IB

Calendar No. 455

106TH CONGRESS

2D SESSION H. R. 4807

[Report No. 106–788]

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

JULY 25, 2000

Additional sponsors: Mr. SERRANO, Mr. DELAHUNT, Mr. BERMAN, Mr.

SHIMKUS, Mrs. MINK of Hawaii, Mr. PALLONE, Mr. MCNULTY, Mr.

HALL of Texas, Mr. ABERCROMBIE, Ms. BROWN of Florida, Mrs. CAPPS,

Mr. STRICKLAND, Mr. BALDACCI, Mr. MARTINEZ, Mr. MCHUGH, Mr.

HORN, Mr. FROST, Ms. ROYBAL-ALLARD, Mr. THOMPSON of California,

Mr. BAIRD, Mr. BENTSEN, Mr. EVANS, Mr. UPTON, Mr. DIXON, Mr.

JEFFERSON, Mr. RANGEL, Mrs. NAPOLITANO, Ms. BERKLEY, Mr. WYNN,

Mr. RODRIGUEZ, Mr. BACA, Ms. SANCHEZ, Ms. MCCARTHY of Missouri,

Mr. BOUCHER, Mr. GONZALEZ, Mr. ACKERMAN, Mr. HOBSON, Mr.

WHITFIELD, Mr. FOSSELLA, Ms. MILLENDER-MCDONALD, Ms. PRYCE of

Ohio, Mr. LARSON, Ms. BALDWIN, Ms. DEGETTE, Mrs. KELLY, Ms. KILPATRICK, Mr. TIAHRT, Ms. RIVERS, Mr. MATSUI, Mr. GREEN of Wisconsin, Mr. KUYKENDALL, Mrs. FOWLER, Mr. KOLBE, Mr. WEXLER, Mr.

GREEN of Texas, Mrs. MALONEY of New York, Mr. INSLEE, Mr.

MALONEY of Connecticut, Mr. GUTIERREZ, Mr. BECERRA, Mr. FILNER,

Mr. DEFAZIO, Ms. ROS-LEHTINEN, Mr. LEACH, Mr. DINGELL, Mr.

MCGOVERN, Mr. LARGENT, Mr. COOKSEY, Mr. SAWYER, Ms.

SCHAKOWSKY, Mr. RUSH, Mrs. BIGGERT, Mr. CALVERT, Mr. CANADY of
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Florida, Mr. LAMPSON, Mr. GANSKE, Mr. SANDERS, Mr. COSTELLO, Mr.

DAVIS of Illinois, Mr. BLAGOJEVICH, Mr. SCHAFFER, Mr. MCINTOSH,

Mr. BORSKI, Mr. GALLEGLY, Mr. LAZIO, Mr. NADLER, Mr. RAMSTAD,

Mr. MEEHAN, Mr. DICKS, Mrs. LOWEY, Mr. SHERMAN, Mr. SABO, Ms.

SLAUGHTER, Mr. BRADY of Pennsylvania, Mr. RAHALL, Mr. FRANK of

Massachusetts, Ms. LEE, Mr. LATOURETTE, Mr. LOBIONDO, Mr.

GILLMOR, Mr. GILMAN, Mr. NEAL of Massachusetts, Mr. GILCHREST,

Mrs. WILSON, Mrs. MYRICK, Mr. SMITH of New Jersey, Mr. TANCREDO,

Mrs. CHRISTENSEN, Mr. FARR of California, Mr. TOWNS, Mr. SMITH of

Washington, Mr. LAHOOD, Mrs. JOHNSON of Connecticut, Mr. CASTLE,

Mr. CUNNINGHAM, Mr. PACKARD, Ms. WATERS, Mr. ENGEL, Mr.

CARDIN, Mrs. THURMAN, Mr. GEJDENSON, Mr. REYNOLDS, Mr. LEWIS

of California, Mr. CONYERS, Mr. FORD, Mr. FORBES, Mr. BLUMENAUER,

Mr. UDALL of New Mexico, Mr. KLECZKA, Mr. BISHOP, Mr. ROEMER,

Ms. KAPTUR, Mr. TURNER, Mr. LIPINSKI, Mr. HASTINGS of Florida, Ms.

JACKSON-LEE of Texas, Mr. FATTAH, Mr. KUCINICH, Mr. MCDERMOTT,

Ms. HOOLEY of Oregon, Mr. PASCRELL, Mr. ANDREWS, Mr. THOMPSON

of Mississippi, Mr. ROMERO-BARCELO ́

, Mr. HOLDEN, Mr. KIND, Ms.

DELAURO, Mr. HOLT, Mr. REYES, Mr. BRADY of Texas, Mr. KILDEE,

Mr. PAYNE, Mr. ALLEN, Mr. SWEENEY, Mrs. JONES of Ohio, Mr. BASS,

Mr. CUMMINGS, Mr. ORTIZ, Mr. WATKINS, Ms. EDDIE BERNICE JOHNSON of Texas, Mrs. MCCARTHY of New York, Mr. OWENS, Mr. PHELPS,

Mr. SANDLIN, Mr. UDALL of Colorado, Ms. NORTON, Mr. CROWLEY, Ms.

DUNN, Mr. MORAN of Virginia, Mr. GIBBONS, Ms. CARSON, Mr. BLILEY,

Mr. HOEFFEL, Mr. OSE, Mr. MOORE, Mr. HALL of Ohio, Mrs. EMERSON,

Mr. LAFALCE, Mr. ROTHMAN, Mr. MENENDEZ, Mr. SHAW, Mr. HILLIARD, Mr. PETERSON of Minnesota, Mr. QUINN, Ms. MCKINNEY, Mr.

UNDERWOOD, Mr. DAVIS of Virginia, Mr. LEWIS of Georgia, Mrs. MEEK

of Florida, Mr. SMITH of Texas, Mr. OLVER, Mr. HOYER, Mr. FRANKS

of New Jersey, Mr. WEINER, Mr. MURTHA, Mr. KLINK, Mr. POMEROY,

Mr. SAXTON, Mr. BOEHLERT, Mr. CLYBURN, Mr. CLEMENT, Mr. DAVIS

of Florida, Mr. FRELINGHUYSEN, Mr. WELDON of Pennsylvania, Mr.

TAUZIN, Mr. SKEEN, Mr. CAPUANO, Mr. DOOLEY of California, Mr.

JACKSON of Illinois, Mr. MOAKLEY, Mr. MEEKS of New York, Mrs.

CLAYTON, Mr. WU, Ms. DANNER, Mr. COYNE, Mr. LEVIN, Mr. STENHOLM, Mr. PASTOR, Mr. MARKEY, Mr. DOYLE, Mr. TRAFICANT, Mr.

PICKERING, Mr. TIERNEY, Mr. SCOTT, Mr. SESSIONS, Mr. BOYD, Mr.

KENNEDY of Rhode Island, Mr. HINOJOSA, Mr. WAMP, Mr. MCCOLLUM,

and Mr. CLAY

JULY 25, 2000

Reported with an amendment, committed to the Committee of the Whole

House on the State of the Union and ordered to be printed
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[Strike out all after the enacting clause and insert the part printed in italic]

[For text of introduced bill, see copy of bill as introduced on June 29, 2000]

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,

3 SECTION 1. SHORT TITLE.

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

5 Amendments of 2000’’.

6 SEC. 2. TABLE OF CONTENTS.

7 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.
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Sec. 202. Use of grants.

Sec. 203. Grants to establish HIV care consortia.

Sec. 204. Provision of treatments.

Sec. 205. State application.

Sec. 206. Distribution of funds.

Sec. 207. Supplemental grants for certain States.

Subtitle B—Provisions Concerning Pregnancy and Perinatal Transmission of

HIV

Sec. 211. Repeals.

Sec. 212. Grants.

Sec. 213. Study by Institute of Medicine.

Subtitle C—Certain Partner Notification Programs

Sec. 221. Grants for compliant partner notification programs.

TITLE III—EARLY INTERVENTION SERVICES

Subtitle A—Formula Grants for States

Sec. 301. Repeal of program.

Subtitle B—Categorical Grants

Sec. 311. Preferences in making grants.

Sec. 312. Planning and development grants.

Sec. 313. Authorization of appropriations.

Subtitle C—General Provisions

Sec. 321. Provision of certain counseling services.

Sec. 322. Additional required agreements.

TITLE IV—OTHER PROGRAMS AND ACTIVITIES

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

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

Sec. 402. AIDS education and training centers.

Subtitle B—General Provisions in Title XXVI

Sec. 411. Evaluations and reports.

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

Sec. 413. Coordination.

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

Sec. 415. Audits.

Sec. 416. Administrative simplification.

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

TITLE V—GENERAL PROVISIONS

Sec. 501. Studies by Institute of Medicine.

