106TH CONGRESS

2D SESSION S. 2311

AN ACT

To revise and extend the Ryan White CARE Act programs

under title XXVI of the Public Health Service Act, to

improve access to health care and the quality of care

under such programs, and to provide for the development

of increased capacity to provide health care and related

support services to individuals and families with HIV

disease, and for other purposes.

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

3 SECTION 1. SHORT TITLE.

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

5 Act Amendments of 2000’’.
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1 SEC. 2. REFERENCES; TABLE OF CONTENTS.

2 (a) REFERENCES.—Except as otherwise expressly

3 provided, whenever in this Act an amendment or repeal

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

5 a section or other provision, the reference shall be consid6 ered to be made to a section or other provision of the Pub7 lic Health Service Act (42 U.S.C. 201 et seq.).

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

9 Act is as follows:

Sec. 1. Short title.

Sec. 2. References; table of contents.

TITLE I—AMENDMENTS TO HIV HEALTH CARE PROGRAM

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

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

Sec. 102. Quality management.

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

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

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

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

Sec. 107. Hold harmless provision.

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

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

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

resources.

Sec. 122. Quality management.

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

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

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

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

and children.

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

Sec. 128. Supplement grants for certain States.

Sec. 129. Use of treatment funds.

Sec. 130. Increase in minimum allotment.

Sec. 131. Set-aside for infants, children, and women.

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

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

Sec. 142. Planning and development grants.
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Sec. 143. Authorization of appropriations for categorical grants.

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

Sec. 145. Preference for certain areas.

Sec. 146. Technical amendment.

Subtitle D—Amendments to Part D (General Provisions)

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

Sec. 152. Limitation on administrative expenses.

Sec. 153. Evaluations and reports.

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

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

Sec. 161. Authorization of appropriations.

TITLE II—MISCELLANEOUS PROVISIONS

Sec. 201. Institute of Medicine study.

1 TITLE I—AMENDMENTS TO HIV

2 HEALTH CARE PROGRAM

3 Subtitle A—Amendments to Part A

4 (Emergency Relief Grants)

5 SEC. 101. DUTIES OF PLANNING COUNCIL, FUNDING PRIOR6 ITIES, QUALITY ASSESSMENT.

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

8 (1) in subsection (b)—

9 (A) in paragraph (2)(C), by inserting be10 fore the semicolon the following: ‘‘, including

11 providers of housing and homeless services’’;

12 and

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

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

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

16 and

17 (2) by adding at the end the following:
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1 ‘‘(d) DUTIES OF PLANNING COUNCIL.—The planning

2 council established under subsection (b) shall have the fol3 lowing duties:

4 ‘‘(1) PRIORITIES FOR ALLOCATION OF

5 FUNDS.—The council shall establish priorities for

6 the allocation of funds within the eligible area, in7 cluding how best to meet each such priority and ad8 ditional factors that a grantee should consider in al9 locating funds under a grant, based on the following

10 factors:

11 ‘‘(A) The size and demographic character12 istics of the population with HIV disease to be

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

14 needs of individuals living with HIV infection

15 who are not receiving HIV-related health serv16 ices.

17 ‘‘(B) The documented needs of the popu18 lation with HIV disease with particular atten19 tion being given to disparities in health services

20 among affected subgroups within the eligible

21 area.

22 ‘‘(C) The demonstrated or probable cost

23 and outcome effectiveness of proposed strate24 gies and interventions, to the extent that data

25 are reasonably available.
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1 ‘‘(D) Priorities of the communities with

2 HIV disease for whom the services are in3 tended.

4 ‘‘(E) The availability of other govern5 mental and non-governmental resources, includ6 ing the State medicaid plan under title XIX of

7 the Social Security Act and the State Children’s

8 Health Insurance Program under title XXI of

9 such Act to cover health care costs of eligible

10 individuals and families with HIV disease.

11 ‘‘(F) Capacity development needs resulting

12 from gaps in the availability of HIV services in

13 historically underserved low-income commu14 nities.

15 ‘‘(2) COMPREHENSIVE SERVICE DELIVERY

16 PLAN.—The council shall develop a comprehensive

17 plan for the organization and delivery of health and

18 support services described in section 2604. Such

19 plan shall be compatible with any existing State or

20 local plans regarding the provision of such services

21 to individuals with HIV disease.

22 ‘‘(3) ASSESSMENT OF FUND ALLOCATION EFFI23 CIENCY.—The council shall assess the efficiency of

24 the administrative mechanism in rapidly allocating
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1 funds to the areas of greatest need within the eligi2 ble area.

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

4 council shall participate in the development of the

5 Statewide coordinated statement of need as initiated

6 by the State public health agency responsible for ad7 ministering grants under part B.

8 ‘‘(5) COORDINATION WITH OTHER FEDERAL

9 GRANTEES.—The council shall coordinate with Fed10 eral grantees providing HIV-related services within

11 the eligible area.

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

13 shall establish methods for obtaining input on com14 munity needs and priorities which may include pub15 lic meetings, conducting focus groups, and convening

16 ad-hoc panels.

