II

Calendar No. 716

106TH CONGRESS

2D SESSION H. R. 4807

IN THE SENATE OF THE UNITED STATES

JULY 26, 2000

Received; read twice and placed on the calendar

To amend the Public Health Service Act to revise and extend

programs established under the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, and for

other purposes.

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

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

3 Act Amendments of 2000’’.

4 SEC. 2. TABLE OF CONTENTS.

5 The table of contents for this Act is as follows:

TITLE I—EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL

NEED FOR SERVICES

Subtitle A—HIV Health Services Planning Councils

Sec. 101. Membership of councils.

Sec. 102. Duties of councils.

Sec. 103. Open meetings; other additional provisions.

Subtitle B—Type and Distribution of Grants

Sec. 111. Formula grants.

Sec. 112. Supplemental grants.

Subtitle C—Other Provisions

Sec. 121. Use of amounts.

Sec. 122. Application.

Sec. 123. Review of administrative costs and compensation.

TITLE II—CARE GRANT PROGRAM

Subtitle A—General Grant Provisions

Sec. 201. Priority for women, infants, and children.

Sec. 202. Use of grants.

Sec. 203. Grants to establish HIV care consortia.

Sec. 204. Provision of treatments.

Sec. 205. State application.

Sec. 206. Distribution of funds.

Sec. 207. Supplemental grants for certain States.

Subtitle B—Provisions Concerning Pregnancy and Perinatal Transmission of

HIV

Sec. 211. Repeals.

Sec. 212. Grants.

Sec. 213. Study by Institute of Medicine.

Subtitle C—Certain Partner Notification Programs

Sec. 221. Grants for compliant partner notification programs.

TITLE III—EARLY INTERVENTION SERVICES

Subtitle A—Formula Grants for States
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Sec. 301. Repeal of program.

Subtitle B—Categorical Grants

Sec. 311. Preferences in making grants.

Sec. 312. Planning and development grants.

Sec. 313. Authorization of appropriations.

Subtitle C—General Provisions

Sec. 321. Provision of certain counseling services.

Sec. 322. Additional required agreements.

TITLE IV—OTHER PROGRAMS AND ACTIVITIES

Subtitle A—Certain Programs for Research, Demonstrations, or Training

Sec. 401. Grants for coordinated services and access to research for women, infants, children, and youth.

Sec. 402. AIDS education and training centers.

Subtitle B—General Provisions in Title XXVI

Sec. 411. Evaluations and reports.

Sec. 412. Data collection through Centers for Disease Control and Prevention.

Sec. 413. Coordination.

Sec. 414. Plan regarding release of prisoners with HIV disease.

Sec. 415. Audits.

Sec. 416. Administrative simplification.

Sec. 417. Authorization of appropriations for parts A and B.

TITLE V—GENERAL PROVISIONS

Sec. 501. Studies by Institute of Medicine.

Sec. 502. Development of rapid HIV test.

TITLE VI—EFFECTIVE DATE

Sec. 601. Effective date.

1 TITLE I—EMERGENCY RELIEF

2 FOR AREAS WITH SUBSTAN3 TIAL NEED FOR SERVICES

4 Subtitle A—HIV Health Services

5 Planning Councils

6 SEC. 101. MEMBERSHIP OF COUNCILS.

7 (a) IN GENERAL.—Section 2602(b) of the Public

8 Health Service Act (42 U.S.C. 300ff–12(b)) is amended—
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1 (1) in paragraph (1), by striking ‘‘demographics

2 of the epidemic in the eligible area involved,’’ and in3 serting ‘‘demographics of the population of individ4 uals with HIV disease in the eligible area involved,’’;

5 and

6 (2) in paragraph (2)—

7 (A) in subparagraph (G), by striking ‘‘or

8 AIDS’’;

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

10 ‘‘and’’ at the end;

11 (C) in subparagraph (L), by striking the

12 period and inserting the following: ‘‘, including

13 but not limited to providers of HIV prevention

14 services; and’’; and

15 (D) by adding at the end the following

16 subparagraph:

17 ‘‘(M) representatives of individuals who

18 formerly were Federal, State, or local prisoners,

19 were released from the custody of the penal sys20 tem during the preceding 3 years, and had HIV

21 disease as of the date on which the individuals

22 were so released.’’.

23 (b) CONFLICTS OF INTERESTS.—Section 2602(b)(5)

24 of the Public Health Service Act (42 U.S.C. 300ff–
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1 12(b)(5)) is amended by adding at the end the following

2 subparagraph:

3 ‘‘(C) COMPOSITION OF COUNCIL.—The fol4 lowing applies regarding the membership of a

5 planning council under paragraph (1):

6 ‘‘(i) Not less than 33 percent of the

7 council shall be individuals who are receiv8 ing HIV-related services pursuant to a

9 grant under section 2601(a), are not offi10 cers, employees, or consultants to any enti11 ty that receives amounts from such a

12 grant, and do not represent any such enti13 ty, and reflect the demographics of the

14 population of individuals with HIV disease

15 as determined under paragraph (4)(A).

16 For purposes of the preceding sentence, an

17 individual shall be considered to be receiv18 ing such services if the individual is a par19 ent of, or a caregiver for, a minor child

20 who is receiving such services.

21 ‘‘(ii) With respect to membership on

22 the planning council, clause (i) may not be

23 construed as having any effect on entities

24 that receive funds from grants under any

25 of parts B through F but do not receive
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1 funds from grants under section 2601(a),

2 on officers or employees of such entities, or

3 on individuals who represent such enti4 ties.’’.

5 SEC. 102. DUTIES OF COUNCILS.

6 (a) IN GENERAL.—Section 2602(b)(4) of the Public

7 Health Service Act (42 U.S.C. 300ff–12(b)(4)) is

8 amended—

9 (1) by redesignating subparagraphs (A) through

10 (E) as subparagraphs (C) through (G), respectively;

11 (2) by inserting before subparagraph (C) (as so

12 redesignated) the following subparagraphs:

13 ‘‘(A) determine the size and demographics

14 of the population of individuals with HIV dis15 ease;

16 ‘‘(B) determine the needs of such popu17 lation, with particular attention to—

18 ‘‘(i) individuals with HIV disease who

19 are not receiving HIV-related services; and

20 ‘‘(ii) disparities in access and services

21 among affected subpopulations and histori22 cally underserved communities;’’;

23 (3) in subparagraph (C) (as so redesignated),

24 by striking clauses (i) through (iv) and inserting the

25 following:
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1 ‘‘(i) size and demographics of the pop2 ulation of individuals with HIV disease (as

3 determined under subparagraph (A)) and

4 the needs of such population (as deter5 mined under subparagraph (B));

6 ‘‘(ii) demonstrated (or probable) cost

7 effectiveness and outcome effectiveness of

8 proposed strategies and interventions, to

9 the extent that data are reasonably avail10 able;

11 ‘‘(iii) priorities of the communities

12 with HIV disease for whom the services

13 are intended;

14 ‘‘(iv) availability of other govern15 mental and nongovernmental resources to

16 provide HIV-related services to individuals

17 and families with HIV disease, including

18 the State plan under title XIX of the So19 cial Security Act (relating to the Medicaid

20 program) and the program under title XXI

21 of such Act (relating to the program for

22 State children’s health insurance); and

23 ‘‘(v) capacity development needs re24 sulting from disparities in the availability
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1 of HIV-related services in historically un2 derserved communities;’’;

3 (4) in subparagraph (D) (as so redesignated),

4 by amending the subparagraph to read as follows:

5 ‘‘(D) develop a comprehensive plan for the

6 organization and delivery of health and support

7 services described in section 2604 that—

8 ‘‘(i) includes a strategy for identifying

9 individuals with HIV disease who are not

10 receiving such services and for informing

11 the individuals of and enabling the individ12 uals to utilize the services, giving par13 ticular attention to eliminating disparities

14 in access and services among affected sub15 populations and historically underserved

16 communities, and including discrete goals,

17 a timetable, and an appropriate allocation

18 of funds;

19 ‘‘(ii) includes a strategy to coordinate

20 the provision of such services with pro21 grams for HIV prevention and for the pre22 vention and treatment of substance abuse,

23 including programs that provide com24 prehensive treatment services for such

25 abuse; and
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1 ‘‘(iii) is compatible with any State or

2 local plan for the provision of services to

3 individuals with HIV disease;’’;

4 (5) in subparagraph (F) (as so redesignated),

5 by striking ‘‘and’’ at the end;

6 (6) in subparagraph (G) (as so redesignated)—

7 (A) by striking ‘‘public meetings,’’ and in8 serting ‘‘public meetings (in accordance with

9 paragraph (7)),’’; and

10 (B) by striking the period and inserting ‘‘;

11 and’’; and

12 (7) by adding at the end the following subpara13 graph:

14 ‘‘(H) coordinate with Federal grantees that

15 provide HIV-related services within the eligible

16 area.’’.

17 (b) PROCESS FOR ESTABLISHING ALLOCATION PRI18 ORITIES.—Section 2602 of the Public Health Service Act

19 (42 U.S.C. 300ff–12) is amended by adding at the end

20 the following subsection:

21 ‘‘(d) PROCESS FOR ESTABLISHING ALLOCATION PRI22 ORITIES.—Promptly after the date of the submission of

23 the report required in section 501(b) of the Ryan White

24 CARE Act Amendments of 2000 (relating to the relation25 ship between epidemiological measures and health care for
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1 certain individuals with HIV disease), the Secretary, in

2 consultation with entities that receive amounts from

3 grants under section 2601(a) or 2611, shall develop epi4 demiologic measures—

5 ‘‘(1) for establishing the number of individuals

6 living with HIV disease who are not receiving HIV7 related health services; and

8 ‘‘(2) for carrying out the duties under sub9 section (b)(4) and section 2617(b).’’.

10 (c) TRAINING.—Section 2602 of the Public Health

11 Service Act (42 U.S.C. 300ff–12), as amended by sub12 section (b) of this section, is amended by adding at the

13 end the following subsection:

14 ‘‘(e) TRAINING GUIDANCE AND MATERIALS.—The

15 Secretary shall provide to each chief elected official receiv16 ing a grant under 2601(a) guidelines and materials for

17 training members of the planning council under paragraph

18 (1) regarding the duties of the council.’’.

19 SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVI20 SIONS.

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

22 U.S.C. 300ff–12(b)) is amended—

23 (1) in paragraph (3), by striking subparagraph

24 (C); and
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1 (2) by adding at the end the following para2 graph:

3 ‘‘(7) PUBLIC DELIBERATIONS.—With respect to

4 a planning council under paragraph (1), the fol5 lowing applies:

6 ‘‘(A) The council may not be chaired solely

7 by an employee of the grantee under section

8 2601(a).

