106TH CONGRESS

2D SESSION S. 2311

AMENDMENTS

In the House of Representatives, U. S.,

October 5, 2000.

Resolved, That the bill from the Senate (S. 2311) entitled ‘‘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’’, do pass with the following

AMENDMENTS:

Strike out all after the enacting clause and insert:

1 SECTION 1. SHORT TITLE.

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

3 Amendments of 2000’’.

4 SEC. 2. TABLE OF CONTENTS.

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

TITLE I—EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL

NEED FOR SERVICES

Subtitle A—HIV Health Services Planning Councils

Sec. 101. Membership of councils.

Sec. 102. Duties of councils.

Sec. 103. Open meetings; other additional provisions.
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Subtitle B—Type and Distribution of Grants

Sec. 111. Formula grants.

Sec. 112. Supplemental grants.

Subtitle C—Other Provisions

Sec. 121. Use of amounts.

Sec. 122. Application.

TITLE II—CARE GRANT PROGRAM

Subtitle A—General Grant Provisions

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

Sec. 202. Use of grants.

Sec. 203. Grants to establish HIV care consortia.

Sec. 204. Provision of treatments.

Sec. 205. State application.

Sec. 206. Distribution of funds.

Sec. 207. Supplemental grants for certain States.

Subtitle B—Provisions Concerning Pregnancy and Perinatal Transmission of

HIV

Sec. 211. Repeals.

Sec. 212. Grants.

Sec. 213. Study by Institute of Medicine.

Subtitle C—Certain Partner Notification Programs

Sec. 221. Grants for compliant partner notification programs.

TITLE III—EARLY INTERVENTION SERVICES

Subtitle A—Formula Grants for States

Sec. 301. Repeal of program.

Subtitle B—Categorical Grants

Sec. 311. Preferences in making grants.

Sec. 312. Planning and development grants.

Sec. 313. Authorization of appropriations.

Subtitle C—General Provisions

Sec. 321. Provision of certain counseling services.

Sec. 322. Additional required agreements.

TITLE IV—OTHER PROGRAMS AND ACTIVITIES

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

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

Sec. 402. AIDS education and training centers.
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Subtitle B—General Provisions in Title XXVI

Sec. 411. Evaluations and reports.

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

Sec. 413. Coordination.

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

Sec. 415. Audits.

Sec. 416. Administrative simplification.

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

TITLE V—GENERAL PROVISIONS

Sec. 501. Studies by Institute of Medicine.

Sec. 502. Development of rapid HIV test.

Sec. 503. Technical corrections.

TITLE VI—EFFECTIVE DATE

Sec. 601. Effective date.

1 TITLE I—EMERGENCY RELIEF

2 FOR AREAS WITH SUBSTAN3 TIAL NEED FOR SERVICES

4 Subtitle A—HIV Health Services

5 Planning Councils

6 SEC. 101. MEMBERSHIP OF COUNCILS.

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

8 Health Service Act (42 U.S.C. 300ff–12(b)) is amended—

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

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

13 and

14 (2) in paragraph (2)—

15 (A) in subparagraph (C), by inserting be16 fore the semicolon the following: ‘‘, including

17 providers of housing and homeless services’’;
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1 (B) in subparagraph (G), by striking ‘‘or

2 AIDS’’;

3 (C) in subparagraph (K), by striking ‘‘and’’

4 at the end;

5 (D) in subparagraph (L), by striking the

6 period and inserting the following: ‘‘, including

7 but not limited to providers of HIV prevention

8 services; and’’; and

9 (E) by adding at the end the following sub10 paragraph:

11 ‘‘(M) representatives of individuals who for12 merly were Federal, State, or local prisoners,

13 were released from the custody of the penal sys14 tem during the preceding 3 years, and had HIV

15 disease as of the date on which the individuals

16 were so released.’’.

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

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

19 is amended by adding at the end the following subpara20 graph:

21 ‘‘(C) COMPOSITION OF COUNCIL.—The fol22 lowing applies regarding the membership of a

23 planning council under paragraph (1):

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

25 council shall be individuals who are receiv-
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1 ing HIV-related services pursuant to a

2 grant under section 2601(a), are not offi3 cers, employees, or consultants to any entity

4 that receives amounts from such a grant,

5 and do not represent any such entity, and

6 reflect the demographics of the population of

7 individuals with HIV disease as determined

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

9 the preceding sentence, an individual shall

10 be considered to be receiving such services if

11 the individual is a parent of, or a caregiver

12 for, a minor child who is receiving such

13 services.

14 ‘‘(ii) With respect to membership on

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

16 construed as having any effect on entities

17 that receive funds from grants under any of

18 parts B through F but do not receive funds

19 from grants under section 2601(a), on offi20 cers or employees of such entities, or on in21 dividuals who represent such entities.’’.

22 SEC. 102. DUTIES OF COUNCILS.

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

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

25 amended—
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1 (1) by redesignating subparagraphs (A) through

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

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

4 redesignated) the following subparagraphs:

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

6 the population of individuals with HIV disease;

7 ‘‘(B) determine the needs of such popu8 lation, with particular attention to—

9 ‘‘(i) individuals with HIV disease who

10 know their HIV status and are not receiv11 ing HIV-related services; and

12 ‘‘(ii) disparities in access and services

13 among affected subpopulations and histori14 cally underserved communities;’’;

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

16 striking clauses (i) through (iv) and inserting the fol17 lowing:

18 ‘‘(i) size and demographics of the pop19 ulation of individuals with HIV disease (as

20 determined under subparagraph (A)) and

21 the needs of such population (as determined

22 under subparagraph (B));

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

24 effectiveness and outcome effectiveness of
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1 proposed strategies and interventions, to the

2 extent that data are reasonably available;

3 ‘‘(iii) priorities of the communities

4 with HIV disease for whom the services are

5 intended;

6 ‘‘(iv) coordination in the provision of

7 services to such individuals with programs

8 for HIV prevention and for the prevention

9 and treatment of substance abuse, including

10 programs that provide comprehensive treat11 ment for such abuse;

12 ‘‘(v) availability of other governmental

13 and non-governmental resources, including

14 the State medicaid plan under title XIX of

15 the Social Security Act and the State Chil16 dren’s Health Insurance Program under

17 title XXI of such Act to cover health care

18 costs of eligible individuals and families

19 with HIV disease; and

20 ‘‘(vi) capacity development needs re21 sulting from disparities in the availability

22 of HIV-related services in historically un23 derserved communities;’’;

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

25 amending the subparagraph to read as follows:
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1 ‘‘(D) develop a comprehensive plan for the

2 organization and delivery of health and support

3 services described in section 2604 that—

4 ‘‘(i) includes a strategy for identifying

5 individuals who know their HIV status and

6 are not receiving such services and for in7 forming the individuals of and enabling the

8 individuals to utilize the services, giving

9 particular attention to eliminating dispari10 ties in access and services among affected

11 subpopulations and historically underserved

12 communities, and including discrete goals,

13 a timetable, and an appropriate allocation

14 of funds;

15 ‘‘(ii) includes a strategy to coordinate

16 the provision of such services with programs

17 for HIV prevention (including outreach and

18 early intervention) and for the prevention

19 and treatment of substance abuse (including

20 programs that provide comprehensive treat21 ment services for such abuse); and

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

23 local plan for the provision of services to in24 dividuals with HIV disease;’’;
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1 (5) in subparagraph (F) (as so redesignated), by

2 striking ‘‘and’’ at the end;

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

4 (A) by striking ‘‘public meetings,’’ and in5 serting ‘‘public meetings (in accordance with

6 paragraph (7)),’’; and

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

8 and’’; and

9 (7) by adding at the end the following subpara10 graph:

11 ‘‘(H) coordinate with Federal grantees that

12 provide HIV-related services within the eligible

13 area.’’.

14 (b) PROCESS FOR ESTABLISHING ALLOCATION PRIOR15 ITIES.—Section 2602 of the Public Health Service Act (42

16 U.S.C. 300ff–12) is amended by adding at the end the fol17 lowing subsection:

18 ‘‘(d) PROCESS FOR ESTABLISHING ALLOCATION PRI19 ORITIES.—Promptly after the date of the submission of the

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

21 Act Amendments of 2000 (relating to the relationship be22 tween epidemiological measures and health care for certain

23 individuals with HIV disease), the Secretary, in consulta24 tion with planning councils and entities that receive
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1 amounts from grants under section 2601(a) or 2611, shall

2 develop epidemiologic measures—

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

4 living with HIV disease who are not receiving HIV5 related health services; and

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

7 (b)(4) and section 2617(b).’’.

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

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

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

11 following subsection:

12 ‘‘(e) TRAINING GUIDANCE AND MATERIALS.—The Sec13 retary shall provide to each chief elected official receiving

14 a grant under 2601(a) guidelines and materials for train15 ing members of the planning council under paragraph (1)

16 regarding the duties of the council.’’.

17 (d) CONFORMING AMENDMENT.—Section 2603(c) of

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

19 amended by striking ‘‘section 2602(b)(3)(A)’’ and inserting

20 ‘‘section 2602(b)(4)(C)’’.

21 SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVI22 SIONS.

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

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

2 (C); and

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

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

6 planning council under paragraph (1), the following

7 applies:

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

9 by an employee of the grantee under section

10 2601(a).

11 ‘‘(B) In accordance with criteria established

12 by the Secretary:

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

14 be open to the public and shall be held only

15 after adequate notice to the public.

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

17 minutes, agenda, or other documents which

18 were made available to or prepared for or

19 by the council shall be available for public

20 inspection and copying at a single location.

21 ‘‘(iii) Detailed minutes of each meeting

22 of the council shall be kept. The accuracy of

23 all minutes shall be certified to by the chair

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

2 apply to any disclosure of information of a

3 personal nature that would constitute a

4 clearly unwarranted invasion of personal

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

7 Subtitle B—Type and Distribution

8 of Grants

9 SEC. 111. FORMULA GRANTS.

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

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

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

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

14 fiscal year’’.

15 (b) AMOUNT OF GRANT; ESTIMATE OF LIVING

16 CASES.—

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

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

19 is amended—

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

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

23 pursuant to this paragraph for fiscal year 2005

24 and subsequent fiscal years, the cases counted for

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

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

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

6 after and below clause (ii)(X)—

7 (i) in the first sentence, by inserting

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

9 be reported to the congressional committees

10 of jurisdiction’’; and

11 (ii) by adding at the end the following

12 sentence: ‘‘Updates shall as applicable take

13 into account the counting of cases of HIV

14 disease pursuant to clause (i).’’.

15 (2) DETERMINATION OF SECRETARY REGARDING

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

18 amended—

19 (A) by redesignating subparagraph (D) as

20 subparagraph (E); and

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

22 following subparagraph:

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

2 1, 2004, the Secretary shall determine

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

5 confirmed by the Director of the Centers for

6 Disease Control and Prevention) sufficiently

7 accurate and reliable for use for purposes of

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

10 consideration the findings of the study

11 under section 501(b) of the Ryan White

12 CARE Act Amendments of 2000 (relating to

13 the relationship between epidemiological

14 measures and health care for certain indi15 viduals with HIV disease).

