II

106TH CONGRESS

2D SESSION S. 2311

To revise and extend the Ryan White CARE Act programs under title XXVI

of the Public Health Service Act, to improve access to health care

and the quality of care under such programs, and to provide for the

development of increased capacity to provide health care and related

support services to individuals and families with HIV disease, and for

other purposes.

IN THE SENATE OF THE UNITED STATES

MARCH 29, 2000

Mr. JEFFORDS (for himself, Mr. KENNEDY, Mr. FRIST, Mr. HATCH, Mr.

DODD, Mr. ENZI, Mr. HARKIN, Ms. MIKULSKI, Mr. BINGAMAN, Mr.

WELLSTONE, Mr. REED, Mr. BIDEN, and Mr. DURBIN) introduced the

following bill; which was read twice and referred to the Committee on

Health, Education, Labor, and Pensions

A BILL

To revise and extend the Ryan White CARE Act programs

under title XXVI of the Public Health Service Act, to

improve access to health care and the quality of care

under such programs, and to provide for the development

of increased capacity to provide health care and related

support services to individuals and families with HIV

disease, and for other purposes.

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

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

3 Act Amendments of 2000’’.

4 SEC. 2. REFERENCES; TABLE OF CONTENTS.

5 (a) REFERENCES.—Except as otherwise expressly

6 provided, whenever in this Act an amendment or repeal

7 is expressed in terms of an amendment to, or repeal of,

8 a section or other provision, the reference shall be consid9 ered to be made to a section or other provision of the Pub10 lic Health Service Act (42 U.S.C. 201 et seq.).

11 (b) Table of Contents.—The table of contents of this

12 Act is as follows:

Sec. 1. Short title.

Sec. 2. References; table of contents.

TITLE I—AMENDMENTS TO HIV HEALTH CARE PROGRAM

Subtitle A—Purpose; Amendments to Part A (Emergency Relief Grants)

Sec. 101. Duties of planning council, funding priorities, quality assessment.

Sec. 102. Quality management.

Sec. 103. Funded entities required to have health care relationships.

Sec. 104. Support services required to be health care-related.

Sec. 105. Use of grant funds for early intervention services.

Sec. 106. Replacement of specified fiscal years regarding the sunset on expedited distribution requirement.

Sec. 107. Hold harmless provision.

Sec. 108. Set-aside for infants, children, and women.

Subtitle B—Amendments to Part B (Care Grant Program)

Sec. 121. State requirements concerning identification of need and allocation of

resources.

Sec. 122. Quality management.

Sec. 123. Funded entities required to have health care referral relationships.

Sec. 124. Support services required to be health care-related.

Sec. 125. Use of grant funds for early intervention services.

Sec. 126. Authorization of appropriations for HIV-related services for women

and children.

Sec. 127. Repeal of requirement for completed Institute of Medicine report.

Sec. 130. Supplement grants for certain States.

Sec. 131. Use of treatment funds.
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Sec. 132. Increase in minimum allotment.

Sec. 133. Set-aside for infants, children, and women.

Subtitle C—Amendments to Part C (Early Intervention Services)

Sec. 141. Amendment of heading; repeal of formula grant program.

Sec. 142. Planning and development grants.

Sec. 143. Authorization of appropriations for categorical grants.

Sec. 144. Administrative expenses ceiling; quality management program.

Sec. 145. Preference for certain areas.

Subtitle D—Amendments to Part D (General Provisions)

Sec. 151. Research involving women, infants, children, and youth.

Sec. 152. Limitation on administrative expenses.

Sec. 153. Evaluations and reports.

Sec. 154. Authorization of appropriations for grants under parts A and B.

Subtitle E—Amendments to Part F (Demonstration and Training)

Sec. 161. Authorization of appropriations.

TITLE II—MISCELLANEOUS PROVISIONS

Sec. 201. Institute of Medicine study.

1 TITLE I—AMENDMENTS TO HIV

2 HEALTH CARE PROGRAM

3 Subtitle A—Purpose; Amendments

4 to Part A (Emergency Relief

5 Grants)

6 SEC. 101. DUTIES OF PLANNING COUNCIL, FUNDING PRIOR7 ITIES, QUALITY ASSESSMENT.

8 Section 2602 (42 U.S.C. 300ff–12) is amended—

9 (1) in subsection (b)—

10 (A) in paragraph (2)(C), by inserting be11 fore the semicolon the following: ‘‘, including

12 providers of housing and homeless services’’;

13 and
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1 (B) in paragraph (4), by striking ‘‘shall—

2 ’’ and all that follows and inserting ‘‘shall have

3 the responsibilities specified in subsection (d).’’;

4 and

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

6 ‘‘(d) DUTIES OF PLANNING COUNCIL.—The planning

7 council established under subsection (b) shall have the fol8 lowing duties:

9 ‘‘(1) PRIORITIES FOR ALLOCATION OF

10 FUNDS.—The council shall establish priorities for

11 the allocation of funds within the eligible area, in12 cluding how best to meet each such priority and ad13 ditional factors that a grantee should consider in al14 locating funds under a grant, based on the following

15 factors:

16 ‘‘(A) The size and demographic character17 istics of the population with HIV disease to be

18 served, including, subject to subsection (e), the

19 needs of individuals living with HIV infection

20 who are not receiving HIV-related health serv21 ices.

22 ‘‘(B) The documented needs of the popu23 lation with HIV disease with particular atten24 tion being given to disparities in health services
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1 among affected subgroups within the eligible

2 area.

3 ‘‘(C) The demonstrated or probable cost

4 and outcome effectiveness of proposed strate5 gies and interventions, to the extent that data

6 are reasonably available.

7 ‘‘(D) Priorities of the communities with

8 HIV disease for whom the services are in9 tended.

10 ‘‘(E) The availability of other govern11 mental and non-governmental resources, includ12 ing the State medicaid plan under title XIX of

13 the Social Security Act and the State Children’s

14 Health Insurance Program under title XXI of

15 such Act to cover health care costs of eligible

16 individuals and families with HIV disease.