9 ‘‘(B) In accordance with criteria estab10 lished by the Secretary:

11 ‘‘(i) The meetings of the council shall

12 be open to the public and shall be held

13 only after adequate notice to the public.

14 ‘‘(ii) The records, reports, transcripts,

15 minutes, agenda, or other documents which

16 were made available to or prepared for or

17 by the council shall be available for public

18 inspection and copying at a single location.

19 ‘‘(iii) Detailed minutes of each meet20 ing of the council shall be kept. The accu21 racy of all minutes shall be certified to by

22 the chair of the council.

23 ‘‘(iv) This subparagraph does not

24 apply to any disclosure of information of a

25 personal nature that would constitute a
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1 clearly unwarranted invasion of personal

2 privacy, including any disclosure of medical

3 information or personnel matters.’’.

4 Subtitle B—Type and Distribution

5 of Grants

6 SEC. 111. FORMULA GRANTS.

7 (a) EXPEDITED DISTRIBUTION.—Section 2603(a)(2)

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

9 13(a)(2)) is amended in the first sentence by striking ‘‘for

10 each of the fiscal years 1996 through 2000’’ and inserting

11 ‘‘for a fiscal year’’.

12 (b) AMOUNT OF GRANT; ESTIMATE OF LIVING

13 CASES.—

14 (1) IN GENERAL.—Section 2603(a)(3)) of the

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

16 13(a)(3)) is amended—

17 (A) in subparagraph (C)(i), by inserting

18 before the semicolon the following: ‘‘, except

19 that (subject to subparagraph (D)), for grants

20 made pursuant to this paragraph for fiscal year

21 2005 and subsequent fiscal years, the cases

22 counted for each 12-month period beginning on

23 or after July 1, 2004, shall be cases of HIV

24 disease (as reported to and confirmed by such
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1 Director) rather than cases of acquired immune

2 deficiency syndrome’’; and

3 (B) in subparagraph (C), in the matter

4 after and below clause (ii)(X)—

5 (i) in the first sentence, by inserting

6 before the period the following: ‘‘, and

7 shall be reported to the congressional com8 mittees of jurisdiction’’; and

9 (ii) by adding at the end the following

10 sentence: ‘‘Updates shall as applicable take

11 into account the counting of cases of HIV

12 disease pursuant to clause (i).’’.

13 (2) DETERMINATION OF SECRETARY REGARD14 ING DATA ON HIV CASES.—Section 2603(a)(3)) of

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

16 13(a)(3)) is amended—

17 (A) by redesignating subparagraph (D) as

18 subparagraph (E); and

19 (B) by inserting after subparagraph (C)

20 the following subparagraph:

21 ‘‘(D) DETERMINATION OF SECRETARY RE22 GARDING DATA ON HIV CASES.—

23 ‘‘(i) IN GENERAL.—Not later than

24 July 1, 2004, the Secretary shall deter25 mine whether there is data on cases of
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1 HIV disease from all eligible areas (re2 ported to and confirmed by the Director of

3 the Centers for Disease Control and Pre4 vention) sufficiently accurate and reliable

5 for use for purposes of subparagraph

6 (C)(i). In making such a determination,

7 the Secretary shall take into consideration

8 the findings of the study under section

9 501(b) of the Ryan White CARE Act

10 Amendments of 2000 (relating to the rela11 tionship between epidemiological measures

12 and health care for certain individuals with

13 HIV disease), the fiscal impact of the use

14 of such data, the impact of the use of such

15 data on the organization and delivery of

16 HIV-related services in eligible areas, and

17 the fiscal impact of not using such data.

18 ‘‘(ii) EFFECT OF ADVERSE DETER19 MINATION.—If under clause (i) the Sec20 retary determines that data on cases of

21 HIV disease is not sufficiently accurate

22 and reliable for use for purposes of sub23 paragraph (C)(i), then notwithstanding

24 such subparagraph, for any fiscal year

25 prior to fiscal year 2007 the references in
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1 such subparagraph to cases of HIV disease

2 do not have any legal effect.

3 ‘‘(iii) GRANTS AND TECHNICAL AS4 SISTANCE REGARDING COUNTING OF HIV

5 CASES.—Of the amounts appropriated

6 under section 2675 for a fiscal year, the

7 Secretary shall reserve amounts to make

8 grants and provide technical assistance to

9 States and eligible areas with respect to

10 obtaining data on cases of HIV disease to

11 ensure that data on such cases is available

12 from all States and eligible areas as soon

13 as is practicable but not later than the be14 ginning of fiscal year 2007.’’.

15 (c) INCREASES IN GRANT.—Section 2603(a)(4)) of

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

17 is amended to read as follows:

18 ‘‘(4) INCREASES IN GRANT.—

19 ‘‘(A) IN GENERAL.—For each fiscal year in

20 a protection period for an eligible area, the Sec21 retary shall increase the amount of the grant

22 made pursuant to paragraph (2) for the area to

23 ensure that—

24 ‘‘(i) for the first fiscal year in the pro25 tection period, the grant is not less than
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1 98 percent of the amount of the grant

2 made for the eligible area pursuant to such

3 paragraph for the base year for the protec4 tion period;

5 ‘‘(ii) for any second fiscal year in such

6 period, the grant is not less than 95.7 per7 cent of the amount of such base year

8 grant;

9 ‘‘(iii) for any third fiscal year in such

10 period, the grant is not less than 91.1 per11 cent of the amount of the base year grant;

12 ‘‘(iv) for any fourth fiscal year in such

13 period, the grant is not less than 84.2 per14 cent of the amount of the base year grant;

15 and

16 ‘‘(v) for any fifth or subsequent fiscal

17 year in such period, the grant is not less

18 than 75 percent of the amount of the base

19 year grant.

20 ‘‘(B) BASE YEAR; PROTECTION PERIOD.—

21 With respect to grants made pursuant to para22 graph (2) for an eligible area:

23 ‘‘(i) The base year for a protection pe24 riod is the fiscal year preceding the trigger

25 grant-reduction year.
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1 ‘‘(ii) The first trigger grant-reduction

2 year is the first fiscal year (after fiscal

3 year 2000) for which the grant for the

4 area is less than the grant for the area for

5 the preceding fiscal year.

6 ‘‘(iii) A protection period begins with

7 the trigger grant-reduction year and con8 tinues until the beginning of the first fiscal

9 year for which the amount of the grant for

10 the area equals or exceeds the amount of

11 the grant for the base year for the period.

12 ‘‘(iv) Any subsequent trigger grant-re13 duction year is the first fiscal year, after

14 the end of the preceding protection period,

15 for which the amount of the grant is less

16 than the amount of the grant for the pre17 ceding fiscal year.’’.

18 SEC. 112. SUPPLEMENTAL GRANTS.

19 (a) IN GENERAL.—Section 2603(b)(2) of the Public

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

21 amended—

22 (1) in the heading for the paragraph, by strik23 ing ‘‘DEFINITION’’ and inserting ‘‘AMOUNT OF

24 GRANT’’;
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1 (2) by redesignating subparagraphs (A) through

2 (C) as subparagraphs (B) through (D), respectively;

3 (3) by inserting before subparagraph (B) (as so

4 redesignated) the following subparagraph:

5 ‘‘(A) IN GENERAL.—The amount of each

6 grant made for purposes of this subsection shall

7 be determined by the Secretary based on a

8 weighting of factors under paragraph (1), with

9 severe need under subparagraph (B) of such

10 paragraph counting one-third.’’;

11 (4) in subparagraph (B) (as so redesignated)—

12 (A) in clause (ii), by striking ‘‘and’’ at the

13 end;

14 (B) in clause (iii), by striking the period

15 and inserting a semicolon; and

16 (C) by adding at the end the following

17 clauses:

18 ‘‘(iv) the current prevalence of HIV

19 disease;

20 ‘‘(v) an increasing need for HIV-re21 lated services, including relative rates of

22 increase in the number of cases of HIV

23 disease; and

24 ‘‘(vi) unmet need for such services, as

25 determined under section 2602(b)(4).’’;
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1 (5) in subparagraph (C) (as so redesignated)—

2 (A) by striking ‘‘subparagraph (A)’’ each

3 place such term appears and inserting ‘‘sub4 paragraph (B)’’;

5 (B) in the second sentence, by striking ‘‘2

6 years after the date of enactment of this para7 graph’’ and inserting ‘‘18 months after the date

8 of the enactment of the Ryan White CARE Act

9 Amendments of 2000’’; and

10 (C) by inserting after the second sentence

11 the following sentence: ‘‘Such a mechanism

12 shall be modified to reflect the findings of the

13 study under section 501(b) of the Ryan White

14 CARE Act Amendments of 2000 (relating to

15 the relationship between epidemiological meas16 ures and health care for certain individuals with

17 HIV disease).’’; and

18 (6) in subparagraph (D) (as so redesignated),

19 by striking ‘‘subparagraph (B)’’ and inserting ‘‘sub20 paragraph (C)’’.

21 (b) REQUIREMENTS FOR APPLICATION.—Section

22 2603(b)(1)(E) of the Public Health Service Act (42

23 U.S.C. 300ff–13(b)(1)(E)) is amended by inserting

24 ‘‘youth,’’ after ‘‘children,’’.
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1 (c) CONFORMING AMENDMENT.—Section 2603(b) of

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

3 amended—

4 (1) by striking paragraph (4); and

5 (2) by redesignating paragraph (5) as para6 graph (4).

