fiscal year 

11 that remain unobligated at the end of the second fiscal 

12 year succeeding the fiscal year during which the funds 

13 were received shall be returned to the Administrator of 

14 the Health Resources and Services Administration who 

15 shall redistribute such funds to carry out section 

16 2618(a)(2)(C)(ii).’’. 

17 (2) CONFORMING AMENDMENTS.—Section 2618 

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

19 28) is amended— 

20 (A) in subsection (a)(2)(I)(ii)(I) by strik21 ing ‘‘subclause (V)’’ and inserting ‘‘subclause 

22 (V) and section 2679’’; and 

23 (B) by striking subsection (d). 
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1 SEC. 6. ENSURING EQUITABLE PER CASE FUNDING. 

2 (a) DISTRIBUTION OF FUNDS.—Section 2618(a) of 

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

4 amended— 

5 (1) in paragraph (1)(A)— 

6 (A) in clause (i)— 

7 (i) in subclause (I), by striking ‘‘cases 

8 of acquired immune deficiency syndrome, 

9 as determined under paragraph (2)(D)’’ 

10 and inserting ‘‘cases of HIV disease (re11 ported to and confirmed as accurate by the 

12 Director of the Centers for Disease Control 

13 and Prevention)’’; and 

14 (ii) in subclause (II)— 

15 (I) by striking ‘‘cases of acquired 

16 immune deficiency syndrome, as de17 termined under paragraph (2)(D)’’ 

18 and inserting ‘‘cases of HIV disease 

19 (reported to and confirmed as accu20 rate by the Director of the Centers for 

21 Disease Control and Prevention)’’; 

22 and 

23 (II) by inserting ‘‘and’’ after the 

24 semicolon; and 

25 (B) in clause (ii), by striking ‘‘paragraph 

26 (2)(H)’’ and inserting ‘‘paragraph (2)(B)’’; and 
12 

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1 (2) in paragraph (2)— 

2 (A) by striking subparagraphs (A) through 

3 (G) and inserting the following: 

4 ‘‘(A) FORMULA.— 

5 ‘‘(i) IN GENERAL.—The amount re6 ferred to in paragraph (1)(A)(ii) for a 

7 State and paragraph (1)(B) for a territory 

8 of the United States shall be determined— 

9 ‘‘(I) for fiscal year 2007, accord10 ing to the formula under this para11 graph as in effect on the day before 

12 the date of enactment of the Ryan 

13 White CARE Act Amendments of 

14 2006; and 

15 ‘‘(II) for fiscal year 2008 and 

16 each succeeding fiscal year, according 

17 to the formula described in clause (ii). 

18 ‘‘(ii) AMOUNT BASED ON CASES NOT

19 COUNTED UNDER PART A.—A State or ter20 ritory of the United States shall receive an 

21 amount under this part for a fiscal year 

22 that bears the same relation to the amount 

23 appropriated under section 2677(b) for 

24 grants under this part for the fiscal year 

25 as the number of cases determined under 
13 

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1 clause (iii) for the State or territory for 

2 such fiscal year bears to the total number 

3 of cases determined under clause (iii) for 

4 all States and territories for such fiscal 

5 year. 

6 ‘‘(iii) NUMBER OF CASES.— 

7 ‘‘(I) REPORTING SYSTEM IN EF8 FECT PRIOR TO OCTOBER 2000.—In 

9 the case of a State or territory that 

10 has enacted an HIV reporting system 

11 that has been confirmed as accurate 

12 and reliable by the Director of the 

13 Centers for Disease Control and Pre14 vention prior to October 1, 2000, the 

15 number of cases under this clause for 

16 such State or territory for a fiscal 

17 year shall be equal to the total num18 ber of reported cases of HIV disease 

19 (reported to and confirmed as accu20 rate by the Director of the Centers for 

21 Disease Control and Prevention) liv22 ing in the State or territory during 

23 such year, minus the number of re24 ported cases of HIV disease (reported 

25 to and confirmed as accurate by the 
14 

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1 Director of the Centers for Disease 

2 Control and Prevention) living in such 

3 State or territory that are within an 

4 eligible area (as determined under 

5 part A). 

6 ‘‘(II) REPORTING SYSTEM IN EF7 FECT PRIOR TO OCTOBER 2006 BUT

8 AFTER OCTOBER 2000.—In the case of 

9 a State or territory that has enacted 

10 an HIV reporting system that has 

11 been confirmed as accurate and reli12 able by the Director of the Centers for 

13 Disease Control and Prevention prior 

14 to October 1, 2006, but on or after 

15 October 1, 2000, the number of cases 

16 under this clause for such State or 

17 territory for a fiscal year shall be 

18 equal to the total number of cases of 

19 HIV disease (estimated by the Direc20 tor of the Centers for Disease Control 

21 and Prevention) living in the State or 

22 territory during such year, minus the 

23 number of cases of HIV disease (esti24 mated by the Director of the Centers 

25 for Disease Control and Prevention) 
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1 living in such State or territory that 

2 are within an eligible area (as deter3 mined under part A). 