17 ‘‘(F) Capacity development needs resulting

18 from gaps in the availability of HIV services in

19 historically underserved low-income commu20 nities.

21 ‘‘(2) COMPREHENSIVE SERVICE DELIVERY

22 PLAN.—The council shall develop a comprehensive

23 plan for the organization and delivery of health and

24 support services described in section 2604. Such

25 plan shall be compatible with any existing State or
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1 local plans regarding the provision of such services

2 to individuals with HIV disease.

3 ‘‘(3) ASSESSMENT OF FUND ALLOCATION EFFI4 CIENCY.—The council shall assess the efficiency of

5 the administrative mechanism in rapidly allocating

6 funds to the areas of greatest need within the eligi7 ble area.

8 ‘‘(4) STATEWIDE STATEMENT OF NEED.—The

9 council shall participate in the development of the

10 Statewide coordinated statement of need as initiated

11 by the State public health agency responsible for ad12 ministering grants under part B.

13 ‘‘(5) COORDINATION WITH OTHER FEDERAL

14 GRANTEES.—The council shall coordinate with Fed15 eral grantees providing HIV-related services within

16 the eligible area.

17 ‘‘(6) COMMUNITY PARTICIPATION.—The council

18 shall establish methods for obtaining input on com19 munity needs and priorities which may include pub20 lic meetings, conducting focus groups, and convening

21 ad-hoc panels.

22 ‘‘(e) PROCESS FOR ESTABLISHING ALLOCATION PRI23 ORITIES.—

24 ‘‘(1) IN GENERAL.—Not later than 24 months

25 after the date of enactment of the Ryan White
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1 CARE Act Amendments of 2000, the Secretary

2 shall—

3 ‘‘(A) consult with eligible metropolitan

4 areas, affected communities, experts, and other

5 appropriate individuals and entities, to develop

6 epidemiologic measures for establishing the

7 number of individuals living with HIV disease

8 who are not receiving HIV-related health serv9 ices; and

10 ‘‘(B) provide advice and technical assist11 ance to planning councils with respect to the

12 process for establishing priorities for the alloca13 tion of funds under subsection (d)(1).

14 ‘‘(2) EXCEPTION.—Grantees under subsection

15 (d)(1)(A) shall not be required to establish priorities

16 for individuals not in care until epidemiologic meas17 ures are developed under paragraph (1).’’.

18 SEC. 102. QUALITY MANAGEMENT.

19 (a) FUNDS AVAILABLE FOR QUALITY MANAGE20 MENT.—Section 2604 (42 U.S.C. 300ff–14) is amended—

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

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

23 (2) by inserting after subsection (b) the fol24 lowing:

25 ‘‘(c) QUALITY MANAGEMENT.—
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1 ‘‘(1) REQUIREMENT.—The chief elected official

2 of an eligible area that receives a grant under this

3 part shall provide for the establishment of a quality

4 management program to assess the extent to which

5 medical services provided to patients under the grant

6 are consistent with the most recent Public Health

7 Service guidelines for the treatment of HIV disease

8 and related opportunistic infection and to develop

9 strategies for improvements in the access to and

10 quality of medical services.

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

12 under a grant awarded under this part, the chief

13 elected official of an eligible area may use, for activi14 ties associated with its quality management pro15 gram, not more than the lesser of—

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

17 the grant; or

18 ‘‘(B) $3,000,000.’’.

19 (b) QUALITY MANAGEMENT REQUIRED FOR ELIGI20 BILITY FOR GRANTS.—Section 2605(a) (42 U.S.C. 300ff–

21 15(a)) is amended—

22 (1) by redesignating paragraphs (3) through

23 (6) as paragraphs (5) through (8), respectively; and

24 (2) by inserting after paragraph (2) the fol25 lowing:
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1 ‘‘(3) that the chief elected official of the eligible

2 area will satisfy all requirements under section

3 2604(c);’’.

4 SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH

5 CARE RELATIONSHIPS.

6 (a) USE OF AMOUNTS.—Section 2604(e)(1) (42

7 U.S.C. 300ff–14(d)(1)) (as so redesignated by section

8 102(a)) is amended by inserting ‘‘and the State Children’s

9 Health Insurance Program under title XXI of such Act’’

10 after ‘‘Social Security Act’’.

11 (b) APPLICATIONS.—Section 2605(a) (42 U.S.C.

12 300ff–15(a)) is amended by inserting after paragraph (3),

13 as added by section 102(b), the following:

14 ‘‘(4) that funded entities within the eligible area

15 that receive funds under a grant under section

16 2601(a) shall maintain appropriate relationships

17 with entities in the area served that constitute key

18 points of access to the health care system for indi19 viduals with HIV disease (including emergency

20 rooms, substance abuse treatment programs, detoxi21 fication centers, adult and juvenile detention facili22 ties, sexually transmitted disease clinics, HIV coun23 seling and testing sites, and homeless shelters) and

24 other entities under section 2652(a) for the purpose

25 of facilitating early intervention for individuals newly
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1 diagnosed with HIV disease and individuals knowl2 edgeable of their status but not in care;’’.

3 SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH

4 CARE-RELATED.

5 (a) IN GENERAL.—Section 2604(b)(1) (42 U.S.C.

