I

106TH CONGRESS

2D SESSION H. R. 4807

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.

IN THE HOUSE OF REPRESENTATIVES

JUNE 29, 2000

Mr. COBURN (for himself, Mr. WAXMAN, Mr. BILIRAKIS, Mr. GREENWOOD,

Mr. BROWN of Ohio, Mr. STUPAK, Mr. ARMEY, Mr. BILBRAY, Mr. NORWOOD, Mr. COX, Mr. ROGAN, Mr. BARRETT of Wisconsin, Mrs. BONO,

Mr. FOLEY, Mr. SHAYS, Mr. HINCHEY, Mr. WEYGAND, Mr. DEUTSCH,

Mr. BURR of North Carolina, Mrs. MORELLA, Mr. WELDON of Florida,

Mr. SHADEGG, and Mr. STEARNS) introduced the following bill; which

was referred to the Committee on Commerce

A BILL

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. Authorization of appropriations; 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

Sec. 301. Repeal of program.
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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.

Sec. 503. Program management.

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), 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 three years, and had

21 HIV disease as of the date on which the indi22 viduals 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. For purposes of the preceding sentence,

14 an individual shall be considered to be re15 ceiving such services if the individual is a

16 parent of, or a caregiver for, a minor child

17 who is receiving such services.

18 ‘‘(ii) With respect to membership on

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

20 construed as having any effect on entities

21 that receive funds from grants under any

22 of parts B through F but do not receive

23 funds from grants under section 2601(a),

24 on officers or employees of such entities, or
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1 on individuals who represent such enti2 ties.’’.

3 SEC. 102. DUTIES OF COUNCILS.

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

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

6 amended—

7 (1) by redesignating subparagraphs (A) through

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

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

10 redesignated) the following subparagraphs:

11 ‘‘(A) determine the size and demographics

12 of the population of individuals with HIV dis13 ease;

14 ‘‘(B) determine the needs of such popu15 lation, with particular attention to—

16 ‘‘(i) individuals with HIV disease who

17 are not receiving HIV-related services; and

18 ‘‘(ii) disparities in access and services

19 among affected subpopulations and histori20 cally underserved communities;’’;

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

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

23 following:

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

2 the needs of such population (as deter3 mined under subparagraph (B));

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

5 effectiveness and outcome effectiveness of

6 proposed strategies and interventions, to

7 the extent that data are reasonably avail8 able;

9 ‘‘(iii) priorities of the communities

10 with HIV disease for whom the services

11 are intended;

12 ‘‘(iv) availability of other govern13 mental and nongovernmental resources to

14 provide HIV-related services to individuals

15 and families with HIV disease, including

16 the State plan under title XIX of the So17 cial Security Act (relating to the Medicaid

18 program) and the program under title XXI

19 of such Act (relating to the program for

20 State children’s health insurance); and

21 ‘‘(v) capacity development needs re22 sulting from disparities in the availability

23 of HIV-related services in historically un24 derserved communities;’’;
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1 (4) in subparagraph (D) (as so redesignated),

2 by amending the subparagraph to read as follows:

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

4 organization and delivery of health and support

5 services described in section 2604 that—

6 ‘‘(i) includes a strategy for identifying

7 individuals with HIV disease who are not

8 receiving such services and for informing

9 the individuals of and enabling the individ10 uals to utilize the services, giving par11 ticular attention to eliminating disparities

12 in access and services among affected sub13 populations and historically underserved

14 communities, and including discrete goals,

15 a timetable, and an appropriate allocation

16 of funds;

17 ‘‘(ii) includes a strategy to coordinate

18 the provision of such services with pro19 grams for HIV prevention and for the pre20 vention and treatment of substance abuse,

21 including programs that provide com22 prehensive treatment services for such

23 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).’’.

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

11 Service Act (42 U.S.C. 300ff–12(b)) is amended by adding

12 at the end the following subsection:

13 ‘‘(d) TRAINING GUIDANCE AND MATERIALS.—The

14 Secretary shall provide to each chief elected official receiv15 ing a grant under 2601(a) guidelines and materials for

16 training members of the planning council under paragraph

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

18 SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVI19 SIONS.

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

21 U.S.C. 300ff–12(b)) is amended—

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

23 (C); and

24 (2) by adding at the end the following para25 graph:
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1 ‘‘(7) PUBLIC DELIBERATIONS.—With respect to

2 a planning council under paragraph (1), the fol3 lowing applies:

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

5 by an employee of the grantee under section

6 2601(a).

7 ‘‘(B) In accordance with criteria estab8 lished by the Secretary:

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

10 be open to the public and shall be held

11 only after adequate notice to the public.

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

13 minutes, agenda, or other documents which

14 were made available to or prepared for or

15 by the council shall be available for public

16 inspection and copying at a single location.

17 ‘‘(iii) Detailed minutes of each meet18 ing of the council shall be kept. The accu19 racy of all minutes shall be certified to by

20 the chair of the council.

21 ‘‘(iv) This subparagraph does not

22 apply to any disclosure of information of a

23 personal nature that would constitute a

24 clearly unwarranted invasion of personal
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1 privacy, including any disclosure of medical

2 information or personnel matters.’’.

3 Subtitle B—Type and Distribution

4 of Grants

5 SEC. 111. FORMULA GRANTS.

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

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

8 13(a)(2)) is amended in the first sentence by striking ‘‘for

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

10 ‘‘for a fiscal year’’.

11 (b) AMOUNT OF GRANT; ESTIMATE OF LIVING

12 CASES.—

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

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

15 13(a)(3)) is amended—

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

17 before the semicolon the following: ‘‘, except

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

19 made pursuant to this paragraph for fiscal year

20 2005 and subsequent fiscal years, the cases

21 counted for each 12-month period beginning on

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

23 disease (as reported to and confirmed by such

24 Director) rather than cases of acquired immune

25 deficiency syndrome’’; and
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1 (B) in subparagraph (C), in the matter

2 after and below clause (ii)(X)—

3 (i) in the first sentence, by inserting

4 before the period the following: ‘‘, and

5 shall be reported to the congressional com6 mittees of jurisdiction’’; and

7 (ii) by adding at the end the following

8 sentence: ‘‘Updates shall as applicable take

9 into account the counting of cases of HIV

10 disease pursuant to clause (i).’’

11 (2) DETERMINATION OF SECRETARY REGARD12 ING DATA ON HIV CASES.—Section 2603(a)(3)) of

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

14 13(a)(3)) is amended—

15 (A) by redesignating subparagraph (D) as

16 subparagraph (E); and

17 (B) by inserting after subparagraph (C)

18 the following subparagraph:

19 ‘‘(D) DETERMINATION OF SECRETARY RE20 GARDING DATA ON HIV CASES.—

21 ‘‘(i) IN GENERAL.—Not later than

22 July 1, 2004, the Secretary shall deter23 mine whether there is data on cases of

24 HIV disease from all eligible areas (re25 ported to and confirmed by the Director of
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1 the Centers for Disease Control and Pre2 vention) sufficiently accurate and reliable

3 for use for purposes of subparagraph

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

5 the Secretary shall take into consideration

6 the findings of the study under section

7 501(b) of the Ryan White CARE Act

8 Amendments of 2000 (relating to the rela9 tionship between epidemiological measures

10 and health care for certain individuals with

11 HIV disease), the fiscal impact of the use

12 of such data, the impact of the use of such

13 data on the organization and delivery of

14 HIV-related services in eligible areas, and

15 the fiscal impact of not using such data.