4 ‘‘(III) REPORTING SYSTEM NOT

5 IN EFFECT BY OCTOBER 2006.—In the 

6 case of a State or territory that has 

7 not enacted an HIV reporting system 

8 that has been confirmed as accurate 

9 and reliable by the Director of the 

10 Centers for Disease Control and Pre11 vention prior to October 1, 2006, the 

12 number of cases under this clause for 

13 such State or territory for a fiscal 

14 year shall be equal to— 

15 ‘‘(aa) until such time as 

16 such State or territory has en17 acted an HIV reporting system 

18 that has been confirmed as accu19 rate and reliable by the Director 

20 of the Centers for Disease Con21 trol and Prevention, the total 

22 number of reported cases of ac23 quired immune deficiency syn24 drome (reported to and con25 firmed as accurate by the Direc-
16 

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1 tor of the Centers for Disease 

2 Control and Prevention) living in 

3 the State or territory during such 

4 year, minus the number of re5 ported cases of acquired immune 

6 deficiency syndrome (reported to 

7 and confirmed as accurate by the 

8 Director of the Centers for Dis9 ease Control and Prevention) liv10 ing in such State or territory 

11 that are within an eligible area 

12 (as determined under part A); 

13 and 

14 ‘‘(bb) once such State or 

15 territory has enacted an HIV re16 porting system that has been 

17 confirmed as accurate and reli18 able by the Director of the Cen19 ters for Disease Control and Pre20 vention, the total number of 

21 cases of HIV disease (estimated 

22 by the Director of the Centers 

23 for Disease Control and Preven24 tion) living in the State or terri25 tory during such year, minus the 
17 

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1 number of cases of HIV disease 

2 (estimated by the Director of the 

3 Centers for Disease Control and 

4 Prevention) living in such State 

5 or territory that are within an el6 igible area (as determined under 

7 part A).’’; 

8 (B) by redesignating subparagraphs (H) 

9 and (I) as subparagraphs (B) and (C), respec10 tively; 

11 (C) in subparagraph (B) (as redesignated 

12 by subparagraph (B))— 

13 (i) by striking ‘‘subparagraph (I)(i)’’ 

14 each place the term appears and inserting 

15 ‘‘subparagraph (C)(i)’’; and 

16 (ii) by adding at the end the fol17 lowing: 

18 ‘‘(iii) EFFECTIVE DATE.—This sub19 paragraph shall be effective through Sep20 tember 30, 2008.’’; and 

21 (D) in subparagraph (C)(i) (as redesig22 nated by subparagraph (B)), by striking sub23 clauses (I) and (II) and inserting the following: 

24 ‘‘(I) 100 percent of such amount; 

25 and 
18 

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1 ‘‘(II) the percentage constituted 

2 by the ratio of the total number of re3 ported cases of HIV disease (reported 

4 to an confirmed as accurate by the 

5 Director of the Centers for Disease 

6 Control and Prevention) living in the 

7 State to the total number of reported 

8 cases of HIV disease (reported to an 

9 confirmed as accurate by the Director 

10 of the Centers for Disease Control 

11 and Prevention) living in all States.’’. 

12 (b) CONFORMING AMENDMENTS.—Section 2631(c) 

13 of the Public Health Service Act (42 U.S.C. 300ff–38(c)) 

14 is amended by striking ‘‘for use for purposes of section 

15 2618(a)(2)(D)(i)’’ and inserting ‘‘as reported to and con16 firmed as accurate and reliable by the Director of the Cen17 ters for Disease Control and Prevention’’. 

18 (c) STRIKING OF SUPPLEMENTAL GRANTS IN

19 EMERGING COMMUNITIES.—Title XXVI of the Public 

20 Health Service Act (42 U.S.C. 300ff–11 et seq.) is amend21 ed by striking section 2620. 

22 SEC. 7. ENSURING FUNDING CORRESPONDS WITH EPIDE23 MIOLOGICAL TRENDS. 

24 (a) ESTABLISHMENT OF PROGRAMS OF GRANTS.— 
19 

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1 (1) IN GENERAL.—Section 2601 of the Public 

2 Health Service Act (42 U.S.C. 300ff–11) is amend3 ed— 

4 (A) in subsection (a), by striking ‘‘for 

5 which there’’ and all that follows through the 

6 period and inserting ‘‘for which there is a cu7 mulative total of more than 2,500 living cases 

8 of HIV disease (reported to and confirmed as 

9 accurate by the Director of the Centers for Dis10 ease Control and Prevention). The Secretary 

11 shall make grants in accordance with section 

12 2603 to not more than 60 metropolitan areas 

13 that are eligible for such grants pursuant to 

14 this subsection.’’; 

15 (B) in subsection (b), by striking ‘‘cases of 

16 acquired immune deficiency syndrome’’ and in17 serting ‘‘living cases of HIV disease’’; 