Sec. 502. Development of rapid HIV test.
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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—

9 (1) in paragraph (1), by striking ‘‘demographics

10 of the epidemic in the eligible area involved,’’ and in11 serting ‘‘demographics of the population of individ12 uals with HIV disease in the eligible area involved,’’;

13 and

14 (2) in paragraph (2)—

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

16 AIDS’’;

17 (B) in subparagraph (K), by striking ‘‘and’’

18 at the end;

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

20 period and inserting the following: ‘‘, including

21 but not limited to providers of HIV prevention

22 services; and’’; and

23 (D) by adding at the end the following sub24 paragraph:
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1 ‘‘(M) representatives of individuals who for2 merly were Federal, State, or local prisoners,

3 were released from the custody of the penal sys4 tem during the preceding three years, and had

5 HIV disease as of the date on which the individ6 uals were so released.’’.

7 (b) CONFLICTS OF INTERESTS.—Section 2602(b)(5) of

8 the Public Health Service Act (42 U.S.C. 300ff–12(b)(5))

9 is amended by adding at the end the following subpara10 graph:

11 ‘‘(C) COMPOSITION OF COUNCIL.—The fol12 lowing applies regarding the membership of a

13 planning council under paragraph (1):

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

15 council shall be individuals who are receiv16 ing HIV-related services pursuant to a

17 grant under section 2601(a), are not offi18 cers, employees, or consultants to any entity

19 that receives amounts from such a grant,

20 and do not represent any such entity, and

21 reflect the demographics of the population of

22 individuals with HIV disease as determined

23 under paragraph (4)(A). For purposes of

24 the preceding sentence, an individual shall

25 be considered to be receiving such services if
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1 the individual is a parent of, or a caregiver

2 for, a minor child who is receiving such

3 services.

4 ‘‘(ii) With respect to membership on

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

6 construed as having any effect on entities

7 that receive funds from grants under any of

8 parts B through F but do not receive funds

9 from grants under section 2601(a), on offi10 cers or employees of such entities, or on in11 dividuals who represent such entities.’’.

12 SEC. 102. DUTIES OF COUNCILS.

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

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

15 amended—

16 (1) by redesignating subparagraphs (A) through

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

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

19 redesignated) the following subparagraphs:

20 ‘‘(A) determine the size and demographics of

21 the population of individuals with HIV disease;

22 ‘‘(B) determine the needs of such popu23 lation, with particular attention to—

24 ‘‘(i) individuals with HIV disease who

25 are not receiving HIV-related services; and
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1 ‘‘(ii) disparities in access and services

2 among affected subpopulations and histori3 cally underserved communities;’’;

4 (3) in subparagraph (C) (as so redesignated), by

5 striking clauses (i) through (iv) and inserting the fol6 lowing:

7 ‘‘(i) size and demographics of the pop8 ulation of individuals with HIV disease (as

9 determined under subparagraph (A)) and

10 the needs of such population (as determined

11 under subparagraph (B));

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

13 effectiveness and outcome effectiveness of

14 proposed strategies and interventions, to the

15 extent that data are reasonably available;

16 ‘‘(iii) priorities of the communities

17 with HIV disease for whom the services are

18 intended;

19 ‘‘(iv) availability of other govern20 mental and nongovernmental resources to

21 provide HIV-related services to individuals

22 and families with HIV disease, including

23 the State plan under title XIX of the Social

24 Security Act (relating to the Medicaid pro25 gram) and the program under title XXI of
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1 such Act (relating to the program for State

2 children’s health insurance); and

3 ‘‘(v) capacity development needs result4 ing from disparities in the availability of

5 HIV-related services in historically under6 served communities;’’;

7 (4) in subparagraph (D) (as so redesignated), by

8 amending the subparagraph to read as follows:

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

10 organization and delivery of health and support

11 services described in section 2604 that—

12 ‘‘(i) includes a strategy for identifying

13 individuals with HIV disease who are not

14 receiving such services and for informing

15 the individuals of and enabling the individ16 uals to utilize the services, giving particular

17 attention to eliminating disparities in ac18 cess and services among affected subpopula19 tions and historically underserved commu20 nities, and including discrete goals, a time21 table, and an appropriate allocation of

22 funds;

23 ‘‘(ii) includes a strategy to coordinate

24 the provision of such services with programs

25 for HIV prevention and for the prevention
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1 and treatment of substance abuse, including

2 programs that provide comprehensive treat3 ment services for such abuse; and

4 ‘‘(iii) is compatible with any State or

5 local plan for the provision of services to in6 dividuals with HIV disease;’’;

7 (5) in subparagraph (F) (as so redesignated), by

8 striking ‘‘and’’ at the end;

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

10 (A) by striking ‘‘public meetings,’’ and in11 serting ‘‘public meetings (in accordance with

12 paragraph (7)),’’; and

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

14 and’’; and

15 (7) by adding at the end the following subpara16 graph:

17 ‘‘(H) coordinate with Federal grantees that

18 provide HIV-related services within the eligible

19 area.’’.

20 (b) PROCESS FOR ESTABLISHING ALLOCATION PRIOR21 ITIES.—Section 2602 of the Public Health Service Act (42

22 U.S.C. 300ff–12) is amended by adding at the end the fol23 lowing subsection:

24 ‘‘(d) PROCESS FOR ESTABLISHING ALLOCATION PRI25 ORITIES.—Promptly after the date of the submission of the
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1 report required in section 501(b) of the Ryan White CARE

2 Act Amendments of 2000 (relating to the relationship be3 tween epidemiological measures and health care for certain

4 individuals with HIV disease), the Secretary, in consulta5 tion with entities that receive amounts from grants under

6 section 2601(a) or 2611, shall develop epidemiologic

7 measures—

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

9 living with HIV disease who are not receiving HIV10 related health services; and

11 ‘‘(2) for carrying out the duties under subsection

12 (b)(4) and section 2617(b).’’.

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

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

15 (b) of this section, is amended by adding at the end the

16 following subsection:

17 ‘‘(e) TRAINING GUIDANCE AND MATERIALS.—The Sec18 retary shall provide to each chief elected official receiving

19 a grant under 2601(a) guidelines and materials for train20 ing members of the planning council under paragraph (1)

21 regarding the duties of the council.’’.

22 SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVI23 SIONS.

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

25 U.S.C. 300ff–12(b)) is amended—
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1 (1) in paragraph (3), by striking subparagraph

2 (C); and

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

5 ‘‘(7) PUBLIC DELIBERATIONS.—With respect to a

6 planning council under paragraph (1), the following

7 applies:

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

9 by an employee of the grantee under section

10 2601(a).

11 ‘‘(B) In accordance with criteria established

12 by the Secretary:

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

14 be open to the public and shall be held only

15 after adequate notice to the public.

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

17 minutes, agenda, or other documents which

18 were made available to or prepared for or

19 by the council shall be available for public

20 inspection and copying at a single location.

21 ‘‘(iii) Detailed minutes of each meeting

22 of the council shall be kept. The accuracy of

23 all minutes shall be certified to by the chair

24 of the council.
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1 ‘‘(iv) This subparagraph does not

2 apply to any disclosure of information of a

3 personal nature that would constitute a

4 clearly unwarranted invasion of personal

5 privacy, including any disclosure of med6 ical information or personnel matters.’’.

7 Subtitle B—Type and Distribution

8 of Grants

9 SEC. 111. FORMULA GRANTS.

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

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

12 is amended in the first sentence by striking ‘‘for each of

13 the fiscal years 1996 through 2000’’ and inserting ‘‘for a

14 fiscal year’’.

15 (b) AMOUNT OF GRANT; ESTIMATE OF LIVING

16 CASES.—

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

18 Public Health Service Act (42 U.S.C. 300ff–13(a)(3))

19 is amended—

20 (A) in subparagraph (C)(i), by inserting be21 fore the semicolon the following: ‘‘, except that

22 (subject to subparagraph (D)), for grants made

23 pursuant to this paragraph for fiscal year 2005

24 and subsequent fiscal years, the cases counted for

25 each 12-month period beginning on or after July
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1 1, 2004, shall be cases of HIV disease (as re2 ported to and confirmed by such Director) rather

3 than cases of acquired immune deficiency syn4 drome’’; and

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

6 after and below clause (ii)(X)—

7 (i) in the first sentence, by inserting

8 before the period the following: ‘‘, and shall

9 be reported to the congressional committees

10 of jurisdiction’’; and

11 (ii) by adding at the end the following

12 sentence: ‘‘Updates shall as applicable take

13 into account the counting of cases of HIV

14 disease pursuant to clause (i).’’

15 (2) DETERMINATION OF SECRETARY REGARDING

16 DATA ON HIV CASES.—Section 2603(a)(3)) of the Pub17 lic Health Service Act (42 U.S.C. 300ff–13(a)(3)) is

18 amended—

19 (A) by redesignating subparagraph (D) as

20 subparagraph (E); and

21 (B) by inserting after subparagraph (C) the

22 following subparagraph:

23 ‘‘(D) DETERMINATION OF SECRETARY RE24 GARDING DATA ON HIV CASES.—
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1 ‘‘(i) IN GENERAL.—Not later than July

2 1, 2004, the Secretary shall determine

3 whether there is data on cases of HIV dis4 ease from all eligible areas (reported to and

5 confirmed by the Director of the Centers for

6 Disease Control and Prevention) sufficiently

7 accurate and reliable for use for purposes of

8 subparagraph (C)(i). In making such a de9 termination, the Secretary shall take into

10 consideration the findings of the study

11 under section 501(b) of the Ryan White

12 CARE Act Amendments of 2000 (relating to

13 the relationship between epidemiological

14 measures and health care for certain indi15 viduals with HIV disease), the fiscal impact

16 of the use of such data, the impact of the use

17 of such data on the organization and deliv18 ery of HIV-related services in eligible areas,

19 and the fiscal impact of not using such

20 data.

