II

Calendar No. 548

106TH CONGRESS

2D SESSION S. 2311

[Report No. 106–294]

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

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

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

development of increased capacity to provide health care and related

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

other purposes.

IN THE SENATE OF THE UNITED STATES

MARCH 29, 2000

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

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

WELLSTONE, Mr. REED, Mr. BIDEN, Mr. DURBIN, Mr. BENNETT, Mr.

LIEBERMAN, Mr. CLELAND, Mr. ROBB, Mrs. MURRAY, Mr. SARBANES,

Mr. GREGG, Mr. GORTON, Mr. BREAUX, Mr. KERRY, Mr. WARNER, Mr.

LUGAR, Mr. LAUTENBERG, Mr. L. CHAFEE, Ms. COLLINS, Mr. MOYNIHAN, Mr. SCHUMER, Mr. BAYH, Mr. INOUYE, and Mr. WYDEN) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

MAY 15, 2000

Reported by Mr. JEFFORDS, with an amendment

[Strike out all after the enacting clause and insert the part printed in italic]

A BILL

To revise and extend the Ryan White CARE Act programs

under title XXVI of the Public Health Service Act, to

improve access to health care and the quality of care
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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’’.

6 SEC. 2. REFERENCES; TABLE OF CONTENTS.

7 (a) REFERENCES.—Except as otherwise expressly

8 provided, whenever in this Act an amendment or repeal

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

10 a section or other provision, the reference shall be consid11 ered to be made to a section or other provision of the Pub12 lic Health Service Act (42 U.S.C. 201 et seq.).

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

14 Act is as follows:

Sec. 1. Short title.

Sec. 2. References; table of contents.

TITLE I—AMENDMENTS TO HIV HEALTH CARE PROGRAM

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

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

Sec. 102. Quality management.

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

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

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

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

Sec. 107. Hold harmless provision.

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

Subtitle B—Amendments to Part B (Care Grant Program)
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Sec. 121. State requirements concerning identification of need and allocation of

resources.

Sec. 122. Quality management.

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

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

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

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

and children.

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

Sec. 130. Supplement grants for certain States.

Sec. 131. Use of treatment funds.

Sec. 132. Increase in minimum allotment.

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

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

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

Sec. 142. Planning and development grants.

Sec. 143. Authorization of appropriations for categorical grants.

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

Sec. 145. Preference for certain areas.

Subtitle D—Amendments to Part D (General Provisions)

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

Sec. 152. Limitation on administrative expenses.

Sec. 153. Evaluations and reports.

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

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

Sec. 161. Authorization of appropriations.

TITLE II—MISCELLANEOUS PROVISIONS

Sec. 201. Institute of Medicine study.

1 TITLE I—AMENDMENTS TO HIV

2 HEALTH CARE PROGRAM

3 Subtitle A—Purpose; Amendments

4 to Part A (Emergency Relief

5 Grants)

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

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

9 (1) in subsection (b)—
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1 (A) in paragraph (2)(C), by inserting be2 fore the semicolon the following: ‘‘, including

3 providers of housing and homeless services’’;

4 and

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

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

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

8 and

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

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

11 council established under subsection (b) shall have the fol12 lowing duties:

13 ‘‘(1) PRIORITIES FOR ALLOCATION OF

14 FUNDS.—The council shall establish priorities for

15 the allocation of funds within the eligible area, in16 cluding how best to meet each such priority and ad17 ditional factors that a grantee should consider in al18 locating funds under a grant, based on the following

19 factors:

20 ‘‘(A) The size and demographic character21 istics of the population with HIV disease to be

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

23 needs of individuals living with HIV infection

24 who are not receiving HIV-related health serv25 ices.
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1 ‘‘(B) The documented needs of the popu2 lation with HIV disease with particular atten3 tion being given to disparities in health services

4 among affected subgroups within the eligible

5 area.

6 ‘‘(C) The demonstrated or probable cost

7 and outcome effectiveness of proposed strate8 gies and interventions, to the extent that data

9 are reasonably available.

10 ‘‘(D) Priorities of the communities with

11 HIV disease for whom the services are in12 tended.

13 ‘‘(E) The availability of other govern14 mental and non-governmental resources, includ15 ing the State medicaid plan under title XIX of

16 the Social Security Act and the State Children’s

17 Health Insurance Program under title XXI of

18 such Act to cover health care costs of eligible

19 individuals and families with HIV disease.

20 ‘‘(F) Capacity development needs resulting

21 from gaps in the availability of HIV services in

22 historically underserved low-income commu23 nities.

24 ‘‘(2) COMPREHENSIVE SERVICE DELIVERY

25 PLAN.—The council shall develop a comprehensive
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1 plan for the organization and delivery of health and

2 support services described in section 2604. Such

3 plan shall be compatible with any existing State or

4 local plans regarding the provision of such services

5 to individuals with HIV disease.

6 ‘‘(3) ASSESSMENT OF FUND ALLOCATION EFFI7 CIENCY.—The council shall assess the efficiency of

8 the administrative mechanism in rapidly allocating

9 funds to the areas of greatest need within the eligi10 ble area.

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

12 council shall participate in the development of the

13 Statewide coordinated statement of need as initiated

14 by the State public health agency responsible for ad15 ministering grants under part B.

16 ‘‘(5) COORDINATION WITH OTHER FEDERAL

17 GRANTEES.—The council shall coordinate with Fed18 eral grantees providing HIV-related services within

19 the eligible area.

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

21 shall establish methods for obtaining input on com22 munity needs and priorities which may include pub23 lic meetings, conducting focus groups, and convening

24 ad-hoc panels.
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1 ‘‘(e) PROCESS FOR ESTABLISHING ALLOCATION PRI2 ORITIES.—

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

4 after the date of enactment of the Ryan White

5 CARE Act Amendments of 2000, the Secretary

6 shall—

7 ‘‘(A) consult with eligible metropolitan

8 areas, affected communities, experts, and other

9 appropriate individuals and entities, to develop

10 epidemiologic measures for establishing the

11 number of individuals living with HIV disease

12 who are not receiving HIV-related health serv13 ices; and

14 ‘‘(B) provide advice and technical assist15 ance to planning councils with respect to the

16 process for establishing priorities for the alloca17 tion of funds under subsection (d)(1).