16 ‘‘(ii) EFFECT OF ADVERSE DETER17 MINATION.—If under clause (i) the Sec18 retary determines that data on cases of

19 HIV disease is not sufficiently accurate

20 and reliable for use for purposes of sub21 paragraph (C)(i), then notwithstanding

22 such subparagraph, for any fiscal year

23 prior to fiscal year 2007 the references in

24 such subparagraph to cases of HIV disease

25 do not have any legal effect.
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1 ‘‘(iii) GRANTS AND TECHNICAL AS2 SISTANCE REGARDING COUNTING OF HIV

3 CASES.—Of the amounts appropriated

4 under section 2675 for a fiscal year, the

5 Secretary shall reserve amounts to make

6 grants and provide technical assistance to

7 States and eligible areas with respect to

8 obtaining data on cases of HIV disease to

9 ensure that data on such cases is available

10 from all States and eligible areas as soon

11 as is practicable but not later than the be12 ginning of fiscal year 2007.’’.

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

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

15 is amended to read as follows:

16 ‘‘(4) INCREASES IN GRANT.—

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

18 a protection period for an eligible area, the Sec19 retary shall increase the amount of the grant

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

21 ensure that—

22 ‘‘(i) for the first fiscal year in the pro23 tection period, the grant is not less than

24 98 percent of the amount of the grant

25 made for the eligible area pursuant to such
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1 paragraph for the base year for the protec2 tion period;

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

4 period, the grant is not less than 95.7 per5 cent of the amount of such base year

6 grant;

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

8 period, the grant is not less than 91.1 per9 cent of the amount of the base year grant;

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

11 period, the grant is not less than 84.2 per12 cent of the amount of the base year grant;

13 and

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

15 year in such period, the grant is not less

16 than 75 percent of the amount of the base

17 year grant.

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

19 With respect to grants made pursuant to para20 graph (2) for an eligible area:

21 ‘‘(i) The base year for a protection pe22 riod is the fiscal year preceding the trigger

23 grant-reduction year.

24 ‘‘(ii) The first trigger grant-reduction

25 year is the first fiscal year (after fiscal
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1 year 2000) for which the grant for the

2 area is less than the grant for the area for

3 the preceding fiscal year.

4 ‘‘(iii) A protection period begins with

5 the trigger grant-reduction year and con6 tinues until the beginning of the first fiscal

7 year for which the amount of the grant for

8 the area equals or exceeds the amount of

9 the grant for the base year for the period.

10 ‘‘(iv) Any subsequent trigger grant-re11 duction year is the first fiscal year, after

12 the end of the preceding protection period,

13 for which the amount of the grant is less

14 than the amount of the grant for the pre15 ceding fiscal year.’’.

16 SEC. 112. SUPPLEMENTAL GRANTS.

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

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

19 amended—

20 (1) in the heading for the paragraph, by strik21 ing ‘‘DEFINITION’’ and inserting ‘‘AMOUNT OF

22 GRANT’’;

23 (2) by redesignating subparagraphs (A) through

24 (C) as subparagraphs (B) through (D), respectively;
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1 (3) by inserting before subparagraph (B) (as so

2 redesignated) the following subparagraph:

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

4 grant made for purposes of this subsection shall

5 be determined by the Secretary based on a

6 weighting of factors under paragraph (1), with

7 severe need under subparagraph (B) of such

8 paragraph counting one-third.’’;

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

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

11 end;

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

13 and inserting a semicolon; and

14 (C) by adding at the end the following

15 clauses:

16 ‘‘(iv) the current prevalence of HIV

17 disease;

18 ‘‘(v) an increasing need for HIV-re19 lated services, including relative rates of

20 increase in the number of cases of HIV

21 disease; as

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

23 determined under section 2602(b)(4).’’;

24 (5) in subparagraph (C) (as so redesignated)—
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1 (A) by striking ‘‘subparagraph (A)’’ each

2 place such term appears and inserting ‘‘sub3 paragraph (B)’’’;

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

5 years after the date of enactment of this para6 graph’’ and inserting ‘‘18 months after the date

7 of the enactment of the Ryan White CARE Act

8 Amendments of 2000’’; and

9 (C) by inserting after the second sentence

10 the following sentence: ‘‘Such a mechanism

11 shall be modified to reflect the findings of the

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

13 CARE Act Amendments of 2000 (relating to

14 the relationship between epidemiological meas15 ures and health care for certain individuals with

16 HIV disease).’’; and

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

18 by striking ‘‘subparagraph (B)’’ and inserting ‘‘sub19 paragraph (C)’’’.

20 (b) CONFORMING AMENDMENT.—Section 2603(b) of

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

22 amended—

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

24 (2) by redesignating paragraph (5) as para25 graph (4).
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1 Subtitle C—Other Provisions

2 SEC. 121. USE OF AMOUNTS.

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

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

5 amended—

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

7 by striking ‘‘HIV-related—’’ and inserting ‘‘HIV-re8 lated services, as follows:’’;

9 (2) in subparagraph (A)—

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

11 follows through ‘‘substance abuse treatment

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

13 and ambulatory health services, including sub14 stance abuse treatment,’’; and

15 (B) by striking ‘‘; and’’ and inserting a pe16 riod;

17 (3) in subparagraph (B), by striking ‘‘(B) inpa18 tient case management’’ and inserting ‘‘(C) Inpa19 tient case management’’;

20 (4) by inserting after subparagraph (A) the fol21 lowing subparagraph:

22 ‘‘(B) Outpatient and ambulatory support

23 services (including case management), to the

24 extent that such services facilitate, support, or

25 sustain the delivery, or benefits of health serv-
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1 ices for individuals and families with HIV dis2 ease.’’; and

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

4 ‘‘(D) Outreach activities that are intended

5 to identify individuals with HIV disease who are

6 not receiving HIV-related services, and that

7 are—

8 ‘‘(i) necessary to implement the strat9 egy under section 2602(b)(4)(D);

10 ‘‘(ii) conducted in a manner consistent

11 with the requirement under section

12 2605(a)(3); and

13 ‘‘(iii) supplement, and do not sup14 plant, such activities that are carried out

15 with amounts appropriated under section

16 317.’’.

17 (b) ADDITIONAL PURPOSES.—Section 2604(b) (42

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

19 amended—

20 (1) by redesignating paragraph (3) as para21 graph (4);

22 (2) by inserting after paragraph (2) the fol23 lowing:

24 ‘‘(3) EARLY INTERVENTION SERVICES.—
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1 ‘‘(A) IN GENERAL.—The purposes for

2 which a grant under section 2601 may be used

3 include providing to individuals with HIV dis4 ease early intervention services described in sec5 tion 2651(b)(2) (including referrals under sub6 paragraph (C) of such section), subject to sub7 paragraph (B). The entities through which such

8 services may be provided under the grant in9 clude public health departments, emergency

10 rooms, substance abuse and mental health

11 treatment programs, detoxification centers, de12 tention facilities, clinics regarding sexually

13 transmitted diseases, homeless shelters, HIV

14 disease counseling and testing sites, health care

15 points of entry specified by States or eligible

16 areas, federally qualified health centers, and en17 tities described in section 2652(a).

18 ‘‘(B) CONDITIONS.—With respect to an en19 tity that proposes to provide early intervention

20 services under subparagraph (A), such subpara21 graph applies only if the entity demonstrates to

22 the satisfaction of the chief elected official for

23 the eligible area involved that—

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

25 otherwise inadequate for the early inter-
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1 vention services the entity proposes to pro2 vide; and

3 ‘‘(ii) the entity will expend funds pur4 suant to such subparagraph to supplement

5 and not supplant other funds available to

6 the entity for the provision of early inter7 vention services for the fiscal year in8 volved.’’; and

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

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

11 term appears;

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

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

14 amended—

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

16 as subsections (d) through (g), respectively; and

17 (2) by inserting after subsection (b) the fol18 lowing:

19 ‘‘(c) QUALITY MANAGEMENT.—

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

21 of an eligible area that receives a grant under this

22 part shall provide for the establishment of a quality

23 management program to assess the extent to which

24 HIV health services provided to patients under the

25 grant are consistent with the most recent Public
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1 Health Service guidelines for the treatment of HIV

2 disease and related opportunistic infection, and as

3 applicable, to develop strategies for ensuring that

4 such services are consistent with the guidelines.

