II 

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 

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’’. 

6 TITLE I—EMERGENCY RELIEF 

7 FOR ELIGIBLE AREAS 

8 SEC. 101. ESTABLISHMENT AND GENERAL ELIGIBILITY. 

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

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

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


cprice-sewell on PROD1PC66 with BILLS
2 

•S 2823 IS

1 ‘‘(b) CONTINUED STATUS AS ELIGIBLE AREA.—Not2 withstanding any other provision of this section, a metro3 politan area shall continue to be eligible to receive a grant 

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

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

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

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

8 by adding at the end the following: ‘‘For purposes of de9 termining eligibility under this part, the boundaries of 

10 each metropolitan area shall be the boundaries that were 

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

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

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

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

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

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

17 and confirmed by the Director of the Centers for Disease 

18 Control and Prevention a cumulative total of more than 

19 2,000 cases of AIDS for the most recent period of 5 cal20 endar years for which such data are available’’. 

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

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

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

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

25 acquired immune deficiency syndrome’’ and inserting 


cprice-sewell on PROD1PC66 with BILLS
3 

•S 2823 IS

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

2 the Director of the Centers for Disease Control and 

3 Prevention)’’; 

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

5 inserting the following: 

6 ‘‘(C) LIVING CASES OF HIV/AIDS.— 

7 ‘‘(i) IN GENERAL.—Except as pro8 vided for in clauses (ii) and (iii), the 

9 amount determined in this subparagraph is 

10 the number of living cases of HIV/AIDS 

11 (reported to and confirmed by the Director 

12 of the Centers for Disease Control and 

13 Prevention) through December 31 of the 

14 most recent calendar year. 

15 ‘‘(ii) FISCAL YEARS 2007 THROUGH

16 2010.—For each of fiscal years 2007 

17 through 2010, the Secretary may use the 

18 proxy number for the number of HIV cases 

19 described in clause (iii) if— 

20 ‘‘(I) the State involved— 

21 ‘‘(aa) is reporting, or the 

22 State will by October 1, 2006 

23 have submitted a transition plan 

24 for reporting, accurate and reli25 able HIV cases to the Director of 


cprice-sewell on PROD1PC66 with BILLS
4 

•S 2823 IS

1 the Centers for Disease Control 

2 and Prevention; or 

3 ‘‘(bb) not later than October 

4 1, 2006, make all necessary stat5 utory changes to allow for the 

6 collection of HIV data certified 

7 by the Director of the Centers 

8 for Disease Control and Preven9 tion; 

10 ‘‘(II) the State involved will by 

11 April 1, 2008, begin reporting accu12 rate and reliable HIV cases, as deter13 mined by the Director of the Centers 

14 for Disease Control and Prevention; 

15 and 

16 ‘‘(III) the Director of the Centers 

17 for Disease Control and Prevention 

18 has determined that such State does 

19 not have an established HIV surveil20 lance system. 

21 ‘‘(iii) AMOUNT DETERMINED.—With 

22 respect to each of fiscal years 2007 

23 through 2010, the amount determined 

24 under this subparagraph shall be the lesser 

25 of— 


cprice-sewell on PROD1PC66 with BILLS
5 

•S 2823 IS

1 ‘‘(I) the product of 0.9 and the 

2 number of living AIDS cases in the 

3 area involved; or 

4 ‘‘(II) an amount equal to 110 

5 percent of the funding level for the 

6 previous fiscal year, taking into ac7 count the shift of the formula pool 

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

9 and 

10 (3) by redesignating subparagraph (E) as sub11 paragraph (D). 

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

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

14 is amended— 

15 (1) by striking ‘‘acquired immune deficiency 

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

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

18 ‘‘HIV/AIDS’’. 

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

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

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

22 end; 

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

24 inserting a semicolon; and 

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


cprice-sewell on PROD1PC66 with BILLS
6 

•S 2823 IS

1 ‘‘(5) the manner in which the expected expendi2 tures under the grant are related to the planning 

3 process for States that receive funding under part B 

4 (including the planning process described in section 

5 2617(b)); and 

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

7 and how those expenditures will improve overall cli8 ent outcomes, as described under the State plan 

9 under section 2617(b), or through additional out10 comes measures.’’. 

11 SEC. 103. TYPE AND DISTRIBUTION OF GRANTS. 

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

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

14 13(a)(2)) is amended by striking ‘‘50 percent’’ and inserting ‘‘662 15 ⁄3 percent’’. 

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

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

18 13(a)(3)(E)) is amended to read as follows: 

19 ‘‘(E) UNEXPENDED FUNDS.— 

20 ‘‘(i) IN GENERAL.—An eligible area 

21 that has unobligated funds for a fiscal year 

22 under a grant under this part shall— 

23 ‘‘(I) return such funds to the 

24 Secretary to be applied as provided 

25 for in subsection (b); or 


cprice-sewell on PROD1PC66 with BILLS
7 

•S 2823 IS

1 ‘‘(II) submit an application to 

2 the Secretary for the use of such 

3 funds in the succeeding fiscal year 

4 that includes a description of the 

5 manner in which the area intends to 

6 use such funds. 

7 ‘‘(ii) CARRYOVER.—With respect to 

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

9 the Secretary shall determine whether the 

10 area involved may carryover any unobli11 gated funds for use under this part in the 

12 succeeding fiscal year or whether such 

13 amounts shall be returned to the Secretary 

14 for use under subsection (b). Notice shall 

15 be provided to the area of such determina16 tion. 

17 ‘‘(iii) FAILURE TO EXPEND FUNDS.— 

18 Amounts carried over by an eligible area 

19 under this subparagraph that are not ex20 pended in the succeeding fiscal year shall 

21 be returned to the Secretary for use under 

22 subsection (b). 

23 ‘‘(iv) CONSIDERATION IN MAKING

24 GRANTS.—The Secretary may, in deter25 mining the amount of a grant for a fiscal 


cprice-sewell on PROD1PC66 with BILLS
8 

•S 2823 IS

1 year under this paragraph, adjust the 

2 grant amount to reflect the amount of un3 expended and uncanceled grant funds re4 maining at the end of the fiscal year pre5 ceding the year for which the grant deter6 mination is to be made. The amount of 

7 any such unexpended funds shall be deter8 mined using the financial status report of 

9 the grantee.’’. 

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

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

12 amended to read as follows: 

13 ‘‘(4) INCREASES IN GRANT.— 

14 ‘‘(A) IN GENERAL.—For eligible areas re15 ceiving grants under this section in fiscal year 

16 2007, the Secretary shall increase the amount 

17 of the grant made pursuant to paragraph (2) 

18 for the area to ensure that— 

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

20 not less than 90 percent of the amount of 

21 the grant made for the eligible area pursu22 ant to such paragraph for the base year; 

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

24 not less than 85 percent of the amount of 

25 such base year grant; and 


cprice-sewell on PROD1PC66 with BILLS
9 

•S 2823 IS

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

2 not less than 80 percent of the amount of 

3 the base year grant. 

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

5 made pursuant to paragraph (2) for an eligible 

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

7 SEC. 104. CORE MEDICAL SERVICES. 

8 Section 2604 of the Public Health Service Act (42 

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

10 following: 

11 ‘‘(h) REQUIRED FUNDING FOR CORE MEDICAL

12 SERVICES.— 

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

14 provision of law, a grantee under this part shall ex15 pend not less than 75 percent of the funds received 

16 under the grant on core medical services, except that 

17 the Secretary shall waive the application of this sub18 section with respect to a grantee if the Secretary de19 termines that, within the service area of the grant20 ee— 

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

22 Drug Assistance Program services; and 

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

24 all individuals infected with HIV/AIDS. 


cprice-sewell on PROD1PC66 with BILLS
10 

•S 2823 IS

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

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

3 with respect to an individual infected with HIV/ 

4 AIDS (including the co-occurring diseases of the in5 dividual) means the following services: 

6 ‘‘(A) Outpatient and ambulatory health 

7 services. 

8 ‘‘(B) AIDS Drug Assistance Program 

9 treatments. 

10 ‘‘(C) AIDS pharmaceutical assistance. 

11 ‘‘(D) Oral health care. 

12 ‘‘(E) Early intervention services. 

13 ‘‘(F) Health insurance premium and cost 

14 sharing assistance for low-income individuals. 

15 ‘‘(G) Home health care. 

16 ‘‘(H) Hospice services. 

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

18 services as defined under section 2614(c), ex19 cept homemaker services. 

20 ‘‘(J) Mental health services. 

21 ‘‘(K) Substance abuse outpatient care. 

22 ‘‘(L) Medical case management, including 

23 treatment adherence services. 

24 ‘‘(3) SUPPORT SERVICES.—Notwithstanding 

25 any other provision of law, and subject to paragraph 


cprice-sewell on PROD1PC66 with BILLS
11 

•S 2823 IS

1 (1), a grantee under this part, subject to the ap2 proval of the Secretary, may provide support services 

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

4 outreach services, medical transportation, nutritional 

5 counseling, linguistic services, and referral for health 

6 care and support services for individuals with HIV/ 

7 AIDS) needed to achieve medical outcomes which 

8 are related to the medical outcomes for an individual 

9 infected with HIV and approved by the Secretary. 