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

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

20 for individuals not in care until epidemiologic meas21 ures are developed under paragraph (1).’’.

22 SEC. 102. QUALITY MANAGEMENT.

23 (a) FUNDS AVAILABLE FOR QUALITY MANAGE24 MENT.—Section 2604 (42 U.S.C. 300ff–14) is amended—
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1 (1) by redesignating subsections (c) through (f)

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

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

5 ‘‘(c) QUALITY MANAGEMENT.—

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

7 of an eligible area that receives a grant under this

8 part shall provide for the establishment of a quality

9 management program to assess the extent to which

10 medical services provided to patients under the grant

11 are consistent with the most recent Public Health

12 Service guidelines for the treatment of HIV disease

13 and related opportunistic infection and to develop

14 strategies for improvements in the access to and

15 quality of medical services.

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

17 under a grant awarded under this part, the chief

18 elected official of an eligible area may use, for activi19 ties associated with its quality management pro20 gram, not more than the lesser of—

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

22 the grant; or

23 ‘‘(B) $3,000,000.’’.
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1 (b) QUALITY MANAGEMENT REQUIRED FOR ELIGI2 BILITY FOR GRANTS.—Section 2605(a) (42 U.S.C. 300ff–

3 15(a)) is amended—

4 (1) by redesignating paragraphs (3) through

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

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

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

9 area will satisfy all requirements under section

10 2604(c);’’.

11 SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH

12 CARE RELATIONSHIPS.

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

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

15 102(a)) is amended by inserting ‘‘and the State Children’s

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

17 after ‘‘Social Security Act’’.

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

19 300ff–15(a)) is amended by inserting after paragraph (3),

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

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

22 that receive funds under a grant under section

23 2601(a) shall maintain appropriate relationships

24 with entities in the area served that constitute key

25 points of access to the health care system for indi-
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1 viduals with HIV disease (including emergency

2 rooms, substance abuse treatment programs, detoxi3 fication centers, adult and juvenile detention facili4 ties, sexually transmitted disease clinics, HIV coun5 seling and testing sites, and homeless shelters) and

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

7 of facilitating early intervention for individuals newly

8 diagnosed with HIV disease and individuals knowl9 edgeable of their status but not in care;’’.

10 SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH

11 CARE-RELATED.

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

13 300ff–14(b)(1)) is amended—

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

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

17 (2) in subparagraph (A)—

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

19 follows through ‘‘substance abuse treatment

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

21 HEALTH SERVICES.—Outpatient and ambula22 tory health services, including substance abuse

23 treatment,’’; and

24 (B) by striking ‘‘; and’’ and inserting a pe25 riod;
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1 (3) in subparagraph (B), by striking ‘‘(B) inpa2 tient case management’’ and inserting ‘‘(C) INPA3 TIENT CASE MANAGEMENT SERVICES.—Inpatient

4 case management’’; and

5 (4) by inserting after subparagraph (A) the fol6 lowing:

7 ‘‘(B) OUTPATIENT SUPPORT SERVICES.—

8 Outpatient and ambulatory support services (in9 cluding case management), to the extent that

10 such services facilitate, enhance, support, or

11 sustain the delivery, continuity, or benefits of

12 health services for individuals and families with

13 HIV disease.’’.

14 (b) CONFORMING AMENDMENT TO APPLICATION RE15 QUIREMENTS.—Section 2605(a) (42 U.S.C. 300ff–15(a)),

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

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

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

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

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

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

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

23 place to ensure that services provided with funds re24 ceived under this part meet the criteria specified in

25 section 2604(b)(1).’’.
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1 SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVEN2 TION SERVICES.

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

4 300ff–14(b)(1)), as amended by section 104(a), is further

5 amended by adding at the end the following:

6 ‘‘(D) EARLY INTERVENTION SERVICES.—

7 Early intervention services as described in sec8 tion 2651(b)(2), with follow-through referral,

9 provided for the purpose of facilitating the ac10 cess of individuals receiving the services to

11 HIV-related health services, but only if the enti12 ty providing such services—

13 ‘‘(i)(I) is receiving funds under sub14 paragraph (A) or (C); or

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

16 of access to services, as described in para17 graph (2)(C), that maintains a relationship

18 with an entity described in subclause (I)

19 and that is serving individuals at elevated

20 risk of HIV disease; and

21 ‘‘(ii) demonstrates to the satisfaction

22 of the chief elected official that no other

23 Federal, State, or local funds are available

24 for the early intervention services the enti25 ty will provide with funds received under

26 this paragraph.’’.
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1 (b) CONFORMING AMENDMENTS TO APPLICATION

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

3 15(a)(1)) is amended—

4 (1) in subparagraph (A), by striking ‘‘services

5 to individuals with HIV disease’’ and inserting

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

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

8 for individuals with HIV disease’’ and inserting

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

10 SEC. 106. REPLACEMENT OF SPECIFIED FISCAL YEARS RE11 GARDING THE SUNSET ON EXPEDITED DIS12 TRIBUTION REQUIREMENTS.

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

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

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

16 SEC. 107. HOLD HARMLESS PROVISION.

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

18 amended to read as follows:

19 ‘‘(4) LIMITATIONS.—

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

21 of fiscal years 2001 through 2005, the Sec22 retary shall ensure that the amount of a grant

23 made to an eligible area under paragraph (2)

24 for such a fiscal year is not less than an

25 amount equal to 98 percent of the amount the
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1 eligible area received for the fiscal year pre2 ceding the year for which the determination is

3 being made.

4 ‘‘(B) APPLICATION OF PROVISION.—Sub5 paragraph (A) shall only apply with respect to

6 those eligible areas receiving a grant under

7 paragraph (2) for fiscal year 2000 in an

8 amount that has been adjusted in accordance

9 with paragraph (4) of this subsection (as in ef10 fect on the day before the date of enactment of

11 the Ryan White CARE Act Amendments of

12 2000).’’.