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

19 disease is not sufficiently accurate and reli20 able for use for purposes of subparagraph

21 (C)(i), then notwithstanding such subpara22 graph, for any fiscal year prior to fiscal

23 year 2007 the references in such subpara24 graph to cases of HIV disease do not have

25 any legal effect.
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1 ‘‘(iii) GRANTS AND TECHNICAL ASSIST2 ANCE REGARDING COUNTING OF HIV

3 CASES.—Of the amounts appropriated

4 under section 318B for a fiscal year, the

5 Secretary shall reserve amounts to make

6 grants and provide technical assistance to

7 States and eligible areas with respect to ob8 taining data on cases of HIV disease to en9 sure that data on such cases is available

10 from all States and eligible areas as soon as

11 is practicable but not later than the begin12 ning of fiscal year 2007.’’.

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

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

15 amended to read as follows:

16 ‘‘(4) INCREASES IN GRANT.—

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

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

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

21 ensure that—

22 ‘‘(i) for the first fiscal year in the pro23 tection period, the grant is not less than 98

24 percent of the amount of the grant made for

25 the eligible area pursuant to such para-
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1 graph for the base year for the protection

2 period;

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

4 period, the grant is not less than 95 percent

5 of the amount of such base year grant;

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

7 period, the grant is not less than 92 percent

8 of the amount of the base year grant;

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

10 period, the grant is not less than 89 percent

11 of the amount of the base year grant; and

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

13 year in such period, if, pursuant to para14 graph (3)(D)(ii)), the references in para15 graph (3)(C)(i) to HIV disease do not have

16 any legal effect, the grant is not less than

17 85 percent of the amount of the base year

18 grant.

19 ‘‘(B) SPECIAL RULE.—If for fiscal year

20 2005, pursuant to paragraph (3)(D)(ii), data on

21 cases of HIV disease are used for purposes of

22 paragraph (3)(C)(i), the Secretary shall increase

23 the amount of a grant made pursuant to para24 graph (2) for an eligible area to ensure that the

25 grant is not less than 98 percent of the amount
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1 of the grant made for the area in fiscal year

2 2004.

3 ‘‘(C) BASE YEAR; PROTECTION PERIOD.—

4 With respect to grants made pursuant to para5 graph (2) for an eligible area:

6 ‘‘(i) The base year for a protection pe7 riod is the fiscal year preceding the trigger

8 grant-reduction year.

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

10 year is the first fiscal year (after fiscal year

11 2000) for which the grant for the area is

12 less than the grant for the area for the pre13 ceding fiscal year.

14 ‘‘(iii) A protection period begins with

15 the trigger grant-reduction year and con16 tinues until the beginning of the first fiscal

17 year for which the amount of the grant de18 termined pursuant to paragraph (2) for the

19 area equals or exceeds the amount of the

20 grant determined under subparagraph (A).

21 ‘‘(iv) Any subsequent trigger grant-re22 duction year is the first fiscal year, after

23 the end of the preceding protection period,

24 for which the amount of the grant is less
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1 than the amount of the grant for the pre2 ceding fiscal year.’’.

3 SEC. 112. SUPPLEMENTAL GRANTS.

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

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

6 amended—

7 (1) in the heading for the paragraph, by striking

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

9 (2) by redesignating subparagraphs (A) through

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

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

12 redesignated) the following subparagraph:

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

14 grant made for purposes of this subsection shall

15 be determined by the Secretary based on a

16 weighting of factors under paragraph (1), with

17 severe need under subparagraph (B) of such

18 paragraph counting one-third.’’;

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

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

21 end;

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

23 and inserting a semicolon; and

24 (C) by adding at the end the following

25 clauses:
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1 ‘‘(iv) the current prevalence of HIV

2 disease;

3 ‘‘(v) an increasing need for HIV-re4 lated services, including relative rates of in5 crease in the number of cases of HIV dis6 ease; and

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

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

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

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

11 place such term appears and inserting ‘‘subpara12 graph (B)’’;

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

14 years after the date of enactment of this para15 graph’’ and inserting ‘‘18 months after the date

16 of the enactment of the Ryan White CARE Act

17 Amendments of 2000’’; and

18 (C) by inserting after the second sentence

19 the following sentence: ‘‘Such a mechanism shall

20 be modified to reflect the findings of the study

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

22 Act Amendments of 2000 (relating to the rela23 tionship between epidemiological measures and

24 health care for certain individuals with HIV dis25 ease).’’; and
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1 (6) in subparagraph (D) (as so redesignated), by

2 striking ‘‘subparagraph (B)’’ and inserting ‘‘subpara3 graph (C)’’.

4 (b) REQUIREMENTS FOR APPLICATION.—Section

5 2603(b)(1)(E) of the Public Health Service Act (42 U.S.C.

6 300ff–13(b)(1)(E)) is amended by inserting ‘‘youth,’’ after

7 ‘‘children,’’.

8 (c) TECHNICAL AND CONFORMING AMENDMENT.—Sec9 tion 2603(b) of the Public Health Service Act (42 U.S.C.

10 300ff–13(b)) is amended—

11 (1) by striking paragraph (4);

12 (2) by redesignating paragraph (5) as para13 graph (4); and

14 (3) in paragraph (4) (as so redesignated), in

15 subparagraph (B), by striking ‘‘grants’’ and inserting

16 ‘‘grant’’.

17 Subtitle C—Other Provisions

18 SEC. 121. USE OF AMOUNTS.

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

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

21 amended—

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

23 by striking ‘‘HIV-related—’’ and inserting ‘‘HIV-re24 lated services, as follows:’’;

25 (2) in subparagraph (A)—
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1 (A) by striking ‘‘outpatient’’ and all that

2 follows through ‘‘substance abuse treatment and’’

3 and inserting the following: ‘‘Outpatient and

4 ambulatory health services, including substance

5 abuse treatment,’’; and

6 (B) by striking ‘‘; and’’ and inserting a pe7 riod;

8 (3) in subparagraph (B), by striking ‘‘(B) inpa9 tient case management’’ and inserting ‘‘(C) Inpatient

10 case management’’;

11 (4) by inserting after subparagraph (A) the fol12 lowing subparagraph:

13 ‘‘(B) Outpatient and ambulatory support

14 services (including case management), to the ex15 tent that such services facilitate, enhance, sup16 port, or sustain the delivery, continuity, or bene17 fits of health services for individuals and fami18 lies with HIV disease.’’; and

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

20 ‘‘(D) Outreach activities that are intended

21 to identify individuals with HIV disease who

22 know their HIV status and are not receiving

23 HIV-related services, and that are—

24 ‘‘(i) necessary to implement the strat25 egy under section 2602(b)(4)(D), including
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1 activities facilitating the access of such in2 dividuals to HIV-related primary care serv3 ices at entities described in paragraph

4 (3)(A);

5 ‘‘(ii) conducted in a manner consistent

6 with the requirements under sections

7 2605(a)(3) and 2651(b)(2); and

8 ‘‘(iii) supplement, and do not sup9 plant, such activities that are carried out

10 with amounts appropriated under section

11 317.’’.

12 (b) EARLY INTERVENTION SERVICES.—Section

13 2604(b) (42 U.S.C. 300ff–14(b)) of the Public Health Serv14 ice Act is amended—

15 (1) by redesignating paragraph (3) as para16 graph (4); and

17 (2) by inserting after paragraph (2) the fol18 lowing:

19 ‘‘(3) EARLY INTERVENTION SERVICES.—

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

21 a grant under section 2601 may be used include

22 providing to individuals with HIV disease early

23 intervention services described in section

24 2651(b)(2), with follow-up referral provided for

25 the purpose of facilitating the access of individ-
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1 uals receiving the services to HIV-related health

2 services. The entities through which such services

3 may be provided under the grant include public

4 health departments, emergency rooms, substance

5 abuse and mental health treatment programs, de6 toxification centers, detention facilities, clinics

7 regarding sexually transmitted diseases, homeless

8 shelters, HIV disease counseling and testing sites,

9 health care points of entry specified by eligible

10 areas, federally qualified health centers, and en11 tities described in section 2652(a) that constitute

12 a point of access to services by maintaining re13 ferral relationships.

14 ‘‘(B) CONDITIONS.—With respect to an enti15 ty that proposes to provide early intervention

16 services under subparagraph (A), such subpara17 graph applies only if the entity demonstrates to

18 the satisfaction of the chief elected official for the

19 eligible area involved that—

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

21 otherwise inadequate for the early interven22 tion services the entity proposes to provide;

23 and

24 ‘‘(ii) the entity will expend funds pur25 suant to such subparagraph to supplement
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1 and not supplant other funds available to

2 the entity for the provision of early inter3 vention services for the fiscal year in4 volved.’’.

5 (c) PRIORITY FOR WOMEN, INFANTS, AND CHIL6 DREN.—Section 2604(b) (42 U.S.C. 300ff–14(b)) of the

7 Public Health Service Act is amended in paragraph (4) (as

8 redesignated by subsection (b)(1) of this section) by amend9 ing the paragraph to read as follows:

10 ‘‘(4) PRIORITY FOR WOMEN, INFANTS AND CHIL11 DREN.—

12 ‘‘(A) IN GENERAL.—For the purpose of pro13 viding health and support services to infants,

14 children, youth, and women with HIV disease,

15 including treatment measures to prevent the

16 perinatal transmission of HIV, the chief elected

17 official of an eligible area, in accordance with

18 the established priorities of the planning council,

19 shall for each of such populations in the eligible

20 area use, from the grants made for the area

21 under section 2601(a) for a fiscal year, not less

22 than the percentage constituted by the ratio of

23 the population involved (infants, children, youth,

24 or women in such area) with acquired immune
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1 deficiency syndrome to the general population in

2 such area of individuals with such syndrome.

3 ‘‘(B) WAIVER.—With respect the population

4 involved, the Secretary may provide to the chief

5 elected official of an eligible area a waiver of the

6 requirement of subparagraph (A) if such official

7 demonstrates to the satisfaction of the Secretary

8 that the population is receiving HIV-related

9 health services through the State medicaid pro10 gram under title XIX of the Social Security Act,

11 the State children’s health insurance program

12 under title XXI of such Act, or other Federal or

13 State programs.’’.

14 (d) QUALITY MANAGEMENT.—Section 2604 of the Pub15 lic Health Service Act (42 U.S.C. 300ff–14) is amended—

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

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

18 (2) by inserting after subsection (b) the fol19 lowing:

20 ‘‘(c) QUALITY MANAGEMENT.—

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

22 an eligible area that receives a grant under this part

23 shall provide for the establishment of a quality man24 agement program to assess the extent to which HIV

25 health services provided to patients under the grant
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1 are consistent with the most recent Public Health

2 Service guidelines for the treatment of HIV disease

3 and related opportunistic infection, and as applica4 ble, to develop strategies for ensuring that such serv5 ices are consistent with the guidelines for improve6 ment in the access to and quality of HIV health serv7 ices.