17 ‘‘(e) PROCESS FOR ESTABLISHING ALLOCATION PRI18 ORITIES.—

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

20 after the date of enactment of the Ryan White

21 CARE Act Amendments of 2000, the Secretary

22 shall—

23 ‘‘(A) consult with eligible metropolitan

24 areas, affected communities, experts, and other

25 appropriate individuals and entities, to develop
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1 epidemiologic measures for establishing the

2 number of individuals living with HIV disease

3 who are not receiving HIV-related health serv4 ices; and

5 ‘‘(B) provide advice and technical assist6 ance to planning councils with respect to the

7 process for establishing priorities for the alloca8 tion of funds under subsection (d)(1).

9 ‘‘(2) EXCEPTION.—Grantees under this part

10 shall not be required to establish priorities for indi11 viduals not in care until epidemiologic measures are

12 developed under paragraph (1).’’.

13 SEC. 102. QUALITY MANAGEMENT.

14 (a) FUNDS AVAILABLE FOR QUALITY MANAGE15 MENT.—Section 2604 (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

22 of an eligible area that receives a grant under this

23 part shall provide for the establishment of a quality

24 management program to assess the extent to which

25 medical 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 to develop

4 strategies for improvements in the access to and

5 quality of medical services.

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

7 under a grant awarded under this part, the chief

8 elected official of an eligible area may use, for activi9 ties associated with its quality management pro10 gram, not more than the lesser of—

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

12 the grant; or

13 ‘‘(B) $3,000,000.’’.

14 (b) QUALITY MANAGEMENT REQUIRED FOR ELIGI15 BILITY FOR GRANTS.—Section 2605(a) (42 U.S.C. 300ff–

16 15(a)) is amended—

17 (1) by redesignating paragraphs (3) through

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

19 (2) by inserting after paragraph (2) the fol20 lowing:

21 ‘‘(3) that the chief elected official of the eligible

22 area will satisfy all requirements under section

23 2604(c);’’.
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1 SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH

2 CARE RELATIONSHIPS.

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

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

5 102(a)) is amended by inserting ‘‘and the State Children’s

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

7 after ‘‘Social Security Act’’.

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

9 300ff–15(a)) is amended by inserting after paragraph (3),

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

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

12 that receive funds under a grant under section

13 2601(a) shall maintain appropriate relationships

14 with entities in the area served that constitute key

15 points of access to the health care system for indi16 viduals with HIV disease (including emergency

17 rooms, substance abuse treatment programs, detoxi18 fication centers, adult and juvenile detention facili19 ties, sexually transmitted disease clinics, HIV coun20 seling and testing sites, mental health programs,

21 and homeless shelters) and other entities under sec22 tion 2652(a) for the purpose of facilitating early

23 intervention for individuals newly diagnosed with

24 HIV disease and individuals knowledgeable of their

25 status but not in care;’’.
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1 SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH

2 CARE-RELATED.

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

4 300ff–14(b)(1)) is amended—

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

6 by striking ‘‘HIV-related—’’ and inserting ‘‘HIV-re7 lated services, as follows:’’;

8 (2) in subparagraph (A)—

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

10 follows through ‘‘substance abuse treatment

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

12 HEALTH SERVICES.—Outpatient and ambula13 tory health services, including substance abuse

14 treatment,’’; and

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

17 (3) in subparagraph (B), by striking ‘‘(B) inpa18 tient case management’’ and inserting ‘‘(C) INPA19 TIENT CASE MANAGEMENT SERVICES.—Inpatient

20 case management’’; and

21 (4) by inserting after subparagraph (A) the fol22 lowing:

23 ‘‘(B) OUTPATIENT SUPPORT SERVICES.—

24 Outpatient and ambulatory support services (in25 cluding case management), to the extent that

26 such services facilitate, enhance, support, or
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1 sustain the delivery, continuity, or benefits of

2 health services for individuals and families with

3 HIV disease.’’.

4 (b) CONFORMING AMENDMENT TO APPLICATION RE5 QUIREMENTS.—Section 2605(a) (42 U.S.C. 300ff–15(a)),

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

7 (1) in paragraph (7) (as so redesignated), by

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

9 (2) in paragraph (8) (as so redesignated), by

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

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

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 SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVEN17 TION SERVICES.

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

19 300ff–14(b)(1)), as amended by section 104(a), is further

20 amended by adding at the end the following:

21 ‘‘(D) EARLY INTERVENTION SERVICES.—

22 Early intervention services as described in sec23 tion 2651(b)(2), with follow-through referral,

24 provided for the purpose of facilitating the ac25 cess of individuals receiving the services to
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1 HIV-related health services, but only if the enti2 ty providing such services—

3 ‘‘(i)(I) is receiving funds under sub4 paragraph (A) or (C); or

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

6 of access to services, as described in sec7 tion 2605(a)(4), that maintains a relation8 ship with an entity described in subclause

9 (I) and that is serving individuals at ele10 vated risk of HIV disease;

11 ‘‘(ii) demonstrates to the satisfaction

12 of the chief elected official that Federal,

13 State, or local funds are inadequate for the

14 early intervention services the entity will

15 provide with funds received under this sub16 paragraph; and

17 ‘‘(iii) demonstrates to the satisfaction

18 of the chief elected official that funds will

19 be utilized under this subparagraph to sup20 plement not supplant other funds available

21 for such services in the year for which such

22 funds are being utilized.