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

14 WOMEN.

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

16 amended—

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

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

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

20 ‘‘ratio of each’’.
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1 Subtitle B—Amendments to Part B

2 (Care Grant Program)

3 SEC. 121. STATE REQUIREMENTS CONCERNING IDENTI4 FICATION OF NEED AND ALLOCATION OF RE5 SOURCES.

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

7 U.S.C. 300ff–22) is amended—

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

9 GENERAL.—A State’’; and

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

11 (A) by striking ‘‘paragraph (2)’’ and in12 serting ‘‘subsection (a)(2) and section 2613’’;

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

14 300ff–27(b)) is amended—

15 (1) in paragraph (1)(C)—

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

17 following:

18 ‘‘(i) the size and demographic charac19 teristics of the population with HIV dis20 ease to be served, except that by not later

21 than October 1, 2002, the State shall take

22 into account the needs of individuals not in

23 care, based on epidemiologic measures de24 veloped by the Secretary in consultation

25 with the State, affected communities, ex-
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1 perts, and other appropriate individuals

2 (such State shall not be required to estab3 lish priorities for individuals not in care

4 until such epidemiologic measures are de5 veloped);’’;

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

7 end; and

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

9 ‘‘(v) the availability of other govern10 mental and non-governmental resources;

11 ‘‘(vi) the capacity development needs

12 resulting in gaps in the provision of HIV

13 services in historically underserved low-in14 come and rural low-income communities;

15 and

16 ‘‘(vii) the efficiency of the administra17 tive mechanism in rapidly allocating funds

18 to the areas of greatest need within the

19 State;’’; and

20 (2) in paragraph (2)—

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

22 ‘‘and’’ at the end;

23 (B) by redesignating subparagraph (C) as

24 subparagraph (F); and
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1 (C) by inserting after subparagraph (B),

2 the following:

3 ‘‘(C) an assurance that capacity develop4 ment needs resulting from gaps in the provision

5 of services in underserved low-income and rural

6 low-income communities will be addressed; and

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

8 subsequent fiscal years, assurances that, in the

9 planning and allocation of resources, the State,

10 through systems of HIV-related health services

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

12 section 2612(a), will make appropriate provi13 sion for the HIV-related health and support

14 service needs of individuals who have been diag15 nosed with HIV disease but who are not cur16 rently receiving such services, based on the epi17 demiologic measures developed under paragraph

18 (1)(C)(i);’’.

19 SEC. 122. QUALITY MANAGEMENT.

20 (a) STATE REQUIREMENT FOR QUALITY MANAGE21 MENT.—Section 2617(b)(4) (42 U.S.C. 300ff–27(b)(4)) is

22 amended—

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

24 the following:

25 ‘‘(C) the State will provide for—
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1 ‘‘(i) the establishment of a quality

2 management program to assess the extent

3 to which medical services provided to pa4 tients under the grant are consistent with

5 the most recent Public Health Service

6 guidelines for the treatment of HIV dis7 ease and related opportunistic infections

8 and to develop strategies for improvements

9 in the access to and quality of medical

10 services; and

11 ‘‘(ii) a periodic review (such as

12 through an independent peer review) to as13 sess the quality and appropriateness of

14 HIV-related health and support services

15 provided by entities that receive funds

16 from the State under this part;’’;

17 (2) by redesignating subparagraphs (E) and

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

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

20 following:

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

22 systems of HIV-related health services provided

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

24 2612(a), has considered strategies for working

25 with providers to make optimal use of financial
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1 assistance under the State medicaid plan under

2 title XIX of the Social Security Act, the State

3 Children’s Health Insurance Program under

4 title XXI of such Act, and other Federal grant5 ees that provide HIV-related services, to maxi6 mize access to quality HIV-related health and

7 support services;

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

9 striking ‘‘and’’ at the end; and

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

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

12 (b) AVAILABILITY OF FUNDS FOR QUALITY MANAGE13 MENT.—

14 (1) AVAILABILITY OF GRANT FUNDS FOR PLAN15 NING AND EVALUATION.—Section 2618(c)(3) (42

16 U.S.C. 300ff–28(c)(3)) is amended by inserting be17 fore the period ‘‘, including not more than

18 $3,000,000 for all activities associated with its qual19 ity management program’’.

20 (2) EXCEPTION TO COMBINED CEILING ON

21 PLANNING AND ADMINISTRATION FUNDS FOR

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

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

24 amended to read as follows:
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1 ‘‘(6) EXCEPTION FOR QUALITY MANAGE2 MENT.—Notwithstanding paragraph (5), a State

3 whose grant under this part for a fiscal year does

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

5 percent of the amount of the grant for the purposes

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

7 ‘‘(A) that portion of such amount in excess

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

9 management program; and

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

11 approves a plan (in such form and containing

12 such information as the Secretary may pre13 scribe) for use of funds for its quality manage14 ment program.’’.

15 SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH

16 CARE RELATIONSHIPS.

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

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

19 at the end the following:

20 ‘‘(H) that funded entities maintain appro21 priate relationships with entities in the area

22 served that constitute key points of access to

23 the health care system for individuals with HIV

24 disease (including emergency rooms, substance

25 abuse treatment programs, detoxification cen-
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1 ters, adult and juvenile detention facilities, sex2 ually transmitted disease clinics, HIV coun3 seling and testing sites, and homeless shelters),

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

5 the purpose of facilitating early intervention for

6 individuals newly diagnosed with HIV disease

7 and individuals knowledgeable of their status

8 but not in care.’’.

9 SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH

10 CARE-RELATED.

11 (a) TECHNICAL AMENDMENT.—Section

12 3(c)(2)(A)(iii) of the Ryan White CARE Act Amendments

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

14 ‘‘before paragraph (2) as so redesignated’’ after ‘‘insert15 ing’’.

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

17 300ff–22(a)(1)), as so designated by section 121(a), is

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

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

20 that apply under such section’’.

21 (c) CONFORMING AMENDMENT TO STATE APPLICA22 TION REQUIREMENT.—Section 2617(b)(2) (42 U.S.C.

23 300ff–27(b)(2)), as amended by section 121(b), is further

24 amended by adding at the end the following:
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1 ‘‘(F) an assurance that the State has pro2 cedures in place to ensure that services pro3 vided with funds received under this section

4 meet the criteria specified in section

5 2604(b)(1)(B); and’’.

