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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2311 Engrossed in Senate (ES)]

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
106th CONGRESS
  2d Session
                                S. 2311

_______________________________________________________________________

                                 AN ACT

 
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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ryan White CARE Act Amendments of 
2000''.

SEC. 2. REFERENCES; TABLE OF CONTENTS.

    (a) References.--Except as otherwise expressly provided, whenever 
in this Act an amendment or repeal is expressed in terms of an 
amendment to, or repeal of, a section or other provision, the reference 
shall be considered to be made to a section or other provision of the 
Public Health Service Act (42 U.S.C. 201 et seq.).
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title.
Sec. 2. References; table of contents.
             TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM

       Subtitle A--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 requirements.
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 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. 128. Supplement grants for certain States.
Sec. 129. Use of treatment funds.
Sec. 130. Increase in minimum allotment.
Sec. 131. 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.
Sec. 146. Technical amendment.
         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.

             TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM

       Subtitle A--Amendments to Part A (Emergency Relief Grants)

SEC. 101. DUTIES OF PLANNING COUNCIL, FUNDING PRIORITIES, QUALITY 
              ASSESSMENT.

    Section 2602 (42 U.S.C. 300ff-12) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (2)(C), by inserting before the 
                semicolon the following: ``, including providers of 
                housing and homeless services''; and
                    (B) in paragraph (4), by striking ``shall--'' and 
                all that follows and inserting ``shall have the 
                responsibilities specified in subsection (d).''; and
            (2) by adding at the end the following:
    ``(d) Duties of Planning Council.--The planning council established 
under subsection (b) shall have the following duties:
            ``(1) Priorities for allocation of funds.--The council 
        shall establish priorities for the allocation of funds within 
        the eligible area, including how best to meet each such 
        priority and additional factors that a grantee should consider 
        in allocating funds under a grant, based on the following 
        factors:
                    ``(A) The size and demographic characteristics of 
                the population with HIV disease to be served, 
                including, subject to subsection (e), the needs of 
                individuals living with HIV infection who are not 
                receiving HIV-related health services.
                    ``(B) The documented needs of the population with 
                HIV disease with particular attention being given to 
                disparities in health services among affected subgroups 
                within the eligible area.
                    ``(C) The demonstrated or probable cost and outcome 
                effectiveness of proposed strategies and interventions, 
                to the extent that data are reasonably available.
                    ``(D) Priorities of the communities with HIV 
                disease for whom the services are intended.
                    ``(E) The availability of other governmental and 
                non-governmental resources, including the State 
                medicaid plan under title XIX of the Social Security 
                Act and the State Children's Health Insurance Program 
                under title XXI of such Act to cover health care costs 
                of eligible individuals and families with HIV disease.
                    ``(F) Capacity development needs resulting from 
                gaps in the availability of HIV services in 
                historically underserved low-income communities.
            ``(2) Comprehensive service delivery plan.--The council 
        shall develop a comprehensive plan for the organization and 
        delivery of health and support services described in section 
        2604. Such plan shall be compatible with any existing State or 
        local plans regarding the provision of such services to 
        individuals with HIV disease.
            ``(3) Assessment of fund allocation efficiency.--The 
        council shall assess the efficiency of the administrative 
        mechanism in rapidly allocating funds to the areas of greatest 
        need within the eligible area.
            ``(4) Statewide statement of need.--The council shall 
        participate in the development of the Statewide coordinated 
        statement of need as initiated by the State public health 
        agency responsible for administering grants under part B.
            ``(5) Coordination with other federal grantees.--The 
        council shall coordinate with Federal grantees providing HIV-
        related services within the eligible area.
            ``(6) Community participation.--The council shall establish 
        methods for obtaining input on community needs and priorities 
        which may include public meetings, conducting focus groups, and 
        convening ad-hoc panels.
    ``(e) Process for Establishing Allocation Priorities.--
            ``(1) In general.--Not later than 24 months after the date 
        of enactment of the Ryan White CARE Act Amendments of 2000, the 
        Secretary shall--
                    ``(A) consult with eligible metropolitan areas, 
                affected communities, experts, and other appropriate 
                individuals and entities, to develop epidemiologic 
                measures for establishing the number of individuals 
                living with HIV disease who are not receiving HIV-
                related health services; and
                    ``(B) provide advice and technical assistance to 
                planning councils with respect to the process for 
                establishing priorities for the allocation of funds 
                under subsection (d)(1).
            ``(2) Exception.--Grantees under this part shall not be 
        required to establish priorities for individuals not in care 
        until epidemiologic measures are developed under paragraph 
        (1).''.

SEC. 102. QUALITY MANAGEMENT.

    (a) Funds Available for Quality Management.--Section 2604 (42 
U.S.C. 300ff-14) is amended--
            (1) by redesignating subsections (c) through (f) as 
        subsections (d) through (g), respectively; and
            (2) by inserting after subsection (b) the following:
    ``(c) Quality Management.--
            ``(1) Requirement.--The chief elected official of an 
        eligible area that receives a grant under this part shall 
        provide for the establishment of a quality management program 
        to assess the extent to which medical services provided to 
        patients under the grant are consistent with the most recent 
        Public Health Service guidelines for the treatment of HIV 
        disease and related opportunistic infection and to develop 
        strategies for improvements in the access to and quality of 
        medical services.
            ``(2) Use of funds.--From amounts received under a grant 
        awarded under this part, the chief elected official of an 
        eligible area may use, for activities associated with its 
        quality management program, not more than the lesser of--
                    ``(A) 5 percent of amounts received under the 
                grant; or
                    ``(B) $3,000,000.''.
    (b) Quality Management Required for Eligibility for Grants.--
Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended--
            (1) by redesignating paragraphs (3) through (6) as 
        paragraphs (5) through (8), respectively; and
            (2) by inserting after paragraph (2) the following:
            ``(3) that the chief elected official of the eligible area 
        will satisfy all requirements under section 2604(c);''.

SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE RELATIONSHIPS.

    (a) Use of Amounts.--Section 2604(e)(1) (42 U.S.C. 300ff-14(d)(1)) 
(as so redesignated by section 102(a)) is amended by inserting ``and 
the State Children's Health Insurance Program under title XXI of such 
Act'' after ``Social Security Act''.
    (b) Applications.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is 
amended by inserting after paragraph (3), as added by section 102(b), 
the following:
            ``(4) that funded entities within the eligible area that 
        receive funds under a grant under section 2601(a) shall 
        maintain appropriate relationships with entities in the area 
        served that constitute key points of access to the health care 
        system for individuals with HIV disease (including emergency 
        rooms, substance abuse treatment programs, detoxification 
        centers, adult and juvenile detention facilities, sexually 
        transmitted disease clinics, HIV counseling and testing sites, 
        mental health programs, and homeless shelters) and other 
        entities under section 2652(a) for the purpose of facilitating 
        early intervention for individuals newly diagnosed with HIV 
        disease and individuals knowledgeable of their status but not 
        in care;''.

SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-RELATED.

    (a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-14(b)(1)) is 
amended--
            (1) in the matter preceding subparagraph (A), by striking 
        ``HIV-related--'' and inserting ``HIV-related services, as 
        follows:'';
            (2) in subparagraph (A)--
                    (A) by striking ``outpatient'' and all that follows 
                through ``substance abuse treatment and'' and inserting 
                the following: ``Outpatient health services.--
                Outpatient and ambulatory health services, including 
                substance abuse treatment,''; and
                    (B) by striking ``; and'' and inserting a period;
            (3) in subparagraph (B), by striking ``(B) inpatient case 
        management'' and inserting ``(C) Inpatient case management 
        services.--Inpatient case management''; and
            (4) by inserting after subparagraph (A) the following:
                    ``(B) Outpatient support services.--Outpatient and 
                ambulatory support services (including case 
                management), to the extent that such services 
                facilitate, enhance, support, or sustain the delivery, 
                continuity, or benefits of health services for 
                individuals and families with HIV disease.''.
    (b) Conforming Amendment to Application Requirements.--Section 
2605(a) (42 U.S.C. 300ff-15(a)), as amended by section 102(b), is 
further amended--
            (1) in paragraph (7) (as so redesignated), by striking 
        ``and'' at the end thereof;
            (2) in paragraph (8) (as so redesignated), by striking the 
        period and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(9) that the eligible area has procedures in place to 
        ensure that services provided with funds received under this 
        part meet the criteria specified in section 2604(b)(1).''.

SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.

    (a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-14(b)(1)), as 
amended by section 104(a), is further amended by adding at the end the 
following:
                    ``(D) Early intervention services.--Early 
                intervention services as described in section 
                2651(b)(2), with follow-through referral, provided for 
                the purpose of facilitating the access of individuals 
                receiving the services to HIV-related health services, 
                but only if the entity providing such services--
                            ``(i)(I) is receiving funds under 
                        subparagraph (A) or (C); or
                            ``(II) is an entity constituting a point of 
                        access to services, as described in section 
                        2605(a)(4), that maintains a relationship with 
                        an entity described in subclause (I) and that 
                        is serving individuals at elevated risk of HIV 
                        disease;
                            ``(ii) demonstrates to the satisfaction of 
                        the chief elected official that Federal, State, 
                        or local funds are inadequate for the early 
                        intervention services the entity will provide 
                        with funds received under this subparagraph; 
                        and
                            ``(iii) demonstrates to the satisfaction of 
                        the chief elected official that funds will be 
                        utilized under this subparagraph to supplement 
                        not supplant other funds available for such 
                        services in the year for which such funds are 
                        being utilized.
    (b) Conforming Amendments to Application Requirements.--Section 
2605(a)(1) (42 U.S.C. 300ff-15(a)(1)) is amended--
            (1) in subparagraph (A), by striking ``services to 
        individuals with HIV disease'' and inserting ``services as 
        described in section 2604(b)(1)''; and
            (2) in subparagraph (B), by striking ``services for 
        individuals with HIV disease'' and inserting ``services as 
        described in section 2604(b)(1)''.

SEC. 106. REPLACEMENT OF SPECIFIED FISCAL YEARS REGARDING THE SUNSET ON 
              EXPEDITED DISTRIBUTION REQUIREMENTS.

    Section 2603(a)(2) (42 U.S.C. 300ff-13(a)(2)) is amended by 
striking ``for each of the fiscal years 1996 through 2000'' and 
inserting ``for a fiscal year''.

SEC. 107. HOLD HARMLESS PROVISION.