6 300ff–14(b)(1)) is amended—

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

8 by striking ‘‘HIV-related—’’ and inserting ‘‘HIV-re9 lated services, as follows:’’;

10 (2) in subparagraph (A)—

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

12 follows through ‘‘substance abuse treatment

13 and’’ and inserting the following: ‘‘OUTPATIENT

14 HEALTH SERVICES.—Outpatient and ambula15 tory health services, including substance abuse

16 treatment,’’; and

17 (B) by striking ‘‘; and’’ and inserting a pe18 riod;

19 (3) in subparagraph (B), by striking ‘‘(B) inpa20 tient case management’’ and inserting ‘‘(C) INPA21 TIENT CASE MANAGEMENT SERVICES.—Inpatient

22 case management’’; and

23 (4) by inserting after subparagraph (A) the fol24 lowing:
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1 ‘‘(B) OUTPATIENT SUPPORT SERVICES.—

2 Outpatient and ambulatory support services (in3 cluding case management), to the extent that

4 such services facilitate, enhance, support, or

5 sustain the delivery, continuity, or benefits of

6 health services for individuals and families with

7 HIV disease.’’.

8 (b) CONFORMING AMENDMENT TO APPLICATION RE9 QUIREMENTS.—Section 2605(a) (42 U.S.C. 300ff–15(a)),

10 as amended by section 102(b), is further amended—

11 (1) in paragraph (6) (as so redesignated), by

12 striking ‘‘and’’ at the end thereof;

13 (2) in paragraph (7) (as so redesignated), by

14 striking the period and inserting ‘‘; and’’; and

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

16 ‘‘(8) that the eligible area has procedures in

17 place to ensure that services provided with funds re18 ceived under this part meet the criteria specified in

19 section 2604(b)(1).’’.

20 SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVEN21 TION SERVICES.

22 (a) IN GENERAL.—Section 2604(b)(1) (42 U.S.C.

23 300ff–14(b)(1)), as amended by section 104(a), is further

24 amended by adding at the end the following:
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1 ‘‘(D) EARLY INTERVENTION SERVICES.—

2 Early intervention services as described in sec3 tion 2651(b)(2), with follow-through referral,

4 provided for the purpose of facilitating the ac5 cess of individuals receiving the services to

6 HIV-related health services, but only if the enti7 ty providing such services—

8 ‘‘(i)(I) is receiving funds under sub9 paragraph (A) or (C); or

10 ‘‘(II) is an entity constituting a point

11 of access to services, as described in para12 graph (2)(C), that maintains a relationship

13 with an entity described in subclause (I)

14 and that is serving individuals at elevated

15 risk of HIV disease; and

16 ‘‘(ii) demonstrates to the satisfaction

17 of the chief elected official that no other

18 Federal, State, or local funds are available

19 for the early intervention services the enti20 ty will provide with funds received under

21 this paragraph.’’.

22 (b) CONFORMING AMENDMENTS TO APPLICATION

23 REQUIREMENTS.—Section 2605(a)(1) (42 U.S.C. 300ff–

24 15(a)(1)) is amended—
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1 (1) in subparagraph (A), by striking ‘‘services

2 to individuals with HIV disease’’ and inserting

3 ‘‘services as described in section 2604(b)(1)’’; and

4 (2) in subparagraph (B), by striking ‘‘services

5 for individuals with HIV disease’’ and inserting

6 ‘‘services as described in section 2604(b)(1)’’.

7 SEC. 106. REPLACEMENT OF SPECIFIED FISCAL YEARS RE8 GARDING THE SUNSET ON EXPEDITED DIS9 TRIBUTION REQUIREMENTS.

10 Section 2603(a)(2) (42 U.S.C. 300ff–13(a)(2)) is

11 amended by striking ‘‘for each of the fiscal years 1996

12 through 2000’’ and inserting ‘‘for a fiscal year’’.

13 SEC. 107. HOLD HARMLESS PROVISION.

14 Section 2603(a)(4) (42 U.S.C. 300ff–13(a)(4)) is

15 amended to read as follows:

16 ‘‘(4) LIMITATIONS.—

17 ‘‘(A) IN GENERAL.—With respect to each

18 of fiscal years 2001 through 2005, the Sec19 retary shall ensure that the amount of a grant

20 made to an eligible area under paragraph (2)

21 for such a fiscal year is not less than an

22 amount equal to 98 percent of the amount the

23 eligible area received for the fiscal year pre24 ceding the year for which the determination is

25 being made.
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1 ‘‘(B) APPLICATION OF PROVISION.—Sub2 paragraph (A) shall only apply with respect to

3 those eligible areas receiving a grant under

4 paragraph (2) for fiscal year 2000 in an

5 amount that has been adjusted in accordance

6 with paragraph (4) of this subsection (as in ef7 fect on the day before the date of enactment of

8 the Ryan White CARE Act Amendments of

9 2000).’’.

10 SEC. 108. SET-ASIDE FOR INFANTS, CHILDREN, AND

11 WOMEN.

12 Section 2604(b)(3) (42 U.S.C. 300ff–14(b)(3)) is

13 amended—

14 (1) by inserting ‘‘for each population under this

15 subsection’’ after ‘‘established priorities’’; and

16 (2) by striking ‘‘ratio of the’’ and inserting

17 ‘‘ratio of each’’.

18 Subtitle B—Amendments to Part B

19 (Care Grant Program)

20 SEC. 121. STATE REQUIREMENTS CONCERNING IDENTI21 FICATION OF NEED AND ALLOCATION OF RE22 SOURCES.

23 (a) GENERAL USE OF GRANTS.—Section 2612 (42

24 U.S.C. 300ff–22) is amended—
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1 (1) by striking ‘‘A State’’ and inserting ‘‘(a) IN

2 GENERAL.—A State’’; and

3 (2) in the matter following paragraph (5)—

4 (A) by striking ‘‘paragraph (2)’’ and in5 serting ‘‘subsection (a)(2) and section 2613’’;

6 (b) APPLICATION.—Section 2617(b) (42 U.S.C.