6 SEC. 125. USE OF GRANT FUNDS FOR EARLY INTERVEN7 TION SERVICES.

8 Section 2612(a) (42 U.S.C. 300ff–22(a)), as amend9 ed by section 121, is further amended by adding at the

10 end the following:

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

12 State, through systems of HIV-related health serv13 ices provided under paragraphs (1), (2), and (3) of

14 section 2612(a), may provide early intervention serv15 ices, as described in section 2651(b)(2), with follow16 up referral, provided for the purpose of facilitating

17 the access of individuals receiving the services to

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

19 providing such services—

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

21 2612(a)(1); or

22 ‘‘(ii) is an entity constituting a point of ac23 cess to services, as described in section

24 2617(b)(4), that maintains a referral relation25 ship with an entity described in clause (i) and
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1 that is serving individuals at elevated risk of

2 HIV disease; and

3 ‘‘(B) demonstrates to the State’s satisfac4 tion that no other Federal, State, or local funds

5 are available for the early intervention services

6 the entity will provide with funds received under

7 this paragraph.’’.

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. SUPPLEMENT 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 areas within the State

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

4 ‘‘(b) ELIGIBILITY.—To be eligible to receive a supple5 mental grant under subsection (a) a State shall—

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

7 subpart; and

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

9 severe need (as defined for purposes of section

10 2603(b)(2)(A) for supplemental financial assistance

11 in areas in the State that are not served through

12 grants under part A.

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

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

15 submitted under section 2617, submit a detailed descrip16 tion of the manner in which the State will use amounts

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

18 description shall include—

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

20 supplemental funds under this section and the plan

21 for the utilization of such funds;

22 ‘‘(2) a demonstration of the existing commit23 ment of local resources, both financial and in-kind;

24 ‘‘(3) a demonstration that the State will main25 tain HIV-related activities at a level that is equal to
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1 not less than the level of such activities in the State

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

3 which the State is applying to receive a grant under

4 this part;

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

6 to utilize such supplemental financial resources in a

7 manner that is immediately responsive and cost ef8 fective;

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

10 allocated in accordance with the local demographic

11 incidence of AIDS including appropriate allocations

12 for services for infants, children, women, and fami13 lies with HIV disease;

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

15 planning process, with particular emphasis on af16 fected communities and individuals with HIV dis17 ease; and

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

19 the proposed services are consistent with local needs

20 assessments and the statewide coordinated state21 ment of need.

22 ‘‘(d) AMOUNT RESERVED FOR EMERGING COMMU23 NITIES.—

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

25 this section for each fiscal year, the Secretary shall
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1 reserve the greater of 50 percent of the amount to

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

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

4 emerging communities for use in such communities.

5 ‘‘(2) DEFINITION.—In paragraph (1), the term

6 ‘emerging community’ means a metropolitan area—

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

8 part A; and

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

10 the Director of the Centers for Disease Control

11 and Prevention a cumulative total of between

12 1000 and 1999 cases of acquired immune defi13 ciency syndrome for the most recent period of

14 5 calendar years for which such data are avail15 able.

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

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

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

19 amount appropriated under section 2677 to carry out part

20 B for such fiscal year that is in excess of the amount ap21 propriated to carry out such part in fiscal year preceding

22 the fiscal year involved.

23 SEC. 129. USE OF TREATMENT FUNDS.

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

25 300ff–26(c)) is amended—
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1 (1) in the matter preceding paragraph (1), by

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

3 made available under this section to—’’;

4 (2) by redesignating paragraphs (1) through

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

6 and realigning the margins of such subparagraphs

7 appropriately;

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

9 by striking ‘‘and’’ at the end;

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

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

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

13 ‘‘(F) encourage, support, and enhance adher14 ence to and compliance with treatment regimens, in15 cluding related medical monitoring.’’;

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

17 following:

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

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

20 ‘‘(2) LIMITATIONS.—

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

22 funds under paragraph (1)(F) unless the limita23 tions on access to HIV/AIDS therapeutic regi24 mens as defined in subsection (e)(2) are elimi25 nated.
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1 ‘‘(B) AMOUNT OF FUNDING.—No State

2 shall use in excess of 10 percent of the amount

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

4 year to carry out activities under paragraph

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

6 Secretary that such additional services are es7 sential and in no way diminish access to thera8 peutics.’’.

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

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

11 following:

12 ‘‘(e) SUPPLEMENTAL GRANTS FOR THE PROVISION

13 OF TREATMENTS.—

14 ‘‘(1) IN GENERAL.—From amounts made avail15 able under paragraph (5), the Secretary shall award

16 supplemental grants to States determined to be eligi17 ble under paragraph (2) to enable such States to

18 provide access to therapeutics to treat HIV disease

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

20 for individuals at or below 200 percent of the Fed21 eral poverty line.

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

23 criteria for the awarding of grants under paragraph

24 (1) to States that demonstrate a severe need. In de25 termining the criteria for demonstrating State sever-
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1 ity of need (as defined for purposes of section

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

3 limitation to access exist such that—

4 ‘‘(A) the State programs under this section

5 are unable to provide HIV/AIDS therapeutic

6 regimens to all eligible individuals living at or

7 below 200 percent of the Federal poverty line;

8 and

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

10 are unable to provide to all eligible individuals

11 appropriate HIV/AIDS therapeutic regimens as

12 recommended in the most recent Federal treat13 ment guidelines.

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

15 may not make a grant to a State under this sub16 section unless the State agrees that—

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

18 or through donations from public or private en19 tities) non-Federal contributions toward the ac20 tivities to be carried out under the grant in an

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

22 funds provided in the grant; and

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

24 requirements for services or scope of benefits

25 limitations under subsection (a) that are more
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1 restrictive than such requirements in effect as

2 of January 1, 2000.

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

4 available under a grant under this subsection shall

5 only be used by the State to provide AIDS/HIV-re6 lated medications. The State shall coordinate the use

7 of such amounts with the amounts otherwise pro8 vided under this section in order to maximize drug

9 coverage.