    Section 2603(a)(4) (42 U.S.C. 300ff-13(a)(4)) is amended to read as 
follows:
            ``(4) Limitation.--With respect to each of fiscal years 
        2001 through 2005, the Secretary shall ensure that the amount 
        of a grant made to an eligible area under paragraph (2) for 
        such a fiscal year is not less than an amount equal to 98 
        percent of the amount the eligible area received for the fiscal 
        year preceding the year for which the determination is being 
        made.''.

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

    Section 2604(b)(3) (42 U.S.C. 300ff-14(b)(3)) is amended--
            (1) by inserting ``for each population under this 
        subsection'' after ``council''; and
            (2) by striking ``ratio of the'' and inserting ``ratio of 
        each''.

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

SEC. 121. STATE REQUIREMENTS CONCERNING IDENTIFICATION OF NEED AND 
              ALLOCATION OF RESOURCES.

    (a) General Use of Grants.--Section 2612 (42 U.S.C. 300ff-22) is 
amended--
            (1) by striking ``A State'' and inserting ``(a) In 
        General.--A State''; and
            (2) in the matter following paragraph (5)--
                    (A) by striking ``Services'' and inserting:
    ``(b) Delivery of Services.--Services'';
                    (B) by striking ``paragraph (1)'' and inserting 
                ``subsection (a)(1)''; and
                    (C) by striking ``paragraph (2)'' and inserting 
                ``subsection (a)(2) and section 2613'';
    (b) Application.--Section 2617(b) (42 U.S.C. 300ff-27(b)) is 
amended--
            (1) in paragraph (1)(C)--
                    (A) by striking clause (i) and inserting the 
                following:
                            ``(i) the size and demographic 
                        characteristics of the population with HIV 
                        disease to be served, except that by not later 
                        than October 1, 2002, the State shall take into 
                        account the needs of individuals not in care, 
                        based on epidemiologic measures developed by 
                        the Secretary in consultation with the State, 
                        affected communities, experts, and other 
                        appropriate individuals (such State shall not 
                        be required to establish priorities for 
                        individuals not in care until such 
                        epidemiologic measures are developed);'';
                    (B) in clause (iii), by striking ``and'' at the 
                end; and
                    (C) by adding at the end the following:
                            ``(v) the availability of other 
                        governmental and non-governmental resources;
                            ``(vi) the capacity development needs 
                        resulting in gaps in the provision of HIV 
                        services in historically underserved low-income 
                        and rural low-income communities; and
                            ``(vii) the efficiency of the 
                        administrative mechanism in rapidly allocating 
                        funds to the areas of greatest need within the 
                        State;''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (B), by striking ``and'' at the 
                end;
                    (B) by redesignating subparagraph (C) as 
                subparagraph (F); and
                    (C) by inserting after subparagraph (B), the 
                following:
                    ``(C) an assurance that capacity development needs 
                resulting from gaps in the provision of services in 
                underserved low-income and rural low-income communities 
                will be addressed; and
                    ``(D) with respect to fiscal year 2003 and 
                subsequent fiscal years, assurances that, in the 
                planning and allocation of resources, the State, 
                through systems of HIV-related health services provided 
                under paragraphs (1), (2), and (3) of section 2612(a), 
                will make appropriate provision for the HIV-related 
                health and support service needs of individuals who 
                have been diagnosed with HIV disease but who are not 
                currently receiving such services, based on the 
                epidemiologic measures developed under paragraph 
                (1)(C)(i);''.

SEC. 122. QUALITY MANAGEMENT.

    (a) State Requirement for Quality Management.--Section 2617(b)(4) 
(42 U.S.C. 300ff-27(b)(4)) is amended--
            (1) by striking subparagraph (C) and inserting the 
        following:
                    ``(C) the State will provide for--
                            ``(i) the establishment of a quality 
                        management program to assess the extent to 
                        which medical services provided to patients 
                        under the grant are consistent with the most 
                        recent Public Health Service guidelines for the 
                        treatment of HIV disease and related 
                        opportunistic infections and to develop 
                        strategies for improvements in the access to 
                        and quality of medical services; and
                            ``(ii) a periodic review (such as through 
                        an independent peer review) to assess the 
                        quality and appropriateness of HIV-related 
                        health and support services provided by 
                        entities that receive funds from the State 
                        under this part;'';
            (2) by redesignating subparagraphs (E) and (F) as 
        subparagraphs (F) and (G), respectively;
            (3) by inserting after subparagraph (D), the following:
                    ``(E) an assurance that the State, through systems 
                of HIV-related health services provided under 
                paragraphs (1), (2), and (3) of section 2612(a), has 
                considered strategies for working with providers to 
                make optimal use of financial assistance under the 
                State medicaid plan under title XIX of the Social 
                Security Act, the State Children's Health Insurance 
                Program under title XXI of such Act, and other Federal 
                grantees that provide HIV-related services, to maximize 
                access to quality HIV-related health and support 
                services;
            (4) in subparagraph (F), as so redesignated, by striking 
        ``and'' at the end; and
            (5) in subparagraph (G), as so redesignated, by striking 
        the period and inserting ``; and''.
    (b) Availability of Funds for Quality Management.--
            (1) Availability of grant funds for planning and 
        evaluation.--Section 2618(c)(3) (42 U.S.C. 300ff-28(c)(3)) is 
        amended by inserting before the period ``, including not more 
        than $3,000,000 for all activities associated with its quality 
        management program''.
            (2) Exception to combined ceiling on planning and 
        administration funds for states with small grants.--Paragraph 
        (6) of section 2618(c) (42 U.S.C. 300ff-28(c)(6)) is amended to 
        read as follows:
            ``(6) Exception for quality management.--Notwithstanding 
        paragraph (5), a State whose grant under this part for a fiscal 
        year does not exceed $1,500,000 may use not to exceed 20 
        percent of the amount of the grant for the purposes described 
        in paragraphs (3) and (4) if--
                    ``(A) that portion of the amount that may be used 
                for such purposes in excess of 15 percent of the grant 
                is used for its quality management program; and
                    ``(B) the State submits and the Secretary approves 
                a plan (in such form and containing such information as 
                the Secretary may prescribe) for use of funds for its 
                quality management program.''.

SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE RELATIONSHIPS.

    Section 2617(b)(4) (42 U.S.C. 300ff-27(b)(4)), as amended by 
section 122(a), is further amended by adding at the end the following:
                    ``(H) that funded entities maintain appropriate 
                relationships with entities in the area served that 
                constitute key points of access to the health care 
                system for individuals with HIV disease (including 
                emergency rooms, substance abuse treatment programs, 
                detoxification centers, adult and juvenile detention 
                facilities, sexually transmitted disease clinics, HIV 
                counseling and testing sites, mental health programs, 
                and homeless shelters), and other entities under 
                section 2652(a), for the purpose of facilitating early 
                intervention for individuals newly diagnosed with HIV 
                disease and individuals knowledgeable of their status 
                but not in care.''.

SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-RELATED.

    (a) Technical Amendment.--Section 3(c)(2)(A)(iii) of the Ryan White 
CARE Act Amendments of 1996 (Public Law 104-146) is amended by 
inserting ``before paragraph (2) as so redesignated'' after 
``inserting''.
    (b) Services.--Section 2612(a)(1) (42 U.S.C. 300ff-22(a)(1)), as so 
designated by section 121(a), is amended by striking ``for individuals 
with HIV disease'' and inserting ``, subject to the conditions and 
limitations that apply under such section''.
    (c) Conforming Amendment to State Application Requirement.--Section 
2617(b)(2) (42 U.S.C. 300ff-27(b)(2)), as amended by section 121(b), is 
further amended by inserting after subparagraph (D) the following:
                    ``(E) an assurance that the State has procedures in 
                place to ensure that services provided with funds 
                received under this section meet the criteria specified 
                in section 2604(b)(1)(B); and''.

SEC. 125. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.

    Section 2612(a) (42 U.S.C. 300ff-22(a)), as amended by section 121, 
is further amended--
            (1) in paragraph (4), by striking ``and'' at the end;
            (2) in paragraph (5), by striking the period and inserting 
        ``; and''; and
            (3) by adding at the end the following:
            ``(6) to provide, through systems of HIV-related health 
        services provided under paragraphs (1), (2), and (3), early 
        intervention services, as described in section 2651(b)(2), with 
        follow-up referral, provided for the purpose of facilitating 
        the access of individuals receiving the services to HIV-related 
        health services, but only if the entity providing such 
        services--
                    ``(A)(i) is receiving funds under section 
                2612(a)(1); or
                    ``(ii) is an entity constituting a point of access 
                to services, as described in section 2617(b)(4), that 
                maintains a referral relationship with an entity 
                described in clause (i) and that is serving individuals 
                at elevated risk of HIV disease;
                    ``(B) demonstrates to the State's satisfaction that 
                other Federal, State, or local funds are inadequate for 
                the early intervention services the entity will provide 
                with funds received under this paragraph; and
                    ``(C) demonstrates to the satisfaction of the State 
                that funds will be utilized under this paragraph to 
                supplement not supplant other funds available for such 
                services in the year for which such funds are being 
                utilized.''.

SEC. 126. AUTHORIZATION OF APPROPRIATIONS FOR HIV-RELATED SERVICES FOR 
              WOMEN AND CHILDREN.

    Section 2625(c)(2) (42 U.S.C. 300ff-33(c)(2)) is amended by 
striking ``fiscal years 1996 through 2000'' and inserting ``fiscal 
years 2001 through 2005''.

SEC. 127. REPEAL OF REQUIREMENT FOR COMPLETED INSTITUTE OF MEDICINE 
              REPORT.

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

SEC. 128. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

    Subpart I of part B of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-11 et seq.) is amended by adding at the end the 
following:

``SEC. 2622. SUPPLEMENTAL GRANTS.

