II 

Calendar No. 580 

109TH CONGRESS 

2D SESSION S. 2823 

To provide life-saving care for those with HIV/AIDS. 

IN THE SENATE OF THE UNITED STATES 

MAY 17, 2006 

Mr. ENZI (for himself, Mr. KENNEDY, Mr. HATCH, Mr. DEWINE, Mr. BURR, 

and Mr. FRIST) introduced the following bill; which was read twice and 

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

AUGUST 3, 2006 

Reported by Mr. ENZI, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To provide life-saving care for those with HIV/AIDS. 

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 HIV/ 

5 AIDS Treatment Modernization Act’’. 


sroberts on PROD1PC70 with BILLS
2 

•S 2823 RS

1 TITLE I—EMERGENCY RELIEF 

2 FOR ELIGIBLE AREAS 

3 SEC. 101. ESTABLISHMENT AND GENERAL ELIGIBILITY. 

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

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

6 subsections (b) through (d) and inserting the following: 

7 ‘‘(b) CONTINUED STATUS AS ELIGIBLE AREA.—Not8 withstanding any other provision of this section, a metro9 politan area shall continue to be eligible to receive a grant 

10 under this part until such area, for three consecutive grant 

11 years, fails to meet the requirements of subsection (a).’’. 

12 (b) DEFINITION.—Section 2607(2) of the Public 

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

14 by adding at the end the following: ‘‘For purposes of de15 termining eligibility under this part, the boundaries of 

16 each metropolitan area shall be the boundaries that were 

17 in effect for each such area for fiscal year 1994.’’. 

18 SEC. 102. LIVING CASES OF HIV/AIDS. 

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

20 Health Service Act (42 U.S.C. 300ff–11(a)) is amended 

21 by striking ‘‘for which there’’ and all that follows through 

22 ‘‘available’’ and inserting ‘‘for which there is reported to 

23 and confirmed by the Director of the Centers for Disease 

24 Control and Prevention a cumulative total of more than 


sroberts on PROD1PC70 with BILLS
3 

•S 2823 RS

1 2,000 cases of AIDS for the most recent period of 5 cal2 endar years for which such data are available’’. 

3 (b) DISTRIBUTION BASED ON LIVING CASES OF HIV/ 

4 AIDS.—Section 2603(a)(3) of the Public Health Service 

5 Act (42 U.S.C. 300ff–13(a)(3)) is amended— 

6 (1) in subparagraph (B), by striking ‘‘cases of 

7 acquired immune deficiency syndrome’’ and inserting 

8 ‘‘cases of HIV/AIDS (reported to and confirmed by 

9 the Director of the Centers for Disease Control and 

10 Prevention)’’; 

11 (2) by striking subparagraphs (C) and (D) and 

12 inserting the following: 

13 ‘‘(C) LIVING CASES OF HIV/AIDS.— 

14 ‘‘(i) IN GENERAL.—Except as pro15 vided for in clauses (ii) and (iii), the 

16 amount determined in this subparagraph is 

17 the number of living cases of HIV/AIDS 

18 (reported to and confirmed by the Director 

19 of the Centers for Disease Control and 

20 Prevention) through December 31 of the 

21 most recent calendar year. 

22 ‘‘(ii) FISCAL YEARS 2007 THROUGH

23 2010.—For each of fiscal years 2007 

24 through 2010, the Secretary may use the 


sroberts on PROD1PC70 with BILLS
4 

•S 2823 RS

1 proxy number for the number of HIV cases 

2 described in clause (iii) if— 

3 ‘‘(I) the State involved— 

4 ‘‘(aa) is reporting, or the 

5 State will by October 1, 2006 

6 have submitted a transition plan 

7 for reporting, accurate and reli8 able HIV cases to the Director of 

9 the Centers for Disease Control 

10 and Prevention; or 

11 ‘‘(bb) not later than October 

12 1, 2006, make all necessary stat13 utory changes to allow for the 

14 collection of HIV data certified 

15 by the Director of the Centers 

16 for Disease Control and Preven17 tion; 

18 ‘‘(II) the State involved will by 

19 April 1, 2008, begin reporting accu20 rate and reliable HIV cases, as deter21 mined by the Director of the Centers 

22 for Disease Control and Prevention; 

23 and 

24 ‘‘(III) the Director of the Centers 

25 for Disease Control and Prevention 


sroberts on PROD1PC70 with BILLS
5 

•S 2823 RS

1 has determined that such State does 

2 not have an established HIV surveil3 lance system. 

4 ‘‘(iii) AMOUNT DETERMINED.—With 

5 respect to each of fiscal years 2007 

6 through 2010, the amount determined 

7 under this subparagraph shall be the lesser 

8 of— 

9 ‘‘(I) the product of 0.9 and the 

10 number of living AIDS cases in the 

11 area involved; or 

12 ‘‘(II) an amount equal to 110 

13 percent of the funding level for the 

14 previous fiscal year, taking into ac15 count the shift of the formula pool 

16 from 0.5 to 0.67 in fiscal year 2006.’’; 

17 and 

18 (3) by redesignating subparagraph (E) as sub19 paragraph (D). 

20 (c) APPLICATION.—Section 2604(b)(4)(A) of the 

21 Public Health Service Act (42 U.S.C. 300ff–14(b)(4)(A)) 

22 is amended— 

23 (1) by striking ‘‘acquired immune deficiency 

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


sroberts on PROD1PC70 with BILLS
6 

•S 2823 RS

1 (2) by striking ‘‘such syndrome’’ and inserting 

2 ‘‘HIV/AIDS’’. 

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

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

5 (1) in paragraph (3), by striking ‘‘and’’ at the 

6 end; 

7 (2) in paragraph (4), by striking the period and 

8 inserting a semicolon; and 

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

10 ‘‘(5) the manner in which the expected expendi11 tures under the grant are related to the planning 

12 process for States that receive funding under part B 

13 (including the planning process described in section 

14 2617(b)); and 

15 ‘‘(6) the expected expenditures under the grant 

16 and how those expenditures will improve overall cli17 ent outcomes, as described under the State plan 

18 under section 2617(b), or through additional out19 comes measures.’’. 

20 SEC. 103. TYPE AND DISTRIBUTION OF GRANTS. 

21 (a) DISTRIBUTION OF FUNDS.—Section 2603(a)(2) 

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

23 13(a)(2)) is amended by striking ‘‘50 percent’’ and inserting ‘‘662 24 ⁄3 percent’’. 


sroberts on PROD1PC70 with BILLS
7 

•S 2823 RS

1 (b) EMERGENCY GRANTS.—Section 2603(a)(3)(E) of 

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

3 13(a)(3)(E)) is amended to read as follows: 

4 ‘‘(E) UNEXPENDED FUNDS.— 

5 ‘‘(i) IN GENERAL.—An eligible area 

6 that has unobligated funds for a fiscal year 

7 under a grant under this part shall— 

8 ‘‘(I) return such funds to the 

9 Secretary to be applied as provided 

10 for in subsection (b); or 

11 ‘‘(II) submit an application to 

12 the Secretary for the use of such 

13 funds in the succeeding fiscal year 

14 that includes a description of the 

15 manner in which the area intends to 

16 use such funds. 

17 ‘‘(ii) CARRYOVER.—With respect to 

18 an application received under clause (i)(II), 

19 the Secretary shall determine whether the 

20 area involved may carryover any unobli21 gated funds for use under this part in the 

22 succeeding fiscal year or whether such 

23 amounts shall be returned to the Secretary 

24 for use under subsection (b). Notice shall 


sroberts on PROD1PC70 with BILLS
8 

•S 2823 RS

1 be provided to the area of such determina2 tion. 

3 ‘‘(iii) FAILURE TO EXPEND FUNDS.— 

4 Amounts carried over by an eligible area 

5 under this subparagraph that are not ex6 pended in the succeeding fiscal year shall 

7 be returned to the Secretary for use under 

8 subsection (b). 

9 ‘‘(iv) CONSIDERATION IN MAKING

10 GRANTS.—The Secretary may, in deter11 mining the amount of a grant for a fiscal 

12 year under this paragraph, adjust the 

13 grant amount to reflect the amount of un14 expended and uncanceled grant funds re15 maining at the end of the fiscal year pre16 ceding the year for which the grant deter17 mination is to be made. The amount of 

18 any such unexpended funds shall be deter19 mined using the financial status report of 

20 the grantee.’’. 

21 (c) HOLD HARMLESS.—Section 2603(a)(4) of the 

22 Public Health Service Act (42 U.S.C. 300ff–13(a)(4)) is 

23 amended to read as follows: 

24 ‘‘(4) INCREASES IN GRANT.— 


sroberts on PROD1PC70 with BILLS
9 

•S 2823 RS

1 ‘‘(A) IN GENERAL.—For eligible areas re2 ceiving grants under this section in fiscal year 

3 2007, the Secretary shall increase the amount 

4 of the grant made pursuant to paragraph (2) 

5 for the area to ensure that— 

6 ‘‘(i) for fiscal year 2007, the grant is 

7 not less than 90 percent of the amount of 

8 the grant made for the eligible area pursu9 ant to such paragraph for the base year; 

10 ‘‘(ii) for fiscal year 2008, the grant is 

11 not less than 85 percent of the amount of 

12 such base year grant; and 

13 ‘‘(iii) for fiscal year 2009, the grant is 

14 not less than 80 percent of the amount of 

15 the base year grant. 

16 ‘‘(B) BASE YEAR.—With respect to grants 

17 made pursuant to paragraph (2) for an eligible 

18 area, the base year shall be fiscal year 2006.’’. 

19 SEC. 104. CORE MEDICAL SERVICES. 

20 Section 2604 of the Public Health Service Act (42 

21 U.S.C. 300ff–14) is amended by adding at the end the 

22 following: 

23 ‘‘(h) REQUIRED FUNDING FOR CORE MEDICAL

24 SERVICES.— 


sroberts on PROD1PC70 with BILLS
10 

•S 2823 RS

1 ‘‘(1) IN GENERAL.—Notwithstanding any other 

2 provision of law, a grantee under this part shall ex3 pend not less than 75 percent of the funds received 

4 under the grant on core medical services, except that 

5 the Secretary shall waive the application of this sub6 section with respect to a grantee if the Secretary de7 termines that, within the service area of the grant8 ee— 

9 ‘‘(A) there is no waiting lists for AIDS 

10 Drug Assistance Program services; and 

11 ‘‘(B) core medical services are available to 

12 all individuals infected with HIV/AIDS. 

13 ‘‘(2) CORE MEDICAL SERVICES.—For purposes 

14 of this subsection, the term ‘core medical services’ 

15 with respect to an individual infected with HIV/ 

16 AIDS (including the co-occurring diseases of the in17 dividual) means the following services: 

18 ‘‘(A) Outpatient and ambulatory health 

19 services. 

20 ‘‘(B) AIDS Drug Assistance Program 

21 treatments. 

22 ‘‘(C) AIDS pharmaceutical assistance. 

23 ‘‘(D) Oral health care. 

24 ‘‘(E) Early intervention services. 


sroberts on PROD1PC70 with BILLS
11 

•S 2823 RS

1 ‘‘(F) Health insurance premium and cost 

2 sharing assistance for low-income individuals. 

3 ‘‘(G) Home health care. 

4 ‘‘(H) Hospice services. 

5 ‘‘(I) Home and community-based health 

6 services as defined under section 2614(c), ex7 cept homemaker services. 

8 ‘‘(J) Mental health services. 

9 ‘‘(K) Substance abuse outpatient care. 

10 ‘‘(L) Medical case management, including 

11 treatment adherence services. 

12 ‘‘(3) SUPPORT SERVICES.—Notwithstanding 

13 any other provision of law, and subject to paragraph 

14 (1), a grantee under this part, subject to the ap15 proval of the Secretary, may provide support services 

16 (such as respite care for individuals with HIV/AIDS, 

17 outreach services, medical transportation, nutritional 

18 counseling, linguistic services, and referral for health 

19 care and support services for individuals with HIV/ 

20 AIDS) needed to achieve medical outcomes which 

21 are related to the medical outcomes for an individual 

22 infected with HIV and approved by the Secretary. 

23 ‘‘(4) DEFINITION OF MEDICAL OUTCOMES.—In 

24 this subsection, the term ‘medical outcomes’ means 


sroberts on PROD1PC70 with BILLS
12 

•S 2823 RS

1 those outcomes affecting the HIV-related clinical 

2 status of an individual with HIV/AIDS. 

3 ‘‘(5) UNEXPENDED FUNDS.—Any amounts re4 quired to be expended for core medical services or 

5 support services under this subsection that remain 

6 unobligated at the end of the fiscal year in which the 

7 funds were awarded shall be remitted to the Sec8 retary for reallocation under section 2603(b).’’. 

9 SEC. 105. SUPPLEMENTAL GRANTS. 

10 Section 2603(b) of the Public Health Service Act (42 

11 U.S.C. 300ff–13(b)) is amended— 

12 (1) by striking ‘‘severe need’’ each place that 

13 such appears and inserting ‘‘demonstrated need’’; 

14 (2) in paragraph (1)— 

15 (A) in the matter preceding subparagraph 

16 (A), by striking ‘‘Not later than’’ and all that 

17 follows through ‘‘the Secretary shall’’ and insert 

18 ‘‘The Secretary shall’’; 

19 (B) by striking subparagraph (F) and in20 serting the following: 

21 ‘‘(F) demonstrate the inclusiveness of af22 fected communities and individuals with HIV/ 

23 AIDS;’’; 

24 (C) in subparagraph (G), by striking the 

25 period and inserting ‘‘; and’’; and 


sroberts on PROD1PC70 with BILLS
13 

•S 2823 RS

1 (D) by adding at the end the following: 

2 ‘‘(H) demonstrate the ability of the appli3 cant to expend funds efficiently by not having 

4 any unexpended funds reallocated under section 

5 2603(a)(3)(E).’’; 

6 (3) in paragraph (2)— 

7 (A) by striking subparagraph (B) and in8 serting the following: 

9 ‘‘(B) DEMONSTRATED NEED.—In deter10 mining demonstrated need for purposes of sub11 paragraph (A), the Secretary shall consider rel12 evant factors that impact the need for supple13 mental financial assistance, including— 

14 ‘‘(i) the unmet need for such services, 

15 as determined under section 2602(b)(4) or 

16 other community input process as defined 

17 under section 2609A(a); 

18 ‘‘(ii) an increasing need for HIV/ 

19 AIDS-related services, including relative 

20 rates of increase in the number of cases of 

21 HIV/AIDS; 

22 ‘‘(iii) the relative rates of increase in 

23 the number of cases of HIV/AIDS within 

24 new or emerging subpopulations; 


sroberts on PROD1PC70 with BILLS
14 

•S 2823 RS

1 ‘‘(iv) the current prevalence of HIV/ 

2 AIDS; 

3 ‘‘(v) relevant factors related to the 

4 cost and complexity of delivering health 

5 care to individuals with HIV/AIDS in the 

6 eligible area; 

7 ‘‘(vi) the impact of co-morbid factors, 

8 including co-occurring infections, deter9 mined relevant by the Secretary; 

10 ‘‘(vii) the prevalence of homelessness; 

11 ‘‘(viii) the prevalence of individuals 

12 described under section 2602(b)(2)(M); 

13 ‘‘(ix) the relevant factors that limit 

14 access to health care, including geographic 

15 variation, adequacy of health insurance 

16 coverage, and language barriers; or 

17 ‘‘(x) the impact of a precipitous de18 cline in the amount received under this 

19 subpart to an increase in unmet need for 

20 such services.’’; and 

21 (B) by striking subparagraphs (C) and 

22 (D). 

23 SEC. 106. ADMINISTRATIVE COSTS. 

24 Section 2604(f) of the Public Health Service Act (42 

25 U.S.C. 300ff–14(f)) is amended— 


sroberts on PROD1PC70 with BILLS
15 

•S 2823 RS

1 (1) in paragraph (1), by striking ‘‘5 percent’’ 

2 and inserting ‘‘10 percent’’; and 

3 (2) in paragraph (2)(B), by inserting ‘‘the ac4 tivities carried out by HIV health services planning 

5 council as established under section 2602(b),’’ after 

6 ‘‘including’’. 

7 SEC. 107. AUDITS. 

8 Section 2605(a) of the Public Health Service Act (42 

9 U.S.C. 300ff–15(a)) is amended— 

10 (1) in paragraph (8), by striking ‘‘and’’ at the 

11 end; 

12 (2) in paragraph (9), by striking the period and 

13 inserting ‘‘; and’’; and 

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

15 ‘‘(10) that the chief elected official will submit 

16 to the lead State agency under section 2617(b)(4), 

17 audits regarding funds expended in accordance with 

18 this part every 2 years and shall include necessary 

19 client-based data to compile unmet need calculations 

20 and Statewide coordinated statements of need proc21 ess.’’. 

22 SEC. 108. PLANNING COUNCIL REPRESENTATION. 

23 Section 2602(b)(2)(G) of the Public Health Service 

24 Act (42 U.S.C. 300ff–12(b)(2)(G)) is amended by insertVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6401 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
16 

•S 2823 RS

1 ing ‘‘, Native Americans, individuals co-infected with hep2 atitis B or C’’ after ‘‘disease’’. 

3 SEC. 109. PAYER OF LAST RESORT. 

4 Section 2605(a)(6)(A) of the Public Health Service 

5 Act (42 U.S.C. 300ff–15(a)(6)(A)) is amended by insert6 ing ‘‘(except for a program administered by or providing 

7 the services of the Indian Health Service)’’ before the 

8 semicolon. 

9 SEC. 110. TRANSITIONAL GRANTS FOR OTHER AREAS. 

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

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

12 (1) by inserting after the part heading the fol13 lowing: 

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

15 (2) by redesignating sections 2606 and 2607 as 

16 sections 2610 and 2610A, respectively; and 

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

18 ‘‘Subpart II—Transitional Grants 

19 ‘‘SEC. 2609. ESTABLISHMENT. 

20 ‘‘(a) ELIGIBLE AREAS.— 

21 ‘‘(1) IN GENERAL.—The Secretary, acting 

22 through the Administrator of the Health Resources 

23 and Services Administration, shall, subject to sub24 section (b), make grants in accordance with this sub25 part for the purpose of assisting in the provision of 


sroberts on PROD1PC70 with BILLS
17 

•S 2823 RS

1 the services specified in section 2604 in any metro2 politan area— 

3 ‘‘(A) for which there has been reported to 

4 and confirmed by the Director of the Centers 

5 for Disease Control and Prevention a cumu6 lative total of at least 1,000, but less than 

7 2,000, cases of acquired immune deficiency syn8 drome for the most recent period of 5 calendar 

9 years for which such data are available; and 

10 ‘‘(B) for which there has been reported to 

11 and confirmed by the Director of the Centers 

12 for Disease Control and Prevention a cumu13 lative total of at least 500, but less than 1,000, 

14 cases of acquired immune deficiency syndrome 

15 for the most recent period of 5 calendar years 

16 for which such data are available. 

17 ‘‘(2) ADDITIONAL ELIGIBLE AREAS.—With re18 spect to fiscal year 2007, a metropolitan area that 

19 received funding under this part for fiscal year 2006 

20 but which does not meet the eligibility threshold de21 scribed in paragraph (1)(A) for fiscal year 2007 

22 shall be deemed to be eligible under such paragraph 

23 (1)(A). 

24 ‘‘(b) CONTINUED STATUS AS ELIGIBLE AREA.—Not25 withstanding any other provision of this section, a metroVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6401 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
18 

•S 2823 RS

1 politan area shall continue to be eligible to receive a grant 

2 under this section until such area, for three consecutive 

3 grant years, fails to meet the applicable requirement of 

4 subparagraph (A) or (B) of subsection (a)(1) concerning 

5 the number of living cases of AIDS over the most recent 

6 5-year period. 

7 ‘‘SEC. 2609A. APPLICATION OF OTHER PROVISIONS. 

8 ‘‘(a) ADMINISTRATION.— 

9 ‘‘(1) IN GENERAL.—The provisions of section 

10 2602 shall apply to areas that receive a grant under 

11 this subpart, except that the chief elected official 

12 may elect not to comply with the provisions of sub13 section (b), so long as the official provides docu14 mentation to the Secretary that details the process 

15 used to obtain community input (particularly from 

16 those inflected with HIV) for the design and imple17 mentation of activities related to such grant. 

18 ‘‘(2) EXCEPTION.—The exception provided for 

19 in paragraph (1) shall not apply in fiscal years 2007 

20 through 2009 to areas that receive funding under 

21 this part. 

22 ‘‘(b) DISTRIBUTION.—The provisions of section 2603 

23 shall apply for purposes of awarding grants under this 

24 subpart, except that— 


sroberts on PROD1PC70 with BILLS
19 

•S 2823 RS

1 ‘‘(1) with respect to areas described in section 

2 2609(a)(1)(A)— 

‘‘(A) 662 3 ⁄3 percent of the amounts appro4 priated under section 2609B(1) for each fiscal 

5 year shall be allocated to such areas as provided 

6 for in section 2603(a); and 

‘‘(B) 331 7 ⁄3 percent of the amounts appro8 priated under section 2609B(1) for each fiscal 

9 year shall be allocated to such areas as provided 

10 for in section 2603(b); and 

11 ‘‘(2) with respect to areas described in section 

12 2609(a)(1)(B), 100 percent of the amounts appro13 priated under section 2609B(2) for each fiscal year 

14 shall be allocated to such areas as provided for in 

15 section 2603(a). 

16 ‘‘(c) HOLD HARMLESS.—Paragraph (4) of section 

17 2603(a) shall not apply to an area for purposes of this 

18 subpart. 

19 ‘‘(d) USE OF AMOUNTS.—Amounts provided to an 

20 area under a grant under this part shall be used by such 

21 entity as provided for in section 2604. 

22 ‘‘(e) APPLICATION.—To be eligible to receive a grant 

23 under this subpart, an area shall submit to the Secretary 

24 an application that meets the requirements of section 

25 2605. 


sroberts on PROD1PC70 with BILLS
20 

•S 2823 RS

1 ‘‘(f) TECHNICAL ASSISTANCE AND DEFINITIONS.— 

2 The provisions of sections 2606 and 2707 shall apply for 

3 purposes of this subpart, except that with respect to the 

4 definition of metropolitan area in section 2607(2), such 

5 term shall be applied so that for purposes of determining 

6 eligible areas, the Secretary shall use the boundaries of 

7 a respective area that were used when the area involved 

8 initially receive funding under this part. 

9 ‘‘SEC. 2609B. AUTHORIZATION OF APPROPRIATIONS. 

10 ‘‘There are authorized to be appropriated to carry out 

11 this subpart— 

12 ‘‘(1) with respect to areas described in section 

13 2609(a)(1)(A), $123,300,000 for fiscal year 2007, 

14 $127,900,000 for fiscal year 2008, $132,600,000 for 

15 fiscal year 2009, $137,500,000 for fiscal year 2010, 

16 and $142,600,000 for fiscal year 2011; and 

17 ‘‘(2) with respect to areas described in section 

18 2609(a)(1)(B), $5,000,000 for each of the fiscal 

19 years 2007 through 2011. 

20 ‘‘Subpart III—General Provisions’’. 

21 (b) REPEAL.—Section 2620 of the Public Health 

22 Service Act (42 U.S.C. 300ff–30) is repealed. 


sroberts on PROD1PC70 with BILLS
21 

•S 2823 RS

1 SEC. 111. AUTHORIZATION OF APPROPRIATIONS. 

2 Subpart I of part A of title XXVI of the Public 

3 Health Service Act (42 U.S.C. 300ff–11) is amended by 

4 adding at the end the following: 

5 ‘‘SEC. 2606. AUTHORIZATION OF APPROPRIATIONS. 