23 (b) CONFORMING AMENDMENTS TO APPLICATION

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

25 15(a)(1)) is amended—
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1 (1) in subparagraph (A), by striking ‘‘services

2 to individuals with HIV disease’’ and inserting

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

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

5 for individuals with HIV disease’’ and inserting

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

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

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

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

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

13 SEC. 107. HOLD HARMLESS PROVISION.

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

15 amended to read as follows:

16 ‘‘(4) LIMITATION.—With respect to each of fis17 cal years 2001 through 2005, the Secretary shall en18 sure that the amount of a grant made to an eligible

19 area under paragraph (2) for such a fiscal year is

20 not less than an amount equal to 98 percent of the

21 amount the eligible area received for the fiscal year

22 preceding the year for which the determination is

23 being made.’’.
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1 SEC. 108. SET-ASIDE FOR INFANTS, CHILDREN, AND

2 WOMEN.

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

4 amended—

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

6 subsection’’ after ‘‘council’’; and

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

8 ‘‘ratio of each’’.

9 Subtitle B—Amendments to Part B

10 (Care Grant Program)

11 SEC. 121. STATE REQUIREMENTS CONCERNING IDENTI12 FICATION OF NEED AND ALLOCATION OF RE13 SOURCES.

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

15 U.S.C. 300ff–22) is amended—

16 (1) by striking ‘‘A State’’ and inserting ‘‘(a) IN

17 GENERAL.—A State’’; and

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

19 (A) by striking ‘‘Services’’ and inserting:

20 ‘‘(b) DELIVERY OF SERVICES.—Services’’;

21 (B) by striking ‘‘paragraph (1)’’ and in22 serting ‘‘subsection (a)(1)’’; and

23 (C) by striking ‘‘paragraph (2)’’ and in24 serting ‘‘subsection (a)(2) and section 2613’’;

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

26 300ff–27(b)) is amended—
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1 (1) in paragraph (1)(C)—

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

3 following:

4 ‘‘(i) the size and demographic charac5 teristics of the population with HIV dis6 ease to be served, except that by not later

7 than October 1, 2002, the State shall take

8 into account the needs of individuals not in

9 care, based on epidemiologic measures de10 veloped by the Secretary in consultation

11 with the State, affected communities, ex12 perts, and other appropriate individuals

13 (such State shall not be required to estab14 lish priorities for individuals not in care

15 until such epidemiologic measures are de16 veloped);’’;

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

18 end; and

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

20 ‘‘(v) the availability of other govern21 mental and non-governmental resources;

22 ‘‘(vi) the capacity development needs

23 resulting in gaps in the provision of HIV

24 services in historically underserved low-in-
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1 come and rural low-income communities;

2 and

3 ‘‘(vii) the efficiency of the administra4 tive mechanism in rapidly allocating funds

5 to the areas of greatest need within the

6 State;’’; and

7 (2) in paragraph (2)—

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

9 ‘‘and’’ at the end;

10 (B) by redesignating subparagraph (C) as

11 subparagraph (F); and

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

13 the following:

14 ‘‘(C) an assurance that capacity develop15 ment needs resulting from gaps in the provision

16 of services in underserved low-income and rural

17 low-income communities will be addressed; and

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

19 subsequent fiscal years, assurances that, in the

20 planning and allocation of resources, the State,

21 through systems of HIV-related health services

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

23 section 2612(a), will make appropriate provi24 sion for the HIV-related health and support

25 service needs of individuals who have been diag-
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1 nosed with HIV disease but who are not cur2 rently receiving such services, based on the epi3 demiologic measures developed under paragraph

4 (1)(C)(i);’’.

5 SEC. 122. QUALITY MANAGEMENT.

6 (a) STATE REQUIREMENT FOR QUALITY MANAGE7 MENT.—Section 2617(b)(4) (42 U.S.C. 300ff–27(b)(4)) is

8 amended—

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

10 the following:

11 ‘‘(C) the State will provide for—

12 ‘‘(i) the establishment of a quality

13 management program to assess the extent

14 to which medical services provided to pa15 tients under the grant are consistent with

16 the most recent Public Health Service

17 guidelines for the treatment of HIV dis18 ease and related opportunistic infections

19 and to develop strategies for improvements

20 in the access to and quality of medical

21 services; and

22 ‘‘(ii) a periodic review (such as

23 through an independent peer review) to as24 sess the quality and appropriateness of

25 HIV-related health and support services
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1 provided by entities that receive funds

2 from the State under this part;’’;

3 (2) by redesignating subparagraphs (E) and

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

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

6 following:

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

8 systems of HIV-related health services provided

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

10 2612(a), has considered strategies for working

11 with providers to make optimal use of financial

12 assistance under the State medicaid plan under

13 title XIX of the Social Security Act, the State

14 Children’s Health Insurance Program under

15 title XXI of such Act, and other Federal grant16 ees that provide HIV-related services, to maxi17 mize access to quality HIV-related health and

18 support services;

19 (4) in subparagraph (F), as so redesignated, by

20 striking ‘‘and’’ at the end; and

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

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

23 (b) AVAILABILITY OF FUNDS FOR QUALITY MANAGE24 MENT.—
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1 (1) AVAILABILITY OF GRANT FUNDS FOR PLAN2 NING AND EVALUATION.—Section 2618(c)(3) (42

3 U.S.C. 300ff–28(c)(3)) is amended by inserting be4 fore the period ‘‘, including not more than

5 $3,000,000 for all activities associated with its qual6 ity management program’’.

7 (2) EXCEPTION TO COMBINED CEILING ON

8 PLANNING AND ADMINISTRATION FUNDS FOR

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

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

11 amended to read as follows:

12 ‘‘(6) EXCEPTION FOR QUALITY MANAGE13 MENT.—Notwithstanding paragraph (5), a State

14 whose grant under this part for a fiscal year does

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

16 percent of the amount of the grant for the purposes

17 described in paragraphs (3) and (4) if—

18 ‘‘(A) that portion of the amount that may

19 be used for such purposes in excess of 15 per20 cent of the grant is used for its quality manage21 ment program; and

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

23 approves a plan (in such form and containing

24 such information as the Secretary may pre-
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1 scribe) for use of funds for its quality manage2 ment program.’’.

3 SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH

4 CARE RELATIONSHIPS.

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

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

7 at the end the following:

8 ‘‘(H) that funded entities maintain appro9 priate relationships with entities in the area

10 served that constitute key points of access to

11 the health care system for individuals with HIV

12 disease (including emergency rooms, substance

13 abuse treatment programs, detoxification cen14 ters, adult and juvenile detention facilities, sex15 ually transmitted disease clinics, HIV coun16 seling and testing sites, mental health pro17 grams, and homeless shelters), and other enti18 ties under section 2652(a), for the purpose of

19 facilitating early intervention for individuals

20 newly diagnosed with HIV disease and individ21 uals knowledgeable of their status but not in

22 care.’’.
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1 SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH

2 CARE-RELATED.

3 (a) TECHNICAL AMENDMENT.—Section

4 3(c)(2)(A)(iii) of the Ryan White CARE Act Amendments

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

6 ‘‘before paragraph (2) as so redesignated’’ after ‘‘insert7 ing’’.

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

9 300ff–22(a)(1)), as so designated by section 121(a), is

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

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

12 that apply under such section’’.

13 (c) CONFORMING AMENDMENT TO STATE APPLICA14 TION REQUIREMENT.—Section 2617(b)(2) (42 U.S.C.

15 300ff–27(b)(2)), as amended by section 121(b), is further

16 amended by inserting after subparagraph (D) the fol17 lowing:

18 ‘‘(E) an assurance that the State has pro19 cedures in place to ensure that services pro20 vided with funds received under this section

21 meet the criteria specified in section

22 2604(b)(1)(B); and’’.

23 SEC. 125. USE OF GRANT FUNDS FOR EARLY INTERVEN24 TION SERVICES.

25 Section 2612(a) (42 U.S.C. 300ff–22(a)), as amend26 ed by section 121, is further amended—
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1 (1) in paragraph (4), by striking ‘‘and’’ at the

2 end;

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

4 inserting ‘‘; and’’; and

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

6 ‘‘(6) to provide, through systems of HIV-related

7 health services provided under paragraphs (1), (2),

8 and (3), early intervention services, as described in

9 section 2651(b)(2), with follow-up referral, provided

10 for the purpose of facilitating the access of individ11 uals receiving the services to HIV-related health

12 services, but only if the entity providing such

13 services—

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

15 2612(a)(1); or

16 ‘‘(ii) is an entity constituting a point of ac17 cess to services, as described in section

18 2617(b)(4), that maintains a referral relation19 ship with an entity described in clause (i) and

20 that is serving individuals at elevated risk of

21 HIV disease;

22 ‘‘(B) demonstrates to the State’s satisfac23 tion that other Federal, State, or local funds

24 are inadequate for the early intervention serv-
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1 ices the entity will provide with funds received

2 under this paragraph; and

3 ‘‘(C) demonstrates to the satisfaction of

4 the State that funds will be utilized under this

5 paragraph to supplement not supplant other

6 funds available for such services in the year for

7 which such funds are being utilized.’’.

8 SEC. 126. AUTHORIZATION OF APPROPRIATIONS FOR HIV9 RELATED SERVICES FOR WOMEN AND CHIL10 DREN.

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

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

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

14 SEC. 127. REPEAL OF REQUIREMENT FOR COMPLETED IN15 STITUTE OF MEDICINE REPORT.

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

17 SEC. 128. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

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

19 Health Service Act (42 U.S.C. 300ff–11 et seq.) is amend20 ed by adding at the end the following:

21 ‘‘SEC. 2622. SUPPLEMENTAL GRANTS.