21 ‘‘(ii) EFFECT OF ADVERSE DETER22 MINATION.—If under clause (i) the Sec23 retary determines that data on cases of HIV

24 disease is not sufficiently accurate and reli25 able for use for purposes of subparagraph
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1 (C)(i), then notwithstanding such subpara2 graph, for any fiscal year prior to fiscal

3 year 2007 the references in such subpara4 graph to cases of HIV disease do not have

5 any legal effect.

6 ‘‘(iii) GRANTS AND TECHNICAL ASSIST7 ANCE REGARDING COUNTING OF HIV

8 CASES.—Of the amounts appropriated

9 under section 2675 for a fiscal year, the

10 Secretary shall reserve amounts to make

11 grants and provide technical assistance to

12 States and eligible areas with respect to ob13 taining data on cases of HIV disease to en14 sure that data on such cases is available

15 from all States and eligible areas as soon as

16 is practicable but not later than the begin17 ning of fiscal year 2007.’’.

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

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

20 amended to read as follows:

21 ‘‘(4) INCREASES IN GRANT.—

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

23 a protection period for an eligible area, the Sec24 retary shall increase the amount of the grant
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1 made pursuant to paragraph (2) for the area to

2 ensure that—

3 ‘‘(i) for the first fiscal year in the pro4 tection period, the grant is not less than 98

5 percent of the amount of the grant made for

6 the eligible area pursuant to such para7 graph for the base year for the protection

8 period;

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

10 period, the grant is not less than 95.7 per11 cent of the amount of such base year grant;

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

13 period, the grant is not less than 91.1 per14 cent of the amount of the base year grant;

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

16 period, the grant is not less than 84.2 per17 cent of the amount of the base year grant;

18 and

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

20 year in such period, the grant is not less

21 than 75 percent of the amount of the base

22 year grant.

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

24 With respect to grants made pursuant to para25 graph (2) for an eligible area:
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1 ‘‘(i) The base year for a protection pe2 riod is the fiscal year preceding the trigger

3 grant-reduction year.

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

5 year is the first fiscal year (after fiscal year

6 2000) for which the grant for the area is

7 less than the grant for the area for the pre8 ceding fiscal year.

9 ‘‘(iii) A protection period begins with

10 the trigger grant-reduction year and con11 tinues until the beginning of the first fiscal

12 year for which the amount of the grant for

13 the area equals or exceeds the amount of the

14 grant for the base year for the period.

15 ‘‘(iv) Any subsequent trigger grant-re16 duction year is the first fiscal year, after

17 the end of the preceding protection period,

18 for which the amount of the grant is less

19 than the amount of the grant for the pre20 ceding fiscal year.’’.

21 SEC. 112. SUPPLEMENTAL GRANTS.

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

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

24 amended—
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1 (1) in the heading for the paragraph, by striking

2 ‘‘DEFINITION’’ and inserting ‘‘AMOUNT OF GRANT’’;

3 (2) by redesignating subparagraphs (A) through

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

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

6 redesignated) the following subparagraph:

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

8 grant made for purposes of this subsection shall

9 be determined by the Secretary based on a

10 weighting of factors under paragraph (1), with

11 severe need under subparagraph (B) of such

12 paragraph counting one-third.’’;

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

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

15 end;

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

17 and inserting a semicolon; and

18 (C) by adding at the end the following

19 clauses:

20 ‘‘(iv) the current prevalence of HIV

21 disease;

22 ‘‘(v) an increasing need for HIV-re23 lated services, including relative rates of in24 crease in the number of cases of HIV dis25 ease; and
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1 ‘‘(vi) unmet need for such services, as

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

3 (5) in subparagraph (C) (as so redesignated)—

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

5 place such term appears and inserting ‘‘subpara6 graph (B)’’’;

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

8 years after the date of enactment of this para9 graph’’ and inserting ‘‘18 months after the date

10 of the enactment of the Ryan White CARE Act

11 Amendments of 2000’’; and

12 (C) by inserting after the second sentence

13 the following sentence: ‘‘Such a mechanism shall

14 be modified to reflect the findings of the study

15 under section 501(b) of the Ryan White CARE

16 Act Amendments of 2000 (relating to the rela17 tionship between epidemiological measures and

18 health care for certain individuals with HIV dis19 ease).’’; and

20 (6) in subparagraph (D) (as so redesignated), by

21 striking ‘‘subparagraph (B)’’ and inserting ‘‘subpara22 graph (C)’’’.

23 (b) REQUIREMENTS FOR APPLICATION.—Section

24 2603(b)(1)(E) of the Public Health Service Act (42 U.S.C.
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1 300ff–13(b)(1)(E)) is amended by inserting ‘‘youth,’’ after

2 ‘‘children,’’.

3 (c) CONFORMING AMENDMENT.—Section 2603(b) of the

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

5 amended—

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

7 (2) by redesignating paragraph (5) as para8 graph (4).

9 Subtitle C—Other Provisions

10 SEC. 121. USE OF AMOUNTS.

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

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

13 amended—

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

15 by striking ‘‘HIV-related—’’ and inserting ‘‘HIV-re16 lated services, as follows:’’;

17 (2) in subparagraph (A)—

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

19 follows through ‘‘substance abuse treatment and’’

20 and inserting the following: ‘‘Outpatient and

21 ambulatory health services, including substance

22 abuse treatment,’’; and

23 (B) by striking ‘‘; and’’ and inserting a pe24 riod;
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1 (3) in subparagraph (B), by striking ‘‘(B) inpa2 tient case management’’ and inserting ‘‘(C) Inpatient

3 case management’’;

4 (4) by inserting after subparagraph (A) the fol5 lowing subparagraph:

6 ‘‘(B) Outpatient and ambulatory support

7 services (including case management), to the ex8 tent that such services facilitate, support, or sus9 tain the delivery, or benefits of health services for

10 individuals and families with HIV disease.’’;

11 and

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

13 ‘‘(D) Outreach activities that are intended

14 to identify individuals with HIV disease who are

15 not receiving HIV-related services, and that

16 are—

17 ‘‘(i) necessary to implement the strat18 egy under section 2602(b)(4)(D), including

19 activities facilitating the access of such in20 dividuals to HIV-related primary care serv21 ices at entities described in paragraph (3);

22 ‘‘(ii) conducted in a manner consistent

23 with the requirements under sections

24 2605(a)(3) and 2651(b)(2); and
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1 ‘‘(iii) supplement, and do not sup2 plant, such activities that are carried out

3 with amounts appropriated under section

4 317.’’.

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

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

7 amended—

8 (1) by redesignating paragraph (3) as para9 graph (4);

10 (2) by inserting after paragraph (2) the fol11 lowing:

12 ‘‘(3) EARLY INTERVENTION SERVICES.—

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

14 a grant under section 2601 may be used include

15 providing to individuals with HIV disease early

16 intervention services described in section

17 2651(b)(2) (including referrals under subpara18 graph (C) of such section), subject to subpara19 graph (B). The entities through which such serv20 ices may be provided under the grant include

21 public health departments, emergency rooms,

22 substance abuse and mental health treatment

23 programs, detoxification centers, detention facili24 ties, clinics regarding sexually transmitted dis25 eases, homeless shelters, HIV disease counseling
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1 and testing sites, health care points of entry

2 specified by States or eligible areas, federally

3 qualified health centers, and entities described in

4 section 2652(a).

5 ‘‘(B) CONDITIONS.—With respect to an enti6 ty that proposes to provide early intervention

7 services under subparagraph (A), such subpara8 graph applies only if the entity demonstrates to

9 the satisfaction of the chief elected official for the

10 eligible area involved that—

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

12 otherwise inadequate for the early interven13 tion services the entity proposes to provide;

14 and

15 ‘‘(ii) the entity will expend funds pur16 suant to such subparagraph to supplement

17 and not supplant other funds available to

18 the entity for the provision of early inter19 vention services for the fiscal year in20 volved.’’; and

21 (3) in paragraph (4) (as so redesignated), by in22 serting ‘‘youth,’’ after ‘‘children,’’ each place such

23 term appears;

24 (c) QUALITY MANAGEMENT.—Section 2604 of the Pub25 lic Health Service Act (42 U.S.C. 300ff–14) is amended—
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1 (1) by redesignating subsections (c) through (f)

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

3 (2) by inserting after subsection (b) the fol4 lowing:

5 ‘‘(c) QUALITY MANAGEMENT.—

6 ‘‘(1) REQUIREMENT.—The chief elected official of

7 an eligible area that receives a grant under this part

8 shall provide for the establishment of a quality man9 agement program to assess the extent to which HIV

10 health services provided to patients under the grant

11 are consistent with the most recent Public Health

12 Service guidelines for the treatment of HIV disease

13 and related opportunistic infection, and as applica14 ble, to develop strategies for ensuring that such serv15 ices are consistent with the guidelines.

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

17 under a grant awarded under this part for a fiscal

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

19 (in addition to amounts to which subsection (f)(1) ap20 plies) use for activities associated with the quality

21 management program required in paragraph (1) not

22 more than the lesser of—

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

24 the grant; or

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

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

3 U.S.C. 300ff–15(a)) is amended—

4 (1) by redesignating paragraphs (3) through (6)

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

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

8 ‘‘(3) that entities within the eligible area that re9 ceive funds under a grant under section 2601(a) will

10 maintain relationships with appropriate entities in

11 the area, including entities described in section

12 2604(b)(3);’’.