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

6 under a grant awarded under this part for a fiscal

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

8 (in addition to amounts to which section 2604(e)(1)

9 applies) use for activities associated with the quality

10 management program required in paragraph (1) not

11 more than the lesser of—

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

13 the grant; or

14 ‘‘(B) $3,000,000.’’.

15 SEC. 122. APPLICATION.

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

17 U.S.C. 300ff–15(a)) is amended—

18 (1) by redesignating paragraphs (3) through

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

20 (2) by inserting after paragraph (2) the fol21 lowing paragraph:

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

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

24 will maintain relationships with appropriate entities
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1 in the area, including entities described in section

2 2604(b)(3);’’.

3 SEC. 123. REVIEW OF ADMINISTRATIVE COSTS AND COM4 PENSATION.

5 Each chief elected official of an eligible area (as de6 fined in section 2607 of the Public Health Service Act)

7 shall ensure that, not later than one year after the date

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

9 eligible area—

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

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

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

13 of the Public Health Service Act have from their

14 overall budget expended amounts for administrative

15 costs (including financial compensation and bene16 fits), expressed as a proportion and indicating the

17 growth in such expenditures, including a statement

18 of the average amount expended for such costs per

19 client served and the average amount expended for

20 such costs per client served in providing HIV-related

21 services; and

22 (2) makes a determination of whether the fi23 nancial compensation of any officers or employees of

24 such entities exceeds that of the chief elected official

25 of the eligible area.
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1 TITLE II—CARE GRANT

2 PROGRAM

3 Subtitle A—General Grant

4 Provisions

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

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

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

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

9 SEC. 202. USE OF GRANTS.

10 Section 2612 of the Public Health Service Act (42

11 U.S.C. 300ff–22) is amended—

12 (1) by striking ‘‘A State may use’’ and insert13 ing ‘‘(a) IN GENERAL.—A State may use’’; and

14 (2) by adding at the end the following sub15 sections:

16 ‘‘(b) SUPPORT SERVICES; OUTREACH.—The pur17 poses for which a grant under this part may be used in18 clude delivering or enhancing the following:

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

20 (including case management) to the extent that such

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

22 benefits of health services for individuals and fami23 lies with HIV disease.
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1 ‘‘(2) Outreach activities that are intended to

2 identify individuals with HIV disease who are not re3 ceiving HIV-related services, and that are—

4 ‘‘(A) necessary to implement the strategy

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

6 ‘‘(B) conducted in a manner consistent

7 with the requirement under section

8 2617(b)(6)(G); and

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

10 such activities that are carried out with

11 amounts appropriated under section 317.’’.

12 ‘‘(c) EARLY INTERVENTION SERVICES.—

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

14 grant under this part may be used include providing

15 to individuals with HIV disease early intervention

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

17 referrals under subparagraph (C) of such section),

18 subject to paragraph (2). The entities through which

19 such services may be provided under the grant in20 clude public health departments, emergency rooms,

21 substance abuse and mental health treatment pro22 grams, detoxification centers, detention facilities,

23 clinics regarding sexually transmitted diseases,

24 homeless shelters, HIV disease counseling and test25 ing sites, health care points of entry specified by
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1 States or eligible areas, federally qualified health

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

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

4 that proposes to provide early intervention services

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

6 the entity demonstrates to the satisfaction of the

7 State area involved that—

8 ‘‘(A) Federal, State, or local funds are oth9 erwise inadequate for the early intervention

10 services the entity proposes to provide; and

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

12 to such paragraph to supplement and not sup13 plant other funds available to the entity for the

14 provision of early intervention services for the

15 fiscal year involved.

16 ‘‘(d) QUALITY MANAGEMENT.—

17 ‘‘(1) REQUIREMENT.—Each State that receives

18 a grant under this part shall provide for the estab19 lishment of a quality management program to assess

20 the extent to which HIV health services provided to

21 patients under the grant are consistent with the

22 most recent Public Health Service guidelines for the

23 treatment of HIV disease and related opportunistic

24 infection, and as applicable, to develop strategies for
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1 ensuring that such services are consistent with the

2 guidelines.

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

4 under a grant awarded under this part for a fiscal

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

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

7 associated with the quality management program re8 quired in paragraph (1) not more than the lesser

9 of—

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

11 the grant; or

12 ‘‘(B) $3,000,000.’’.

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

14 Section 2613 of the Public Health Service Act (42

15 U.S.C. 300ff–23) is amended—

16 (1) in subsection (b)(1)—

17 (A) in subparagraph (A), by inserting be18 fore the semicolon the following: ‘‘, particularly

19 those experiencing disparities in access and

20 services and those who reside in historically un21 derserved communities’’; and

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

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

24 consistent with the comprehensive plan under

25 2617(b)(4) and’’; and
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1 (2) in subsection (c)(1)—

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

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

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

5 period and inserting ‘‘; and’’; and

6 (C) by adding at the end the following sub7 paragraph:

8 ‘‘(F) demonstrates that adequate planning

9 occurred to address disparities in access and

10 services and historically underserved commu11 nities.’’.

12 SEC. 204. PROVISION OF TREATMENTS.

13 Section 2616 of the Public Health Service Act (42

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

15 following subsection:

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

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

18 under this part to provide the therapeutics described in

19 such subsection by paying on behalf of individuals with

20 HIV disease the costs of purchasing or maintaining health

21 insurance or plans whose coverage includes a full range

22 of such therapeutics and appropriate primary care serv23 ices.’’.
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1 SEC. 205. STATE APPLICATION.

2 (a) DETERMINATION OF SIZE AND NEEDS OF POPU3 LATION; COMPREHENSIVE PLAN.—Section 2617(b) of the

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

5 amended—

6 (1) by redesignating paragraphs (2) through

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

8 (2) by inserting after paragraph (1) the fol9 lowing paragraphs:

10 ‘‘(2) a determination of the size and demo11 graphics of the population of individuals with HIV

12 disease in the State;

13 ‘‘(3) a determination of the needs of such popu14 lation, with particular attention to—

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

16 not receiving HIV-related services; and

17 ‘‘(B) disparities in access and services

18 among affected subpopulations and historically

19 underserved communities;’’; and

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

21 (A) by striking ‘‘comprehensive plan for

22 the organization’’ and inserting ‘‘comprehensive

23 plan that describes the organization’’;

24 (B) by striking ‘‘, including—’’ and insert25 ing ‘‘, and that—’’;
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1 (C) by redesignating subparagraphs (A)

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

3 respectively;

4 (D) by inserting before subparagraph (C)

5 the following subparagraphs:

6 ‘‘(A) establishes priorities for the allocation

7 of funds within the State based on—

8 ‘‘(i) size and demographics of the pop9 ulation of individuals with HIV disease (as

10 determined under paragraph (2)) and the

11 needs of such population (as determined

12 under paragraph (3));

13 ‘‘(ii) availability of other governmental

14 and nongovernmental resources to provide

15 HIV-related services to individuals and

16 families with HIV disease;

17 ‘‘(iii) capacity development needs re18 sulting from disparities in the availability

19 of HIV-related services in historically un20 derserved communities and rural commu21 nities; and