18 (C) by striking subsection (c) and inserting 

19 the following: 

20 ‘‘(c) REQUIREMENTS REGARDING POPULATION.— 

21 ‘‘(1) NUMBER OF INDIVIDUALS.—The Secretary 

22 may not make a grant under this section for a met23 ropolitan area unless the area has a population of 

24 500,000 or more individuals. 
20 

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1 ‘‘(2) GEOGRAPHIC BOUNDARIES.—For purposes 

2 of eligibility under this part, the boundaries of each 

3 metropolitan area are the boundaries that cor4 respond with the Office of Management and Budget 

5 definition of metropolitan statistical area for the 

6 year that is most recent to the year for which the 

7 determination is made.’’; and 

8 (D) by striking subsection (d) and insert9 ing the following: 

10 ‘‘(d) CONTINUED STATUS AS ELIGIBLE AREA.— 

11 ‘‘(1) METROPOLITAN AREAS THAT WERE ELIGI12 BLE AREAS FOR FISCAL YEAR 1996.—Notwith13 standing any other provision of this section, a metro14 politan area that was an eligible area under this part 

15 for fiscal year 1996 shall be an eligible area under 

16 this part until such metropolitan area does not meet 

17 the qualifications of an eligible area as described in 

18 this section for 2 consecutive years. 

19 ‘‘(2) METROPOLITAN AREAS TO REMAIN ELIGI20 BLE AREAS UNTIL 2 CONSECUTIVE YEARS OF NOT

21 QUALIFYING AS AN ELIGIBLE AREA.—Notwith22 standing any other provision of this section except as 

23 provided in paragraph (1), a metropolitan area shall 

24 be deemed an eligible area under this section until 

25 such time as such metropolitan area does not meet 
21 

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1 the qualifications of an eligible area as described in 

2 this section for 2 consecutive years.’’. 

3 (2) EFFECTIVE DATE.—The amendments made 

4 by paragraph (1) shall take effect on October 1, 

5 2007. 

6 (b) TYPE AND DISTRIBUTION OF GRANTS.—Section 

7 2603(a)(4) of the Public Health Service Act (42 U.S.C. 

8 300ff–13(a)) is amended— 

9 (1) in subparagraph (A), by striking ‘‘For 

10 each’’ and inserting ‘‘Except as provided in subpara11 graph (D), for each’’; and 

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

13 ‘‘(D) PHASE-OUT OF INCREASES IN

14 GRANTS.—Notwithstanding any other provision 

15 of this paragraph— 

16 ‘‘(i) for fiscal year 2007, in the case 

17 of an eligible area in a protection period 

18 for such fiscal year, the Secretary shall in19 crease the amount of the grant made pur20 suant to paragraph (2) for the area to en21 sure that the grant is not less than 50 per22 cent of the amount of the grant made for 

23 the eligible area pursuant to such para24 graph for the base year for the protection 

25 period; 
22 

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1 ‘‘(ii) for fiscal year 2008, in the case 

2 of an eligible area in a protection period 

3 for such fiscal year, the Secretary shall in4 crease the amount of the grant made pur5 suant to paragraph (2) for the area to en6 sure that the grant is not less than 25 per7 cent of the amount of the grant made for 

8 the eligible area pursuant to such para9 graph for the base year for the protection 

10 period; and 

11 ‘‘(iii) for fiscal year 2009 and each 

12 succeeding fiscal year, in the case of an eli13 gible area in a protection period for such 

14 fiscal year, the Secretary shall not increase 

15 the amount of the grant pursuant to this 

16 paragraph.’’. 

17 SEC. 8. PROHIBITION ON FUNDING FOR ENTITIES THAT 

18 PROHIBIT OR IMPOSE BARRIERS ON PART19 NER NOTIFICATION. 

20 Part D of title XXVI of the Public Health Service 

21 Act (42 U.S.C. 300ff–71 et seq.), as amended by section 

22 5, is further amended by adding at the end the following: 
23 

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1 ‘‘SEC. 2679A. PROHIBITION ON FUNDING FOR ENTITIES 

2 THAT PROHIBIT OR IMPOSE BARRIERS ON 

3 PARTNER NOTIFICATION. 

4 ‘‘Beginning 25 months after the date of enactment 

5 of this section, a State or locality that prohibits or imposes 

6 significant administrative, statutory, regulatory, or prac7 tical barriers to programs of partner notification shall not 

8 be eligible to receive funds under this title.’’. 

9 SEC. 9. COVERAGE FOR TREATMENT FOR HEPATITIS B AND 

10 HEPATITIS C CO-INFECTION. 

11 (a) COVERAGE UNDER PARTS A AND B.—Section 

12 2604(b)(1) of the Public Health Service Act (42 U.S.C. 

13 300ff–14(b)(1)) is amended by adding at the end the fol14 lowing: 

15 ‘‘(E) Treatment for hepatitis B or hepa16 titis C for HIV-positive individuals who are co17 infected with such hepatitis.’’. 