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

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

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

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

19 area—

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

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

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

23 of the Public Health Service Act have from their over24 all budget expended amounts for administrative costs

25 (including financial compensation and benefits), ex26 pressed as a proportion and indicating the growth in
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1 such expenditures, including a statement of the aver2 age amount expended for such costs per client served

3 and the average amount expended for such costs per

4 client served in providing HIV-related services; and

5 (2) makes a determination of whether the finan6 cial compensation of any officers or employees of such

7 entities exceeds that of the chief elected official of the

8 eligible area.

9 TITLE II—CARE GRANT

10 PROGRAM

11 Subtitle A—General Grant

12 Provisions

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

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

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

16 ‘‘children,’’ each place such term appears.

17 SEC. 202. USE OF GRANTS.

18 Section 2612 of the Public Health Service Act (42

19 U.S.C. 300ff–22) is amended—

20 (1) by striking ‘‘A State may use’’ and inserting

21 ‘‘(a) IN GENERAL.—A State may use’’; and

22 (2) by adding at the end the following sub23 sections:
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1 ‘‘(b) SUPPORT SERVICES; OUTREACH.—The purposes

2 for which a grant under this part may be used include de3 livering or enhancing the following:

4 ‘‘(1) Support services under section 2611(a) (in5 cluding case management) to the extent that such

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

7 benefits of health services for individuals and families

8 with HIV disease.

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

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

12 ‘‘(A) necessary to implement the strategy

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

14 ‘‘(B) conducted in a manner consistent with

15 the requirement under section 2617(b)(6)(G);

16 and

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

18 activities that are carried out with amounts ap19 propriated under section 317.

20 ‘‘(c) EARLY INTERVENTION SERVICES.—

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

22 grant under this part may be used include providing

23 to individuals with HIV disease early intervention

24 services described in section 2651(b)(2) (including re25 ferrals under subparagraph (C) of such section), sub-
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1 ject to paragraph (2). The entities through which such

2 services may be provided under the grant include

3 public health departments, emergency rooms, sub4 stance abuse and mental health treatment programs,

5 detoxification centers, detention facilities, clinics re6 garding sexually transmitted diseases, homeless shel7 ters, HIV disease counseling and testing sites, health

8 care points of entry specified by States or eligible

9 areas, federally qualified health centers, and entities

10 described in section 2652(a).

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

12 that proposes to provide early intervention services

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

14 the entity demonstrates to the satisfaction of the State

15 involved that—

16 ‘‘(A) Federal, State, or local funds are oth17 erwise inadequate for the early intervention serv18 ices the entity proposes to provide; and

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

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

22 provision of early intervention services for the

23 fiscal year involved.

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

2 grant under this part shall provide for the establish3 ment of a quality management program to assess the

4 extent to which HIV health services provided to pa5 tients under the grant are consistent with the most re6 cent Public Health Service guidelines for the treat7 ment of HIV disease and related opportunistic infec8 tion, and as applicable, to develop strategies for en9 suring that such services are consistent with the

10 guidelines.

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

12 under a grant awarded under this part for a fiscal

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

14 section 2618(c)(5) applies) use for activities associ15 ated with the quality management program required

16 in paragraph (1) not more than the lesser of—

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

18 the grant; or

19 ‘‘(B) $3,000,000.’’.

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

21 Section 2613 of the Public Health Service Act (42

22 U.S.C. 300ff–23) is amended—

23 (1) in subsection (b)(1)—

24 (A) in subparagraph (A), by inserting be25 fore the semicolon the following: ‘‘, particularly
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1 those experiencing disparities in access and serv2 ices and those who reside in historically under3 served communities’’; and

4 (B) in subparagraph (B), by inserting after

5 ‘‘by such consortium’’ the following: ‘‘is con6 sistent with the comprehensive plan under

7 2617(b)(4) and’’;

8 (2) in subsection (c)(1)—

9 (A) in subparagraph (D), by striking ‘‘and’’

10 after the semicolon at the end;

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

12 period and inserting ‘‘; and’’;

13 (C) by adding at the end the following sub14 paragraph:

15 ‘‘(F) demonstrates that adequate planning

16 occurred to address disparities in access and

17 services and historically underserved commu18 nities.’’; and

19 (3) in subsection (c)(2)—

20 (A) in subparagraph (B), by striking ‘‘and’’

21 after the semicolon;

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

23 period and inserting ‘‘; and’’; and

24 (C) by inserting after subparagraph (C) the

25 following subparagraph:
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1 ‘‘(D) entities described in section

2 2602(b)(2).’’.

3 SEC. 204. PROVISION OF TREATMENTS.

4 Section 2616 of the Public Health Service Act (42

5 U.S.C. 300ff–26) is amended by adding at the end the fol6 lowing subsection:

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

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

9 under this part to provide the therapeutics described in such

10 subsection by paying on behalf of individuals with HIV dis11 ease the costs of purchasing or maintaining health insur12 ance or plans whose coverage includes a full range of such

13 therapeutics and appropriate primary care services.’’.

14 SEC. 205. STATE APPLICATION.

15 (a) DETERMINATION OF SIZE AND NEEDS OF POPU16 LATION; COMPREHENSIVE PLAN.—Section 2617(b) of the

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

18 amended—

19 (1) by redesignating paragraphs (2) through (4)

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

21 (2) by inserting after paragraph (1) the fol22 lowing paragraphs:

23 ‘‘(2) a determination of the size and demo24 graphics of the population of individuals with HIV

25 disease in the State;
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1 ‘‘(3) a determination of the needs of such popu2 lation, with particular attention to—

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

4 not receiving HIV-related services; and

5 ‘‘(B) disparities in access and services

6 among affected subpopulations and historically

7 underserved communities;’’; and

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

9 (A) by striking ‘‘comprehensive plan for the

10 organization’’ and inserting ‘‘comprehensive

11 plan that describes the organization’’;

12 (B) by striking ‘‘, including—’’ and insert13 ing ‘‘, and that—’’;

14 (C) by redesignating subparagraphs (A)

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

16 respectively;

17 (D) by inserting before subparagraph (C)

18 the following subparagraphs:

19 ‘‘(A) establishes priorities for the allocation

20 of funds within the State based on—

21 ‘‘(i) size and demographics of the pop22 ulation of individuals with HIV disease (as

23 determined under paragraph (2)) and the

24 needs of such population (as determined

25 under paragraph (3));
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1 ‘‘(ii) availability of other governmental

2 and nongovernmental resources to provide

3 HIV-related services to individuals and

4 families with HIV disease;

5 ‘‘(iii) capacity development needs re6 sulting from disparities in the availability

7 of HIV-related services in historically un8 derserved communities and rural commu9 nities; and

10 ‘‘(iv) the efficiency of the administra11 tive mechanism of the State for rapidly al12 locating funds to the areas of greatest need

13 within the State;

14 ‘‘(B) includes a strategy for identifying in15 dividuals with HIV disease who are not receiv16 ing such services and for informing the individ17 uals of and enabling the individuals to utilize

18 the services, giving particular attention to elimi19 nating disparities in access and services among

20 affected subpopulations and historically under21 served communities, and including discrete goals,

22 a timetable, and an appropriate allocation of

23 funds;

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

25 provision of such services with programs for HIV
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1 prevention and for the prevention and treatment

2 of substance abuse, including programs that pro3 vide comprehensive treatment services for such

4 abuse;’’;

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

6 by subparagraph (C) of this paragraph), by in7 serting ‘‘describes’’ before ‘‘the services and ac8 tivities’’;

9 (F) in subparagraph (E) (as so redesig10 nated), by inserting ‘‘provides’’ before ‘‘a de11 scription’’; and

12 (G) in subparagraph (F) (as so redesig13 nated), by inserting ‘‘provides’’ before ‘‘a de14 scription’’.

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

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

17 of this section, is amended—

18 (1) in paragraph (5), by striking ‘‘HIV’’ and in19 serting ‘‘HIV disease’’; and

20 (2) in paragraph (6), by amending subpara21 graph (A) to read as follows:

22 ‘‘(A) the public health agency that is ad23 ministering the grant for the State engages in a

24 public advisory planning process, including pub25 lic hearings, that includes the participants under
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1 paragraph (5), and entities described in section

2 2602(b)(2), in developing the comprehensive plan

3 under paragraph (4) and commenting on the im4 plementation of such plan;’’.

5 (c) HEALTH CARE RELATIONSHIPS.—Section 2617(b)

6 of the Public Health Service Act, as amended by subsection

7 (a) of this section, is amended in paragraph (6)—

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

9 the end;

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

11 and inserting ‘‘; and’’; and

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

14 ‘‘(G) entities within areas in which activi15 ties under the grant are carried out will main16 tain relationships with appropriate entities in

17 the area, including entities described in section

18 2612(c);’’.

19 SEC. 206. DISTRIBUTION OF FUNDS.

20 (a) MINIMUM ALLOTMENT.— Section 2618(b)(1)(A)(i)

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

22 28(b)(1)(A)(i)) is amended—

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

24 inserting ‘‘$200,000’’; and
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1 (2) in subclause (II), by striking ‘‘$250,000’’ and

2 inserting ‘‘$500,000’’.