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

11 this subsection, the term ‘medical outcomes’ means 

12 those outcomes affecting the HIV-related clinical 

13 status of an individual with HIV/AIDS. 

14 ‘‘(5) UNEXPENDED FUNDS.—Any amounts re15 quired to be expended for core medical services or 

16 support services under this subsection that remain 

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

18 funds were awarded shall be remitted to the Sec19 retary for reallocation under section 2603(b).’’. 

20 SEC. 105. SUPPLEMENTAL GRANTS. 

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

22 U.S.C. 300ff–13(b)) is amended— 

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

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

25 (2) in paragraph (1)— 


cprice-sewell on PROD1PC66 with BILLS
12 

•S 2823 IS

1 (A) in the matter preceding subparagraph 

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

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

4 ‘‘The Secretary shall’’; 

5 (B) by striking subparagraph (F) and in6 serting the following: 

7 ‘‘(F) demonstrate the inclusiveness of af8 fected communities and individuals with HIV/ 

9 AIDS;’’; 

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

11 period and inserting ‘‘; and’’; and 

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

13 ‘‘(H) demonstrate the ability of the appli14 cant to expend funds efficiently by not having 

15 any unexpended funds reallocated under section 

16 2603(a)(3)(E).’’; 

17 (3) in paragraph (2)— 

18 (A) by striking subparagraph (B) and in19 serting the following: 

20 ‘‘(B) DEMONSTRATED NEED.—In deter21 mining demonstrated need for purposes of sub22 paragraph (A), the Secretary shall consider rel23 evant factors that impact the need for supple24 mental financial assistance, including— 


cprice-sewell on PROD1PC66 with BILLS
13 

•S 2823 IS

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

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

3 other community input process as defined 

4 under section 2609A(a); 

5 ‘‘(ii) an increasing need for HIV/ 

6 AIDS-related services, including relative 

7 rates of increase in the number of cases of 

8 HIV/AIDS; 

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

10 the number of cases of HIV/AIDS within 

11 new or emerging subpopulations; 

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

13 AIDS; 

14 ‘‘(v) relevant factors related to the 

15 cost and complexity of delivering health 

16 care to individuals with HIV/AIDS in the 

17 eligible area; 

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

19 including co-occurring infections, deter20 mined relevant by the Secretary; 

21 ‘‘(vii) the prevalence of homelessness; 

22 ‘‘(viii) the prevalence of individuals 

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

24 ‘‘(ix) the relevant factors that limit 

25 access to health care, including geographic 


cprice-sewell on PROD1PC66 with BILLS
14 

•S 2823 IS

1 variation, adequacy of health insurance 

2 coverage, and language barriers; or 

3 ‘‘(x) the impact of a precipitous de4 cline in the amount received under this 

5 subpart to an increase in unmet need for 

6 such services.’’; and 

7 (B) by striking subparagraphs (C) and 

8 (D). 

9 SEC. 106. ADMINISTRATIVE COSTS. 

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

11 U.S.C. 300ff–14(f)) is amended— 

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

13 and inserting ‘‘10 percent’’; and 

14 (2) in paragraph (2)(B), by inserting ‘‘the ac15 tivities carried out by HIV health services planning 

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

17 ‘‘including’’. 

18 SEC. 107. AUDITS. 

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

20 U.S.C. 300ff–15(a)) is amended— 

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

22 end; 

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

24 inserting ‘‘; and’’; and 

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


cprice-sewell on PROD1PC66 with BILLS
15 

•S 2823 IS

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

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

3 audits regarding funds expended in accordance with 

4 this part every 2 years and shall include necessary 

5 client-based data to compile unmet need calculations 

6 and Statewide coordinated statements of need proc7 ess.’’. 

8 SEC. 108. PLANNING COUNCIL REPRESENTATION. 

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

10 Act (42 U.S.C. 300ff–12(b)(2)(G)) is amended by insert11 ing ‘‘, Native Americans, individuals co-infected with hep12 atitis B or C’’ after ‘‘disease’’. 

13 SEC. 109. PAYER OF LAST RESORT. 

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

15 Act (42 U.S.C. 300ff–15(a)(6)(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 SEC. 110. TRANSITIONAL GRANTS FOR OTHER AREAS. 

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

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

22 (1) by inserting after the part heading the fol23 lowing: 


cprice-sewell on PROD1PC66 with BILLS
16 

•S 2823 IS

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

2 (2) by redesignating sections 2606 and 2607 as 

3 sections 2610 and 2610A, respectively; and 

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

5 ‘‘Subpart II—Transitional Grants 

6 ‘‘SEC. 2609. ESTABLISHMENT. 

7 ‘‘(a) ELIGIBLE AREAS.— 

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

9 through the Administrator of the Health Resources 

10 and Services Administration, shall, subject to sub11 section (b), make grants in accordance with this sub12 part for the purpose of assisting in the provision of 

13 the services specified in section 2604 in any metro14 politan area— 

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

16 and confirmed by the Director of the Centers 

17 for Disease Control and Prevention a cumu18 lative total of at least 1,000, but less than 

19 2,000, cases of acquired immune deficiency syn20 drome for the most recent period of 5 calendar 

21 years for which such data are available; and 

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

23 and confirmed by the Director of the Centers 

24 for Disease Control and Prevention a cumu25 lative total of at least 500, but less than 1,000, 

26 cases of acquired immune deficiency syndrome 


cprice-sewell on PROD1PC66 with BILLS
17 

•S 2823 IS

1 for the most recent period of 5 calendar years 

2 for which such data are available. 

3 ‘‘(2) ADDITIONAL ELIGIBLE AREAS.—With re4 spect to fiscal year 2007, a metropolitan area that 

5 received funding under this part for fiscal year 2006 

6 but which does not meet the eligibility threshold de7 scribed in paragraph (1)(A) for fiscal year 2007 

8 shall be deemed to be eligible under such paragraph 

9 (1)(A). 

10 ‘‘(b) CONTINUED STATUS AS ELIGIBLE AREA.—Not11 withstanding any other provision of this section, a metro12 politan area shall continue to be eligible to receive a grant 

13 under this section until such area, for three consecutive 

14 grant years, fails to meet the applicable requirement of 

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

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

17 5-year period. 

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

19 ‘‘(a) ADMINISTRATION.— 

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

21 2602 shall apply to areas that receive a grant under 

22 this subpart, except that the chief elected official 

23 may elect not to comply with the provisions of sub24 section (b), so long as the official provides docu25 mentation to the Secretary that details the process 


cprice-sewell on PROD1PC66 with BILLS
18 

•S 2823 IS

1 used to obtain community input (particularly from 

2 those inflected with HIV) for the design and imple3 mentation of activities related to such grant. 

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

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

6 through 2009 to areas that receive funding under 

7 this part. 

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

9 shall apply for purposes of awarding grants under this 

10 subpart, except that— 

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

12 2609(a)(1)(A)— 

‘‘(A) 662 13 ⁄3 percent of the amounts appro14 priated under section 2609B(1) for each fiscal 

15 year shall be allocated to such areas as provided 

16 for in section 2603(a); and 

‘‘(B) 331 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(b); and 

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

22 2609(a)(1)(B), 100 percent of the amounts appro23 priated under section 2609B(2) for each fiscal year 

24 shall be allocated to such areas as provided for in 

25 section 2603(a). 


cprice-sewell on PROD1PC66 with BILLS
19 

•S 2823 IS

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

2 2603(a) shall not apply to an area for purposes of this 

3 subpart. 

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

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

6 entity as provided for in section 2604. 

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

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

9 an application that meets the requirements of section 

10 2605. 

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

12 The provisions of sections 2606 and 2707 shall apply for 

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

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

15 term shall be applied so that for purposes of determining 

16 eligible areas, the Secretary shall use the boundaries of 

17 a respective area that were used when the area involved 

18 initially receive funding under this part. 

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

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

21 this subpart— 

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

23 2609(a)(1)(A), $123,300,000 for fiscal year 2007, 

24 $127,900,000 for fiscal year 2008, $132,600,000 for 


cprice-sewell on PROD1PC66 with BILLS
20 

•S 2823 IS

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

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

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

4 2609(a)(1)(B), $5,000,000 for each of the fiscal 

5 years 2007 through 2011. 

6 ‘‘Subpart III—General Provisions’’. 

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

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

9 SEC. 111. AUTHORIZATION OF APPROPRIATIONS. 

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

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

12 adding at the end the following: 

13 ‘‘SEC. 2606. AUTHORIZATION OF APPROPRIATIONS. 

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

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

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

17 $450,100,000 for fiscal year 2009, $466,800,000 for fis18 cal year 2010, and $484,100,000 for fiscal year 2011.’’. 

19 TITLE II—CARE GRANTS 

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

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

22 Health Service Act (42 U.S.C. 300ff–21(b)(1)) is amend23 ed— 

24 (1) by striking ‘‘acquired immune deficiency 

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


cprice-sewell on PROD1PC66 with BILLS
21 

•S 2823 IS

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

2 ‘‘HIV/AIDS’’. 