7 300ff–27(b)) is amended—

8 (1) in paragraph (1)(C)—

9 (A) by striking clause (i) and inserting the

10 following:

11 ‘‘(i) the size and demographic charac12 teristics of the population with HIV dis13 ease to be served, except that by not later

14 than October 1, 2002, the State shall take

15 into account the needs of individuals not in

16 care, based on epidemiologic measures de17 veloped by the Secretary in consultation

18 with the State, affected communities, ex19 perts, and other appropriate individuals

20 (such State shall not be required to estab21 lish priorities for individuals not in care

22 until such epidemiologic measures are de23 veloped);’’;

24 (B) in clause (iii), by striking ‘‘and’’ at the

25 end; and
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1 (C) by adding at the end the following:

2 ‘‘(v) the availability of other govern3 mental and non-governmental resources;

4 ‘‘(vi) the capacity development needs

5 resulting in gaps in the provision of HIV

6 services in historically underserved low-in7 come and rural low-income communities;

8 and

9 ‘‘(vii) the efficiency of the administra10 tive mechanism in rapidly allocating funds

11 to the areas of greatest need within the

12 State;’’; and

13 (2) in paragraph (2)—

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

15 ‘‘and’’ at the end;

16 (B) by redesignating subparagraph (C) as

17 subparagraph (F); and

18 (C) by inserting after subparagraph (B),

19 the following:

20 ‘‘(C) an assurance that capacity develop21 ment needs resulting from gaps in the provision

22 of services in underserved low-income and rural

23 low-income communities will be addressed; and

24 ‘‘(D) with respect to fiscal year 2003 and

25 subsequent fiscal years, assurances that, in the
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1 planning and allocation of resources, the State,

2 through systems of HIV-related health services

3 provided under paragraphs (1), (2), and (3) of

4 section 2612(a), will make appropriate provi5 sion for the HIV-related health and support

6 service needs of individuals who have been diag7 nosed with HIV disease but who are not cur8 rently receiving such services, based on the epi9 demiologic measures developed under paragraph

10 (1)(C)(i);’’.

11 SEC. 122. QUALITY MANAGEMENT.

12 (a) STATE REQUIREMENT FOR QUALITY MANAGE13 MENT.—Section 2617(b)(4) (42 U.S.C. 300ff–27(b)(4)) is

14 amended—

15 (1) by striking subparagraph (C) and inserting

16 the following:

17 ‘‘(C) the State will provide for—

18 ‘‘(i) the establishment of a quality

19 management program to assess the extent

20 to which medical services provided to pa21 tients under the grant are consistent with

22 the most recent Public Health Service

23 guidelines for the treatment of HIV dis24 ease and related opportunistic infections

25 and to develop strategies for improvements
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1 in the access to and quality of medical

2 services; and

3 ‘‘(ii) a periodic review (such as

4 through an independent peer review) to as5 sess the quality and appropriateness of

6 HIV-related health and support services

7 provided by entities that receive funds

8 from the State under this part;’’;

9 (2) by redesignating subparagraphs (E) and

10 (F) as subparagraphs (F) and (G), respectively;

11 (3) by inserting after subparagraph (D), the

12 following:

13 ‘‘(E) an assurance that the State, through

14 systems of HIV-related health services provided

15 under paragraphs (1), (2), and (3) of section

16 2612(a), has considered strategies for working

17 with providers to make optimal use of financial

18 assistance under the State medicaid plan under

19 title XIX of the Social Security Act, the State

20 Children’s Health Insurance Program under

21 title XXI of such Act, and other Federal grant22 ees that provide HIV-related services, to maxi23 mize access to quality HIV-related health and

24 support services;
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1 (4) in subparagraph (F), as so redesignated, by

2 striking ‘‘and’’ at the end; and

3 (5) in subparagraph (G), as so redesignated, by

4 striking the period and inserting ‘‘; and’’.

5 (b) AVAILABILITY OF FUNDS FOR QUALITY MANAGE6 MENT.—

7 (1) AVAILABILITY OF GRANT FUNDS FOR PLAN8 NING AND EVALUATION.—Section 2618(c)(3) (42

9 U.S.C. 300ff–28(c)(3)) is amended by inserting be10 fore the period ‘‘, including not more than

11 $3,000,000 for all activities associated with its qual12 ity management program’’.

13 (2) EXCEPTION TO COMBINED CEILING ON

14 PLANNING AND ADMINISTRATION FUNDS FOR

15 STATES WITH SMALL GRANTS.—Paragraph (6) of

16 section 2618(c) (42 U.S.C. 300ff–28(c)(6)) is

17 amended to read as follows:

18 ‘‘(6) EXCEPTION FOR QUALITY MANAGE19 MENT.—Notwithstanding paragraph (5), a State

20 whose grant under this part for a fiscal year does

21 not exceed $1,500,000 may use not to exceed 20

22 percent of the amount of the grant for the purposes

23 described in paragraphs (3) and (4) if—
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1 ‘‘(A) that portion of such amount in excess

2 of 15 percent of the grant is used for its quality

3 management program; and

4 ‘‘(B) the State submits and the Secretary

5 approves a plan (in such form and containing

6 such information as the Secretary may pre7 scribe) for use of funds for its quality manage8 ment program.’’.

9 SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH

10 CARE RELATIONSHIPS.

11 Section 2617(b)(4) (42 U.S.C. 300ff–27(b)(4)), as

12 amended by section 122(a), is further amended by adding

13 at the end the following:

14 ‘‘(H) that funded entities maintain appro15 priate relationships with entities in the area

16 served that constitute key points of access to

17 the health care system for individuals with HIV

18 disease (including emergency rooms, substance

19 abuse treatment programs, detoxification cen20 ters, adult and juvenile detention facilities, sex21 ually transmitted disease clinics, HIV coun22 seling and testing sites, and homeless shelters),

23 and other entities under section 2652(a), for

24 the purpose of facilitating early intervention for

25 individuals newly diagnosed with HIV disease
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1 and individuals knowledgeable of their status

2 but not in care.’’.

3 SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH

4 CARE-RELATED.

5 (a) TECHNICAL AMENDMENT.—Section

6 3(c)(2)(A)(iii) of the Ryan White CARE Act Amendments

7 of 1996 (Public Law 104–146) is amended by inserting

8 ‘‘before paragraph (2) as so redesignated’’ after ‘‘insert9 ing’’.

10 (b) SERVICES.—Section 2612(a)(1) (42 U.S.C.