6 ‘‘For the purpose of carrying put this subpart, there 

7 are authorized to be appropriated $418,600,000 for fiscal 

8 year 2007, $434,100,000 for fiscal year 2008, 

9 $450,100,000 for fiscal year 2009, $466,800,000 for fis10 cal year 2010, and $484,100,000 for fiscal year 2011.’’. 

11 TITLE II—CARE GRANTS 

12 SEC. 201. LIVING CASES OF HIV/AIDS. 

13 (a) PRIORITY.—Section 2611(b)(1) of the Public 

14 Health Service Act (42 U.S.C. 300ff–21(b)(1)) is amend15 ed— 

16 (1) by striking ‘‘acquired immune deficiency 

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

18 (2) by striking ‘‘such syndrome’’ and inserting 

19 ‘‘HIV/AIDS’’. 

20 (b) APPLICATION.—Section 2617(d)(3) of the Public 

21 Health Service Act (42 U.S.C. 300ff–27(d)(3)) is amend22 ed— 

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

24 immune deficiency syndrome’’ and inserting ‘‘HIV/ 

25 AIDS’’; and 


sroberts on PROD1PC70 with BILLS
22 

•S 2823 RS

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

2 immune deficiency syndrome’’ and inserting ‘‘HIV/ 

3 AIDS’’. 

4 (c) DISTRIBUTION OF FUNDS.—Section 2618(a) of 

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

6 amended— 

7 (1) in paragraph (1)(A)(i)— 

8 (A) in subclause (I), by striking ‘‘cases of 

9 acquired immune deficiency syndrome, as deter10 mined under paragraph (2)(D)’’ and inserting 

11 ‘‘living cases of AIDS (reported to and con12 firmed by the Director of the Centers for Dis13 ease Control and Prevention)’’; and 

14 (B) in subclause (II)— 

15 (i) by striking ‘‘cases of acquired im16 mune deficiency syndrome, as determined 

17 under paragraph (2)(D)’’ and inserting 

18 ‘‘living cases of AIDS (reported to and 

19 confirmed by the Director of the Centers 

20 for Disease Control and Prevention)’’; and 

21 (ii) by inserting ‘‘and’’ after the semi22 colon; and 

23 (2) in paragraph (2)— 

24 (A) in subparagraph (B), by striking ‘‘esti25 mated number of living cases of acquired imVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6401 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
23 

•S 2823 RS

1 mune deficiency syndrome’’ and inserting 

2 ‘‘number of living cases of HIV/AIDS’’; 

3 (B) in subparagraph (C)— 

4 (i) by striking ‘‘estimated’’ each place 

5 that such term appears; and 

6 (ii) by striking ‘‘acquired immune de7 ficiency syndrome’’ each place that such 

8 appears and inserting ‘‘HIV/AIDS’’; and 

9 (C) by striking subparagraph (D) and in10 serting the following: 

11 ‘‘(F) LIVING CASES OF HIV/AIDS.— 

12 ‘‘(i) IN GENERAL.—Except as pro13 vided for in clause (ii) and (iii), the 

14 amount determined in this subparagraph is 

15 the number of living cases of HIV/AIDS 

16 (reported to and confirmed by the Director 

17 of the Centers for Disease Control and 

18 Prevention) through December 31 of the 

19 most recent calendar year involved. 

20 ‘‘(ii) FISCAL YEARS 2007 THROUGH

21 2010.—For each of fiscal years 2007 

22 through 2010, the Secretary may use the 

23 proxy number for the number of HIV cases 

24 described in clause (iii) if— 

25 ‘‘(I) the State involved— 


sroberts on PROD1PC70 with BILLS
24 

•S 2823 RS

1 ‘‘(aa) is reporting, or the 

2 State will by October 1, 2006 

3 have submitted a transition plan 

4 for reporting, accurate and reli5 able HIV cases to the Director of 

6 the Centers for Disease Control 

7 and Prevention; or 

8 ‘‘(bb) not later than October 

9 1, 2006, make all necessary stat10 utory changes to allow for the 

11 collection of HIV data certified 

12 by the Director of the Centers 

13 for Disease Control and Preven14 tion; 

15 ‘‘(II) the State involved will by 

16 April 1, 2008, begin reporting accu17 rate and reliable HIV cases, as deter18 mined by the Director of the Centers 

19 for Disease Control and Prevention; 

20 and 

21 ‘‘(III) the Director of the Centers 

22 for Disease Control and Prevention 

23 has determined that such State does 

24 not have an established HIV surveil25 lance system. 


sroberts on PROD1PC70 with BILLS
25 

•S 2823 RS

1 ‘‘(iii) AMOUNT DETERMINED.—With 

2 respect to each of fiscal years 2007 

3 through 2010, the amount determined 

4 under this subparagraph shall be the lesser 

5 of— 

6 ‘‘(I) the product of 0.9 and the 

7 number of living AIDS cases in the 

8 area involved; or 

9 ‘‘(II) an amount equal to 110 

10 percent of the funding level for the 

11 previous fiscal year.’’. 

12 SEC. 202. AIDS DRUG ASSISTANCE PROGRAM. 

13 (a) REQUIREMENT OF MINIMUM DRUG LIST.—Sec14 tion 2616 of the Public Health Service Act (42 U.S.C. 

15 300ff–26) is amended— 

16 (1) in subsection (c), by striking paragraph (1) 

17 and inserting the following: 

18 ‘‘(1) ensure that those treatments contained on 

19 the list of core AIDS Drug Assistance Program 

20 antiretroviral medications developed by the Secretary 

21 based on Public Health Service guidelines, are the 

22 minimum required treatments to be included under 

23 the program established under this section;’’; and 

24 (2) in subsection (d), by adding at the end the 

25 following: ‘‘The Secretary, in consultation with the 


sroberts on PROD1PC70 with BILLS
26 

•S 2823 RS

1 Public Health Service, shall develop and maintain a 

2 list of classes of core AIDS Drug Assistance Pro3 gram antiretroviral medications that shall be based 

4 upon those medications included in the Department 

5 of Health and Human Service’s Public Health Serv6 ice HIV/AIDS Clinical Practice Guidelines for use of 

7 HIV/AIDS Drugs, drugs needed to manage symp8 toms associated with HIV infection.’’. 

9 (b) STATE REQUIREMENTS.—Subclauses (I) through 

10 (III) of section 2618(a)(2)(I)(ii) of the Public Health 

11 Service Act (42 U.S.C. 300ff–28(a)(2)(I)(ii)(I)–(III)) are 

12 amended to read as follows: 

13 ‘‘(I) IN GENERAL.—From 

14 amounts made available under 

15 subclause (V), the Secretary shall 

16 award supplemental grants to 

17 States described in subclause (II) 

18 to enable such States to purchase 

19 and distribute to eligible individ20 uals (as described in section 

21 2616(b)), pharmaceutical thera22 peutics described under sections 

23 2616(a) and 2616(c). 

24 ‘‘(II) ELIGIBLE STATES.— 

25 For purposes of subclause (I), a 


sroberts on PROD1PC70 with BILLS
27 

•S 2823 RS

1 State shall be an eligible State if 

2 the State did not have unex3 pended funds subject to realloca4 tion under section 2618(d) and, 

5 in accordance with criteria estab6 lished by the Secretary, dem7 onstrates a severe need for a 

8 grant under this clause. In devel9 oping such criteria, the Secretary 

10 shall consider eligibility stand11 ards, formulary composition, the 

12 number of eligible individuals to 

13 whom a State is unable to pro14 vide therapeutics described in 

15 section 2616(a), and an unantici16 pated increase of eligible individ17 uals with HIV/AIDS. 

18 ‘‘(III) STATE REQUIREMENTS.— 

19 The Secretary may not make a grant 

20 to a State under this clause unless the 

21 State agrees that the State will make 

22 available (directly or through dona23 tions of public or private entities) 

24 non-Federal contributions toward the 

25 activities to be carried out under the 


sroberts on PROD1PC70 with BILLS
28 

•S 2823 RS

1 grant in an amount equal to $1 for 

2 each $4 of Federal funds provided in 

3 the grant, except that the Secretary 

4 may waive this subclause if the State 

5 has otherwise fully complied with sec6 tion 2617(d) with respect to the grant 

7 year involved.’’. 

8 (c) INCREASE IN ADAP SET-ASIDE.—Section 

9 2618(a)(2)(I)(ii)(V) of the Public Health Service Act (42 

10 U.S.C. 300ff–28(a)(2)(I)(ii)(V)) is amended by striking 

11 ‘‘3’’ and inserting ‘‘5’’. 

12 (d) DRUG REBATE PROGRAM.—Section 2616 of the 

13 Public Health Service Act (42 U.S.C. 300ff–26) is amend14 ed by adding at the end the following: 

15 ‘‘(f) DRUG REBATE PROGRAM.—A State shall ensure 

16 that any drug rebates received on drugs purchased from 

17 funds provided under this section are applied to activities 

18 supported under this title, with a preference for activities 

19 described under this section.’’. 

20 SEC. 203. COORDINATION. 

21 Section 2617(b) of the Public Health Service Act (42 

22 U.S.C. 300ff–27(b)) is amended— 

23 (1) by redesignating paragraphs (4) through 

24 (6) as paragraphs (5) through (7), respectively; 


sroberts on PROD1PC70 with BILLS
29 

•S 2823 RS

1 (2) by inserting after paragraph (3), the fol2 lowing: 

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

4 shall— 

5 ‘‘(A) administer all assistance received 

6 under this part; 

7 ‘‘(B) conduct the needs assessment and 

8 prepare the State plan under paragraph (3); 

9 ‘‘(C) prepare all applications for assistance 

10 under this part; 

11 ‘‘(D) receive notices with respect to pro12 grams under this title; 

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

14 the Secretary all audits from grantees within 

15 the State, including audits regarding funds ex16 pended in accordance with this part; and 

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

18 appropriate by the Secretary to facilitate the 

19 coordination of programs under this title.’’; 

20 (3) in paragraph (5) (as so redesignated)— 

21 (A) in the matter preceding subparagraph 

22 (A), by striking ‘‘under this part’’ and inserting 

23 ‘‘under any provision of this title’’; 

24 (B) in subparagraph (E), by striking 

25 ‘‘and’’ at the end; and 


sroberts on PROD1PC70 with BILLS
30 

•S 2823 RS

1 (C) by inserting after subparagraph (F), 

2 the following: 

3 ‘‘(G) includes key outcomes to be measured 

4 by all entities in the State receiving assistance 

5 under this title; and’’. 

6 SEC. 204. DISTRIBUTION OF FUNDS. 

7 (a) IN GENERAL.—Section 2618(a)(2) of the Public 

8 Health Service Act (42 U.S.C. 300ff–28(a)(2)) is amend9 ed— 

10 (1) in subparagraph (A)— 

11 (A) in clause (i), by striking ‘‘and (I)’’ and 

12 inserting ‘‘, (I), and (J)’’; and 

13 (B) in clause (ii)— 

14 (i) in subclause (I)— 

15 (I) by striking ‘‘0.8’’ and insert16 ing ‘‘0.75’’; and 

17 (II) by striking ‘‘and’’ at the end; 

18 (ii) in subclause (II), by striking the 

19 period and inserting ‘‘; and’’; and 

20 (iii) by adding at the end the fol21 lowing: 

22 ‘‘(III) the product of 0.05 and 

23 the ratio of the locality distribution 

24 factor (as determined under subpara25 graph (D)) to the sum of the respecVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6401 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
31 

•S 2823 RS

1 tive State distribution factors for all 

2 States and territories.’’; 

3 (2) in subparagraph (C)(ii), by striking ‘‘(as de4 termined under part A)’’ and inserting ‘‘under sub5 part I of part A and an eligible area under section 

6 2609(a)(1)(A)’’; 

7 (3) by inserting after subparagraph (C), the fol8 lowing: 

9 ‘‘(D) LOCALITY DISTRIBUTION FACTOR.— 

10 For purposes of subparagraph (A)(ii)(III), the 

11 term ‘locality distribution factor’ means an 

12 amount equal to the sum of— 

13 ‘‘(i) the number of living cases of 

14 HIV/AIDS in the State or territory in15 volved, as determined under subparagraph 

16 (F); less 

17 ‘‘(ii) the number of living cases of 

18 HIV/AIDS in such State or territory that 

19 are within an eligible area (as determined 

20 under subpart I of part A and section 

21 2609(a)(1)(A)).’’; 

22 (4) by striking subparagraph (E) and inserting 

23 the following: 

24 ‘‘(E) SEVERITY OF NEED.— 


sroberts on PROD1PC70 with BILLS
32 

•S 2823 RS

1 ‘‘(i) FISCAL YEARS BEGINNING WITH

2 2011.—If, by January 1, 2010, the Sec3 retary notifies the appropriate committees 

4 of Congress that the Secretary has devel5 oped a severity of need index, in accord6 ance with clause (v), the provisions of sub7 paragraphs (A) through (D) shall not 

8 apply for fiscal year 2011 or any fiscal 

9 year thereafter, and the Secretary shall use 

10 the severity of need index (as defined in 

11 clause (iv)) for the determination of the 

12 formula allocations, subject to the Con13 gressional Review Act. 

14 ‘‘(ii) SUBSEQUENT FISCAL YEARS.— 

15 If, on or before any January 1 that is sub16 sequent to the date referred to in clause 

17 (i), the Secretary notifies the appropriate 

18 committees of Congress that the Secretary 

19 has developed a severity of need index, in 

20 accordance with clause (v), for each suc21 ceeding fiscal year, the provisions of sub22 paragraphs (A) through (D) shall not 

23 apply, and the Secretary shall use the se24 verity of need index (as defined in clause 

25 (iv)) for the determination of the formula 


sroberts on PROD1PC70 with BILLS
33 

•S 2823 RS

1 allocations, subject to the Congressional 

2 Review Act. 

3 ‘‘(iii) FISCAL YEAR 2013.—The Sec4 retary shall notify the appropriate commit5 tees of Congress that the Secretary has de6 veloped a severity of need index by Janu7 ary 1, 2012, and the provisions of subpara8 graphs (A) through (D) shall not apply, 

9 and the Secretary shall use the severity of 

10 need index (as defined in clause (iv)) for 

11 the formula allocations for fiscal year 

12 2013, subject to the Congressional Review 

13 Act. 

14 ‘‘(iv) DEFINITION OF SEVERITY OF

15 NEED INDEX.—In this subparagraph, the 

16 term ‘severity of need index’ means the 

17 index of the relative needs of individuals 

18 within the State, as identified by a variety 

19 of different factors, and is a factor that is 

20 multiplied by the number of living HIV/ 

21 AIDS cases in the State, providing dif22 ferent weights to those cases based on 

23 their needs. 

24 ‘‘(v) REQUIREMENTS FOR SECRE25 TARIAL NOTIFICATION.—When the SecVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6401 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
34 

•S 2823 RS

1 retary notifies the appropriate committees 

2 of Congress that the Secretary has devel3 oped a severity of need index, the Sec4 retary shall provide the following: 

5 ‘‘(I) Methodology for and ration6 ale behind developing the severity of 

7 need index, including information re8 lated to the field testing of the sever9 ity of need index. 

10 ‘‘(II) Expected changes in fund11 ing allocations, given the application 

12 of the severity of need index and the 

13 elimination of the provisions of sub14 paragraphs (A) through (D). 

15 ‘‘(III) Information regarding the 

16 process by which the Secretary re17 ceived community input regarding the 

18 application of the severity of need 

19 index. 

20 ‘‘(IV) Timeline and process for 

21 the implementation of the severity of 

22 need index to ensure that it is applied 

23 in the following fiscal year. 

24 ‘‘(vi) ANNUAL REPORTS.—Not later 

25 than 1 year after the date of enactment of 


sroberts on PROD1PC70 with BILLS
35 

•S 2823 RS

1 the Ryan White HIV/AIDS Treatment 

2 Modernization Act, and annually thereafter 

3 until the Secretary notifies Congress that 

4 the Secretary has developed a severity of 

5 need index in accordance with this sub6 paragraph, the Secretary shall prepare and 

7 submit to the appropriate committees of 

8 Congress a report— 

9 ‘‘(I) that updates progress to10 ward having client level data; 

11 ‘‘(II) that updates the progress 

12 toward having a severity of need 

13 index, including information related to 

14 the methodology and process for ob15 taining community input; and 

16 ‘‘(III) that, as applicable, states 

17 whether the Secretary could develop a 

18 severity of need index before fiscal 

19 year 2010.’’. 

20 (5) by striking subparagraph (G), and inserting 

21 the following: 

22 ‘‘(G) UNEXPENDED FUNDS.— 

23 ‘‘(i) IN GENERAL.—A State that has 

24 unobligated funds for a fiscal year under a 

25 grant under this part shall— 


sroberts on PROD1PC70 with BILLS
36 

•S 2823 RS

1 ‘‘(I) return such funds to the 

2 Secretary to be applied as provided 

3 for in section 2620; or 

4 ‘‘(II) submit an application to 

5 the Secretary for the use of such 

6 funds in the succeeding fiscal year 

7 that includes a description of the 

8 manner in which the State intends to 

9 use such funds. 

10 ‘‘(ii) CARRYOVER.—With respect to 

11 an application received under clause (i)(II), 

12 the Secretary shall determine whether the 

13 State involved may carryover any unobli14 gated funds for use under this part in the 

15 succeeding fiscal year or whether such 

16 amounts shall be returned to the Secretary 

17 for use under section 2620. Notice shall be 

18 provided to the area of such determination. 

19 ‘‘(iii) FAILURE TO EXPEND FUNDS.— 

20 Amounts carried over by a State under 

21 this subparagraph that are not expended in 

22 the succeeding fiscal year shall be returned 

23 to the Secretary for use under section 

24 2610. 


sroberts on PROD1PC70 with BILLS
37 

•S 2823 RS

1 ‘‘(iv) CONSIDERATION IN MAKING

2 GRANTS.—The Secretary may, in deter3 mining the amount of a grant for a fiscal 

4 year under this paragraph, adjust the 

5 grant amount to reflect the amount of un6 expended and uncanceled grant funds re7 maining at the end of the fiscal year pre8 ceding the year for which the grant deter9 mination is to be made. The amount of 

10 any such unexpended funds shall be deter11 mined using the financial status report of 

12 the grantee.’’; 

13 (6) by striking subparagraph (H); and 

14 (7) in subparagraph (I)(ii), by striking sub15 clause (VI) and inserting the following: 

16 ‘‘(VI) INCREASES IN GRANT.— 

17 ‘‘(aa) IN GENERAL.—For el18 igible areas receiving grants 

19 under this section in fiscal year 

20 2007, the Secretary shall in21 crease the amount of the grant 

22 made pursuant to paragraph (2) 

23 for the State to ensure that— 

24 ‘‘(AA) for fiscal year 

25 2007, the grant is not less 


sroberts on PROD1PC70 with BILLS
38 

•S 2823 RS

1 than 90 percent of the 

2 amount of the grant made 

3 for the State under section 

4 2620 and section 2618(a) 

5 for the base year; 

6 ‘‘(BB) for fiscal year 

7 2008, the grant is not less 

8 than 85 percent of the 

9 amount of such base year 

10 grant; and 

11 ‘‘(CC) for fiscal year 

12 2009, the grant is not less 

13 than 80 percent of the 

14 amount of the base year 

15 grant. 

16 ‘‘(bb) BASE YEAR.—With re17 spect to grants made pursuant to 

18 paragraph (2) for an State, the 

19 base year shall be fiscal year 

20 2006.’’. 

21 (b) REALLOCATION.—Section 2618(d) of the Public 

22 Health Service Act (42 U.S.C. 300ff–28(d)) is amended 

23 by striking ‘‘in proportion to the original grants made to 

24 such States’’ and insert ‘‘reallocated pursuant to section 

25 2620’’. 


sroberts on PROD1PC70 with BILLS
39 

•S 2823 RS

1 SEC. 205. CORE MEDICAL SERVICES. 

2 Section 2612 of the Public Health Service Act (42 

3 U.S.C. 300ff–22) is amended by adding at the end the 

4 following: 

5 ‘‘(e) REQUIRED FUNDING FOR CORE MEDICAL SERV6 ICES.— 

7 ‘‘(1) IN GENERAL.—Notwithstanding any other 

8 provision of law, a grantee under this part shall ex9 pend not less than 75 percent of the funds received 

10 under the grant on core medical services, except that 

11 the Secretary shall waive the application of this sub12 section with respect to a grantee if the Secretary de13 termines that, within the service area of the grant14 ee— 

15 ‘‘(A) there is no waiting lists for AIDS 

16 Drug Assistance Program services; and 

17 ‘‘(B) core medical services are available to 

18 all individuals infected with HIV/AIDS. 

19 ‘‘(2) CORE MEDICAL SERVICES.—For purposes 

20 of this subsection, the term ‘core medical services’ 

21 with respect to an individual infected with HIV/ 

22 AIDS (including the co-occurring diseases of the in23 dividual) means the following services: 

24 ‘‘(A) Outpatient and ambulatory health 

25 services. 


sroberts on PROD1PC70 with BILLS
40 

•S 2823 RS

1 ‘‘(B) AIDS Drug Assistance Program 

2 treatments. 

3 ‘‘(C) AIDS pharmaceutical assistance. 

4 ‘‘(D) Oral health care. 

5 ‘‘(E) Early intervention services. 

6 ‘‘(F) Health insurance premium and cost 

7 sharing assistance for low-income individuals. 

8 ‘‘(G) Home health care. 

9 ‘‘(H) Hospice services. 

10 ‘‘(I) Home and community-based health 

11 services as defined under section 2614(c), ex12 cept homemaker services. 

13 ‘‘(J) Mental health services. 

14 ‘‘(K) Substance abuse outpatient care. 

15 ‘‘(L) Medical case management, including 

16 treatment adherence services. 

17 ‘‘(3) SUPPORT SERVICES.—Notwithstanding 

18 any other provision of law, and subject to paragraph 

19 (1), a grantee under this part, subject to the ap20 proval of the Secretary, may provide support services 

21 (such as respite care for individuals with HIV/AIDS, 

22 outreach services, medical transportation, nutritional 

23 counseling, linguistic services, and referral for health 

24 care and support services for individuals with HIV/ 

25 AIDS) needed to achieve medical outcomes which 


sroberts on PROD1PC70 with BILLS
41 

•S 2823 RS

1 are related to the medical outcomes for an individual 

2 infected with HIV and approved by the Secretary. 

3 ‘‘(4) DEFINITION OF MEDICAL OUTCOMES.—In 

4 this subsection, the term ‘medical outcomes’ means 

5 those outcomes affecting the HIV-related clinical 

6 status of an individual with HIV/AIDS. 

7 ‘‘(5) UNEXPENDED FUNDS.—Any amounts re8 quired to be expended for core medical services or 

9 support services under this subsection that remain 

10 unobligated at the end of the fiscal year in which the 

11 funds were awarded shall be remitted to the Sec12 retary for reallocation under section 2620.’’. 

13 SEC. 206. SUPPLEMENTAL GRANTS. 

14 (a) IN GENERAL.—Section 2620 of the Public Health 

15 Service Act (42 U.S.C. 300ff–30) is amended to read as 

16 follows: 

17 ‘‘SEC. 2620. SUPPLEMENTAL GRANTS. 