7 Subtitle C—Other Provisions

8 SEC. 121. USE OF AMOUNTS.

9 (a) PRIMARY PURPOSES.—Section 2604(b)(1) of the

10 Public Health Service Act (42 U.S.C. 300ff–14(b)(1)) is

11 amended—

12 (1) in the matter preceding subparagraph (A),

13 by striking ‘‘HIV-related—’’ and inserting ‘‘HIV-re14 lated services, as follows:’’;

15 (2) in subparagraph (A)—

16 (A) by striking ‘‘outpatient’’ and all that

17 follows through ‘‘substance abuse treatment

18 and’’ and inserting the following: ‘‘Outpatient

19 and ambulatory health services, including sub20 stance abuse treatment,’’; and

21 (B) by striking ‘‘; and’’ and inserting a pe22 riod;

23 (3) in subparagraph (B), by striking ‘‘(B) inpa24 tient case management’’ and inserting ‘‘(C) Inpa25 tient case management’’;
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1 (4) by inserting after subparagraph (A) the fol2 lowing subparagraph:

3 ‘‘(B) Outpatient and ambulatory support

4 services (including case management), to the

5 extent that such services facilitate, support, or

6 sustain the delivery, or benefits of health serv7 ices for individuals and families with HIV dis8 ease.’’; and

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

10 ‘‘(D) Outreach activities that are intended

11 to identify individuals with HIV disease who are

12 not receiving HIV-related services, and that

13 are—

14 ‘‘(i) necessary to implement the strat15 egy under section 2602(b)(4)(D), including

16 activities facilitating the access of such in17 dividuals to HIV-related primary care serv18 ices at entities described in paragraph (3);

19 ‘‘(ii) conducted in a manner consistent

20 with the requirements under sections

21 2605(a)(3) and 2651(b)(2); and

22 ‘‘(iii) supplement, and do not sup23 plant, such activities that are carried out

24 with amounts appropriated under section

25 317.’’.
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1 (b) ADDITIONAL PURPOSES.—Section 2604(b) (42

2 U.S.C. 300ff–14(b)) of the Public Health Service Act is

3 amended—

4 (1) by redesignating paragraph (3) as para5 graph (4);

6 (2) by inserting after paragraph (2) the fol7 lowing:

8 ‘‘(3) EARLY INTERVENTION SERVICES.—

9 ‘‘(A) IN GENERAL.—The purposes for

10 which a grant under section 2601 may be used

11 include providing to individuals with HIV dis12 ease early intervention services described in sec13 tion 2651(b)(2) (including referrals under sub14 paragraph (C) of such section), subject to sub15 paragraph (B). The entities through which such

16 services may be provided under the grant in17 clude public health departments, emergency

18 rooms, substance abuse and mental health

19 treatment programs, detoxification centers, de20 tention facilities, clinics regarding sexually

21 transmitted diseases, homeless shelters, HIV

22 disease counseling and testing sites, health care

23 points of entry specified by States or eligible

24 areas, federally qualified health centers, and en25 tities described in section 2652(a).
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1 ‘‘(B) CONDITIONS.—With respect to an en2 tity that proposes to provide early intervention

3 services under subparagraph (A), such subpara4 graph applies only if the entity demonstrates to

5 the satisfaction of the chief elected official for

6 the eligible area involved that—

7 ‘‘(i) Federal, State, or local funds are

8 otherwise inadequate for the early inter9 vention services the entity proposes to pro10 vide; and

11 ‘‘(ii) the entity will expend funds pur12 suant to such subparagraph to supplement

13 and not supplant other funds available to

14 the entity for the provision of early inter15 vention services for the fiscal year in16 volved.’’; and

17 (3) in paragraph (4) (as so redesignated), by

18 inserting ‘‘youth,’’ after ‘‘children,’’ each place such

19 term appears;

20 (c) QUALITY MANAGEMENT.—Section 2604 of the

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

22 amended—

23 (1) by redesignating subsections (c) through (f)

24 as subsections (d) through (g), respectively; and
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1 (2) by inserting after subsection (b) the fol2 lowing:

3 ‘‘(c) QUALITY MANAGEMENT.—

4 ‘‘(1) REQUIREMENT.—The chief elected official

5 of an eligible area that receives a grant under this

6 part shall provide for the establishment of a quality

7 management program to assess the extent to which

8 HIV health services provided to patients under the

9 grant are consistent with the most recent Public

10 Health Service guidelines for the treatment of HIV

11 disease and related opportunistic infection, and as

12 applicable, to develop strategies for ensuring that

13 such services are consistent with the guidelines.

14 ‘‘(2) USE OF FUNDS.—From amounts received

15 under a grant awarded under this part for a fiscal

16 year, the chief elected official of an eligible area may

17 (in addition to amounts to which subsection (f)(1)

18 applies) use for activities associated with the quality

19 management program required in paragraph (1) not

20 more than the lesser of—

21 ‘‘(A) 5 percent of amounts received under

22 the grant; or

23 ‘‘(B) $3,000,000.’’.
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1 SEC. 122. APPLICATION.

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

3 U.S.C. 300ff–15(a)) is amended—

4 (1) by redesignating paragraphs (3) through

5 (6) as paragraphs (4) through (7), respectively; and

6 (2) by inserting after paragraph (2) the fol7 lowing paragraph:

8 ‘‘(3) that entities within the eligible area that

9 receive funds under a grant under section 2601(a)

10 will maintain relationships with appropriate entities

11 in the area, including entities described in section

12 2604(b)(3);’’.

13 SEC. 123. REVIEW OF ADMINISTRATIVE COSTS AND COM14 PENSATION.

15 Each chief elected official of an eligible area (as de16 fined in section 2607 of the Public Health Service Act)

17 shall ensure that, not later than 1 year after the date of

18 the enactment of this Act, the planning council for the

19 eligible area—

20 (1) conducts a review of the existing, available

21 data on the extent to which entities in the area that

22 receive amounts from a grant under section 2601(a)

23 of the Public Health Service Act have from their

24 overall budget expended amounts for administrative

25 costs (including financial compensation and bene26 fits), expressed as a proportion and indicating the
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1 growth in such expenditures, including a statement

2 of the average amount expended for such costs per

3 client served and the average amount expended for

4 such costs per client served in providing HIV-related

5 services; and

6 (2) makes a determination of whether the fi7 nancial compensation of any officers or employees of

8 such entities exceeds that of the chief elected official

9 of the eligible area.

10 TITLE II—CARE GRANT

11 PROGRAM

12 Subtitle A—General Grant

13 Provisions

14 SEC. 201. PRIORITY FOR WOMEN, INFANTS, AND CHILDREN.

15 Section 2611(b) of the Public Health Service Act (42

16 U.S.C. 300ff–21(b)) is amended by inserting ‘‘youth,’’

17 after ‘‘children,’’ each place such term appears.

18 SEC. 202. USE OF GRANTS.

19 Section 2612 of the Public Health Service Act (42

20 U.S.C. 300ff–22) is amended—

21 (1) by striking ‘‘A State may use’’ and insert22 ing ‘‘(a) IN GENERAL.—A State may use’’; and

23 (2) by adding at the end the following sub24 sections:
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1 ‘‘(b) SUPPORT SERVICES; OUTREACH.—The pur2 poses for which a grant under this part may be used in3 clude delivering or enhancing the following:

4 ‘‘(1) Support services under section 2611(a)

5 (including case management) to the extent that such

6 services facilitate, support, or sustain the delivery, or

7 benefits of health services for individuals and fami8 lies with HIV disease.

9 ‘‘(2) Outreach activities that are intended to

10 identify individuals with HIV disease who are not re11 ceiving HIV-related services, and that are—

12 ‘‘(A) necessary to implement the strategy

13 under section 2617(b)(4)(B);

14 ‘‘(B) conducted in a manner consistent

15 with the requirement under section

16 2617(b)(6)(G); and

17 ‘‘(C) supplement, and do not supplant,

18 such activities that are carried out with

19 amounts appropriated under section 317.

20 ‘‘(c) EARLY INTERVENTION SERVICES.—

21 ‘‘(1) IN GENERAL.—The purposes for which a

22 grant under this part may be used include providing

23 to individuals with HIV disease early intervention

24 services described in section 2651(b)(2) (including

25 referrals under subparagraph (C) of such section),
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1 subject to paragraph (2). The entities through which

2 such services may be provided under the grant in3 clude public health departments, emergency rooms,

4 substance abuse and mental health treatment pro5 grams, detoxification centers, detention facilities,

6 clinics regarding sexually transmitted diseases,

7 homeless shelters, HIV disease counseling and test8 ing sites, health care points of entry specified by

9 States or eligible areas, federally qualified health

10 centers, and entities described in section 2652(a).

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

12 that proposes to provide early intervention services

13 under paragraph (1), such paragraph applies only if

14 the entity demonstrates to the satisfaction of the

15 State involved that—

16 ‘‘(A) Federal, State, or local funds are oth17 erwise inadequate for the early intervention

18 services the entity proposes to provide; and

19 ‘‘(B) the entity will expend funds pursuant

20 to such paragraph to supplement and not sup21 plant other funds available to the entity for the

22 provision of early intervention services for the

23 fiscal year involved.

24 ‘‘(d) QUALITY MANAGEMENT.—
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1 ‘‘(1) REQUIREMENT.—Each State that receives

2 a grant under this part shall provide for the estab3 lishment of a quality management program to assess

4 the extent to which HIV health services provided to

5 patients under the grant are consistent with the

6 most recent Public Health Service guidelines for the

7 treatment of HIV disease and related opportunistic

8 infection, and as applicable, to develop strategies for

9 ensuring that such services are consistent with the

10 guidelines.

11 ‘‘(2) USE OF FUNDS.—From amounts received

12 under a grant awarded under this part for a fiscal

13 year, the State may (in addition to amounts to

14 which section 2618(c)(5) applies) use for activities

15 associated with the quality management program re16 quired in paragraph (1) not more than the lesser

17 of—

18 ‘‘(A) 5 percent of amounts received under

19 the grant; or

20 ‘‘(B) $3,000,000.’’.

21 SEC. 203. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

22 Section 2613 of the Public Health Service Act (42

23 U.S.C. 300ff–23) is amended—

24 (1) in subsection (b)(1)—
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1 (A) in subparagraph (A), by inserting be2 fore the semicolon the following: ‘‘, particularly

3 those experiencing disparities in access and

4 services and those who reside in historically un5 derserved communities’’; and

6 (B) in subparagraph (B), by inserting

7 after ‘‘by such consortium’’ the following: ‘‘is

8 consistent with the comprehensive plan under

9 2617(b)(4) and’’;

10 (2) in subsection (c)(1)—

11 (A) in subparagraph (D), by striking

12 ‘‘and’’ after the semicolon at the end;

13 (B) in subparagraph (E), by striking the

14 period and inserting ‘‘; and’’; and

15 (C) by adding at the end the following sub16 paragraph:

17 ‘‘(F) demonstrates that adequate planning

18 occurred to address disparities in access and

19 services and historically underserved commu20 nities.’’; and

21 (3) in subsection (c)(2)—

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

23 ‘‘and’’ after the semicolon;

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

25 period and inserting ‘‘; and’’; and
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1 (C) by inserting after subparagraph (C)

2 the following subparagraph:

3 ‘‘(D) entities described in section

4 2602(b)(2).’’.

5 SEC. 204. PROVISION OF TREATMENTS.

6 Section 2616 of the Public Health Service Act (42

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

8 following subsection:

9 ‘‘(e) USE OF HEALTH INSURANCE AND PLANS.—In

10 carrying out subsection (a), a State may expend a grant

11 under this part to provide the therapeutics described in

12 such subsection by paying on behalf of individuals with

13 HIV disease the costs of purchasing or maintaining health

14 insurance or plans whose coverage includes a full range

15 of such therapeutics and appropriate primary care serv16 ices.’’.