18 (b) COVERAGE UNDER PART C.—Section 2651(b)(2) 

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

20 51(b)(2)) is amended— 

21 (1) in subparagraph (E), by striking the period 

22 at the end and inserting ‘‘; and’’; and 

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

24 ‘‘(F) providing treatment for hepatitis B 

25 or hepatitis C for HIV-positive individuals who 

26 are co-infected with such hepatitis.’’. 
24 

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1 (c) SPECIAL PROJECTS OF NATIONAL SIGNIFI2 CANCE.—Section 2691(d) of the Public Health Service Act 

3 (42 U.S.C. 300ff–101(d)) is amended— 

4 (1) in paragraph (5), by striking ‘‘and’’ after 

5 the semicolon; 

6 (2) in paragraph (6), by striking the period at 

7 the end and inserting ‘‘; and’’; and 

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

9 ‘‘(7) HIV-positive individuals who are co-in10 fected with hepatitis B or hepatitis C.’’. 

11 (d) HIV/AIDS COMMUNITIES, SCHOOLS, AND CEN12 TERS.—Section 2692(a)(1) of the Public Health Service 

13 Act (42 U.S.C. 300ff–111(a)(1)) is amended— 

14 (1) in subparagraph (C), by striking ‘‘and’’ 

15 after the semicolon; 

16 (2) in subparagraph (D), by striking the period 

17 at the end and inserting ‘‘; and’’; and 

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

19 ‘‘(E) to educate health care providers and 

20 service providers regarding identification, treat21 ment, and treatment adherence and prevention 

22 education for patients co-infected with HIV and 

23 hepatitis B or hepatitis C.’’. 
25 

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1 SEC. 10. PLANNING COUNCILS. 

2 Section 2602(b) of the Public Health Service Act (42 

3 U.S.C. 300ff–12(b)) is amended— 

4 (1) in paragraph (2)— 

5 (A) in subparagraph (L), by striking 

6 ‘‘and’’ after the semicolon; 

7 (B) in subparagraph (M), by striking the 

8 period at the end and inserting a semicolon; 

9 and 

10 (C) by adding at the end the following: 

11 ‘‘(N) faith-based organizations; and 

12 ‘‘(O) individuals who are co-infected with 

13 HIV and hepatitis B or hepatitis C.’’; 

14 (2) in paragraph (5)— 

15 (A) in subparagraph (B), by adding at the 

16 end the following: ‘‘Any conflict of interest of 

17 an individual on the planning council shall be 

18 reported to the Administrator of the Health Re19 sources and Services Administration and shall 

20 be available to the public.’’; and 

21 (B) in subparagraph (C)(i), by striking ‘‘, 

22 are not officers’’ and all that follows through 

23 ‘‘paragraph (4)(A).’’ and inserting ‘‘and reflect 

24 the demographics of the population of individ25 uals with HIV disease as determined under 

26 paragraph (4)(A), and not less than 51 percent 
26 

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1 of the council shall be individuals who are not 

2 officers, employees, or consultants to any entity 

3 that receives amounts from such a grant and do 

4 not represent any such entity.’’; and 

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

6 ‘‘(8) FUNDING DECISIONS.—Any funding deci7 sion of the planning council shall require approval by 

8 the chief elected official and chief executive officer of 

9 the eligible area involved.’’. 

10 SEC. 11. REDUCTION OF ADMINISTRATIVE COSTS. 

11 (a) PART A.—Section 2604(f)(2) of the Public 

12 Health Service Act (42 U.S.C. 300ff–14(f)(2)) is amend13 ed— 

14 (1) in subparagraph (A), by striking ‘‘and’’ 

15 after the semicolon; 

16 (2) in subparagraph (B), by striking the period 

17 at the end and inserting ‘‘; and’’; and 

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

19 ‘‘(C) costs associated with the activities of 

20 the planning council and the planning for the 

21 allocation of funds and services under this 

22 part.’’. 

23 (b) PART B.—Section 2618(b) of the Public Health 

24 Service Act (42 U.S.C. 300ff–28(b)) is amended— 
27 

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1 (1) by inserting before paragraph (2) the fol2 lowing: 

3 ‘‘(1) [Reserved].’’; and 

4 (2) in paragraph (4)— 

5 (A) in subparagraph (B), by inserting ‘‘, 

6 including costs associated with the planning for 

7 the allocation of funds and services under this 

8 part’’ before the period at the end; and 

9 (B) in subparagraph (C)— 

10 (i) in clause (ii), by striking ‘‘and’’ 

11 after the semicolon; 

12 (ii) in clause (iii), by striking the pe13 riod at the end and inserting ‘‘; and’’; and 

14 (iii) by adding at the end the fol15 lowing: 

16 ‘‘(iv) costs associated with the plan17 ning for the allocation of funds and serv18 ices under this part.’’. 