18 ‘‘(a) IN GENERAL.—The Secretary shall utilize 

19 amounts appropriated under section 2622 for a fiscal year 

20 and made available in accordance with subsection (c) to 

21 award grants to States whose applications under section 

22 2617 demonstrate a need in the State for supplemental 

23 financial assistance to combat the HIV epidemic and that 

24 have not had unexpended funds subject to the reallocation 

25 under section 2618(a)(2)(G). 


sroberts on PROD1PC70 with BILLS
42 

•S 2823 RS

1 ‘‘(b) DEMONSTRATED NEED.—In determining dem2 onstrated need for purposes of subsection (a), the Sec3 retary shall consider relevant factors that impact the need 

4 for supplemental financial assistance, including— 

5 ‘‘(1) the unmet need for such services, as deter6 mined under section 2602(b)(4) or other community 

7 input process as defined under section 2609A(a); 

8 ‘‘(2) an increasing need for HIV/AIDS-related 

9 services, including relative rates of increase in the 

10 number of cases of HIV/AIDS; 

11 ‘‘(3) the relative rates of increase in the number 

12 of cases of HIV/AIDS within new or emerging sub13 populations; 

14 ‘‘(4) the current prevalence of HIV/AIDS; 

15 ‘‘(5) relevant factors related to the cost and 

16 complexity of delivering health care to individuals 

17 with HIV/AIDS in the eligible area; 

18 ‘‘(6) the impact of co-morbid factors, including 

19 co-occurring infections, determined relevant by the 

20 Secretary; 

21 ‘‘(7) the prevalence of homelessness; 

22 ‘‘(8) the prevalence of individuals described 

23 under section 2602(b)(2)(M); 

24 ‘‘(9) the relevant factors that limit access to 

25 health care, including geographic variation, adequacy 


sroberts on PROD1PC70 with BILLS
43 

•S 2823 RS

1 of health insurance coverage, and language barriers; 

2 or 

3 ‘‘(10) the impact of a precipitous decline in the 

4 amount received under this subpart to an increase in 

5 unmet need for such services. 

6 ‘‘(c) AMOUNT AND TRIGGER OF FUNDING.— 

7 ‘‘(1) AMOUNT.—For each fiscal year beginning 

8 with the trigger year described in paragraph (2), the 

9 Secretary shall make available for purposes of 

awarding grants under this section, 1 10 ⁄3 of the sum 

11 of— 

12 ‘‘(A) the amount appropriated under sec13 tion 2622 for such fiscal year; less 

14 ‘‘(B) the amount made available to carry 

15 out section 2618(a)(2)(I) and section 2621 for 

16 such fiscal year. 

17 ‘‘(2) TRIGGER YEAR.—This section shall be ef18 fective only for fiscal years beginning in the first fis19 cal year in which the amount appropriated under 

20 section 2621, excluding any amounts made available 

21 to carry out section 2618(a)(2)(I) and section 2621 

22 for such fiscal year, exceeds the amount appro23 priated under section 2677(b) (as such section ex24 isted on the day before the date of enactment of the 

25 Ryan White HIV/AIDS Treatment Modernization 


sroberts on PROD1PC70 with BILLS
44 

•S 2823 RS

1 Act) for fiscal year 2006, excluding any amount 

2 made available to carry out section 2618(a)(2)(I) for 

3 fiscal year 2006.’’. 

4 (b) CONFORMING AMENDMENTS.—Section 2618 of 

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

6 amended— 

7 (1) in subsection (a)(1), by striking ‘‘section 

8 2677’’ and inserting ‘‘section 2622 and to the provi9 sions of section 2620’’; and 

10 (2) in subsection (c)(1), by inserting ‘‘, except 

11 for grants awarded under section 2620,’’ after 

12 ‘‘under this part’’. 

13 SEC. 207. REDUCTION OF THE ADAP WAITING LIST. 

14 Subpart I of part B of title XXVI of the Public 

15 Health Service Act (42 U.S.C. 300ff–21 et seq.) is amend16 ed by adding at the end the following: 

17 ‘‘SEC. 2621. REDUCTION OF THE ADAP WAITING LIST. 

18 ‘‘(a) IN GENERAL.—If the Secretary determines that 

19 there is additional need for States to have funds to provide 

20 eligible individuals (as described in section 2616(b)) ap21 propriate access to pharmaceutical therapies, the Sec22 retary may make supplemental grants to States described 

23 in subsection (b) to enable such States to purchase and 

24 distribute to eligible individuals pharmaceutical therapies 

25 as described in sections 2616(a) and 2616(e). 


sroberts on PROD1PC70 with BILLS
45 

•S 2823 RS

1 ‘‘(b) ELIGIBLE STATES.—For purposes of subsection 

2 (a), a State is an eligible State if the State did not have 

3 unexpended funds subject to reallocation under section 

4 2618(d), and, in accordance with criteria established by 

5 the Secretary, demonstrates a need for a grant under such 

6 subsection. In developing such criteria, the Secretary shall 

7 consider eligibility standards, formulary composition, the 

8 number of eligible individuals to whom the State is unable 

9 to provide therapeutics described in section 2616(a), and 

10 unanticipated increases in the number of eligible individ11 uals. 

12 ‘‘(c) STATE REQUIREMENTS.—The Secretary may 

13 not make a grant to a State under this section unless the 

14 State involved agrees that the State will make available 

15 (directly or through donations from public or private enti16 ties) non-Federal contributions toward the activities to be 

17 carried out under the grant in an amount equal to $1 for 

18 each $4 of Federal funds provided under the grant, except 

19 that the Secretary may waive this subsection if the State 

20 has otherwise fully complied with section 2617(d) with re21 spect to the grant year involved. 

22 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

23 is authorized to be appropriated to carry out this section, 

24 $40,000,000 for fiscal year 2007.’’. 


sroberts on PROD1PC70 with BILLS
46 

•S 2823 RS

1 SEC. 208. NATIVE AMERICAN REPRESENTATION. 

2 Section 2617(b)(6) of the Public Health Service Act 

3 (42 U.S.C. 300ff–27(b)(5)), as so redesignated, is amend4 ed by inserting ‘‘Native Americans within the State,’’ be5 fore ‘‘representatives of grantees’’. 

6 SEC. 209. PAYER OF LAST RESORT. 

7 Section 2617(b)(7)(F)(ii) of the Public Health Serv8 ice Act (42 U.S.C. 300ff–27(b)(6))is amended by inserting 

9 ‘‘(except for a program administered by or providing the 

10 services of the Indian Health Services)’’ before the semi11 colon. 

12 SEC. 210. HEPATITIS. 

13 Section 2614(a)(3) of the Public Health Service Act 

14 (42 U.S.C. 300ff–24(a)(3)) is amended by inserting ‘‘, in15 cluding speciality care (including vaccinations) for hepa16 titis coinfection,’’ after ‘‘health services’’. 

17 SEC. 211. AUTHORIZATION OF APPROPRIATIONS. 

18 Subpart I of part B of title XXVI of the Public 

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

20 amended by section 207, is further amended by adding 

21 at the end the following: 

22 ‘‘SEC. 2622. AUTHORIZATION OF APPROPRIATIONS. 

23 ‘‘For the purpose of carrying put this subpart, there 

24 are authorized to be appropriated $1,190,400,000 for fis25 cal year 2007, $1,193,000,000 for fiscal year 2008, 

26 $1,237,100,000 for fiscal year 2009, $1,282,900,000 for 


sroberts on PROD1PC70 with BILLS
47 

•S 2823 RS

1 fiscal year 2010, and $1,330,300,000 for fiscal year 

2 2011.’’. 

3 TITLE III—EARLY 

4 INTERVENTION SERVICES 

5 SEC. 301. CATEGORICAL GRANTS. 

6 (a) ESTABLISHMENT OF PROGRAM.—Section 

7 2651(b) of the Public Health Service Act (42 U.S.C. 

8 300ff–51(b)) is amended— 

9 (1) in paragraph (2)(D), by striking ‘‘the dis10 ease’’ and inserting ‘‘HIV/AIDS’’; 

11 (2) in paragraph (4)(B)— 

12 (A) in clause (i), by striking ‘‘paragraphs 

13 (1)’’ and all that follows through ‘‘2652(a)’’ 

14 and inserting ‘‘subparagraphs (A), (D), (E), 

15 and (F) of section 12652(a)(1)’’; and 

16 (B) in clause (ii), by striking ‘‘paragraphs 

17 (3) and (4) of section 2652(a)’’ and inserting 

18 ‘‘subparagraphs (B) and (C) of section 

19 2652(a)(1)’’; and 

20 (3) in paragraph (5)(A), by striking ‘‘the dis21 ease’’ each place that such appears and inserting 

22 ‘‘HIV/AIDS’’. 

23 (b) MINIMUM QUALIFICATION OF GRANTEES.—Sec24 tion 2652(a) of the Public Health Service Act (42 U.S.C. 

25 300ff–52(a)) is amended to read as follows: 


sroberts on PROD1PC70 with BILLS
48 

•S 2823 RS

1 ‘‘(a) ELIGIBLE ENTITIES.— 

2 ‘‘(1) IN GENERAL.—The entities referred to in 

3 section 2651(a) are public entities and nonprofit pri4 vate entities that are— 

5 ‘‘(A) federally-qualified health centers 

6 under section 1905(l)(2)(B) of the Social Secu7 rity Act; 

8 ‘‘(B) grantees under section 1001 (regard9 ing family planning) other than States; 

10 ‘‘(C) comprehensive hemophilia diagnostic 

11 and treatment centers; 

12 ‘‘(D) rural health clinics; 

13 ‘‘(E) health facilities operated by or pursu14 ant to a contract with the Indian Health Serv15 ice; 

16 ‘‘(F) nonprofit private entities that provide 

17 comprehensive primary care services to popu18 lations at risk of HIV/AIDS. 

19 ‘‘(2) UNDERSERVED POPULATIONS.—Entities 

20 described in paragraph (1) shall serve underserved 

21 populations which may include minority populations 

22 and Native American populations, ex-offenders, indi23 viduals co-infected with HIV and hepatitis B or C, 

24 low-income populations, inner city populations, and 

25 rural populations.’’. 


sroberts on PROD1PC70 with BILLS
49 

•S 2823 RS

1 (c) PREFERENCES IN MAKING GRANTS.—Section 

2 2653 of the Public Health Service Act (42 U.S.C. 300ff– 

3 53) is amended— 

4 (1) in subsection (b)(1)— 

5 (A) in subparagraph (A), by striking ‘‘ac6 quired immune deficiency syndrome’’ and in7 serting ‘‘HIV/AIDS’’; and 

8 (B) in subparagraph (D), by inserting be9 fore the semicolon the following: ‘‘and the num10 ber of cases of individuals coinfected with HIV/ 

11 AIDS and hepatitis B or C’’; and 

12 (2) in subsection (d)(2), by striking ‘‘special 

13 consideration’’ and inserting ‘‘preference’’. 

14 (d) PLANNING AND DEVELOPMENT GRANTS.—Sec15 tion 2654(c) of the Public Health Service Act (42 U.S.C. 

16 300ff–54(c)) is amended— 

17 (1) in paragraph (1)— 

18 (A) in subparagraph (A), by striking 

19 ‘‘HIV’’; and 

20 (B) in subparagraph (B), by striking 

21 ‘‘HIV’’ and inserting ‘‘HIV/AIDS’’; and 

22 (2) in paragraph (3), by striking ‘‘or under23 served communities’’ and inserting ‘‘areas or to un24 derserved populations’’. 


sroberts on PROD1PC70 with BILLS
50 

•S 2823 RS

1 (e) AUTHORIZATION OF APPROPRIATIONS.—Section 

2 2655 of the Public Health Service Act (42 U.S.C. 300ff– 

3 55) is amended by striking ‘‘such sums’’ and all that fol4 lows through ‘‘2005’’ and inserting ‘‘, $218,600,000 for 

5 fiscal year 2007, $226,700,000 for fiscal year 2008, 

6 $235,100,000 for fiscal year 2009, $234,800,000 for fis7 cal year 2010, and $252,800,000 for fiscal year 2011’’. 

8 SEC. 302. GENERAL PROVISIONS. 

9 (a) COUNSELING SERVICES.—Section 2662(a) of the 

10 Public Health Service Act (42 U.S.C. 300ff–62(a)) is 

11 amended by striking ‘‘the disease’’ and inserting ‘‘HIV/ 

12 AIDS’’. 

13 (b) APPLICABILITY OF CERTAIN REQUIREMENTS.— 

14 Section 2663 of the Public Health Service Act (42 U.S.C. 

15 300ff–63) is amended by striking ‘‘will, without’’ and all 

16 that follows through ‘‘be carried’’ and inserting ‘‘with 

17 funds appropriated through this Act will be carried’’. 

18 (c) ADDITIONAL REQUIRED AGREEMENTS.—Section 

19 2664(a) of the Public Health Service Act (42 U.S.C. 

20 300ff–64(a)) is amended— 

21 (1) in paragraph (1)— 

22 (A) in subparagraph (A), by striking 

23 ‘‘and’’ at the end; 

24 (B) in subparagraph (B), by striking 

25 ‘‘and’’ at the end; and 


sroberts on PROD1PC70 with BILLS
51 

•S 2823 RS

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

2 ‘‘(C) information regarding how the ex3 pected expenditures of the grant are related to 

4 the planning process for localities funded under 

5 part A (including the planning process de6 scribed in section 2602) and for States funded 

7 under part B (including the planning process 

8 described in section 2617(b)); and 

9 ‘‘(D) a specification of the expected ex10 penditures and how those expenditures will im11 prove overall client outcomes, as described in 

12 the State plan under section 2617(b) or 

13 through additional outcome measures;’’; 

14 (2) in paragraph (2), by striking the period and 

15 inserting a semicolon; and 

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

17 ‘‘(3) the applicant agrees to provide additional 

18 documentation to the Secretary regarding the proc19 ess used to obtain community input into the design 

20 and implementation of activities related to such 

21 grant; and 

22 ‘‘(4) the applicant agrees to submit to the lead 

23 State agency under section 2617(b)(4) audits re24 garding funds expended in accordance with this title 

25 and shall include necessary client level data to comVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6401 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
52 

•S 2823 RS

1 plete unmet need calculations and Statewide coordi2 nated statements of need process.’’. 

3 SEC. 303. CORE MEDICAL SERVICES. 

4 Subpart II of part C of title XXVI of the Public 

5 Health Service Act (42 U.S.C. 300ff–61 et seq.) is amend6 ed by adding at the end the following: 

7 ‘‘SEC. 2688. REQUIRED FUNDING FOR CORE MEDICAL SERV8 ICES. 

9 ‘‘(a) IN GENERAL.—Notwithstanding any other pro10 vision of law, a grantee under this part shall expend not 

11 less than 75 percent of the funds received under the grant 

12 on core medical services, except that the Secretary shall 

13 waive the application of this section with respect to a 

14 grantee if the Secretary determines that, within the service 

15 area of the grantee— 

16 ‘‘(1) there is no waiting lists for AIDS Drug 

17 Assistance Program services; and 

18 ‘‘(2) core medical services are available to all 

19 individuals infected with HIV/AIDS. 

20 ‘‘(b) CORE MEDICAL SERVICES.—For purposes of 

21 this section, the term ‘core medical services’ with respect 

22 to an individual infected with HIV/AIDS (including the 

23 co-occurring diseases of the individual) means the fol24 lowing services: 

25 ‘‘(1) Outpatient and ambulatory health services. 


sroberts on PROD1PC70 with BILLS
53 

•S 2823 RS

1 ‘‘(2) AIDS Drug Assistance Program treat2 ments. 

3 ‘‘(3) AIDS pharmaceutical assistance. 

4 ‘‘(4) Oral health care. 

5 ‘‘(5) Early intervention services. 

6 ‘‘(6) Health insurance premium and cost shar7 ing assistance for low-income individuals. 

8 ‘‘(7) Home health care. 

9 ‘‘(8) Hospice services. 

10 ‘‘(9) Home and community-based health serv11 ices as defined under section 2614(c), except home12 maker services. 

13 ‘‘(10) Mental health services. 

14 ‘‘(11) Substance abuse outpatient care. 

15 ‘‘(12) Medical case management, including 

16 treatment adherence services. 

17 ‘‘(c) SUPPORT SERVICES.—Notwithstanding any 

18 other provision of law, and subject to subsection (a), a 

19 grantee under this part, subject to the approval of the Sec20 retary, may provide support services (such as respite care 

21 for individuals with HIV/AIDS, outreach services, medical 

22 transportation, nutritional counseling, linguistic services, 

23 and referral for health care and support services for indi24 viduals with HIV/AIDS) needed to achieve medical out25 comes which are related to the medical outcomes for an 


sroberts on PROD1PC70 with BILLS
54 

•S 2823 RS

1 individual infected with HIV and approved by the Sec2 retary. 

3 ‘‘(d) DEFINITION OF MEDICAL OUTCOMES.—In this 

4 section, the term ‘medical outcomes’ means those out5 comes affecting the HIV-related clinical status of an indi6 vidual with HIV/AIDS. 

7 ‘‘(e) UNEXPENDED FUNDS.—Any amounts required 

8 to be expended for core medical services or support serv9 ices under this section that remain unobligated at the end 

10 of the fiscal year in which the funds were awarded shall 

11 be remitted to the Secretary for reallocation under this 

12 section.’’. 

13 SEC. 304. PAYER OF LAST RESORT. 

14 Section 2664(f)(1)(A) of the Public Health Service 

15 Act (42 U.S.C. 300ff–64(f)(1)(A)) is amended by insert16 ing ‘‘(except for a program administered by or providing 

17 the services of the Indian Health Service)’’ before the 

18 semicolon. 

19 TITLE IV—WOMEN, INFANTS, 

20 CHILDREN, AND YOUTH 

21 SEC. 401. WOMEN, INFANTS, CHILDREN, AND YOUTH. 

22 Part D of title XXVI of the Public Health Service 

23 Act (42 U.S.C. 300ff–71 et seq.) is amended to read as 

24 follows: 


sroberts on PROD1PC70 with BILLS
55 

•S 2823 RS

1 ‘‘PART D—WOMEN, INFANTS, CHILDREN, AND 

2 YOUTH 

3 ‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND AC4 CESS TO RESEARCH FOR WOMEN, INFANTS, 

5 CHILDREN, AND YOUTH. 

6 ‘‘(a) IN GENERAL.—The Secretary, acting through 

7 the Administrator of the Health Resources and Services 

8 Administration, shall award grants to public and nonprofit 

9 private entities (including a health facility operated by or 

10 pursuant to a contract with the Indian Health Service) 

11 that provide family-centered care involving outpatient or 

12 ambulatory care (directly or through contracts) for 

13 women, infants, children, and youth with HIV/AIDS. 

14 ‘‘(b) ADDITIONAL SERVICES FOR PATIENTS AND

15 FAMILIES.—Funds provided under grants awarded under 

16 subsection (a) may be also be used for the following sup17 port services: 

18 ‘‘(1) Family-centered care including case man19 agement. 

20 ‘‘(2) Referrals for additional services includ21 ing— 

22 ‘‘(A) referrals for inpatient hospital serv23 ices, treatment for substance abuse, and mental 

24 health services; and 

25 ‘‘(B) referrals for other social and support 

26 services, as appropriate. 


sroberts on PROD1PC70 with BILLS
56 

•S 2823 RS

1 ‘‘(3) Additional services necessary to enable the 

2 patient and the family to participate in the program 

3 established by the applicant pursuant to such sub4 section including services designed to recruit and re5 tain youth with HIV. 

6 ‘‘(4) The provision of information and edu7 cation on opportunities to participate in HIV/AIDS8 related clinical research. 

9 ‘‘(c) COORDINATION WITH OTHER ENTITIES.—A 

10 grant awarded under subsection (a) may be made only if 

11 the applicant provides an agreement that includes the fol12 lowing: 

13 ‘‘(1) The applicant will coordinate activities 

14 under the grant with other providers of health care 

15 services under this Act, and under title V of the So16 cial Security Act. 

17 ‘‘(2) The applicant will participate in the state18 wide coordinated statement of need under part B 

19 (where it has been initiated by the public health 

20 agency responsible for administering grants under 

21 part B) and in revisions of such statement. 

22 ‘‘(3) The applicant will every 2 years submit to 

23 the lead State agency under section 2617(b)(4) au24 dits regarding funds expended in accordance with 

25 this title and shall include necessary client-level data 


sroberts on PROD1PC70 with BILLS
57 

•S 2823 RS

1 to complete unmet need calculations and Statewide 

2 coordinated statements of need process. 

3 ‘‘(d) ADMINISTRATION.— 

4 ‘‘(1) APPLICATION.—A grant may only be 

5 awarded to an entity under subsection (a) if an ap6 plication for the grant is submitted to the Secretary 

7 and the application is in such form, is made in such 

8 manner, and contains such agreements, assurances, 

9 and information as the Secretary determines to be 

10 necessary to carry out this section. Such application 

11 shall include the following: 

12 ‘‘(A) Information regarding how the ex13 pected expenditures of the grant are related to 

14 the planning process for localities funded under 

15 part A (including the planning process outlined 

16 in section 2602) and for States funded under 

17 part B (including the planning process outlined 

18 in section 2617(b). 

19 ‘‘(B) A specification of the expected ex20 penditures and how those expenditures will im21 prove overall patient outcomes, as outlined as 

22 part of the State plan (under section 2617(b)) 

23 or through additional outcome measures. 

24 ‘‘(2) QUALITY MANAGEMENT PROGRAM.—A 

25 grantee under this section shall implement a quality 


sroberts on PROD1PC70 with BILLS
58 

•S 2823 RS

1 management program to assess the extent to which 

2 HIV health services provided to patients under the 

3 grant are consistent with the most recent Public 

4 Health Service guidelines for the treatment of HIV/ 

5 AIDS and related opportunistic infection, and as ap6 plicable, to develop strategies for ensuring that such 

7 services are consistent with the guidelines for im8 provement in the access to and quality of HIV 

9 health services. 

10 ‘‘(e) ANNUAL REVIEW OF PROGRAMS; EVALUA11 TIONS.— 

12 ‘‘(1) REVIEW REGARDING ACCESS TO AND PAR13 TICIPATION IN PROGRAMS.—With respect to a grant 

14 under subsection (a) for an entity for a fiscal year, 

15 the Secretary shall, not later than 180 days after 

16 the end of the fiscal year, provide for the conduct 

17 and completion of a review of the operation during 

18 the year of the program carried out under such sub19 section by the entity. The purpose of such review 

20 shall be the development of recommendations, as ap21 propriate, for improvements in the following: 

22 ‘‘(A) Procedures used by the entity to allo23 cate opportunities and services under subsection 

24 (a) among patients of the entity who are 

25 women, infants, children, or youth. 


sroberts on PROD1PC70 with BILLS
59 

•S 2823 RS

1 ‘‘(B) Other procedures or policies of the 

2 entity regarding the participation of such indi3 viduals in such program. 

4 ‘‘(2) EVALUATIONS.——The Secretary shall, di5 rectly or through contracts with public and private 

6 entities, provide for evaluations of programs carried 

7 out pursuant to subsection (a). 

8 ‘‘(f) CAP ON ADMINISTRATIVE EXPENSES.—A grant9 ee may not use more than 10 percent of amounts received 

10 under a grant awarded under this section for administra11 tive expenses. 