17 SEC. 205. STATE APPLICATION.

18 (a) DETERMINATION OF SIZE AND NEEDS OF POPU19 LATION; COMPREHENSIVE PLAN.—Section 2617(b) of the

20 Public Health Service Act (42 U.S.C. 300ff–27(b)) is

21 amended—

22 (1) by redesignating paragraphs (2) through

23 (4) as paragraphs (4) through (6), respectively;

24 (2) by inserting after paragraph (1) the fol25 lowing paragraphs:
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1 ‘‘(2) a determination of the size and demo2 graphics of the population of individuals with HIV

3 disease in the State;

4 ‘‘(3) a determination of the needs of such popu5 lation, with particular attention to—

6 ‘‘(A) individuals with HIV disease who are

7 not receiving HIV-related services; and

8 ‘‘(B) disparities in access and services

9 among affected subpopulations and historically

10 underserved communities;’’; and

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

12 (A) by striking ‘‘comprehensive plan for

13 the organization’’ and inserting ‘‘comprehensive

14 plan that describes the organization’’;

15 (B) by striking ‘‘, including—’’ and insert16 ing ‘‘, and that—’’;

17 (C) by redesignating subparagraphs (A)

18 through (C) as subparagraphs (D) through (F),

19 respectively;

20 (D) by inserting before subparagraph (C)

21 the following subparagraphs:

22 ‘‘(A) establishes priorities for the allocation

23 of funds within the State based on—

24 ‘‘(i) size and demographics of the pop25 ulation of individuals with HIV disease (as
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1 determined under paragraph (2)) and the

2 needs of such population (as determined

3 under paragraph (3));

4 ‘‘(ii) availability of other governmental

5 and nongovernmental resources to provide

6 HIV-related services to individuals and

7 families with HIV disease;

8 ‘‘(iii) capacity development needs re9 sulting from disparities in the availability

10 of HIV-related services in historically un11 derserved communities and rural commu12 nities; and

13 ‘‘(iv) the efficiency of the administra14 tive mechanism of the State for rapidly al15 locating funds to the areas of greatest need

16 within the State;

17 ‘‘(B) includes a strategy for identifying in18 dividuals with HIV disease who are not receiv19 ing such services and for informing the individ20 uals of and enabling the individuals to utilize

21 the services, giving particular attention to elimi22 nating disparities in access and services among

23 affected subpopulations and historically under24 served communities, and including discrete
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1 goals, a timetable, and an appropriate alloca2 tion of funds;

3 ‘‘(C) includes a strategy to coordinate the

4 provision of such services with programs for

5 HIV prevention and for the prevention and

6 treatment of substance abuse, including pro7 grams that provide comprehensive treatment

8 services for such abuse;’’;

9 (E) in subparagraph (D) (as redesignated

10 by subparagraph (C) of this paragraph), by in11 serting ‘‘describes’’ before ‘‘the services and ac12 tivities’’;

13 (F) in subparagraph (E) (as so redesig14 nated), by inserting ‘‘provides’’ before ‘‘a de15 scription’’; and

16 (G) in subparagraph (F) (as so redesig17 nated), by inserting ‘‘provides’’ before ‘‘a de18 scription’’.

19 (b) PUBLIC PARTICIPATION.—Section 2617(b) of the

20 Public Health Service Act, as amended by subsection (a)

21 of this section, is amended—

22 (1) in paragraph (5), by striking ‘‘HIV’’ and in23 serting ‘‘HIV disease’’; and

24 (2) in paragraph (6), by amending subpara25 graph (A) to read as follows:
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1 ‘‘(A) the public health agency that is ad2 ministering the grant for the State engages in

3 a public advisory planning process, including

4 public hearings, that includes the participants

5 under paragraph (5), and entities described in

6 section 2602(b)(2), in developing the com7 prehensive plan under paragraph (4) and com8 menting on the implementation of such plan;’’.

9 (c) HEALTH CARE RELATIONSHIPS.—Section

10 2617(b) of the Public Health Service Act, as amended by

11 subsection (a) of this section, is amended in paragraph

12 (6)—

13 (1) in subparagraph (E), by striking ‘‘and’’ at

14 the end;

15 (2) in subparagraph (F), by striking the period

16 and inserting ‘‘; and’’; and

17 (3) by adding at the end the following subpara18 graph:

19 ‘‘(G) entities within areas in which activi20 ties under the grant are carried out will main21 tain relationships with appropriate entities in

22 the area, including entities described in section

23 2612(c);’’.
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1 SEC. 206. DISTRIBUTION OF FUNDS.

2 (a) MINIMUM ALLOTMENT.—Section

3 2618(b)(1)(A)(i) of the Public Health Service Act (42

4 U.S.C. 300ff–28(b)(1)(A)(i)) is amended—

5 (1) in subclause (I), by striking ‘‘$100,000’’

6 and inserting ‘‘$200,000’’; and

7 (2) in subclause (II), by striking ‘‘$250,000’’

8 and inserting ‘‘$500,000’’.

9 (b) AMOUNT OF GRANT; ESTIMATE OF LIVING

10 CASES.—Section 2618(b)(2) of the Public Health Service

11 Act (42 U.S.C. 300ff–28(b)(2)) is amended—

12 (1) in subparagraph (D)(i), by inserting before

13 the semicolon the following: ‘‘, except that (subject

14 to subparagraph (E)), for grants made pursuant to

15 this paragraph for fiscal year 2005 and subsequent

16 fiscal years, the cases counted for each 12-month pe17 riod beginning on or after July 1, 2004, shall be

18 cases of HIV disease (as reported to and confirmed

19 by such Director) rather than cases of acquired im20 mune deficiency syndrome’’;

21 (2) by redesignating subparagraphs (E)

22 through (H) as subparagraphs (F) through (I), re23 spectively; and

24 (3) by inserting after subparagraph (D) the fol25 lowing subparagraph:
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1 ‘‘(E) DETERMINATION OF SECRETARY RE2 GARDING DATA ON HIV CASES.—If under

3 2603(a)(3)(D)(i) the Secretary determines that

4 data on cases of HIV disease is not sufficiently

5 accurate and reliable, then notwithstanding sub6 paragraph (D) of this paragraph, for any fiscal

7 year prior to fiscal year 2007 the references in

8 such subparagraph to cases of HIV disease do

9 not have any legal effect.’’.

10 (c) INCREASES IN FORMULA AMOUNT.—Section

11 2618(b) of the Public Health Service Act (42 U.S.C.

12 300ff–28(b)) is amended—

13 (1) in paragraph (1)(A)(ii), by inserting before

14 the semicolon the following: ‘‘and then, as applica15 ble, increased under paragraph (2)(H)’’; and

16 (2) in paragraph (2)—

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

18 ‘‘subparagraph (H)’’ and inserting ‘‘subpara19 graphs (H) and (I)’’; and

20 (B) in subparagraph (H) (as redesignated

21 by subsection (b)(2) of this section), by amend22 ing the subparagraph to read as follows:

23 ‘‘(H) LIMITATION.—

24 ‘‘(i) IN GENERAL.—The Secretary

25 shall ensure that the amount of a grant
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1 awarded to a State or territory under sec2 tion 2611 for a fiscal year is not less

3 than—

4 ‘‘(I) with respect to fiscal year

5 2001, 99 percent;

6 ‘‘(II) with respect to fiscal year

7 2002, 98 percent;

8 ‘‘(III) with respect to fiscal year

9 2003, 97 percent;

10 ‘‘(IV) with respect to fiscal year

11 2004, 96 percent; and

12 ‘‘(V) with respect to fiscal year

13 2005, 95 percent,

14 of the amount such State or territory re15 ceived for fiscal year 2000 under such sec16 tion. In administering this subparagraph,

17 the Secretary shall, with respect to States

18 or territories that will under such section

19 receive grants in amounts that exceed the

20 amounts that such States received under

21 such section for fiscal year 2000, propor22 tionally reduce such amounts to ensure

23 compliance with this subparagraph. In

24 making such reductions, the Secretary

25 shall ensure that no such State receives
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1 less than that State received for fiscal year

2 2000.

3 ‘‘(ii) RATABLE REDUCTION.—If the

4 amount appropriated under section 2677

5 for a fiscal year and available for grants

6 under section 2611 is less than the amount

7 appropriated and available under such sec8 tion for fiscal year 2000, the limitation

9 contained in clause (i) shall be reduced by

10 a percentage equal to the percentage of the

11 reduction in such amounts appropriated

12 and available.’’.

13 (d) TERRITORIES.—Section 2618(b)(1)(B) of the

14 Public Health Service Act (42 U.S.C. 300ff–28(b)(1)(B))

15 is amended by inserting ‘‘the greater of $50,000 or’’ after

16 ‘‘shall be’’.

17 (e) SEPARATE TREATMENT DRUG GRANTS.—Section

18 2618(b)(2) of the Public Health Service Act, as amended

19 by subsection (b)(3) of this section, is amended in sub20 paragraph (I)—

21 (1) by redesignating clauses (i) and (ii) as sub22 clauses (I) and (II), respectively;

23 (2) by striking ‘‘(I) APPROPRIATIONS’’ and all

24 that follows through ‘‘With respect to’’ and inserting

25 the following:
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1 ‘‘(I) APPROPRIATIONS FOR TREATMENT

2 DRUG PROGRAM.—

3 ‘‘(i) FORMULA GRANTS.—With respect

4 to’’;

5 (3) in subclause (I) of clause (i) (as designated

6 by paragraphs (1) and (2)), by striking ‘‘100 per7 cent’’ and inserting ‘‘98 percent’’; and

8 (4) by adding at the end the following clause:

9 ‘‘(ii) SUPPLEMENTAL TREATMENT

10 DRUG GRANTS.—

11 ‘‘(I) IN GENERAL.—With respect

12 to the fiscal year involved, if under

13 section 2677 an appropriations Act

14 provides an amount exclusively for

15 carrying out section 2616, and such

16 amount is not less than the amount so

17 provided for the preceding fiscal year,

18 the Secretary shall reserve 2 percent

19 of such amount for making grants to

20 States whose population of individuals

21 with HIV disease has, as determined

22 by the Secretary, a need for quantities

23 of therapeutics described in section

24 2616(a) greater than the quantities

25 available pursuant to clause (i). Such
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1 a grant is available for purposes of

2 obtaining such therapeutics. The Sec3 retary shall carry out this clause as a

4 program of discretionary grants, and

5 not as a program of formula grants.

6 ‘‘(II) DISTRIBUTION OF

7 GRANTS.—The Secretary shall dis8 burse all amounts under grants under

9 subclause (I) for a fiscal year not

10 later than 240 days after the date on

11 which the amount referred to in such

12 subclause with respect to section 2616

13 becomes available.