22 ‘‘(a) IN GENERAL.—The Secretary shall award sup23 plemental grants to States determined to be eligible under

24 subsection (b) to enable such States to provide comprehen25 sive services of the type described in section 2612(a) to
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1 supplement the services otherwise provided by the State

2 under a grant under this subpart in emerging communities

3 within the State that are not eligible to receive grants

4 under part A.

5 ‘‘(b) ELIGIBILITY.—To be eligible to receive a supple6 mental grant under subsection (a) a State shall—

7 ‘‘(1) be eligible to receive a grant under this

8 subpart;

9 ‘‘(2) demonstrate the existence in the State of

10 an emerging community as defined in subsection

11 (d)(1); and

12 ‘‘(3) submit the information described in sub13 section (c).

14 ‘‘(c) REPORTING REQUIREMENTS.—A State that de15 sires a grant under this section shall, as part of the State

16 application submitted under section 2617, submit a de17 tailed description of the manner in which the State will

18 use amounts received under the grant and of the severity

19 of need. Such description shall include—

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

21 supplemental funds under this section and the plan

22 for the utilization of such funds in the emerging

23 community;

24 ‘‘(2) a demonstration of the existing commit25 ment of local resources, both financial and in-kind;
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1 ‘‘(3) a demonstration that the State will main2 tain HIV-related activities at a level that is equal to

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

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

5 which the State is applying to receive a grant under

6 this part;

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

8 to utilize such supplemental financial resources in a

9 manner that is immediately responsive and cost ef10 fective;

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

12 allocated in accordance with the local demographic

13 incidence of AIDS including appropriate allocations

14 for services for infants, children, women, and fami15 lies with HIV disease;

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

17 planning process, with particular emphasis on af18 fected communities and individuals with HIV dis19 ease; and

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

21 the proposed services are consistent with local needs

22 assessments and the statewide coordinated state23 ment of need.
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1 ‘‘(d) DEFINITION OF EMERGING COMMUNITY.—In

2 this section, the term ‘emerging community’ means a met3 ropolitan area—

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

5 A; and

6 ‘‘(2) for which there has been reported to the

7 Director of the Centers for Disease Control and Pre8 vention a cumulative total of between 500 and 1999

9 cases of acquired immune deficiency syndrome for

10 the most recent period of 5 calendar years for which

11 such data are available.

12 ‘‘(e) FUNDING.—

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

14 with respect to each fiscal year beginning with fiscal

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

16 shall utilize—

17 ‘‘(A) the greater of—

18 ‘‘(i) 25 percent of the amount appro19 priated under 2677 to carry out part B,

20 excluding the amount appropriated under

21 section 2618(b)(2)(H), for such fiscal year

22 that is in excess of the amount appro23 priated to carry out such part in fiscal

24 year preceding the fiscal year involved; or

25 ‘‘(ii) $5,000,000;
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1 to provide funds to States for use in emerging

2 communities with at least 1000, but less than

3 2000, cases of AIDS as reported to and con4 firmed by the Director of the Centers for Dis5 ease Control and Prevention for the five year

6 period preceding the year for which the grant is

7 being awarded; and

8 ‘‘(B) the greater of—

9 ‘‘(i) 25 percent of the amount appro10 priated under 2677 to carry out part B,

11 excluding the amount appropriated under

12 section 2618(b)(2)(H), for such fiscal year

13 that is in excess of the amount appro14 priated to carry out such part in fiscal

15 year preceding the fiscal year involved; or

16 ‘‘(ii) $5,000,000;

17 to provide funds to States for use in emerging

18 communities with at least 500, but less than

19 1000, cases of AIDS reported to and confirmed

20 by the Director of the Centers for Disease Con21 trol and Prevention for the five year period pre22 ceding the year for which the grant is being

23 awarded.

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

25 be effective only for fiscal years beginning in the
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1 first fiscal year in which the amount appropriated

2 under 2677 to carry out part B, excluding the

3 amount appropriated under section 2618(b)(2)(H),

4 exceeds by at least $20,000,000 the amount appro5 priated under 2677 to carry out part B in fiscal year

6 2000, excluding the amount appropriated under sec7 tion 2618(b)(2)(H).

8 ‘‘(3) MINIMUM AMOUNT IN FUTURE YEARS.—

9 Beginning with the first fiscal year in which

10 amounts provided for emerging communities under

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

12 paragraph (1)(B) equals $5,000,000, the Secretary

13 shall ensure that amounts made available under this

14 section for the types of emerging communities de15 scribed in each such paragraph in subsequent fiscal

16 years is at least $5,000,000.

17 ‘‘(4) DISTRIBUTION.—The amount of a grant

18 awarded to a State under this section shall be deter19 mined by the Secretary based on the formula de20 scribed in section 2618(b)(2), except that in apply21 ing such formula, the Secretary shall—

22 ‘‘(A) substitute ‘1.0’ for ‘.80’ in subpara23 graph (A)(ii)(I) of such section; and
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1 ‘‘(B) not consider the provisions of sub2 paragraphs (A)(ii)(II) and (C) of such sec3 tion.’’.