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

9 under a grant awarded under this part for a fiscal

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

11 (in addition to amounts to which subsection (f)(1) ap12 plies) use for activities associated with the quality

13 management program required in paragraph (1) not

14 more than the lesser of—

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

16 the grant; or

17 ‘‘(B) $3,000,000.’’.

18 SEC. 122. APPLICATION.

19 (a) IN GENERAL.—Section 2605(a) of the Public

20 Health Service Act (42 U.S.C. 300ff–15(a)) is amended—

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

22 as paragraphs (5) through (8), respectively; and

23 (2) by inserting after paragraph (2) the fol24 lowing paragraphs:
27

•S 2311 EAH

1 ‘‘(3) that entities within the eligible area that re2 ceive funds under a grant under this part will main3 tain appropriate relationships with entities in the eli4 gible area served that constitute key points of access

5 to the health care system for individuals with HIV

6 disease (including emergency rooms, substance abuse

7 treatment programs, detoxification centers, adult and

8 juvenile detention facilities, sexually transmitted dis9 ease clinics, HIV counseling and testing sites, mental

10 health programs, and homeless shelters), and other en11 tities under section 2604(b)(3) and 2652(a), for the

12 purpose of facilitating early intervention for individ13 uals newly diagnosed with HIV disease and individ14 uals knowledgeable of their HIV status but not in

15 care;

16 ‘‘(4) that the chief elected official of the eligible

17 area will satisfy all requirements under section

18 2604(c);’’.

19 (b) CONFORMING AMENDMENTS.—Section 2605(a) (42

20 U.S.C. 300ff–15(a)(1)) is amended—

21 (1) in paragraph (1)—

22 (A) in subparagraph (A), by striking ‘‘serv23 ices to individuals with HIV disease’’ and insert24 ing ‘‘services as described in section 2604(b)(1)’’;

25 and
28

•S 2311 EAH

1 (B) in subparagraph (B), by striking ‘‘serv2 ices for individuals with HIV disease’’ and in3 serting ‘‘services as described in section

4 2604(b)(1)’’;

5 (2) in paragraph (7) (as redesignated by sub6 section (a)(1) of this section), by striking ‘‘and’’ at

7 the end;

8 (3) in paragraph (8) (as so redesignated), by

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

10 (4) by adding at the end the following para11 graph:

12 ‘‘(9) that the eligible area has procedures in

13 place to ensure that services provided with funds re14 ceived under this part meet the criteria specified in

15 section 2604(b)(1).’’.

16 TITLE II—CARE GRANT

17 PROGRAM

18 Subtitle A—General Grant

19 Provisions

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

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

22 U.S.C. 300ff–21(b)) is amended to read as follows:

23 ‘‘(b) PRIORITY FOR WOMEN, INFANTS AND CHIL24 DREN.—
29

•S 2311 EAH

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

2 health and support services to infants, children,

3 youth, and women with HIV disease, including treat4 ment measures to prevent the perinatal transmission

5 of HIV, a State shall for each of such populations use,

6 of the funds allocated under this part to the State for

7 a fiscal year, not less than the percentage constituted

8 by the ratio of the population involved (infants, chil9 dren, youth, or women in the State) with acquired

10 immune deficiency syndrome to the general popu11 lation in the State of individuals with such syn12 drome.

13 ‘‘(2) WAIVER.—With respect the population in14 volved, the Secretary may provide to a State a waiver

15 of the requirement of paragraph (1) if the State dem16 onstrates to the satisfaction of the Secretary that the

17 population is receiving HIV-related health services

18 through the State medicaid program under title XIX

19 of the Social Security Act, the State children’s health

20 insurance program under title XXI of such Act, or

21 other Federal or State programs.’’.

22 SEC. 202. USE OF GRANTS.

23 Section 2612 of the Public Health Service Act (42

24 U.S.C. 300ff–22) is amended—
30

•S 2311 EAH

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

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

3 (2) by adding at the end the following sub4 sections:

5 ‘‘(b) SUPPORT SERVICES; OUTREACH.—The purposes

6 for which a grant under this part may be used include de7 livering or enhancing the following:

8 ‘‘(1) Outpatient and ambulatory support services

9 under section 2611(a) (including case management)

10 to the extent that such services facilitate, enhance,

11 support, or sustain the delivery, continuity, or bene12 fits of health services for individuals and families

13 with HIV disease.

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

15 identify individuals with HIV disease who know their

16 HIV status and are not receiving HIV-related serv17 ices, and that are—

18 ‘‘(A) necessary to implement the strategy

19 under section 2617(b)(4)(B), including activities

20 facilitating the access of such individuals to

21 HIV-related primary care services at entities de22 scribed in subsection (c)(1);

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

24 the requirement under section 2617(b)(6)(G) and

25 2651(b)(2); and
31

•S 2311 EAH

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

2 activities that are carried out with amounts ap3 propriated under section 317.

4 ‘‘(c) EARLY INTERVENTION SERVICES.—

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

6 grant under this part may be used include providing

7 to individuals with HIV disease early intervention

8 services described in section 2651(b)(2), with follow9 up referral provided for the purpose of facilitating the

10 access of individuals receiving the services to HIV-re11 lated health services. The entities through which such

12 services may be provided under the grant include

13 public health departments, emergency rooms, sub14 stance abuse and mental health treatment programs,

15 detoxification centers, detention facilities, clinics re16 garding sexually transmitted diseases, homeless shel17 ters, HIV disease counseling and testing sites, health

18 care points of entry specified by States or eligible

19 areas, federally qualified health centers, and entities

20 described in section 2652(a) that constitute a point of

21 access to services by maintaining referral relation22 ships.

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

24 that proposes to provide early intervention services

25 under paragraph (1), such paragraph applies only if
32

•S 2311 EAH

1 the entity demonstrates to the satisfaction of the State

2 involved that—

3 ‘‘(A) Federal, State, or local funds are oth4 erwise inadequate for the early intervention serv5 ices the entity proposes to provide; and

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

7 to such paragraph to supplement and not sup8 plant other funds available to the entity for the

9 provision of early intervention services for the

10 fiscal year involved.

11 ‘‘(d) QUALITY MANAGEMENT.—

12 ‘‘(1) REQUIREMENT.—Each State that receives a

13 grant under this part shall provide for the establish14 ment of a quality management program to assess the

15 extent to which HIV health services provided to pa16 tients under the grant are consistent with the most re17 cent Public Health Service guidelines for the treat18 ment of HIV disease and related opportunistic infec19 tion, and as applicable, to develop strategies for en20 suring that such services are consistent with the

21 guidelines for improvement in the access to and qual22 ity of HIV health services.

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

24 under a grant awarded under this part for a fiscal

25 year, the State may (in addition to amounts to which
33

•S 2311 EAH

1 section 2618(b)(5) applies) use for activities associ2 ated with the quality management program required

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

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

5 the grant; or

6 ‘‘(B) $3,000,000.’’.

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

8 Section 2613 of the Public Health Service Act (42

9 U.S.C. 300ff–23) is amended—

10 (1) in subsection (b)(1)—

11 (A) in subparagraph (A), by inserting be12 fore the semicolon the following: ‘‘, particularly

13 those experiencing disparities in access and serv14 ices and those who reside in historically under15 served communities’’; and

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

17 ‘‘by such consortium’’ the following: ‘‘is con18 sistent with the comprehensive plan under

19 2617(b)(4) and’’;

20 (2) in subsection (c)(1)—

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

22 after the semicolon at the end;

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

24 period and inserting ‘‘; and’’; and
34

•S 2311 EAH

1 (C) by adding at the end the following sub2 paragraph:

3 ‘‘(F) demonstrates that adequate planning

4 occurred to address disparities in access and

5 services and historically underserved commu6 nities.’’; and

7 (3) in subsection (c)(2)—

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

9 after the semicolon;

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

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

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

13 following subparagraph:

14 ‘‘(D) the types of entities described in sec15 tion 2602(b)(2).’’.

16 SEC. 204. PROVISION OF TREATMENTS.

17 (a) IN GENERAL.—Section 2616(c) of the Public

18 Health Service Act (42 U.S.C. 300ff–26(c)) is amended—

19 (1) in paragraph (4), by striking ‘‘and’’ after the

20 semicolon at the end;

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

22 inserting ‘‘; and’’; and

23 (3) by inserting after paragraph (5) the fol24 lowing:
35

•S 2311 EAH

1 ‘‘(6) encourage, support, and enhance adherence

2 to and compliance with treatment regimens, includ3 ing related medical monitoring.

4 ‘‘Of the amount reserved by a State for a fiscal year for

5 use under this section, the State may not use more than

6 5 percent to carry out services under paragraph (6), except

7 that the percentage applicable with respect to such para8 graph is 10 percent if the State demonstrates to the Sec9 retary that such additional services are essential and in no

10 way diminish access to the therapeutics described in sub11 section (a).’’.

12 (b) HEALTH INSURANCE AND PLANS.—Section 2616

13 of the Public Health Service Act (42 U.S.C. 300ff–26) is

14 amended by adding at the end the following subsection:

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

16 ‘‘(1) IN GENERAL.—In carrying out subsection

17 (a), a State may expend a grant under this part to

18 provide the therapeutics described in such subsection

19 by paying on behalf of individuals with HIV disease

20 the costs of purchasing or maintaining health insur21 ance or plans whose coverage includes a full range of

22 such therapeutics and appropriate primary care serv23 ices.

24 ‘‘(2) LIMITATION.—The authority established in

25 paragraph (1) applies only to the extent that, for the
36

•S 2311 EAH

1 fiscal year involved, the costs of the health insurance

2 or plans to be purchased or maintained under such

3 paragraph do not exceed the costs of otherwise pro4 viding therapeutics described in subsection (a).’’.