11 300ff–22(a)(1)), as so designated by section 121(a), is

12 amended by striking ‘‘for individuals with HIV disease’’

13 and inserting ‘‘, subject to the conditions and limitations

14 that apply under such section’’.

15 (c) CONFORMING AMENDMENT TO STATE APPLICA16 TION REQUIREMENT.—Section 2617(b)(2) (42 U.S.C.

17 300ff–27(b)(2)), as amended by section 121(b), is further

18 amended by adding at the end the following:

19 ‘‘(F) an assurance that the State has pro20 cedures in place to ensure that services pro21 vided with funds received under this section

22 meet the criteria specified in section

23 2604(b)(1)(B); and’’.
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1 SEC. 125. USE OF GRANT FUNDS FOR EARLY INTERVEN2 TION SERVICES.

3 Section 2612(a) (42 U.S.C. 300ff–22(a)), as amend4 ed by section 121, is further amended by adding at the

5 end the following:

6 ‘‘(6) EARLY INTERVENTION SERVICES.—The

7 State, through systems of HIV-related health serv8 ices provided under paragraphs (1), (2), and (3) of

9 section 2612(a), may provide early intervention serv10 ices, as described in section 2651(b)(2), with follow11 up referral, provided for the purpose of facilitating

12 the access of individuals receiving the services to

13 HIV-related health services, but only if the entity

14 providing such services—

15 ‘‘(A)(i) is receiving funds under section

16 2612(a)(1); or

17 ‘‘(ii) is an entity constituting a point of ac18 cess to services, as described in section

19 2617(b)(4), that maintains a referral relation20 ship with an entity described in clause (i) and

21 that is serving individuals at elevated risk of

22 HIV disease; and

23 ‘‘(B) demonstrates to the State’s satisfac24 tion that no other Federal, State, or local funds

25 are available for the early intervention services
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1 the entity will provide with funds received under

2 this paragraph.’’.

3 SEC. 126. AUTHORIZATION OF APPROPRIATIONS FOR HIV4 RELATED SERVICES FOR WOMEN AND CHIL5 DREN.

6 Section 2625(c)(2) (42 U.S.C. 300ff–33(c)(2)) is

7 amended by striking ‘‘fiscal years 1996 through 2000’’

8 and inserting ‘‘fiscal years 2001 through 2005’’.

9 SEC. 127. REPEAL OF REQUIREMENT FOR COMPLETED IN10 STITUTE OF MEDICINE REPORT.

11 Section 2628 (42 U.S.C. 300ff–36) is repealed.

12 SEC. 128. SUPPLEMENT GRANTS FOR CERTAIN STATES.

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

14 Health Service Act (42 U.S.C. 300ff–11 et seq.) is amend15 ed by adding at the end the following:

16 ‘‘SEC. 2622. SUPPLEMENTAL GRANTS.

17 ‘‘(a) IN GENERAL.—The Secretary shall award sup18 plemental grants to States determined to be eligible under

19 subsection (b) to enable such States to provide comprehen20 sive services of the type described in section 2612(a) to

21 supplement the services otherwise provided by the State

22 under a grant under this subpart in areas within the State

23 that are not eligible to receive grants under part A.

24 ‘‘(b) ELIGIBILITY.—To be eligible to receive a supple25 mental grant under subsection (a) a State shall—
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1 ‘‘(1) be eligible to receive a grant under this

2 subpart; and

3 ‘‘(2) demonstrate to the Secretary that there is

4 severe need (as defined for purposes of section

5 2603(b)(2)(A) for supplemental financial assistance

6 in areas in the State that are not served through

7 grants under part A.

8 ‘‘(c) APPLICATION.—A State that desires a grant

9 under this section shall, as part of the State application

10 submitted under section 2617, submit a detailed descrip11 tion of the manner in which the State will use amounts

12 received under the grant and of the severity of need. Such

13 description shall include—

14 ‘‘(1) a report concerning the dissemination of

15 supplemental funds under this section and the plan

16 for the utilization of such funds;

17 ‘‘(2) a demonstration of the existing commit18 ment of local resources, both financial and in-kind;

19 ‘‘(3) a demonstration that the State will main20 tain HIV-related activities at a level that is equal to

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

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

23 which the State is applying to receive a grant under

24 this part;
25

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1 ‘‘(4) a demonstration of the ability of the State

2 to utilize such supplemental financial resources in a

3 manner that is immediately responsive and cost ef4 fective;

5 ‘‘(5) a demonstration that the resources will be

6 allocated in accordance with the local demographic

7 incidence of AIDS including appropriate allocations

8 for services for infants, children, women, and fami9 lies with HIV disease;

10 ‘‘(6) a demonstration of the inclusiveness of the

11 planning process, with particular emphasis on af12 fected communities and individuals with HIV dis13 ease; and

14 ‘‘(7) a demonstration of the manner in which

15 the proposed services are consistent with local needs

16 assessments and the statewide coordinated state17 ment of need.

18 ‘‘(d) AMOUNT RESERVED FOR EMERGING COMMU19 NITIES.—

20 ‘‘(1) IN GENERAL.—For awarding grants under

21 this section for each fiscal year, the Secretary shall

22 reserve the greater of 50 percent of the amount to

23 be utilized under subsection (e) for such fiscal year

24 or $5,000,000, to be provided to States that contain

25 emerging communities for use in such communities.
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1 ‘‘(2) DEFINITION.—In paragraph (1), the term

2 ‘emerging community’ means a metropolitan area—

3 ‘‘(A) that is not eligible for a grant under

4 part A; and

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

6 the Director of the Centers for Disease Control

7 and Prevention a cumulative total of between

8 1000 and 1999 cases of acquired immune defi9 ciency syndrome for the most recent period of

10 5 calendar years for which such data are avail11 able.

12 ‘‘(e) APPROPRIATIONS.—With respect to each fiscal

13 year beginning with fiscal year 2001, the Secretary, to

14 carry out this section, shall utilize 50 percent of the

15 amount appropriated under section 2677 to carry out part

16 B for such fiscal year that is in excess of the amount ap17 propriated to carry out such part in fiscal year preceding

18 the fiscal year involved.