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

4 Health Service Act (42 U.S.C. 300ff–27(d)(3)) is amend5 ed— 

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

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

8 AIDS’’; and 

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

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

11 AIDS’’. 

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

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

14 amended— 

15 (1) in paragraph (1)(A)(i)— 

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

17 acquired immune deficiency syndrome, as deter18 mined under paragraph (2)(D)’’ and inserting 

19 ‘‘living cases of AIDS (reported to and con20 firmed by the Director of the Centers for Dis21 ease Control and Prevention)’’; and 

22 (B) in subclause (II)— 

23 (i) by striking ‘‘cases of acquired im24 mune deficiency syndrome, as determined 

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


cprice-sewell on PROD1PC66 with BILLS
22 

•S 2823 IS

1 ‘‘living cases of AIDS (reported to and 

2 confirmed by the Director of the Centers 

3 for Disease Control and Prevention)’’; and 

4 (ii) by inserting ‘‘and’’ after the semi5 colon; and 

6 (2) in paragraph (2)— 

7 (A) in subparagraph (B), by striking ‘‘esti8 mated number of living cases of acquired im9 mune deficiency syndrome’’ and inserting 

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

11 (B) in subparagraph (C)— 

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

13 that such term appears; and 

14 (ii) by striking ‘‘acquired immune de15 ficiency syndrome’’ each place that such 

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

17 (C) by striking subparagraph (D) and in18 serting the following: 

19 ‘‘(F) LIVING CASES OF HIV/AIDS.— 

20 ‘‘(i) IN GENERAL.—Except as pro21 vided for in clause (ii) and (iii), the 

22 amount determined in this subparagraph is 

23 the number of living cases of HIV/AIDS 

24 (reported to and confirmed by the Director 

25 of the Centers for Disease Control and 


cprice-sewell on PROD1PC66 with BILLS
23 

•S 2823 IS

1 Prevention) through December 31 of the 

2 most recent calendar year involved. 

3 ‘‘(ii) FISCAL YEARS 2007 THROUGH

4 2010.—For each of fiscal years 2007 

5 through 2010, the Secretary may use the 

6 proxy number for the number of HIV cases 

7 described in clause (iii) if— 

8 ‘‘(I) the State involved— 

9 ‘‘(aa) is reporting, or the 

10 State will by October 1, 2006 

11 have submitted a transition plan 

12 for reporting, accurate and reli13 able HIV cases to the Director of 

14 the Centers for Disease Control 

15 and Prevention; or 

16 ‘‘(bb) not later than October 

17 1, 2006, make all necessary stat18 utory changes to allow for the 

19 collection of HIV data certified 

20 by the Director of the Centers 

21 for Disease Control and Preven22 tion; 

23 ‘‘(II) the State involved will by 

24 April 1, 2008, begin reporting accu25 rate and reliable HIV cases, as deterVerDate Aug 31 2005 08:28 May 23, 2006 Jkt 049200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S2823.IS S2823

cprice-sewell on PROD1PC66 with BILLS
24 

•S 2823 IS

1 mined by the Director of the Centers 

2 for Disease Control and Prevention; 

3 and 

4 ‘‘(III) the Director of the Centers 

5 for Disease Control and Prevention 

6 has determined that such State does 

7 not have an established HIV surveil8 lance system. 

9 ‘‘(iii) AMOUNT DETERMINED.—With 

10 respect to each of fiscal years 2007 

11 through 2010, the amount determined 

12 under this subparagraph shall be the lesser 

13 of— 

14 ‘‘(I) the product of 0.9 and the 

15 number of living AIDS cases in the 

16 area involved; or 

17 ‘‘(II) an amount equal to 110 

18 percent of the funding level for the 

19 previous fiscal year.’’. 

20 SEC. 202. AIDS DRUG ASSISTANCE PROGRAM. 

21 (a) REQUIREMENT OF MINIMUM DRUG LIST.—Sec22 tion 2616 of the Public Health Service Act (42 U.S.C. 

23 300ff–26) is amended— 

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

25 and inserting the following: 


cprice-sewell on PROD1PC66 with BILLS
25 

•S 2823 IS

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

2 the list of core AIDS Drug Assistance Program 

3 antiretroviral medications developed by the Secretary 

4 based on Public Health Service guidelines, are the 

5 minimum required treatments to be included under 

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

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

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

9 Public Health Service, shall develop and maintain a 

10 list of classes of core AIDS Drug Assistance Pro11 gram antiretroviral medications that shall be based 

12 upon those medications included in the Department 

13 of Health and Human Service’s Public Health Serv14 ice HIV/AIDS Clinical Practice Guidelines for use of 

15 HIV/AIDS Drugs, drugs needed to manage symp16 toms associated with HIV infection.’’. 

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

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

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

20 amended to read as follows: 

21 ‘‘(I) IN GENERAL.—From 

22 amounts made available under 

23 subclause (V), the Secretary shall 

24 award supplemental grants to 

25 States described in subclause (II) 


cprice-sewell on PROD1PC66 with BILLS
26 

•S 2823 IS

1 to enable such States to purchase 

2 and distribute to eligible individ3 uals (as described in section 

4 2616(b)), pharmaceutical thera5 peutics described under sections 

6 2616(a) and 2616(c). 

7 ‘‘(II) ELIGIBLE STATES.— 

8 For purposes of subclause (I), a 

9 State shall be an eligible State if 

10 the State did not have unex11 pended funds subject to realloca12 tion under section 2618(d) and, 

13 in accordance with criteria estab14 lished by the Secretary, dem15 onstrates a severe need for a 

16 grant under this clause. In devel17 oping such criteria, the Secretary 

18 shall consider eligibility stand19 ards, formulary composition, the 

20 number of eligible individuals to 

21 whom a State is unable to pro22 vide therapeutics described in 

23 section 2616(a), and an unantici24 pated increase of eligible individ25 uals with HIV/AIDS. 


cprice-sewell on PROD1PC66 with BILLS
27 

•S 2823 IS

1 ‘‘(III) STATE REQUIREMENTS.— 

2 The Secretary may not make a grant 

3 to a State under this clause unless the 

4 State agrees that the State will make 

5 available (directly or through dona6 tions of public or private entities) 

7 non-Federal contributions toward the 

8 activities to be carried out under the 

9 grant in an amount equal to $1 for 

10 each $4 of Federal funds provided in 

11 the grant, except that the Secretary 

12 may waive this subclause if the State 

13 has otherwise fully complied with sec14 tion 2617(d) with respect to the grant 

15 year involved.’’. 

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

17 2618(a)(2)(I)(ii)(V) of the Public Health Service Act (42 

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

19 ‘‘3’’ and inserting ‘‘5’’. 

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

21 Public Health Service Act (42 U.S.C. 300ff–26) is amend22 ed by adding at the end the following: 

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

24 that any drug rebates received on drugs purchased from 

25 funds provided under this section are applied to activities 


cprice-sewell on PROD1PC66 with BILLS
28 

•S 2823 IS

1 supported under this title, with a preference for activities 

2 described under this section.’’. 

3 SEC. 203. COORDINATION. 

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

5 U.S.C. 300ff–27(b)) is amended— 

6 (1) by redesignating paragraphs (4) through 

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

8 (2) by inserting after paragraph (3), the fol9 lowing: 

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

11 shall— 

12 ‘‘(A) administer all assistance received 

13 under this part; 

14 ‘‘(B) conduct the needs assessment and 

15 prepare the State plan under paragraph (3); 

16 ‘‘(C) prepare all applications for assistance 

17 under this part; 

18 ‘‘(D) receive notices with respect to pro19 grams under this title; 

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

21 the Secretary all audits from grantees within 

22 the State, including audits regarding funds ex23 pended in accordance with this part; and 


cprice-sewell on PROD1PC66 with BILLS
29 

•S 2823 IS

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

2 appropriate by the Secretary to facilitate the 

3 coordination of programs under this title.’’; 

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

5 (A) in the matter preceding subparagraph 

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

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

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

9 ‘‘and’’ at the end; and 

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

11 the following: 

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

13 by all entities in the State receiving assistance 

14 under this title; and’’. 

15 SEC. 204. DISTRIBUTION OF FUNDS. 

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

17 Health Service Act (42 U.S.C. 300ff–28(a)(2)) is amend18 ed— 

19 (1) in subparagraph (A)— 

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

21 inserting ‘‘, (I), and (J)’’; and 

22 (B) in clause (ii)— 

23 (i) in subclause (I)— 

24 (I) by striking ‘‘0.8’’ and insert25 ing ‘‘0.75’’; and 


cprice-sewell on PROD1PC66 with BILLS
30 

•S 2823 IS

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

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

3 period and inserting ‘‘; and’’; and 

4 (iii) by adding at the end the fol5 lowing: 

6 ‘‘(III) the product of 0.05 and 

7 the ratio of the locality distribution 

8 factor (as determined under subpara9 graph (D)) to the sum of the respec10 tive State distribution factors for all 

11 States and territories.’’; 

12 (2) in subparagraph (C)(ii), by striking ‘‘(as de13 termined under part A)’’ and inserting ‘‘under sub14 part I of part A and an eligible area under section 

15 2609(a)(1)(A)’’; 

16 (3) by inserting after subparagraph (C), the fol17 lowing: 

18 ‘‘(D) LOCALITY DISTRIBUTION FACTOR.— 

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

20 term ‘locality distribution factor’ means an 

21 amount equal to the sum of— 

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

23 HIV/AIDS in the State or territory in24 volved, as determined under subparagraph 

25 (F); less 


cprice-sewell on PROD1PC66 with BILLS
31 

•S 2823 IS

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

2 HIV/AIDS in such State or territory that 

3 are within an eligible area (as determined 

4 under subpart I of part A and section 

5 2609(a)(1)(A)).’’; 

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

7 the following: 

8 ‘‘(E) SEVERITY OF NEED.— 

9 ‘‘(i) FISCAL YEARS BEGINNING WITH

10 2011.—If, by January 1, 2010, the Sec11 retary notifies the appropriate committees 

12 of Congress that the Secretary has devel13 oped a severity of need index, in accord14 ance with clause (v), the provisions of sub15 paragraphs (A) through (D) shall not 

16 apply for fiscal year 2011 or any fiscal 

17 year thereafter, and the Secretary shall use 

18 the severity of need index (as defined in 

19 clause (iv)) for the determination of the 

20 formula allocations, subject to the Con21 gressional Review Act. 