5 SEC. 205. STATE APPLICATION.

6 (a) DETERMINATION OF SIZE AND NEEDS OF POPU7 LATION; COMPREHENSIVE PLAN.—Section 2617(b) of the

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

9 amended—

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

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

12 (2) by inserting after paragraph (1) the fol13 lowing paragraphs:

14 ‘‘(2) a determination of the size and demo15 graphics of the population of individuals with HIV

16 disease in the State;

17 ‘‘(3) a determination of the needs of such popu18 lation, with particular attention to—

19 ‘‘(A) individuals with HIV disease who

20 know their HIV status and are not receiving

21 HIV-related services; and

22 ‘‘(B) disparities in access and services

23 among affected subpopulations and historically

24 underserved communities;’’; and

25 (3) in paragraph (4) (as so redesignated)—
37

•S 2311 EAH

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

2 organization’’ and inserting ‘‘comprehensive

3 plan that describes the organization’’;

4 (B) by striking ‘‘, including—’’ and insert5 ing ‘‘, and that—’’;

6 (C) by redesignating subparagraphs (A)

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

8 respectively;

9 (D) by inserting before subparagraph (C)

10 the following subparagraphs:

11 ‘‘(A) establishes priorities for the allocation

12 of funds within the State based on—

13 ‘‘(i) size and demographics of the pop14 ulation of individuals with HIV disease (as

15 determined under paragraph (2)) and the

16 needs of such population (as determined

17 under paragraph (3));

18 ‘‘(ii) availability of other governmental

19 and non-governmental resources, including

20 the State medicaid plan under title XIX of

21 the Social Security Act and the State Chil22 dren’s Health Insurance Program under

23 title XXI of such Act to cover health care

24 costs of eligible individuals and families

25 with HIV disease;
38

•S 2311 EAH

1 ‘‘(iii) capacity development needs re2 sulting from disparities in the availability

3 of HIV-related services in historically un4 derserved communities and rural commu5 nities; and

6 ‘‘(iv) the efficiency of the administra7 tive mechanism of the State for rapidly al8 locating funds to the areas of greatest need

9 within the State;

10 ‘‘(B) includes a strategy for identifying in11 dividuals who know their HIV status and are

12 not receiving such services and for informing the

13 individuals of and enabling the individuals to

14 utilize the services, giving particular attention to

15 eliminating disparities in access and services

16 among affected subpopulations and historically

17 underserved communities, and including discrete

18 goals, a timetable, and an appropriate allocation

19 of funds;

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

21 provision of such services with programs for HIV

22 prevention (including outreach and early inter23 vention) and for the prevention and treatment of

24 substance abuse (including programs that pro-
39

•S 2311 EAH

1 vide comprehensive treatment services for such

2 abuse);’’;

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

4 by subparagraph (C) of this paragraph), by in5 serting ‘‘describes’’ before ‘‘the services and ac6 tivities’’;

7 (F) in subparagraph (E) (as so redesig8 nated), by inserting ‘‘provides’’ before ‘‘a de9 scription’’; and

10 (G) in subparagraph (F) (as so redesig11 nated), by inserting ‘‘provides’’ before ‘‘a de12 scription’’.

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

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

15 of this section, is amended—

16 (1) in paragraph (5), by striking ‘‘HIV’’ and in17 serting ‘‘HIV disease’’; and

18 (2) in paragraph (6), by amending subpara19 graph (A) to read as follows:

20 ‘‘(A) the public health agency that is ad21 ministering the grant for the State engages in a

22 public advisory planning process, including pub23 lic hearings, that includes the participants under

24 paragraph (5), and the types of entities described

25 in section 2602(b)(2), in developing the com-
40

•S 2311 EAH

1 prehensive plan under paragraph (4) and com2 menting on the implementation of such plan;’’.

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

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

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

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

7 the end;

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

9 and inserting ‘‘; and’’; and

10 (3) by adding at the end the following subpara11 graph:

12 ‘‘(G) entities within areas in which activi13 ties under the grant are carried out will main14 tain appropriate relationships with entities in

15 the area served that constitute key points of ac16 cess to the health care system for individuals

17 with HIV disease (including emergency rooms,

18 substance abuse treatment programs, detoxifica19 tion centers, adult and juvenile detention facili20 ties, sexually transmitted disease clinics, HIV

21 counseling and testing sites, mental health pro22 grams, and homeless shelters), and other entities

23 under section 2612(c) and 2652(a), for the pur24 pose of facilitating early intervention for indi25 viduals newly diagnosed with HIV disease and
41

•S 2311 EAH

1 individuals knowledgeable of their HIV status

2 but not in care.’’.

3 SEC. 206. DISTRIBUTION OF FUNDS.

4 (a) MINIMUM ALLOTMENT.—Section 2618 of the Pub5 lic Health Service Act (42 U.S.C. 300ff–28) is amended—

6 (1) by redesignating subsections (b) through (e)

7 as subsections (a) through (d), respectively; and

8 (2) in subsection (a) (as so redesignated), in

9 paragraph (1)(A)(i)—

10 (A) in subclause (I), by striking ‘‘$100,000’’

11 and inserting ‘‘$200,000’’; and

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

13 ‘‘$250,000’’ and inserting ‘‘$500,000’’.

14 (b) AMOUNT OF GRANT; ESTIMATE OF LIVING

15 CASES.—Section 2618(a) of the Public Health Service Act

16 (as redesignated by subsection (a)(1) of this section) is

17 amended in paragraph (2)—

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

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

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

21 paragraph or section 2620 for fiscal year 2005 and

22 subsequent fiscal years, the cases counted for each 12-

23 month period beginning on or after July 1, 2004,

24 shall be cases of HIV disease (as reported to and con-
42

•S 2311 EAH

1 firmed by such Director) rather than cases of acquired

2 immune deficiency syndrome’’;

3 (2) by redesignating subparagraphs (E) through

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

5 and

6 (3) by inserting after subparagraph (D) the fol7 lowing subparagraph:

8 ‘‘(E) DETERMINATION OF SECRETARY RE9 GARDING DATA ON HIV CASES.—If under

10 2603(a)(3)(D)(i) the Secretary determines that

11 data on cases of HIV disease are not sufficiently

12 accurate and reliable, then notwithstanding sub13 paragraph (D) of this paragraph, for any fiscal

14 year prior to fiscal year 2007 the references in

15 such subparagraph to cases of HIV disease do

16 not have any legal effect.’’.

17 (c) INCREASES IN FORMULA AMOUNT.—Section

18 2618(a) of the Public Health Service Act (as redesignated

19 by subsection (a)(1) of this section) is amended—

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

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

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

23 (2) in paragraph (2)—
43

•S 2311 EAH

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

2 ‘‘subparagraph (H)’’ and inserting ‘‘subpara3 graphs (H) and (I)’’; and

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

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

6 the subparagraph to read as follows:

7 ‘‘(H) LIMITATION.—

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

9 ensure that the amount of a grant awarded

10 to a State or territory under section 2611 or

11 subparagraph (I)(i) for a fiscal year is not

12 less than—

13 ‘‘(I) with respect to fiscal year

14 2001, 99 percent;

15 ‘‘(II) with respect to fiscal year

16 2002, 98 percent;

17 ‘‘(III) with respect to fiscal year

18 2003, 97 percent;

19 ‘‘(IV) with respect to fiscal year

20 2004, 96 percent; and

21 ‘‘(V) with respect to fiscal year

22 2005, 95 percent,

23 of the amount such State or territory re24 ceived for fiscal year 2000 under section

25 2611 or subparagraph (I)(i), respectively
44

•S 2311 EAH

1 (notwithstanding such subparagraph). In

2 administering this subparagraph, the Sec3 retary shall, with respect to States or terri4 tories that will under such section receive

5 grants in amounts that exceed the amounts

6 that such States received under such section

7 or subparagraph for fiscal year 2000, pro8 portionally reduce such amounts to ensure

9 compliance with this subparagraph. In

10 making such reductions, the Secretary shall

11 ensure that no such State receives less than

12 that State received for fiscal year 2000.

13 ‘‘(ii) RATABLE REDUCTION.—If the

14 amount appropriated under section 2677

15 for a fiscal year and available for grants

16 under section 2611 or subparagraph (I)(i)

17 is less than the amount appropriated and

18 available for fiscal year 2000 under section

19 2611 or subparagraph (I)(i), respectively,

20 the limitation contained in clause (i) for the

21 grants involved shall be reduced by a per22 centage equal to the percentage of the reduc23 tion in such amounts appropriated and

24 available.’’.
45

•S 2311 EAH

1 (d) TERRITORIES.—Section 2618(a) of the Public

2 Health Service Act (as redesignated by subsection (a)(1) of

3 this section) is amended in paragraph (1)(B) by inserting

4 ‘‘the greater of $50,000 or’’ after ‘‘shall be’’.

5 (e) SEPARATE TREATMENT DRUG GRANTS.—Section

6 2618(a) of the Public Health Service Act (as redesignated

7 by subsection (a)(1) of this section and amended by sub8 section (b)(2) of this section) is amended in paragraph

9 (2)(I)—

10 (1) by redesignating clauses (i) and (ii) as sub11 clauses (I) and (II), respectively;

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

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

14 the following:

15 ‘‘(I) APPROPRIATIONS FOR TREATMENT

16 DRUG PROGRAM.—

17 ‘‘(i) FORMULA GRANTS.—With respect

18 to’’;

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

20 by paragraphs (1) and (2)), by inserting before the

21 semicolon the following: ‘‘, less the percentage reserved

22 under clause (ii)(V)’’; and

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

24 ‘‘(ii) SUPPLEMENTAL TREATMENT

25 DRUG GRANTS.—
46

•S 2311 EAH

1 ‘‘(I) IN GENERAL.—From

2 amounts made available under sub3 clause (V), the Secretary shall make

4 supplemental grants to States described

5 in subclause (II) to enable such States

6 to increase access to therapeutics de7 scribed in section 2616(a), as provided

8 by the State under section 2616(c)(2).

9 ‘‘(II) ELIGIBLE STATES.—For

10 purposes of subclause (I), a State de11 scribed in this subclause is a State

12 that, in accordance with criteria estab13 lished by the Secretary, demonstrates a

14 severe need for a grant under such sub15 clause. In developing such criteria, the

16 Secretary shall consider eligibility

17 standards, formulary composition, and

18 the number of eligible individuals at or

19 below 200 percent of the official pov20 erty line to whom the State is unable

21 to provide therapeutics described in

22 section 2616(a).

23 ‘‘(III) STATE REQUIREMENTS.—

24 The Secretary may not make a grant
47

•S 2311 EAH

1 to a State under this clause unless the

2 State agrees that—

3 ‘‘(aa) the State will make

4 available (directly or through do5 nations from public or private en6 tities) non-Federal contributions

7 toward the activities to carried

8 out under the grant in an amount

9 equal to $1 for each $4 of Federal

10 funds provided in the grant; and

11 ‘‘(bb) the State will not im12 pose eligibility requirements for

13 services or scope of benefits limita14 tions under section 2616(a) that

15 are more restrictive than such re16 quirements in effect as of January

17 1, 2000.

18 ‘‘(IV) USE AND COORDINA19 TION.—Amounts made available

20 under a grant under this clause

21 shall only be used by the State to

22 provide HIV/AIDS-related medi23 cations. The State shall coordinate

24 the use of such amounts with the

25 amounts otherwise provided under
48

•S 2311 EAH

1 section 2616(a) in order to maxi2 mize drug coverage.

3 ‘‘(V) FUNDING.—For the purpose

4 of making grants under this clause, the

5 Secretary shall each fiscal year reserve

6 3 percent of the amount referred to in

7 clause (i) with respect to section 2616,

8 subject to subclause (VI).

9 ‘‘(VI) LIMITATION.—In reserving

10 amounts under subclause (V) and mak11 ing grants under this clause for a fis12 cal year, the Secretary shall ensure for

13 each State that the total of the grant

14 under section 2611 for the State for the

15 fiscal year and the grant under clause

16 (i) for the State for the fiscal year is

17 not less than such total for the State

18 for the preceding fiscal year.’’.

19 (f) TECHNICAL AMENDMENT.—Section 2618(a) of the

20 Public Health Service Act (as redesignated by subsection

21 (a)(1) of this section) is amended in paragraph (3)(B) by

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

23 inserting ‘‘the Republic of the Marshall Islands, the Fed24 erated States of Micronesia, and the Republic of Palau, and
49

•S 2311 EAH

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

2 Puerto Rico’’.

3 SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

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

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

6 (1) by striking section 2621; and

7 (2) by inserting after section 2619 the following

8 section:

9 ‘‘SEC. 2620. SUPPLEMENTAL GRANTS.