19 SEC. 129. USE OF TREATMENT FUNDS.

20 (a) STATE DUTIES.—Section 2616(c) (42 U.S.C.

21 300ff–26(c)) is amended—

22 (1) in the matter preceding paragraph (1), by

23 striking ‘‘shall—’’ and inserting ‘‘shall use funds

24 made available under this section to—’’;
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1 (2) by redesignating paragraphs (1) through

2 (5) as subparagraphs (A) through (E), respectively

3 and realigning the margins of such subparagraphs

4 appropriately;

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

6 by striking ‘‘and’’ at the end;

7 (4) in subparagraph (E) (as so redesignated),

8 by striking the period and ‘‘; and’’; and

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

10 ‘‘(F) encourage, support, and enhance adher11 ence to and compliance with treatment regimens, in12 cluding related medical monitoring.’’;

13 (6) by striking ‘‘In carrying’’ and inserting the

14 following:

15 ‘‘(1) IN GENERAL.—In carrying’’; and

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

17 ‘‘(2) LIMITATIONS.—

18 ‘‘(A) IN GENERAL.—No State shall use

19 funds under paragraph (1)(F) unless the limita20 tions on access to HIV/AIDS therapeutic regi21 mens as defined in subsection (e)(2) are elimi22 nated.

23 ‘‘(B) AMOUNT OF FUNDING.—No State

24 shall use in excess of 10 percent of the amount

25 set-aside for use under this section in any fiscal
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1 year to carry out activities under paragraph

2 (1)(F) unless the State demonstrates to the

3 Secretary that such additional services are es4 sential and in no way diminish access to thera5 peutics.’’.

6 (b) SUPPLEMENT GRANTS.—Section 2616 (42

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

8 following:

9 ‘‘(e) SUPPLEMENTAL GRANTS FOR THE PROVISION

10 OF TREATMENTS.—

11 ‘‘(1) IN GENERAL.—From amounts made avail12 able under paragraph (5), the Secretary shall award

13 supplemental grants to States determined to be eligi14 ble under paragraph (2) to enable such States to

15 provide access to therapeutics to treat HIV disease

16 as provided by the State under subsection (c)(1)(B)

17 for individuals at or below 200 percent of the Fed18 eral poverty line.

19 ‘‘(2) CRITERIA.—The Secretary shall develop

20 criteria for the awarding of grants under paragraph

21 (1) to States that demonstrate a severe need. In de22 termining the criteria for demonstrating State sever23 ity of need (as defined for purposes of section

24 2603(b)(2)(A)), the Secretary shall consider whether

25 limitation to access exist such that—
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1 ‘‘(A) the State programs under this section

2 are unable to provide HIV/AIDS therapeutic

3 regimens to all eligible individuals living at or

4 below 200 percent of the Federal poverty line;

5 and

6 ‘‘(B) the State programs under this section

7 are unable to provide to all eligible individuals

8 appropriate HIV/AIDS therapeutic regimens as

9 recommended in the most recent Federal treat10 ment guidelines.

11 ‘‘(3) STATE REQUIREMENT.—The Secretary

12 may not make a grant to a State under this sub13 section unless the State agrees that—

14 ‘‘(A) the State will make available (directly

15 or through donations from public or private en16 tities) non-Federal contributions toward the ac17 tivities to be carried out under the grant in an

18 amount equal to $1 for each $4 of Federal

19 funds provided in the grant; and

20 ‘‘(B) the State will not impose eligibility

21 requirements for services or scope of benefits

22 limitations under subsection (a) that are more

23 restrictive than such requirements in effect as

24 of January 1, 2000.
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1 ‘‘(4) USE AND COORDINATION.—Amounts made

2 available under a grant under this subsection shall

3 only be used by the State to provide AIDS/HIV-re4 lated medications. The State shall coordinate the use

5 of such amounts with the amounts otherwise pro6 vided under this section in order to maximize drug

7 coverage.

8 ‘‘(5) FUNDING.—

9 ‘‘(A) RESERVATION OF AMOUNT.—The

10 Secretary may reserve not to exceed 4 percent,

11 but not less than 2 percent, of any amount re12 ferred to in section 2618(b)(2)(H) that is ap13 propriated for a fiscal year, to carry out this

14 subsection.

15 ‘‘(B) MINIMUM AMOUNT.—In providing

16 grants under this subsection, the Secretary

17 shall ensure that the amount of a grant to a

18 State under this part is not less than the

19 amount the State received under this part in

20 the previous fiscal year, as a result of grants

21 provided under this subsection.’’.

22 (c) SUPPLEMENT AND NOT SUPPLANT.—Section

23 2616 (42 U.S.C. 300ff–26(c)), as amended by subsection

24 (b), is further amended by adding at the end the following:
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1 ‘‘(f) SUPPLEMENT NOT SUPPLANT.—Notwith2 standing any other provision of law, amounts made avail3 able under this section shall be used to supplement and

4 not supplant other funding available to provide treatments

5 of the type that may be provided under this section.’’.

6 SEC. 130. INCREASE IN MINIMUM ALLOTMENT.

7 (a) IN GENERAL.—Section 2618(b)(1)(A)(i) (42

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

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

10 and inserting ‘‘$200,000’’; and

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

12 and inserting ‘‘$500,000’’.

13 (b) TECHNICAL AMENDMENT.—Section

14 2618(b)(3)(B) (42 U.S.C. 300ff–28(b)(3)(B)) is amended

15 by striking ‘‘and the Republic of the Marshall Islands’’

16 and inserting ‘‘, the Republic of the Marshall Islands, the

17 Federated States of Micronesia, and the Republic of

18 Palau’’.

19 SEC. 131. SET-ASIDE FOR INFANTS, CHILDREN, AND

20 WOMEN.

21 Section 2611(b) (42 U.S.C. 300ff–21(b)) is

22 amended—

23 (1) by inserting ‘‘for each population under this

24 subsection’’ after ‘‘State shall use’’; and
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1 (2) by striking ‘‘ratio of the’’ and inserting

2 ‘‘ratio of each’’.