14 ‘‘(III) REQUIREMENT OF MATCH15 ING FUNDS.—A condition for receiv16 ing a grant under subclause (I) is

17 that the State agree to make available

18 (directly or through donations from

19 public or private entities) non-Federal

20 contributions toward the costs of ob21 taining the therapeutics involved in an

22 amount that is not less than 25 per23 cent of such costs (determined in the

24 same manner as under

25 2617(d)(2)(A)).’’.
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1 (f) TECHNICAL AMENDMENT.—Section

2 2618(b)(3)(B) of the Public Health Service Act (42

3 U.S.C. 300ff–28(b)(3)(B)) is amended by striking ‘‘and

4 the Republic of the Marshall Islands’’ and inserting ‘‘the

5 Republic of the Marshall Islands, the Federated States of

6 Micronesia, and the Republic of Palau, and only for pur7 poses of paragraph (1) the Commonwealth of Puerto

8 Rico’’.

9 SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

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

11 Health Service Act (42 U.S.C. 300ff–11 et seq.) is

12 amended—

13 (1) by striking section 2621; and

14 (2) by inserting after section 2620 the following

15 section:

16 ‘‘SEC. 2621. SUPPLEMENTAL GRANTS.

17 ‘‘(a) IN GENERAL.—From amounts available pursu18 ant to subsection (d) for a fiscal year, the Secretary shall

19 make grants to States that meet the conditions to receive

20 grants under section 2611, and that have one or more eli21 gible communities, for the purpose of providing in such

22 communities comprehensive services of the type described

23 in section 2612(a) to supplement the development and

24 care activities, primary care, and support services other-
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1 wise provided in such communities by the State under a

2 grant under section 2611.

3 ‘‘(b) ELIGIBLE COMMUNITY.—For purposes of this

4 section, the term ‘eligible community’ means a geographic

5 area that—

6 ‘‘(1) is not within any eligible area as defined

7 in section 2607; and

8 ‘‘(2) has a severe need for supplemental finan9 cial assistance to combat the HIV epidemic, accord10 ing to criteria developed by the Secretary in con11 sultation with the States, including evidence of un12 derserved or rural areas or both.

13 ‘‘(c) APPLICATION.—A grant under subsection (a)

14 may be made to a State if the State submits to the Sec15 retary, as part of the State application submitted under

16 section 2617, such information as required to apply for

17 funds under this section as determined by the Secretary

18 in consultation with the States.

19 ‘‘(d) FUNDING.—

20 ‘‘(1) IN GENERAL.—For the purpose of making

21 grants under subsection (a) for a fiscal year, the

22 Secretary shall reserve 50 percent of the amount

23 specified in paragraph (2).

24 ‘‘(2) INCREASES IN PART B FUNDING.—
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1 ‘‘(A) IN GENERAL.—For purposes of para2 graph (1), the amount specified in this para3 graph is the amount by which the amount ap4 propriated under section 2677 for the fiscal

5 year involved and available for carrying out

6 part B is an increase over the amount so appro7 priated and available for the preceding fiscal

8 year, subject to subparagraphs (B) and (C).

9 ‘‘(B) INITIAL ALLOCATION YEAR.—The al10 location under paragraph (1) shall not be made

11 until the first fiscal year for which the amount

12 appropriated under section 2677 for the fiscal

13 year involved and available for carrying out

14 part B is an increase of not less than

15 $20,000,000 over the amount so appropriated

16 and available for fiscal year 2000, subject to

17 subparagraph (C).

18 ‘‘(C) EXCLUSION REGARDING SEPARATE

19 TREATMENT DRUG GRANTS.—Each determina20 tion under subparagraph (A) or (B) of the

21 amount appropriated under section 2677 for a

22 fiscal year and available for carrying out part

23 B shall be made without regard to any amount

24 to which section 2618(b)(2)(I)(i) applies.’’.
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1 Subtitle B—Provisions Concerning

2 Pregnancy and Perinatal Trans3 mission of HIV

4 SEC. 211. REPEALS.

5 Subpart II of part B of title XXVI of the Public

6 Health Service Act (42 U.S.C. 300ff–33 et seq.) is

7 amended—

8 (1) in section 2626, by striking each of sub9 sections (d) through (f); and

10 (2) by striking section 2627.

11 SEC. 212. GRANTS.

12 (a) IN GENERAL.—Section 2625(c) of the Public

13 Health Service Act (42 U.S.C. 300ff–33) is amended—

14 (1) in paragraph (1), by inserting at the end

15 the following subparagraph:

16 ‘‘(F) Making available to pregnant women

17 with HIV disease, and to the infants of women

18 with such disease, treatment services for such

19 disease in accordance with applicable rec20 ommendations of the Secretary.’’;

21 (2) by amending paragraph (2) to read as fol22 lows:

23 ‘‘(2) FUNDING.—

24 ‘‘(A) AUTHORIZATION OF APPROPRIA25 TIONS.—For the purpose of carrying out this
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1 subsection, there are authorized to be appro2 priated $30,000,000 for each of the fiscal years

3 2001 through 2005. Amounts made available

4 under section 2677 for carrying out this part

5 are not available for carrying out this section

6 unless otherwise authorized.

7 ‘‘(B) ALLOCATIONS FOR CERTAIN

8 STATES.—

9 ‘‘(i) IN GENERAL.—Of the amounts

10 appropriated under subparagraph (A) for a

11 fiscal year in excess of $10,000,000, the

12 Secretary shall reserve the applicable per13 centage under clause (ii) for making grants

14 under paragraph (1) to States that under

15 law (including under regulations or the dis16 cretion of State officials) have—

17 ‘‘(I) a requirement that all new18 born infants born in the State be test19 ed for HIV disease; or

20 ‘‘(II) a requirement that newborn

21 infants born in the State be tested for

22 HIV disease in circumstances in

23 which the attending obstetrician for

24 the birth does not know the HIV sta25 tus of the mother of the infant.
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1 ‘‘(ii) APPLICABLE PERCENTAGE.—For

2 purposes of clause (i), the applicable

3 amount for a fiscal year is as follows:

4 ‘‘(I) For fiscal year 2001, 25 per5 cent.

6 ‘‘(II) For fiscal year 2002, 50

7 percent.

8 ‘‘(III) For fiscal year 2003, 50

9 percent.

10 ‘‘(IV) For fiscal year 2004, 75

11 percent.

12 ‘‘(V) For fiscal year 2005, 75

13 percent.

14 ‘‘(C) CERTAIN PROVISIONS.—With respect

15 to grants under paragraph (1) that are made

16 with amounts reserved under subparagraph (B)

17 of this paragraph:

18 ‘‘(i) Such a grant may not be made in

19 an amount exceeding $4,000,000.

20 ‘‘(ii) If pursuant to clause (i) or pur21 suant to an insufficient number of quali22 fying applications for such grants (or

23 both), the full amount reserved under sub24 paragraph (B) for a fiscal year is not obli25 gated, the requirement under such sub-
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1 paragraph to reserve amounts ceases to

2 apply.’’; and

3 (3) by adding at the end the following para4 graph:

5 ‘‘(4) MAINTENANCE OF EFFORT.—A condition

6 for the receipt of a grant under paragraph (1) is

7 that the State involved agree that the grant will be

8 used to supplement and not supplant other funds

9 available to the State to carry out the purposes of

10 the grant.’’.

11 (b) SPECIAL FUNDING RULE FOR FISCAL YEAR

12 2001.—

13 (1) IN GENERAL.—If for fiscal year 2001 the

14 amount appropriated under paragraph (2)(A) of sec15 tion 2625(c) of the Public Health Service Act is less

16 than $14,000,000—

17 (A) the Secretary of Health and Human

18 Services shall, for the purpose of making grants

19 under paragraph (1) of such section, reserve

20 from the amount specified in paragraph (2) of

21 this subsection an amount equal to the dif22 ference between $14,000,000 and the amount

23 appropriated under paragraph (2)(A) of such

24 section for such fiscal year;
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1 (B) the amount so reserved shall, for pur2 poses of paragraph (2)(B)(i) of such section, be

3 considered to have been appropriated under

4 paragraph (2)(A) of such section; and

5 (C) the percentage specified in paragraph

6 (2)(B)(ii)(I) of such section is deemed to be 50

7 percent.

8 (2) ALLOCATION FROM INCREASES IN FUNDING

9 FOR PART B.—For purposes of paragraph (1), the

10 amount specified in this paragraph is the amount by

11 which the amount appropriated under section 2677

12 of the Public Health Service Act for fiscal year 2001

13 and available for grants under section 2611 of such

14 Act is an increase over the amount so appropriated

15 and available for fiscal year 2000.

16 SEC. 213. STUDY BY INSTITUTE OF MEDICINE.

17 Subpart II of part B of title XXVI of the Public

18 Health Service Act (42 U.S.C. 300ff–33 et seq.) is amend19 ed by adding at the end the following section:

20 ‘‘SEC. 2630. RECOMMENDATIONS FOR REDUCING INCI21 DENCE OF PERINATAL TRANSMISSION.

22 ‘‘(a) STUDY BY INSTITUTE OF MEDICINE.—

23 ‘‘(1) IN GENERAL.—The Secretary shall request

24 the Institute of Medicine to enter into an agreement
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1 with the Secretary under which such Institute con2 ducts a study to provide the following:

3 ‘‘(A) For the most recent fiscal year for

4 which the information is available, a determina5 tion of the number of newborn infants with

6 HIV born in the United States with respect to

7 whom the attending obstetrician for the birth

8 did not know the HIV status of the mother.

9 ‘‘(B) A determination for each State of

10 any barriers, including legal barriers, that pre11 vent or discourage an obstetrician from making

12 it a routine practice to offer pregnant women

13 an HIV test and a routine practice to test new14 born infants for HIV disease in circumstances

15 in which the obstetrician does not know the

16 HIV status of the mother of the infant.

17 ‘‘(C) Recommendations for each State for

18 reducing the incidence of cases of the perinatal

19 transmission of HIV, including recommenda20 tions on removing the barriers identified under

21 subparagraph (B).

22 If such Institute declines to conduct the study, the

23 Secretary shall enter into an agreement with another

24 appropriate public or nonprofit private entity to con25 duct the study.
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1 ‘‘(2) REPORT.—The Secretary shall ensure

2 that, not later than 18 months after the effective

3 date of this section, the study required in paragraph

4 (1) is completed and a report describing the findings

5 made in the study is submitted to the appropriate

6 committees of the Congress, the Secretary, and the

7 chief public health official of each of the States.