10 ‘‘(5) FUNDING.—

11 ‘‘(A) RESERVATION OF AMOUNT.—The

12 Secretary may reserve not to exceed 4 percent,

13 but not less than 2 percent, of any amount re14 ferred to in section 2618(b)(2)(H) that is ap15 propriated for a fiscal year, to carry out this

16 subsection.

17 ‘‘(B) MINIMUM AMOUNT.—In providing

18 grants under this subsection, the Secretary

19 shall ensure that the amount of a grant to a

20 State under this part is not less than the

21 amount the State received under this part in

22 the previous fiscal year, as a result of grants

23 provided under this subsection.’’.
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1 (c) SUPPLEMENT AND NOT SUPPLANT.—Section

2 2616 (42 U.S.C. 300ff–26(c)), as amended by subsection

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

4 ‘‘(f) SUPPLEMENT NOT SUPPLANT.—Notwith5 standing any other provision of law, amounts made avail6 able under this section shall be used to supplement and

7 not supplant other funding available to provide treatments

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

9 SEC. 130. INCREASE IN MINIMUM ALLOTMENT.

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

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

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

13 and inserting ‘‘$200,000’’; and

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

15 and inserting ‘‘$500,000’’.

16 (b) TECHNICAL AMENDMENT.—Section

17 2618(b)(3)(B) (42 U.S.C. 300ff–28(b)(3)(B)) is amended

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

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

20 Federated States of Micronesia, and the Republic of

21 Palau’’.

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

23 WOMEN.

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

25 amended—
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1 (1) by inserting ‘‘for each population under this

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

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

4 ‘‘ratio of each’’.

5 Subtitle C—Amendments to Part C

6 (Early Intervention Services)

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

8 GRANT PROGRAM.

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

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

11 ‘‘PART C—EARLY INTERVENTION AND PRIMARY CARE

12 SERVICES’’.

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

14 300ff–41 et seq.) is amended—

15 (1) by repealing subpart I; and

16 (2) by redesignating subparts II and III as sub17 parts I and II.

18 (c) CONFORMING AMENDMENTS.—

19 (1) INFORMATION REGARDING RECEIPT OF

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

21 61(a)) is amended by striking ‘‘unless—’’ and all

22 that follows through ‘‘(2) in the case of’’ and insert23 ing ‘‘unless, in the case of’’.

24 (2) ADDITIONAL AGREEMENTS.—Section 2664

25 (42 U.S.C. 300ff–64) is amended—
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•S 2311 RS

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

2 ‘‘2642(b) or’’;

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

4 ‘‘2642(b) or’’; and

5 (C) by striking subsection (h).

6 SEC. 142. PLANNING AND DEVELOPMENT GRANTS.

7 (a) ALLOWING PLANNING AND DEVELOPMENT

8 GRANT TO EXPAND ABILITY TO PROVIDE PRIMARY CARE

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

10 amended—

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

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

13 planning and development grants to public and non14 profit private entities for the purpose of—

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

16 early intervention services; or

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

18 capacity, preparedness, and expertise to deliver

19 primary care services to individuals with HIV

20 disease in underserved low-income communities

21 on the condition that the funds are not used to

22 purchase or improve land or to purchase, con23 struct, or permanently improve (other than

24 minor remodeling) any building or other facil25 ity.’’; and
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1 (2) in paragraphs (2) and (3) by striking

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

3 inserting ‘‘paragraph (1)(A)’’.

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

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

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

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

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

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

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

14 an amount not to exceed $50,000.

15 ‘‘(B) CAPACITY DEVELOPMENT.—

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

18 not to exceed $150,000.

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

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

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

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

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

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

5 inserting ‘‘2001 through 2005’’.

6 SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY

7 MANAGEMENT PROGRAM.

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

9 amended—

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

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

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

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

15 inserting ‘‘; and’’; and

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

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

19 the extent to which medical services funded under

20 this title that are provided to patients are consistent

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

23 opportunistic infections and that improvements in

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

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

3 adding at the end the following:

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

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

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

10 Subtitle D—Amendments to Part D

11 (General Provisions)

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

14 (a) ELIMINATION OF REQUIREMENT TO ENROLL

15 SIGNIFICANT NUMBERS OF WOMEN AND CHILDREN.—

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

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

18 (C) and (D); and

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

20 (b) INFORMATION AND EDUCATION.—Section

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

22 at the end the following:

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

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

3 71(f)) is amended—

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

6 ‘‘(f) ADMINISTRATION.—

7 ‘‘(1) APPLICATION.—’’; and

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

9 ‘‘(2) QUALITY MANAGEMENT PROGRAM.—A

10 grantee under this section shall implement a quality

11 management program.’’.

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

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

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

17 projects to existing sites under this section for purposes

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

20 reasonably served by such projects.’’.

21 (e) AUTHORIZATION OF APPROPRIATIONS.—Section

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

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

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

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

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

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

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

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

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

9 later than 12 months after the date of enactment of

10 the Ryan White Care Act Amendments of 2000, the

11 Secretary, in consultation with grantees under this

12 part, shall conduct a review of the administrative,

13 program support, and direct service-related activities

14 that are carried out under this part to ensure that

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

19 ‘‘(2) REQUIREMENTS.—

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

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

23 in consultation with grantees under this part,

24 shall determine the relationship between the

25 costs of the activities referred to in paragraph

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

2 such paragraph.

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

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

9 SEC. 153. EVALUATIONS AND REPORTS.

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

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

12 through 2005’’.

13 SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR

14 GRANTS UNDER PARTS A AND B.

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

16 read as follows:

17 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

18 ‘‘There are authorized to be appropriated—

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

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

21 2005; and

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

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

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

2 (Demonstration and Training)

3 SEC. 161. AUTHORIZATION OF APPROPRIATIONS.

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

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

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

7 2001 through 2005’’.

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

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

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

11 2001 through 2005’’.

12 TITLE II—MISCELLANEOUS

13 PROVISIONS

14 SEC. 201. INSTITUTE OF MEDICINE STUDY.

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

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

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

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

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

22 and under-insured individuals with HIV disease.