19 SEC. 12. RAPID ROUTINE TESTING. 

20 (a) IN GENERAL.—Part D of title XXVI of the Pub21 lic Health Service Act (42 U.S.C. 300ff–71 et seq.), as 

22 amended by sections 5 and 8, is further amended by add23 ing at the end the following: 

24 ‘‘SEC. 2679B. RAPID ROUTINE TESTING. 

25 ‘‘(a) IN GENERAL.— 
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1 ‘‘(1) IN GENERAL.—Except as provided in para2 graph (2), the Secretary shall require rapid routine 

3 testing of each client at any health facility, provider, 

4 clinic, or entity (including an HIV, STD, or sub5 stance abuse clinic) receiving funding from the Cen6 ters for Disease Control and Prevention, the Sub7 stance Abuse and Mental Health Services Adminis8 tration, the Health Resources and Services Adminis9 tration, the Centers for Medicare & Medicaid Serv10 ices, or any reproductive health program adminis11 tered by the Secretary. 

12 ‘‘(2) EXCEPTION.—Rapid routine testing shall 

13 not be required in the case of an individual who has 

14 already been diagnosed with HIV infection. 

15 ‘‘(b) PREGNANT WOMEN AND NEWBORNS.—The Sec16 retary shall require— 

17 ‘‘(1) a health facility receiving Federal funds or 

18 a Federal health program (including a program sup19 ported under this title) that is treating a pregnant 

20 woman to offer to such woman routine testing; and 

21 ‘‘(2) a health facility receiving Federal funds or 

22 a Federal health program (including a program sup23 ported under this title) that is treating a newborn to 

24 offer to the parents of such newborn rapid routine 
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1 testing of such newborn if such newborn’s mother’s 

2 HIV status is unknown. 

3 ‘‘(c) COUNSELING AND TREATMENT.—An entity or 

4 program that conducts routine testing pursuant to this 

5 section shall provide to each individual tested pursuant to 

6 this section who tests positive for HIV antibodies, appro7 priate counseling and referral into treatment in a timely 

8 manner. 

9 ‘‘(d) TESTING.—The Director of the Centers for Dis10 ease Control and Prevention shall annually purchase and 

11 distribute not less than 1,500,000 rapid HIV tests, includ12 ing tests that are oral based. 

13 ‘‘(e) STATE OR LOCAL PROHIBITIONS.—Beginning 

14 25 months after the date of enactment of this section, a 

15 State or locality that prohibits or imposes significant ad16 ministrative, statutory, regulatory, or practical barriers to 

17 routine testing as described in this section shall not be 

18 eligible to receive funds under this title.’’. 

19 (b) CDC GUIDELINES FOR PREGNANT WOMEN.— 

20 Section 2625 of the Public Health Service Act (42 U.S.C. 

21 300ff–33) is amended— 

22 (1) in subsection (a), by striking ‘‘voluntary’’ 

23 and inserting ‘‘routine’’; and 
30 

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1 (2) in subsection (c)(1)(C), by striking ‘‘vol2 untary HIV testing for such disease’’ and inserting 

3 ‘‘routine testing’’. 

4 SEC. 13. ADAP RECOMMENDED FORMULARY AND REPORT 

5 CARD. 

6 Section 2616 of the Public Health Service Act (42 

7 U.S.C. 300ff–26) is amended by adding at the end the 

8 following: 

9 ‘‘(f) RECOMMENDATIONS FOR MINIMUM STANDARD

10 FORMULARY AND ANNUAL REPORT.— 

11 ‘‘(1) IN GENERAL.—In carrying out this sec12 tion, the Secretary shall issue guidelines that provide 

13 recommendations for therapeutics described in sub14 section (a) that shall, at a minimum, be included in 

15 the formularies that are maintained by the States 

16 for purposes of this section. 

17 ‘‘(2) ANNUAL REPORTS.—Not later than May 

18 31 of each year, the Secretary shall submit to Con19 gress a report that, with respect to the program 

20 under this section, specifies the following: 

21 ‘‘(A) For each State: 

22 ‘‘(i) The number of patients who have 

23 requested therapeutics described in sub24 section (a) from the program as carried 

25 out in the State, but are on a waiting list 
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1 because such program does not have the 

2 capacity to serve the patients. 

3 ‘‘(ii) If patients on the waiting list are 

4 receiving such therapeutics, the sources 

5 from which the patients are obtaining the 

6 therapeutics. 

7 ‘‘(iii) The estimated cost to provide 

8 the amount of therapeutics that would be 

9 necessary to serve all patients on the wait10 ing list and thereby eliminate the wait in 

11 the State. 

12 ‘‘(iv) Each source of funds that, in 

13 addition to funds appropriated to carry out 

14 this part, is used by the State to provide 

15 therapeutics under the program. 

16 ‘‘(B) Each State whose formulary main17 tained for purposes of the program does not 

18 meet the recommendations of the Secretary 

19 under paragraph (1). 