    ``(a) In General.--The Secretary shall award supplemental grants to 
States determined to be eligible under subsection (b) to enable such 
States to provide comprehensive services of the type described in 
section 2612(a) to supplement the services otherwise provided by the 
State under a grant under this subpart in emerging communities within 
the State that are not eligible to receive grants under part A.
    ``(b) Eligibility.--To be eligible to receive a supplemental grant 
under subsection (a) a State shall--
            ``(1) be eligible to receive a grant under this subpart;
            ``(2) demonstrate the existence in the State of an emerging 
        community as defined in subsection (d)(1); and
            ``(3) submit the information described in subsection (c).
    ``(c) Reporting Requirements.--A State that desires a grant under 
this section shall, as part of the State application submitted under 
section 2617, submit a detailed description of the manner in which the 
State will use amounts received under the grant and of the severity of 
need. Such description shall include--
            ``(1) a report concerning the dissemination of supplemental 
        funds under this section and the plan for the utilization of 
        such funds in the emerging community;
            ``(2) a demonstration of the existing commitment of local 
        resources, both financial and in-kind;
            ``(3) a demonstration that the State will maintain HIV-
        related activities at a level that is equal to not less than 
        the level of such activities in the State for the 1-year period 
        preceding the fiscal year for which the State is applying to 
        receive a grant under this part;
            ``(4) a demonstration of the ability of the State to 
        utilize such supplemental financial resources in a manner that 
        is immediately responsive and cost effective;
            ``(5) a demonstration that the resources will be allocated 
        in accordance with the local demographic incidence of AIDS 
        including appropriate allocations for services for infants, 
        children, women, and families with HIV disease;
            ``(6) a demonstration of the inclusiveness of the planning 
        process, with particular emphasis on affected communities and 
        individuals with HIV disease; and
            ``(7) a demonstration of the manner in which the proposed 
        services are consistent with local needs assessments and the 
        statewide coordinated statement of need.
    ``(d) Definition of Emerging Community.--In this section, the term 
`emerging community' means a metropolitan area--
            ``(1) that is not eligible for a grant under part A; and
            ``(2) for which there has been reported to the Director of 
        the Centers for Disease Control and Prevention a cumulative 
        total of between 500 and 1999 cases of acquired immune 
        deficiency syndrome for the most recent period of 5 calendar 
        years for which such data are available.
    ``(e) Funding.--
            ``(1) In general.--Subject to paragraph (2), with respect 
        to each fiscal year beginning with fiscal year 2001, the 
        Secretary, to carry out this section, shall utilize--
                    ``(A) the greater of--
                            ``(i) 25 percent of the amount appropriated 
                        under 2677 to carry out part B, excluding the 
                        amount appropriated under section 
                        2618(b)(2)(H), for such fiscal year that is in 
                        excess of the amount appropriated to carry out 
                        such part in fiscal year preceding the fiscal 
                        year involved; or
                            ``(ii) $5,000,000;
                to provide funds to States for use in emerging 
                communities with at least 1000, but less than 2000, 
                cases of AIDS as reported to and confirmed by the 
                Director of the Centers for Disease Control and 
                Prevention for the five year period preceding the year 
                for which the grant is being awarded; and
                    ``(B) the greater of--
                            ``(i) 25 percent of the amount appropriated 
                        under 2677 to carry out part B, excluding the 
                        amount appropriated under section 
                        2618(b)(2)(H), for such fiscal year that is in 
                        excess of the amount appropriated to carry out 
                        such part in fiscal year preceding the fiscal 
                        year involved; or
                            ``(ii) $5,000,000;
                to provide funds to States for use in emerging 
                communities with at least 500, but less than 1000, 
                cases of AIDS reported to and confirmed by the Director 
                of the Centers for Disease Control and Prevention for 
                the five year period preceding the year for which the 
                grant is being awarded.
            ``(2) Trigger of funding.--This section shall be effective 
        only for fiscal years beginning in the first fiscal year in 
        which the amount appropriated under 2677 to carry out part B, 
        excluding the amount appropriated under section 2618(b)(2)(H), 
        exceeds by at least $20,000,000 the amount appropriated under 
        2677 to carry out part B in fiscal year 2000, excluding the 
        amount appropriated under section 2618(b)(2)(H).
            ``(3) Minimum amount in future years.--Beginning with the 
        first fiscal year in which amounts provided for emerging 
        communities under paragraph (1)(A) equals $5,000,000 and under 
        paragraph (1)(B) equals $5,000,000, the Secretary shall ensure 
        that amounts made available under this section for the types of 
        emerging communities described in each such paragraph in 
        subsequent fiscal years is at least $5,000,000.
            ``(4) Distribution.--The amount of a grant awarded to a 
        State under this section shall be determined by the Secretary 
        based on the formula described in section 2618(b)(2), except 
        that in applying such formula, the Secretary shall--
                    ``(A) substitute `1.0' for `.80' in subparagraph 
                (A)(ii)(I) of such section; and
                    ``(B) not consider the provisions of subparagraphs 
                (A)(ii)(II) and (C) of such section.''.

SEC. 129. USE OF TREATMENT FUNDS.