22 ‘‘(iv) the efficiency of the administra23 tive mechanism of the State for rapidly al24 locating funds to the areas of greatest need

25 within the State;
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1 ‘‘(B) includes a strategy for identifying in2 dividuals with HIV disease who are not receiv3 ing such services and for informing the individ4 uals of and enabling the individuals to utilize

5 the services, giving particular attention to elimi6 nating disparities in access and services among

7 affected subpopulations and historically under8 served communities, and including discrete

9 goals, a timetable, and an appropriate alloca10 tion of funds;

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

12 provision of such services with programs for

13 HIV prevention and for the prevention and

14 treatment of substance abuse, including pro15 grams that provide comprehensive treatment

16 services for such abuse;’’;

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

18 by subparagraph (C) of this paragraph), by in19 serting ‘‘describes’’ before ‘‘the services and ac20 tivities’’;

21 (F) in subparagraph (E) (as so redesig22 nated), by inserting ‘‘provides’’ before ‘‘a de23 scription’’; and
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•HR 4807 IH

1 (G) in subparagraph (F) (as so redesig2 nated), by inserting ‘‘provides’’ before ‘‘a de3 scription’’.

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

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

6 of this section, is amended—

7 (1) in paragraph (5), by striking ‘‘HIV’’ and in8 serting ‘‘HIV disease’’; and

9 (2) in paragraph (6), by amending subpara10 graph (A) to read as follows:

11 ‘‘(A) the public health agency that is ad12 ministering the grant for the State engages in

13 a public advisory planning process, including

14 public hearings, that includes the participants

15 under paragraph (5) in developing the com16 prehensive plan under paragraph (4) and com17 menting on the implementation of such plan;’’.

18 (c) HEALTH CARE RELATIONSHIPS.—Section

19 2617(b) of the Public Health Service Act, as amended by

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

21 (6)—

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

23 the end;

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

25 and inserting ‘‘; and’’; and
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•HR 4807 IH

1 (3) by adding at the end the following subpara2 graph:

3 ‘‘(G) entities within areas in which activi4 ties under the grant are carried out will main5 tain relationships with appropriate entities in

6 the area, including entities described in section

7 2612(c);’’.

8 SEC. 206. DISTRIBUTION OF FUNDS.

9 (a) MINIMUM ALLOTMENT.— Section 2618(b)(1) of

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

11 is amended—

12 (1) in subparagraph (A)(i)—

13 (A) in subclause (I), by striking

14 ‘‘$100,000’’ and inserting ‘‘$200,000’’; and

15 (B) in subclause (II), by striking

16 ‘‘$250,000’’ and inserting ‘‘$500,000’’; and

17 (2) in subparagraph (B), by inserting after

18 ‘‘shall be’’ the following: ‘‘the greater of $50,000

19 or’’.

20 (b) AMOUNT OF GRANT; ESTIMATE OF LIVING

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

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

23 (1) in subparagraph (A)(i), by striking ‘‘sub24 paragraph (H)’’ and inserting ‘‘subparagraph (I)’’;
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•HR 4807 IH

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

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

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

4 this paragraph for fiscal year 2005 and subsequent

5 fiscal years, the cases counted for each 12-month pe6 riod beginning on or after July 1, 2004, shall be

7 cases of HIV disease (as reported to and confirmed

8 by such Director) rather than cases of acquired im9 mune deficiency syndrome’’;

10 (3) by redesignating subparagraphs (E)

11 through (H) as subparagraphs (F) through (I), re12 spectively; and

13 (4) by inserting after subparagraph (D) the fol14 lowing subparagraph:

15 ‘‘(E) DETERMINATION OF SECRETARY RE16 GARDING DATA ON HIV CASES.—If under

17 2603(a)(3)(D)(i) the Secretary determines that

18 data on cases of HIV disease is not sufficiently

19 accurate and reliable, then notwithstanding sub20 paragraph (D) of this paragraph, for any fiscal

21 year prior to fiscal year 2007 the references in

22 such subparagraph to cases of HIV disease do

23 not have any legal effect.’’.
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1 (c) INCREASES IN FORMULA AMOUNT.—Section

2 2618(b) of the Public Health Service Act (42 U.S.C.

3 300ff–28(b)) is amended—

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

5 the semicolon the following: ‘‘and then, as applica6 ble, increased under paragraph (3)’’;

7 (2) in paragraph (2)(A)(i), by inserting before

8 the semicolon the following: ‘‘and paragraph (3)’’;

9 (3) by redesignating paragraph (3) as para10 graph (4); and

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

13 ‘‘(3) INCREASES IN FORMULA AMOUNT.—

14 ‘‘(A) ALLOCATION.—Of the amount appro15 priated under section 2677 for the fiscal year

16 involved for grants under part B, the Secretary

17 shall reserve a percentage to increase, in ac18 cordance with this paragraph, the amounts de19 termined for the States for the fiscal year under

20 paragraph ((2)(A) (in this paragraph referred

21 to as the ‘formula amount’).

22 ‘‘(B) INCREASES FOR CERTAIN STATES.—

23 For each fiscal year in a protection period for

24 a State, the Secretary shall increase the for25 mula amount for the State to ensure that—
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1 ‘‘(i) for the first fiscal year in the pro2 tection period, the formula amount is not

3 less than 98 percent of the formula

4 amount for the State for the base year for

5 the protection period;

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

7 period, the formula amount is not less

8 than 95.7 percent of the formula amount

9 for such base year;

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

11 period, the formula amount is not less

12 than 91.1 percent of the formula amount

13 for the base year;

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

15 period, the formula amount is not less

16 than 84.2 percent of the formula amount

17 for the base year; and

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

19 year in such period, the formula amount is

20 not less than 75 percent of the formula

21 amount for the base year.

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

23 With respect to a formula amount for a State:
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•HR 4807 IH

1 ‘‘(i) The base year for a protection pe2 riod is the fiscal year preceding the trigger

3 formula-reduction year.

4 ‘‘(ii) The first trigger formula-reduc5 tion year is the first fiscal year (after fiscal

6 year 2000) for which the formula amount

7 grant for the State is less than the formula

8 amount for the State for the preceding fis9 cal year.

10 ‘‘(iii) A protection period begins with

11 the trigger formula-reduction year and

12 continues until the beginning of the first

13 fiscal year for which the formula amount

14 for the State equals or exceeds the formula

15 amount for the base year for the period.

16 ‘‘(iv) Any subsequent trigger formula17 reduction year is the first fiscal year, after

18 the end of the preceding protection period,

19 for which the formula amount is less than

20 the formula amount for the preceding fis21 cal year.’’.

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

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

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

25 ‘‘shall be’’.
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1 (e) SEPARATE TREATMENT DRUG GRANTS.—Section

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

3 by subsection (b)(3) of this section, is amended in sub4 paragraph (I)—

5 (1) by redesignating clauses (i) and (ii) as sub6 clauses (I) and (II), respectively;

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

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

9 the following:

10 ‘‘(I) APPROPRIATIONS FOR TREATMENT

11 DRUG PROGRAM.—

12 ‘‘(i) FORMULA GRANTS.—With respect

13 to’’;

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

15 by paragraphs (1) and (2)), by striking ‘‘100 per16 cent’’ and inserting ‘‘98 percent’’; and

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

18 ‘‘(ii) SUPPLEMENTAL TREATMENT

19 DRUG GRANTS.—

20 ‘‘(I) IN GENERAL.—With respect

21 to the fiscal year involved, if under

22 section 2677 an appropriations Act

23 provides an amount exclusively for

24 carrying out section 2616, and such

25 amount is not less than the amount so
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1 provided for the preceding fiscal year,

2 the Secretary shall reserve 2 percent

3 of such amount for making grants to

4 States whose population of individuals

5 with HIV disease has, as determined

6 by the Secretary, a need for quantities

7 of therapeutics described in section

8 2616(a) greater than the quantities

9 available pursuant to clause (i). Such

10 a grant is available for purposes of

11 obtaining such therapeutics. The Sec12 retary shall carry out this clause as a

13 program of discretionary grants, and

14 not as a program of formula grants.