3 Subtitle C—Amendments to Part C

4 (Early Intervention Services)

5 SEC. 141. AMENDMENT OF HEADING; REPEAL OF FORMULA

6 GRANT PROGRAM.

7 (a) AMENDMENT OF HEADING.—The heading of part

8 C of title XXVI is amended to read as follows:

9 ‘‘PART C—EARLY INTERVENTION AND PRIMARY CARE

10 SERVICES’’.

11 (b) REPEAL.—Part C of title XXVI (42 U.S.C.

12 300ff–41 et seq.) is amended—

13 (1) by repealing subpart I; and

14 (2) by redesignating subparts II and III as sub15 parts I and II.

16 (c) CONFORMING AMENDMENTS.—

17 (1) INFORMATION REGARDING RECEIPT OF

18 SERVICES.—Section 2661(a) (42 U.S.C. 300ff–

19 61(a)) is amended by striking ‘‘unless—’’ and all

20 that follows through ‘‘(2) in the case of’’ and insert21 ing ‘‘unless, in the case of’’.

22 (2) ADDITIONAL AGREEMENTS.—Section 2664

23 (42 U.S.C. 300ff–64) is amended—

24 (A) in subsection (e)(5), by striking

25 ‘‘2642(b) or’’;
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1 (B) in subsection (f)(2), by striking

2 ‘‘2642(b) or’’; and

3 (C) by striking subsection (h).

4 SEC. 142. PLANNING AND DEVELOPMENT GRANTS.

5 (a) ALLOWING PLANNING AND DEVELOPMENT

6 GRANT TO EXPAND ABILITY TO PROVIDE PRIMARY CARE

7 SERVICES.—Section 2654(c) (42 U.S.C. 300ff–54(c)) is

8 amended—

9 (1) in paragraph (1), to read as follows:

10 ‘‘(1) IN GENERAL.—The Secretary may provide

11 planning and development grants to public and non12 profit private entities for the purpose of—

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

14 early intervention services; or

15 ‘‘(B) assisting such entities to expand the

16 capacity, preparedness, and expertise to deliver

17 primary care services to individuals with HIV

18 disease in underserved low-income communities

19 on the condition that the funds are not used to

20 purchase or improve land or to purchase, con21 struct, or permanently improve (other than

22 minor remodeling) any building or other facil23 ity.’’; and
34

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1 (2) in paragraphs (2) and (3) by striking

2 ‘‘paragraph (1)’’ each place that such appears and

3 inserting ‘‘paragraph (1)(A)’’.

4 (b) AMOUNT; DURATION.—Section 2654(c) (42

5 U.S.C. 300ff–54(c)), as amended by subsection (a), is fur6 ther amended—

7 (1) by redesignating paragraph (4) as para8 graph (5); and

9 (2) by inserting after paragraph (3) the fol10 lowing:

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

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

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

14 an amount not to exceed $50,000.

15 ‘‘(B) CAPACITY DEVELOPMENT.—

16 ‘‘(i) AMOUNT.—A grant under para17 graph (1)(B) may be made in an amount

18 not to exceed $150,000.

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

20 of a grant under paragraph (1)(B), includ21 ing any renewal, may not exceed 3 years.’’.

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

23 (42 U.S.C. 300ff–54(c)(5)), as so redesignated by sub24 section (b), is amended by striking ‘‘1 percent’’ and insert25 ing ‘‘5 percent’’.
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1 SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CAT2 EGORICAL GRANTS.

3 Section 2655 (42 U.S.C. 300ff–55) is amended by

4 striking ‘‘1996’’ and all that follows through ‘‘2000’’ and

5 inserting ‘‘2001 through 2005’’.

6 SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY

7 MANAGEMENT PROGRAM.

8 Section 2664(g) (42 U.S.C. 300ff–64(g)) is

9 amended—

10 (1) in paragraph (3), to read as follows:

11 ‘‘(3) the applicant will not expend more than 10

12 percent of the grant for costs of administrative ac13 tivities with respect to the grant;’’;

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

15 inserting ‘‘; and’’; and

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

17 ‘‘(5) the applicant will provide for the establish18 ment of a quality management program to assess

19 the extent to which medical services funded under

20 this title that are provided to patients are consistent

21 with the most recent Public Health Service guide22 lines for the treatment of HIV disease and related

23 opportunistic infections and that improvements in

24 the access to and quality of medical services are ad25 dressed.’’.
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1 SEC. 145. PREFERENCE FOR CERTAIN AREAS.

2 Section 2651 (42 U.S.C. 300ff–51) is amended by

3 adding at the end the following:

4 ‘‘(d) PREFERENCE IN AWARDING GRANTS.—Begin5 ning in fiscal year 2001, in awarding new grants under

6 this section, the Secretary shall give preference to appli7 cants that will use amounts received under the grant to

8 serve areas that are otherwise not eligible to receive assist9 ance under part A.’’.

10 Subtitle D—Amendments to Part D

11 (General Provisions)

12 SEC. 151. RESEARCH INVOLVING WOMEN, INFANTS, CHIL13 DREN, AND YOUTH.

14 (a) ELIMINATION OF REQUIREMENT TO ENROLL

15 SIGNIFICANT NUMBERS OF WOMEN AND CHILDREN.—

16 Section 2671(b) (42 U.S.C. 300ff–71(b)) is amended—

17 (1) in paragraph (1), by striking subparagraphs

18 (C) and (D); and

19 (2) by striking paragraphs (3) and (4).