10 ‘‘(a) IN GENERAL.—The Secretary shall award supple11 mental grants to States determined to be eligible under sub12 section (b) to enable such States to provide comprehensive

13 services of the type described in section 2612(a) to supple14 ment the services otherwise provided by the State under a

15 grant under this subpart in emerging communities within

16 the State that are not eligible to receive grants under part

17 A.

18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a supple19 mental grant under subsection (a), a State shall—

20 ‘‘(1) be eligible to receive a grant under this sub21 part;

22 ‘‘(2) demonstrate the existence in the State of an

23 emerging community as defined in subsection (d)(1);

24 and
50

•S 2311 EAH

1 ‘‘(3) submit the information described in sub2 section (c).

3 ‘‘(c) REPORTING REQUIREMENTS.—A State that de4 sires a grant under this section shall, as part of the State

5 application submitted under section 2617, submit a detailed

6 description of the manner in which the State will use

7 amounts received under the grant and of the severity of

8 need. Such description shall include—

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

10 supplemental funds under this section and the plan

11 for the utilization of such funds in the emerging com12 munity;

13 ‘‘(2) a demonstration of the existing commitment

14 of local resources, both financial and in-kind;

15 ‘‘(3) a demonstration that the State will main16 tain HIV-related activities at a level that is equal to

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

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

19 which the State is applying to receive a grant under

20 this part;

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

22 to utilize such supplemental financial resources in a

23 manner that is immediately responsive and cost effec24 tive;
51

•S 2311 EAH

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

2 allocated in accordance with the local demographic

3 incidence of AIDS including appropriate allocations

4 for services for infants, children, women, and families

5 with HIV disease;

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

7 planning process, with particular emphasis on af8 fected communities and individuals with HIV disease;

9 and

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

11 proposed services are consistent with local needs as12 sessments and the statewide coordinated statement of

13 need.

14 ‘‘(d) DEFINITION OF EMERGING COMMUNITY.—In this

15 section, the term ‘emerging community’ means a metropoli16 tan area—

17 ‘‘(1) that is not eligible for a grant under part

18 A; and

19 ‘‘(2) for which there has been reported to the Di20 rector of the Centers for Disease Control and Preven21 tion a cumulative total of between 500 and 1999 cases

22 of acquired immune deficiency syndrome for the most

23 recent period of 5 calendar years for which such data

24 are available (except that, for fiscal year 2005 and

25 subsequent fiscal years, cases of HIV disease shall be
52

•S 2311 EAH

1 counted rather than cases of acquired immune defi2 ciency syndrome if cases of HIV disease are being

3 counted for purposes of section 2618(a)(2)(D)(i)).

4 ‘‘(e) FUNDING.—

5 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

6 with respect to each fiscal year beginning with fiscal

7 year 2001, the Secretary, to carry out this section,

8 shall utilize—

9 ‘‘(A) the greater of—

10 ‘‘(i) 25 percent of the amount appro11 priated under 2677 to carry out part B, ex12 cluding the amount appropriated under sec13 tion 2618(a)(2)(I), for such fiscal year that

14 is in excess of the amount appropriated to

15 carry out such part in fiscal year preceding

16 the fiscal year involved; or

17 ‘‘(ii) $5,000,000,

18 to provide funds to States for use in emerging

19 communities with at least 1000, but less than

20 2000, cases of AIDS as reported to and con21 firmed by the Director of the Centers for Disease

22 Control and Prevention for the five year period

23 preceding the year for which the grant is being

24 awarded; and

25 ‘‘(B) the greater of—
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•S 2311 EAH

1 ‘‘(i) 25 percent of the amount appro2 priated under 2677 to carry out part B, ex3 cluding the amount appropriated under sec4 tion 2618(a)(2)(I), for such fiscal year that

5 is in excess of the amount appropriated to

6 carry out such part in fiscal year preceding

7 the fiscal year involved; or

8 ‘‘(ii) $5,000,000,

9 to provide funds to States for use in emerging

10 communities with at least 500, but less than

11 1000, cases of AIDS reported to and confirmed

12 by the Director of the Centers for Disease Control

13 and Prevention for the five year period preceding

14 the year for which the grant is being awarded.

15 ‘‘(2) TRIGGER OF FUNDING.—This section shall

16 be effective only for fiscal years beginning in the first

17 fiscal year in which the amount appropriated under

18 2677 to carry out part B, excluding the amount ap19 propriated under section 2618(a)(2)(I), exceeds by at

20 least $20,000,000 the amount appropriated under

21 2677 to carry out part B in fiscal year 2000, exclud22 ing the amount appropriated under section

23 2618(a)(2)(I).

24 ‘‘(3) MINIMUM AMOUNT IN FUTURE YEARS.—Be25 ginning with the first fiscal year in which amounts
54

•S 2311 EAH

1 provided for emerging communities under paragraph

2 (1)(A) equals $5,000,000 and under paragraph (1)(B)

3 equals $5,000,000, the Secretary shall ensure that

4 amounts made available under this section for the

5 types of emerging communities described in each such

6 paragraph in subsequent fiscal years is at least

7 $5,000,000.

8 ‘‘(4) DISTRIBUTION.—Grants under this section

9 for emerging communities shall be formula grants.

10 There shall be two categories of such formula grants,

11 as follows:

12 ‘‘(A) One category of such grants shall be

13 for emerging communities for which the cumu14 lative total of cases for purposes of subsection

15 (d)(2) is 999 or fewer cases. The grant made to

16 such an emerging community for a fiscal year

17 shall be the product of—

18 ‘‘(i) an amount equal to 50 percent of

19 the amount available pursuant to this sub20 section for the fiscal year involved; and

21 ‘‘(ii) a percentage equal to the ratio

22 constituted by the number of cases for such

23 emerging community for the fiscal year over

24 the aggregate number of such cases for such
55

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1 year for all emerging communities to which

2 this subparagraph applies.

3 ‘‘(B) The other category of formula grants

4 shall be for emerging communities for which the

5 cumulative total of cases for purposes of sub6 section (d)(2) is 1000 or more cases. The grant

7 made to such an emerging community for a fis8 cal year shall be the product of—

9 ‘‘(i) an amount equal to 50 percent of

10 the amount available pursuant to this sub11 section for the fiscal year involved; and

12 ‘‘(ii) a percentage equal to the ratio

13 constituted by the number of cases for such

14 community for the fiscal year over the ag15 gregate number of such cases for the fiscal

16 year for all emerging communities to which

17 this subparagraph applies.’’.

18 Subtitle B—Provisions Concerning

19 Pregnancy and Perinatal Trans20 mission of HIV

21 SEC. 211. REPEALS.

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

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

24 (1) in section 2626, by striking each of sub25 sections (d) through (f);
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•S 2311 EAH

1 (2) by striking sections 2627 and 2628; and

2 (3) by redesignating section 2629 as section

3 2627.

4 SEC. 212. GRANTS.

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

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

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

8 following subparagraph:

9 ‘‘(F) Making available to pregnant women

10 with HIV disease, and to the infants of women

11 with such disease, treatment services for such

12 disease in accordance with applicable rec13 ommendations of the Secretary.’’;

14 (2) by amending paragraph (2) to read as fol15 lows:

16 ‘‘(2) FUNDING.—

17 ‘‘(A) AUTHORIZATION OF APPROPRIA18 TIONS.—For the purpose of carrying out this

19 subsection, there are authorized to be appro20 priated $30,000,000 for each of the fiscal years

21 2001 through 2005. Amounts made available

22 under section 2677 for carrying out this part are

23 not available for carrying out this section unless

24 otherwise authorized.

25 ‘‘(B) ALLOCATIONS FOR CERTAIN STATES.—
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•S 2311 EAH

1 ‘‘(i) IN GENERAL.—Of the amounts ap2 propriated under subparagraph (A) for a

3 fiscal year in excess of $10,000,000—

4 ‘‘(I) the Secretary shall reserve the

5 applicable percentage under clause (iv)

6 for making grants under paragraph

7 (1) both to States described in clause

8 (ii) and States described in clause

9 (iii); and

10 ‘‘(II) the Secretary shall reserve

11 the remaining amounts for other

12 States, taking into consideration the

13 factors described in subparagraph

14 (C)(iii), except that this subclause does

15 not apply to any State that for the fis16 cal year involved is receiving amounts

17 pursuant to subclause (I).

18 ‘‘(ii) REQUIRED TESTING OF

19 NEWBORNS.—For purposes of clause (i)(I),

20 the States described in this clause are States

21 that under law (including under regulations

22 or the discretion of State officials) have—

23 ‘‘(I) a requirement that all new24 born infants born in the State be tested

25 for HIV disease and that the biological
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•S 2311 EAH

1 mother of each such infant, and the

2 legal guardian of the infant (if other

3 than the biological mother), be in4 formed of the results of the testing; or

5 ‘‘(II) a requirement that newborn

6 infants born in the State be tested for

7 HIV disease in circumstances in which

8 the attending obstetrician for the birth

9 does not know the HIV status of the

10 mother of the infant, and that the bio11 logical mother of each such infant, and

12 the legal guardian of the infant (if

13 other than the biological mother), be

14 informed of the results of the testing.

15 ‘‘(iii) MOST SIGNIFICANT REDUCTION

16 IN CASES OF PERINATAL TRANSMISSION.—

17 For purposes of clause (i)(I), the States de18 scribed in this clause are the following (ex19 clusive of States described in clause (ii)), as

20 applicable:

21 ‘‘(I) For fiscal years 2001 and

22 2002, the two States that, relative to

23 other States, have the most significant

24 reduction in the rate of new cases of

25 the perinatal transmission of HIV (as
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1 indicated by the number of such cases

2 reported to the Director of the Centers

3 for Disease Control and Prevention for

4 the most recent periods for which the

5 data are available).

6 ‘‘(II) For fiscal years 2003 and

7 2004, the three States that have the

8 most significant such reduction.

9 ‘‘(III) For fiscal year 2005, the

10 four States that have the most signifi11 cant such reduction.

12 ‘‘(iv) APPLICABLE PERCENTAGE.—For

13 purposes of clause (i), the applicable

14 amount for a fiscal year is as follows:

15 ‘‘(I) For fiscal year 2001, 33 per16 cent.

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

19 ‘‘(III) For fiscal year 2003, 67

20 percent.

21 ‘‘(IV) For fiscal year 2004, 75

22 percent.

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

2 grants under paragraph (1) that are made with

3 amounts reserved under subparagraph (B) of this

4 paragraph:

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

6 an amount exceeding $4,000,000.

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

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

12 the requirement under such subparagraph

13 to reserve amounts ceases to apply.

14 ‘‘(iii) In the case of a State that meets

15 the conditions to receive amounts reserved

16 under subparagraph (B)(i)(II), the Sec17 retary shall in making grants consider the

18 following factors:

19 ‘‘(I) The extent of the reduction in

20 the rate of new cases of the perinatal

21 transmission of HIV.