15 ‘‘(II) DISTRIBUTION OF

16 GRANTS.—The Secretary shall dis17 burse all amounts under grants under

18 subclause (I) for a fiscal year not

19 later than 240 days after the date on

20 which the amount referred to in such

21 subclause with respect to section 2616

22 becomes available.

23 ‘‘(III) REQUIREMENT OF MATCH24 ING FUNDS.—A condition for receiv25 ing a grant under subclause (I) is
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1 that the State agree to make available

2 (directly or through donations from

3 public or private entities) non-Federal

4 contributions toward the costs of ob5 taining the therapeutics involved in an

6 amount that is not less than 25 per7 cent of such costs (determined in the

8 same manner as under

9 2617(d)(2)(A)).’’.

10 (f) TECHNICAL AMENDMENT.—Section 2618(b) of

11 the Public Health Service Act, as amended by subsection

12 (c)(3) of this section, is amended in paragraph (4)(B) by

13 striking ‘‘and the Republic of the Marshall Islands’’ and

14 inserting ‘‘, the Republic of the Marshall Islands, the Fed15 erated States of Micronesia, and the Republic of Palau,

16 and only for purposes of paragraph (1) the Commonwealth

17 of Puerto Rico’’.

18 SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

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

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

21 amended—

22 (1) by striking section 2621; and

23 (2) by inserting after section 2620 the following

24 section:
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1 ‘‘SEC. 2621. SUPPLEMENTAL GRANTS.

2 ‘‘(a) IN GENERAL.—From amounts available pursu3 ant to subsection (d) for a fiscal year, the Secretary shall

4 make grants to States that meet the conditions to receive

5 grants under section 2611, and that have one or more eli6 gible communities, for the purpose of providing in such

7 communities comprehensive services of the type described

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

9 care activities, primary care, and support services other10 wise provided in such communities by the State under a

11 grant under section 2611.

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

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

14 area that—

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

16 in section 2607; and

17 ‘‘(2) has a severe need for supplemental finan18 cial assistance to combat the HIV epidemic, as dem19 onstrated by the State according to criteria under

20 section 2603(b)(2).

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

22 may be made to a State only if the State submits to the

23 Secretary, as part of the State application submitted

24 under section 2617, a detailed description of the following:

25 ‘‘(1) Evidence that in the eligible communities

26 involved here are disparities in access and services
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1 among affected subpopulations and historically un2 derserved communities.

3 ‘‘(2) A report concerning the dissemination of

4 amounts from a grant under subsection (a) and the

5 plan for the utilization of such amounts in the eligi6 ble communities involved.

7 ‘‘(3) A demonstration of the existing commit8 ment of local resources, both financial and in-kind.

9 ‘‘(4) A demonstration that the State will main10 tain HIV-related activities at a level that is equal to

11 not less than the level of such activities in the State

12 for the 1-year period preceding the fiscal year for

13 which the State is applying to receive a grant under

14 this part.

15 ‘‘(5) A demonstration of the ability of the State

16 to utilize such supplemental financial resources in a

17 manner that is immediately responsive and cost ef18 fective.

19 ‘‘(6) A demonstration that the resources will be

20 allocated in accordance with the comprehensive plan

21 under section 2617(b)(4), including appropriate allo22 cations for services for infants, children, women, and

23 families with HIV disease.

24 ‘‘(7) A demonstration of the inclusiveness of the

25 planning process, with particular emphasis on af-
45

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1 fected communities and individuals with HIV dis2 ease.

3 ‘‘(8) A demonstration of the manner in which

4 the proposed services are consistent with local needs

5 assessments and the statewide coordinated state6 ment of need.

7 ‘‘(d) FUNDING.—

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

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

10 Secretary shall reserve 50 percent of the amount

11 specified in paragraph (2).

12 ‘‘(2) INCREASES IN PART B FUNDING.—

13 ‘‘(A) IN GENERAL.—For purposes of para14 graph (1), the amount specified in this para15 graph is the amount by which the amount ap16 propriated under section 2677 for the fiscal

17 year involved and available for carrying out

18 part B is an increase over the amount so appro19 priated and available for the preceding fiscal

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

21 ‘‘(B) INITIAL ALLOCATION YEAR.—The al22 location under paragraph (1) shall not made

23 until the first fiscal year for which the amount

24 appropriated under section 2677 for the fiscal

25 year involved and available for carrying out
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1 part B is an increase of not less than

2 $20,000,000 over the amount so appropriated

3 and available for fiscal year 2000, subject to

4 subparagraph (C).

5 ‘‘(C) EXCLUSION REGARDING SEPARATE

6 TREATMENT DRUG GRANTS.—Each determina7 tion under subparagraph (A) or (B) of the

8 amount appropriated under section 2677 for a

9 fiscal year and available for carrying out part

10 B shall be made without regard to any amount

11 to which section 2618(b)(2)(I)(i) applies.’’.

12 Subtitle B—Provisions Concerning

13 Pregnancy and Perinatal Trans14 mission of HIV

15 SEC. 211. AUTHORIZATION OF APPROPRIATIONS; REPEALS.

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

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

18 amended—

19 (1) in section 2626, by striking each of sub20 sections (d) through (f); and

21 (2) by striking section 2627.

22 SEC. 212. GRANTS.

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

24 Health Service Act (42 U.S.C. 300ff–33) is amended—
47

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

2 the following subparagraph:

3 ‘‘(F) Making available to pregnant women

4 with HIV disease, and to the infants of women

5 with such disease, treatment services for such

6 disease in accordance with applicable rec7 ommendations of the Secretary.’’;

8 (2) by amending paragraph (2) to read as fol9 lows:

10 ‘‘(2) FUNDING.—

11 ‘‘(A) AUTHORIZATION OF APPROPRIA12 TIONS.—For the purpose of carrying out this

13 subsection, there are authorized to be appro14 priated $30,000,000 for each of the fiscal years

15 2001 through 2005. Amounts made available

16 under section 2677 for carrying out this part

17 are not available for carrying out this section

18 unless otherwise authorized.

19 ‘‘(B) ALLOCATIONS FOR CERTAIN

20 STATES.—

21 ‘‘(i) IN GENERAL.—Of the amounts

22 appropriated under subparagraph (A) for a

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

24 Secretary shall reserve the applicable per25 centage under clause (ii) for making grants
48

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1 under paragraph (1) to States that under

2 law (including under regulations or the dis3 cretion of State officials) have—

4 ‘‘(I) a requirement that all new5 born infants born in the State be test6 ed for HIV disease; or

7 ‘‘(II) a requirement that newborn

8 infants born in the State be tested for

9 HIV disease in circumstances in

10 which the attending obstetrician for

11 the birth does not know the HIV sta12 tus of the mother of the infant.

13 ‘‘(ii) APPLICABLE PERCENTAGE.—For

14 purposes of clause (i), the applicable

15 amount for a fiscal year is as follows:

16 ‘‘(I) For fiscal year 2001, 25 per17 cent.

18 ‘‘(II) For fiscal year 2002, 50

19 percent.

20 ‘‘(III) For fiscal year 2003, 50

21 percent.

22 ‘‘(IV) For fiscal year 2004, 75

23 percent.