20 (b) INFORMATION AND EDUCATION.—Section

21 2671(d) (42 U.S.C. 300ff–71(d)) is amended by adding

22 at the end the following:

23 ‘‘(4) The applicant will provide individuals with

24 information and education on opportunities to par25 ticipate in HIV/AIDS-related clinical research.’’.
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1 (c) QUALITY MANAGEMENT; ADMINISTRATIVE EX2 PENSES CEILING.—Section 2671(f) (42 U.S.C. 300ff–

3 71(f)) is amended—

4 (1) by striking the subsection heading and des5 ignation and inserting the following:

6 ‘‘(f) ADMINISTRATION.—

7 ‘‘(1) APPLICATION.—’’; and

8 (2) by adding at the end the following:

9 ‘‘(2) QUALITY MANAGEMENT PROGRAM.—A

10 grantee under this section shall implement a quality

11 management program.’’.

12 (d) COORDINATION.—Section 2671(g) (42 U.S.C.

13 300ff–71(g)) is amended by adding at the end the fol14 lowing: ‘‘The Secretary acting through the Director of

15 NIH, shall examine the distribution and availability of on16 going and appropriate HIV/AIDS-related research

17 projects to existing sites under this section for purposes

18 of enhancing and expanding voluntary access to HIV-re19 lated research, especially within communities that are not

20 reasonably served by such projects.’’.

21 (e) AUTHORIZATION OF APPROPRIATIONS.—Section

22 2671(j) (42 U.S.C. 300ff–71(j)) is amended by striking

23 ‘‘fiscal years 1996 through 2000’’ and inserting ‘‘fiscal

24 years 2001 through 2005’’.
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1 SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.

2 Section 2671 (42 U.S.C. 300ff–71) is amended—

3 (1) by redesignating subsections (i) and (j), as

4 subsections (j) and (k), respectively; and

5 (2) by inserting after subsection (h), the fol6 lowing:

7 ‘‘(i) LIMITATION ON ADMINISTRATIVE EXPENSES.—

8 ‘‘(1) DETERMINATION BY SECRETARY.—Not

9 later than 12 months after the date of enactment of

10 the Ryan White Care Act Amendments of 2000, the

11 Secretary, in consultation with grantees under this

12 part, shall conduct a review of the administrative,

13 program support, and direct service-related activities

14 that are carried out under this part to ensure that

15 eligible individuals have access to quality, HIV-re16 lated health and support services and research op17 portunities under this part, and to support the pro18 vision of such services.

19 ‘‘(2) REQUIREMENTS.—

20 ‘‘(A) IN GENERAL.—Not later than 180

21 days after the expiration of the 12-month pe22 riod referred to in paragraph (1) the Secretary,

23 in consultation with grantees under this part,

24 shall determine the relationship between the

25 costs of the activities referred to in paragraph

26 (1) and the access of eligible individuals to the
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1 services and research opportunities described in

2 such paragraph.

3 ‘‘(B) LIMITATION.—After a final deter4 mination under subparagraph (A), the Sec5 retary may not make a grant under this part

6 unless the grantee complies with such require7 ments as may be included in such determina8 tion.’’.

9 SEC. 153. EVALUATIONS AND REPORTS.

10 Section 2674(c) (42 U.S.C. 399ff–74(c)) is amended

11 by striking ‘‘1991 through 1995’’ and inserting ‘‘2001

12 through 2005’’.

13 SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR

14 GRANTS UNDER PARTS A AND B.

15 Section 2677 (42 U.S.C. 300ff–77) is amended to

16 read as follows:

17 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

18 ‘‘There are authorized to be appropriated—

19 ‘‘(1) such sums as may be necessary to carry

20 out part A for each of the fiscal years 2001 through

21 2005; and

22 ‘‘(2) such sums as may be necessary to carry

23 out part B for each of the fiscal years 2001 through

24 2005.’’.
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1 Subtitle E—Amendments to Part F

2 (Demonstration and Training)

3 SEC. 161. AUTHORIZATION OF APPROPRIATIONS.

4 (a) SCHOOLS; CENTERS.—Section 2692(c)(1) (42

5 U.S.C. 300ff–111(c)(1)) is amended by striking ‘‘fiscal

6 years 1996 through 2000’’ and inserting ‘‘fiscal years

7 2001 through 2005’’.

8 (b) DENTAL SCHOOLS.—Section 2692(c)(2) (42

9 U.S.C. 300ff–111(c)(2)) is amended by striking ‘‘fiscal

10 years 1996 through 2000’’ and inserting ‘‘fiscal years

11 2001 through 2005’’.

12 TITLE II—MISCELLANEOUS

13 PROVISIONS

14 SEC. 201. INSTITUTE OF MEDICINE STUDY.

15 (a) IN GENERAL.—Not later than 120 days after the

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

17 Human Services shall enter into a contract with the Insti18 tute of Medicine for the conduct of a study concerning

19 the appropriate epidemiological measures and their rela20 tionship to the financing and delivery of primary care and

21 health-related support services for low-income, uninsured,

22 and under-insured individuals with HIV disease.

23 (b) REQUIREMENTS.—

24 (1) COMPLETION.—The study under subsection

25 (a) shall be completed not later than 21 months
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1 after the date on which the contract referred to in

2 such subsection is entered into.

3 (2) ISSUES TO BE CONSIDERED.—The study

4 conducted under subsection (a) shall consider—

5 (A) the availability and utility of health

6 outcomes measures and data for HIV primary

7 care and support services and the extent to

8 which those measures and data could be used to

9 measure the quality of such funded services;

10 (B) the effectiveness and efficiency of serv11 ice delivery (including the quality of services,

12 health outcomes, and resource use) within the

13 context of a changing health care and thera14 peutic environment as well as the changing epi15 demiology of the epidemic;

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; and

21 (D) other factors determined to be relevant

22 to assessing an individual’s or community’s

23 ability to gain and sustain access to quality

24 HIV services.
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1 (c) REPORT.—Not later than 90 days after the date

2 on which the study is completed under subsection (a), the

3 Secretary of Health and Human Services shall prepare

4 and submit to the appropriate committees of Congress a

5 report describing the manner in which the conclusions and

6 recommendations of the Institute of Medicine can be ad7 dressed and implemented.

Æ