8 ‘‘(b) PROGRESS TOWARD RECOMMENDATIONS.—

9 Each State shall comply with the following (as applicable

10 to the fiscal year involved):

11 ‘‘(1) For fiscal year 2004, the State shall sub12 mit to the Secretary a report describing the actions

13 taken by the State toward meeting the recommenda14 tions specified for the State under subsection

15 (a)(1)(C).

16 ‘‘(2) For fiscal year 2005 and each subsequent

17 fiscal year—

18 ‘‘(A) the State shall make reasonable

19 progress toward meeting such recommenda20 tions; or

21 ‘‘(B) if the State has not made such

22 progress—

23 ‘‘(i) the State shall cooperate with the

24 Director of the Centers for Disease Control
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1 and Prevention in carrying out activities

2 toward meeting the recommendations; and

3 ‘‘(ii) the State shall submit to the

4 Secretary a report containing a description

5 of any barriers identified under subsection

6 (a)(1)(B) that continue to exist in the

7 State; as applicable, the factors underlying

8 the continued existence of such barriers;

9 and a description of how the State intends

10 to reduce the incidence of cases of the

11 perinatal transmission of HIV.

12 ‘‘(c) SUBMISSION OF REPORTS TO CONGRESS.—The

13 Secretary shall submit to the appropriate committees of

14 the Congress each report received by the Secretary under

15 subsection (b)(2)(B)(ii).’’.

16 Subtitle C—Certain Partner

17 Notification Programs

18 SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICA19 TION PROGRAMS.

20 Part B of title XXVI of the Public Health Service

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

22 at the end the following subpart:
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1 ‘‘Subpart III—Certain Partner Notification Programs

2 ‘‘SEC. 2631. GRANTS FOR PARTNER NOTIFICATION PRO3 GRAMS.

4 ‘‘(a) IN GENERAL.—In the case of States whose laws

5 or regulations are in accordance with subsection (b), the

6 Secretary, subject to subsection (c)(2), may make grants

7 to the States for carrying out programs to provide partner

8 counseling and referral services.

9 ‘‘(b) DESCRIPTION OF COMPLIANT STATE PRO10 GRAMS.—For purposes of subsection (a), the laws or regu11 lations of a State are in accordance with this subsection

12 if under such laws or regulations (including programs car13 ried out pursuant to the discretion of State officials) the

14 following policies are in effect:

15 ‘‘(1) The State requires that the public health

16 officer of the State carry out a program of partner

17 notification to inform partners of individuals with

18 HIV disease that the partners may have been ex19 posed to the disease.

20 ‘‘(2)(A) In the case of a health entity that pro21 vides for the performance on an individual of a test

22 for HIV disease, or that treats the individual for the

23 disease, the State requires, subject to subparagraph

24 (B), that the entity confidentially report the positive

25 test results to the State public health officer in a

26 manner recommended and approved by the Director
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1 of the Centers for Disease Control and Prevention,

2 together with such additional information as may be

3 necessary for carrying out such program.

4 ‘‘(B) The State may provide that the require5 ment of subparagraph (A) does not apply to the

6 testing of an individual for HIV disease if the indi7 vidual underwent the testing through a program de8 signed to perform the test and provide the results to

9 the individual without the individual disclosing his or

10 her identity to the program. This subparagraph may

11 not be construed as affecting the requirement of

12 subparagraph (A) with respect to a health entity

13 that treats an individual for HIV disease.

14 ‘‘(3) The program under paragraph (1) is car15 ried out in accordance with the following:

16 ‘‘(A) Partners are provided with an appro17 priate opportunity to learn that the partners

18 have been exposed to HIV disease, subject to

19 subparagraph (B).

20 ‘‘(B) The State does not inform partners

21 of the identity of the infected individuals in22 volved.

23 ‘‘(C) Counseling and testing for HIV dis24 ease are made available to the partners and to

25 infected individuals, and such counseling in-
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1 cludes information on modes of transmission for

2 the disease, including information on prenatal

3 and perinatal transmission and preventing

4 transmission.

5 ‘‘(D) Counseling of infected individuals

6 and their partners includes the provision of in7 formation regarding therapeutic measures for

8 preventing and treating the deterioration of the

9 immune system and conditions arising from the

10 disease, and the provision of other prevention11 related information.

12 ‘‘(E) Referrals for appropriate services are

13 provided to partners and infected individuals,

14 including referrals for support services and

15 legal aid.

16 ‘‘(F) Notifications under subparagraph (A)

17 are provided in person, unless doing so is an

18 unreasonable burden on the State.

19 ‘‘(G) There is no criminal or civil penalty

20 on, or civil liability for, an infected individual if

21 the individual chooses not to identify the part22 ners of the individual, or the individual does not

23 otherwise cooperate with such program.

24 ‘‘(H) The failure of the State to notify

25 partners is not a basis for the civil liability of
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1 any health entity who under the program re2 ported to the State the identity of the infected

3 individual involved.

4 ‘‘(I) The State provides that the provisions

5 of the program may not be construed as prohib6 iting the State from providing a notification

7 under subparagraph (A) without the consent of

8 the infected individual involved.

9 ‘‘(4) The State annually reports to the Director

10 of the Centers for Disease Control and Prevention

11 the number of individuals from whom the names of

12 partners have been sought under the program under

13 paragraph (1), the number of such individuals who

14 provided the names of partners, and the number of

15 partners so named who were notified under the pro16 gram.

17 ‘‘(5) The State cooperates with such Director in

18 carrying out a national program of partner notifica19 tion, including the sharing of information between

20 the public health officers of the States.

21 ‘‘(c) REPORTING SYSTEM FOR CASES OF HIV DIS22 EASE.—

23 ‘‘(1) PREFERENCE IN MAKING GRANTS

24 THROUGH FISCAL YEAR 2003.—In making grants

25 under subsection (a) for each of the fiscal years
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1 2001 through 2003, the Secretary shall give pref2 erence to States whose reporting systems for cases

3 of HIV disease produce data on such cases that is

4 sufficiently accurate and reliable for use for pur5 poses of section 2618(b)(2)(D)(i).

6 ‘‘(2) ELIGIBILITY CONDITION AFTER FISCAL

7 YEAR 2003.—For fiscal year 2004 and subsequent

8 fiscal years, a State may not receive a grant under

9 subsection (a) unless the reporting system of the

10 State for cases of HIV disease produces data on

11 such cases that is sufficiently accurate and reliable

12 for purposes of section 2618(b)(2)(D)(i).

13 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For the

14 purpose of carrying out this section, there are authorized

15 to be appropriated $30,000,000 for fiscal year 2001, and

16 such sums as may be necessary for each of the fiscal years

17 2002 through 2005.’’.

18 TITLE III—EARLY

19 INTERVENTION SERVICES

20 Subtitle A—Formula Grants for

21 States

22 SEC. 301. REPEAL OF PROGRAM.

23 Subpart I of part C of title XXVI of the Public

24 Health Service Act (42 U.S.C. 300ff–41 et seq.) is re25 pealed.
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1 Subtitle B—Categorical Grants

2 SEC. 311. PREFERENCES IN MAKING GRANTS.

3 Section 2653 of the Public Health Service Act (42

4 U.S.C. 300ff–53) is amended by adding at the end the

5 following subsection:

6 ‘‘(d) UNDERSERVED AND RURAL AREAS.—Of the ap7 plicants who qualify for preference under this section, the

8 Secretary shall give preference to applicants that will ex9 pend the grant under section 2651 to provide early inter10 vention under such section in rural areas or in areas that

11 are underserved with respect to such services.’’.

12 SEC. 312. PLANNING AND DEVELOPMENT GRANTS.

13 (a) IN GENERAL.—Section 2654(c)(1) of the Public

14 Health Service Act (42 U.S.C. 300ff–54(c)(1)) is amended

15 by striking ‘‘planning grants’’ and all that follows and in16 serting the following: ‘‘planning grants to public and non17 profit private entities for purposes of—

18 ‘‘(A) enabling such entities to provide HIV

19 early intervention services; and

20 ‘‘(B) assisting the entities in expanding

21 their capacity to provide HIV-related health

22 services, including early intervention services, in

23 low-income communities and affected sub24 populations that are underserved with respect

25 to such services (subject to the condition that a
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1 grant pursuant to this subparagraph may not

2 be expended to purchase or improve land, or to

3 purchase, construct, or permanently improve,

4 other than minor remodeling, any building or

5 other facility).’’.

6 (b) AMOUNT; DURATION.—Section 2654(c) of the

7 Public Health Service Act (42 U.S.C. 300ff–54(c)) is fur8 ther amended—

9 (1) by redesignating paragraph (4) as para10 graph (5); and

11 (2) by inserting after paragraph (3) the fol12 lowing:

13 ‘‘(4) AMOUNT AND DURATION OF GRANTS.—

14 ‘‘(A) EARLY INTERVENTION SERVICES.—A

15 grant under paragraph (1)(A) may be made in

16 an amount not to exceed $50,000.

17 ‘‘(B) CAPACITY DEVELOPMENT.—

18 ‘‘(i) AMOUNT.—A grant under para19 graph (1)(B) may be made in an amount

20 not to exceed $150,000.

21 ‘‘(ii) DURATION.—The total duration

22 of a grant under paragraph (1)(B), includ23 ing any renewal, may not exceed 3 years.’’.

24 (c) INCREASE IN LIMITATION.—Section 2654(c)(5)

25 of the Public Health Service Act (42 U.S.C. 300ff–
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1 54(c)(5)), as redesignated by subsection (b), is amended

2 by striking ‘‘1 percent’’ and inserting ‘‘5 percent’’.

3 SEC. 313. AUTHORIZATION OF APPROPRIATIONS.

4 Section 2655 of the Public Health Service Act (42

5 U.S.C. 300ff–55) is amended by striking ‘‘in each of’’ and

6 all that follows and inserting ‘‘for each of the fiscal years

7 2001 through 2005.’’.

8 Subtitle C—General Provisions

9 SEC. 321. PROVISION OF CERTAIN COUNSELING SERVICES.

10 Section 2662(c)(3) of the Public Health Service Act

11 (42 U.S.C. 300ff–62(c)(3)) is amended—

12 (1) in the matter preceding subparagraph (A),

13 by striking ‘‘counseling on—’’ and inserting ‘‘coun14 seling—’’;

15 (2) in each of subparagraphs (A), (B), and (D),

16 by inserting ‘‘on’’ after the subparagraph designa17 tion; and

18 (3) in subparagraph (C)—

19 (A) by striking ‘‘(C) the benefits’’ and in20 serting ‘‘(C)(i) that explains the benefits’’; and

21 (B) by inserting after clause (i) (as des22 ignated by subparagraph (A) of this paragraph)

23 the following clause:

24 ‘‘(ii) that emphasizes it is the duty of in25 fected individuals to disclose their infected sta-
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1 tus to their sexual partners and their partners

2 in the sharing of hypodermic needles; that pro3 vides advice to infected individuals on the man4 ner in which such disclosures can be made; and

5 that emphasizes that it is the continuing duty

6 of the individuals to avoid any behaviors that

7 will expose others to HIV.