22 ‘‘(II) The extent of the reduction

23 in the rate of new cases of perinatal

24 cases of acquired immune deficiency

25 syndrome.
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•S 2311 EAH

1 ‘‘(III) The overall incidence of

2 cases of infection with HIV among

3 women of childbearing age.

4 ‘‘(IV) The overall incidence of

5 cases of acquired immune deficiency

6 syndrome among women of child7 bearing age.

8 ‘‘(V) The higher acceptance rate of

9 HIV testing of pregnant women.

10 ‘‘(VI) The extent to which women

11 and children with HIV disease are re12 ceiving HIV-related health services.

13 ‘‘(VII) The extent to which HIV14 exposed children are receiving health

15 services appropriate to such exposure.’’;

16 and

17 (3) by adding at the end the following para18 graph:

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

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

21 State involved agree that the grant will be used to

22 supplement and not supplant other funds available to

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

24 (b) SPECIAL FUNDING RULE FOR FISCAL YEAR

25 2001.—
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1 (1) IN GENERAL.—If for fiscal year 2001 the

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

4 than $14,000,000—

5 (A) the Secretary of Health and Human

6 Services shall, for the purpose of making grants

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

8 the amount specified in paragraph (2) of this

9 subsection an amount equal to the difference be10 tween $14,000,000 and the amount appropriated

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

12 fiscal year (notwithstanding any other provision

13 of this Act or the amendments made by this Act);

14 (B) the amount so reserved shall, for pur15 poses of paragraph (2)(B)(i) of such section, be

16 considered to have been appropriated under

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

18 (C) the percentage specified in paragraph

19 (2)(B)(iv)(I) of such section is deemed to be 50

20 percent.

21 (2) ALLOCATION FROM INCREASES IN FUNDING

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

23 amount specified in this paragraph is the amount by

24 which the amount appropriated under section 2677 of

25 the Public Health Service Act for fiscal year 2001
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•S 2311 EAH

1 and available for grants under section 2611 of such

2 Act is an increase over the amount so appropriated

3 and available for fiscal year 2000.

4 SEC. 213. STUDY BY INSTITUTE OF MEDICINE.

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

6 Service Act, as amended by section 211(3), is amended by

7 adding at the end the following section:

8 ‘‘SEC. 2628. RECOMMENDATIONS FOR REDUCING INCI9 DENCE OF PERINATAL TRANSMISSION.

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

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

12 the Institute of Medicine to enter into an agreement

13 with the Secretary under which such Institute con14 ducts a study to provide the following:

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

16 which the information is available, a determina17 tion of the number of newborn infants with HIV

18 born in the United States with respect to whom

19 the attending obstetrician for the birth did not

20 know the HIV status of the mother.

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

22 barriers, including legal barriers, that prevent or

23 discourage an obstetrician from making it a rou24 tine practice to offer pregnant women an HIV

25 test and a routine practice to test newborn in-
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1 fants for HIV disease in circumstances in which

2 the obstetrician does not know the HIV status of

3 the mother of the infant.

4 ‘‘(C) Recommendations for each State for

5 reducing the incidence of cases of the perinatal

6 transmission of HIV, including recommendations

7 on removing the barriers identified under sub8 paragraph (B).

9 If such Institute declines to conduct the study, the

10 Secretary shall enter into an agreement with another

11 appropriate public or nonprofit private entity to con12 duct the study.

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

14 not later than 18 months after the effective date of

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

16 completed and a report describing the findings made

17 in the study is submitted to the appropriate commit18 tees of the Congress, the Secretary, and the chief pub19 lic health official of each of the States.

20 ‘‘(b) PROGRESS TOWARD RECOMMENDATIONS.—In fis21 cal year 2004, the Secretary shall collect information from

22 the States describing the actions taken by the States toward

23 meeting the recommendations specified for the States under

24 subsection (a)(1)(C).
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1 ‘‘(c) SUBMISSION OF REPORTS TO CONGRESS.—The

2 Secretary shall submit to the appropriate committees of the

3 Congress reports describing the information collected under

4 subsection (b).’’.

5 Subtitle C—Certain Partner

6 Notification Programs

7 SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICA8 TION PROGRAMS.

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

10 (42 U.S.C. 300ff–21 et seq.) is amended by adding at the

11 end the following subpart:

12 ‘‘Subpart III—Certain Partner Notification Programs

13 ‘‘SEC. 2631. GRANTS FOR PARTNER NOTIFICATION PRO14 GRAMS.

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

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

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

18 the States for carrying out programs to provide partner

19 counseling and referral services.

20 ‘‘(b) DESCRIPTION OF COMPLIANT STATE PRO21 GRAMS.—For purposes of subsection (a), the laws or regula22 tions of a State are in accordance with this subsection if

23 under such laws or regulations (including programs carried

24 out pursuant to the discretion of State officials) the fol25 lowing policies are in effect:
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•S 2311 EAH

1 ‘‘(1) The State requires that the public health of2 ficer of the State carry out a program of partner no3 tification to inform partners of individuals with HIV

4 disease that the partners may have been exposed to

5 the disease.

6 ‘‘(2)(A) In the case of a health entity that pro7 vides for the performance on an individual of a test

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

9 disease, the State requires, subject to subparagraph

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

11 test results to the State public health officer in a

12 manner recommended and approved by the Director

13 of the Centers for Disease Control and Prevention, to14 gether with such additional information as may be

15 necessary for carrying out such program.

16 ‘‘(B) The State may provide that the require17 ment of subparagraph (A) does not apply to the test18 ing of an individual for HIV disease if the individual

19 underwent the testing through a program designed to

20 perform the test and provide the results to the indi21 vidual without the individual disclosing his or her

22 identity to the program. This subparagraph may not

23 be construed as affecting the requirement of subpara24 graph (A) with respect to a health entity that treats

25 an individual for HIV disease.
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•S 2311 EAH

1 ‘‘(3) The program under paragraph (1) is car2 ried out in accordance with the following:

3 ‘‘(A) Partners are provided with an appro4 priate opportunity to learn that the partners

5 have been exposed to HIV disease, subject to sub6 paragraph (B).

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

8 the identity of the infected individuals involved.

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

10 are made available to the partners and to in11 fected individuals, and such counseling includes

12 information on modes of transmission for the

13 disease, including information on prenatal and

14 perinatal transmission and preventing trans15 mission.

16 ‘‘(D) Counseling of infected individuals and

17 their partners includes the provision of informa18 tion regarding therapeutic measures for pre19 venting and treating the deterioration of the im20 mune system and conditions arising from the

21 disease, and the provision of other prevention-re22 lated information.

23 ‘‘(E) Referrals for appropriate services are

24 provided to partners and infected individuals,
68

•S 2311 EAH

1 including referrals for support services and legal

2 aid.

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

4 are provided in person, unless doing so is an un5 reasonable burden on the State.

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

7 on, or civil liability for, an infected individual

8 if the individual chooses not to identify the part9 ners of the individual, or the individual does not

10 otherwise cooperate with such program.

11 ‘‘(H) The failure of the State to notify part12 ners is not a basis for the civil liability of any

13 health entity who under the program reported to

14 the State the identity of the infected individual

15 involved.

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

17 of the program may not be construed as prohib18 iting the State from providing a notification

19 under subparagraph (A) without the consent of

20 the infected individual involved.

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

22 of the Centers for Disease Control and Prevention the

23 number of individuals from whom the names of part24 ners have been sought under the program under para25 graph (1), the number of such individuals who pro-
69

•S 2311 EAH

1 vided the names of partners, and the number of part2 ners so named who were notified under the program.

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

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

6 public health officers of the States.

7 ‘‘(c) REPORTING SYSTEM FOR CASES OF HIV DIS8 EASE; PREFERENCE IN MAKING GRANTS.—In making

9 grants under subsection (a), the Secretary shall give pref10 erence to States whose reporting systems for cases of HIV

11 disease produce data on such cases that is sufficiently accu12 rate and reliable for use for purposes of section

13 2618(a)(2)(D)(i).

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

15 purpose of carrying out this section, there are authorized

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

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

18 2002 through 2005.’’.
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1 TITLE III—EARLY

2 INTERVENTION SERVICES

3 Subtitle A—Formula Grants for

4 States

5 SEC. 301. REPEAL OF PROGRAM.

6 (a) REPEAL.—Subpart I of part C of title XXVI of

7 the Public Health Service Act (42 U.S.C. 300ff–41 et seq.)

8 is repealed.

9 (b) CONFORMING AMENDMENTS.—Part C of title XXVI

10 of the Public Health Service Act (42 U.S.C. 300ff–41 et

11 seq.), as amended by subsection (a) of this section, is

12 amended—

13 (1) by redesignating subparts II and III as sub14 parts I and II, respectively;

15 (2) in section 2661(a), by striking ‘‘unless—’’

16 and all that follows through ‘‘(2) in the case of’’ and

17 inserting ‘‘unless, in the case of’’; and

18 (3) in section 2664—

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

20 ‘‘2642(b) or’’;

21 (B) in subsection (f)(2), by striking

22 ‘‘2642(b) or’’; and

23 (C) by striking subsection (h).
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•S 2311 EAH

1 Subtitle B—Categorical Grants

2 SEC. 311. PREFERENCES IN MAKING GRANTS.

3 Section 2653 of the Public Health Service Act (42

4 U.S.C. 300ff–53) is amended by adding at the end the fol5 lowing subsection:

6 ‘‘(d) CERTAIN AREAS.—Of the applicants who qualify

7 for preference under this section—

8 ‘‘(1) the Secretary shall give preference to appli9 cants that will expend the grant under section 2651

10 to provide early intervention under such section in

11 rural areas; and

12 ‘‘(2) the Secretary shall give special consider13 ation to areas that are underserved with respect to

14 such services.’’.

15 SEC. 312. PLANNING AND DEVELOPMENT GRANTS.

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

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

18 by striking ‘‘planning grants’’ and all that follows and in19 serting the following: ‘‘planning grants to public and non20 profit private entities for purposes of—

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

22 early intervention services; and

23 ‘‘(B) assisting the entities in expanding

24 their capacity to provide HIV-related health

25 services, including early intervention services, in
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•S 2311 EAH

1 low-income communities and affected subpopula2 tions that are underserved with respect to such

3 services (subject to the condition that a grant

4 pursuant to this subparagraph may not be ex5 pended to purchase or improve land, or to pur6 chase, construct, or permanently improve, other

7 than minor remodeling, any building or other fa8 cility).’’.

9 (b) AMOUNT; DURATION.—Section 2654(c) of the Pub10 lic Health Service Act (42 U.S.C. 300ff–54(c)) is further

11 amended—

12 (1) by redesignating paragraph (4) as para13 graph (5); and

14 (2) by inserting after paragraph (3) the fol15 lowing:

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

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

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

19 an amount not to exceed $50,000.