3 (b) AMOUNT OF GRANT; ESTIMATE OF LIVING

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

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

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

7 the semicolon the following: ‘‘, except that (subject to

8 subparagraph (E)), for grants made pursuant to this

9 paragraph for fiscal year 2005 and subsequent fiscal

10 years, the cases counted for each 12-month period be11 ginning on or after July 1, 2004, shall be cases of

12 HIV disease (as reported to and confirmed by such

13 Director) rather than cases of acquired immune defi14 ciency syndrome’’;

15 (2) by redesignating subparagraphs (E) through

16 (H) as subparagraphs (F) through (I), respectively;

17 and

18 (3) by inserting after subparagraph (D) the fol19 lowing subparagraph:

20 ‘‘(E) DETERMINATION OF SECRETARY RE21 GARDING DATA ON HIV CASES.—If under

22 2603(a)(3)(D)(i) the Secretary determines that

23 data on cases of HIV disease is not sufficiently

24 accurate and reliable, then notwithstanding sub25 paragraph (D) of this paragraph, for any fiscal
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1 year prior to fiscal year 2007 the references in

2 such subparagraph to cases of HIV disease do

3 not have any legal effect.’’.

4 (c) INCREASES IN FORMULA AMOUNT.—Section

5 2618(b) of the Public Health Service Act (42 U.S.C. 300ff–

6 28(b)) is amended—

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

8 the semicolon the following: ‘‘and then, as applicable,

9 increased under paragraph (2)(H)’’; and

10 (2) in paragraph (2)—

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

12 ‘‘subparagraph (H)’’ and inserting ‘‘subpara13 graphs (H) and (I)’’; and

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

15 by subsection (b)(2) of this section), by amending

16 the subparagraph to read as follows:

17 ‘‘(H) LIMITATION.—

18 ‘‘(i) IN GENERAL.—The Secretary shall

19 ensure that the amount of a grant awarded

20 to a State or territory under section 2611

21 for a fiscal year is not less than—

22 ‘‘(I) with respect to fiscal year

23 2001, 99 percent;

24 ‘‘(II) with respect to fiscal year

25 2002, 98 percent;
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1 ‘‘(III) with respect to fiscal year

2 2003, 97 percent;

3 ‘‘(IV) with respect to fiscal year

4 2004, 96 percent; and

5 ‘‘(V) with respect to fiscal year

6 2005, 95 percent;

7 of the amount such State or territory re8 ceived for fiscal year 2000 under such sec9 tion. In administering this subparagraph,

10 the Secretary shall, with respect to States or

11 territories that will under such section re12 ceive grants in amounts that exceed the

13 amounts that such States received under

14 such section for fiscal year 2000, propor15 tionally reduce such amounts to ensure com16 pliance with this subparagraph. In making

17 such reductions, the Secretary shall ensure

18 that no such State receives less than that

19 State received for fiscal year 2000.

20 ‘‘(ii) RATABLE REDUCTION.—If the

21 amount appropriated under section 2677

22 for a fiscal year and available for grants

23 under section 2611 is less than the amount

24 appropriated and available under such sec25 tion for fiscal year 2000, the limitation con-
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1 tained in clause (i) shall be reduced by a

2 percentage equal to the percentage of the re3 duction in such amounts appropriated and

4 available.’’.

5 (d) TERRITORIES.—Section 2618(b)(1)(B) of the Pub6 lic Health Service Act (42 U.S.C. 300ff–28(b)(1)(B)) is

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

8 ‘‘shall be’’.

9 (e) SEPARATE TREATMENT DRUG GRANTS.—Section

10 2618(b)(2) of the Public Health Service Act, as amended

11 by subsection (b)(3) of this section, is amended in subpara12 graph (I)—

13 (1) by redesignating clauses (i) and (ii) as sub14 clauses (I) and (II), respectively;

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

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

17 the following:

18 ‘‘(I) APPROPRIATIONS FOR TREATMENT

19 DRUG PROGRAM.—

20 ‘‘(i) FORMULA GRANTS.—With respect

21 to’’;

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

23 by paragraphs (1) and (2)), by striking ‘‘100 per24 cent’’ and inserting ‘‘98 percent’’; and

25 (4) by adding at the end the following clause:
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1 ‘‘(ii) SUPPLEMENTAL TREATMENT

2 DRUG GRANTS.—

3 ‘‘(I) IN GENERAL.—With respect

4 to the fiscal year involved, if under sec5 tion 2677 an appropriations Act pro6 vides an amount exclusively for car7 rying out section 2616, and such

8 amount is not less than the amount so

9 provided for the preceding fiscal year,

10 the Secretary shall reserve 2 percent of

11 such amount for making grants to

12 States whose population of individuals

13 with HIV disease has, as determined

14 by the Secretary, a need for quantities

15 of therapeutics described in section

16 2616(a) greater than the quantities

17 available pursuant to clause (i). Such

18 a grant is available for purposes of ob19 taining such therapeutics. The Sec20 retary shall carry out this clause as a

21 program of discretionary grants, and

22 not as a program of formula grants.

23 ‘‘(II) DISTRIBUTION OF

24 GRANTS.—The Secretary shall disburse

25 all amounts under grants under sub-
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1 clause (I) for a fiscal year not later

2 than 240 days after the date on which

3 the amount referred to in such sub4 clause with respect to section 2616 be5 comes available.

6 ‘‘(III) REQUIREMENT OF MATCH7 ING FUNDS.—A condition for receiving

8 a grant under subclause (I) is that the

9 State agree to make available (directly

10 or through donations from public or

11 private entities) non-Federal contribu12 tions toward the costs of obtaining the

13 therapeutics involved in an amount

14 that is not less than 25 percent of such

15 costs (determined in the same manner

16 as under 2617(d)(2)(A)).’’.

17 (f) TECHNICAL AMENDMENT.—Section 2618(b)(3)(B)

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

19 28(b)(3)(B)) is amended by striking ‘‘and the Republic of

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

21 Marshall Islands, the Federated States of Micronesia, and

22 the Republic of Palau, and only for purposes of paragraph

23 (1) the Commonwealth of Puerto Rico’’.
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1 SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

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

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

4 (1) by striking section 2621; and

5 (2) by inserting after section 2620 the following

6 section:

7 ‘‘SEC. 2621. SUPPLEMENTAL GRANTS.

8 ‘‘(a) IN GENERAL.—From amounts available pursuant

9 to subsection (d) for a fiscal year, the Secretary shall make

10 grants to States that meet the conditions to receive grants

11 under section 2611, and that have one or more eligible com12 munities, for the purpose of providing in such communities

13 comprehensive services of the type described in section

14 2612(a) to supplement the development and care activities,

15 primary care, and support services otherwise provided in

16 such communities by the State under a grant under section

17 2611.

18 ‘‘(b) ELIGIBLE COMMUNITY.—For purposes of this sec19 tion, the term ‘eligible community’ means a geographic area

20 that—

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

22 in section 2607; and

23 ‘‘(2) has a severe need for supplemental financial

24 assistance to combat the HIV epidemic, according to

25 criteria developed by the Secretary in consultation
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1 with the States, including evidence of underserved or

2 rural areas or both.

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

4 be made to a State if the State submits to the Secretary,

5 as part of the State application submitted under section

6 2617, such information as required to apply for funds

7 under this section as determined by the Secretary in con8 sultation with the States.

9 ‘‘(d) FUNDING.—

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

11 grants under subsection (a) for a fiscal year, the Sec12 retary shall reserve 50 percent of the amount specified

13 in paragraph (2).

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

15 ‘‘(A) IN GENERAL.—For purposes of para16 graph (1), the amount specified in this para17 graph is the amount by which the amount ap18 propriated under section 2677 for the fiscal year

19 involved and available for carrying out part B

20 is an increase over the amount so appropriated

21 and available for the preceding fiscal year, sub22 ject to subparagraphs (B) and (C).

23 ‘‘(B) INITIAL ALLOCATION YEAR.—The allo24 cation under paragraph (1) shall not be made

25 until the first fiscal year for which the amount
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1 appropriated under section 2677 for the fiscal

2 year involved and available for carrying out

3 part B is an increase of not less than

4 $20,000,000 over the amount so appropriated

5 and available for fiscal year 2000, subject to sub6 paragraph (C).

7 ‘‘(C) EXCLUSION REGARDING SEPARATE

8 TREATMENT DRUG GRANTS.—Each determina9 tion under subparagraph (A) or (B) of the

10 amount appropriated under section 2677 for a

11 fiscal year and available for carrying out part

12 B shall be made without regard to any amount

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

14 Subtitle B—Provisions Concerning

15 Pregnancy and Perinatal Trans16 mission of HIV

17 SEC. 211. REPEALS.

18 Subpart II of part B of title XXVI of the Public Health

19 Service Act (42 U.S.C. 300ff–33 et seq.) is amended—

20 (1) in section 2626, by striking each of sub21 sections (d) through (f); and

22 (2) by striking section 2627.

23 SEC. 212. GRANTS.

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

25 Health Service Act (42 U.S.C. 300ff–33) is amended—
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1 (1) in paragraph (1), by inserting at the end the

2 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 are

17 not available for carrying out this section unless

18 otherwise authorized.

19 ‘‘(B) ALLOCATIONS FOR CERTAIN STATES.—

20 ‘‘(i) IN GENERAL.—Of the amounts ap21 propriated under subparagraph (A) for a

22 fiscal year in excess of $10,000,000, the Sec23 retary shall reserve the applicable percent24 age under clause (ii) for making grants

25 under paragraph (1) to States that under
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1 law (including under regulations or the dis2 cretion of State officials) have—

3 ‘‘(I) a requirement that all new4 born infants born in the State be tested

5 for HIV disease; or

6 ‘‘(II) a requirement that newborn

7 infants born in the State be tested for

8 HIV disease in circumstances in which

9 the attending obstetrician for the birth

10 does not know the HIV status of the

11 mother of the infant.