12 ‘‘(g) TRAINING AND TECHNICAL ASSISTANCE.— 

13 From the amounts appropriated under subsection (i) for 

14 a fiscal year, the Secretary may use not more than 5 per15 cent to provide, directly or through contracts with public 

16 and private entities (which may include grantees under 

17 subsection (a)), training and technical assistance to assist 

18 applicants and grantees under subsection (a) in complying 

19 with the requirements of this section. 

20 ‘‘(h) DEFINITIONS.—In this section: 

21 ‘‘(1) ADMINISTRATIVE EXPENSES.—The term 

22 ‘administrative expenses’ means funds that are to be 

23 used by grantees for grant management and moni24 toring activities, including costs related to any staff 

25 or activity unrelated to services or indirect costs. 


sroberts on PROD1PC70 with BILLS
60 

•S 2823 RS

1 ‘‘(2) INDIRECT COSTS.—The term ‘indirect 

2 costs’ means costs included in a Federally negotiated 

3 indirect rate. 

4 ‘‘(3) SERVICES.—The term ‘services’ means— 

5 ‘‘(A) services that are provided to clients to 

6 meet the goals and objectives of the program 

7 under this section, including the provision of 

8 professional, diagnostic, and therapeutic serv9 ices by a primary care provider or a referral to 

10 and provision of specialty care; and 

11 ‘‘(B) services that sustain program activity 

12 and contribute to or help improve services 

13 under subparagraph (A). 

14 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For the 

15 purpose of carrying out this section, there are authorized 

16 to be appropriated, $71,800,000 for each of the fiscal 

17 years 2007 through 2011.’’. 

18 SEC. 402. GAO REPORT. 

19 Not later than 24 months after the date of enactment 

20 of this Act, the Comptroller General of the Government 

21 Accountability Office shall conduct an evaluation, and sub22 mit to Congress a report, concerning the funding provided 

23 for under part D of title XXVI of the Public Health Serv24 ice Act to determine— 


sroberts on PROD1PC70 with BILLS
61 

•S 2823 RS

1 (1) how funds are used to provide the adminis2 trative expenses, indirect costs, and services, as de3 fined in section 2671(h) of such title, for individuals 

4 with HIV/AIDS; 

5 (2) how funds are used to provide the adminis6 trative expenses, indirect costs, and services, as de7 fined in section 2671(h) of such title, to family 

8 members of women, infants, children, and youth in9 fected with HIV/AIDS; 

10 (3) how funds are used to provide family-cen11 tered care involving outpatient or ambulatory care 

12 authorized under section 2671(a) of such title; 

13 (4) how funds are used to provide additional 

14 services authorized under section 2671(b) of such 

15 title; and 

16 (5) how funds are used to help identify HIV17 positive pregnant women and connect them with care 

18 that can improve their health and prevent perinatal 

19 transmission. 

20 TITLE V—GENERAL PROVISIONS 

21 SEC. 501. GENERAL PROVISIONS. 

22 Part E of title XXVI of the Public Health Service 

23 Act (42 U.S.C. 300ff–80 et seq.) is amended to read as 

24 follows: 


sroberts on PROD1PC70 with BILLS
62 

•S 2823 RS

1 ‘‘PART E—GENERAL PROVISIONS 

2 ‘‘SEC. 2681. COORDINATION. 

3 ‘‘(a) REQUIREMENT.—The Secretary shall ensure 

4 that the Health Resources and Services Administration, 

5 the Centers for Disease Control and Prevention, the Sub6 stance Abuse and Mental Health Services Administration, 

7 and the Centers for Medicare & Medicaid Services coordi8 nate the planning, funding, and implementation of Federal 

9 HIV programs including the Minority AIDS Initiative 

10 under section 2693 to enhance the continuity of care and 

11 prevention services for individuals with HIV/AIDS or 

12 those at risk of such disease. The Secretary shall consult 

13 with other Federal agencies, including the Department of 

14 Veterans Affairs, as needed and utilize planning informa15 tion submitted to such agencies by the States and entities 

16 eligible for assistance under this title. 

17 ‘‘(b) REPORT.—The Secretary shall biennially pre18 pare and submit to the appropriate committees of the Con19 gress a report concerning the coordination efforts at the 

20 Federal, State, and local levels described in this section, 

21 including a description of Federal barriers to HIV pro22 gram integration and a strategy for eliminating such bar23 riers and enhancing the continuity of care and prevention 

24 services for individuals with HIV/AIDS or those at risk 

25 of such disease. 


sroberts on PROD1PC70 with BILLS
63 

•S 2823 RS

1 ‘‘(c) INTEGRATION BY STATE.—As a condition of re2 ceipt of funds under this title, a State shall provide assur3 ances to the Secretary that health support services funded 

4 under this title will be integrated with other such services, 

5 that programs will be coordinated with other available pro6 grams (including Medicaid), and that the continuity of 

7 care and prevention services of individuals with HIV/AIDS 

8 is enhanced. 

9 ‘‘(d) INTEGRATION BY LOCAL OR PRIVATE ENTI10 TIES.—As a condition of receipt of funds under this title, 

11 a local government or private nonprofit entity shall provide 

12 assurances to the Secretary that services funded under 

13 this title will be integrated with other such services, that 

14 programs will be coordinated with other available pro15 grams (including Medicaid), and that the continuity of 

16 care and prevention services of individuals with HIV is 

17 enhanced. 

18 ‘‘SEC. 2682. AUDITS. 

19 ‘‘(a) IN GENERAL.—For fiscal year 2007, and each 

20 subsequent fiscal year, the Secretary may reduce the 

21 amounts of grants under this title to a State or political 

22 subdivision of a State for a fiscal year if, with respect to 

23 such grants for the second preceding fiscal year, the State 

24 or subdivision fails to prepare audits in accordance with 

25 the procedures of section 7502 of title 31, United States 


sroberts on PROD1PC70 with BILLS
64 

•S 2823 RS

1 Code. The Secretary shall annually select representative 

2 samples of such audits, prepare summaries of the selected 

3 audits, and submit the summaries to the Congress. 

4 ‘‘(b) POSTING ON THE INTERNET.—All audits that 

5 the Secretary receives from the State lead agency under 

6 section 2617(b)(4) shall be posted on the Internet website 

7 of the Health Resources and Services Administration. 

8 ‘‘SEC. 2683. PUBLIC HEALTH EMERGENCY. 

9 ‘‘(a) IN GENERAL.—In an emergency area and dur10 ing an emergency period, the Secretary shall have the au11 thority to waive such requirements of this title to improve 

12 the health and safety of those receiving care under this 

13 title and the general public, except that the Secretary may 

14 not expend more than 5 percent of the funds allocated 

15 under this title for sections 2620 and section 2603(b). 

16 ‘‘(b) EMERGENCY AREA AND EMERGENCY PE17 RIOD.—In this section: 

18 ‘‘(1) EMERGENCY AREA.—The term ‘emergency 

19 area’ means a geographic area in which there ex20 ists— 

21 ‘‘(A) an emergency or disaster declared by 

22 the President pursuant to the National Emer23 gencies Act of the Robert T. Stafford Disaster 

24 Relief and Emergency Assistance Act; and 


sroberts on PROD1PC70 with BILLS
65 

•S 2823 RS

1 ‘‘(B) a public health emergency declared 

2 by the Secretary pursuant to section 319. 

3 ‘‘(2) EMERGENCY PERIOD.—The term ‘emer4 gency period’ means the period in which there ex5 ists— 

6 ‘‘(A) an emergency or disaster declared by 

7 the President pursuant to the National Emer8 gencies Act of the Robert T. Stafford Disaster 

9 Relief and Emergency Assistance Act; and 

10 ‘‘(B) a public health emergency declared 

11 by the Secretary pursuant to section 319. 

12 ‘‘(c) UNOBLIGATED FUNDS.—If funds under a grant 

13 under this section are not expended for an emergency in 

14 the fiscal year in which the emergency is declared, such 

15 funds shall be returned to the Secretary for reallocation 

16 under sections 2603(b) and 2620. 

17 ‘‘SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN AC18 TIVITIES. 

19 ‘‘None of the funds appropriated under this title shall 

20 be used to fund AIDS programs, or to develop materials, 

21 designed to promote or encourage, directly, intravenous 

22 drug use or sexual activity, whether homosexual or hetero23 sexual. Funds authorized under this title may be used to 

24 provide medical treatment and support services for indi25 viduals with HIV. 


sroberts on PROD1PC70 with BILLS
66 

•S 2823 RS

1 ‘‘SEC. 2685. PRIVACY PROTECTIONS. 

2 ‘‘The Secretary shall collect client-level data under 

3 this title in a manner that is consistent with the unique 

4 identifier as reported to the Director of the Centers for 

5 Disease Control and Prevention as of the date of enact6 ment of this section. 

7 ‘‘SEC. 2686. GAO REPORT. 

8 ‘‘The Comptroller General of the Government Ac9 countability Office shall biennially submit to the appro10 priate committees of Congress a report that includes a de11 scription of Federal, State, and local barriers to HIV pro12 gram integration, particularly for racial and ethnic minori13 ties, and recommendations for enhancing the continuity 

14 of care and the provision of prevention services for individ15 uals with HIV/AIDS or those at risk for such disease. 

16 Such report shall include a demonstration of the manner 

17 in which funds under this subpart are being expended and 

18 to what extent the services provided with such funds in19 crease access to prevention and care services for individ20 uals with HIV/AIDS and build stronger community link21 ages to address HIV prevention and care for racial and 

22 ethnic minority communities. 

23 ‘‘SEC. 2687. DEFINITIONS. 

24 ‘‘For purposes of this title: 


sroberts on PROD1PC70 with BILLS
67 

•S 2823 RS

1 ‘‘(1) COUNSELING.—The term ‘counseling’ 

2 means such counseling provided by an individual 

3 trained to provide such counseling. 

4 ‘‘(2) FAMILY-CENTERED CARE.—The term 

5 ‘family-centered care’ means the system of services 

6 described in this section that is targeted specifically 

7 to the special needs of infants, children, women and 

8 families. Family-centered care shall be based on a 

9 partnership between parents, professionals, and the 

10 community designed to ensure an integrated, coordi11 nated, culturally sensitive, and community-based 

12 continuum of care for children, women, and families 

13 with HIV/AIDS. 

14 ‘‘(3) FAMILIES WITH HIV/AIDS.—The term 

15 ‘families with HIV/AIDS’ means families in which 

16 one or more members have HIV/AIDS. 

17 ‘‘(4) HIV.—The term ‘HIV’ means infection 

18 with the etiologic agent for acquired immune defi19 ciency syndrome. 

20 ‘‘(5) HIV/AIDS.—The term ‘HIV/AIDS’ means 

21 infection with the etiologic agent for acquired im22 mune deficiency syndrome, and includes any condi23 tion arising from such syndrome. 

24 ‘‘(6) OFFICIAL POVERTY LINE.—The term ‘offi25 cial poverty line’ means the poverty line established 


sroberts on PROD1PC70 with BILLS
68 

•S 2823 RS

1 by the Director of the Office of Management and 

2 Budget and revised by the Secretary in accordance 

3 with section 673(2) of the Omnibus Budget Rec4 onciliation Act of 1981. 

5 ‘‘(7) PERSON.—The term ‘person’ includes one 

6 or more individuals, governments (including the 

7 Federal Government and the governments of the 

8 States), governmental agencies, political subdivi9 sions, labor unions, partnerships, associations, cor10 porations, legal representatives, mutual companies, 

11 joint-stock companies, trusts, unincorporated organi12 zations, receivers, trustees, and trustees in cases 

13 under title 11, United States Code. 

14 ‘‘(8) STATE.—The term ‘State’, except as oth15 erwise specifically provided, means each of the 50 

16 States, the District of Columbia, the Virgin Islands, 

17 Guam, American Samoa, the Commonwealth of the 

18 Northern Mariana Islands, Puerto Rico, and the Re19 public of the Marshall Islands. 

20 ‘‘(9) YOUTH WITH HIV.—The term ‘youth with 

21 HIV’ means individuals who are 13 through 24 

22 years old and who have HIV/AIDS.’’. 


sroberts on PROD1PC70 with BILLS
69 

•S 2823 RS

1 TITLE VI—DEMONSTRATION 

2 AND TRAINING 

3 SEC. 601. DEMONSTRATION AND TRAINING. 

4 Subpart I of part F of title XXVI of the Public 

5 Health Service Act (42 U.S.C. 300ff–101 et seq.) is 

6 amended to read as follows: 

7 ‘‘PART F—DEMONSTRATION AND TRAINING 

8 ‘‘Subpart I—Special Projects of National Significance 

9 ‘‘SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFI10 CANCE. 

11 ‘‘(a) IN GENERAL.—Of the amount appropriated 

12 under each of parts A, B, C, and D for each fiscal year, 

13 the Secretary shall use the greater of $20,000,000 or an 

14 amount equal to 3 percent of such amount appropriated 

15 under each such part, but not to exceed $25,000,000, to 

16 administer special projects of national significance to— 

17 ‘‘(1) quickly respond to emerging needs of indi18 viduals receiving assistance under this title; and 

19 ‘‘(2) to fund special programs to develop a 

20 standard electronic client information data system to 

21 improve the ability of grantees under this title to re22 port client-level data to the Secretary. 

23 ‘‘(b) GRANTS.—The Secretary shall award grants 

24 under subsection (a) to entities eligible for funding under 

25 parts A, B, C, and D based on— 


sroberts on PROD1PC70 with BILLS
70 

•S 2823 RS

1 ‘‘(1)(A) whether the funding will promote ob2 taining client level data as it relates to the creation 

3 of a severity of need index under section 

4 2618(a)(2)(E)(iii), including funds to facilitate the 

5 purchase and enhance the utilization of qualified 

6 health information technology systems; 

7 ‘‘(B) demonstrated ability to create and main8 tain a qualified health information technology sys9 tem; 

10 ‘‘(C) the potential replicability of the proposed 

11 activity in other similar localities or nationally; 

12 ‘‘(D) the demonstrated reliability of the pro13 posed qualified health information technology system 

14 across a variety of providers, geographic regions, 

15 and clients; and 

16 ‘‘(E) the demonstrated ability to maintain a 

17 safe and secure qualified health information system; 

18 or 

19 ‘‘(2) newly emerging needs of individuals receiv20 ing assistance under this title. 

21 ‘‘(c) COORDINATION.—The Secretary may not make 

22 a grant under this section unless the applicant submits 

23 evidence that the proposed program is consistent with the 

24 statewide coordinated statement of need, and the appliVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6401 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
71 

•S 2823 RS

1 cant agrees to participate in the ongoing revision process 

2 of such statement of need. 

3 ‘‘(d) PRIVACY PROTECTION.—The Secretary may not 

4 make a grant under this section for the development of 

5 a qualified health information technology system unless 

6 the applicant provides assurances to the Secretary that the 

7 system will comply with the privacy regulations promul8 gated under section 264(c) of the Health Insurance Port9 ability and Accountability Act of 1996. 

10 ‘‘(e) REPLICATION.—The Secretary shall make infor11 mation concerning successful models or programs devel12 oped under this part available to grantees under this title 

13 for the purpose of coordination, replication, and integra14 tion. To facilitate efforts under this subsection, the Sec15 retary may provide for peer-based technical assistance 

16 from grantees funded under this part.’’. 

17 SEC. 602. AIDS EDUCATION AND TRAINING CENTERS. 

18 Section 2692(a)(2) of the Public Health Service Act 

19 (42 U.S.C. 300ff–92(a)(2)) is amended— 

20 (1) in subparagraph (A)— 

21 (A) by inserting ‘‘and Native Americans’’ 

22 after ‘‘minority individuals’’; and 

23 (B) by striking ‘‘and’’ at the end; 

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

25 and inserting ‘‘; and’’; and 


sroberts on PROD1PC70 with BILLS
72 

•S 2823 RS

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

2 ‘‘(C) train or result in the training of 

3 health professionals and allied health profes4 sionals to provide treatment for hepatitis B or 

5 C co-infected individuals.’’. 

6 SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE 

7 UNDER RYAN WHITE COMPREHENSIVE AIDS 

8 RESOURCES EMERGENCY ACT OF 1990. 

9 Part F of title XXVI of the Public Health Service 

10 Act (42 U.S.C. 300ff–101 et seq.) is amended by adding 

11 at the end the following: 

12 ‘‘Subpart II—Minority AIDS Initiative 

13 ‘‘SEC. 2693. MINORITY AIDS INITIATIVE. 

14 ‘‘(a) IN GENERAL.—There is authorized to be appro15 priated for the purpose of carrying out activities under 

16 this section to evaluate and address the disproportionate 

17 impact of HIV disease and disparities in access, treat18 ment, care, and outcome on racial and ethnic minorities, 

19 including African Americans, Alaska Natives, Latinos, 

20 American Indians, Asian Americans, Native Hawaiians, 

21 and Pacific Islanders, $131,200,000 for fiscal year 2007, 

22 $135,100,000 for fiscal year 2008, $139,100,000 for fis23 cal year 2009, $143,200,000 for fiscal year 2010, and 

24 $147,500,000 for fiscal year 2010. 

25 ‘‘(b) CERTAIN ACTIVITIES.— 


sroberts on PROD1PC70 with BILLS
73 

•S 2823 RS

1 ‘‘(1) IN GENERAL.—In carrying out the purpose 

2 described in subsection (a), the Secretary shall pro3 vide for— 

4 ‘‘(A) emergency assistance under part A; 

5 ‘‘(B) comprehensive care under part B; 

6 ‘‘(C) early intervention services under part 

7 C; 

8 ‘‘(D) services through demonstration 

9 projects for HIV-related care; and 

10 ‘‘(E) activities through education and 

11 training centers under section 2692. 

12 ‘‘(2) ALLOCATIONS AMONG ACTIVITIES.—Activi13 ties under paragraph (1) shall be carried out by the 

14 Secretary in accordance with the following: 

15 ‘‘(A) Of the amount appropriated for each 

16 fiscal year under subsection (a), $43,800,000 

17 for fiscal year 2007, $45,400,000 for fiscal year 

18 2008, $47,100,000 for fiscal year 2009, 

19 $48,800,000 for fiscal year 2010, and 

20 $50,700,000 for fiscal year 2010, shall be used 

21 for competitive, supplemental grants to improve 

22 HIV-related health outcomes to reduce existing 

23 racial and ethnic health disparities. 

24 ‘‘(B) Of the amount appropriated for each 

25 fiscal year under subsection (a), $7,000,000 for 


sroberts on PROD1PC70 with BILLS
74 

•S 2823 RS

1 fiscal year 2007, $7,300,000 for fiscal year 

2 2008, $7,500,000 for fiscal year 2009, 

3 $7,800,000 for fiscal year 2010, and 

4 $8,100,000 for fiscal year 2010, shall be used 

5 for competitive, supplemental support edu6 cational and outreach services to increase the 

7 number of eligible racial and ethnic minorities 

8 who have access to treatment through the pro9 gram under section 2616 for therapeutics. 

10 ‘‘(C) Of the amount appropriated for each 

11 fiscal year under subsection (a), $53,400,000 

12 for fiscal year 2007, $55,400,000 for fiscal year 

13 2008, $57,400,000 for fiscal year 2009, 

14 $59,500,000 for fiscal year 2010, and 

15 $61,800,000 for fiscal year 2010, shall be used 

16 for planning grants, capacity-building grants, 

17 and services grants to health care providers who 

18 have a history of providing culturally and lin19 guistically appropriate care and services to ra20 cial and ethnic minorities. 

21 ‘‘(D) Of the amount appropriated for each 

22 fiscal year under subsection (a), $18,500,000 

23 for each of fiscal years 2007 through 2011 shall 

24 be used for sustaining and expanding efforts to 

25 deliver comprehensive, culturally and linguisVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6401 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
75 

•S 2823 RS

1 tically appropriate research-based intervention 

2 and care services for HIV disease to racial and 

3 ethnic minority women, infants, children, and 

4 youth. 

5 ‘‘(E) Of the amount appropriated for each 

6 fiscal year under subsection (a), $8,500,000 for 

7 each of fiscal years 2007 through 2011 shall be 

8 used for increasing the training capacity of cen9 ters to expand the number of community-based 

10 racial and ethnic minority health care profes11 sionals with treatment expertise and knowledge 

12 about the most appropriate standards of HIV 

13 disease-related treatments and medical care for 

14 adults, adolescents, and children with HIV dis15 ease. 

16 ‘‘(e) CONSISTENCY WITH PRIOR PROGRAM.—With 

17 respect to the purpose described in subsection (a), the Sec18 retary shall carry out this section consistent with the ac19 tivities carried out under this title by the Secretary pursu20 ant to the Departments of Labor, Health and Human 

21 Services, and Education, and Related Agencies Appropria22 tions Act, 2002 (Public Law 107–116).’’. 

23 SEC. 604. AUTHORIZATION OF APPROPRIATIONS. 

24 Section 2692(c) of the Public Health Service Act (42 

25 U.S.C. 300ff–92(c)) is amended to read as follows: 


sroberts on PROD1PC70 with BILLS
76 

•S 2823 RS

1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.— 

2 ‘‘(1) SCHOOLS; CENTERS.—For the purpose of 

3 awarding grants under subsection (a), there and au4 thorized to be appropriated $34,700,000 for each of 

5 fiscal years 2007 through 2011. 

6 ‘‘(2) DENTAL SCHOOLS.—For the purpose of 

7 awarding grants under paragraphs (2) and (3) of 

8 subsection (b), there are authorized to be appro9 priated $13,000,000 for each of fiscal years 2007 

10 through 2011.’’. 

11 TITLE VII—MISCELLANEOUS 

12 PROVISIONS 

13 SEC. 701. HEPATITIS. 

14 (a) PROVISION OF CERTAIN COUNSELING SERV15 ICES.—Section 2662 of the Public Health Service Act (42 

16 U.S.C. 300ff–62) is amended— 

17 (1) in subsection (a)— 

18 (A) in paragraph (1), by inserting ‘‘, hepa19 titis B, and hepatitis C’’ before the semicolon; 

20 (B) in paragraph (2), by inserting ‘‘and 

21 testing for hepatitis B and hepatitis C’’ before 

22 the semicolon; 

23 (C) in paragraph (6), by striking ‘‘and’’ at 

24 the end; 


sroberts on PROD1PC70 with BILLS
77 

•S 2823 RS

1 (D) in paragraph (7), by striking the pe2 riod and inserting ‘‘; and’’; and 

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

4 ‘‘(8) if diagnosed with chronic hepatitis B or 

5 hepatitis C co-infection, the potential of developing 

6 hepatitis-related liver disease and its impact on HIV/ 

7 AIDS.’’; and 

8 (2) in subsection (c)(3)(C)(i), by inserting ‘‘, 

9 hepatitis B, or hepatitis B’’ after ‘‘exposed to HIV’’ 

10 each place that such appears. 