20 ‘‘(B) CAPACITY DEVELOPMENT.—

21 ‘‘(i) AMOUNT.—A grant under para22 graph (1)(B) may be made in an amount

23 not to exceed $150,000.
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•S 2311 EAH

1 ‘‘(ii) DURATION.—The total duration

2 of a grant under paragraph (1)(B), includ3 ing any renewal, may not exceed 3 years.’’.

4 (c) INCREASE IN LIMITATION.—Section 2654(c)(5) of

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

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

7 ‘‘1 percent’’ and inserting ‘‘5 percent’’.

8 SEC. 313. AUTHORIZATION OF APPROPRIATIONS.

9 Section 2655 of the Public Health Service Act (42

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

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

12 2001 through 2005.’’.

13 Subtitle C—General Provisions

14 SEC. 321. PROVISION OF CERTAIN COUNSELING SERVICES.

15 Section 2662(c)(3) of the Public Health Service Act (42

16 U.S.C. 300ff–62(c)(3)) is amended—

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

18 by striking ‘‘counseling on—’’ and inserting ‘‘coun19 seling—’’;

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

21 by inserting ‘‘on’’ after the subparagraph designation;

22 and

23 (3) in subparagraph (C)—

24 (A) by striking ‘‘(C) the benefits’’ and in25 serting ‘‘(C)(i) that explains the benefits’’; and
74

•S 2311 EAH

1 (B) by inserting after clause (i) (as des2 ignated by subparagraph (A) of this paragraph)

3 the following clause:

4 ‘‘(ii) that emphasizes it is the duty of in5 fected individuals to disclose their infected status

6 to their sexual partners and their partners in the

7 sharing of hypodermic needles; that provides ad8 vice to infected individuals on the manner in

9 which such disclosures can be made; and that

10 emphasizes that it is the continuing duty of the

11 individuals to avoid any behaviors that will ex12 pose others to HIV.’’.

13 SEC. 322. ADDITIONAL REQUIRED AGREEMENTS.

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

15 U.S.C. 300ff–64(g)) is amended—

16 (1) in paragraph (3)—

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

18 ‘‘10 percent’’; and

19 (B) by striking ‘‘and’’ after the semicolon at

20 the end;

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

22 inserting ‘‘; and’’; and

23 (3) by adding at the end the following para24 graph:
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•S 2311 EAH

1 ‘‘(5) the applicant will provide for the establish2 ment of a quality management program—

3 ‘‘(A) to assess the extent to which medical

4 services funded under this title that are provided

5 to patients are consistent with the most recent

6 Public Health Service guidelines for the treat7 ment of HIV disease and related opportunistic

8 infections, and as applicable, to develop strate9 gies for ensuring that such services are consistent

10 with the guidelines; and

11 ‘‘(B) to ensure that improvements in the ac12 cess to and quality of HIV health services are ad13 dressed.’’.

14 TITLE IV—OTHER PROGRAMS

15 AND ACTIVITIES

16 Subtitle A—Certain Programs for

17 Research, Demonstrations, or

18 Training

19 SEC. 401. GRANTS FOR COORDINATED SERVICES AND AC20 CESS TO RESEARCH FOR WOMEN, INFANTS,

21 CHILDREN, AND YOUTH.

22 (a) ELIMINATION OF REQUIREMENT TO ENROLL SIG23 NIFICANT NUMBERS OF WOMEN AND CHILDREN.—Section

24 2671(b) (42 U.S.C. 300ff–71(b)) is amended—
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•S 2311 EAH

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

2 (C) and (D) and inserting the following:

3 ‘‘(C) The applicant will demonstrate link4 ages to research and how access to such research

5 is being offered to patients.’’; and

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

7 (b) INFORMATION AND EDUCATION.—Section 2671(d)

8 (42 U.S.C. 300ff–71(d)) is amended by adding at the end

9 the following:

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

11 information and education on opportunities to par12 ticipate in HIV/AIDS-related clinical research.’’.

13 (c) QUALITY MANAGEMENT; ADMINISTRATIVE EX14 PENSES CEILING.—Section 2671(f) (42 U.S.C. 300ff–71(f))

15 is amended—

16 (1) by striking the subsection heading and des17 ignation and inserting the following:

18 ‘‘(f) ADMINISTRATION.—

19 ‘‘(1) APPLICATION.—’’; and

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

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

22 grantee under this section shall implement a quality

23 management program to assess the extent to which

24 HIV health services provided to patients under the

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

2 disease and related opportunistic infection, and as

3 applicable, to develop strategies for ensuring that such

4 services are consistent with the guidelines for im5 provement in the access to and quality of HIV health

6 services.’’.

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

8 300ff–71(g)) is amended by adding at the end the following:

9 ‘‘The Secretary acting through the Director of NIH, shall

10 examine the distribution and availability of ongoing and

11 appropriate HIV/AIDS-related research projects to existing

12 sites under this section for purposes of enhancing and ex13 panding voluntary access to HIV-related research, espe14 cially within communities that are not reasonably served

15 by such projects. Not later than 12 months after the date

16 of the enactment of the Ryan White CARE Act Amendments

17 of 2000, the Secretary shall prepare and submit to the ap18 propriate committees of Congress a report that describes the

19 findings made by the Director and the manner in which

20 the conclusions based on those findings can be addressed.’’.

21 (e) ADMINISTRATIVE EXPENSES.—Section 2671 of the

22 Public Health Service Act (42 U.S.C. 300ff–71) is

23 amended—

24 (1) by redesignating subsections (i) and (j) as

25 subsections (j) and (k), respectively; and
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1 (2) by inserting after subsection (h) the following

2 subsection:

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

4 ‘‘(1) DETERMINATION BY SECRETARY.—Not later

5 than 12 months after the date of the enactment of the

6 Ryan White Care Act Amendments of 2000, the Sec7 retary, in consultation with grantees under this part,

8 shall conduct a review of the administrative, program

9 support, and direct service-related activities that are

10 carried out under this part to ensure that eligible in11 dividuals have access to quality, HIV-related health

12 and support services and research opportunities under

13 this part, and to support the provision of such serv14 ices.

15 ‘‘(2) REQUIREMENTS.—

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

17 days after the expiration of the 12-month period

18 referred to in paragraph (1) the Secretary, in

19 consultation with grantees under this part, shall

20 determine the relationship between the costs of

21 the activities referred to in paragraph (1) and

22 the access of eligible individuals to the services

23 and research opportunities described in such

24 paragraph.
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1 ‘‘(B) LIMITATION.—After a final determina2 tion under subparagraph (A), the Secretary may

3 not make a grant under this part unless the

4 grantee complies with such requirements as may

5 be included in such determination.’’.

6 (f) AUTHORIZATION OF APPROPRIATIONS.—Section

7 2671 of the Public Health Service Act (42 U.S.C. 300ff–

8 71) is amended in subsection (j) (as redesignated by sub9 section (e)(1) of this section) by striking ‘‘fiscal years 1996

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

11 2005’’.

12 SEC. 402. AIDS EDUCATION AND TRAINING CENTERS.

13 (a) SCHOOLS; CENTERS.—

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

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

16 111(a)(1)) is amended—

17 (A) in subparagraph (A)—

18 (i) by striking ‘‘training’’ and insert19 ing ‘‘to train’’;

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

21 inserting ‘‘, including’’; and

22 (iii) by inserting before the semicolon

23 the following: ‘‘, and including (as applica24 ble to the type of health professional in-
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1 volved), prenatal and other gynecological

2 care for women with HIV disease’’;

3 (B) in subparagraph (B), by striking ‘‘and’’

4 after the semicolon at the end;

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

6 period and inserting ‘‘; and’’; and

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

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

9 care of women with HIV disease, including pre10 natal and other gynecological care for such

11 women.’’.

12 (2) DISSEMINATION OF TREATMENT GUIDELINES;

13 MEDICAL CONSULTATION ACTIVITIES.—Not later than

14 90 days after the date of the enactment of this Act,

15 the Secretary of Health and Human Services shall

16 issue and begin implementation of a strategy for the

17 dissemination of HIV treatment information to health

18 care providers and patients.

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

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

21 (1) by amending paragraph (1) to read as fol22 lows:

23 ‘‘(1) IN GENERAL.—

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

25 grants to dental schools and programs described
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1 in subparagraph (B) to assist such schools and

2 programs with respect to oral health care to pa3 tients with HIV disease.

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

5 of this subsection, the dental schools and pro6 grams referred to in this subparagraph are den7 tal schools and programs that were described in

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

9 on the day before the date of the enactment of the

10 Health Professions Education Partnerships Act

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

12 dental hygiene programs that are accredited by

13 the Commission on Dental Accreditation.’’;

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

15 and inserting ‘‘the section referred to in paragraph

16 (1)(B)’’; and

17 (3) by inserting after paragraph (4) the fol18 lowing paragraph:

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

20 may make grants to dental schools and programs de21 scribed in paragraph (1)(B) that partner with com22 munity-based dentists to provide oral health care to

23 patients with HIV disease in unserved areas. Such

24 partnerships shall permit the training of dental stu-
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1 dents and residents and the participation of commu2 nity dentists as adjunct faculty.’’.

3 (c) AUTHORIZATION OF APPROPRIATIONS.—

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

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

6 111(c)(1)) is amended by striking ‘‘fiscal years 1996

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

8 through 2005’’.

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

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

11 is amended to read as follows:

12 ‘‘(2) DENTAL SCHOOLS.—

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

14 grants under paragraphs (1) through (4) of sub15 section (b), there are authorized to be appro16 priated such sums as may be necessary for each

17 of the fiscal years 2001 through 2005.

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

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

20 are authorized to be appropriated such sums as

21 may be necessary for each of the fiscal years

22 2001 through 2005.’’.
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1 Subtitle B—General Provisions in

2 Title XXVI

3 SEC. 411. EVALUATIONS AND REPORTS.

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

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

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

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

9 Part B of title III of the Public Health Service Act

10 (42 U.S.C. 243 et seq.) is amended by inserting after section

11 318A the following section:

12 ‘‘DATA COLLECTION REGARDING PROGRAMS UNDER TITLE

13 XXVI

14 ‘‘SEC. 318B. For the purpose of collecting and pro15 viding data for program planning and evaluation activities

16 under title XXVI, there are authorized to be appropriated

17 to the Secretary (acting through the Director of the Centers

18 for Disease Control and Prevention) such sums as may be

19 necessary for each of the fiscal years 2001 through 2005.

20 Such authorization of appropriations is in addition to

21 other authorizations of appropriations that are available

22 for such purpose.’’.

23 SEC. 413. COORDINATION.

24 Section 2675 of the Public Health Service Act (42

25 U.S.C. 300ff–75) is amended—
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1 (1) by amending subsection (a) to read as fol2 lows:

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

4 the Health Resources and Services Administration, the Cen5 ters for Disease Control and Prevention, the Substance

6 Abuse and Mental Health Services Administration, and the

7 Health Care Financing Administration coordinate the

8 planning, funding, and implementation of Federal HIV

9 programs to enhance the continuity of care and prevention

10 services for individuals with HIV disease or those at risk

11 of such disease. The Secretary shall consult with other Fed12 eral agencies, including the Department of Veterans Affairs,

13 as needed and utilize planning information submitted to

14 such agencies by the States and entities eligible for sup15 port.’’;

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

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

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

19 subsection:

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

21 and submit to the appropriate committees of the Congress

22 a report concerning the coordination efforts at the Federal,

23 State, and local levels described in this section, including

24 a description of Federal barriers to HIV program integra25 tion and a strategy for eliminating such barriers and en-
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1 hancing the continuity of care and prevention services for

2 individuals with HIV disease or those at risk of such dis3 ease.’’; and

4 (4) in each of subsections (c) and (d) (as redesig5 nated by paragraph (2) of this section), by inserting

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

7 each place such term appears.