24 ‘‘(V) For fiscal year 2005, 75

25 percent.
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1 ‘‘(C) CERTAIN PROVISIONS.—With respect

2 to grants under paragraph (1) that are made

3 with amounts reserved under subparagraph (B)

4 of this paragraph:

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

6 an amount exceeding $4,000,000.

7 ‘‘(ii) If pursuant to clause (i) or pur8 suant to an insufficient number of quali9 fying applications for such grants (or

10 both), the full amount reserved under sub11 paragraph (B) for a fiscal year is not obli12 gated, the requirement under such sub13 paragraph to reserve amounts ceases to

14 apply.’’; and

15 (3) by adding at the end the following para16 graph:

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

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

19 that the State involved agree that the grant will be

20 used to supplement and not supplant other funds

21 available to the State to carry out the purposes of

22 the grant.’’.

23 (b) SPECIAL FUNDING RULE FOR FISCAL YEAR

24 2001.—
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1 (1) IN GENERAL.—If for fiscal year 2001 the

2 amount appropriated under paragraph (2)(A) of sec3 tion 2625(c) of the Public Health Service Act is less

4 than $14,000,000—

5 (A) the Secretary of Health and Human

6 Services shall, for the purpose of making grants

7 under paragraph (1) of such section, reserve

8 from the amount specified in paragraph (2) of

9 this subsection an amount equal to the dif10 ference between $14,000,000 and the amount

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

12 section for such fiscal year;

13 (B) the amount so reserved shall, for pur14 poses of paragraph (2)(B)(i) of such section, be

15 considered to have been appropriated under

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

17 (C) the percentage specified in paragraph

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

19 percent.

20 (2) ALLOCATION FROM INCREASES IN FUNDING

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

22 amount specified in this paragraph is the amount by

23 which the amount appropriated under section 2677

24 of the Public Health Service Act for fiscal year 2001

25 and available for grants under section 2611 of such
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1 Act is an increase over the amount so appropriated

2 and available for fiscal year 2000.

3 SEC. 213. STUDY BY INSTITUTE OF MEDICINE.

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

5 Health Service Act (42 U.S.C. 300ff–33 et seq.) is amend6 ed by adding at the end the following section:

7 ‘‘SEC. 2630. RECOMMENDATIONS FOR REDUCING INCI8 DENCE OF PERINATAL TRANSMISSION.

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

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

11 the Institute of Medicine to enter into an agreement

12 with the Secretary under which such Institute con13 ducts a study to provide the following:

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

15 which the information is available, a determina16 tion of the number of newborn infants with

17 HIV born in the United States with respect to

18 whom the attending obstetrician for the birth

19 did not know the HIV status of the mother.

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

21 any barriers, including legal barriers, that pre22 vent or discourage an obstetrician from making

23 it a routine practice to offer pregnant women

24 an HIV test and a routine practice to test new25 born infants for HIV disease in circumstances
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1 in which the obstetrician does not know the

2 HIV status of the mother of the infant.

3 ‘‘(C) Recommendations for each State for

4 reducing the incidence of cases of the perinatal

5 transmission of HIV, including recommenda6 tions on removing the barriers identified under

7 subparagraph (B).

8 If such Institute declines to conduct the study, the

9 Secretary shall enter into an agreement with another

10 appropriate public or nonprofit private entity to con11 duct the study.

12 ‘‘(2) REPORT.—The Secretary shall ensure

13 that, not later than 18 months after the effective

14 date of this section, the study required in paragraph

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

16 made in the study is submitted to the appropriate

17 committees of the Congress, the Secretary, and the

18 chief public health official of each of the States.

19 ‘‘(b) PROGRESS TOWARD RECOMMENDATIONS.—

20 Each State shall comply with the following (as applicable

21 to the fiscal year involved):

22 ‘‘(1) For fiscal year 2004, the State shall sub23 mit to the Secretary a report describing the actions

24 taken by the State toward meeting the recommenda-
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1 tions specified for the State under subsection

2 (a)(1)(C).

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

4 fiscal year—

5 ‘‘(A) the State shall make reasonable

6 progress toward meeting such recommenda7 tions; or

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

9 progress—

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

11 Director of the Centers for Disease Control

12 and Prevention in carrying out activities

13 toward meeting the recommendations; and

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

15 Secretary a report containing a description

16 of any barriers identified under subsection

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

18 State; as applicable, the factors underlying

19 the continued existence of such barriers;

20 and a description of how the State intends

21 to reduce the incidence of cases of the

22 perinatal transmission of HIV.

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

24 Secretary shall submit to the appropriate committees of
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1 the Congress each report received by the Secretary under

2 subsection (b)(2)(B)(ii).’’.

3 Subtitle C—Certain Partner

4 Notification Programs

5 SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICA6 TION PROGRAMS.

7 Part B of title XXVI of the Public Health Service

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

9 at the end the following subpart:

10 ‘‘Subpart III—Certain Partner Notification Programs

11 ‘‘SEC. 2631. GRANTS FOR PARTNER NOTIFICATION PRO12 GRAMS.

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

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

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

16 to the States for carrying out programs to provide partner

17 counseling and referral services.

18 ‘‘(b) DESCRIPTION OF COMPLIANT STATE PRO19 GRAMS.—For purposes of subsection (a), the laws or regu20 lations of a State are in accordance with this subsection

21 if under such laws or regulations (including programs car22 ried out pursuant to the discretion of State officials) the

23 following policies are in effect:

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

25 officer of the State carry out a program of partner
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1 notification to inform partners of individuals with

2 HIV disease that the partners may have been ex3 posed to the disease.

4 ‘‘(2)(A) In the case of a health entity that pro5 vides for the performance on an individual of a test

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

7 disease, the State requires, subject to subparagraph

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

9 test results to the State public health officer in a

10 manner recommended and approved by the Director

11 of the Centers for Disease Control and Prevention,

12 together with such additional information as may be

13 necessary for carrying out such program.

14 ‘‘(B) The State may provide that the require15 ment of subparagraph (A) does not apply to the

16 testing of an individual for HIV disease if the indi17 vidual underwent the testing through a program de18 signed to perform the test and provide the results to

19 the individual without the individual disclosing his or

20 her identity to the program. This subparagraph may

21 not be construed as affecting the requirement of

22 subparagraph (A) with respect to a health entity

23 that treats an individual for HIV disease.

24 ‘‘(3) The program under paragraph (1) is car25 ried out in accordance with the following:
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1 ‘‘(A) Partners are provided with an appro2 priate opportunity to learn that the partners

3 have been exposed to HIV disease, subject to

4 subparagraph (B).

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

6 of the identity of the infected individuals in7 volved.

8 ‘‘(C) Counseling and testing for HIV dis9 ease are made available to the partners and to

10 infected individuals, and such counseling in11 cludes information on modes of transmission for

12 the disease, including information on prenatal

13 and perinatal transmission and preventing

14 transmission.

15 ‘‘(D) Counseling of infected individuals

16 and their partners includes the provision of in17 formation regarding therapeutic measures for

18 preventing and treating the deterioration of the

19 immune system and conditions arising from the

20 disease, and the provision of other prevention21 related information.

22 ‘‘(E) Referrals for appropriate services are

23 provided to partners and infected individuals,

24 including referrals for support services and

25 legal aid.
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1 ‘‘(F) Notifications under subparagraph (A)

2 are provided in person, unless doing so is an

3 unreasonable burden on the State.

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

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

6 the individual chooses not to identify the part7 ners of the individual, or the individual does not

8 otherwise cooperate with such program.

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

10 partners is not a basis for the civil liability of

11 any health entity who under the program re12 ported to the State the identity of the infected

13 individual involved.