20 ‘‘(C) The actions being taken by States 

21 with such waiting lists to reduce the number of 

22 patients on the lists, including any restrictions 

23 imposed by the States on the number or quan24 tity of therapeutics made available under the 

25 program. 
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1 ‘‘(D) The amount of funds each State re2 ceives under this title and how such funds have 

3 been allocated among each of the following cat4 egories: 

5 ‘‘(i) Therapeutics. 

6 ‘‘(ii) Primary medical care, including 

7 medical evaluations and physician services. 

8 ‘‘(iii) Support services, administrative 

9 costs, and other expenses not included in 

10 clause (i) or (ii).’’. 

11 SEC. 14. STATE FLEXIBILITY IN PROVIDING HIV/AIDS CARE. 

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

13 Service Act (42 U.S.C. 300ff–22), as amended by section 

14 4, is further amended by adding at the end the following: 

15 ‘‘(f) STATE FLEXIBILITY IN PROVIDING HIV/AIDS 

16 CARE.—Upon approval by the Secretary, a State may use 

17 amounts provided under a grant made under this part for 

18 providing medical assistance to individuals who are eligible 

19 for assistance under title XIX of the Social Security Act 

20 (42 U.S.C. 1396 et seq.) and are HIV-positive.’’. 

21 (b) SUPPLEMENT, NOT SUPPLANT.—Part D of title 

22 XXVI of the Public Health Service Act (42 U.S.C. 300ff– 

23 71 et seq.), as amended by sections 5, 8, and 12, is further 

24 amended by adding at the end the following: 
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1 ‘‘SEC. 2679C. SUPPLEMENT, NOT SUPPLANT STATE MED2 ICAID FUNDING. 

3 ‘‘Funds received by a State under this title shall be 

4 used to supplement, and not supplant, State funds that 

5 would otherwise be used for the State share of expendi6 tures under a State plan under title XIX of the Social 

7 Security Act (42 U.S.C. 1396 et seq.) for providing med8 ical assistance to individuals who are eligible for such as9 sistance and are HIV-positive.’’. 

10 SEC. 15. PRICES PAID FOR THERAPEUTICS FOR ADAP. 

11 (a) IN GENERAL.—Section 2616 of the Public Health 

12 Service Act (42 U.S.C. 300ff–26), as amended by section 

13 13, is further amended by adding at the end the following: 

14 ‘‘(g) PRICES PAID FOR THERAPEUTICS.—The Ad15 ministrator of the Health Resources and Services Admin16 istration shall routinely analyze and report to Congress 

17 on the prices for therapeutics paid by programs estab18 lished under this section.’’. 

19 (b) COORDINATION OF ALL THERAPEUTIC PUR20 CHASES THROUGH ADAP.—Part D of title XXVI of the 

21 Public Health Service Act (42 U.S.C. 300ff–71 et seq.), 

22 as amended by sections 5, 8, 12, and 14, is further amend23 ed by adding at the end the following: 
34 

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1 ‘‘SEC. 2679D. COORDINATION OF ALL THERAPEUTIC PUR2 CHASES THROUGH ADAP. 

3 ‘‘In any purchases of therapeutics to treat HIV dis4 ease pursuant to a program that receives Federal assist5 ance under this title, an entity shall coordinate such pur6 chases through the program described in section 2616 in 

7 order to ensure that the recipients of the therapeutics are 

8 receiving the best possible price for the therapeutics.’’. 

9 SEC. 16. AUTHORIZATION OF APPROPRIATIONS FOR ADAP. 

10 Section 2616 of the Public Health Service Act (42 

11 U.S.C. 300ff–26), as amended by sections 13 and 15, is 

12 further amended by adding at the end the following: 

13 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this sec15 tion— 

16 ‘‘(1) $800,000,000 for fiscal year 2006; 

17 ‘‘(2) $870,000,000 for fiscal year 2007; 

18 ‘‘(3) $940,000,000 for fiscal year 2008; 

19 ‘‘(4) $1,010,000,000 for fiscal year 2009; and 

20 ‘‘(5) $1,080,000,000 for fiscal year 2010.’’. 

21 SEC. 17. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE. 

22 Section 2691 of the Public Health Service Act (42 

23 U.S.C. 300ff–101) is amended— 

24 (1) in subsection (a), by striking ‘‘the greater 

25 of $20,000,000 or 3 percent of such amount appro26 priated under each such part, but not to exceed 
35 

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1 $25,000,000,’’ and inserting ‘‘not more than 

2 $15,000,000’’; and 

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

4 ‘‘(h) PILOT PROGRAMS.—The Secretary, acting 

5 through the Administrator of the Health Resources and 

6 Services Administration, shall use funds available under 

7 this section to conduct not less than 5 pilot programs to 

8 evaluate various forms of partner notification programs, 

9 including attitudes of source patients and those being noti10 fied towards such services and the cost effectiveness of 

11 such programs. 

12 ‘‘(i) STANDARD ELECTRONIC CLIENT INFORMATION

13 DATA SYSTEM.—The Secretary, acting through the Ad14 ministrator of the Health Resources and Services Admin15 istration, shall use funds available under this section to 

16 develop a standard electronic client information data sys17 tem to improve coordination of coverage provided to pa18 tients under programs supported under this title, as well 

19 as programs under the medicare program under title 

20 XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 

21 and the medicaid program under title XIX of such Act 

22 (42 U.S.C. 1396 et seq.). 