8 SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH

9 HIV DISEASE.

10 Section 2675 of the Public Health Service Act, as

11 amended by section 413(2) of this Act, is amended by add12 ing at the end the following subsection:

13 ‘‘(e) RECOMMENDATIONS REGARDING RELEASE OF

14 PRISONERS.—After consultation with the Attorney General

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

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

17 amounts from grants under part A or B, the Secretary, con18 sistent with the coordination required in subsection (a),

19 shall develop a plan for the medical case management of

20 and the provision of support services to individuals who

21 were Federal or State prisoners and had HIV disease as

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

23 custody of the penal system. The Secretary shall submit the

24 plan to the Congress not later than 2 years after the date
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1 of the enactment of the Ryan White CARE Act Amendments

2 of 2000.’’.

3 SEC. 415. AUDITS.

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

5 (42 U.S.C. 300ff–71 et seq.) is amended by inserting after

6 section 2675 the following section:

7 ‘‘SEC. 2675A. AUDITS.

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

9 Secretary may reduce the amounts of grants under this title

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

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

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

13 in accordance with the procedures of section 7502 of title

14 31, United States Code. The Secretary shall annually select

15 representative samples of such audits, prepare summaries

16 of the selected audits, and submit the summaries to the Con17 gress.’’.

18 SEC. 416. ADMINISTRATIVE SIMPLIFICATION.

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

20 as amended by section 415 of this Act, is amended by insert21 ing after section 2675A the following section:

22 ‘‘SEC. 2675B. ADMINISTRATIVE SIMPLIFICATION REGARD23 ING PARTS A AND B.

24 ‘‘(a) COORDINATED DISBURSEMENT.—After consulta25 tion with the States, with eligible areas under part A, and
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1 with entities that receive amounts from grants under part

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

3 the disbursement of appropriations for grants under part

4 A with the disbursement of appropriations for grants under

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

6 amounts from such grants in complying with the require7 ments of such parts. The Secretary shall submit the plan

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

9 the enactment of the Ryan White CARE Act Amendments

10 of 2000. Not later than 2 years after the date on which the

11 plan is so submitted, the Secretary shall complete the imple12 mentation of the plan, notwithstanding any provision of

13 this title that is inconsistent with the plan.

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

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

16 entities that receive amounts from grants under part A or

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

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

19 efficiency of grantees under such parts in complying with

20 the requirements of such parts, would be improved by re21 quiring that applications for grants under such parts be

22 submitted biennially rather than annually. The Secretary

23 shall submit such determination to the Congress not later

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

25 White CARE Act Amendments of 2000.
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1 ‘‘(c) APPLICATION SIMPLIFICATION.—After consulta2 tion with the States, with eligible areas under part A, and

3 with entities that receive amounts from grants under part

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

5 the process for applications under parts A and B. The Sec6 retary shall submit the plan to the Congress not later than

7 18 months after the date of the enactment of the Ryan White

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

9 after the date on which the plan is so submitted, the Sec10 retary shall complete the implementation of the plan, not11 withstanding any provision of this title that is inconsistent

12 with the plan.’’.

13 SEC. 417. AUTHORIZATION OF APPROPRIATIONS FOR

14 PARTS A AND B.

15 Section 2677 of the Public Health Service Act (42

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

17 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

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

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

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

21 2005.

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

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

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

25 2005.’’.
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1 TITLE V—GENERAL PROVISIONS

2 SEC. 501. STUDIES BY INSTITUTE OF MEDICINE.

3 (a) STATE SURVEILLANCE SYSTEMS ON PREVALENCE

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

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

6 the Institute of Medicine to enter into an agreement with

7 the Secretary under which such Institute conducts a study

8 to provide the following:

9 (1) A determination of whether the surveillance

10 system of each of the States regarding the human im11 munodeficiency virus provides for the reporting of

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

13 sufficient to provide adequate and reliable informa14 tion on the number of such cases and the demographic

15 characteristics of such cases, both for the State in gen16 eral and for specific geographic areas in the State.

17 (2) A determination of whether such information

18 is sufficiently accurate for purposes of formula grants

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

20 Health Service Act.

21 (3) With respect to any State whose surveillance

22 system does not provide adequate and reliable infor23 mation on cases of infection with the virus, rec24 ommendations regarding the manner in which the

25 State can improve the system.
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1 (b) RELATIONSHIP BETWEEN EPIDEMIOLOGICAL

2 MEASURES AND HEALTH CARE FOR CERTAIN INDIVIDUALS

3 WITH HIV DISEASE.—

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

5 the Institute of Medicine to enter into an agreement

6 with the Secretary under which such Institute con7 ducts a study concerning the appropriate epidemio8 logical measures and their relationship to the financ9 ing and delivery of primary care and health-related

10 support services for low-income, uninsured, and

11 under-insured individuals with HIV disease.

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

13 shall ensure that the study under paragraph (1) con14 siders the following:

15 (A) The availability and utility of health

16 outcomes measures and data for HIV primary

17 care and support services and the extent to which

18 those measures and data could be used to meas19 ure the quality of such funded services.

20 (B) The effectiveness and efficiency of serv21 ice delivery (including the quality of services,

22 health outcomes, and resource use) within the

23 context of a changing health care and thera24 peutic environment, as well as the changing epi25 demiology of the epidemic, including deter-
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1 mining the actual costs, potential savings, and

2 overall financial impact of modifying the pro3 gram under title XIX of the Social Security Act

4 to establish eligibility for medical assistance

5 under such title on the basis of infection with the

6 human immunodeficiency virus rather than pro7 viding such assistance only if the infection has

8 progressed to acquired immune deficiency syn9 drome.

10 (C) Existing and needed epidemiological

11 data and other analytic tools for resource plan12 ning and allocation decisions, specifically for es13 timating severity of need of a community and

14 the relationship to the allocations process.

15 (D) Other factors determined to be relevant

16 to assessing an individual’s or community’s abil17 ity to gain and sustain access to quality HIV

18 services.

19 (c) OTHER ENTITIES.—If the Institute of Medicine de20 clines to conduct a study under this section, the Secretary

21 shall enter into an agreement with another appropriate

22 public or nonprofit private entity to conduct the study.

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

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

25 enactment of this Act, the study required in sub-
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1 section (a) is completed and a report describing the

2 findings made in the study is submitted to the appro3 priate committees of the Congress; and

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

5 enactment of this Act, the study required in sub6 section (b) is completed and a report describing the

7 findings made in the study is submitted to such com8 mittees.

9 SEC. 502. DEVELOPMENT OF RAPID HIV TEST.

10 (a) EXPANSION, INTENSIFICATION, AND COORDINATION

11 OF RESEARCH AND OTHER ACTIVITIES.—

12 (1) IN GENERAL.—The Director of NIH shall ex13 pand, intensify, and coordinate research and other

14 activities of the National Institutes of Health with re15 spect to the development of reliable and affordable

16 tests for HIV disease that can rapidly be adminis17 tered and whose results can rapidly be obtained (in

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

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

20 NIH shall periodically submit to the appropriate

21 committees of Congress a report describing the re22 search and other activities conducted or supported

23 under paragraph (1).

24 (3) AUTHORIZATION OF APPROPRIATIONS.—For

25 the purpose of carrying out this subsection, there are
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1 authorized to be appropriated such sums as may be

2 necessary for each of the fiscal years 2001 through

3 2005.

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

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

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

7 in consultation with the Director of the Centers for

8 Disease Control and Prevention and the Commis9 sioner of Food and Drugs, shall submit to the appro10 priate committees of the Congress a report describing

11 the progress made towards, and barriers to, the pre12 market review and commercial distribution of rapid

13 HIV tests. The report shall—

14 (A) assess the public health need for and

15 public health benefits of rapid HIV tests, includ16 ing the minimization of false positive results

17 through the availability of multiple rapid HIV

18 tests;

19 (B) make recommendations regarding the

20 need for the expedited review of rapid HIV test

21 applications submitted to the Center for Bio22 logics Evaluation and Research and, if such rec23 ommendations are favorable, specify criteria and

24 procedures for such expedited review; and
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1 (C) specify whether the barriers to the pre2 market review of rapid HIV tests include the un3 necessary application of requirements—

4 (i) necessary to ensure the efficacy of

5 devices for donor screening to rapid HIV

6 tests intended for use in other screening sit7 uations; or

8 (ii) for identifying antibodies to HIV

9 subtypes of rare incidence in the United

10 States to rapid HIV tests intended for use

11 in screening situations other than donor

12 screening.

13 (c) GUIDELINES OF CENTERS FOR DISEASE CONTROL

14 AND PREVENTION.—Promptly after commercial distribu15 tion of a rapid HIV test begins, the Secretary, acting

16 through the Director of the Centers for Disease Control and

17 Prevention, shall establish or update guidelines that include

18 recommendations for States, hospitals, and other appro19 priate entities regarding the ready availability of such tests

20 for administration to pregnant women who are in labor

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

22 is not known to the attending obstetrician.
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1 SEC. 503. TECHNICAL CORRECTIONS.

2 (a) PUBLIC HEALTH SERVICE ACT.—Title XXVI of the

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

4 amended—

5 (1) in section 2605(d)—

6 (A) in paragraph (1), by striking ‘‘section

7 2608’’ and inserting ‘‘section 2677’’; and

8 (B) in paragraph (4), by inserting ‘‘sec9 tion’’ before 2601(a)’’; and

10 (2) in section 2673(a), in the matter preceding

11 paragraph (1), by striking ‘‘the Agency for Health

12 Care Policy and Research’’ and inserting ‘‘the Direc13 tor of the Agency for Healthcare Research and Qual14 ity’’.

15 (b) RELATED ACT.—The first paragraph (2) of section

16 3(c) of the Ryan White Care Act Amendments of 1996 (Pub17 lic Law 104–146; 110 Stat. 1354) is amended in subpara18 graph (A)(iii) by striking ‘‘by inserting the following new

19 paragraph:’’ and inserting ‘‘by inserting before paragraph

20 (2) (as so redesignated) the following new paragraph’’.

21 TITLE VI—EFFECTIVE DATE

22 SEC. 601. EFFECTIVE DATE.

23 This Act and the amendments made by this Act take

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

25 of this Act, whichever occurs later.
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Amend the title so as to read ‘‘An Act to amend the

Public Health Service Act to revise and extend programs

established under the Ryan White Comprehensive AIDS

Resources Emergency Act of 1990, and for other purposes.’’.

Attest:

Clerk.