22 ‘‘(ii) SUBSEQUENT FISCAL YEARS.— 

23 If, on or before any January 1 that is sub24 sequent to the date referred to in clause 

25 (i), the Secretary notifies the appropriate 


cprice-sewell on PROD1PC66 with BILLS
32 

•S 2823 IS

1 committees of Congress that the Secretary 

2 has developed a severity of need index, in 

3 accordance with clause (v), for each suc4 ceeding fiscal year, the provisions of sub5 paragraphs (A) through (D) shall not 

6 apply, and the Secretary shall use the se7 verity of need index (as defined in clause 

8 (iv)) for the determination of the formula 

9 allocations, subject to the Congressional 

10 Review Act. 

11 ‘‘(iii) FISCAL YEAR 2013.—The Sec12 retary shall notify the appropriate commit13 tees of Congress that the Secretary has de14 veloped a severity of need index by Janu15 ary 1, 2012, and the provisions of subpara16 graphs (A) through (D) shall not apply, 

17 and the Secretary shall use the severity of 

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

19 the formula allocations for fiscal year 

20 2013, subject to the Congressional Review 

21 Act. 

22 ‘‘(iv) DEFINITION OF SEVERITY OF

23 NEED INDEX.—In this subparagraph, the 

24 term ‘severity of need index’ means the 

25 index of the relative needs of individuals 


cprice-sewell on PROD1PC66 with BILLS
33 

•S 2823 IS

1 within the State, as identified by a variety 

2 of different factors, and is a factor that is 

3 multiplied by the number of living HIV/ 

4 AIDS cases in the State, providing dif5 ferent weights to those cases based on 

6 their needs. 

7 ‘‘(v) REQUIREMENTS FOR SECRE8 TARIAL NOTIFICATION.—When the Sec9 retary notifies the appropriate committees 

10 of Congress that the Secretary has devel11 oped a severity of need index, the Sec12 retary shall 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 sever17 ity of need index. 

18 ‘‘(II) Expected changes in fund19 ing allocations, given the application 

20 of the severity of need index and the 

21 elimination of the provisions of sub22 paragraphs (A) through (D). 

23 ‘‘(III) Information regarding the 

24 process by which the Secretary re25 ceived community input regarding the 


cprice-sewell on PROD1PC66 with BILLS
34 

•S 2823 IS

1 application of the severity of need 

2 index. 

3 ‘‘(IV) Timeline and process for 

4 the implementation of the severity of 

5 need index to ensure that it is applied 

6 in 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 

10 Modernization Act, and annually thereafter 

11 until the Secretary notifies Congress that 

12 the Secretary has developed a severity of 

13 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 to18 ward having client level data; 

19 ‘‘(II) that updates the progress 

20 toward having a severity of need 

21 index, including information related to 

22 the methodology and process for ob23 taining community input; and 

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

25 whether the Secretary could develop a 


cprice-sewell on PROD1PC66 with BILLS
35 

•S 2823 IS

1 severity of need index before fiscal 

2 year 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 

10 Secretary to be applied as provided 

11 for in section 2620; or 

12 ‘‘(II) submit an application to 

13 the Secretary for the use of such 

14 funds in the succeeding fiscal year 

15 that includes a description of the 

16 manner in which the State intends to 

17 use such funds. 

18 ‘‘(ii) CARRYOVER.—With respect to 

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

20 the Secretary shall determine whether the 

21 State 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 


cprice-sewell on PROD1PC66 with BILLS
36 

•S 2823 IS

1 for use under section 2620. Notice shall be 

2 provided to the area of such determination. 

3 ‘‘(iii) FAILURE TO EXPEND FUNDS.— 

4 Amounts carried over by a State under 

5 this subparagraph that are not expended in 

6 the succeeding fiscal year shall be returned 

7 to the Secretary for use under section 

8 2610. 

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 (6) by striking subparagraph (H); and 

22 (7) in subparagraph (I)(ii), by striking sub23 clause (VI) and inserting the following: 

24 ‘‘(VI) INCREASES IN GRANT.— 


cprice-sewell on PROD1PC66 with BILLS
37 

•S 2823 IS

1 ‘‘(aa) IN GENERAL.—For el2 igible areas receiving grants 

3 under this section in fiscal year 

4 2007, the Secretary shall in5 crease the amount of the grant 

6 made pursuant to paragraph (2) 

7 for the State to ensure that— 

8 ‘‘(AA) for fiscal year 

9 2007, the grant is not less 

10 than 90 percent of the 

11 amount of the grant made 

12 for the State under section 

13 2620 and section 2618(a) 

14 for the base year; 

15 ‘‘(BB) for fiscal year 

16 2008, the grant is not less 

17 than 85 percent of the 

18 amount of such base year 

19 grant; and 

20 ‘‘(CC) for fiscal year 

21 2009, the grant is not less 

22 than 80 percent of the 

23 amount of the base year 

24 grant. 


cprice-sewell on PROD1PC66 with BILLS
38 

•S 2823 IS

1 ‘‘(bb) BASE YEAR.—With re2 spect to grants made pursuant to 

3 paragraph (2) for an State, the 

4 base year shall be fiscal year 

5 2006.’’. 

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

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

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

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

10 2620’’. 

11 SEC. 205. CORE MEDICAL SERVICES. 

12 Section 2612 of the Public Health Service Act (42 

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

14 following: 

15 ‘‘(e) REQUIRED FUNDING FOR CORE MEDICAL SERV16 ICES.— 

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

18 provision of law, a grantee under this part shall ex19 pend not less than 75 percent of the funds received 

20 under the grant on core medical services, except that 

21 the Secretary shall waive the application of this sub22 section with respect to a grantee if the Secretary de23 termines that, within the service area of the grant24 ee— 


cprice-sewell on PROD1PC66 with BILLS
39 

•S 2823 IS

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

2 Drug Assistance Program services; and 

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

4 all individuals infected with HIV/AIDS. 

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

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

7 with respect to an individual infected with HIV/ 

8 AIDS (including the co-occurring diseases of the in9 dividual) means the following services: 

10 ‘‘(A) Outpatient and ambulatory health 

11 services. 

12 ‘‘(B) AIDS Drug Assistance Program 

13 treatments. 

14 ‘‘(C) AIDS pharmaceutical assistance. 

15 ‘‘(D) Oral health care. 

16 ‘‘(E) Early intervention services. 

17 ‘‘(F) Health insurance premium and cost 

18 sharing assistance for low-income individuals. 

19 ‘‘(G) Home health care. 

20 ‘‘(H) Hospice services. 

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

22 services as defined under section 2614(c), ex23 cept homemaker services. 

24 ‘‘(J) Mental health services. 

25 ‘‘(K) Substance abuse outpatient care. 


cprice-sewell on PROD1PC66 with BILLS
40 

•S 2823 IS

1 ‘‘(L) Medical case management, including 

2 treatment adherence services. 

3 ‘‘(3) SUPPORT SERVICES.—Notwithstanding 

4 any other provision of law, and subject to paragraph 

5 (1), a grantee under this part, subject to the ap6 proval of the Secretary, may provide support services 

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

8 outreach services, medical transportation, nutritional 

9 counseling, linguistic services, and referral for health 

10 care and support services for individuals with HIV/ 

11 AIDS) needed to achieve medical outcomes which 

12 are related to the medical outcomes for an individual 

13 infected with HIV and approved by the Secretary. 

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

15 this subsection, the term ‘medical outcomes’ means 

16 those outcomes affecting the HIV-related clinical 

17 status of an individual with HIV/AIDS. 

18 ‘‘(5) UNEXPENDED FUNDS.—Any amounts re19 quired to be expended for core medical services or 

20 support services under this subsection that remain 

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

22 funds were awarded shall be remitted to the Sec23 retary for reallocation under section 2620.’’. 


cprice-sewell on PROD1PC66 with BILLS
41 

•S 2823 IS

1 SEC. 206. SUPPLEMENTAL GRANTS. 

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

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

4 follows: 

5 ‘‘SEC. 2620. SUPPLEMENTAL GRANTS. 