4 SEC. 129. USE OF TREATMENT FUNDS.

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

6 300ff–26(c)) is amended—

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

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

9 made available under this section to—’’;

10 (2) by redesignating paragraphs (1) through

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

12 and realigning the margins of such subparagraphs

13 appropriately;

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

15 by striking ‘‘and’’ at the end;

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

17 by striking the period and inserting ‘‘; and’’; and

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

19 ‘‘(F) encourage, support, and enhance adher20 ence to and compliance with treatment regimens, in21 cluding related medical monitoring.’’;

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

23 following:

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

25 (7) by adding at the end the following:
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1 ‘‘(2) LIMITATIONS.—

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

3 funds under paragraph (1)(F) unless the limita4 tions on access to HIV/AIDS therapeutic regi5 mens as defined in subsection (e)(2) are elimi6 nated.

7 ‘‘(B) AMOUNT OF FUNDING.—No State

8 shall use in excess of 10 percent of the amount

9 set-aside for use under this section in any fiscal

10 year to carry out activities under paragraph

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

12 Secretary that such additional services are es13 sential and in no way diminish access to thera14 peutics.’’.

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

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

17 following:

18 ‘‘(e) SUPPLEMENTAL GRANTS FOR THE PROVISION

19 OF TREATMENTS.—

20 ‘‘(1) IN GENERAL.—From amounts made avail21 able under paragraph (5), the Secretary shall award

22 supplemental grants to States determined to be eligi23 ble under paragraph (2) to enable such States to in24 crease access to therapeutics to treat HIV disease as

25 provided by the State under subsection (c)(1)(B) for
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1 individuals at or below 200 percent of the Federal

2 poverty line.

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

4 criteria for the awarding of grants under paragraph

5 (1) to States that demonstrate a severe need. In de6 termining the criteria for demonstrating State sever7 ity of need, the Secretary shall consider eligibility

8 standards and formulary composition.

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

10 may not make a grant to a State under this sub11 section unless the State agrees that—

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

13 or through donations from public or private en14 tities) non-Federal contributions toward the ac15 tivities to be carried out under the grant in an

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

17 funds provided in the grant; and

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

19 requirements for services or scope of benefits

20 limitations under subsection (a) that are more

21 restrictive than such requirements in effect as

22 of January 1, 2000.

23 ‘‘(4) USE AND COORDINATION.—Amounts made

24 available under a grant under this subsection shall

25 only be used by the State to provide HIV/AIDS-re-
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1 lated medications. The State shall coordinate the use

2 of such amounts with the amounts otherwise pro3 vided under this section in order to maximize drug

4 coverage.

5 ‘‘(5) FUNDING.—

6 ‘‘(A) RESERVATION OF AMOUNT.—The

7 Secretary shall reserve 3 percent of any amount

8 referred to in section 2618(b)(2)(H) that is ap9 propriated for a fiscal year, to carry out this

10 subsection.

11 ‘‘(B) MINIMUM AMOUNT.—In providing

12 grants under this subsection, the Secretary

13 shall ensure that the amount of a grant to a

14 State under this part is not less than the

15 amount the State received under this part in

16 the previous fiscal year, as a result of grants

17 provided under this subsection.’’.

18 (c) SUPPLEMENT AND NOT SUPPLANT.—Section

19 2616 (42 U.S.C. 300ff–26(c)), as amended by subsection

20 (b), is further amended by adding at the end the following:

21 ‘‘(f) SUPPLEMENT NOT SUPPLANT.—Notwith22 standing any other provision of law, amounts made avail23 able under this section shall be used to supplement and

24 not supplant other funding available to provide treatments

25 of the type that may be provided under this section.’’.
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1 SEC. 130. INCREASE IN MINIMUM ALLOTMENT.

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

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

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

5 and inserting ‘‘$200,000’’; and

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

7 and inserting ‘‘$500,000’’.

8 (b) TERRITORIES.—Section 2618(b)(1)(B) (42

9 U.S.C. 300ff–28(b)(1)(B)) is amended by inserting ‘‘the

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

11 (c) TECHNICAL AMENDMENT.—Section

12 2618(b)(3)(B) (42 U.S.C. 300ff–28(b)(3)(B)) is amended

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

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

15 Federated States of Micronesia, and the Republic of

16 Palau, and only for purposes of paragraph (1) the Com17 monwealth of Puerto Rico’’.

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

19 WOMEN.

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

21 amended—

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

23 subsection’’ after ‘‘State shall use’’; and

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

25 ‘‘ratio of each’’.
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1 Subtitle C—Amendments to Part C

2 (Early Intervention Services)

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

4 GRANT PROGRAM.

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

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

7 ‘‘PART C—EARLY INTERVENTION AND PRIMARY CARE

8 SERVICES’’.

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

10 300ff–41 et seq.) is amended—

11 (1) by repealing subpart I; and

12 (2) by redesignating subparts II and III as sub13 parts I and II.