23 (b) REQUIREMENTS.—

24 (1) COMPLETION.—The study under subsection

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

2 such subsection is entered into.

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

4 conducted under subsection (a) shall consider—

5 (A) the availability and utility of health

6 outcomes measures and data for HIV primary

7 care and support services and the extent to

8 which those measures and data could be used to

9 measure the quality of such funded services;

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

12 health outcomes, and resource use) within the

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

16 (C) existing and needed epidemiological

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

20 the relationship to the allocations process; and

21 (D) other factors determined to be relevant

22 to assessing an individual’s or community’s

23 ability to gain and sustain access to quality

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

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

3 Secretary of Health and Human Services shall prepare

4 and submit to the appropriate committees of Congress a

5 report describing the manner in which the conclusions and

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

8 SECTION 1. SHORT TITLE.

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

10 Amendments of 2000’’.

11 SEC. 2. REFERENCES; TABLE OF CONTENTS.

12 (a) REFERENCES.—Except as otherwise expressly pro13 vided, whenever in this Act an amendment or repeal is ex14 pressed in terms of an amendment to, or repeal of, a section

15 or other provision, the reference shall be considered to be

16 made to a section or other provision of the Public Health

17 Service Act (42 U.S.C. 201 et seq.).

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

19 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.
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Sec. 107. Hold harmless provision.

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

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

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

resources.

Sec. 122. Quality management.

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

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

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

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

children.

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

Sec. 128. Supplement grants for certain States.

Sec. 129. Use of treatment funds.

Sec. 130. Increase in minimum allotment.

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

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

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

Sec. 142. Planning and development grants.

Sec. 143. Authorization of appropriations for categorical grants.

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

Sec. 145. Preference for certain areas.

Sec. 146. Technical amendment.

Subtitle D—Amendments to Part D (General Provisions)

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

Sec. 152. Limitation on administrative expenses.

Sec. 153. Evaluations and reports.

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

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

Sec. 161. Authorization of appropriations.

TITLE II—MISCELLANEOUS PROVISIONS

Sec. 201. Institute of Medicine study.

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—
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1 (1) in subsection (b)—

2 (A) in paragraph (2)(C), by inserting before

3 the semicolon the following: ‘‘, including pro4 viders of housing and homeless services’’; and

5 (B) in paragraph (4), by striking

6 ‘‘shall—’’ and all that follows and inserting

7 ‘‘shall have the responsibilities specified in sub8 section (d).’’; and

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

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

11 council established under subsection (b) shall have the fol12 lowing duties:

13 ‘‘(1) PRIORITIES FOR ALLOCATION OF FUNDS.—

14 The council shall establish priorities for the allocation

15 of funds within the eligible area, including how best

16 to meet each such priority and additional factors that

17 a grantee should consider in allocating funds under

18 a grant, based on the following factors:

19 ‘‘(A) The size and demographic characteris20 tics of the population with HIV disease to be

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

22 needs of individuals living with HIV infection

23 who are not receiving HIV-related health serv24 ices.
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1 ‘‘(B) The documented needs of the popu2 lation with HIV disease with particular atten3 tion being given to disparities in health services

4 among affected subgroups within the eligible

5 area.

6 ‘‘(C) The demonstrated or probable cost and

7 outcome effectiveness of proposed strategies and

8 interventions, to the extent that data are reason9 ably available.

10 ‘‘(D) Priorities of the communities with

11 HIV disease for whom the services are intended.

12 ‘‘(E) The availability of other governmental

13 and non-governmental resources, including the

14 State medicaid plan under title XIX of the So15 cial Security Act and the State Children’s

16 Health Insurance Program under title XXI of

17 such Act to cover health care costs of eligible in18 dividuals and families with HIV disease.

19 ‘‘(F) Capacity development needs resulting

20 from gaps in the availability of HIV services in

21 historically underserved low-income commu22 nities.

23 ‘‘(2) COMPREHENSIVE SERVICE DELIVERY

24 PLAN.—The council shall develop a comprehensive

25 plan for the organization and delivery of health and
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1 support services described in section 2604. Such plan

2 shall be compatible with any existing State or local

3 plans regarding the provision of such services to indi4 viduals with HIV disease.

5 ‘‘(3) ASSESSMENT OF FUND ALLOCATION EFFI6 CIENCY.—The council shall assess the efficiency of the

7 administrative mechanism in rapidly allocating

8 funds to the areas of greatest need within the eligible

9 area.

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

11 council shall participate in the development of the

12 Statewide coordinated statement of need as initiated

13 by the State public health agency responsible for ad14 ministering grants under part B.

15 ‘‘(5) COORDINATION WITH OTHER FEDERAL

16 GRANTEES.—The council shall coordinate with Fed17 eral grantees providing HIV-related services within

18 the eligible area.

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

20 shall establish methods for obtaining input on com21 munity needs and priorities which may include pub22 lic meetings, conducting focus groups, and convening

23 ad-hoc panels.

24 ‘‘(e) PROCESS FOR ESTABLISHING ALLOCATION PRI25 ORITIES.—
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1 ‘‘(1) IN GENERAL.—Not later than 24 months

2 after the date of enactment of the Ryan White CARE

3 Act Amendments of 2000, the Secretary shall—

4 ‘‘(A) consult with eligible metropolitan

5 areas, affected communities, experts, and other

6 appropriate individuals and entities, to develop

7 epidemiologic measures for establishing the num8 ber of individuals living with HIV disease who

9 are not receiving HIV-related health services;

10 and

11 ‘‘(B) provide advice and technical assist12 ance to planning councils with respect to the

13 process for establishing priorities for the alloca14 tion of funds under subsection (d)(1).

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

16 shall not be required to establish priorities for indi17 viduals not in care until epidemiologic measures are

18 developed under paragraph (1).’’.

19 SEC. 102. QUALITY MANAGEMENT.

20 (a) FUNDS AVAILABLE FOR QUALITY MANAGEMENT.—

21 Section 2604 (42 U.S.C. 300ff–14) is amended—

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

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

24 (2) by inserting after subsection (b) the fol25 lowing:
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1 ‘‘(c) QUALITY MANAGEMENT.—

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

3 an eligible area that receives a grant under this part

4 shall provide for the establishment of a quality man5 agement program to assess the extent to which med6 ical services provided to patients under the grant are

7 consistent with the most recent Public Health Service

8 guidelines for the treatment of HIV disease and re9 lated opportunistic infection and to develop strategies

10 for improvements in the access to and quality of med11 ical services.