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

7 amounts appropriated under section 2622 for a fiscal year 

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

9 award grants to States whose applications under section 

10 2617 demonstrate a need in the State for supplemental 

11 financial assistance to combat the HIV epidemic and that 

12 have not had unexpended funds subject to the reallocation 

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

14 ‘‘(b) DEMONSTRATED NEED.—In determining dem15 onstrated need for purposes of subsection (a), the Sec16 retary shall consider relevant factors that impact the need 

17 for supplemental financial assistance, including— 

18 ‘‘(1) the unmet need for such services, as deter19 mined under section 2602(b)(4) or other community 

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

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

22 services, including relative rates of increase in the 

23 number of cases of HIV/AIDS; 

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

25 of cases of HIV/AIDS within new or emerging sub26 populations; 


cprice-sewell on PROD1PC66 with BILLS
42 

•S 2823 IS

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

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

3 complexity of delivering health care to individuals 

4 with HIV/AIDS in the eligible area; 

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

6 co-occurring infections, determined relevant by the 

7 Secretary; 

8 ‘‘(7) the prevalence of homelessness; 

9 ‘‘(8) the prevalence of individuals described 

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

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

12 health care, including geographic variation, adequacy 

13 of health insurance coverage, and language barriers; 

14 or 

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

16 amount received under this subpart to an increase in 

17 unmet need for such services. 

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

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

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

21 Secretary shall make available for purposes of 

awarding grants under this section, 1 22 ⁄3 of the sum 

23 of— 

24 ‘‘(A) the amount appropriated under sec25 tion 2622 for such fiscal year; less 


cprice-sewell on PROD1PC66 with BILLS
43 

•S 2823 IS

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

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

3 such fiscal year. 

4 ‘‘(2) TRIGGER YEAR.—This section shall be ef5 fective only for fiscal years beginning in the first fis6 cal year in which the amount appropriated under 

7 section 2621, excluding any amounts made available 

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

9 for such fiscal year, exceeds the amount appro10 priated under section 2677(b) (as such section ex11 isted on the day before the date of enactment of the 

12 Ryan White HIV/AIDS Treatment Modernization 

13 Act) for fiscal year 2006, excluding any amount 

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

15 fiscal year 2006.’’. 

16 (b) CONFORMING AMENDMENTS.—Section 2618 of 

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

18 amended— 

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

20 2677’’ and inserting ‘‘section 2622 and to the provi21 sions of section 2620’’; and 

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

23 for grants awarded under section 2620,’’ after 

24 ‘‘under this part’’. 


cprice-sewell on PROD1PC66 with BILLS
44 

•S 2823 IS

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

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

3 Health Service Act (42 U.S.C. 300ff–21 et seq.) is amend4 ed by adding at the end the following: 

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

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

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

8 eligible individuals (as described in section 2616(b)) ap9 propriate access to pharmaceutical therapies, the Sec10 retary may make supplemental grants to States described 

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

12 distribute to eligible individuals pharmaceutical therapies 

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

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

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

16 unexpended funds subject to reallocation under section 

17 2618(d), and, in accordance with criteria established by 

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

19 subsection. In developing such criteria, the Secretary shall 

20 consider eligibility standards, formulary composition, the 

21 number of eligible individuals to whom the State is unable 

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

23 unanticipated increases in the number of eligible individ24 uals. 

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

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


cprice-sewell on PROD1PC66 with BILLS
45 

•S 2823 IS

1 State involved agrees that the State will make available 

2 (directly or through donations from public or private enti3 ties) non-Federal contributions toward the activities to be 

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

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

6 that the Secretary may waive this subsection if the State 

7 has otherwise fully complied with section 2617(d) with re8 spect to the grant year involved. 

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

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

11 $40,000,000 for fiscal year 2007.’’. 

12 SEC. 208. NATIVE AMERICAN REPRESENTATION. 

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

14 (42 U.S.C. 300ff–27(b)(5)), as so redesignated, is amend15 ed by inserting ‘‘Native Americans within the State,’’ be16 fore ‘‘representatives of grantees’’. 

17 SEC. 209. PAYER OF LAST RESORT. 

18 Section 2617(b)(7)(F)(ii) of the Public Health Serv19 ice Act (42 U.S.C. 300ff–27(b)(6))is amended by inserting 

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

21 services of the Indian Health Services)’’ before the semi22 colon. 

23 SEC. 210. HEPATITIS. 

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

25 (42 U.S.C. 300ff–24(a)(3)) is amended by inserting ‘‘, inVerDate Aug 31 2005 08:28 May 23, 2006 Jkt 049200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S2823.IS S2823

cprice-sewell on PROD1PC66 with BILLS
46 

•S 2823 IS

1 cluding speciality care (including vaccinations) for hepa2 titis coinfection,’’ after ‘‘health services’’. 

3 SEC. 211. AUTHORIZATION OF APPROPRIATIONS. 

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

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

6 amended by section 207, is further amended by adding 

7 at the end the following: 

8 ‘‘SEC. 2622. AUTHORIZATION OF APPROPRIATIONS. 

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

10 are authorized to be appropriated $1,190,400,000 for fis11 cal year 2007, $1,193,000,000 for fiscal year 2008, 

12 $1,237,100,000 for fiscal year 2009, $1,282,900,000 for 

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

14 2011.’’. 

15 TITLE III—EARLY 

16 INTERVENTION SERVICES 

17 SEC. 301. CATEGORICAL GRANTS. 

18 (a) ESTABLISHMENT OF PROGRAM.—Section 

19 2651(b) of the Public Health Service Act (42 U.S.C. 

20 300ff–51(b)) is amended— 

21 (1) in paragraph (2)(D), by striking ‘‘the dis22 ease’’ and inserting ‘‘HIV/AIDS’’; 

23 (2) in paragraph (4)(B)— 

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

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


cprice-sewell on PROD1PC66 with BILLS
47 

•S 2823 IS

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

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

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

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

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

6 2652(a)(1)’’; and 

7 (3) in paragraph (5)(A), by striking ‘‘the dis8 ease’’ each place that such appears and inserting 

9 ‘‘HIV/AIDS’’. 

10 (b) MINIMUM QUALIFICATION OF GRANTEES.—Sec11 tion 2652(a) of the Public Health Service Act (42 U.S.C. 

12 300ff–52(a)) is amended to read as follows: 

13 ‘‘(a) ELIGIBLE ENTITIES.— 

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

15 section 2651(a) are public entities and nonprofit pri16 vate entities that are— 

17 ‘‘(A) federally-qualified health centers 

18 under section 1905(l)(2)(B) of the Social Secu19 rity Act; 

20 ‘‘(B) grantees under section 1001 (regard21 ing family planning) other than States; 

22 ‘‘(C) comprehensive hemophilia diagnostic 

23 and treatment centers; 

24 ‘‘(D) rural health clinics; 


cprice-sewell on PROD1PC66 with BILLS
48 

•S 2823 IS

1 ‘‘(E) health facilities operated by or pursu2 ant to a contract with the Indian Health Serv3 ice; 

4 ‘‘(F) nonprofit private entities that provide 

5 comprehensive primary care services to popu6 lations at risk of HIV/AIDS. 

7 ‘‘(2) UNDERSERVED POPULATIONS.—Entities 

8 described in paragraph (1) shall serve underserved 

9 populations which may include minority populations 

10 and Native American populations, ex-offenders, indi11 viduals co-infected with HIV and hepatitis B or C, 

12 low-income populations, inner city populations, and 

13 rural populations.’’. 

14 (c) PREFERENCES IN MAKING GRANTS.—Section 

15 2653 of the Public Health Service Act (42 U.S.C. 300ff– 

16 53) is amended— 

17 (1) in subsection (b)(1)— 

18 (A) in subparagraph (A), by striking ‘‘ac19 quired immune deficiency syndrome’’ and in20 serting ‘‘HIV/AIDS’’; and 

21 (B) in subparagraph (D), by inserting be22 fore the semicolon the following: ‘‘and the num23 ber of cases of individuals coinfected with HIV/ 

24 AIDS and hepatitis B or C’’; and 


cprice-sewell on PROD1PC66 with BILLS
49 

•S 2823 IS

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

2 consideration’’ and inserting ‘‘preference’’. 

3 (d) PLANNING AND DEVELOPMENT GRANTS.—Sec4 tion 2654(c) of the Public Health Service Act (42 U.S.C. 

5 300ff–54(c)) is amended— 

6 (1) in paragraph (1)— 

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

8 ‘‘HIV’’; and 

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

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

11 (2) in paragraph (3), by striking ‘‘or under12 served communities’’ and inserting ‘‘areas or to un13 derserved populations’’. 

14 (e) AUTHORIZATION OF APPROPRIATIONS.—Section 

15 2655 of the Public Health Service Act (42 U.S.C. 300ff– 

16 55) is amended by striking ‘‘such sums’’ and all that fol17 lows through ‘‘2005’’ and inserting ‘‘, $218,600,000 for 

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

19 $235,100,000 for fiscal year 2009, $234,800,000 for fis20 cal year 2010, and $252,800,000 for fiscal year 2011’’. 

21 SEC. 302. GENERAL PROVISIONS. 

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

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

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

25 AIDS’’. 


cprice-sewell on PROD1PC66 with BILLS
50 

•S 2823 IS

1 (b) APPLICABILITY OF CERTAIN REQUIREMENTS.— 

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

3 300ff–63) is amended by striking ‘‘will, without’’ and all 

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

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

6 (c) ADDITIONAL REQUIRED AGREEMENTS.—Section 

7 2664(a) of the Public Health Service Act (42 U.S.C. 