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

15 of the program may not be construed as prohib16 iting the State from providing a notification

17 under subparagraph (A) without the consent of

18 the infected individual involved.

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

20 of the Centers for Disease Control and Prevention

21 the number of individuals from whom the names of

22 partners have been sought under the program under

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

24 provided the names of partners, and the number of
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1 partners so named who were notified under the pro2 gram.

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

4 carrying out a national program of partner notifica5 tion, including the sharing of information between

6 the public health officers of the States.

7 ‘‘(c) REPORTING SYSTEM FOR CASES OF HIV DIS8 EASE.—

9 ‘‘(1) PREFERENCE IN MAKING GRANTS

10 THROUGH FISCAL YEAR 2003.—In making grants

11 under subsection (a) for each of the fiscal years

12 2001 through 2003, the Secretary shall give pref13 erence to States whose reporting systems for cases

14 of HIV disease produce data on such cases that is

15 sufficiently accurate and reliable for use for pur16 poses of section 2618(b)(2)(D)(i).

17 ‘‘(2) ELIGIBILITY CONDITION AFTER FISCAL

18 YEAR 2003.—For fiscal year 2004 and subsequent

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

20 subsection (a) unless the reporting system of the

21 State for cases of HIV disease produces data on

22 such cases that is sufficiently accurate and reliable

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

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

25 purpose of carrying out this section, there are authorized
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1 to be appropriated $30,000,000 for fiscal year 2001, and

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

3 2002 through 2005.’’.

4 TITLE III—EARLY

5 INTERVENTION SERVICES

6 Subtitle A—Formula Grants for

7 States

8 SEC. 301. REPEAL OF PROGRAM.

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

10 Health Service Act (42 U.S.C. 300ff–41 et seq.) is re11 pealed.

12 Subtitle B—Categorical Grants

13 SEC. 311. PREFERENCES IN MAKING GRANTS.

14 Section 2653 of the Public Health Service Act (42

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

16 following subsection:

17 ‘‘(d) UNDERSERVED AND RURAL AREAS.—Of the ap18 plicants who qualify for preference under this section, the

19 Secretary shall give preference to applicants that will ex20 pend the grant under section 2651 to provide early inter21 vention under such section in rural areas or in areas that

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

23 SEC. 312. PLANNING AND DEVELOPMENT GRANTS.

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

25 Health Service Act (42 U.S.C. 300ff–54(c)(1)) is amended
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1 by striking ‘‘for the purpose of’’ and all that follows and

2 inserting the following: ‘‘for purposes of—

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

4 early intervention services; and

5 ‘‘(B) assisting the entities in expanding

6 their capacity to provide HIV-related health

7 services, including early intervention services, in

8 low-income communities and affected sub9 populations that are underserved with respect

10 to such services (subject to the condition that a

11 grant pursuant to this subparagraph may not

12 be expended to purchase or improve land, or to

13 purchase, construct, or permanently improve,

14 other than minor remodeling, any building or

15 other facility).’’.

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

17 Public Health Service Act (42 U.S.C. 300ff–54(c)) is fur18 ther amended—

19 (1) by redesignating paragraph (4) as para20 graph (5); and

21 (2) by inserting after paragraph (3) the fol22 lowing:

23 ‘‘(4) AMOUNT AND DURATION OF GRANTS.—
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1 ‘‘(A) EARLY INTERVENTION SERVICES.—A

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

3 an amount not to exceed $50,000.

4 ‘‘(B) CAPACITY DEVELOPMENT.—

5 ‘‘(i) AMOUNT.—A grant under para6 graph (1)(B) may be made in an amount

7 not to exceed $150,000.

8 ‘‘(ii) DURATION.—The total duration

9 of a grant under paragraph (1)(B), includ10 ing any renewal, may not exceed 3 years.’’.

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

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

13 54(c)(5)), as redesignated by subsection (b), is amended

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

15 SEC. 313. AUTHORIZATION OF APPROPRIATIONS.

16 Section 2655 of the Public Health Service Act (42

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

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

19 2001 through 2005.’’.

20 Subtitle C—General Provisions

21 SEC. 321. PROVISION OF CERTAIN COUNSELING SERVICES.

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

23 (42 U.S.C. 300ff–62(c)(3)) is amended—
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1 (1) in the matter preceding subparagraph (A),

2 by striking ‘‘counseling on—’’ and inserting ‘‘coun3 seling—’’;

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

5 by inserting ‘‘on’’ after the subparagraph designa6 tion; and

7 (3) in subparagraph (C)—

8 (A) by striking ‘‘(C) the benefits’’ and in9 serting ‘‘(C)(i) that explains the benefits’’; and

10 (B) by inserting after clause (i) (as des11 ignated by subparagraph (A) of this paragraph)

12 the following clause:

13 ‘‘(ii) that emphasizes it is the duty of in14 fected individuals to disclose their infected sta15 tus to their sexual partners and their partners

16 in the sharing of hypodermic needles; that pro17 vides advice to infected individuals on the man18 ner in which such disclosures can be made; and

19 that emphasizes that it is the continuing duty

20 of the individuals to avoid any behaviors that

21 will expose others to HIV;

22 SEC. 322. ADDITIONAL REQUIRED AGREEMENTS.

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

24 U.S.C. 300ff–64(g)) is amended—

25 (1) in paragraph (3)—
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1 (A) by striking ‘‘7.5 percent’’ and inserting

2 ‘‘10 percent’’; and

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

4 at the end;

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

6 inserting ‘‘; and’’; and

7 (3) by adding at the end the following para8 graph:

9 ‘‘(5) the applicant will provide for the establish10 ment of a quality management program to assess

11 the extent to which medical services funded under

12 this title that are provided to patients are consistent

13 with the most recent Public Health Service guide14 lines for the treatment of HIV disease and related

15 opportunistic infections and that improvements in

16 the access to and quality of medical services are ad17 dressed.’’.
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1 TITLE IV—OTHER PROGRAMS

2 AND ACTIVITIES

3 Subtitle A—Certain Programs for

4 Research, Demonstrations, or

5 Training

6 SEC. 401. GRANTS FOR COORDINATED SERVICES AND AC7 CESS TO RESEARCH FOR WOMEN, INFANTS,

8 CHILDREN, AND YOUTH.

9 Section 2671 of the Public Health Service Act (42

10 U.S.C. 300ff–71) is amended—

11 (1) in subsection (b)—

12 (A) in paragraph (1), by striking subpara13 graphs (C) and (D) and inserting the following:

14 ‘‘(C) The applicant will demonstrate link15 ages to research and how access to such re16 search is being offered to patients.’’; and

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

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

19 following: ‘‘In addition, the Secretary, in coordina20 tion with the Director of such Institutes, shall exam21 ine the distribution and availability of appropriate

22 HIV-related research projects with respect to grant23 ees under subsection (a) for purposes of enhancing

24 and expanding HIV-related research, especially with-
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1 in communities that are underrepresented with re2 spect to such projects.’’;

3 (3) in subsection (f)—

4 (A) by striking the subsection heading and

5 designation and inserting the following:

6 ‘‘(f) ADMINISTRATION.—

7 ‘‘(1) APPLICATION.—’’; and

8 (B) by adding at the end the following

9 paragraph:

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

11 grantee under this section shall implement a quality

12 management program.’’; and

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

14 2000’’ and inserting ‘‘2001 through 2005’’.