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

13 under a grant awarded under this part, the chief

14 elected official of an eligible area may use, for activi15 ties associated with its quality management program,

16 not more than the lesser of—

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

18 the grant; or

19 ‘‘(B) $3,000,000.’’.

20 (b) QUALITY MANAGEMENT REQUIRED FOR ELIGI21 BILITY FOR GRANTS.—Section 2605(a) (42 U.S.C. 300ff–

22 15(a)) is amended—

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

24 as paragraphs (5) through (8), respectively; and
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1 (2) by inserting after paragraph (2) the fol2 lowing:

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

4 area will satisfy all requirements under section

5 2604(c);’’.

6 SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH

7 CARE RELATIONSHIPS.

8 (a) USE OF AMOUNTS.—Section 2604(e)(1) (42 U.S.C.

9 300ff–14(d)(1)) (as so redesignated by section 102(a)) is

10 amended by inserting ‘‘and the State Children’s Health In11 surance Program under title XXI of such Act’’ after ‘‘Social

12 Security Act’’.

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

14 300ff–15(a)) is amended by inserting after paragraph (3),

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

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

17 that receive funds under a grant under section

18 2601(a) shall maintain appropriate relationships

19 with entities in the area served that constitute key

20 points of access to the health care system for individ21 uals with HIV disease (including emergency rooms,

22 substance abuse treatment programs, detoxification

23 centers, adult and juvenile detention facilities, sexu24 ally transmitted disease clinics, HIV counseling and

25 testing sites, mental health programs, and homeless
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1 shelters) and other entities under section 2652(a) for

2 the purpose of facilitating early intervention for indi3 viduals newly diagnosed with HIV disease and indi4 viduals knowledgeable of their status but not in

5 care;’’.

6 SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH

7 CARE-RELATED.

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

9 300ff–14(b)(1)) is amended—

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

11 by striking ‘‘HIV-related—’’ and inserting ‘‘HIV-re12 lated services, as follows:’’;

13 (2) in subparagraph (A)—

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

15 follows through ‘‘substance abuse treatment and’’

16 and inserting the following: ‘‘OUTPATIENT

17 HEALTH SERVICES.—Outpatient and ambulatory

18 health services, including substance abuse treat19 ment,’’; and

20 (B) by striking ‘‘; and’’ and inserting a pe21 riod;

22 (3) in subparagraph (B), by striking ‘‘(B) inpa23 tient case management’’ and inserting ‘‘(C) INPA24 TIENT CASE MANAGEMENT SERVICES.—Inpatient case

25 management’’; and
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1 (4) by inserting after subparagraph (A) the fol2 lowing:

3 ‘‘(B) OUTPATIENT SUPPORT SERVICES.—

4 Outpatient and ambulatory support services (in5 cluding case management), to the extent that

6 such services facilitate, enhance, support, or sus7 tain the delivery, continuity, or benefits of health

8 services for individuals and families with HIV

9 disease.’’.

10 (b) CONFORMING AMENDMENT TO APPLICATION RE11 QUIREMENTS.—Section 2605(a) (42 U.S.C. 300ff–15(a)), as

12 amended by section 102(b), is further amended—

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

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

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

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

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

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

19 place to ensure that services provided with funds re20 ceived under this part meet the criteria specified in

21 section 2604(b)(1).’’.
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1 SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVENTION

2 SERVICES.

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

4 300ff–14(b)(1)), as amended by section 104(a), is further

5 amended by adding at the end the following:

6 ‘‘(D) EARLY INTERVENTION SERVICES.—

7 Early intervention services as described in sec8 tion 2651(b)(2), with follow-through referral,

9 provided for the purpose of facilitating the access

10 of individuals receiving the services to HIV-re11 lated health services, but only if the entity pro12 viding such services—

13 ‘‘(i)(I) is receiving funds under sub14 paragraph (A) or (C); or

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

16 of access to services, as described in section

17 2605(a)(4), that maintains a relationship

18 with an entity described in subclause (I)

19 and that is serving individuals at elevated

20 risk of HIV disease;

21 ‘‘(ii) demonstrates to the satisfaction of

22 the chief elected official that Federal, State,

23 or local funds are inadequate for the early

24 intervention services the entity will provide

25 with funds received under this subpara26 graph; and
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1 ‘‘(iii) demonstrates to the satisfaction

2 of the chief elected official that funds will be

3 utilized under this subparagraph to supple4 ment not supplant other funds available for

5 such services in the year for which such

6 funds are being utilized.’’.

7 (b) CONFORMING AMENDMENTS TO APPLICATION RE8 QUIREMENTS.—Section 2605(a)(1) (42 U.S.C. 300ff–

9 15(a)(1)) is amended—

10 (1) in subparagraph (A), by striking ‘‘services to

11 individuals with HIV disease’’ and inserting ‘‘services

12 as described in section 2604(b)(1)’’; and

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

14 for individuals with HIV disease’’ and inserting

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

16 SEC. 106. REPLACEMENT OF SPECIFIED FISCAL YEARS RE17 GARDING THE SUNSET ON EXPEDITED DIS18 TRIBUTION REQUIREMENTS.

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

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

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

22 SEC. 107. HOLD HARMLESS PROVISION.

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

24 amended to read as follows:
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1 ‘‘(4) LIMITATION.—With respect to each of fiscal

2 years 2001 through 2005, the Secretary shall ensure

3 that the amount of a grant made to an eligible area

4 under paragraph (2) for such a fiscal year is not less

5 than an amount equal to 98 percent of the amount

6 the eligible area received for the fiscal year preceding

7 the year for which the determination is being made.’’.

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

9 WOMEN.

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

11 amended—

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

13 subsection’’ after ‘‘council’’; and

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

15 ‘‘ratio of each’’.