14 (c) CONFORMING AMENDMENTS.—

15 (1) INFORMATION REGARDING RECEIPT OF

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

17 61(a)) is amended by striking ‘‘unless—’’ and all

18 that follows through ‘‘(2) in the case of’’ and insert19 ing ‘‘unless, in the case of’’.

20 (2) ADDITIONAL AGREEMENTS.—Section 2664

21 (42 U.S.C. 300ff–64) is amended—

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

23 ‘‘2642(b) or’’;

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

25 ‘‘2642(b) or’’; and
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1 (C) by striking subsection (h).

2 SEC. 142. PLANNING AND DEVELOPMENT GRANTS.

3 (a) ALLOWING PLANNING AND DEVELOPMENT

4 GRANT TO EXPAND ABILITY TO PROVIDE PRIMARY CARE

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

6 amended—

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

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

9 planning and development grants to public and non10 profit private entities for the purpose of—

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

12 early intervention services; or

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

14 capacity, preparedness, and expertise to deliver

15 primary care services to individuals with HIV

16 disease in underserved low-income communities

17 on the condition that the funds are not used to

18 purchase or improve land or to purchase, con19 struct, or permanently improve (other than

20 minor remodeling) any building or other facil21 ity.’’; and

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

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

24 inserting ‘‘paragraph (1)(A)’’.
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1 (b) AMOUNT; DURATION.—Section 2654(c) (42

2 U.S.C. 300ff–54(c)), as amended by subsection (a), is fur3 ther amended—

4 (1) by redesignating paragraph (4) as para5 graph (5); and

6 (2) by inserting after paragraph (3) the fol7 lowing:

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

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

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

11 an amount not to exceed $50,000.

12 ‘‘(B) CAPACITY DEVELOPMENT.—

13 ‘‘(i) AMOUNT.—A grant under para14 graph (1)(B) may be made in an amount

15 not to exceed $150,000.

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

17 of a grant under paragraph (1)(B), includ18 ing any renewal, may not exceed 3 years.’’.

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

20 (42 U.S.C. 300ff–54(c)(5)), as so redesignated by sub21 section (b), is amended by striking ‘‘1 percent’’ and insert22 ing ‘‘5 percent’’.
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1 SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CAT2 EGORICAL GRANTS.

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

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

5 inserting ‘‘2001 through 2005’’.

6 SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY

7 MANAGEMENT PROGRAM.

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

9 amended—

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

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

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

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

15 inserting ‘‘; and’’; and

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

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

19 the extent to which medical services funded under

20 this title that are provided to patients are consistent

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

23 opportunistic infections and that improvements in

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

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

3 adding at the end the following:

4 ‘‘(d) PREFERENCE IN AWARDING GRANTS.—In

5 awarding new grants under this section, the Secretary

6 shall give preference to applicants that will use amounts

7 received under the grant to serve areas that are deter8 mined to be rural and underserved for the purposes of pro9 viding health care to individuals infected with HIV or di10 agnosed with AIDS.’’.

11 SEC. 146. TECHNICAL AMENDMENT.

12 Section 2652(a) (42 U.S.C. 300ff-52(a)) is

13 amended—

14 (1) striking paragraphs (1) and (2) and insert15 ing the following:

16 ‘‘(1) health centers under section 330;’’; and

17 (2) by redesignating paragraphs (3) through

18 (6) as paragraphs (2) through (5), respectively.

19 Subtitle D—Amendments to Part D

20 (General Provisions)

21 SEC. 151. RESEARCH INVOLVING WOMEN, INFANTS, CHIL22 DREN, AND YOUTH.

23 (a) ELIMINATION OF REQUIREMENT TO ENROLL

24 SIGNIFICANT NUMBERS OF WOMEN AND CHILDREN.—

25 Section 2671(b) (42 U.S.C. 300ff–71(b)) is amended—
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1 (1) in paragraph (1), by striking subparagraphs

2 (C) and (D); and

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

4 (b) INFORMATION AND EDUCATION.—Section

5 2671(d) (42 U.S.C. 300ff–71(d)) is amended by adding

6 at the end the following:

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

8 information and education on opportunities to par9 ticipate in HIV/AIDS-related clinical research.’’.

10 (c) QUALITY MANAGEMENT; ADMINISTRATIVE EX11 PENSES CEILING.—Section 2671(f) (42 U.S.C. 300ff–

12 71(f)) is amended—

13 (1) by striking the subsection heading and des14 ignation and inserting the following:

15 ‘‘(f) ADMINISTRATION.—

16 ‘‘(1) APPLICATION.—’’; and

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

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

19 grantee under this section shall implement a quality

20 management program.’’.

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

22 300ff–71(g)) is amended by adding at the end the fol23 lowing: ‘‘The Secretary acting through the Director of

24 NIH, shall examine the distribution and availability of on25 going and appropriate HIV/AIDS-related research
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1 projects to existing sites under this section for purposes

2 of enhancing and expanding voluntary access to HIV-re3 lated research, especially within communities that are not

4 reasonably served by such projects. Not later than 12

5 months after the date of enactment of the Ryan White

6 CARE Act Amendments of 2000, the Secretary shall pre7 pare and submit to the appropriate committees of Con8 gress a report that describes the findings made by the Di9 rector and the manner in which the conclusions based on

10 those findings can be addressed.’’.