8 300ff–64(a)) is amended— 

9 (1) in paragraph (1)— 

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

11 ‘‘and’’ at the end; 

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

13 ‘‘and’’ at the end; and 

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

15 ‘‘(C) information regarding how the ex16 pected expenditures of the grant are related to 

17 the planning process for localities funded under 

18 part A (including the planning process de19 scribed in section 2602) and for States funded 

20 under part B (including the planning process 

21 described in section 2617(b)); and 

22 ‘‘(D) a specification of the expected ex23 penditures and how those expenditures will im24 prove overall client outcomes, as described in 


cprice-sewell on PROD1PC66 with BILLS
51 

•S 2823 IS

1 the State plan under section 2617(b) or 

2 through additional outcome measures;’’; 

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

4 inserting a semicolon; and 

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

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

7 documentation to the Secretary regarding the proc8 ess used to obtain community input into the design 

9 and implementation of activities related to such 

10 grant; and 

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

12 State agency under section 2617(b)(4) audits re13 garding funds expended in accordance with this title 

14 and shall include necessary client level data to com15 plete unmet need calculations and Statewide coordi16 nated statements of need process.’’. 

17 SEC. 303. CORE MEDICAL SERVICES. 

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

19 Health Service Act (42 U.S.C. 300ff–61 et seq.) is amend20 ed by adding at the end the following: 

21 ‘‘SEC. 2688. REQUIRED FUNDING FOR CORE MEDICAL SERV22 ICES. 

23 ‘‘(a) IN GENERAL.—Notwithstanding any other pro24 vision of law, a grantee under this part shall expend not 

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


cprice-sewell on PROD1PC66 with BILLS
52 

•S 2823 IS

1 on core medical services, except that the Secretary shall 

2 waive the application of this section with respect to a 

3 grantee if the Secretary determines that, within the service 

4 area of the grantee— 

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

6 Assistance Program services; and 

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

8 individuals infected with HIV/AIDS. 

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

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

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

12 co-occurring diseases of the individual) means the fol13 lowing services: 

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

15 ‘‘(2) AIDS Drug Assistance Program treat16 ments. 

17 ‘‘(3) AIDS pharmaceutical assistance. 

18 ‘‘(4) Oral health care. 

19 ‘‘(5) Early intervention services. 

20 ‘‘(6) Health insurance premium and cost shar21 ing assistance for low-income individuals. 

22 ‘‘(7) Home health care. 

23 ‘‘(8) Hospice services. 


cprice-sewell on PROD1PC66 with BILLS
53 

•S 2823 IS

1 ‘‘(9) Home and community-based health serv2 ices as defined under section 2614(c), except home3 maker services. 

4 ‘‘(10) Mental health services. 

5 ‘‘(11) Substance abuse outpatient care. 

6 ‘‘(12) Medical case management, including 

7 treatment adherence services. 

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

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

10 grantee under this part, subject to the approval of the Sec11 retary, may provide support services (such as respite care 

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

13 transportation, nutritional counseling, linguistic services, 

14 and referral for health care and support services for indi15 viduals with HIV/AIDS) needed to achieve medical out16 comes which are related to the medical outcomes for an 

17 individual infected with HIV and approved by the Sec18 retary. 

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

20 section, the term ‘medical outcomes’ means those out21 comes affecting the HIV-related clinical status of an indi22 vidual with HIV/AIDS. 

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

24 to be expended for core medical services or support serv25 ices under this section that remain unobligated at the end 


cprice-sewell on PROD1PC66 with BILLS
54 

•S 2823 IS

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

2 be remitted to the Secretary for reallocation under this 

3 section.’’. 

4 SEC. 304. PAYER OF LAST RESORT. 

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

6 Act (42 U.S.C. 300ff–64(f)(1)(A)) is amended by insert7 ing ‘‘(except for a program administered by or providing 

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

9 semicolon. 

10 TITLE IV—WOMEN, INFANTS, 

11 CHILDREN, AND YOUTH 

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

13 Part D of title XXVI of the Public Health Service 

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

15 follows: 

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

17 YOUTH 

18 ‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND AC19 CESS TO RESEARCH FOR WOMEN, INFANTS, 

20 CHILDREN, AND YOUTH. 

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

22 the Administrator of the Health Resources and Services 

23 Administration, shall award grants to public and nonprofit 

24 private entities (including a health facility operated by or 

25 pursuant to a contract with the Indian Health Service) 


cprice-sewell on PROD1PC66 with BILLS
55 

•S 2823 IS

1 that provide family-centered care involving outpatient or 

2 ambulatory care (directly or through contracts) for 

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

4 ‘‘(b) ADDITIONAL SERVICES FOR PATIENTS AND

5 FAMILIES.—Funds provided under grants awarded under 

6 subsection (a) may be also be used for the following sup7 port services: 

8 ‘‘(1) Family-centered care including case man9 agement. 

10 ‘‘(2) Referrals for additional services includ11 ing— 

12 ‘‘(A) referrals for inpatient hospital serv13 ices, treatment for substance abuse, and mental 

14 health services; and 

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

16 services, as appropriate. 

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

18 patient and the family to participate in the program 

19 established by the applicant pursuant to such sub20 section including services designed to recruit and re21 tain youth with HIV. 

22 ‘‘(4) The provision of information and edu23 cation on opportunities to participate in HIV/AIDS24 related clinical research. 


cprice-sewell on PROD1PC66 with BILLS
56 

•S 2823 IS

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

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

3 the applicant provides an agreement that includes the fol4 lowing: 

5 ‘‘(1) The applicant will coordinate activities 

6 under the grant with other providers of health care 

7 services under this Act, and under title V of the So8 cial Security Act. 

9 ‘‘(2) The applicant will participate in the state10 wide coordinated statement of need under part B 

11 (where it has been initiated by the public health 

12 agency responsible for administering grants under 

13 part B) and in revisions of such statement. 

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

15 the lead State agency under section 2617(b)(4) au16 dits regarding funds expended in accordance with 

17 this title and shall include necessary client-level data 

18 to complete unmet need calculations and Statewide 

19 coordinated statements of need process. 

20 ‘‘(d) ADMINISTRATION.— 

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

22 awarded to an entity under subsection (a) if an ap23 plication for the grant is submitted to the Secretary 

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

25 manner, and contains such agreements, assurances, 


cprice-sewell on PROD1PC66 with BILLS
57 

•S 2823 IS

1 and information as the Secretary determines to be 

2 necessary to carry out this section. Such application 

3 shall include the following: 

4 ‘‘(A) Information regarding how the ex5 pected expenditures of the grant are related to 

6 the planning process for localities funded under 

7 part A (including the planning process outlined 

8 in section 2602) and for States funded under 

9 part B (including the planning process outlined 

10 in section 2617(b). 

11 ‘‘(B) A specification of the expected ex12 penditures and how those expenditures will im13 prove overall patient outcomes, as outlined as 

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

15 or through additional outcome measures. 

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

17 grantee under this section shall implement a quality 

18 management program to assess the extent to which 

19 HIV health services provided to patients under the 

20 grant are consistent with the most recent Public 

21 Health Service guidelines for the treatment of HIV/ 

22 AIDS and related opportunistic infection, and as ap23 plicable, to develop strategies for ensuring that such 

24 services are consistent with the guidelines for imVerDate Aug 31 2005 08:28 May 23, 2006 Jkt 049200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\S2823.IS S2823

cprice-sewell on PROD1PC66 with BILLS
58 

•S 2823 IS

1 provement in the access to and quality of HIV 

2 health services. 

3 ‘‘(e) ANNUAL REVIEW OF PROGRAMS; EVALUA4 TIONS.— 

5 ‘‘(1) REVIEW REGARDING ACCESS TO AND PAR6 TICIPATION IN PROGRAMS.—With respect to a grant 

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

8 the Secretary shall, not later than 180 days after 

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

10 and completion of a review of the operation during 

11 the year of the program carried out under such sub12 section by the entity. The purpose of such review 

13 shall be the development of recommendations, as ap14 propriate, for improvements in the following: 

15 ‘‘(A) Procedures used by the entity to allo16 cate opportunities and services under subsection 

17 (a) among patients of the entity who are 

18 women, infants, children, or youth. 

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

20 entity regarding the participation of such indi21 viduals in such program. 

22 ‘‘(2) EVALUATIONS.——The Secretary shall, di23 rectly or through contracts with public and private 

24 entities, provide for evaluations of programs carried 

25 out pursuant to subsection (a). 


cprice-sewell on PROD1PC66 with BILLS
59 

•S 2823 IS

1 ‘‘(f) CAP ON ADMINISTRATIVE EXPENSES.—A grant2 ee may not use more than 10 percent of amounts received 

3 under a grant awarded under this section for administra4 tive expenses. 

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

6 From the amounts appropriated under subsection (i) for 

7 a fiscal year, the Secretary may use not more than 5 per8 cent to provide, directly or through contracts with public 

9 and private entities (which may include grantees under 

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

11 applicants and grantees under subsection (a) in complying 

12 with the requirements of this section. 

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

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

15 ‘administrative expenses’ means funds that are to be 

16 used by grantees for grant management and moni17 toring activities, including costs related to any staff 

18 or activity unrelated to services or indirect costs. 