12 ‘‘(ii) APPLICABLE PERCENTAGE.—For

13 purposes of clause (i), the applicable

14 amount for a fiscal year is as follows:

15 ‘‘(I) For fiscal year 2001, 25 per16 cent.

17 ‘‘(II) For fiscal year 2002, 50 per18 cent.

19 ‘‘(III) For fiscal year 2003, 50

20 percent.

21 ‘‘(IV) For fiscal year 2004, 75

22 percent.

23 ‘‘(V) For fiscal year 2005, 75 per24 cent.
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1 ‘‘(C) CERTAIN PROVISIONS.—With respect to

2 grants under paragraph (1) that are made with

3 amounts reserved under subparagraph (B) of this

4 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 both),

10 the full amount reserved under subpara11 graph (B) for a fiscal year is not obligated,

12 the requirement under such subparagraph

13 to reserve amounts ceases to apply.’’; and

14 (3) by adding at the end the following para15 graph:

16 ‘‘(4) MAINTENANCE OF EFFORT.—A condition for

17 the receipt of a grant under paragraph (1) is that the

18 State involved agree that the grant will be used to

19 supplement and not supplant other funds available to

20 the State to carry out the purposes of the grant.’’.

21 (b) SPECIAL FUNDING RULE FOR FISCAL YEAR

22 2001.—

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

24 amount appropriated under paragraph (2)(A) of sec-
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1 tion 2625(c) of the Public Health Service Act is less

2 than $14,000,000—

3 (A) the Secretary of Health and Human

4 Services shall, for the purpose of making grants

5 under paragraph (1) of such section, reserve from

6 the amount specified in paragraph (2) of this

7 subsection an amount equal to the difference be8 tween $14,000,000 and the amount appropriated

9 under paragraph (2)(A) of such section for such

10 fiscal year;

11 (B) the amount so reserved shall, for pur12 poses of paragraph (2)(B)(i) of such section, be

13 considered to have been appropriated under

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

15 (C) the percentage specified in paragraph

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

17 percent.

18 (2) ALLOCATION FROM INCREASES IN FUNDING

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

20 amount specified in this paragraph is the amount by

21 which the amount appropriated under section 2677 of

22 the Public Health Service Act for fiscal year 2001

23 and available for grants under section 2611 of such

24 Act is an increase over the amount so appropriated

25 and available for fiscal year 2000.
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1 SEC. 213. STUDY BY INSTITUTE OF MEDICINE.

2 Subpart II of part B of title XXVI of the Public Health

3 Service Act (42 U.S.C. 300ff–33 et seq.) is amended by add4 ing at the end the following section:

5 ‘‘SEC. 2630. RECOMMENDATIONS FOR REDUCING INCI6 DENCE OF PERINATAL TRANSMISSION.

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

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

9 the Institute of Medicine to enter into an agreement

10 with the Secretary under which such Institute con11 ducts a study to provide the following:

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

13 which the information is available, a determina14 tion of the number of newborn infants with HIV

15 born in the United States with respect to whom

16 the attending obstetrician for the birth did not

17 know the HIV status of the mother.

18 ‘‘(B) A determination for each State of any

19 barriers, including legal barriers, that prevent or

20 discourage an obstetrician from making it a rou21 tine practice to offer pregnant women an HIV

22 test and a routine practice to test newborn in23 fants for HIV disease in circumstances in which

24 the obstetrician does not know the HIV status of

25 the mother of the infant.
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1 ‘‘(C) Recommendations for each State for

2 reducing the incidence of cases of the perinatal

3 transmission of HIV, including recommendations

4 on removing the barriers identified under sub5 paragraph (B).

6 If such Institute declines to conduct the study, the

7 Secretary shall enter into an agreement with another

8 appropriate public or nonprofit private entity to con9 duct the study.

10 ‘‘(2) REPORT.—The Secretary shall ensure that,

11 not later than 18 months after the effective date of

12 this section, the study required in paragraph (1) is

13 completed and a report describing the findings made

14 in the study is submitted to the appropriate commit15 tees of the Congress, the Secretary, and the chief pub16 lic health official of each of the States.

17 ‘‘(b) PROGRESS TOWARD RECOMMENDATIONS.—Each

18 State shall comply with the following (as applicable to the

19 fiscal year involved):

20 ‘‘(1) For fiscal year 2004, the State shall submit

21 to the Secretary a report describing the actions taken

22 by the State toward meeting the recommendations

23 specified for the State under subsection (a)(1)(C).

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

25 fiscal year—
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1 ‘‘(A) the State shall make reasonable

2 progress toward meeting such recommendations;

3 or

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

5 progress—

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

7 Director of the Centers for Disease Control

8 and Prevention in carrying out activities

9 toward meeting the recommendations; and

10 ‘‘(ii) the State shall submit to the Sec11 retary a report containing a description of

12 any barriers identified under subsection

13 (a)(1)(B) that continue to exist in the State;

14 as applicable, the factors underlying the

15 continued existence of such barriers; and a

16 description of how the State intends to re17 duce the incidence of cases of the perinatal

18 transmission of HIV.

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

20 Secretary shall submit to the appropriate committees of the

21 Congress each report received by the Secretary under sub22 section (b)(2)(B)(ii).’’.
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1 Subtitle C—Certain Partner

2 Notification Programs

3 SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICA4 TION PROGRAMS.

5 Part B of title XXVI of the Public Health Service Act

6 (42 U.S.C. 300ff–21 et seq.) is amended by adding at the

7 end the following subpart:

8 ‘‘Subpart III—Certain Partner Notification Programs

9 ‘‘SEC. 2631. GRANTS FOR PARTNER NOTIFICATION PRO10 GRAMS.

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

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

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

14 the States for carrying out programs to provide partner

15 counseling and referral services.

16 ‘‘(b) DESCRIPTION OF COMPLIANT STATE PRO17 GRAMS.—For purposes of subsection (a), the laws or regula18 tions of a State are in accordance with this subsection if

19 under such laws or regulations (including programs carried

20 out pursuant to the discretion of State officials) the fol21 lowing policies are in effect:

22 ‘‘(1) The State requires that the public health of23 ficer of the State carry out a program of partner no24 tification to inform partners of individuals with HIV
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1 disease that the partners may have been exposed to

2 the disease.

3 ‘‘(2)(A) In the case of a health entity that pro4 vides for the performance on an individual of a test

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

6 disease, the State requires, subject to subparagraph

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

8 test results to the State public health officer in a

9 manner recommended and approved by the Director

10 of the Centers for Disease Control and Prevention, to11 gether with such additional information as may be

12 necessary for carrying out such program.

13 ‘‘(B) The State may provide that the require14 ment of subparagraph (A) does not apply to the test15 ing of an individual for HIV disease if the individual

16 underwent the testing through a program designed to

17 perform the test and provide the results to the indi18 vidual without the individual disclosing his or her

19 identity to the program. This subparagraph may not

20 be construed as affecting the requirement of subpara21 graph (A) with respect to a health entity that treats

22 an individual for HIV disease.

23 ‘‘(3) The program under paragraph (1) is car24 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 sub4 paragraph (B).

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

6 the identity of the infected individuals involved.

7 ‘‘(C) Counseling and testing for HIV disease

8 are made available to the partners and to in9 fected individuals, and such counseling includes

10 information on modes of transmission for the

11 disease, including information on prenatal and

12 perinatal transmission and preventing trans13 mission.

14 ‘‘(D) Counseling of infected individuals and

15 their partners includes the provision of informa16 tion regarding therapeutic measures for pre17 venting and treating the deterioration of the im18 mune system and conditions arising from the

19 disease, and the provision of other prevention-re20 lated information.

21 ‘‘(E) Referrals for appropriate services are

22 provided to partners and infected individuals,

23 including referrals for support services and legal

24 aid.
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1 ‘‘(F) Notifications under subparagraph (A)

2 are provided in person, unless doing so is an un3 reasonable burden on the State.

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

5 on, or civil liability for, an infected individual

6 if 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 part10 ners is not a basis for the civil liability of any

11 health entity who under the program reported to

12 the State the identity of the infected individual

13 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 the

21 number of individuals from whom the names of part22 ners have been sought under the program under para23 graph (1), the number of such individuals who pro24 vided the names of partners, and the number of part25 ners so named who were notified under the program.
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1 ‘‘(5) The State cooperates with such Director in

2 carrying out a national program of partner notifica3 tion, including the sharing of information between the

4 public health officers of the States.

5 ‘‘(c) REPORTING SYSTEM FOR CASES OF HIV DIS6 EASE.—

7 ‘‘(1) PREFERENCE IN MAKING GRANTS THROUGH

8 FISCAL YEAR 2003.—In making grants under sub9 section (a) for each of the fiscal years 2001 through

10 2003, the Secretary shall give preference to States

11 whose reporting systems for cases of HIV disease

12 produce data on such cases that is sufficiently accu13 rate and reliable for use for purposes of section

14 2618(b)(2)(D)(i).