11 (e) AUTHORIZATION OF APPROPRIATIONS.—Section

12 2671(j) (42 U.S.C. 300ff–71(j)) is amended by striking

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

14 years 2001 through 2005’’.

15 SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.

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

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

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

19 (2) by inserting after subsection (h), the fol20 lowing:

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

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

23 later than 12 months after the date of enactment of

24 the Ryan White Care Act Amendments of 2000, the

25 Secretary, in consultation with grantees under this
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1 part, shall conduct a review of the administrative,

2 program support, and direct service-related activities

3 that are carried out under this part to ensure that

4 eligible individuals have access to quality, HIV-re5 lated health and support services and research op6 portunities under this part, and to support the pro7 vision of such services.

8 ‘‘(2) REQUIREMENTS.—

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

10 days after the expiration of the 12-month pe11 riod referred to in paragraph (1) the Secretary,

12 in consultation with grantees under this part,

13 shall determine the relationship between the

14 costs of the activities referred to in paragraph

15 (1) and the access of eligible individuals to the

16 services and research opportunities described in

17 such paragraph.

18 ‘‘(B) LIMITATION.—After a final deter19 mination under subparagraph (A), the Sec20 retary may not make a grant under this part

21 unless the grantee complies with such require22 ments as may be included in such determina23 tion.’’.
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1 SEC. 153. EVALUATIONS AND REPORTS.

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

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

4 through 2005’’.

5 SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR

6 GRANTS UNDER PARTS A AND B.

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

8 read as follows:

9 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

10 ‘‘There are authorized to be appropriated—

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

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

13 2005; and

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

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

16 2005.’’.

17 Subtitle E—Amendments to Part F

18 (Demonstration and Training)

19 SEC. 161. AUTHORIZATION OF APPROPRIATIONS.

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

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

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

23 2001 through 2005’’.

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

25 U.S.C. 300ff–111(c)(2)) is amended by striking ‘‘fiscal
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1 years 1996 through 2000’’ and inserting ‘‘fiscal years

2 2001 through 2005’’.

3 (c) DENTAL SCHOOLS AND PROGRAMS.—Section

4 2692(b) of the Public Health Service Act (42 U.S.C.

5 300ff-111(b)) is amended—

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

7 ‘‘777(b)(4)(B)’’ and inserting ‘‘777(b)(4)(B) (as

8 such section existed on the day before the date of

9 enactment of the Health Professions Education

10 Partnerships Act of 1998 (Public Law 105-392))

11 and dental hygiene programs that are accredited by

12 the Commission on Dental Accreditation’’; and

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

14 ‘‘777(b)(4)(B)’’ and inserting ‘‘777(b)(4)(B) (as

15 such section existed on the day before the date of

16 enactment of the Health Professions Education

17 Partnerships Act of 1998 (Public Law 105-392))’’.

18 TITLE II—MISCELLANEOUS

19 PROVISIONS

20 SEC. 201. INSTITUTE OF MEDICINE STUDY.

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

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

23 Human Services shall enter into a contract with the Insti24 tute of Medicine for the conduct of a study concerning

25 the appropriate epidemiological measures and their rela-
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1 tionship to the financing and delivery of primary care and

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

3 and under-insured individuals with HIV disease.

4 (b) REQUIREMENTS.—

5 (1) COMPLETION.—The study under subsection

6 (a) shall be completed not later than 21 months

7 after the date on which the contract referred to in

8 such subsection is entered into.

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

10 conducted under subsection (a) shall consider—

11 (A) the availability and utility of health

12 outcomes measures and data for HIV primary

13 care and support services and the extent to

14 which those measures and data could be used to

15 measure the quality of such funded services;

16 (B) the effectiveness and efficiency of serv17 ice delivery (including the quality of services,

18 health outcomes, and resource use) within the

19 context of a changing health care and thera20 peutic environment as well as the changing epi21 demiology of the epidemic;

22 (C) existing and needed epidemiological

23 data and other analytic tools for resource plan24 ning and allocation decisions, specifically for es-
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1 timating severity of need of a community and

2 the relationship to the allocations process; and

3 (D) other factors determined to be relevant

4 to assessing an individual’s or community’s

5 ability to gain and sustain access to quality

6 HIV services.

7 (c) REPORT.—Not later than 90 days after the date

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

9 Secretary of Health and Human Services shall prepare

10 and submit to the appropriate committees of Congress a

11 report describing the manner in which the conclusions and

12 recommendations of the Institute of Medicine can be ad13 dressed and implemented.

Passed the Senate June 6, 2000.

Attest:

Secretary.

106TH CONGRESS

2D SESSION S. 2311

AN ACT

To revise and extend the Ryan White CARE Act

programs under title XXVI of the Public HealthService Act, to improve access to health care andthe quality of care under such programs, and toprovide for the development of increased capacityto provide health care and related support services to individuals and families with HIV disease,and for other purposes.