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

20 costs’ means costs included in a Federally negotiated 

21 indirect rate. 

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

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

24 meet the goals and objectives of the program 

25 under this section, including the provision of 


cprice-sewell on PROD1PC66 with BILLS
60 

•S 2823 IS

1 professional, diagnostic, and therapeutic serv2 ices by a primary care provider or a referral to 

3 and provision of specialty care; and 

4 ‘‘(B) services that sustain program activity 

5 and contribute to or help improve services 

6 under subparagraph (A). 

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

8 purpose of carrying out this section, there are authorized 

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

10 years 2007 through 2011.’’. 

11 SEC. 402. GAO REPORT. 

12 Not later than 24 months after the date of enactment 

13 of this Act, the Comptroller General of the Government 

14 Accountability Office shall conduct an evaluation, and sub15 mit to Congress a report, concerning the funding provided 

16 for under part D of title XXVI of the Public Health Serv17 ice Act to determine— 

18 (1) how funds are used to provide the adminis19 trative expenses, indirect costs, and services, as de20 fined in section 2671(h) of such title, for individuals 

21 with HIV/AIDS; 

22 (2) how funds are used to provide the adminis23 trative expenses, indirect costs, and services, as de24 fined in section 2671(h) of such title, to family 


cprice-sewell on PROD1PC66 with BILLS
61 

•S 2823 IS

1 members of women, infants, children, and youth in2 fected with HIV/AIDS; 

3 (3) how funds are used to provide family-cen4 tered care involving outpatient or ambulatory care 

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

6 (4) how funds are used to provide additional 

7 services authorized under section 2671(b) of such 

8 title; and 

9 (5) how funds are used to help identify HIV10 positive pregnant women and connect them with care 

11 that can improve their health and prevent perinatal 

12 transmission. 

13 TITLE V—GENERAL PROVISIONS 

14 SEC. 501. GENERAL PROVISIONS. 

15 Part E of title XXVI of the Public Health Service 

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

17 follows: 

18 ‘‘PART E—GENERAL PROVISIONS 

19 ‘‘SEC. 2681. COORDINATION. 

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

21 that the Health Resources and Services Administration, 

22 the Centers for Disease Control and Prevention, the Sub23 stance Abuse and Mental Health Services Administration, 

24 and the Centers for Medicare & Medicaid Services coordi25 nate the planning, funding, and implementation of Federal 


cprice-sewell on PROD1PC66 with BILLS
62 

•S 2823 IS

1 HIV programs including the Minority AIDS Initiative 

2 under section 2693 to enhance the continuity of care and 

3 prevention services for individuals with HIV/AIDS or 

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

5 with other Federal agencies, including the Department of 

6 Veterans Affairs, as needed and utilize planning informa7 tion submitted to such agencies by the States and entities 

8 eligible for assistance under this title. 

9 ‘‘(b) REPORT.—The Secretary shall biennially pre10 pare and submit to the appropriate committees of the Con11 gress a report concerning the coordination efforts at the 

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

13 including a description of Federal barriers to HIV pro14 gram integration and a strategy for eliminating such bar15 riers and enhancing the continuity of care and prevention 

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

17 of such disease. 

18 ‘‘(c) INTEGRATION BY STATE.—As a condition of re19 ceipt of funds under this title, a State shall provide assur20 ances to the Secretary that health support services funded 

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

22 that programs will be coordinated with other available pro23 grams (including Medicaid), and that the continuity of 

24 care and prevention services of individuals with HIV/AIDS 

25 is enhanced. 


cprice-sewell on PROD1PC66 with BILLS
63 

•S 2823 IS

1 ‘‘(d) INTEGRATION BY LOCAL OR PRIVATE ENTI2 TIES.—As a condition of receipt of funds under this title, 

3 a local government or private nonprofit entity shall provide 

4 assurances to the Secretary that services funded under 

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

6 programs will be coordinated with other available pro7 grams (including Medicaid), and that the continuity of 

8 care and prevention services of individuals with HIV is 

9 enhanced. 

10 ‘‘SEC. 2682. AUDITS. 

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

12 subsequent fiscal year, the Secretary may reduce the 

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

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

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

16 or subdivision fails to prepare audits in accordance with 

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

18 Code. The Secretary shall annually select representative 

19 samples of such audits, prepare summaries of the selected 

20 audits, and submit the summaries to the Congress. 

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

22 the Secretary receives from the State lead agency under 

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

24 of the Health Resources and Services Administration. 


cprice-sewell on PROD1PC66 with BILLS
64 

•S 2823 IS

1 ‘‘SEC. 2683. PUBLIC HEALTH EMERGENCY. 

2 ‘‘(a) IN GENERAL.—In an emergency area and dur3 ing an emergency period, the Secretary shall have the au4 thority to waive such requirements of this title to improve 

5 the health and safety of those receiving care under this 

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

7 not expend more than 5 percent of the funds allocated 

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

9 ‘‘(b) EMERGENCY AREA AND EMERGENCY PE10 RIOD.—In this section: 

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

12 area’ means a geographic area in which there ex13 ists— 

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

15 the President pursuant to the National Emer16 gencies Act of the Robert T. Stafford Disaster 

17 Relief and Emergency Assistance Act; and 

18 ‘‘(B) a public health emergency declared 

19 by the Secretary pursuant to section 319. 

20 ‘‘(2) EMERGENCY PERIOD.—The term ‘emer21 gency period’ means the period in which there ex22 ists— 

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

24 the President pursuant to the National Emer25 gencies Act of the Robert T. Stafford Disaster 

26 Relief and Emergency Assistance Act; and 


cprice-sewell on PROD1PC66 with BILLS
65 

•S 2823 IS

1 ‘‘(B) a public health emergency declared 

2 by the Secretary pursuant to section 319. 

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

4 under this section are not expended for an emergency in 

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

6 funds shall be returned to the Secretary for reallocation 

7 under sections 2603(b) and 2620. 

8 ‘‘SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN AC9 TIVITIES. 

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

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

12 designed to promote or encourage, directly, intravenous 

13 drug use or sexual activity, whether homosexual or hetero14 sexual. Funds authorized under this title may be used to 

15 provide medical treatment and support services for indi16 viduals with HIV. 

17 ‘‘SEC. 2685. PRIVACY PROTECTIONS. 

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

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

20 identifier as reported to the Director of the Centers for 

21 Disease Control and Prevention as of the date of enact22 ment of this section. 

23 ‘‘SEC. 2686. GAO REPORT. 

24 ‘‘The Comptroller General of the Government Ac25 countability Office shall biennially submit to the approVerDate Aug 31 2005 08:28 May 23, 2006 Jkt 049200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\S2823.IS S2823

cprice-sewell on PROD1PC66 with BILLS
66 

•S 2823 IS

1 priate committees of Congress a report that includes a de2 scription of Federal, State, and local barriers to HIV pro3 gram integration, particularly for racial and ethnic minori4 ties, and recommendations for enhancing the continuity 

5 of care and the provision of prevention services for individ6 uals with HIV/AIDS or those at risk for such disease. 

7 Such report shall include a demonstration of the manner 

8 in which funds under this subpart are being expended and 

9 to what extent the services provided with such funds in10 crease access to prevention and care services for individ11 uals with HIV/AIDS and build stronger community link12 ages to address HIV prevention and care for racial and 

13 ethnic minority communities. 

14 ‘‘SEC. 2687. DEFINITIONS. 

15 ‘‘For purposes of this title: 

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

17 means such counseling provided by an individual 

18 trained to provide such counseling. 

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

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

21 described in this section that is targeted specifically 

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

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

24 partnership between parents, professionals, and the 

25 community designed to ensure an integrated, coordiVerDate Aug 31 2005 08:28 May 23, 2006 Jkt 049200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\S2823.IS S2823

cprice-sewell on PROD1PC66 with BILLS
67 

•S 2823 IS

1 nated, culturally sensitive, and community-based 

2 continuum of care for children, women, and families 

3 with HIV/AIDS. 

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

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

6 one or more members have HIV/AIDS. 

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

8 with the etiologic agent for acquired immune defi9 ciency syndrome. 

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

11 infection with the etiologic agent for acquired im12 mune deficiency syndrome, and includes any condi13 tion arising from such syndrome. 

14 ‘‘(6) OFFICIAL POVERTY LINE.—The term ‘offi15 cial poverty line’ means the poverty line established 

16 by the Director of the Office of Management and 

17 Budget and revised by the Secretary in accordance 

18 with section 673(2) of the Omnibus Budget Rec19 onciliation Act of 1981. 

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

21 or more individuals, governments (including the 

22 Federal Government and the governments of the 

23 States), governmental agencies, political subdivi24 sions, labor unions, partnerships, associations, cor25 porations, legal representatives, mutual companies, 


cprice-sewell on PROD1PC66 with BILLS
68 

•S 2823 IS

1 joint-stock companies, trusts, unincorporated organi2 zations, receivers, trustees, and trustees in cases 

3 under title 11, United States Code. 