15 SEC. 402. AIDS EDUCATION AND TRAINING CENTERS.

16 (a) SCHOOLS; CENTERS.—

17 (1) IN GENERAL.—Section 2692(a) of the Pub18 lic Health Service Act (42 U.S.C. 300ff–111(a)) is

19 amended—

20 (A) in subparagraph (A)—

21 (i) by striking ‘‘training’’ and insert22 ing ‘‘to train’’;

23 (ii) by striking ‘‘and including’’ and

24 inserting ‘‘, including’’; and
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•HR 4807 IH

1 (iii) by inserting before the semicolon

2 the following: ‘‘, and including (as applica3 ble to the type of health professional in4 volved), prenatal and other gynecological

5 care for women with HIV disease’’;

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

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

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

9 period and inserting ‘‘; and’’; and

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

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

12 care of women with HIV disease, including pre13 natal and other gynecological care for such

14 women.’’.

15 (2) DISSEMINATION OF TREATMENT GUIDE16 LINES; MEDICAL CONSULTATION ACTIVITIES.—Not

17 later than 90 days after the date of the enactment

18 of this Act, the Secretary of Health and Human

19 Services shall issue and begin implementation of a

20 strategy for the dissemination of HIV treatment in21 formation to health care providers and patients.

22 (b) DENTAL SCHOOLS.—Section 2692(b) of the Pub23 lic Health Service Act (42 U.S.C. 300ff–111(b)) is

24 amended—
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1 (1) by amending paragraph (1) to read as fol2 lows:

3 ‘‘(1) IN GENERAL.—

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

5 grants to dental schools and programs de6 scribed in subparagraph (B) to assist such

7 schools and programs with respect to oral

8 health care to patients with HIV disease.

9 ‘‘(B) ELIGIBLE APPLICANTS.—For pur10 poses of this subsection, the dental schools and

11 programs referred to in this subparagraph are

12 dental schools and programs that were de13 scribed in section 777(b)(4)(B) as such section

14 was in effect on the day before the date of en15 actment of the Health Professions Education

16 Partnerships Act of 1998 (Public Law 105–

17 392) and in addition dental hygiene programs

18 that are accredited by the Commission on Den19 tal Accreditation.’’;

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

21 ‘‘777(b)(4)(B)’’ and inserting ‘‘the section referred

22 to in paragraph (1)(B)’’; and

23 (3) by inserting after paragraph (4) the fol24 lowing paragraph:
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1 ‘‘(5) COMMUNITY-BASED CARE.—The Secretary

2 may make grants to dental schools and programs de3 scribed in paragraph (1)(B) that partner with com4 munity-based dentists to provide oral health care to

5 patients with HIV disease in unserved areas. Such

6 partnerships shall permit the training of dental stu7 dents and residents and the participation of commu8 nity dentists as adjunct faculty.’’.

9 (c) AUTHORIZATION OF APPROPRIATIONS.—

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

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

12 111(c)(1)) is amended by striking ‘‘fiscal years 1996

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

14 through 2005’’.

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

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

17 111(c)(2)) is amended to read as follows:

18 ‘‘(2) DENTAL SCHOOLS.—

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

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

21 subsection (b), there are authorized to be ap22 propriated such sums as may be necessary for

23 each of the fiscal years 2001 through 2005.

24 ‘‘(B) COMMUNITY-BASED CARE.—For the

25 purpose of grants under subsection (b)(5), there
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1 are authorized to be appropriated such sums as

2 may be necessary for each of the fiscal years

3 2001 through 2005.’’.

4 Subtitle B—General Provisions in

5 Title XXVI

6 SEC. 411. EVALUATIONS AND REPORTS.

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

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

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

10 SEC. 412. DATA COLLECTION THROUGH CENTERS FOR DIS11 EASE CONTROL AND PREVENTION.

12 Part D of title XXVI of the Public Health Service

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

14 (1) by redesignating section 2675 as section

15 2675A; and

16 (2) by inserting after section 2674 the following

17 section:

18 ‘‘SEC. 2675. DATA COLLECTION.

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

20 program planning and evaluation activities under this

21 title, there are authorized to be appropriated to the Sec22 retary (acting through the Director of the Centers for Dis23 ease Control and Prevention) such sums as may be nec24 essary for each of the fiscal years 2001 through 2005.

25 Such authorization of appropriations is in addition to
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1 other authorizations of appropriations that are available

2 for such purpose.’’.

3 SEC. 413. COORDINATION.

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

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

6 (1) by amending subsection (a) to read as fol7 lows:

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

9 that the Health Resources and Services Administration,

10 the Centers for Disease Control and Prevention, the Sub11 stance Abuse and Mental Health Services Administration,

12 and the Health Care Financing Administration coordinate

13 the planning, funding, and implementation of Federal

14 HIV programs to enhance the continuity of care and pre15 vention services for individuals with HIV disease or those

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

17 other Federal agencies, including the Department of Vet18 erans Affairs, as needed and utilize planning information

19 submitted to such agencies by the States and entities eligi20 ble for support.’’;

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

22 subsections (c) and (d), respectively;

23 (3) by inserting after subsection (b) the fol24 lowing subsection:
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1 ‘‘(b) REPORT.—The Secretary shall biennially pre2 pare and submit to the appropriate committees of the Con3 gress a report concerning the coordination efforts at the

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

5 including a description of Federal barriers to HIV pro6 gram integration and a strategy for eliminating such bar7 riers and enhancing the continuity of care and prevention

8 services for individuals with HIV disease or those at risk

9 of such disease.’’; and

10 (4) in each of subsections (c) and (d) (as redes11 ignated by paragraph (2) of this section), by insert12 ing ‘‘and prevention services’’ after ‘‘continuity of

13 care’’ each place such term appears.

14 SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH

15 HIV DISEASE.

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

17 redesignated by section 412 of this Act, is amended by

18 adding at the end the following subsection:

19 ‘‘(d) RECOMMENDATIONS REGARDING RELEASE OF

20 PRISONERS.—After consultation with the Attorney Gen21 eral and the Director of the Bureau of Prisons, with

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

23 that receive amounts from grants under part A or B, the

24 Secretary, consistent with the coordination required in

25 subsection (a), shall develop a plan for the medical case
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1 management of and the provision of support services to

2 individuals who were Federal or State prisoners and had

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

4 released from the custody of the penal system. The Sec5 retary shall submit the plan to the Congress not later than

6 two years after the date of the enactment of the Ryan

7 White CARE Act Amendments of 2000.’’.

8 SEC. 415. AUDITS.

9 Part D of title XXVI of the Public Health Service

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

11 by inserting after section 2675A the following section:

12 ‘‘SEC. 2675B. AUDITS.

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

14 the Secretary may reduce the amounts of grants under

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

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

17 preceding fiscal year, the State or subdivision fails to pre18 pare audits in accordance with the procedures of section

19 7502 of title 31, United States Code. The Secretary shall

20 annually select representative samples of such audits, pre21 pare summaries of the selected audits, and submit the

22 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 REGARDING

6 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 two 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 two years after the date of the enactment

8 of 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 two 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

3 to 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 three years after the date of

10 the 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 two years after the date of

15 the 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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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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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 SEC. 503. PROGRAM MANAGEMENT.

8 Of the amounts available to the Secretary of Health

9 and Human Services for fiscal year 2001 and subsequent

10 fiscal years for program management at the Health Re11 sources and Services Administration, the Secretary shall

12 expend amounts necessary to ensure that the number of

13 full-time-equivalent staff of the Bureau of HIV/AIDS who

14 administer programs under title XXVI of the Public

15 Health Service Act is not less than 20 percent above the

16 number of such staff for fiscal year 2000.

17 TITLE VI—EFFECTIVE DATE

18 SEC. 601. EFFECTIVE DATE.

19 This Act and the amendments made by this Act take

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

21 of this Act, whichever occurs later.

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