11 (b) USE OF AMOUNTS.—Section 2667 of the Public 

12 Health Service Act (42 U.S.C. 300ff–67) is amended— 

13 (1) in paragraph (2), by striking ‘‘and’’ at the 

14 end; 

15 (2) in paragraph (3), by striking the period and 

16 inserting ‘‘; and’’; and 

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

18 ‘‘(4) shall provide information on the trans19 mission and prevention of hepatitis A, B, and C and 

20 the location of entities that provide hepatitis A and 

21 B vaccinations to individuals with HIV.’’. 

22 SEC. 702. TECHNICAL PROVISIONS. 

23 Title XXVI of the Public Health Service Act (42 

24 U.S.C. 300ff et seq.) is amended by striking ‘‘HIV disVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6401 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
78 

•S 2823 RS

1 ease’’ each place that such appears and inserting ‘‘HIV/ 

2 AIDS’’. 

3 SEC. 703. REPEAL. 

4 Section 2677 of the Public Health Service Act (42 

5 U.S.C. 300ff–77) is repealed. 

6 SECTION 1. SHORT TITLE. 

7 This Act may be cited as the ‘‘Ryan White HIV/AIDS 

8 Treatment Modernization Act of 2006’’. 

9 TITLE I—EMERGENCY RELIEF 

10 FOR ELIGIBLE AREAS 

11 SEC. 101. ESTABLISHMENT AND GENERAL ELIGIBILITY. 

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

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

14 subsections (b) through (d) and inserting the following: 

15 ‘‘(b) CONTINUED STATUS AS ELIGIBLE AREA.—Not16 withstanding any other provision of this section, a metro17 politan area shall continue to be eligible to receive a grant 

18 under this part until such area, for three consecutive grant 

19 years, fails to meet the requirements of subsection (a).’’. 

20 (b) DEFINITION.—Section 2607(2) of the Public 

21 Health Service Act (42 U.S.C. 300ff–17(2)) is amended by 

22 adding at the end the following: ‘‘For purposes of deter23 mining eligibility under this part, the boundaries of each 

24 metropolitan area shall be the boundaries that were in effect 

25 for each such area for fiscal year 1994.’’. 


sroberts on PROD1PC70 with BILLS
79 

•S 2823 RS

1 SEC. 102. LIVING CASES OF HIV/AIDS. 

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

3 Health Service Act (42 U.S.C. 300ff–11(a)) is amended by 

4 striking ‘‘for which there’’ and all that follows through 

5 ‘‘available’’ and inserting ‘‘for which there is reported to 

6 and confirmed by the Director of the Centers for Disease 

7 Control and Prevention a cumulative total of more than 

8 2,000 cases of AIDS for the most recent period of 5 calendar 

9 years for which such data are available’’. 

10 (b) DISTRIBUTION BASED ON LIVING CASES OF HIV/ 

11 AIDS.—Section 2603(a)(3) of the Public Health Service 

12 Act (42 U.S.C. 300ff–13(a)(3)) is amended— 

13 (1) in subparagraph (B), by striking ‘‘cases of 

14 acquired immune deficiency syndrome’’ and inserting 

15 ‘‘cases of HIV/AIDS (reported to and confirmed by 

16 the Director of the Centers for Disease Control and 

17 Prevention)’’; 

18 (2) by striking subparagraphs (C) and (D) and 

19 inserting the following: 

20 ‘‘(C) LIVING CASES OF HIV/AIDS.— 

21 ‘‘(i) IN GENERAL.—Except as provided 

22 for in clauses (ii) and (iii), the amount de23 termined in this subparagraph is the num24 ber of living cases of HIV/AIDS (reported to 

25 and confirmed by the Director of the Cen26 ters for Disease Control and Prevention) 


sroberts on PROD1PC70 with BILLS
80 

•S 2823 RS

1 through December 31 of the most recent cal2 endar year. 

3 ‘‘(ii) FISCAL YEARS 2007 THROUGH

4 2010.—For each of fiscal years 2007 through 

5 2010, the Secretary may use the proxy 

6 number for the number of HIV cases de7 scribed in clause (iii) if— 

8 ‘‘(I) the State involved— 

9 ‘‘(aa) is reporting, or the 

10 State will by October 1, 2006 have 

11 submitted a transition plan for 

12 reporting, accurate and reliable 

13 HIV cases to the Director of the 

14 Centers for Disease Control and 

15 Prevention; or 

16 ‘‘(bb) not later than October 

17 1, 2006, make all necessary statu18 tory changes to allow for the col19 lection of HIV data certified by 

20 the Director of the Centers for 

21 Disease Control and Prevention; 

22 ‘‘(II) the State involved will by 

23 April 1, 2008, begin reporting accurate 

24 and reliable HIV cases, as determined 


sroberts on PROD1PC70 with BILLS
81 

•S 2823 RS

1 by the Director of the Centers for Dis2 ease Control and Prevention; and 

3 ‘‘(III) the Director of the Centers 

4 for Disease Control and Prevention has 

5 determined that such State does not 

6 have an established HIV surveillance 

7 system. 

8 ‘‘(iii) AMOUNT DETERMINED.—With 

9 respect to each of fiscal years 2007 through 

10 2010, the amount determined under this 

11 subparagraph shall be the lesser of— 

12 ‘‘(I) the product of 0.9 and the 

13 number of living AIDS cases in the 

14 area involved; or 

15 ‘‘(II) an amount equal to 110 per16 cent of the funding level for the pre17 vious fiscal year, taking into account 

18 the shift of the formula pool from 0.5 

19 to 0.67 in fiscal year 2006.’’; and 

20 (3) by redesignating subparagraph (E) as sub21 paragraph (D). 

22 (c) APPLICATION.—Section 2604(b)(4)(A) of the Public 

23 Health Service Act (42 U.S.C. 300ff–14(b)(4)(A)) is amend24 ed— 


sroberts on PROD1PC70 with BILLS
82 

•S 2823 RS

1 (1) by striking ‘‘acquired immune deficiency 

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

3 (2) by striking ‘‘such syndrome’’ and inserting 

4 ‘‘HIV/AIDS’’. 

5 (d) COORDINATION.—Section 2605(b) of the Public 

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

7 (1) in paragraph (3), by striking ‘‘and’’ at the 

8 end; 

9 (2) in paragraph (4), by striking the period and 

10 inserting a semicolon; and 

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

12 ‘‘(5) the manner in which the expected expendi13 tures under the grant are related to the planning 

14 process for States that receive funding under part B 

15 (including the planning process described in section 

16 2617(b)); and 

17 ‘‘(6) the expected expenditures under the grant 

18 and how those expenditures will improve overall cli19 ent outcomes, as described under the State plan under 

20 section 2617(b), or through additional outcomes meas21 ures.’’. 

22 SEC. 103. TYPE AND DISTRIBUTION OF GRANTS. 

23 (a) DISTRIBUTION OF FUNDS.—Section 2603(a)(2) of 

24 the Public Health Service Act (42 U.S.C. 300ff–13(a)(2)) 


sroberts on PROD1PC70 with BILLS
83 

•S 2823 RS

is amended by striking ‘‘50 percent’’ and inserting ‘‘662 1 ⁄3

2 percent’’. 

3 (b) EMERGENCY GRANTS.—Section 2603(a)(3)(E) of 

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

5 13(a)(3)(E)) is amended to read as follows: 

6 ‘‘(E) UNEXPENDED FUNDS.— 

7 ‘‘(i) IN GENERAL.—An eligible area 

8 that has unobligated funds for a fiscal year 

9 under a grant under this part shall— 

10 ‘‘(I) return such funds to the Sec11 retary to be applied as provided for in 

12 subsection (b); or 

13 ‘‘(II) submit an application to the 

14 Secretary for the use of such funds in 

15 the succeeding fiscal year that includes 

16 a description of the manner in which 

17 the area intends to use such funds. 

18 ‘‘(ii) CARRYOVER.—With respect to an 

19 application received under clause (i)(II), 

20 the Secretary shall determine whether the 

21 area involved may carryover any unobli22 gated funds for use under this part in the 

23 succeeding fiscal year or whether such 

24 amounts shall be returned to the Secretary 


sroberts on PROD1PC70 with BILLS
84 

•S 2823 RS

1 for use under subsection (b). Notice shall be 

2 provided to the area of such determination. 

3 ‘‘(iii) FAILURE TO EXPEND FUNDS.— 

4 Amounts carried over by an eligible area 

5 under this subparagraph that are not ex6 pended in the succeeding fiscal year shall be 

7 returned to the Secretary for use under sub8 section (b). 

9 ‘‘(iv) CONSIDERATION IN MAKING

10 GRANTS.—The Secretary may, in deter11 mining the amount of a grant for a fiscal 

12 year under this paragraph, adjust the grant 

13 amount to reflect the amount of unexpended 

14 and uncanceled grant funds remaining at 

15 the end of the fiscal year preceding the year 

16 for which the grant determination is to be 

17 made. The amount of any such unexpended 

18 funds shall be determined using the finan19 cial status report of the grantee.’’. 

20 (c) HOLD HARMLESS.—Section 2603(a)(4) of the Pub21 lic Health Service Act (42 U.S.C. 300ff–13(a)(4)) is amend22 ed to read as follows: 

23 ‘‘(4) INCREASES IN GRANT.— 

24 ‘‘(A) IN GENERAL.—For eligible areas re25 ceiving grants under this section in fiscal year 


sroberts on PROD1PC70 with BILLS
85 

•S 2823 RS

1 2007, the Secretary shall increase the amount of 

2 the grant made pursuant to paragraph (2) for 

3 the area to ensure that— 

4 ‘‘(i) for fiscal year 2007, the grant is 

5 not less than 90 percent of the amount of 

6 the grant made for the eligible area pursu7 ant to such paragraph for the base year; 

8 ‘‘(ii) for fiscal year 2008, the grant is 

9 not less than 85 percent of the amount of 

10 such base year grant; and 

11 ‘‘(iii) for fiscal year 2009, the grant is 

12 not less than 80 percent of the amount of 

13 the base year grant. 

14 ‘‘(B) BASE YEAR.—With respect to grants 

15 made pursuant to paragraph (2) for an eligible 

16 area, the base year shall be fiscal year 2006.’’. 

17 SEC. 104. CORE MEDICAL SERVICES. 

18 Section 2604 of the Public Health Service Act (42 

19 U.S.C. 300ff–14) is amended by adding at the end the fol20 lowing: 

21 ‘‘(h) REQUIRED FUNDING FOR CORE MEDICAL SERV22 ICES.— 

23 ‘‘(1) IN GENERAL.—Notwithstanding any other 

24 provision of law, a grantee under this part shall ex25 pend not less than 75 percent of the funds received 


sroberts on PROD1PC70 with BILLS
86 

•S 2823 RS

1 under the grant on core medical services, except that 

2 the Secretary shall waive the application of this sub3 section with respect to a grantee if the Secretary de4 termines that, within the service area of the grantee— 

5 ‘‘(A) there is no waiting lists for AIDS 

6 Drug Assistance Program services; and 

7 ‘‘(B) core medical services are available to 

8 all individuals infected with HIV/AIDS. 

9 ‘‘(2) CORE MEDICAL SERVICES.—For purposes of 

10 this subsection, the term ‘core medical services’ with 

11 respect to an individual infected with HIV/AIDS (in12 cluding the co-occurring diseases of the individual) 

13 means the following services: 

14 ‘‘(A) Outpatient and ambulatory health 

15 services. 

16 ‘‘(B) AIDS Drug Assistance Program treat17 ments. 

18 ‘‘(C) AIDS pharmaceutical assistance. 

19 ‘‘(D) Oral health care. 

20 ‘‘(E) Early intervention services. 

21 ‘‘(F) Health insurance premium and cost 

22 sharing assistance for low-income individuals. 

23 ‘‘(G) Home health care. 

24 ‘‘(H) Hospice services. 


sroberts on PROD1PC70 with BILLS
87 

•S 2823 RS

1 ‘‘(I) Home and community-based health 

2 services as defined under section 2614(c), except 

3 homemaker services. 

4 ‘‘(J) Mental health services. 

5 ‘‘(K) Substance abuse outpatient care. 

6 ‘‘(L) Medical case management, including 

7 treatment adherence services. 

8 ‘‘(3) SUPPORT SERVICES.—Notwithstanding any 

9 other provision of law, and subject to paragraph (1), 

10 a grantee under this part, subject to the approval of 

11 the Secretary, may provide support services (such as 

12 respite care for individuals with HIV/AIDS, outreach 

13 services, medical transportation, nutritional coun14 seling, linguistic services, and referral for health care 

15 and support services for individuals with HIV/AIDS) 

16 needed to achieve medical outcomes which are related 

17 to the medical outcomes for an individual infected 

18 with HIV and approved by the Secretary. 

19 ‘‘(4) DEFINITION OF MEDICAL OUTCOMES.—In 

20 this subsection, the term ‘medical outcomes’ means 

21 those outcomes affecting the HIV-related clinical sta22 tus of an individual with HIV/AIDS. 

23 ‘‘(5) UNEXPENDED FUNDS.—Any amounts re24 quired to be expended for core medical services or sup25 port services under this subsection that remain unobVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6203 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
88 

•S 2823 RS

1 ligated at the end of the fiscal year in which the funds 

2 were awarded shall be remitted to the Secretary for 

3 reallocation under section 2603(b).’’. 

4 SEC. 105. SUPPLEMENTAL GRANTS. 

5 Section 2603(b) of the Public Health Service Act (42 

6 U.S.C. 300ff–13(b)) is amended— 

7 (1) by striking ‘‘severe need’’ each place that 

8 such appears and inserting ‘‘demonstrated need’’; 

9 (2) in paragraph (1)— 

10 (A) in the matter preceding subparagraph 

11 (A), by striking ‘‘Not later than’’ and all that 

12 follows through ‘‘the Secretary shall’’ and insert 

13 ‘‘The Secretary shall’’; 

14 (B) by striking subparagraph (F) and in15 serting the following: 

16 ‘‘(F) demonstrate the inclusiveness of af17 fected communities and individuals with HIV/ 

18 AIDS;’’; 

19 (C) in subparagraph (G), by striking the 

20 period and inserting ‘‘; and’’; and 

21 (D) by adding at the end the following: 

22 ‘‘(H) demonstrate the ability of the appli23 cant to expend funds efficiently by not having 

24 any unexpended funds reallocated under section 

25 2603(a)(3)(E).’’; 


sroberts on PROD1PC70 with BILLS
89 

•S 2823 RS

1 (3) in paragraph (2)— 

2 (A) by striking subparagraph (B) and in3 serting the following: 

4 ‘‘(B) DEMONSTRATED NEED.—In deter5 mining demonstrated need for purposes of sub6 paragraph (A), the Secretary shall consider rel7 evant factors that impact the need for supple8 mental financial assistance, including— 

9 ‘‘(i) the unmet need for such services, 

10 as determined under section 2602(b)(4) or 

11 other community input process as defined 

12 under section 2609A(a); 

13 ‘‘(ii) an increasing need for HIV/ 

14 AIDS-related services, including relative 

15 rates of increase in the number of cases of 

16 HIV/AIDS; 

17 ‘‘(iii) the relative rates of increase in 

18 the number of cases of HIV/AIDS within 

19 new or emerging subpopulations; 

20 ‘‘(iv) the current prevalence of HIV/ 

21 AIDS; 

22 ‘‘(v) relevant factors related to the cost 

23 and complexity of delivering health care to 

24 individuals with HIV/AIDS in the eligible 

25 area; 


sroberts on PROD1PC70 with BILLS
90 

•S 2823 RS

1 ‘‘(vi) the impact of co-morbid factors, 

2 including co-occurring infections, deter3 mined relevant by the Secretary; 

4 ‘‘(vii) the prevalence of homelessness; 

5 ‘‘(viii) the prevalence of individuals 

6 described under section 2602(b)(2)(M); 

7 ‘‘(ix) the relevant factors that limit ac8 cess to health care, including geographic 

9 variation, adequacy of health insurance cov10 erage, and language barriers; or 

11 ‘‘(x) the impact of a precipitous decline 

12 in the amount received under this subpart 

13 to an increase in unmet need for such serv14 ices.’’; and 

15 (B) by striking subparagraphs (C) and (D). 

16 SEC. 106. ADMINISTRATIVE COSTS. 

17 Section 2604(f) of the Public Health Service Act (42 

18 U.S.C. 300ff–14(f)) is amended— 

19 (1) in paragraph (1), by striking ‘‘5 percent’’ 

20 and inserting ‘‘10 percent’’; and 

21 (2) in paragraph (2)(B), by inserting ‘‘the ac22 tivities carried out by HIV health services planning 

23 council as established under section 2602(b),’’ after 

24 ‘‘including’’. 


sroberts on PROD1PC70 with BILLS
91 

•S 2823 RS

1 SEC. 107. AUDITS. 

2 Section 2605(a) of the Public Health Service Act (42 

3 U.S.C. 300ff–15(a)) is amended— 

4 (1) in paragraph (8), by striking ‘‘and’’ at the 

5 end; 

6 (2) in paragraph (9), by striking the period and 

7 inserting ‘‘; and’’; and 

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

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

10 the lead State agency under section 2617(b)(4), audits 

11 regarding funds expended in accordance with this 

12 part every 2 years and shall include necessary client13 based data to compile unmet need calculations and 

14 Statewide coordinated statements of need process.’’. 

15 SEC. 108. PLANNING COUNCIL REPRESENTATION. 

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

17 (42 U.S.C. 300ff–12(b)(2)(G)) is amended by inserting ‘‘, 

18 Native Americans, individuals co-infected with hepatitis B 

19 or C’’ after ‘‘disease’’. 

20 SEC. 109. PAYER OF LAST RESORT. 

21 Section 2605(a)(6)(A) of the Public Health Service Act 

22 (42 U.S.C. 300ff–15(a)(6)(A)) is amended by inserting 

23 ‘‘(except for a program administered by or providing the 

24 services of the Indian Health Service)’’ before the semicolon. 


sroberts on PROD1PC70 with BILLS
92 

•S 2823 RS

1 SEC. 110. TRANSITIONAL GRANTS FOR OTHER AREAS. 

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

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

4 (1) by inserting after the part heading the fol5 lowing: 

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

7 (2) by redesignating sections 2606 and 2607 as 

8 sections 2610 and 2610A, respectively; and 

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

10 ‘‘Subpart II—Transitional Grants 

11 ‘‘SEC. 2609. ESTABLISHMENT. 

12 ‘‘(a) ELIGIBLE AREAS.— 

13 ‘‘(1) IN GENERAL.—The Secretary, acting 

14 through the Administrator of the Health Resources 

15 and Services Administration, shall, subject to sub16 section (b), make grants in accordance with this sub17 part for the purpose of assisting in the provision of 

18 the services specified in section 2604 in any metro19 politan area— 

20 ‘‘(A) for which there has been reported to 

21 and confirmed by the Director of the Centers for 

22 Disease Control and Prevention a cumulative 

23 total of at least 1,000, but less than 2,000, cases 

24 of acquired immune deficiency syndrome for the 

25 most recent period of 5 calendar years for which 

26 such data are available; and 


sroberts on PROD1PC70 with BILLS
93 

•S 2823 RS

1 ‘‘(B) for which there has been reported to 

2 and confirmed by the Director of the Centers for 

3 Disease Control and Prevention a cumulative 

4 total of at least 500, but less than 1,000, cases 

5 of acquired immune deficiency syndrome for the 

6 most recent period of 5 calendar years for which 

7 such data are available. 

8 ‘‘(2) ADDITIONAL ELIGIBLE AREAS.—With re9 spect to fiscal year 2007, a metropolitan area that re10 ceived funding under this part for fiscal year 2006 

11 but which does not meet the eligibility threshold de12 scribed in paragraph (1)(A) for fiscal year 2007 shall 

13 be deemed to be eligible under such paragraph (1)(A). 

14 ‘‘(b) CONTINUED STATUS AS ELIGIBLE AREA.—Not15 withstanding any other provision of this section, a metro16 politan area shall continue to be eligible to receive a grant 

17 under this section until such area, for three consecutive 

18 grant years, fails to meet the applicable requirement of sub19 paragraph (A) or (B) of subsection (a)(1) concerning the 

20 number of living cases of AIDS over the most recent 5-year 

21 period. 

22 ‘‘SEC. 2609A. APPLICATION OF OTHER PROVISIONS. 

23 ‘‘(a) ADMINISTRATION.— 

24 ‘‘(1) IN GENERAL.—The provisions of section 

25 2602 shall apply to areas that receive a grant under 


sroberts on PROD1PC70 with BILLS
94 

•S 2823 RS

1 this subpart, except that the chief elected official may 

2 elect not to comply with the provisions of subsection 

3 (b), so long as the official provides documentation to 

4 the Secretary that details the process used to obtain 

5 community input (particularly from those inflected 

6 with HIV) for the design and implementation of ac7 tivities related to such grant. 

8 ‘‘(2) EXCEPTION.—The exception provided for in 

9 paragraph (1) shall not apply in fiscal years 2007 

10 through 2009 to areas that receive funding under this 

11 part. 

12 ‘‘(b) DISTRIBUTION.—The provisions of section 2603 

13 shall apply for purposes of awarding grants under this sub14 part, except that— 

15 ‘‘(1) with respect to areas described in section 

16 2609(a)(1)(A)— 

‘‘(A) 662 17 ⁄3 percent of the amounts appro18 priated under section 2609B(1) for each fiscal 

19 year shall be allocated to such areas as provided 

20 for in section 2603(a); and 

‘‘(B) 331 21 ⁄3 percent of the amounts appro22 priated under section 2609B(1) for each fiscal 

23 year shall be allocated to such areas as provided 

24 for in section 2603(b); and 


sroberts on PROD1PC70 with BILLS
95 

•S 2823 RS

1 ‘‘(2) with respect to areas described in section 

2 2609(a)(1)(B), 100 percent of the amounts appro3 priated under section 2609B(2) for each fiscal year 

4 shall be allocated to such areas as provided for in sec5 tion 2603(a). 

6 ‘‘(c) HOLD HARMLESS.—Paragraph (4) of section 

7 2603(a) shall not apply to an area for purposes of this sub8 part. 

9 ‘‘(d) USE OF AMOUNTS.—Amounts provided to an 

10 area under a grant under this part shall be used by such 

11 entity as provided for in section 2604. 

12 ‘‘(e) APPLICATION.—To be eligible to receive a grant 

13 under this subpart, an area shall submit to the Secretary 

14 an application that meets the requirements of section 2605. 

15 ‘‘(f) TECHNICAL ASSISTANCE AND DEFINITIONS.—The 

16 provisions of sections 2606 and 2707 shall apply for pur17 poses of this subpart, except that with respect to the defini18 tion of metropolitan area in section 2607(2), such term 

19 shall be applied so that for purposes of determining eligible 

20 areas, the Secretary shall use the boundaries of a respective 

21 area that were used when the area involved initially receive 

22 funding under this part. 

23 ‘‘SEC. 2609B. AUTHORIZATION OF APPROPRIATIONS. 

24 ‘‘There are authorized to be appropriated to carry out 

25 this subpart— 


sroberts on PROD1PC70 with BILLS
96 

•S 2823 RS

1 ‘‘(1) with respect to areas described in section 

2 2609(a)(1)(A), $123,300,000 for fiscal year 2007, 

3 $127,900,000 for fiscal year 2008, $132,600,000 for 

4 fiscal year 2009, $137,500,000 for fiscal year 2010, 

5 and $142,600,000 for fiscal year 2011; and 

6 ‘‘(2) with respect to areas described in section 

7 2609(a)(1)(B), $5,000,000 for each of the fiscal years 

8 2007 through 2011. 

9 ‘‘Subpart III—General Provisions’’. 

10 (b) REPEAL.—Section 2620 of the Public Health Serv11 ice Act (42 U.S.C. 300ff–30) is repealed. 

12 SEC. 111. AUTHORIZATION OF APPROPRIATIONS. 

13 Subpart I of part A of title XXVI of the Public Health 

14 Service Act (42 U.S.C. 300ff–11) is amended by adding at 

15 the end the following: 

16 ‘‘SEC. 2606. AUTHORIZATION OF APPROPRIATIONS. 