8 SEC. 322. ADDITIONAL REQUIRED AGREEMENTS.

9 Section 2664(g) of the Public Health Service Act (42

10 U.S.C. 300ff–64(g)) is amended—

11 (1) in paragraph (3)—

12 (A) by striking ‘‘7.5 percent’’ and inserting

13 ‘‘10 percent’’; and

14 (B) by striking ‘‘and’’ after the semicolon

15 at the end;

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

17 inserting ‘‘; and’’; and

18 (3) by adding at the end the following para19 graph:

20 ‘‘(5) the applicant will provide for the establish21 ment of a quality management program to assess

22 the extent to which medical services funded under

23 this title that are provided to patients are consistent

24 with the most recent Public Health Service guide25 lines for the treatment of HIV disease and related
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1 opportunistic infections and that improvements in

2 the access to and quality of medical services are ad3 dressed.’’.

4 TITLE IV—OTHER PROGRAMS

5 AND ACTIVITIES

6 Subtitle A—Certain Programs for

7 Research, Demonstrations, or

8 Training

9 SEC. 401. GRANTS FOR COORDINATED SERVICES AND AC10 CESS TO RESEARCH FOR WOMEN, INFANTS,

11 CHILDREN, AND YOUTH.

12 Section 2671 of the Public Health Service Act (42

13 U.S.C. 300ff–71) is amended—

14 (1) in subsection (b)—

15 (A) in paragraph (1), by striking subpara16 graphs (C) and (D) and inserting the following:

17 ‘‘(C) The applicant will demonstrate link18 ages to research and how access to such re19 search is being offered to patients.’’; and

20 (B) by striking paragraphs (3) and (4);

21 (2) in subsection (g), by adding at the end the

22 following: ‘‘In addition, the Secretary, in coordina23 tion with the Director of such Institutes, shall exam24 ine the distribution and availability of appropriate

25 HIV-related research projects with respect to grant-
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1 ees under subsection (a) for purposes of enhancing

2 and expanding HIV-related research, especially with3 in communities that are underrepresented with re4 spect to such projects.’’;

5 (3) in subsection (f)—

6 (A) by striking the subsection heading and

7 designation and inserting the following:

8 ‘‘(f) ADMINISTRATION.—

9 ‘‘(1) APPLICATION.—’’; and

10 (B) by adding at the end the following

11 paragraph:

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

13 grantee under this section shall implement a quality

14 management program.’’; and

15 (4) in subsection (j), by striking ‘‘1996 through

16 2000’’ and inserting ‘‘2001 through 2005’’.

17 SEC. 402. AIDS EDUCATION AND TRAINING CENTERS.

18 (a) SCHOOLS; CENTERS.—

19 (1) IN GENERAL.—Section 2692(a)(1) of the

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

21 111(a)(1)) is amended—

22 (A) in subparagraph (A)—

23 (i) by striking ‘‘training’’ and insert24 ing ‘‘to train’’;
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1 (ii) by striking ‘‘and including’’ and

2 inserting ‘‘, including’’; and

3 (iii) by inserting before the semicolon

4 the following: ‘‘, and including (as applica5 ble to the type of health professional in6 volved), prenatal and other gynecological

7 care for women with HIV disease’’;

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

9 ‘‘and’’ after the semicolon at the end;

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

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

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

13 ‘‘(D) to develop protocols for the medical

14 care of women with HIV disease, including pre15 natal and other gynecological care for such

16 women.’’.

17 (2) DISSEMINATION OF TREATMENT GUIDE18 LINES; MEDICAL CONSULTATION ACTIVITIES.—Not

19 later than 90 days after the date of the enactment

20 of this Act, the Secretary of Health and Human

21 Services shall issue and begin implementation of a

22 strategy for the dissemination of HIV treatment in23 formation to health care providers and patients.
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1 (b) DENTAL SCHOOLS.—Section 2692(b) of the Pub2 lic Health Service Act (42 U.S.C. 300ff–111(b)) is

3 amended—

4 (1) by amending paragraph (1) to read as fol5 lows:

6 ‘‘(1) IN GENERAL.—

7 ‘‘(A) GRANTS.—The Secretary may make

8 grants to dental schools and programs de9 scribed in subparagraph (B) to assist such

10 schools and programs with respect to oral

11 health care to patients with HIV disease.

12 ‘‘(B) ELIGIBLE APPLICANTS.—For pur13 poses of this subsection, the dental schools and

14 programs referred to in this subparagraph are

15 dental schools and programs that were de16 scribed in section 777(b)(4)(B) as such section

17 was in effect on the day before the date of the

18 enactment of the Health Professions Education

19 Partnerships Act of 1998 (Public Law 105–

20 392) and in addition dental hygiene programs

21 that are accredited by the Commission on Den22 tal Accreditation.’’;

23 (2) in paragraph (2), by striking

24 ‘‘777(b)(4)(B)’’ and inserting ‘‘the section referred

25 to in paragraph (1)(B)’’; and
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1 (3) by inserting after paragraph (4) the fol2 lowing paragraph:

3 ‘‘(5) COMMUNITY-BASED CARE.—The Secretary

4 may make grants to dental schools and programs de5 scribed in paragraph (1)(B) that partner with com6 munity-based dentists to provide oral health care to

7 patients with HIV disease in unserved areas. Such

8 partnerships shall permit the training of dental stu9 dents and residents and the participation of commu10 nity dentists as adjunct faculty.’’.

11 (c) AUTHORIZATION OF APPROPRIATIONS.—

12 (1) SCHOOLS; CENTERS.—Section 2692(c)(1) of

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

14 111(c)(1)) is amended by striking ‘‘fiscal years 1996

15 through 2000’’ and inserting ‘‘fiscal years 2001

16 through 2005’’.

17 (2) DENTAL SCHOOLS.—Section 2692(c)(2) of

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

19 111(c)(2)) is amended to read as follows:

20 ‘‘(2) DENTAL SCHOOLS.—

21 ‘‘(A) IN GENERAL.—For the purpose of

22 grants under paragraphs (1) through (4) of

23 subsection (b), there are authorized to be ap24 propriated such sums as may be necessary for

25 each of the fiscal years 2001 through 2005.
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1 ‘‘(B) COMMUNITY-BASED CARE.—For the

2 purpose of grants under subsection (b)(5), there

3 are authorized to be appropriated such sums as

4 may be necessary for each of the fiscal years

5 2001 through 2005.’’.

6 Subtitle B—General Provisions in

7 Title XXVI

8 SEC. 411. EVALUATIONS AND REPORTS.

9 Section 2674(c) of the Public Health Service Act (42

10 U.S.C. 300ff–74(c)) is amended by striking ‘‘1991

11 through 1995’’ and inserting ‘‘2001 through 2005’’.

12 SEC. 412. DATA COLLECTION THROUGH CENTERS FOR DIS13 EASE CONTROL AND PREVENTION.

14 Part D of title XXVI of the Public Health Service

15 Act (42 U.S.C. 300ff–71 et seq.) is amended—

16 (1) by redesignating section 2675 as section

17 2675A; and

18 (2) by inserting after section 2674 the following

19 section:

20 ‘‘SEC. 2675. DATA COLLECTION.

21 ‘‘For the purpose of collecting and providing data for

22 program planning and evaluation activities under this

23 title, there are authorized to be appropriated to the Sec24 retary (acting through the Director of the Centers for Dis25 ease Control and Prevention) such sums as may be nec-
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1 essary for each of the fiscal years 2001 through 2005.

2 Such authorization of appropriations is in addition to

3 other authorizations of appropriations that are available

4 for such purpose.’’.

5 SEC. 413. COORDINATION.

6 Section 2675A of the Public Health Service Act, as

7 redesignated by section 412 of this Act, is amended—

8 (1) by amending subsection (a) to read as fol9 lows:

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

11 that the Health Resources and Services Administration,

12 the Centers for Disease Control and Prevention, the Sub13 stance Abuse and Mental Health Services Administration,

14 and the Health Care Financing Administration coordinate

15 the planning, funding, and implementation of Federal

16 HIV programs to enhance the continuity of care and pre17 vention services for individuals with HIV disease or those

18 at risk of such disease. The Secretary shall consult with

19 other Federal agencies, including the Department of Vet20 erans Affairs, as needed and utilize planning information

21 submitted to such agencies by the States and entities eligi22 ble for support.’’;

23 (2) by redesignating subsections (b) and (c) as

24 subsections (c) and (d), respectively;
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1 (3) by inserting after subsection (b) the fol2 lowing subsection:

3 ‘‘(b) REPORT.—The Secretary shall biennially pre4 pare and submit to the appropriate committees of the Con5 gress a report concerning the coordination efforts at the

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

7 including a description of Federal barriers to HIV pro8 gram integration and a strategy for eliminating such bar9 riers and enhancing the continuity of care and prevention

10 services for individuals with HIV disease or those at risk

11 of such disease.’’; and

12 (4) in each of subsections (c) and (d) (as redes13 ignated by paragraph (2) of this section), by insert14 ing ‘‘and prevention services’’ after ‘‘continuity of

15 care’’ each place such term appears.

16 SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH

17 HIV DISEASE.

18 Section 2675A of the Public Health Service Act, as

19 amended by section 413(2) of this Act, is amended by add20 ing at the end the following subsection:

21 ‘‘(e) RECOMMENDATIONS REGARDING RELEASE OF

22 PRISONERS.—After consultation with the Attorney Gen23 eral and the Director of the Bureau of Prisons, with

24 States, with eligible areas under part A, and with entities

25 that receive amounts from grants under part A or B, the
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1 Secretary, consistent with the coordination required in

2 subsection (a), shall develop a plan for the medical case

3 management of and the provision of support services to

4 individuals who were Federal or State prisoners and had

5 HIV disease as of the date on which the individuals were

6 released from the custody of the penal system. The Sec7 retary shall submit the plan to the Congress not later than

8 2 years after the date of the enactment of the Ryan White

9 CARE Act Amendments of 2000.’’.

10 SEC. 415. AUDITS.

11 Part D of title XXVI of the Public Health Service

12 Act, as amended by section 412 of this Act, is amended

13 by inserting after section 2675A the following section:

14 ‘‘SEC. 2675B. AUDITS.