15 ‘‘(2) ELIGIBILITY CONDITION AFTER FISCAL

16 YEAR 2003.—For fiscal year 2004 and subsequent fis17 cal years, a State may not receive a grant under sub18 section (a) unless the reporting system of the State for

19 cases of HIV disease produces data on such cases that

20 is sufficiently accurate and reliable for purposes of

21 section 2618(b)(2)(D)(i).

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

23 purpose of carrying out this section, there are authorized

24 to be appropriated $30,000,000 for fiscal year 2001, and
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1 such sums as may be necessary for each of the fiscal years

2 2002 through 2005.’’.

3 TITLE III—EARLY

4 INTERVENTION SERVICES

5 Subtitle A—Formula Grants for

6 States

7 SEC. 301. REPEAL OF PROGRAM.

8 Subpart I of part C of title XXVI of the Public Health

9 Service Act (42 U.S.C. 300ff–41 et seq.) is repealed.

10 Subtitle B—Categorical Grants

11 SEC. 311. PREFERENCES IN MAKING GRANTS.

12 Section 2653 of the Public Health Service Act (42

13 U.S.C. 300ff–53) is amended by adding at the end the fol14 lowing subsection:

15 ‘‘(d) UNDERSERVED AND RURAL AREAS.—Of the ap16 plicants who qualify for preference under this section, the

17 Secretary shall give preference to applicants that will ex18 pend the grant under section 2651 to provide early inter19 vention under such section in rural areas or in areas that

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

21 SEC. 312. PLANNING AND DEVELOPMENT GRANTS.

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

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

24 by striking ‘‘planning grants’’ and all that follows and in-
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1 serting the following: ‘‘planning grants to public and non2 profit private entities 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 subpopula9 tions that are underserved with respect to such

10 services (subject to the condition that a grant

11 pursuant to this subparagraph may not be ex12 pended to purchase or improve land, or to pur13 chase, construct, or permanently improve, other

14 than minor remodeling, any building or other fa15 cility).’’.

16 (b) AMOUNT; DURATION.—Section 2654(c) of the Pub17 lic Health Service Act (42 U.S.C. 300ff–54(c)) is further

18 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) of

12 the Public Health Service Act (42 U.S.C. 300ff–54(c)(5)),

13 as redesignated by subsection (b), is amended by striking

14 ‘‘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 (42

23 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 designation;

6 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 status

15 to their sexual partners and their partners in the

16 sharing of hypodermic needles; that provides ad17 vice to infected individuals on the manner in

18 which such disclosures can be made; and that

19 emphasizes that it is the continuing duty of the

20 individuals to avoid any behaviors that will ex21 pose 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 at

4 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 the

11 extent to which medical services funded under this

12 title that are provided to patients are consistent with

13 the most recent Public Health Service guidelines for

14 the treatment of HIV disease and related opportun15 istic infections and that improvements in the access

16 to and quality of medical services are addressed.’’.
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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 research

16 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 grantees

23 under subsection (a) for purposes of enhancing and

24 expanding HIV-related research, especially within
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1 communities that are underrepresented with respect to

2 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)(1) of the

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

19 111(a)(1)) is 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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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 ‘‘and’’

7 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 GUIDELINES;

16 MEDICAL CONSULTATION ACTIVITIES.—Not later than

17 90 days after the date of the enactment of this Act,

18 the Secretary of Health and Human Services shall

19 issue and begin implementation of a strategy for the

20 dissemination of HIV treatment information to health

21 care providers and patients.

22 (b) DENTAL SCHOOLS.—Section 2692(b) of the Public

23 Health Service Act (42 U.S.C. 300ff–111(b)) is amended—

24 (1) by amending paragraph (1) to read as fol25 lows:
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1 ‘‘(1) IN GENERAL.—

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

3 grants to dental schools and programs described

4 in subparagraph (B) to assist such schools and

5 programs with respect to oral health care to pa6 tients with HIV disease.

7 ‘‘(B) ELIGIBLE APPLICANTS.—For purposes

8 of this subsection, the dental schools and pro9 grams referred to in this subparagraph are den10 tal schools and programs that were described in

11 section 777(b)(4)(B) as such section was in effect

12 on the day before the date of enactment of the

13 Health Professions Education Partnerships Act

14 of 1998 (Public Law 105–392) and in addition

15 dental hygiene programs that are accredited by

16 the Commission on Dental Accreditation.’’;

17 (2) in paragraph (2), by striking ‘‘777(b)(4)(B)’’

18 and inserting ‘‘the section referred to in paragraph

19 (1)(B)’’; and

20 (3) by inserting after paragraph (4) the fol21 lowing paragraph:

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

23 may make grants to dental schools and programs de24 scribed in paragraph (1)(B) that partner with com25 munity-based dentists to provide oral health care to
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1 patients with HIV disease in unserved areas. Such

2 partnerships shall permit the training of dental stu3 dents and residents and the participation of commu4 nity dentists as adjunct faculty.’’.

5 (c) AUTHORIZATION OF APPROPRIATIONS.—

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

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

8 111(c)(1)) is amended by striking ‘‘fiscal years 1996

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

10 through 2005’’.

11 (2) DENTAL SCHOOLS.—Section 2692(c)(2) of the

12 Public Health Service Act (42 U.S.C. 300ff–111(c)(2))

13 is amended to read as follows:

14 ‘‘(2) DENTAL SCHOOLS.—

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

16 grants under paragraphs (1) through (4) of sub17 section (b), there are authorized to be appro18 priated such sums as may be necessary for each

19 of the fiscal years 2001 through 2005.

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

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

22 are authorized to be appropriated such sums as

23 may be necessary for each of the fiscal years

24 2001 through 2005.’’.
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1 Subtitle B—General Provisions in

2 Title XXVI

3 SEC. 411. EVALUATIONS AND REPORTS.

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

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

6 1995’’ and inserting ‘‘2001 through 2005’’.

7 SEC. 412. DATA COLLECTION THROUGH CENTERS FOR DIS8 EASE CONTROL AND PREVENTION.

9 Part D of title XXVI of the Public Health Service Act

10 (42 U.S.C. 300ff–71 et seq.) is amended—

11 (1) by redesignating section 2675 as section

12 2675A; and

13 (2) by inserting after section 2674 the following

14 section:

15 ‘‘SEC. 2675. DATA COLLECTION.

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

17 program planning and evaluation activities under this

18 title, there are authorized to be appropriated to the Sec19 retary (acting through the Director of the Centers for Dis20 ease Control and Prevention) such sums as may be nec21 essary for each of the fiscal years 2001 through 2005. Such

22 authorization of appropriations is in addition to other au23 thorizations of appropriations that are available for such

24 purpose.’’.
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1 SEC. 413. COORDINATION.

2 Section 2675A of the Public Health Service Act, as re3 designated by section 412 of this Act, is amended—

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

6 ‘‘(a) REQUIREMENT.—The Secretary shall ensure that

7 the Health Resources and Services Administration, the Cen8 ters for Disease Control and Prevention, the Substance

9 Abuse and Mental Health Services Administration, and the

10 Health Care Financing Administration coordinate the

11 planning, funding, and implementation of Federal HIV

12 programs to enhance the continuity of care and prevention

13 services for individuals with HIV disease or those at risk

14 of such disease. The Secretary shall consult with other Fed15 eral agencies, including the Department of Veterans Affairs,

16 as needed and utilize planning information submitted to

17 such agencies by the States and entities eligible for sup18 port.’’;

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

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

21 (3) by inserting after subsection (b) the following

22 subsection:

23 ‘‘(b) REPORT.—The Secretary shall biennially prepare

24 and submit to the appropriate committees of the Congress

25 a report concerning the coordination efforts at the Federal,

26 State, and local levels described in this section, including
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1 a description of Federal barriers to HIV program integra2 tion and a strategy for eliminating such barriers and en3 hancing the continuity of care and prevention services for

4 individuals with HIV disease or those at risk of such dis5 ease.’’; and

6 (4) in each of subsections (c) and (d) (as redesig7 nated by paragraph (2) of this section), by inserting

8 ‘‘and prevention services’’ after ‘‘continuity of care’’

9 each place such term appears.

10 SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH

11 HIV DISEASE.

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

13 amended by section 413(2) of this Act, is amended by add14 ing at the end the following subsection:

15 ‘‘(e) RECOMMENDATIONS REGARDING RELEASE OF

16 PRISONERS.—After consultation with the Attorney General

17 and the Director of the Bureau of Prisons, with States, with

18 eligible areas under part A, and with entities that receive

19 amounts from grants under part A or B, the Secretary, con20 sistent with the coordination required in subsection (a),

21 shall develop a plan for the medical case management of

22 and the provision of support services to individuals who

23 were Federal or State prisoners and had HIV disease as

24 of the date on which the individuals were released from the

25 custody of the penal system. The Secretary shall submit the
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1 plan to the Congress not later than two years after the date

2 of the enactment of the Ryan White CARE Act Amendments

3 of 2000.’’.

4 SEC. 415. AUDITS.

5 Part D of title XXVI of the Public Health Service Act,

6 as amended by section 412 of this Act, is amended by insert7 ing after section 2675A the following section:

8 ‘‘SEC. 2675B. AUDITS.

9 ‘‘For fiscal year 2002 and subsequent fiscal years, the

10 Secretary may reduce the amounts of grants under this title

11 to a State or political subdivision of a State for a fiscal

12 year if, with respect to such grants for the second preceding

13 fiscal year, the State or subdivision fails to prepare audits

14 in accordance with the procedures of section 7502 of title

15 31, United States Code. The Secretary shall annually select

16 representative samples of such audits, prepare summaries

17 of the selected audits, and submit the summaries to the Con18 gress.’’.