23 ‘‘(j) STUDY.—The Secretary, acting through the Ad24 ministrator of the Health Resources and Services Admin25 istration, shall use funds available under this section to 
36 

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1 conduct a study to develop recommendations for best pri2 mary medical care practices for disease management for 

3 those living with HIV disease or AIDS.’’. 

4 SEC. 18. HOUSING OPPORTUNITIES FOR PERSONS WITH 

5 HIV/AIDS. 

6 (a) HOPWA FORMULA AMENDMENTS.—Section 

7 854(c) of the AIDS Housing Opportunity Act (42 U.S.C. 

8 12903(c)) is amended— 

9 (1) in paragraph (1)— 

10 (A) by striking ‘‘The Secretary’’ and in11 serting ‘‘Except as provided in subsection (h), 

12 the Secretary’’; 

13 (B) by striking ‘‘cases of acquired im14 munodeficiency syndrome’’ each place that 

15 terms appears and inserting ‘‘reported living 

16 cases of HIV disease (as reported to, and con17 firmed as accurate, by the Director of the Cen18 ters for Disease Control and Prevention)’’; 

19 (C) in subparagraph (B), by striking ‘‘ac20 quired immunodeficiency syndrome’’ and insert21 ing ‘‘reported living cases of HIV disease (as 

22 reported to, and confirmed as accurate, by the 

23 Director of the Centers for Disease Control and 

24 Prevention)’’; and 
37 

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1 (D) in the undesignated matter following 

2 subparagraph (B), in the second sentence, by 

3 striking ‘‘reported to and confirmed by the Di4 rector of the Centers for Disease Control of the 

5 Public Health Service’’; and 

6 (2) in paragraph (3), by striking ‘‘acquired im7 munodeficiency syndrome’’ each place that term ap8 pears and inserting ‘‘HIV disease’’. 

9 (b) TRANSITION FORMULA AND EXCEPTION TO THE

10 USE OF REPORTED HIV DATA.—Section 854 of the 

11 AIDS Housing Opportunity Act (42 U.S.C. 12903) is 

12 amended by adding at the end the following: 

13 ‘‘(g) TRANSITION FORMULA.—In applying the for14 mula allocation under subsection (c)(1), the Secretary 

15 shall— 

16 ‘‘(1) for fiscal year 2007, allocate— 

17 ‘‘(A) 75 percent of any amounts made 

18 available for allocation, using the formula allo19 cation described in subsection (c), as in effect 

20 on the day before the date of enactment of the 

21 Ryan White CARE Act Amendments of 2006; 

22 and 

23 ‘‘(B) 25 percent of such amounts made 

24 available for allocation, using the formula allo25 cation described in subsection (c), as amended 
38 

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1 by the Ryan White CARE Act Amendments of 

2 2006; 

3 ‘‘(2) for fiscal year 2008, allocate— 

4 ‘‘(A) 25 percent of any amounts made 

5 available for allocation, using the formula allo6 cation described in subsection (c), as in effect 

7 on the day before the date of enactment of the 

8 Ryan White CARE Act Amendments of 2006; 

9 and 

10 ‘‘(B) 75 percent of such amounts made 

11 available for allocation, using the formula allo12 cation described in subsection (c), as amended 

13 by the Ryan White CARE Act Amendments of 

14 2006; and 

15 ‘‘(3) for fiscal year 2009, and each fiscal year 

16 thereafter, allocate any amounts made available for 

17 allocation using the formula allocation described in 

18 subsection (c), as amended by the Ryan White 

19 CARE Act Amendments of 2006. 

20 ‘‘(h) EXCEPTION TO THE USE OF REPORTED HIV 

21 DATA.—Any State or city— 

22 ‘‘(1) that has enacted an HIV reporting system 

23 that has been confirmed as accurate and reliable by 

24 the Director of the Centers for Disease Control and 

25 Prevention prior to October 1, 2000, shall for pur-
39 

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1 poses of allocating any amounts under subsection (c) 

2 to that State or city, have such allocation deter3 mined by using the formula allocation described in 

4 such subsection, as amended by the Ryan White 

5 CARE Act Amendments of 2006; 

6 ‘‘(2) that has enacted an HIV reporting system 

7 that has been confirmed as accurate and reliable by 

8 the Director of the Centers for Disease Control and 

9 Prevention prior to October 1, 2006, but on or after 

10 October 1, 2000, shall for purposes of allocating any 

11 amounts under subsection (c) to that State or city, 

12 have such allocation determined by using the for13 mula allocation based on the number of cases of 

14 HIV disease (estimated by the Director of the Cen15 ters for Disease Control and Prevention) instead of 

16 reported living cases of HIV disease (as reported to, 

17 and confirmed as accurate, by the Director of the 

18 Centers for Disease Control and Prevention); and 

19 ‘‘(3) that does not have an HIV reporting sys20 tem that has been confirmed as accurate and reliable 