4 ‘‘(8) STATE.—The term ‘State’, except as oth5 erwise specifically provided, means each of the 50 

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

7 Guam, American Samoa, the Commonwealth of the 

8 Northern Mariana Islands, Puerto Rico, and the Re9 public of the Marshall Islands. 

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

11 HIV’ means individuals who are 13 through 24 

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

13 TITLE VI—DEMONSTRATION 

14 AND TRAINING 

15 SEC. 601. DEMONSTRATION AND TRAINING. 

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

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

18 amended to read as follows: 

19 ‘‘PART F—DEMONSTRATION AND TRAINING 

20 ‘‘Subpart I—Special Projects of National Significance 

21 ‘‘SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFI22 CANCE. 

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

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

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


cprice-sewell on PROD1PC66 with BILLS
69 

•S 2823 IS

1 amount equal to 3 percent of such amount appropriated 

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

3 administer special projects of national significance to— 

4 ‘‘(1) quickly respond to emerging needs of indi5 viduals receiving assistance under this title; and 

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

7 standard electronic client information data system to 

8 improve the ability of grantees under this title to re9 port client-level data to the Secretary. 

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

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

12 parts A, B, C, and D based on— 

13 ‘‘(1)(A) whether the funding will promote ob14 taining client level data as it relates to the creation 

15 of a severity of need index under section 

16 2618(a)(2)(E)(iii), including funds to facilitate the 

17 purchase and enhance the utilization of qualified 

18 health information technology systems; 

19 ‘‘(B) demonstrated ability to create and main20 tain a qualified health information technology sys21 tem; 

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

23 activity in other similar localities or nationally; 

24 ‘‘(D) the demonstrated reliability of the pro25 posed qualified health information technology system 


cprice-sewell on PROD1PC66 with BILLS
70 

•S 2823 IS

1 across a variety of providers, geographic regions, 

2 and clients; and 

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

4 safe and secure qualified health information system; 

5 or 

6 ‘‘(2) newly emerging needs of individuals receiv7 ing assistance under this title. 

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

9 a grant under this section unless the applicant submits 

10 evidence that the proposed program is consistent with the 

11 statewide coordinated statement of need, and the appli12 cant agrees to participate in the ongoing revision process 

13 of such statement of need. 

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

15 make a grant under this section for the development of 

16 a qualified health information technology system unless 

17 the applicant provides assurances to the Secretary that the 

18 system will comply with the privacy regulations promul19 gated under section 264(c) of the Health Insurance Port20 ability and Accountability Act of 1996. 

21 ‘‘(e) REPLICATION.—The Secretary shall make infor22 mation concerning successful models or programs devel23 oped under this part available to grantees under this title 

24 for the purpose of coordination, replication, and integra25 tion. To facilitate efforts under this subsection, the SecVerDate Aug 31 2005 08:28 May 23, 2006 Jkt 049200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\S2823.IS S2823

cprice-sewell on PROD1PC66 with BILLS
71 

•S 2823 IS

1 retary may provide for peer-based technical assistance 

2 from grantees funded under this part.’’. 

3 SEC. 602. AIDS EDUCATION AND TRAINING CENTERS. 

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

5 (42 U.S.C. 300ff–92(a)(2)) is amended— 

6 (1) in subparagraph (A)— 

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

8 after ‘‘minority individuals’’; and 

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

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

11 and inserting ‘‘; and’’; and 

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

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

14 health professionals and allied health profes15 sionals to provide treatment for hepatitis B or 

16 C co-infected individuals.’’. 

17 SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE 

18 UNDER RYAN WHITE COMPREHENSIVE AIDS 

19 RESOURCES EMERGENCY ACT OF 1990. 

20 Part F of title XXVI of the Public Health Service 

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

22 at the end the following: 


cprice-sewell on PROD1PC66 with BILLS
72 

•S 2823 IS

1 ‘‘Subpart II—Minority AIDS Initiative 

2 ‘‘SEC. 2693. MINORITY AIDS INITIATIVE. 

3 ‘‘(a) IN GENERAL.—There is authorized to be appro4 priated for the purpose of carrying out activities under 

5 this section to evaluate and address the disproportionate 

6 impact of HIV disease and disparities in access, treat7 ment, care, and outcome on racial and ethnic minorities, 

8 including African Americans, Alaska Natives, Latinos, 

9 American Indians, Asian Americans, Native Hawaiians, 

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

11 $135,100,000 for fiscal year 2008, $139,100,000 for fis12 cal year 2009, $143,200,000 for fiscal year 2010, and 

13 $147,500,000 for fiscal year 2010. 

14 ‘‘(b) CERTAIN ACTIVITIES.— 

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

16 described in subsection (a), the Secretary shall pro17 vide for— 

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

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

20 ‘‘(C) early intervention services under part 

21 C; 

22 ‘‘(D) services through demonstration 

23 projects for HIV-related care; and 

24 ‘‘(E) activities through education and 

25 training centers under section 2692. 


cprice-sewell on PROD1PC66 with BILLS
73 

•S 2823 IS

1 ‘‘(2) ALLOCATIONS AMONG ACTIVITIES.—Activi2 ties under paragraph (1) shall be carried out by the 

3 Secretary in accordance with the following: 

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

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

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

7 2008, $47,100,000 for fiscal year 2009, 

8 $48,800,000 for fiscal year 2010, and 

9 $50,700,000 for fiscal year 2010, shall be used 

10 for competitive, supplemental grants to improve 

11 HIV-related health outcomes to reduce existing 

12 racial and ethnic health disparities. 

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

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

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

16 2008, $7,500,000 for fiscal year 2009, 

17 $7,800,000 for fiscal year 2010, and 

18 $8,100,000 for fiscal year 2010, shall be used 

19 for competitive, supplemental support edu20 cational and outreach services to increase the 

21 number of eligible racial and ethnic minorities 

22 who have access to treatment through the pro23 gram under section 2616 for therapeutics. 

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

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


cprice-sewell on PROD1PC66 with BILLS
74 

•S 2823 IS

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

2 2008, $57,400,000 for fiscal year 2009, 

3 $59,500,000 for fiscal year 2010, and 

4 $61,800,000 for fiscal year 2010, shall be used 

5 for planning grants, capacity-building grants, 

6 and services grants to health care providers who 

7 have a history of providing culturally and lin8 guistically appropriate care and services to ra9 cial and ethnic minorities. 

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

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

12 for each of fiscal years 2007 through 2011 shall 

13 be used for sustaining and expanding efforts to 

14 deliver comprehensive, culturally and linguis15 tically appropriate research-based intervention 

16 and care services for HIV disease to racial and 

17 ethnic minority women, infants, children, and 

18 youth. 

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

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

21 each of fiscal years 2007 through 2011 shall be 

22 used for increasing the training capacity of cen23 ters to expand the number of community-based 

24 racial and ethnic minority health care profes25 sionals with treatment expertise and knowledge 


cprice-sewell on PROD1PC66 with BILLS
75 

•S 2823 IS

1 about the most appropriate standards of HIV 

2 disease-related treatments and medical care for 

3 adults, adolescents, and children with HIV dis4 ease. 

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

6 respect to the purpose described in subsection (a), the Sec7 retary shall carry out this section consistent with the ac8 tivities carried out under this title by the Secretary pursu9 ant to the Departments of Labor, Health and Human 

10 Services, and Education, and Related Agencies Appropria11 tions Act, 2002 (Public Law 107–116).’’. 

12 SEC. 604. AUTHORIZATION OF APPROPRIATIONS. 

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

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

15 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.— 

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

17 awarding grants under subsection (a), there and au18 thorized to be appropriated $34,700,000 for each of 

19 fiscal years 2007 through 2011. 

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

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

22 subsection (b), there are authorized to be appro23 priated $13,000,000 for each of fiscal years 2007 

24 through 2011.’’. 


cprice-sewell on PROD1PC66 with BILLS
76 

•S 2823 IS

1 TITLE VII—MISCELLANEOUS 

2 PROVISIONS 

3 SEC. 701. HEPATITIS. 

4 (a) PROVISION OF CERTAIN COUNSELING SERV5 ICES.—Section 2662 of the Public Health Service Act (42 

6 U.S.C. 300ff–62) is amended— 

7 (1) in subsection (a)— 

8 (A) in paragraph (1), by inserting ‘‘, hepa9 titis B, and hepatitis C’’ before the semicolon; 

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

11 testing for hepatitis B and hepatitis C’’ before 

12 the semicolon; 

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

14 the end; 

15 (D) in paragraph (7), by striking the pe16 riod and inserting ‘‘; and’’; and 

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

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

19 hepatitis C co-infection, the potential of developing 

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

21 AIDS.’’; and 

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

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

24 each place that such appears. 


cprice-sewell on PROD1PC66 with BILLS
77 

•S 2823 IS

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

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

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

4 end; 

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

6 inserting ‘‘; and’’; and 

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

8 ‘‘(4) shall provide information on the trans9 mission and prevention of hepatitis A, B, and C and 

10 the location of entities that provide hepatitis A and 

11 B vaccinations to individuals with HIV.’’. 

12 SEC. 702. TECHNICAL PROVISIONS. 

13 Title XXVI of the Public Health Service Act (42 

14 U.S.C. 300ff et seq.) is amended by striking ‘‘HIV dis15 ease’’ each place that such appears and inserting ‘‘HIV/ 

16 AIDS’’. 

17 SEC. 703. REPEAL. 

18 Section 2677 of the Public Health Service Act (42 

19 U.S.C. 300ff–77) is repealed. 

Æ 


cprice-sewell on PROD1PC66 with BILLS