19 SEC. 416. ADMINISTRATIVE SIMPLIFICATION.

20 Part D of title XXVI of the Public Health Service Act,

21 as amended by section 415 of this Act, is amended by insert22 ing after section 2675B the following section:
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1 ‘‘SEC. 2675C. ADMINISTRATIVE SIMPLIFICATION REGARD2 ING PARTS A AND B.

3 ‘‘(a) COORDINATED DISBURSEMENT.—After consulta4 tion with the States, with eligible areas under part A, and

5 with entities that receive amounts from grants under part

6 A or B, the Secretary shall develop a plan for coordinating

7 the disbursement of appropriations for grants under part

8 A with the disbursement of appropriations for grants under

9 part B in order to assist grantees and other recipients of

10 amounts from such grants in complying with the require11 ments of such parts. The Secretary shall submit the plan

12 to the Congress not later than 18 months after the date of

13 the enactment of the Ryan White CARE Act Amendments

14 of 2000. Not later than two years after the date on which

15 the plan is so submitted, the Secretary shall complete the

16 implementation of the plan, notwithstanding any provision

17 of this title that is inconsistent with the plan.

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

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

20 entities that receive amounts from grants under part A or

21 B, the Secretary shall make a determination of whether the

22 administration of parts A and B by the Secretary, and the

23 efficiency of grantees under such parts in complying with

24 the requirements of such parts, would be improved by re25 quiring that applications for grants under such parts be

26 submitted biennially rather than annually. The Secretary
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1 shall submit such determination to the Congress not later

2 than two years after the date of the enactment of the Ryan

3 White CARE Act Amendments of 2000.

4 ‘‘(c) APPLICATION SIMPLIFICATION.—After consulta5 tion with the States, with eligible areas under part A, and

6 with entities that receive amounts from grants under part

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

8 the process for applications under parts A and B. The Sec9 retary shall submit the plan to the Congress not later than

10 18 months after the date of the enactment of the Ryan White

11 CARE Act Amendments of 2000. Not later than two years

12 after the date on which the plan is so submitted, the Sec13 retary shall complete the implementation of the plan, not14 withstanding any provision of this title that is inconsistent

15 with the plan.’’.

16 SEC. 417. AUTHORIZATION OF APPROPRIATIONS FOR

17 PARTS A AND B.

18 Section 2677 of the Public Health Service Act (42

19 U.S.C. 300ff–77) is amended to read as follows:

20 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

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

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

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

24 2005.
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1 ‘‘(b) PART B.—For the purpose of carrying out part

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

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

4 2005.’’.

5 TITLE V—GENERAL PROVISIONS

6 SEC. 501. STUDIES BY INSTITUTE OF MEDICINE.

7 (a) STATE SURVEILLANCE SYSTEMS ON PREVALENCE

8 OF HIV.—The Secretary of Health and Human Services

9 (referred to in this section as the ‘‘Secretary’’) shall request

10 the Institute of Medicine to enter into an agreement with

11 the Secretary under which such Institute conducts a study

12 to provide the following:

13 (1) A determination of whether the surveillance

14 system of each of the States regarding the human im15 munodeficiency virus provides for the reporting of

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

17 sufficient to provide adequate and reliable informa18 tion on the number of such cases and the demographic

19 characteristics of such cases, both for the State in gen20 eral and for specific geographic areas in the State.

21 (2) A determination of whether such information

22 is sufficiently accurate for purposes of formula grants

23 under parts A and B of title XXVI of the Public

24 Health Service Act.
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1 (3) With respect to any State whose surveillance

2 system does not provide adequate and reliable infor3 mation on cases of infection with the virus, rec4 ommendations regarding the manner in which the

5 State can improve the system.

6 (b) RELATIONSHIP BETWEEN EPIDEMIOLOGICAL

7 MEASURES AND HEALTH CARE FOR CERTAIN INDIVIDUALS

8 WITH HIV DISEASE.—

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

10 the Institute of Medicine to enter into an agreement

11 with the Secretary under which such Institute con12 ducts a study concerning the appropriate epidemio13 logical measures and their relationship to the financ14 ing and delivery of primary care and health-related

15 support services for low-income, uninsured, and

16 under-insured individuals with HIV disease.

17 (2) ISSUES TO BE CONSIDERED.—The Secretary

18 shall ensure that the study under paragraph (1) con19 siders the following:

20 (A) The availability and utility of health

21 outcomes measures and data for HIV primary

22 care and support services and the extent to which

23 those measures and data could be used to meas24 ure the quality of such funded services.
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1 (B) The effectiveness and efficiency of serv2 ice delivery (including the quality of services,

3 health outcomes, and resource use) within the

4 context of a changing health care and thera5 peutic environment, as well as the changing epi6 demiology of the epidemic, including deter7 mining the actual costs, potential savings, and

8 overall financial impact of modifying the pro9 gram under title XIX of the Social Security Act

10 to establish eligibility for medical assistance

11 under such title on the basis of infection with the

12 human immunodeficiency virus rather than pro13 viding such assistance only if the infection has

14 progressed to acquired immune deficiency syn15 drome.

16 (C) Existing and needed epidemiological

17 data and other analytic tools for resource plan18 ning and allocation decisions, specifically for es19 timating severity of need of a community and

20 the relationship to the allocations process.

21 (D) Other factors determined to be relevant

22 to assessing an individual’s or community’s abil23 ity to gain and sustain access to quality HIV

24 services.
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1 (c) OTHER ENTITIES.—If the Institute of Medicine de2 clines to conduct a study under this section, the Secretary

3 shall enter into an agreement with another appropriate

4 public or nonprofit private entity to conduct the study.

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

6 (1) not later than three years after the date of

7 the enactment of this Act, the study required in sub8 section (a) is completed and a report describing the

9 findings made in the study is submitted to the appro10 priate committees of the Congress; and

11 (2) not later than two years after the date of the

12 enactment of this Act, the study required in sub13 section (b) is completed and a report describing the

14 findings made in the study is submitted to such com15 mittees.

16 SEC. 502. DEVELOPMENT OF RAPID HIV TEST.

17 (a) EXPANSION, INTENSIFICATION, AND COORDINATION

18 OF RESEARCH AND OTHER ACTIVITIES.—

19 (1) IN GENERAL.—The Director of NIH shall ex20 pand, intensify, and coordinate research and other

21 activities of the National Institutes of Health with re22 spect to the development of reliable and affordable

23 tests for HIV disease that can rapidly be adminis24 tered and whose results can rapidly be obtained (in

25 this section referred to a ‘‘rapid HIV test’’).
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1 (2) REPORT TO CONGRESS.—The Director of

2 NIH shall periodically submit to the appropriate

3 committees of Congress a report describing the re4 search and other activities conducted or supported

5 under paragraph (1).

6 (3) AUTHORIZATION OF APPROPRIATIONS.—For

7 the purpose of carrying out this subsection, there are

8 authorized to be appropriated such sums as may be

9 necessary for each of the fiscal years 2001 through

10 2005.

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

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

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

14 in consultation with the Director of the Centers for

15 Disease Control and Prevention and the Commis16 sioner of Food and Drugs, shall submit to the appro17 priate committees of the Congress a report describing

18 the progress made towards, and barriers to, the pre19 market review and commercial distribution of rapid

20 HIV tests. The report shall—

21 (A) assess the public health need for and

22 public health benefits of rapid HIV tests, includ23 ing the minimization of false positive results

24 through the availability of multiple rapid HIV

25 tests;
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1 (B) make recommendations regarding the

2 need for the expedited review of rapid HIV test

3 applications submitted to the Center for Bio4 logics Evaluation and Research and, if such rec5 ommendations are favorable, specify criteria and

6 procedures for such expedited review; and

7 (C) specify whether the barriers to the pre8 market review of rapid HIV tests include the un9 necessary application of requirements—

10 (i) necessary to ensure the efficacy of

11 devices for donor screening to rapid HIV

12 tests intended for use in other screening sit13 uations; or

14 (ii) for identifying antibodies to HIV

15 subtypes of rare incidence in the United

16 States to rapid HIV tests intended for use

17 in screening situations other than donor

18 screening.

19 (c) GUIDELINES OF CENTERS FOR DISEASE CONTROL

20 AND PREVENTION.—Promptly after commercial distribu21 tion of a rapid HIV test begins, the Secretary, acting

22 through the Director of the Centers for Disease Control and

23 Prevention, shall establish or update guidelines that include

24 recommendations for States, hospitals, and other appro25 priate entities regarding the ready availability of such tests
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1 for administration to pregnant women who are in labor

2 or in the late stage of pregnancy and whose HIV status

3 is not known to the attending obstetrician.

4 TITLE VI—EFFECTIVE DATE

5 SEC. 601. EFFECTIVE DATE.

6 This Act and the amendments made by this Act take

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

8 of this Act, whichever occurs later.

Calendar No. 455

106TH CONGRESS

2D SESSION H. R. 4807

[Report No. 106–788]

A BILL

To amend the Public Health Service Act to revise

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

JULY 25, 2000

Reported with an amendment, committed to the Committee of the Whole House on the State of the Union,

and ordered to be printed