17 ‘‘For the purpose of carrying put this subpart, there 

18 are authorized to be appropriated $418,600,000 for fiscal 

19 year 2007, $434,100,000 for fiscal year 2008, $450,100,000 

20 for fiscal year 2009, $466,800,000 for fiscal year 2010, and 

21 $484,100,000 for fiscal year 2011.’’. 


sroberts on PROD1PC70 with BILLS
97 

•S 2823 RS

1 TITLE II—CARE GRANTS 

2 SEC. 201. LIVING CASES OF HIV/AIDS. 

3 (a) PRIORITY.—Section 2611(b)(1) of the Public 

4 Health Service Act (42 U.S.C. 300ff–21(b)(1)) is amend5 ed— 

6 (1) by striking ‘‘acquired immune deficiency 

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

8 (2) by striking ‘‘such syndrome’’ and inserting 

9 ‘‘HIV/AIDS’’. 

10 (b) APPLICATION.—Section 2617(d)(3) of the Public 

11 Health Service Act (42 U.S.C. 300ff–27(d)(3)) is amend12 ed— 

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

14 immune deficiency syndrome’’ and inserting ‘‘HIV/ 

15 AIDS’’; and 

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

17 immune deficiency syndrome’’ and inserting ‘‘HIV/ 

18 AIDS’’. 

19 (c) DISTRIBUTION OF FUNDS.—Section 2618(a) of the 

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

21 amended— 

22 (1) in paragraph (1)(A)(i)— 

23 (A) in subclause (I), by striking ‘‘cases of 

24 acquired immune deficiency syndrome, as deter25 mined under paragraph (2)(D)’’ and inserting 


sroberts on PROD1PC70 with BILLS
98 

•S 2823 RS

1 ‘‘living cases of AIDS (reported to and confirmed 

2 by the Director of the Centers for Disease Control 

3 and Prevention)’’; and 

4 (B) in subclause (II)— 

5 (i) by striking ‘‘cases of acquired im6 mune deficiency syndrome, as determined 

7 under paragraph (2)(D)’’ and inserting 

8 ‘‘living cases of AIDS (reported to and con9 firmed by the Director of the Centers for 

10 Disease Control and Prevention)’’; and 

11 (ii) by inserting ‘‘and’’ after the semi12 colon; and 

13 (2) in paragraph (2)— 

14 (A) in subparagraph (B), by striking ‘‘esti15 mated number of living cases of acquired im16 mune deficiency syndrome’’ and inserting ‘‘num17 ber of living cases of HIV/AIDS’’; 

18 (B) in subparagraph (C)— 

19 (i) by striking ‘‘estimated’’ each place 

20 that such term appears; and 

21 (ii) by striking ‘‘acquired immune de22 ficiency syndrome’’ each place that such ap23 pears and inserting ‘‘HIV/AIDS’’; and 

24 (C) by striking subparagraph (D) and in25 serting the following: 


sroberts on PROD1PC70 with BILLS
99 

•S 2823 RS

1 ‘‘(F) LIVING CASES OF HIV/AIDS.— 

2 ‘‘(i) IN GENERAL.—Except as provided 

3 for in clause (ii) and (iii), the amount de4 termined in this subparagraph is the num5 ber of living cases of HIV/AIDS (reported to 

6 and confirmed by the Director of the Cen7 ters for Disease Control and Prevention) 

8 through December 31 of the most recent cal9 endar year involved. 

10 ‘‘(ii) FISCAL YEARS 2007 THROUGH

11 2010.—For each of fiscal years 2007 through 

12 2010, the Secretary may use the proxy 

13 number for the number of HIV cases de14 scribed in clause (iii) if— 

15 ‘‘(I) the State involved— 

16 ‘‘(aa) is reporting, or the 

17 State will by October 1, 2006 have 

18 submitted a transition plan for 

19 reporting, accurate and reliable 

20 HIV cases to the Director of the 

21 Centers for Disease Control and 

22 Prevention; or 

23 ‘‘(bb) not later than October 

24 1, 2006, make all necessary statu25 tory changes to allow for the colVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6203 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
100 

•S 2823 RS

1 lection of HIV data certified by 

2 the Director of the Centers for 

3 Disease Control and Prevention; 

4 ‘‘(II) the State involved will by 

5 April 1, 2008, begin reporting accurate 

6 and reliable HIV cases, as determined 

7 by the Director of the Centers for Dis8 ease Control and Prevention; and 

9 ‘‘(III) the Director of the Centers 

10 for Disease Control and Prevention has 

11 determined that such State does not 

12 have an established HIV surveillance 

13 system. 

14 ‘‘(iii) AMOUNT DETERMINED.—With 

15 respect to each of fiscal years 2007 through 

16 2010, the amount determined under this 

17 subparagraph shall be the lesser of— 

18 ‘‘(I) the product of 0.9 and the 

19 number of living AIDS cases in the 

20 area involved; or 

21 ‘‘(II) an amount equal to 110 per22 cent of the funding level for the pre23 vious fiscal year.’’. 


sroberts on PROD1PC70 with BILLS
101 

•S 2823 RS

1 SEC. 202. AIDS DRUG ASSISTANCE PROGRAM. 

2 (a) REQUIREMENT OF MINIMUM DRUG LIST.—Section 

3 2616 of the Public Health Service Act (42 U.S.C. 300ff– 

4 26) is amended— 

5 (1) in subsection (c), by striking paragraph (1) 

6 and inserting the following: 

7 ‘‘(1) ensure that those treatments contained on 

8 the list of core AIDS Drug Assistance Program 

9 antiretroviral medications developed by the Secretary 

10 based on Public Health Service guidelines, are the 

11 minimum required treatments to be included under 

12 the program established under this section;’’; and 

13 (2) in subsection (d), by adding at the end the 

14 following: ‘‘The Secretary, in consultation with the 

15 Public Health Service, shall develop and maintain a 

16 list of classes of core AIDS Drug Assistance Program 

17 antiretroviral medications that shall be based upon 

18 those medications included in the Department of 

19 Health and Human Service’s Public Health Service 

20 HIV/AIDS Clinical Practice Guidelines for use of 

21 HIV/AIDS Drugs, drugs needed to manage symptoms 

22 associated with HIV infection.’’. 

23 (b) STATE REQUIREMENTS.—Subclauses (I) through 

24 (III) of section 2618(a)(2)(I)(ii) of the Public Health Serv25 ice Act (42 U.S.C. 300ff–28(a)(2)(I)(ii) (I)–(III)) are 

26 amended to read as follows: 


sroberts on PROD1PC70 with BILLS
102 

•S 2823 RS

1 ‘‘(I) IN GENERAL.—From 

2 amounts made available under 

3 subclause (V), the Secretary shall 

4 award supplemental grants to 

5 States described in subclause (II) 

6 to enable such States to purchase 

7 and distribute to eligible individ8 uals (as described in section 

9 2616(b)), pharmaceutical thera10 peutics described under sections 

11 2616(a) and 2616(c). 

12 ‘‘(II) ELIGIBLE STATES.— 

13 For purposes of subclause (I), a 

14 State shall be an eligible State if 

15 the State did not have unexpended 

16 funds subject to reallocation under 

17 section 2618(d) and, in accord18 ance with criteria established by 

19 the Secretary, demonstrates a se20 vere need for a grant under this 

21 clause. In developing such cri22 teria, the Secretary shall consider 

23 eligibility standards, formulary 

24 composition, the number of eligi25 ble individuals to whom a State is 


sroberts on PROD1PC70 with BILLS
103 

•S 2823 RS

1 unable to provide therapeutics de2 scribed in section 2616(a), and an 

3 unanticipated increase of eligible 

4 individuals with HIV/AIDS. 

5 ‘‘(III) STATE REQUIREMENTS.— 

6 The Secretary may not make a grant 

7 to a State under this clause unless the 

8 State agrees that the State will make 

9 available (directly or through dona10 tions of public or private entities) non11 Federal contributions toward the ac12 tivities to be carried out under the 

13 grant in an amount equal to $1 for 

14 each $4 of Federal funds provided in 

15 the grant, except that the Secretary 

16 may waive this subclause if the State 

17 has otherwise fully complied with sec18 tion 2617(d) with respect to the grant 

19 year involved.’’. 

20 (c) INCREASE IN ADAP SET-ASIDE.—Section 

21 2618(a)(2)(I)(ii)(V) of the Public Health Service Act (42 

22 U.S.C. 300ff–28(a)(2)(I)(ii)(V)) is amended by striking ‘‘3’’ 

23 and inserting ‘‘5’’. 


sroberts on PROD1PC70 with BILLS
104 

•S 2823 RS

1 (d) DRUG REBATE PROGRAM.—Section 2616 of the 

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

3 by adding at the end the following: 

4 ‘‘(f) DRUG REBATE PROGRAM.—A State shall ensure 

5 that any drug rebates received on drugs purchased from 

6 funds provided under this section are applied to activities 

7 supported under this title, with a preference for activities 

8 described under this section.’’. 

9 SEC. 203. COORDINATION. 

10 Section 2617(b) of the Public Health Service Act (42 

11 U.S.C. 300ff–27(b)) is amended— 

12 (1) by redesignating paragraphs (4) through (6) 

13 as paragraphs (5) through (7), respectively; 

14 (2) by inserting after paragraph (3), the fol15 lowing: 

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

17 shall— 

18 ‘‘(A) administer all assistance received 

19 under this part; 

20 ‘‘(B) conduct the needs assessment and pre21 pare the State plan under paragraph (3); 

22 ‘‘(C) prepare all applications for assistance 

23 under this part; 

24 ‘‘(D) receive notices with respect to pro25 grams under this title; 


sroberts on PROD1PC70 with BILLS
105 

•S 2823 RS

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

2 Secretary all audits from grantees within the 

3 State, including audits regarding funds ex4 pended in accordance with this part; and 

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

6 appropriate by the Secretary to facilitate the co7 ordination of programs under this title.’’; 

8 (3) in paragraph (5) (as so redesignated)— 

9 (A) in the matter preceding subparagraph 

10 (A), by striking ‘‘under this part’’ and inserting 

11 ‘‘under any provision of this title’’; 

12 (B) in subparagraph (E), by striking ‘‘and’’ 

13 at the end; and 

14 (C) by inserting after subparagraph (F), the 

15 following: 

16 ‘‘(G) includes key outcomes to be measured 

17 by all entities in the State receiving assistance 

18 under this title; and’’. 

19 SEC. 204. DISTRIBUTION OF FUNDS. 

20 (a) IN GENERAL.—Section 2618(a)(2) of the Public 

21 Health Service Act (42 U.S.C. 300ff–28(a)(2)) is amend22 ed— 

23 (1) in subparagraph (A)— 

24 (A) in clause (i), by striking ‘‘and (I)’’ and 

25 inserting ‘‘, (I), and (J)’’; and 


sroberts on PROD1PC70 with BILLS
106 

•S 2823 RS

1 (B) in clause (ii)— 

2 (i) in subclause (I)— 

3 (I) by striking ‘‘0.8’’ and insert4 ing ‘‘0.75’’; and 

5 (II) by striking ‘‘and’’ at the end; 

6 (ii) in subclause (II), by striking the 

7 period and inserting ‘‘; and’’; and 

8 (iii) by adding at the end the fol9 lowing: 

10 ‘‘(III) the product of 0.05 and the 

11 ratio of the locality distribution factor 

12 (as determined under subparagraph 

13 (D)) to the sum of the respective State 

14 distribution factors for all States and 

15 territories.’’; 

16 (2) in subparagraph (C)(ii), by striking ‘‘(as de17 termined under part A)’’ and inserting ‘‘under sub18 part I of part A and an eligible area under section 

19 2609(a)(1)(A)’’; 

20 (3) by inserting after subparagraph (C), the fol21 lowing: 

22 ‘‘(D) LOCALITY DISTRIBUTION FACTOR.— 

23 For purposes of subparagraph (A)(ii)(III), the 

24 term ‘locality distribution factor’ means an 

25 amount equal to the sum of— 


sroberts on PROD1PC70 with BILLS
107 

•S 2823 RS

1 ‘‘(i) the number of living cases of HIV/ 

2 AIDS in the State or territory involved, as 

3 determined under subparagraph (F); less 

4 ‘‘(ii) the number of living cases of 

5 HIV/AIDS in such State or territory that 

6 are within an eligible area (as determined 

7 under subpart I of part A and section 

8 2609(a)(1)(A)).’’; 

9 (4) by striking subparagraph (E) and inserting 

10 the following: 

11 ‘‘(E) SEVERITY OF NEED.— 

12 ‘‘(i) FISCAL YEARS BEGINNING WITH

13 2011.—If, by January 1, 2010, the Secretary 

14 notifies the appropriate committees of Con15 gress that the Secretary has developed a se16 verity of need index, in accordance with 

17 clause (v), the provisions of subparagraphs 

18 (A) through (D) shall not apply for fiscal 

19 year 2011 or any fiscal year thereafter, and 

20 the Secretary shall use the severity of need 

21 index (as defined in clause (iv)) for the de22 termination of the formula allocations, sub23 ject to the Congressional Review Act. 

24 ‘‘(ii) SUBSEQUENT FISCAL YEARS.—If, 

25 on or before any January 1 that is subseVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6203 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
108 

•S 2823 RS

1 quent to the date referred to in clause (i), 

2 the Secretary notifies the appropriate com3 mittees of Congress that the Secretary has 

4 developed a severity of need index, in ac5 cordance with clause (v), for each suc6 ceeding fiscal year, the provisions of sub7 paragraphs (A) through (D) shall not 

8 apply, and the Secretary shall use the sever9 ity of need index (as defined in clause (iv)) 

10 for the determination of the formula alloca11 tions, subject to the Congressional Review 

12 Act. 

13 ‘‘(iii) FISCAL YEAR 2013.—The Sec14 retary shall notify the appropriate commit15 tees of Congress that the Secretary has de16 veloped a severity of need index by January 

17 1, 2012, and the provisions of subpara18 graphs (A) through (D) shall not apply, 

19 and the Secretary shall use the severity of 

20 need index (as defined in clause (iv)) for the 

21 formula allocations for fiscal year 2013, 

22 subject to the Congressional Review Act. 

23 ‘‘(iv) DEFINITION OF SEVERITY OF

24 NEED INDEX.—In this subparagraph, the 

25 term ‘severity of need index’ means the 


sroberts on PROD1PC70 with BILLS
109 

•S 2823 RS

1 index of the relative needs of individuals 

2 within the State, as identified by a variety 

3 of different factors, and is a factor that is 

4 multiplied by the number of living HIV/ 

5 AIDS cases in the State, providing different 

6 weights to those cases based on their needs. 

7 ‘‘(v) REQUIREMENTS FOR SECRE8 TARIAL NOTIFICATION.—When the Secretary 

9 notifies the appropriate committees of Con10 gress that the Secretary has developed a se11 verity of need index, the Secretary shall 

12 provide the following: 

13 ‘‘(I) Methodology for and ration14 ale behind developing the severity of 

15 need index, including information re16 lated to the field testing of the severity 

17 of need index. 

18 ‘‘(II) Expected changes in funding 

19 allocations, given the application of the 

20 severity of need index and the elimi21 nation of the provisions of subpara22 graphs (A) through (D). 

23 ‘‘(III) Information regarding the 

24 process by which the Secretary received 


sroberts on PROD1PC70 with BILLS
110 

•S 2823 RS

1 community input regarding the appli2 cation of the severity of need index. 

3 ‘‘(IV) Timeline and process for the 

4 implementation of the severity of need 

5 index to ensure that it is applied in 

6 the following fiscal year. 

7 ‘‘(vi) ANNUAL REPORTS.—Not later 

8 than 1 year after the date of enactment of 

9 the Ryan White HIV/AIDS Treatment Mod10 ernization Act of 2006, and annually there11 after until the Secretary notifies Congress 

12 that the Secretary has developed a severity 

13 of need index in accordance with this sub14 paragraph, the Secretary shall prepare and 

15 submit to the appropriate committees of 

16 Congress a report— 

17 ‘‘(I) that updates progress toward 

18 having client level data; 

19 ‘‘(II) that updates the progress to20 ward having a severity of need index, 

21 including information related to the 

22 methodology and process for obtaining 

23 community input; and 

24 ‘‘(III) that, as applicable, states 

25 whether the Secretary could develop a 


sroberts on PROD1PC70 with BILLS
111 

•S 2823 RS

1 severity of need index before fiscal year 

2 2010.’’. 

3 (5) by striking subparagraph (G), and inserting 

4 the following: 

5 ‘‘(G) UNEXPENDED FUNDS.— 

6 ‘‘(i) IN GENERAL.—A State that has 

7 unobligated funds for a fiscal year under a 

8 grant under this part shall— 

9 ‘‘(I) return such funds to the Sec10 retary to be applied as provided for in 

11 section 2620; or 

12 ‘‘(II) submit an application to the 

13 Secretary for the use of such funds in 

14 the succeeding fiscal year that includes 

15 a description of the manner in which 

16 the State intends to use such funds. 

17 ‘‘(ii) CARRYOVER.—With respect to an 

18 application received under clause (i)(II), 

19 the Secretary shall determine whether the 

20 State involved may carryover any unobli21 gated funds for use under this part in the 

22 succeeding fiscal year or whether such 

23 amounts shall be returned to the Secretary 

24 for use under section 2620. Notice shall be 

25 provided to the area of such determination. 


sroberts on PROD1PC70 with BILLS
112 

•S 2823 RS

1 ‘‘(iii) FAILURE TO EXPEND FUNDS.— 

2 Amounts carried over by a State under this 

3 subparagraph that are not expended in the 

4 succeeding fiscal year shall be returned to 

5 the Secretary for use under section 2610. 

6 ‘‘(iv) CONSIDERATION IN MAKING

7 GRANTS.—The Secretary may, in deter8 mining the amount of a grant for a fiscal 

9 year under this paragraph, adjust the grant 

10 amount to reflect the amount of unexpended 

11 and uncanceled grant funds remaining at 

12 the end of the fiscal year preceding the year 

13 for which the grant determination is to be 

14 made. The amount of any such unexpended 

15 funds shall be determined using the finan16 cial status report of the grantee.’’; 

17 (6) by striking subparagraph (H); and 

18 (7) in subparagraph (I)(ii), by striking sub19 clause (VI) and inserting the following: 

20 ‘‘(VI) INCREASES IN GRANT.— 

21 ‘‘(aa) IN GENERAL.—For eli22 gible areas receiving grants under 

23 this section in fiscal year 2007, 

24 the Secretary shall increase the 

25 amount of the grant made pursuVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6203 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
113 

•S 2823 RS

1 ant to paragraph (2) for the State 

2 to ensure that— 

3 ‘‘(AA) for fiscal year 

4 2007, the grant is not less 

5 than 90 percent of the 

6 amount of the grant made for 

7 the State under section 2620 

8 and section 2618(a) for the 

9 base year; 

10 ‘‘(BB) for fiscal year 

11 2008, the grant is not less 

12 than 85 percent of the 

13 amount of such base year 

14 grant; and 

15 ‘‘(CC) for fiscal year 

16 2009, the grant is not less 

17 than 80 percent of the 

18 amount of the base year 

19 grant. 

20 ‘‘(bb) BASE YEAR.—With re21 spect to grants made pursuant to 

22 paragraph (2) for an State, the 

23 base year shall be fiscal year 

24 2006.’’. 


sroberts on PROD1PC70 with BILLS
114 

•S 2823 RS

1 (b) REALLOCATION.—Section 2618(d) of the Public 

2 Health Service Act (42 U.S.C. 300ff–28(d)) is amended by 

3 striking ‘‘in proportion to the original grants made to such 

4 States’’ and insert ‘‘reallocated pursuant to section 2620’’. 

5 SEC. 205. CORE MEDICAL SERVICES. 

6 Section 2612 of the Public Health Service Act (42 

7 U.S.C. 300ff–22) is amended by adding at the end the fol8 lowing: 

9 ‘‘(e) REQUIRED FUNDING FOR CORE MEDICAL SERV10 ICES.— 

11 ‘‘(1) IN GENERAL.—Notwithstanding any other 

12 provision of law, a grantee under this part shall ex13 pend not less than 75 percent of the funds received 

14 under the grant on core medical services, except that 

15 the Secretary shall waive the application of this sub16 section with respect to a grantee if the Secretary de17 termines that, within the service area of the grantee— 

18 ‘‘(A) there is no waiting lists for AIDS 

19 Drug Assistance Program services; and 

20 ‘‘(B) core medical services are available to 

21 all individuals infected with HIV/AIDS. 

22 ‘‘(2) CORE MEDICAL SERVICES.—For purposes of 

23 this subsection, the term ‘core medical services’ with 

24 respect to an individual infected with HIV/AIDS (inVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6203 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
115 

•S 2823 RS

1 cluding the co-occurring diseases of the individual) 

2 means the following services: 

3 ‘‘(A) Outpatient and ambulatory health 

4 services. 

5 ‘‘(B) AIDS Drug Assistance Program treat6 ments. 

7 ‘‘(C) AIDS pharmaceutical assistance. 

8 ‘‘(D) Oral health care. 

9 ‘‘(E) Early intervention services. 

10 ‘‘(F) Health insurance premium and cost 

11 sharing assistance for low-income individuals. 

12 ‘‘(G) Home health care. 

13 ‘‘(H) Hospice services. 

14 ‘‘(I) Home and community-based health 

15 services as defined under section 2614(c), except 

16 homemaker services. 

17 ‘‘(J) Mental health services. 

18 ‘‘(K) Substance abuse outpatient care. 

19 ‘‘(L) Medical case management, including 

20 treatment adherence services. 

21 ‘‘(3) SUPPORT SERVICES.—Notwithstanding any 

22 other provision of law, and subject to paragraph (1), 

23 a grantee under this part, subject to the approval of 

24 the Secretary, may provide support services (such as 

25 respite care for individuals with HIV/AIDS, outreach 


sroberts on PROD1PC70 with BILLS
116 

•S 2823 RS

1 services, medical transportation, nutritional coun2 seling, linguistic services, and referral for health care 

3 and support services for individuals with HIV/AIDS) 

4 needed to achieve medical outcomes which are related 

5 to the medical outcomes for an individual infected 

6 with HIV and approved by the Secretary. 

7 ‘‘(4) DEFINITION OF MEDICAL OUTCOMES.—In 

8 this subsection, the term ‘medical outcomes’ means 

9 those outcomes affecting the HIV-related clinical sta10 tus of an individual with HIV/AIDS. 

11 ‘‘(5) UNEXPENDED FUNDS.—Any amounts re12 quired to be expended for core medical services or sup13 port services under this subsection that remain unob14 ligated at the end of the fiscal year in which the funds 

15 were awarded shall be remitted to the Secretary for 

16 reallocation under section 2620.’’. 

17 SEC. 206. SUPPLEMENTAL GRANTS. 

18 (a) IN GENERAL.—Section 2620 of the Public Health 

19 Service Act (42 U.S.C. 300ff–30) is amended to read as fol20 lows: 

21 ‘‘SEC. 2620. SUPPLEMENTAL GRANTS. 

22 ‘‘(a) IN GENERAL.—The Secretary shall utilize 

23 amounts appropriated under section 2622 for a fiscal year 

24 and made available in accordance with subsection (c) to 

25 award grants to States whose applications under section 


sroberts on PROD1PC70 with BILLS
117 

•S 2823 RS

1 2617 demonstrate a need in the State for supplemental fi2 nancial assistance to combat the HIV epidemic and that 

3 have not had unexpended funds subject to the reallocation 

4 under section 2618(a)(2)(G). 