21 by the Director of the Centers for Disease Control 

22 and Prevention prior to October 1, 2006, shall for 

23 purposes of allocating any amounts under subsection 

24 (c) to that State or city— 
40 

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1 ‘‘(A) until such time as such State or city 

2 has enacted an HIV reporting system that has 

3 been confirmed as accurate and reliable by the 

4 Director of the Centers for Disease Control and 

5 Prevention, have such allocation determined by 

6 using the formula allocation described in such 

7 subsection as in effect on the day before the 

8 date of enactment of the Ryan White CARE 

9 Act Amendments of 2006; and 

10 ‘‘(B) once such State or city has enacted 

11 an HIV reporting system that has been con12 firmed as accurate and reliable by the Director 

13 of the Centers for Disease Control and Preven14 tion, have such allocation determined by using 

15 the formula allocation based on the number of 

16 cases of HIV disease (estimated by the Director 

17 of the Centers for Disease Control and Preven18 tion) instead of reported living cases of HIV 

19 disease (as reported to, and confirmed as accu20 rate, by the Director of the Centers for Disease 

21 Control and Prevention).’’. 

22 (c) ALLOCATION REQUIREMENT.—Section 854 of the 

23 AIDS Housing Opportunity Act (42 U.S.C. 12903) is 

24 amended by adding at the end the following: 
41 

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1 ‘‘(h) ALLOCATION REQUIREMENT.—The Secretary 

2 shall ensure that not less than 75 percent of all amounts 

3 allocated under this section are used for the provision, 

4 construction, maintenance, or development of housing as5 sistance.’’. 

6 SEC. 19. ENSURING STABILITY IN INFRASTRUCTURE. 

7 Section 2618(a)(2)(B)(i) of the Public Health Service 

8 Act (42 U.S.C. 300ff–28(a)(2)(B)(i)), as redesignated by 

9 section 6, is amended— 

10 (1) by striking ‘‘2000’’ each place the term ap11 pears and inserting ‘‘2005’’; 

12 (2) in subclause (I), by striking ‘‘2001, 99 per13 cent’’ and inserting ‘‘2006, 95 percent’’; 

14 (3) in subclause (II), by striking ‘‘2002, 98 per15 cent’’ and inserting ‘‘2007, 90 percent’’; 

16 (4) in subclause (III), by striking ‘‘2003, 97 

17 percent’’ and inserting ‘‘2008, 85 percent’’; 

18 (5) in subclause (IV), by striking ‘‘2004, 96 

19 percent’’ and inserting ‘‘2009, 80 percent’’; and 

20 (6) in subclause (V), by striking ‘‘2005, 95 per21 cent’’ and inserting ‘‘2010, 75 percent’’. 

22 SEC. 20. COORDINATION OF GRANTEES. 

23 Section 2675 of the Public Health Service Act (42 

24 U.S.C. 300ff–75) is amended by adding at the end the 

25 following: 
42 

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1 ‘‘(f) COORDINATION OF GRANTEES REQUIREMENT.— 

2 ‘‘(1) IN GENERAL.—The Secretary shall provide 

3 State AIDS officials with the authority to request 

4 and obtain all information necessary for States to 

5 coordinate HIV care and treatment pursuant to this 

6 title with other federally funded projects to maximize 

7 efficiency and effectiveness of HIV/AIDS services. 

8 ‘‘(2) COORDINATION OF SERVICES.—As a con9 dition of receipt of funds under this title, an entity 

10 shall participate in a process established by the 

11 State in which the entity is located to coordinate 

12 HIV/AIDS services across the State.’’. 

13 SEC. 21. TECHNICAL CORRECTIONS. 

14 Title XXVI of the Public Health Service Act (42 

15 U.S.C. 300ff–11 et seq.) is amended— 

16 (1) in section 2604— 

17 (A) in subsection (b)(2)(A), by striking 

18 ‘‘entities,,’’ and inserting ‘‘entities,’’; and 

19 (B) in subsection (f)— 

20 (i) by striking the subsection heading 

21 and inserting the following: ‘‘ADMINISTRA22 TION’’; and 

23 (ii) in paragraph (1), by striking ‘‘ad24 ministration,.’’ and inserting ‘‘administra25 tion.’’; 
43 

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1 (2) in section 2617(b)(6)(B)(iv), by inserting 

2 ‘‘section’’ before ‘‘2615’’; 

3 (3) in section 2618(a)(3)(B), by striking 

4 ‘‘means,’’ and inserting ‘‘means’’; 

5 (4) in section 2662(c)(3)(C)(ii), by striking 

6 ‘‘HIV.’’ and inserting ‘‘HIV; and’’; and 

7 (5) in section 2692(b)(2), by striking ‘‘in sec8 tion the section’’ and inserting ‘‘in the section’’. 

Æ