15 ‘‘For fiscal year 2002 and subsequent fiscal years,

16 the Secretary may reduce the amounts of grants under

17 this title to a State or political subdivision of a State for

18 a fiscal year if, with respect to such grants for the second

19 preceding fiscal year, the State or subdivision fails to pre20 pare audits in accordance with the procedures of section

21 7502 of title 31, United States Code. The Secretary shall

22 annually select representative samples of such audits, pre23 pare summaries of the selected audits, and submit the

24 summaries to the Congress.’’.
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1 SEC. 416. ADMINISTRATIVE SIMPLIFICATION.

2 Part D of title XXVI of the Public Health Service

3 Act, as amended by section 415 of this Act, is amended

4 by inserting after section 2675B the following section:

5 ‘‘SEC. 2675C. ADMINISTRATIVE SIMPLIFICATION REGARD6 ING PARTS A AND B.

7 ‘‘(a) COORDINATED DISBURSEMENT.—After con8 sultation with the States, with eligible areas under part

9 A, and with entities that receive amounts from grants

10 under part A or B, the Secretary shall develop a plan for

11 coordinating the disbursement of appropriations for

12 grants under part A with the disbursement of appropria13 tions for grants under part B in order to assist grantees

14 and other recipients of amounts from such grants in com15 plying with the requirements of such parts. The Secretary

16 shall submit the plan to the Congress not later than 18

17 months after the date of the enactment of the Ryan White

18 CARE Act Amendments of 2000. Not later than 2 years

19 after the date on which the plan is so submitted, the Sec20 retary shall complete the implementation of the plan, not21 withstanding any provision of this title that is inconsistent

22 with the plan.

23 ‘‘(b) BIENNIAL APPLICATIONS.—After consultation

24 with the States, with eligible areas under part A, and with

25 entities that receive amounts from grants under part A

26 or B, the Secretary shall make a determination of whether
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1 the administration of parts A and B by the Secretary, and

2 the efficiency of grantees under such parts in complying

3 with the requirements of such parts, would be improved

4 by requiring that applications for grants under such parts

5 be submitted biennially rather than annually. The Sec6 retary shall submit such determination to the Congress

7 not later than 2 years after the date of the enactment of

8 the Ryan White CARE Act Amendments of 2000.

9 ‘‘(c) APPLICATION SIMPLIFICATION.—After consulta10 tion with the States, with eligible areas under part A, and

11 with entities that receive amounts from grants under part

12 A or B, the Secretary shall develop a plan for simplifying

13 the process for applications under parts A and B. The Sec14 retary shall submit the plan to the Congress not later than

15 18 months after the date of the enactment of the Ryan

16 White CARE Act Amendments of 2000. Not later than

17 2 years after the date on which the plan is so submitted,

18 the Secretary shall complete the implementation of the

19 plan, notwithstanding any provision of this title that is

20 inconsistent with the plan.’’.

21 SEC. 417. AUTHORIZATION OF APPROPRIATIONS FOR

22 PARTS A AND B.

23 Section 2677 of the Public Health Service Act (42

24 U.S.C. 300ff–77) is amended to read as follows:
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1 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

2 ‘‘(a) PART A.—For the purpose of carrying out part

3 A, there are authorized to be appropriated such sums as

4 may be necessary for each of the fiscal years 2001 through

5 2005.

6 ‘‘(b) PART B.—For the purpose of carrying out part

7 B, there are authorized to be appropriated such sums as

8 may be necessary for each of the fiscal years 2001 through

9 2005.’’.

10 TITLE V—GENERAL PROVISIONS

11 SEC. 501. STUDIES BY INSTITUTE OF MEDICINE.

12 (a) STATE SURVEILLANCE SYSTEMS ON PREVA13 LENCE OF HIV.—The Secretary of Health and Human

14 Services (referred to in this section as the ‘‘Secretary’’)

15 shall request the Institute of Medicine to enter into an

16 agreement with the Secretary under which such Institute

17 conducts a study to provide the following:

18 (1) A determination of whether the surveillance

19 system of each of the States regarding the human

20 immunodeficiency virus provides for the reporting of

21 cases of infection with the virus in a manner that is

22 sufficient to provide adequate and reliable informa23 tion on the number of such cases and the demo24 graphic characteristics of such cases, both for the

25 State in general and for specific geographic areas in

26 the State.
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1 (2) A determination of whether such informa2 tion is sufficiently accurate for purposes of formula

3 grants under parts A and B of title XXVI of the

4 Public Health Service Act.

5 (3) With respect to any State whose surveil6 lance system does not provide adequate and reliable

7 information on cases of infection with the virus, rec8 ommendations regarding the manner in which the

9 State can improve the system.

10 (b) RELATIONSHIP BETWEEN EPIDEMIOLOGICAL

11 MEASURES AND HEALTH CARE FOR CERTAIN INDIVID12 UALS WITH HIV DISEASE.—

13 (1) IN GENERAL.—The Secretary shall request

14 the Institute of Medicine to enter into an agreement

15 with the Secretary under which such Institute con16 ducts a study concerning the appropriate epidemio17 logical measures and their relationship to the financ18 ing and delivery of primary care and health-related

19 support services for low-income, uninsured, and

20 under-insured individuals with HIV disease.

21 (2) ISSUES TO BE CONSIDERED.—The Sec22 retary shall ensure that the study under paragraph

23 (1) considers the following:

24 (A) The availability and utility of health

25 outcomes measures and data for HIV primary
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1 care and support services and the extent to

2 which those measures and data could be used to

3 measure the quality of such funded services.

4 (B) The effectiveness and efficiency of

5 service delivery (including the quality of serv6 ices, health outcomes, and resource use) within

7 the context of a changing health care and

8 therapeutic environment, as well as the chang9 ing epidemiology of the epidemic, including de10 termining the actual costs, potential savings,

11 and overall financial impact of modifying the

12 program under title XIX of the Social Security

13 Act to establish eligibility for medical assistance

14 under such title on the basis of infection with

15 the human immunodeficiency virus rather than

16 providing such assistance only if the infection

17 has progressed to acquired immune deficiency

18 syndrome.

19 (C) Existing and needed epidemiological

20 data and other analytic tools for resource plan21 ning and allocation decisions, specifically for es22 timating severity of need of a community and

23 the relationship to the allocations process.

24 (D) Other factors determined to be rel25 evant to assessing an individual’s or commu-
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1 nity’s ability to gain and sustain access to qual2 ity HIV services.

3 (c) OTHER ENTITIES.—If the Institute of Medicine

4 declines to conduct a study under this section, the Sec5 retary shall enter into an agreement with another appro6 priate public or nonprofit private entity to conduct the

7 study.

8 (d) REPORT.—The Secretary shall ensure that—

9 (1) not later than 3 years after the date of the

10 enactment of this Act, the study required in sub11 section (a) is completed and a report describing the

12 findings made in the study is submitted to the ap13 propriate committees of the Congress; and

14 (2) not later than 2 years after the date of the

15 enactment of this Act, the study required in sub16 section (b) is completed and a report describing the

17 findings made in the study is submitted to such

18 committees.

19 SEC. 502. DEVELOPMENT OF RAPID HIV TEST.

20 (a) EXPANSION, INTENSIFICATION, AND COORDINA21 TION OF RESEARCH AND OTHER ACTIVITIES.—

22 (1) IN GENERAL.—The Director of NIH shall

23 expand, intensify, and coordinate research and other

24 activities of the National Institutes of Health with

25 respect to the development of reliable and affordable
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1 tests for HIV disease that can rapidly be adminis2 tered and whose results can rapidly be obtained (in

3 this section referred to a ‘‘rapid HIV test’’).

4 (2) REPORT TO CONGRESS.—The Director of

5 NIH shall periodically submit to the appropriate

6 committees of Congress a report describing the re7 search and other activities conducted or supported

8 under paragraph (1).

9 (3) AUTHORIZATION OF APPROPRIATIONS.—For

10 the purpose of carrying out this subsection, there

11 are authorized to be appropriated such sums as may

12 be necessary for each of the fiscal years 2001

13 through 2005.

14 (b) PREMARKET REVIEW OF RAPID HIV TESTS.—

15 (1) IN GENERAL.—Not later than 90 days after

16 the date of the enactment of this Act, the Secretary,

17 in consultation with the Director of the Centers for

18 Disease Control and Prevention and the Commis19 sioner of Food and Drugs, shall submit to the ap20 propriate committees of the Congress a report de21 scribing the progress made towards, and barriers to,

22 the premarket review and commercial distribution of

23 rapid HIV tests. The report shall—

24 (A) assess the public health need for and

25 public health benefits of rapid HIV tests, in-
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HR 4807 PCS

1 cluding the minimization of false positive re2 sults through the availability of multiple rapid

3 HIV tests;

4 (B) make recommendations regarding the

5 need for the expedited review of rapid HIV test

6 applications submitted to the Center for Bio7 logics Evaluation and Research and, if such rec8 ommendations are favorable, specify criteria

9 and procedures for such expedited review; and

10 (C) specify whether the barriers to the pre11 market review of rapid HIV tests include the

12 unnecessary application of requirements—

13 (i) necessary to ensure the efficacy of

14 devices for donor screening to rapid HIV

15 tests intended for use in other screening

16 situations; or

17 (ii) for identifying antibodies to HIV

18 subtypes of rare incidence in the United

19 States to rapid HIV tests intended for use

20 in screening situations other than donor

21 screening.

22 (c) GUIDELINES OF CENTERS FOR DISEASE CON23 TROL AND PREVENTION.—Promptly after commercial dis24 tribution of a rapid HIV test begins, the Secretary, acting

25 through the Director of the Centers for Disease Control
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HR 4807 PCS

1 and Prevention, shall establish or update guidelines that

2 include recommendations for States, hospitals, and other

3 appropriate entities regarding the ready availability of

4 such tests for administration to pregnant women who are

5 in labor or in the late stage of pregnancy and whose HIV

6 status is not known to the attending obstetrician.

7 TITLE VI—EFFECTIVE DATE

8 SEC. 601. EFFECTIVE DATE.

9 This Act and the amendments made by this Act take

10 effect October 1, 2000, or upon the date of the enactment

11 of this Act, whichever occurs later.

Passed the House of Representatives July 26 (legislative day, July 25), 2000.

Attest: JEFF TRANDAHL,

Clerk.
Calendar No. 716

106TH CONGRESS

2D SESSION H. R. 4807

AN ACT

To amend the Public Health Service Act to revise

and extend programs established under the RyanWhite Comprehensive AIDS Resources Emergency Act of 1990, and for other purposes.

JULY 26, 2000

Received; read twice and placed on the calendar