5 ‘‘(b) DEMONSTRATED NEED.—In determining dem6 onstrated need for purposes of subsection (a), the Secretary 

7 shall consider relevant factors that impact the need for sup8 plemental financial assistance, including— 

9 ‘‘(1) the unmet need for such services, as deter10 mined under section 2602(b)(4) or other community 

11 input process as defined under section 2609A(a); 

12 ‘‘(2) an increasing need for HIV/AIDS-related 

13 services, including relative rates of increase in the 

14 number of cases of HIV/AIDS; 

15 ‘‘(3) the relative rates of increase in the number 

16 of cases of HIV/AIDS within new or emerging sub17 populations; 

18 ‘‘(4) the current prevalence of HIV/AIDS; 

19 ‘‘(5) relevant factors related to the cost and com20 plexity of delivering health care to individuals with 

21 HIV/AIDS in the eligible area; 

22 ‘‘(6) the impact of co-morbid factors, including 

23 co-occurring infections, determined relevant by the 

24 Secretary; 

25 ‘‘(7) the prevalence of homelessness; 


sroberts on PROD1PC70 with BILLS
118 

•S 2823 RS

1 ‘‘(8) the prevalence of individuals described 

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

3 ‘‘(9) the relevant factors that limit access to 

4 health care, including geographic variation, adequacy 

5 of health insurance coverage, and language barriers; 

6 or 

7 ‘‘(10) the impact of a precipitous decline in the 

8 amount received under this subpart to an increase in 

9 unmet need for such services. 

10 ‘‘(c) AMOUNT AND TRIGGER OF FUNDING.— 

11 ‘‘(1) AMOUNT.—For each fiscal year beginning 

12 with the trigger year described in paragraph (2), the 

13 Secretary shall make available for purposes of awarding grants under this section, 1 14 ⁄3 of the sum of— 

15 ‘‘(A) the amount appropriated under sec16 tion 2622 for such fiscal year; less 

17 ‘‘(B) the amount made available to carry 

18 out section 2618(a)(2)(I) and section 2621 for 

19 such fiscal year. 

20 ‘‘(2) TRIGGER YEAR.—This section shall be effec21 tive only for fiscal years beginning in the first fiscal 

22 year in which the amount appropriated under section 

23 2621, excluding any amounts made available to carry 

24 out section 2618(a)(2)(I) and section 2621 for such 

25 fiscal year, exceeds the amount appropriated under 


sroberts on PROD1PC70 with BILLS
119 

•S 2823 RS

1 section 2677(b) (as such section existed on the day be2 fore the date of enactment of the Ryan White HIV/ 

3 AIDS Treatment Modernization Act of 2006) for fis4 cal year 2006, excluding any amount made available 

5 to carry out section 2618(a)(2)(I) for fiscal year 

6 2006.’’. 

7 (b) CONFORMING AMENDMENTS.—Section 2618 of the 

8 Public Health Service Act (42 U.S.C. 300ff–28) is amend9 ed— 

10 (1) in subsection (a)(1), by striking ‘‘section 

11 2677’’ and inserting ‘‘section 2622 and to the provi12 sions of section 2620’’; and 

13 (2) in subsection (c)(1), by inserting ‘‘, except for 

14 grants awarded under section 2620,’’ after ‘‘under 

15 this part’’. 

16 SEC. 207. REDUCTION OF THE ADAP WAITING LIST. 

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

18 Service Act (42 U.S.C. 300ff–21 et seq.) is amended by add19 ing at the end the following: 

20 ‘‘SEC. 2621. REDUCTION OF THE ADAP WAITING LIST. 

21 ‘‘(a) IN GENERAL.—If the Secretary determines that 

22 there is additional need for States to have funds to provide 

23 eligible individuals (as described in section 2616(b)) appro24 priate access to pharmaceutical therapies, the Secretary 

25 may make supplemental grants to States described in subVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6203 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
120 

•S 2823 RS

1 section (b) to enable such States to purchase and distribute 

2 to eligible individuals pharmaceutical therapies as de3 scribed in sections 2616(a) and 2616(e). 

4 ‘‘(b) ELIGIBLE STATES.—For purposes of subsection 

5 (a), a State is an eligible State if the State did not have 

6 unexpended funds subject to reallocation under section 

7 2618(d), and, in accordance with criteria established by the 

8 Secretary, demonstrates a need for a grant under such sub9 section. In developing such criteria, the Secretary shall con10 sider eligibility standards, formulary composition, the 

11 number of eligible individuals to whom the State is unable 

12 to provide therapeutics described in section 2616(a), and 

13 unanticipated increases in the number of eligible individ14 uals. 

15 ‘‘(c) STATE REQUIREMENTS.—The Secretary may not 

16 make a grant to a State under this section unless the State 

17 involved agrees that the State will make available (directly 

18 or through donations from public or private entities) non19 Federal contributions toward the activities to be carried out 

20 under the grant in an amount equal to $1 for each $4 of 

21 Federal funds provided under the grant, except that the Sec22 retary may waive this subsection if the State has otherwise 

23 fully complied with section 2617(d) with respect to the 

24 grant year involved. 


sroberts on PROD1PC70 with BILLS
121 

•S 2823 RS

1 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to carry out this section, 

3 $40,000,000 for fiscal year 2007.’’. 

4 SEC. 208. NATIVE AMERICAN REPRESENTATION. 

5 Section 2617(b)(6) of the Public Health Service Act 

6 (42 U.S.C. 300ff–27(b)(5)), as so redesignated, is amended 

7 by inserting ‘‘Native Americans within the State,’’ before 

8 ‘‘representatives of grantees’’. 

9 SEC. 209. PAYER OF LAST RESORT. 

10 Section 2617(b)(7)(F)(ii) of the Public Health Service 

11 Act (42 U.S.C. 300ff–27(b)(6))is amended by inserting 

12 ‘‘(except for a program administered by or providing the 

13 services of the Indian Health Services)’’ before the semi14 colon. 

15 SEC. 210. HEPATITIS. 

16 Section 2614(a)(3) of the Public Health Service Act 

17 (42 U.S.C. 300ff–24(a)(3)) is amended by inserting ‘‘, in18 cluding speciality care (including vaccinations) for hepa19 titis coinfection,’’ after ‘‘health services’’. 

20 SEC. 211. AUTHORIZATION OF APPROPRIATIONS. 

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

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

23 section 207, is further amended by adding at the end the 

24 following: 


sroberts on PROD1PC70 with BILLS
122 

•S 2823 RS

1 ‘‘SEC. 2622. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘For the purpose of carrying put this subpart, there 

3 are authorized to be appropriated $1,190,400,000 for fiscal 

4 year 2007, $1,193,000,000 for fiscal year 2008, 

5 $1,237,100,000 for fiscal year 2009, $1,282,900,000 for fis6 cal year 2010, and $1,330,300,000 for fiscal year 2011.’’. 

7 TITLE III—EARLY 

8 INTERVENTION SERVICES 

9 SEC. 301. CATEGORICAL GRANTS. 

10 (a) ESTABLISHMENT OF PROGRAM.—Section 2651(b) 

11 of the Public Health Service Act (42 U.S.C. 300ff–51(b)) 

12 is amended— 

13 (1) in paragraph (2)(D), by striking ‘‘the dis14 ease’’ and inserting ‘‘HIV/AIDS’’; 

15 (2) in paragraph (4)(B)— 

16 (A) in clause (i), by striking ‘‘paragraphs 

17 (1)’’ and all that follows through ‘‘2652(a)’’ and 

18 inserting ‘‘subparagraphs (A), (D), (E), and (F) 

19 of section 12652(a)(1)’’; and 

20 (B) in clause (ii), by striking ‘‘paragraphs 

21 (3) and (4) of section 2652(a)’’ and inserting 

22 ‘‘subparagraphs (B) and (C) of section 

23 2652(a)(1)’’; and 

24 (3) in paragraph (5)(A), by striking ‘‘the dis25 ease’’ each place that such appears and inserting 

26 ‘‘HIV/AIDS’’. 


sroberts on PROD1PC70 with BILLS
123 

•S 2823 RS

1 (b) MINIMUM QUALIFICATION OF GRANTEES.—Section 

2 2652(a) of the Public Health Service Act (42 U.S.C. 300ff– 

3 52(a)) is amended to read as follows: 

4 ‘‘(a) ELIGIBLE ENTITIES.— 

5 ‘‘(1) IN GENERAL.—The entities referred to in 

6 section 2651(a) are public entities and nonprofit pri7 vate entities that are— 

8 ‘‘(A) federally-qualified health centers under 

9 section 1905(l)(2)(B) of the Social Security Act; 

10 ‘‘(B) grantees under section 1001 (regarding 

11 family planning) other than States; 

12 ‘‘(C) comprehensive hemophilia diagnostic 

13 and treatment centers; 

14 ‘‘(D) rural health clinics; 

15 ‘‘(E) health facilities operated by or pursu16 ant to a contract with the Indian Health Serv17 ice; 

18 ‘‘(F) nonprofit private entities that provide 

19 comprehensive primary care services to popu20 lations at risk of HIV/AIDS. 

21 ‘‘(2) UNDERSERVED POPULATIONS.—Entities de22 scribed in paragraph (1) shall serve underserved pop23 ulations which may include minority populations 

24 and Native American populations, ex-offenders, indi25 viduals co-infected with HIV and hepatitis B or C, 


sroberts on PROD1PC70 with BILLS
124 

•S 2823 RS

1 low-income populations, inner city populations, and 

2 rural populations.’’. 

3 (c) PREFERENCES IN MAKING GRANTS.—Section 2653 

4 of the Public Health Service Act (42 U.S.C. 300ff–53) is 

5 amended— 

6 (1) in subsection (b)(1)— 

7 (A) in subparagraph (A), by striking ‘‘ac8 quired immune deficiency syndrome’’ and insert9 ing ‘‘HIV/AIDS’’; and 

10 (B) in subparagraph (D), by inserting be11 fore the semicolon the following: ‘‘and the num12 ber of cases of individuals coinfected with HIV/ 

13 AIDS and hepatitis B or C’’; and 

14 (2) in subsection (d)(2), by striking ‘‘special con15 sideration’’ and inserting ‘‘preference’’. 

16 (d) PLANNING AND DEVELOPMENT GRANTS.—Section 

17 2654(c) of the Public Health Service Act (42 U.S.C. 300ff– 

18 54(c)) is amended— 

19 (1) in paragraph (1)— 

20 (A) in subparagraph (A), by striking 

21 ‘‘HIV’’; and 

22 (B) in subparagraph (B), by striking 

23 ‘‘HIV’’ and inserting ‘‘HIV/AIDS’’; and 


sroberts on PROD1PC70 with BILLS
125 

•S 2823 RS

1 (2) in paragraph (3), by striking ‘‘or under2 served communities’’ and inserting ‘‘areas or to un3 derserved populations’’. 

4 (e) AUTHORIZATION OF APPROPRIATIONS.—Section 

5 2655 of the Public Health Service Act (42 U.S.C. 300ff– 

6 55) is amended by striking ‘‘such sums’’ and all that follows 

7 through ‘‘2005’’ and inserting ‘‘, $218,600,000 for fiscal 

8 year 2007, $226,700,000 for fiscal year 2008, $235,100,000 

9 for fiscal year 2009, $234,800,000 for fiscal year 2010, and 

10 $252,800,000 for fiscal year 2011’’. 

11 SEC. 302. GENERAL PROVISIONS. 

12 (a) COUNSELING SERVICES.—Section 2662(a) of the 

13 Public Health Service Act (42 U.S.C. 300ff–62(a)) is 

14 amended by striking ‘‘the disease’’ and inserting ‘‘HIV/ 

15 AIDS’’. 

16 (b) APPLICABILITY OF CERTAIN REQUIREMENTS.— 

17 Section 2663 of the Public Health Service Act (42 U.S.C. 

18 300ff–63) is amended by striking ‘‘will, without’’ and all 

19 that follows through ‘‘be carried’’ and inserting ‘‘with funds 

20 appropriated through this Act will be carried’’. 

21 (c) ADDITIONAL REQUIRED AGREEMENTS.—Section 

22 2664(a) of the Public Health Service Act (42 U.S.C. 300ff– 

23 64(a)) is amended— 

24 (1) in paragraph (1)— 


sroberts on PROD1PC70 with BILLS
126 

•S 2823 RS

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

2 at the end; 

3 (B) in subparagraph (B), by striking ‘‘and’’ 

4 at the end; and 

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

6 ‘‘(C) information regarding how the ex7 pected expenditures of the grant are related to 

8 the planning process for localities funded under 

9 part A (including the planning process described 

10 in section 2602) and for States funded under 

11 part B (including the planning process described 

12 in section 2617(b)); and 

13 ‘‘(D) a specification of the expected expendi14 tures and how those expenditures will improve 

15 overall client outcomes, as described in the State 

16 plan under section 2617(b) or through additional 

17 outcome measures;’’; 

18 (2) in paragraph (2), by striking the period and 

19 inserting a semicolon; and 

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

21 ‘‘(3) the applicant agrees to provide additional 

22 documentation to the Secretary regarding the process 

23 used to obtain community input into the design and 

24 implementation of activities related to such grant; 

25 and 


sroberts on PROD1PC70 with BILLS
127 

•S 2823 RS

1 ‘‘(4) the applicant agrees to submit to the lead 

2 State agency under section 2617(b)(4) audits regard3 ing funds expended in accordance with this title and 

4 shall include necessary client level data to complete 

5 unmet need calculations and Statewide coordinated 

6 statements of need process.’’. 

7 SEC. 303. CORE MEDICAL SERVICES. 

8 Subpart II of part C of title XXVI of the Public Health 

9 Service Act (42 U.S.C. 300ff–61 et seq.) is amended by add10 ing at the end the following: 

11 ‘‘SEC. 2688. REQUIRED FUNDING FOR CORE MEDICAL SERV12 ICES. 

13 ‘‘(a) IN GENERAL.—Notwithstanding any other provi14 sion of law, a grantee under this part shall expend not less 

15 than 75 percent of the funds received under the grant on 

16 core medical services, except that the Secretary shall waive 

17 the application of this section with respect to a grantee if 

18 the Secretary determines that, within the service area of the 

19 grantee— 

20 ‘‘(1) there is no waiting lists for AIDS Drug As21 sistance Program services; and 

22 ‘‘(2) core medical services are available to all in23 dividuals infected with HIV/AIDS. 

24 ‘‘(b) CORE MEDICAL SERVICES.—For purposes of this 

25 section, the term ‘core medical services’ with respect to an 


sroberts on PROD1PC70 with BILLS
128 

•S 2823 RS

1 individual infected with HIV/AIDS (including the co-occur2 ring diseases of the individual) means the following services: 

3 ‘‘(1) Outpatient and ambulatory health services. 

4 ‘‘(2) AIDS Drug Assistance Program treatments. 

5 ‘‘(3) AIDS pharmaceutical assistance. 

6 ‘‘(4) Oral health care. 

7 ‘‘(5) Early intervention services. 

8 ‘‘(6) Health insurance premium and cost sharing 

9 assistance for low-income individuals. 

10 ‘‘(7) Home health care. 

11 ‘‘(8) Hospice services. 

12 ‘‘(9) Home and community-based health services 

13 as defined under section 2614(c), except homemaker 

14 services. 

15 ‘‘(10) Mental health services. 

16 ‘‘(11) Substance abuse outpatient care. 

17 ‘‘(12) Medical case management, including treat18 ment adherence services. 

19 ‘‘(c) SUPPORT SERVICES.—Notwithstanding any other 

20 provision of law, and subject to subsection (a), a grantee 

21 under this part, subject to the approval of the Secretary, 

22 may provide support services (such as respite care for indi23 viduals with HIV/AIDS, outreach services, medical trans24 portation, nutritional counseling, linguistic services, and 

25 referral for health care and support services for individuals 


sroberts on PROD1PC70 with BILLS
129 

•S 2823 RS

1 with HIV/AIDS) needed to achieve medical outcomes which 

2 are related to the medical outcomes for an individual in3 fected with HIV and approved by the Secretary. 

4 ‘‘(d) DEFINITION OF MEDICAL OUTCOMES.—In this 

5 section, the term ‘medical outcomes’ means those outcomes 

6 affecting the HIV-related clinical status of an individual 

7 with HIV/AIDS. 

8 ‘‘(e) UNEXPENDED FUNDS.—Any amounts required to 

9 be expended for core medical services or support services 

10 under this section that remain unobligated at the end of 

11 the fiscal year in which the funds were awarded shall be 

12 remitted to the Secretary for reallocation under this sec13 tion.’’. 

14 SEC. 304. PAYER OF LAST RESORT. 

15 Section 2664(f)(1)(A) of the Public Health Service Act 

16 (42 U.S.C. 300ff–64(f)(1)(A)) is amended by inserting ‘‘(ex17 cept for a program administered by or providing the serv18 ices of the Indian Health Service)’’ before the semicolon. 

19 TITLE IV—WOMEN, INFANTS, 

20 CHILDREN, AND YOUTH 

21 SEC. 401. WOMEN, INFANTS, CHILDREN, AND YOUTH. 

22 Part D of title XXVI of the Public Health Service Act 

23 (42 U.S.C. 300ff–71 et seq.) is amended to read as follows: 


sroberts on PROD1PC70 with BILLS
130 

•S 2823 RS

1 ‘‘PART D—WOMEN, INFANTS, CHILDREN, AND 

2 YOUTH 

3 ‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND AC4 CESS TO RESEARCH FOR WOMEN, INFANTS, 

5 CHILDREN, AND YOUTH. 

6 ‘‘(a) IN GENERAL.—The Secretary, acting through the 

7 Administrator of the Health Resources and Services Admin8 istration, shall award grants to public and nonprofit pri9 vate entities (including a health facility operated by or pur10 suant to a contract with the Indian Health Service) that 

11 provide family-centered care involving outpatient or ambu12 latory care (directly or through contracts) for women, in13 fants, children, and youth with HIV/AIDS. 

14 ‘‘(b) ADDITIONAL SERVICES FOR PATIENTS AND FAMI15 LIES.—Funds provided under grants awarded under sub16 section (a) may be also be used for the following support 

17 services: 

18 ‘‘(1) Family-centered care including case man19 agement. 

20 ‘‘(2) Referrals for additional services including— 

21 ‘‘(A) referrals for inpatient hospital serv22 ices, treatment for substance abuse, and mental 

23 health services; and 

24 ‘‘(B) referrals for other social and support 

25 services, as appropriate. 


sroberts on PROD1PC70 with BILLS
131 

•S 2823 RS

1 ‘‘(3) Additional services necessary to enable the 

2 patient and the family to participate in the program 

3 established by the applicant pursuant to such sub4 section including services designed to recruit and re5 tain youth with HIV. 

6 ‘‘(4) The provision of information and education 

7 on opportunities to participate in HIV/AIDS-related 

8 clinical research. 

9 ‘‘(c) COORDINATION WITH OTHER ENTITIES.—A 

10 grant awarded under subsection (a) may be made only if 

11 the applicant provides an agreement that includes the fol12 lowing: 

13 ‘‘(1) The applicant will coordinate activities 

14 under the grant with other providers of health care 

15 services under this Act, and under title V of the So16 cial Security Act. 

17 ‘‘(2) The applicant will participate in the state18 wide coordinated statement of need under part B 

19 (where it has been initiated by the public health agen20 cy responsible for administering grants under part B) 

21 and in revisions of such statement. 

22 ‘‘(3) The applicant will every 2 years submit to 

23 the lead State agency under section 2617(b)(4) audits 

24 regarding funds expended in accordance with this 

25 title and shall include necessary client-level data to 


sroberts on PROD1PC70 with BILLS
132 

•S 2823 RS

1 complete unmet need calculations and Statewide co2 ordinated statements of need process. 

3 ‘‘(d) ADMINISTRATION.— 

4 ‘‘(1) APPLICATION.—A grant may only be 

5 awarded to an entity under subsection (a) if an ap6 plication for the grant is submitted to the Secretary 

7 and the application is in such form, is made in such 

8 manner, and contains such agreements, assurances, 

9 and information as the Secretary determines to be 

10 necessary to carry out this section. Such application 

11 shall include the following: 

12 ‘‘(A) Information regarding how the ex13 pected expenditures of the grant are related to 

14 the planning process for localities funded under 

15 part A (including the planning process outlined 

16 in section 2602) and for States funded under 

17 part B (including the planning process outlined 

18 in section 2617(b). 

19 ‘‘(B) A specification of the expected expend20 itures and how those expenditures will improve 

21 overall patient outcomes, as outlined as part of 

22 the State plan (under section 2617(b)) or 

23 through additional outcome measures. 

24 ‘‘(2) QUALITY MANAGEMENT PROGRAM.—A 

25 grantee under this section shall implement a quality 


sroberts on PROD1PC70 with BILLS
133 

•S 2823 RS

1 management program to assess the extent to which 

2 HIV health services provided to patients under the 

3 grant are consistent with the most recent Public 

4 Health Service guidelines for the treatment of HIV/ 

5 AIDS and related opportunistic infection, and as ap6 plicable, to develop strategies for ensuring that such 

7 services are consistent with the guidelines for im8 provement in the access to and quality of HIV health 

9 services. 

10 ‘‘(e) ANNUAL REVIEW OF PROGRAMS; EVALUATIONS.— 

11 ‘‘(1) REVIEW REGARDING ACCESS TO AND PAR12 TICIPATION IN PROGRAMS.—With respect to a grant 

13 under subsection (a) for an entity for a fiscal year, 

14 the Secretary shall, not later than 180 days after the 

15 end of the fiscal year, provide for the conduct and 

16 completion of a review of the operation during the 

17 year of the program carried out under such subsection 

18 by the entity. The purpose of such review shall be the 

19 development of recommendations, as appropriate, for 

20 improvements in the following: 

21 ‘‘(A) Procedures used by the entity to allo22 cate opportunities and services under subsection 

23 (a) among patients of the entity who are women, 

24 infants, children, or youth. 


sroberts on PROD1PC70 with BILLS
134 

•S 2823 RS

1 ‘‘(B) Other procedures or policies of the en2 tity regarding the participation of such individ3 uals in such program. 

4 ‘‘(2) EVALUATIONS.——The Secretary shall, di5 rectly or through contracts with public and private 

6 entities, provide for evaluations of programs carried 

7 out pursuant to subsection (a). 

8 ‘‘(f) CAP ON ADMINISTRATIVE EXPENSES.—A grantee 

9 may not use more than 10 percent of amounts received 

10 under a grant awarded under this section for administra11 tive expenses. 

12 ‘‘(g) TRAINING AND TECHNICAL ASSISTANCE.—From 

13 the amounts appropriated under subsection (i) for a fiscal 

14 year, the Secretary may use not more than 5 percent to 

15 provide, directly or through contracts with public and pri16 vate entities (which may include grantees under subsection 

17 (a)), training and technical assistance to assist applicants 

18 and grantees under subsection (a) in complying with the 

19 requirements of this section. 

20 ‘‘(h) DEFINITIONS.—In this section: 

21 ‘‘(1) ADMINISTRATIVE EXPENSES.—The term 

22 ‘administrative expenses’ means funds that are to be 

23 used by grantees for grant management and moni24 toring activities, including costs related to any staff 

25 or activity unrelated to services or indirect costs. 


sroberts on PROD1PC70 with BILLS
135 

•S 2823 RS

1 ‘‘(2) INDIRECT COSTS.—The term ‘indirect costs’ 

2 means costs included in a Federally negotiated indi3 rect rate. 