    (a) State Duties.--Section 2616(c) (42 U.S.C. 300ff-26(c)) is 
amended--
            (1) in the matter preceding paragraph (1), by striking 
        ``shall--'' and inserting ``shall use funds made available 
        under this section to--'';
            (2) by redesignating paragraphs (1) through (5) as 
        subparagraphs (A) through (E), respectively and realigning the 
        margins of such subparagraphs appropriately;
            (3) in subparagraph (D) (as so redesignated), by striking 
        ``and'' at the end;
            (4) in subparagraph (E) (as so redesignated), by striking 
        the period and inserting ``; and''; and
            (5) by adding at the end the following:
            ``(F) encourage, support, and enhance adherence to and 
        compliance with treatment regimens, including related medical 
        monitoring.'';
            (6) by striking ``In carrying'' and inserting the 
        following:
            ``(1) In general.--In carrying''; and
            (7) by adding at the end the following:
            ``(2) Limitations.--
                    ``(A) In general.--No State shall use funds under 
                paragraph (1)(F) unless the limitations on access to 
                HIV/AIDS therapeutic regimens as defined in subsection 
                (e)(2) are eliminated.
                    ``(B) Amount of funding.--No State shall use in 
                excess of 10 percent of the amount set-aside for use 
                under this section in any fiscal year to carry out 
                activities under paragraph (1)(F) unless the State 
                demonstrates to the Secretary that such additional 
                services are essential and in no way diminish access to 
                therapeutics.''.
    (b) Supplement Grants.--Section 2616 (42 U.S.C. 300ff-26) is 
amended by adding at the end the following:
    ``(e) Supplemental Grants for the Provision of Treatments.--
            ``(1) In general.--From amounts made available under 
        paragraph (5), the Secretary shall award supplemental grants to 
        States determined to be eligible under paragraph (2) to enable 
        such States to increase access to therapeutics to treat HIV 
        disease as provided by the State under subsection (c)(1)(B) for 
        individuals at or below 200 percent of the Federal poverty 
        line.
            ``(2) Criteria.--The Secretary shall develop criteria for 
        the awarding of grants under paragraph (1) to States that 
        demonstrate a severe need. In determining the criteria for 
        demonstrating State severity of need, the Secretary shall 
        consider eligibility standards and formulary composition.
            ``(3) State requirement.--The Secretary may not make a 
        grant to a State under this subsection unless the State agrees 
        that--
                    ``(A) the State will make available (directly or 
                through donations from public or private entities) non-
                Federal contributions toward the activities to be 
                carried out under the grant in an amount equal to $1 
                for each $4 of Federal funds provided in the grant; and
                    ``(B) the State will not impose eligibility 
                requirements for services or scope of benefits 
                limitations under subsection (a) that are more 
                restrictive than such requirements in effect as of 
                January 1, 2000.
            ``(4) Use and coordination.--Amounts made available under a 
        grant under this subsection shall only be used by the State to 
        provide HIV/AIDS-related medications. The State shall 
        coordinate the use of such amounts with the amounts otherwise 
        provided under this section in order to maximize drug coverage.
            ``(5) Funding.--
                    ``(A) Reservation of amount.--The Secretary shall 
                reserve 3 percent of any amount referred to in section 
                2618(b)(2)(H) that is appropriated for a fiscal year, 
                to carry out this subsection.
                    ``(B) Minimum amount.--In providing grants under 
                this subsection, the Secretary shall ensure that the 
                amount of a grant to a State under this part is not 
                less than the amount the State received under this part 
                in the previous fiscal year, as a result of grants 
                provided under this subsection.''.
    (c) Supplement and not Supplant.--Section 2616 (42 U.S.C. 300ff-
26(c)), as amended by subsection (b), is further amended by adding at 
the end the following:
    ``(f) Supplement not Supplant.--Notwithstanding any other provision 
of law, amounts made available under this section shall be used to 
supplement and not supplant other funding available to provide 
treatments of the type that may be provided under this section.''.

SEC. 130. INCREASE IN MINIMUM ALLOTMENT.

    (a) In General.--Section 2618(b)(1)(A)(i) (42 U.S.C. 300ff-
28(b)(1)(A)(i)) is amended--
            (1) in subclause (I), by striking ``$100,000'' and 
        inserting ``$200,000''; and
            (2) in subclause (II), by striking ``$250,000'' and 
        inserting ``$500,000''.
    (b) Territories.--Section 2618(b)(1)(B) (42 U.S.C. 300ff-
28(b)(1)(B)) is amended by inserting ``the greater of $50,000 or'' 
after ``shall be''.
    (c) Technical Amendment.--Section 2618(b)(3)(B) (42 U.S.C. 300ff-
28(b)(3)(B)) is amended by striking ``and the Republic of the Marshall 
Islands'' and inserting ``, the Republic of the Marshall Islands, the 
Federated States of Micronesia, and the Republic of Palau, and only for 
purposes of paragraph (1) the Commonwealth of Puerto Rico''.

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

    Section 2611(b) (42 U.S.C. 300ff-21(b)) is amended--
            (1) by inserting ``for each population under this 
        subsection'' after ``State shall use''; and
            (2) by striking ``ratio of the'' and inserting ``ratio of 
        each''.

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

SEC. 141. AMENDMENT OF HEADING; REPEAL OF FORMULA GRANT PROGRAM.

    (a) Amendment of Heading.--The heading of part C of title XXVI is 
amended to read as follows:

       ``Part C--Early Intervention and Primary Care Services''.

    (b) Repeal.--Part C of title XXVI (42 U.S.C. 300ff-41 et seq.) is 
amended--
            (1) by repealing subpart I; and
            (2) by redesignating subparts II and III as subparts I and 
        II.
    (c) Conforming Amendments.--
            (1) Information regarding receipt of services.--Section 
        2661(a) (42 U.S.C. 300ff-61(a)) is amended by striking 
        ``unless--'' and all that follows through ``(2) in the case 
        of'' and inserting ``unless, in the case of''.
            (2) Additional agreements.--Section 2664 (42 U.S.C. 300ff-
        64) is amended--
                    (A) in subsection (e)(5), by striking ``2642(b) 
                or'';
                    (B) in subsection (f)(2), by striking ``2642(b) 
                or''; and
                    (C) by striking subsection (h).

SEC. 142. PLANNING AND DEVELOPMENT GRANTS.