4 ‘‘(3) SERVICES.—The term ‘services’ means— 

5 ‘‘(A) services that are provided to clients to 

6 meet the goals and objectives of the program 

7 under this section, including the provision of 

8 professional, diagnostic, and therapeutic services 

9 by a primary care provider or a referral to and 

10 provision of specialty care; and 

11 ‘‘(B) services that sustain program activity 

12 and contribute to or help improve services under 

13 subparagraph (A). 

14 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For the 

15 purpose of carrying out this section, there are authorized 

16 to be appropriated, $71,800,000 for each of the fiscal years 

17 2007 through 2011.’’. 

18 SEC. 402. GAO REPORT. 

19 Not later than 24 months after the date of enactment 

20 of this Act, the Comptroller General of the Government Ac21 countability Office shall conduct an evaluation, and submit 

22 to Congress a report, concerning the funding provided for 

23 under part D of title XXVI of the Public Health Service 

24 Act to determine— 


sroberts on PROD1PC70 with BILLS
136 

•S 2823 RS

1 (1) how funds are used to provide the adminis2 trative expenses, indirect costs, and services, as de3 fined in section 2671(h) of such title, for individuals 

4 with HIV/AIDS; 

5 (2) how funds are used to provide the adminis6 trative expenses, indirect costs, and services, as de7 fined in section 2671(h) of such title, to family mem8 bers of women, infants, children, and youth infected 

9 with HIV/AIDS; 

10 (3) how funds are used to provide family-cen11 tered care involving outpatient or ambulatory care 

12 authorized under section 2671(a) of such title; 

13 (4) how funds are used to provide additional 

14 services authorized under section 2671(b) of such title; 

15 and 

16 (5) how funds are used to help identify HIV17 positive pregnant women and connect them with care 

18 that can improve their health and prevent perinatal 

19 transmission. 

20 TITLE V—GENERAL PROVISIONS 

21 SEC. 501. GENERAL PROVISIONS. 

22 Part E of title XXVI of the Public Health Service Act 

23 (42 U.S.C. 300ff–80 et seq.) is amended to read as follows: 


sroberts on PROD1PC70 with BILLS
137 

•S 2823 RS

1 ‘‘PART E—GENERAL PROVISIONS 

2 ‘‘SEC. 2681. COORDINATION. 

3 ‘‘(a) REQUIREMENT.—The Secretary shall ensure that 

4 the Health Resources and Services Administration, the Cen5 ters for Disease Control and Prevention, the Substance 

6 Abuse and Mental Health Services Administration, and the 

7 Centers for Medicare & Medicaid Services coordinate the 

8 planning, funding, and implementation of Federal HIV 

9 programs including the Minority AIDS Initiative under 

10 section 2693 to enhance the continuity of care and preven11 tion services for individuals with HIV/AIDS or those at risk 

12 of such disease. The Secretary shall consult with other Fed13 eral agencies, including the Department of Veterans Affairs, 

14 as needed and utilize planning information submitted to 

15 such agencies by the States and entities eligible for assist16 ance under this title. 

17 ‘‘(b) REPORT.—The Secretary shall biennially prepare 

18 and submit to the appropriate committees of the Congress 

19 a report concerning the coordination efforts at the Federal, 

20 State, and local levels described in this section, including 

21 a description of Federal barriers to HIV program integra22 tion and a strategy for eliminating such barriers and en23 hancing the continuity of care and prevention services for 

24 individuals with HIV/AIDS or those at risk of such disease. 

25 ‘‘(c) INTEGRATION BY STATE.—As a condition of re26 ceipt of funds under this title, a State shall provide assurVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6203 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
138 

•S 2823 RS

1 ances to the Secretary that health support services funded 

2 under this title will be integrated with other such services, 

3 that programs will be coordinated with other available pro4 grams (including Medicaid), and that the continuity of care 

5 and prevention services of individuals with HIV/AIDS is 

6 enhanced. 

7 ‘‘(d) INTEGRATION BY LOCAL OR PRIVATE ENTI8 TIES.—As a condition of receipt of funds under this title, 

9 a local government or private nonprofit entity shall provide 

10 assurances to the Secretary that services funded under this 

11 title will be integrated with other such services, that pro12 grams will be coordinated with other available programs 

13 (including Medicaid), and that the continuity of care and 

14 prevention services of individuals with HIV is enhanced. 

15 ‘‘SEC. 2682. AUDITS. 

16 ‘‘(a) IN GENERAL.—For fiscal year 2007, and each 

17 subsequent fiscal year, the Secretary may reduce the 

18 amounts of grants under this title to a State or political 

19 subdivision of a State for a fiscal year if, with respect to 

20 such grants for the second preceding fiscal year, the State 

21 or subdivision fails to prepare audits in accordance with 

22 the procedures of section 7502 of title 31, United States 

23 Code. The Secretary shall annually select representative 

24 samples of such audits, prepare summaries of the selected 

25 audits, and submit the summaries to the Congress. 


sroberts on PROD1PC70 with BILLS
139 

•S 2823 RS

1 ‘‘(b) POSTING ON THE INTERNET.—All audits that the 

2 Secretary receives from the State lead agency under section 

3 2617(b)(4) shall be posted on the Internet website of the 

4 Health Resources and Services Administration. 

5 ‘‘SEC. 2683. PUBLIC HEALTH EMERGENCY. 

6 ‘‘(a) IN GENERAL.—In an emergency area and during 

7 an emergency period, the Secretary shall have the authority 

8 to waive such requirements of this title to improve the 

9 health and safety of those receiving care under this title and 

10 the general public, except that the Secretary may not ex11 pend more than 5 percent of the funds allocated under this 

12 title for sections 2620 and section 2603(b). 

13 ‘‘(b) EMERGENCY AREA AND EMERGENCY PERIOD.— 

14 In this section: 

15 ‘‘(1) EMERGENCY AREA.—The term ‘emergency 

16 area’ means a geographic area in which there exists— 

17 ‘‘(A) an emergency or disaster declared by 

18 the President pursuant to the National Emer19 gencies Act of the Robert T. Stafford Disaster 

20 Relief and Emergency Assistance Act; and 

21 ‘‘(B) a public health emergency declared by 

22 the Secretary pursuant to section 319. 

23 ‘‘(2) EMERGENCY PERIOD.—The term ‘emergency 

24 period’ means the period in which there exists— 


sroberts on PROD1PC70 with BILLS
140 

•S 2823 RS

1 ‘‘(A) an emergency or disaster declared by 

2 the President pursuant to the National Emer3 gencies Act of the Robert T. Stafford Disaster 

4 Relief and Emergency Assistance Act; and 

5 ‘‘(B) a public health emergency declared by 

6 the Secretary pursuant to section 319. 

7 ‘‘(c) UNOBLIGATED FUNDS.—If funds under a grant 

8 under this section are not expended for an emergency in 

9 the fiscal year in which the emergency is declared, such 

10 funds shall be returned to the Secretary for reallocation 

11 under sections 2603(b) and 2620. 

12 ‘‘SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN AC13 TIVITIES. 

14 ‘‘None of the funds appropriated under this title shall 

15 be used to fund AIDS programs, or to develop materials, 

16 designed to promote or encourage, directly, intravenous 

17 drug use or sexual activity, whether homosexual or hetero18 sexual. Funds authorized under this title may be used to 

19 provide medical treatment and support services for individ20 uals with HIV. 

21 ‘‘SEC. 2685. PRIVACY PROTECTIONS. 

22 ‘‘The Secretary shall collect client-level data under this 

23 title in a manner that is consistent with the unique identi24 fier as reported to the Director of the Centers for Disease 


sroberts on PROD1PC70 with BILLS
141 

•S 2823 RS

1 Control and Prevention as of the date of enactment of this 

2 section. 

3 ‘‘SEC. 2686. GAO REPORT. 

4 ‘‘The Comptroller General of the Government Account5 ability Office shall biennially submit to the appropriate 

6 committees of Congress a report that includes a description 

7 of Federal, State, and local barriers to HIV program inte8 gration, particularly for racial and ethnic minorities, and 

9 recommendations for enhancing the continuity of care and 

10 the provision of prevention services for individuals with 

11 HIV/AIDS or those at risk for such disease. Such report 

12 shall include a demonstration of the manner in which funds 

13 under this subpart are being expended and to what extent 

14 the services provided with such funds increase access to pre15 vention and care services for individuals with HIV/AIDS 

16 and build stronger community linkages to address HIV pre17 vention and care for racial and ethnic minority commu18 nities. 

19 ‘‘SEC. 2687. DEFINITIONS. 

20 ‘‘For purposes of this title: 

21 ‘‘(1) COUNSELING.—The term ‘counseling’ means 

22 such counseling provided by an individual trained to 

23 provide such counseling. 

24 ‘‘(2) FAMILY-CENTERED CARE.—The term ‘fam25 ily-centered care’ means the system of services deVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6203 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
142 

•S 2823 RS

1 scribed in this section that is targeted specifically to 

2 the special needs of infants, children, women and 

3 families. Family-centered care shall be based on a 

4 partnership between parents, professionals, and the 

5 community designed to ensure an integrated, coordi6 nated, culturally sensitive, and community-based con7 tinuum of care for children, women, and families 

8 with HIV/AIDS. 

9 ‘‘(3) FAMILIES WITH HIV/AIDS.—The term ‘fami10 lies with HIV/AIDS’ means families in which one or 

11 more members have HIV/AIDS. 

12 ‘‘(4) HIV.—The term ‘HIV’ means infection 

13 with the etiologic agent for acquired immune defi14 ciency syndrome. 

15 ‘‘(5) HIV/AIDS.—The term ‘HIV/AIDS’ means 

16 infection with the etiologic agent for acquired im17 mune deficiency syndrome, and includes any condi18 tion arising from such syndrome. 

19 ‘‘(6) OFFICIAL POVERTY LINE.—The term ‘offi20 cial poverty line’ means the poverty line established 

21 by the Director of the Office of Management and 

22 Budget and revised by the Secretary in accordance 

23 with section 673(2) of the Omnibus Budget Reconcili24 ation Act of 1981. 


sroberts on PROD1PC70 with BILLS
143 

•S 2823 RS

1 ‘‘(7) PERSON.—The term ‘person’ includes one or 

2 more individuals, governments (including the Federal 

3 Government and the governments of the States), gov4 ernmental agencies, political subdivisions, labor 

5 unions, partnerships, associations, corporations, legal 

6 representatives, mutual companies, joint-stock compa7 nies, trusts, unincorporated organizations, receivers, 

8 trustees, and trustees in cases under title 11, United 

9 States Code. 

10 ‘‘(8) STATE.—The term ‘State’, except as other11 wise specifically provided, means each of the 50 

12 States, the District of Columbia, the Virgin Islands, 

13 Guam, American Samoa, the Commonwealth of the 

14 Northern Mariana Islands, Puerto Rico, and the Re15 public of the Marshall Islands. 

16 ‘‘(9) YOUTH WITH HIV.—The term ‘youth with 

17 HIV’ means individuals who are 13 through 24 years 

18 old and who have HIV/AIDS.’’. 

19 TITLE VI—DEMONSTRATION AND 

20 TRAINING 

21 SEC. 601. DEMONSTRATION AND TRAINING. 

22 Subpart I of part F of title XXVI of the Public Health 

23 Service Act (42 U.S.C. 300ff–101 et seq.) is amended to read 

24 as follows: 


sroberts on PROD1PC70 with BILLS
144 

•S 2823 RS

1 ‘‘PART F—DEMONSTRATION AND TRAINING 

2 ‘‘Subpart I—Special Projects of National Significance 

3 ‘‘SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFI4 CANCE. 

5 ‘‘(a) IN GENERAL.—Of the amount appropriated 

6 under each of parts A, B, C, and D for each fiscal year, 

7 the Secretary shall use the greater of $20,000,000 or an 

8 amount equal to 3 percent of such amount appropriated 

9 under each such part, but not to exceed $25,000,000, to ad10 minister special projects of national significance to— 

11 ‘‘(1) quickly respond to emerging needs of indi12 viduals receiving assistance under this title; and 

13 ‘‘(2) to fund special programs to develop a 

14 standard electronic client information data system to 

15 improve the ability of grantees under this title to re16 port client-level data to the Secretary. 

17 ‘‘(b) GRANTS.—The Secretary shall award grants 

18 under subsection (a) to entities eligible for funding under 

19 parts A, B, C, and D based on— 

20 ‘‘(1)(A) whether the funding will promote obtain21 ing client level data as it relates to the creation of a 

22 severity of need index under section 

23 2618(a)(2)(E)(iii), including funds to facilitate the 

24 purchase and enhance the utilization of qualified 

25 health information technology systems; 


sroberts on PROD1PC70 with BILLS
145 

•S 2823 RS

1 ‘‘(B) demonstrated ability to create and main2 tain a qualified health information technology system; 

3 ‘‘(C) the potential replicability of the proposed 

4 activity in other similar localities or nationally; 

5 ‘‘(D) the demonstrated reliability of the proposed 

6 qualified health information technology system across 

7 a variety of providers, geographic regions, and clients; 

8 and 

9 ‘‘(E) the demonstrated ability to maintain a safe 

10 and secure qualified health information system; or 

11 ‘‘(2) newly emerging needs of individuals receiv12 ing assistance under this title. 

13 ‘‘(c) COORDINATION.—The Secretary may not make a 

14 grant under this section unless the applicant submits evi15 dence that the proposed program is consistent with the 

16 statewide coordinated statement of need, and the applicant 

17 agrees to participate in the ongoing revision process of such 

18 statement of need. 

19 ‘‘(d) PRIVACY PROTECTION.—The Secretary may not 

20 make a grant under this section for the development of a 

21 qualified health information technology system unless the 

22 applicant provides assurances to the Secretary that the sys23 tem will comply with the privacy regulations promulgated 

24 under section 264(c) of the Health Insurance Portability 

25 and Accountability Act of 1996. 


sroberts on PROD1PC70 with BILLS
146 

•S 2823 RS

1 ‘‘(e) REPLICATION.—The Secretary shall make infor2 mation concerning successful models or programs developed 

3 under this part available to grantees under this title for 

4 the purpose of coordination, replication, and integration. 

5 To facilitate efforts under this subsection, the Secretary 

6 may provide for peer-based technical assistance from grant7 ees funded under this part.’’. 

8 SEC. 602. AIDS EDUCATION AND TRAINING CENTERS. 

9 Section 2692(a)(2) of the Public Health Service Act 

10 (42 U.S.C. 300ff–92(a)(2)) is amended— 

11 (1) in subparagraph (A)— 

12 (A) by inserting ‘‘and Native Americans’’ 

13 after ‘‘minority individuals’’; and 

14 (B) by striking ‘‘and’’ at the end; 

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

16 and inserting ‘‘; and’’; and 

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

18 ‘‘(C) train or result in the training of 

19 health professionals and allied health profes20 sionals to provide treatment for hepatitis B or C 

21 co-infected individuals.’’. 


sroberts on PROD1PC70 with BILLS
147 

•S 2823 RS

1 SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE 

2 UNDER RYAN WHITE COMPREHENSIVE AIDS 

3 RESOURCES EMERGENCY ACT OF 1990. 

4 Part F of title XXVI of the Public Health Service Act 

5 (42 U.S.C. 300ff–101 et seq.) is amended by adding at the 

6 end the following: 

7 ‘‘Subpart II—Minority AIDS Initiative 

8 ‘‘SEC. 2693. MINORITY AIDS INITIATIVE. 

9 ‘‘(a) IN GENERAL.—There is authorized to be appro10 priated for the purpose of carrying out activities under this 

11 section to evaluate and address the disproportionate impact 

12 of HIV disease and disparities in access, treatment, care, 

13 and outcome on racial and ethnic minorities, including Af14 rican Americans, Alaska Natives, Latinos, American Indi15 ans, Asian Americans, Native Hawaiians, and Pacific Is16 landers, $131,200,000 for fiscal year 2007, $135,100,000 for 

17 fiscal year 2008, $139,100,000 for fiscal year 2009, 

18 $143,200,000 for fiscal year 2010, and $147,500,000 for fis19 cal year 2010. 

20 ‘‘(b) CERTAIN ACTIVITIES.— 

21 ‘‘(1) IN GENERAL.—In carrying out the purpose 

22 described in subsection (a), the Secretary shall pro23 vide for— 

24 ‘‘(A) emergency assistance under part A; 

25 ‘‘(B) comprehensive care under part B; 


sroberts on PROD1PC70 with BILLS
148 

•S 2823 RS

1 ‘‘(C) early intervention services under part 

2 C; 

3 ‘‘(D) services through demonstration 

4 projects for HIV-related care; and 

5 ‘‘(E) activities through education and train6 ing centers under section 2692. 

7 ‘‘(2) ALLOCATIONS AMONG ACTIVITIES.—Activi8 ties under paragraph (1) shall be carried out by the 

9 Secretary in accordance with the following: 

10 ‘‘(A) Of the amount appropriated for each 

11 fiscal year under subsection (a), $43,800,000 for 

12 fiscal year 2007, $45,400,000 for fiscal year 

13 2008, $47,100,000 for fiscal year 2009, 

14 $48,800,000 for fiscal year 2010, and 

15 $50,700,000 for fiscal year 2010, shall be used 

16 for competitive, supplemental grants to improve 

17 HIV-related health outcomes to reduce existing 

18 racial and ethnic health disparities. 

19 ‘‘(B) Of the amount appropriated for each 

20 fiscal year under subsection (a), $7,000,000 for 

21 fiscal year 2007, $7,300,000 for fiscal year 2008, 

22 $7,500,000 for fiscal year 2009, $7,800,000 for 

23 fiscal year 2010, and $8,100,000 for fiscal year 

24 2010, shall be used for competitive, supplemental 

25 support educational and outreach services to inVerDate Aug 31 2005 23:09 Aug 04, 2006 Jkt 049200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6203 E:\BILLS\S2823.RS S2823

sroberts on PROD1PC70 with BILLS
149 

•S 2823 RS

1 crease the number of eligible racial and ethnic 

2 minorities who have access to treatment through 

3 the program under section 2616 for therapeutics. 

4 ‘‘(C) Of the amount appropriated for each 

5 fiscal year under subsection (a), $53,400,000 for 

6 fiscal year 2007, $55,400,000 for fiscal year 

7 2008, $57,400,000 for fiscal year 2009, 

8 $59,500,000 for fiscal year 2010, and 

9 $61,800,000 for fiscal year 2010, shall be used 

10 for planning grants, capacity-building grants, 

11 and services grants to health care providers who 

12 have a history of providing culturally and lin13 guistically appropriate care and services to ra14 cial and ethnic minorities. 

15 ‘‘(D) Of the amount appropriated for each 

16 fiscal year under subsection (a), $18,500,000 for 

17 each of fiscal years 2007 through 2011 shall be 

18 used for sustaining and expanding efforts to de19 liver comprehensive, culturally and linguistically 

20 appropriate research-based intervention and care 

21 services for HIV disease to racial and ethnic mi22 nority women, infants, children, and youth. 

23 ‘‘(E) Of the amount appropriated for each 

24 fiscal year under subsection (a), $8,500,000 for 

25 each of fiscal years 2007 through 2011 shall be 


sroberts on PROD1PC70 with BILLS
150 

•S 2823 RS

1 used for increasing the training capacity of cen2 ters to expand the number of community-based 

3 racial and ethnic minority health care profes4 sionals with treatment expertise and knowledge 

5 about the most appropriate standards of HIV 

6 disease-related treatments and medical care for 

7 adults, adolescents, and children with HIV dis8 ease. 

9 ‘‘(e) CONSISTENCY WITH PRIOR PROGRAM.—With re10 spect to the purpose described in subsection (a), the Sec11 retary shall carry out this section consistent with the activi12 ties carried out under this title by the Secretary pursuant 

13 to the Departments of Labor, Health and Human Services, 

14 and Education, and Related Agencies Appropriations Act, 

15 2002 (Public Law 107–116).’’. 

16 SEC. 604. AUTHORIZATION OF APPROPRIATIONS. 

17 Section 2692(c) of the Public Health Service Act (42 

18 U.S.C. 300ff–92(c)) is amended to read as follows: 

19 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.— 

20 ‘‘(1) SCHOOLS; CENTERS.—For the purpose of 

21 awarding grants under subsection (a), there and au22 thorized to be appropriated $34,700,000 for each of 

23 fiscal years 2007 through 2011. 

24 ‘‘(2) DENTAL SCHOOLS.—For the purpose of 

25 awarding grants under paragraphs (2) and (3) of 


sroberts on PROD1PC70 with BILLS
151 

•S 2823 RS

1 subsection (b), there are authorized to be appropriated 

2 $13,000,000 for each of fiscal years 2007 through 

3 2011.’’. 

4 TITLE VII—MISCELLANEOUS 

5 PROVISIONS 

6 SEC. 701. HEPATITIS. 

7 (a) PROVISION OF CERTAIN COUNSELING SERVICES.— 

8 Section 2662 of the Public Health Service Act (42 U.S.C. 

9 300ff–62) is amended— 

10 (1) in subsection (a)— 

11 (A) in paragraph (1), by inserting ‘‘, hepa12 titis B, and hepatitis C’’ before the semicolon; 

13 (B) in paragraph (2), by inserting ‘‘and 

14 testing for hepatitis B and hepatitis C’’ before 

15 the semicolon; 

16 (C) in paragraph (6), by striking ‘‘and’’ at 

17 the end; 

18 (D) in paragraph (7), by striking the pe19 riod and inserting ‘‘; and’’; and 

20 (E) by adding at the end the following: 

21 ‘‘(8) if diagnosed with chronic hepatitis B or 

22 hepatitis C co-infection, the potential of developing 

23 hepatitis-related liver disease and its impact on HIV/ 

24 AIDS.’’; and 


sroberts on PROD1PC70 with BILLS
152 

•S 2823 RS

1 (2) in subsection (c)(3)(C)(i), by inserting ‘‘, 

2 hepatitis B, or hepatitis B’’ after ‘‘exposed to HIV’’ 

3 each place that such appears. 

4 (b) USE OF AMOUNTS.—Section 2667 of the Public 

5 Health Service Act (42 U.S.C. 300ff–67) is amended— 

6 (1) in paragraph (2), by striking ‘‘and’’ at the 

7 end; 

8 (2) in paragraph (3), by striking the period and 

9 inserting ‘‘; and’’; and 

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

11 ‘‘(4) shall provide information on the trans12 mission and prevention of hepatitis A, B, and C and 

13 the location of entities that provide hepatitis A and 

14 B vaccinations to individuals with HIV.’’. 

15 SEC. 702. TECHNICAL PROVISIONS. 

16 Title XXVI of the Public Health Service Act (42 U.S.C. 

17 300ff et seq.) is amended by striking ‘‘HIV disease’’ each 

18 place that such appears and inserting ‘‘HIV/AIDS’’. 

19 SEC. 703. REPEAL. 

20 Section 2677 of the Public Health Service Act (42 

21 U.S.C. 300ff–77) is repealed. 


sroberts on PROD1PC70 with BILLS

sroberts on PROD1PC70 with BILLS
Calendar No. 580 

109TH CONGRESS 

2D SESSION S. 2823 

A BILL 

To provide life-saving care for those with HIV/ 

AIDS. 

AUGUST 3, 2006 

Reported with an amendment 


sroberts on PROD1PC70 with BILLS