    (a) Allowing Planning and Development Grant To Expand Ability To 
Provide Primary Care Services.--Section 2654(c) (42 U.S.C. 300ff-54(c)) 
is amended--
            (1) in paragraph (1), to read as follows:
            ``(1) In general.--The Secretary may provide planning and 
        development grants to public and nonprofit private entities for 
        the purpose of--
                    ``(A) enabling such entities to provide HIV early 
                intervention services; or
                    ``(B) assisting such entities to expand the 
                capacity, preparedness, and expertise to deliver 
                primary care services to individuals with HIV disease 
                in underserved low-income communities on the condition 
                that the funds are not used to purchase or improve land 
                or to purchase, construct, or permanently improve 
                (other than minor remodeling) any building or other 
                facility.''; and
            (2) in paragraphs (2) and (3) by striking ``paragraph (1)'' 
        each place that such appears and inserting ``paragraph 
        (1)(A)''.
    (b) Amount; Duration.--Section 2654(c) (42 U.S.C. 300ff-54(c)), as 
amended by subsection (a), is further amended--
            (1) by redesignating paragraph (4) as paragraph (5); and
            (2) by inserting after paragraph (3) the following:
            ``(4) Amount and duration of grants.--
                    ``(A) Early intervention services.--A grant under 
                paragraph (1)(A) may be made in an amount not to exceed 
                $50,000.
                    ``(B) Capacity development.--
                            ``(i) Amount.--A grant under paragraph 
                        (1)(B) may be made in an amount not to exceed 
                        $150,000.
                            ``(ii) Duration.--The total duration of a 
                        grant under paragraph (1)(B), including any 
                        renewal, may not exceed 3 years.''.
    (c) Increase in limitation.--Section 2654(c)(5) (42 U.S.C. 300ff-
54(c)(5)), as so redesignated by subsection (b), is amended by striking 
``1 percent'' and inserting ``5 percent''.

SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CATEGORICAL GRANTS.

    Section 2655 (42 U.S.C. 300ff-55) is amended by striking ``1996'' 
and all that follows through ``2000'' and inserting ``2001 through 
2005''.

SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY MANAGEMENT PROGRAM.

    Section 2664(g) (42 U.S.C. 300ff-64(g)) is amended--
            (1) in paragraph (3), to read as follows:
            ``(3) the applicant will not expend more than 10 percent of 
        the grant for costs of administrative activities with respect 
        to the grant;'';
            (2) in paragraph (4), by striking the period and inserting 
        ``; and''; and
            (3) by adding at the end the following:
            ``(5) the applicant will provide for the establishment of a 
        quality management program to assess the extent to which 
        medical services funded under this title that are provided to 
        patients are consistent with the most recent Public Health 
        Service guidelines for the treatment of HIV disease and related 
        opportunistic infections and that improvements in the access to 
        and quality of medical services are addressed.''.

SEC. 145. PREFERENCE FOR CERTAIN AREAS.

    Section 2651 (42 U.S.C. 300ff-51) is amended by adding at the end 
the following:
    ``(d) Preference in Awarding Grants.--In awarding new grants under 
this section, the Secretary shall give preference to applicants that 
will use amounts received under the grant to serve areas that are 
determined to be rural and underserved for the purposes of providing 
health care to individuals infected with HIV or diagnosed with AIDS.''.

SEC. 146. TECHNICAL AMENDMENT.

    Section 2652(a) (42 U.S.C. 300ff-52(a)) is amended--
            (1) striking paragraphs (1) and (2) and inserting the 
        following:
            ``(1) health centers under section 330;''; and
            (2) by redesignating paragraphs (3) through (6) as 
        paragraphs (2) through (5), respectively.

         Subtitle D--Amendments to Part D (General Provisions)

SEC. 151. RESEARCH INVOLVING WOMEN, INFANTS, CHILDREN, AND YOUTH.

    (a) Elimination of Requirement To Enroll Significant Numbers of 
Women and Children.--Section 2671(b) (42 U.S.C. 300ff-71(b)) is 
amended--
            (1) in paragraph (1), by striking subparagraphs (C) and 
        (D); and
            (2) by striking paragraphs (3) and (4).
    (b) Information and Education.--Section 2671(d) (42 U.S.C. 300ff-
71(d)) is amended by adding at the end the following:
            ``(4) The applicant will provide individuals with 
        information and education on opportunities to participate in 
        HIV/AIDS-related clinical research.''.
    (c) Quality Management; Administrative Expenses Ceiling.--Section 
2671(f) (42 U.S.C. 300ff-71(f)) is amended--
            (1) by striking the subsection heading and designation and 
        inserting the following:
    ``(f) Administration.--
            ``(1) Application.--''; and
            (2) by adding at the end the following:
            ``(2) Quality management program.--A grantee under this 
        section shall implement a quality management program.''.
    (d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g)) is 
amended by adding at the end the following: ``The Secretary acting 
through the Director of NIH, shall examine the distribution and 
availability of ongoing and appropriate HIV/AIDS-related research 
projects to existing sites under this section for purposes of enhancing 
and expanding voluntary access to HIV-related research, especially 
within communities that are not reasonably served by such projects. Not 
later than 12 months after the date of enactment of the Ryan White CARE 
Act Amendments of 2000, the Secretary shall prepare and submit to the 
appropriate committees of Congress a report that describes the findings 
made by the Director and the manner in which the conclusions based on 
those findings can be addressed.''.
    (e) Authorization of Appropriations.--Section 2671(j) (42 U.S.C. 
300ff-71(j)) is amended by striking ``fiscal years 1996 through 2000'' 
and inserting ``fiscal years 2001 through 2005''.

SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.

    Section 2671 (42 U.S.C. 300ff-71) is amended--
            (1) by redesignating subsections (i) and (j), as 
        subsections (j) and (k), respectively; and
            (2) by inserting after subsection (h), the following:
    ``(i) Limitation on Administrative Expenses.--
            ``(1) Determination by secretary.--Not later than 12 months 
        after the date of enactment of the Ryan White Care Act 
        Amendments of 2000, the Secretary, in consultation with 
        grantees under this part, shall conduct a review of the 
        administrative, program support, and direct service-related 
        activities that are carried out under this part to ensure that 
        eligible individuals have access to quality, HIV-related health 
        and support services and research opportunities under this 
        part, and to support the provision of such services.
            ``(2) Requirements.--
                    ``(A) In general.--Not later than 180 days after 
                the expiration of the 12-month period referred to in 
                paragraph (1) the Secretary, in consultation with 
                grantees under this part, shall determine the 
                relationship between the costs of the activities 
                referred to in paragraph (1) and the access of eligible 
                individuals to the services and research opportunities 
                described in such paragraph.
                    ``(B) Limitation.--After a final determination 
                under subparagraph (A), the Secretary may not make a 
                grant under this part unless the grantee complies with 
                such requirements as may be included in such 
                determination.''.

SEC. 153. EVALUATIONS AND REPORTS.

    Section 2674(c) (42 U.S.C. 399ff-74(c)) is amended by striking 
``1991 through 1995'' and inserting ``2001 through 2005''.

SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR GRANTS UNDER PARTS A AND 
              B.

    Section 2677 (42 U.S.C. 300ff-77) is amended to read as follows:

``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated--
            ``(1) such sums as may be necessary to carry out part A for 
        each of the fiscal years 2001 through 2005; and
            ``(2) such sums as may be necessary to carry out part B for 
        each of the fiscal years 2001 through 2005.''.

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

SEC. 161. AUTHORIZATION OF APPROPRIATIONS.

    (a) Schools; Centers.--Section 2692(c)(1) (42 U.S.C. 300ff-
111(c)(1)) is amended by striking ``fiscal years 1996 through 2000'' 
and inserting ``fiscal years 2001 through 2005''.
    (b) Dental Schools.--Section 2692(c)(2) (42 U.S.C. 300ff-111(c)(2)) 
is amended by striking ``fiscal years 1996 through 2000'' and inserting 
``fiscal years 2001 through 2005''.
    (c) Dental Schools and Programs.--Section 2692(b) of the Public 
Health Service Act (42 U.S.C. 300ff-111(b)) is amended--
            (1) in paragraph (1), by striking ``777(b)(4)(B)'' and 
        inserting ``777(b)(4)(B) (as such section existed on the day 
        before the date of enactment of the Health Professions 
        Education Partnerships Act of 1998 (Public Law 105-392)) and 
        dental hygiene programs that are accredited by the Commission 
        on Dental Accreditation''; and
            (2) in paragraph (2), by striking ``777(b)(4)(B)'' and 
        inserting ``777(b)(4)(B) (as such section existed on the day 
        before the date of enactment of the Health Professions 
        Education Partnerships Act of 1998 (Public Law 105-392))''.

                   TITLE II--MISCELLANEOUS PROVISIONS

SEC. 201. INSTITUTE OF MEDICINE STUDY.

    (a) In General.--Not later than 120 days after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
enter into a contract with the Institute of Medicine for the conduct of 
a study concerning the appropriate epidemiological measures and their 
relationship to the financing and delivery of primary care and health-
related support services for low-income, uninsured, and under-insured 
individuals with HIV disease.
    (b) Requirements.--
            (1) Completion.--The study under subsection (a) shall be 
        completed not later than 21 months after the date on which the 
        contract referred to in such subsection is entered into.
            (2) Issues to be considered.--The study conducted under 
        subsection (a) shall consider--
                    (A) the availability and utility of health outcomes 
                measures and data for HIV primary care and support 
                services and the extent to which those measures and 
                data could be used to measure the quality of such 
                funded services;
                    (B) the effectiveness and efficiency of service 
                delivery (including the quality of services, health 
                outcomes, and resource use) within the context of a 
                changing health care and therapeutic environment as 
                well as the changing epidemiology of the epidemic;
                    (C) existing and needed epidemiological data and 
                other analytic tools for resource planning and 
                allocation decisions, specifically for estimating 
                severity of need of a community and the relationship to 
                the allocations process; and
                    (D) other factors determined to be relevant to 
                assessing an individual's or community's ability to 
                gain and sustain access to quality HIV services.
    (c) Report.--Not later than 90 days after the date on which the 
study is completed under subsection (a), the Secretary of Health and 
Human Services shall prepare and submit to the appropriate committees 
of Congress a report describing the manner in which the conclusions and 
recommendations of the Institute of Medicine can be addressed and 
implemented.

            Passed the Senate June 6, 2000.

            Attest:

                                                             Secretary.
106th CONGRESS

  2d Session

                                S. 2311

_______________________________________________________________________

                                 AN ACT

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.

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