16 Subtitle B—Amendments to Part B

17 (Care Grant Program)

18 SEC. 121. STATE REQUIREMENTS CONCERNING IDENTIFICA19 TION OF NEED AND ALLOCATION OF RE20 SOURCES.

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

22 U.S.C. 300ff–22) is amended—

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

24 GENERAL.—A State’’; and

25 (2) in the matter following paragraph (5)—
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1 (A) by striking ‘‘Services’’ and inserting:

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

3 (B) by striking ‘‘paragraph (1)’’ and insert4 ing ‘‘subsection (a)(1)’’; and

5 (C) by striking ‘‘paragraph (2)’’ and insert6 ing ‘‘subsection (a)(2) and section 2613’’;

7 (b) APPLICATION.—Section 2617(b) (42 U.S.C. 300ff–

8 27(b)) is amended—

9 (1) in paragraph (1)(C)—

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

11 following:

12 ‘‘(i) the size and demographic charac13 teristics of the population with HIV disease

14 to be served, except that by not later than

15 October 1, 2002, the State shall take into

16 account the needs of individuals not in care,

17 based on epidemiologic measures developed

18 by the Secretary in consultation with the

19 State, affected communities, experts, and

20 other appropriate individuals (such State

21 shall not be required to establish priorities

22 for individuals not in care until such epi23 demiologic measures are developed);’’;

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

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

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

4 ‘‘(vi) the capacity development needs

5 resulting in gaps in the provision of HIV

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

8 and

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

11 to the areas of greatest need within the

12 State;’’; and

13 (2) in paragraph (2)—

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

15 at the end;

16 (B) by redesignating subparagraph (C) as

17 subparagraph (F); and

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

19 the following:

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

22 of services in underserved low-income and rural

23 low-income communities will be addressed; and

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

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

2 through systems of HIV-related health services

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

4 section 2612(a), will make appropriate provision

5 for the HIV-related health and support service

6 needs of individuals who have been diagnosed

7 with HIV disease but who are not currently re8 ceiving such services, based on the epidemiologic

9 measures developed under paragraph (1)(C)(i);’’.

10 SEC. 122. QUALITY MANAGEMENT.

11 (a) STATE REQUIREMENT FOR QUALITY MANAGE12 MENT.—Section 2617(b)(4) (42 U.S.C. 300ff–27(b)(4)) is

13 amended—

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

15 the following:

16 ‘‘(C) the State will provide for—

17 ‘‘(i) the establishment of a quality

18 management program to assess the extent to

19 which medical services provided to patients

20 under the grant are consistent with the most

21 recent Public Health Service guidelines for

22 the treatment of HIV disease and related

23 opportunistic infections and to develop

24 strategies for improvements in the access to

25 and quality of medical services; and
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1 ‘‘(ii) a periodic review (such as

2 through an independent peer review) to as3 sess the quality and appropriateness of

4 HIV-related health and support services

5 provided by entities that receive funds from

6 the State under this part;’’;

7 (2) by redesignating subparagraphs (E) and (F)

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

9 (3) by inserting after subparagraph (D), the fol10 lowing:

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

12 systems of HIV-related health services provided

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

14 2612(a), has considered strategies for working

15 with providers to make optimal use of financial

16 assistance under the State medicaid plan under

17 title XIX of the Social Security Act, the State

18 Children’s Health Insurance Program under title

19 XXI of such Act, and other Federal grantees that

20 provide HIV-related services, to maximize access

21 to quality HIV-related health and support serv22 ices;’’;

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

24 striking ‘‘and’’ at the end; and
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1 (5) in subparagraph (G), as so redesignated, by

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

3 (b) AVAILABILITY OF FUNDS FOR QUALITY MANAGE4 MENT.—

5 (1) AVAILABILITY OF GRANT FUNDS FOR PLAN6 NING AND EVALUATION.—Section 2618(c)(3) (42

7 U.S.C. 300ff–28(c)(3)) is amended by inserting before

8 the period ‘‘, including not more than $3,000,000 for

9 all activities associated with its quality management

10 program’’.

11 (2) EXCEPTION TO COMBINED CEILING ON PLAN12 NING AND ADMINISTRATION FUNDS FOR STATES WITH

13 SMALL GRANTS.—Paragraph (6) of section 2618(c)

14 (42 U.S.C. 300ff–28(c)(6)) is amended to read as fol15 lows:

16 ‘‘(6) EXCEPTION FOR QUALITY MANAGEMENT.—

17 Notwithstanding paragraph (5), a State whose grant

18 under this part for a fiscal year does not exceed

19 $1,500,000 may use not to exceed 20 percent of the

20 amount of the grant for the purposes described in

21 paragraphs (3) and (4) if—

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

23 be used for such purposes in excess of 15 percent

24 of the grant is used for its quality management

25 program; and
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1 ‘‘(B) the State submits and the Secretary

2 approves a plan (in such form and containing

3 such information as the Secretary may pre4 scribe) for use of funds for its quality manage5 ment program.’’.

6 SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH

7 CARE RELATIONSHIPS.

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

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

10 at the end the following:

11 ‘‘(H) that funded entities maintain appro12 priate relationships with entities in the area

13 served that constitute key points of access to the

14 health care system for individuals with HIV dis15 ease (including emergency rooms, substance

16 abuse treatment programs, detoxification centers,

17 adult and juvenile detention facilities, sexually

18 transmitted disease clinics, HIV counseling and

19 testing sites, mental health programs, and home20 less shelters), and other entities under section

21 2652(a), for the purpose of facilitating early

22 intervention for individuals newly diagnosed

23 with HIV disease and individuals knowledgeable

24 of their status but not in care.’’.
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1 SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH

2 CARE-RELATED.

3 (a) TECHNICAL AMENDMENT.—Section 3(c)(2)(A)(iii)

4 of the Ryan White CARE Act Amendments of 1996 (Public

5 Law 104–146) is amended by inserting ‘‘before paragraph

6 (2) as so redesignated’’ after ‘‘inserting’’.

7 (b) SERVICES.—Section 2612(a)(1) (42 U.S.C. 300ff–

8 22(a)(1)), as so designated by section 121(a), is amended

9 by striking ‘‘for individuals with HIV disease’’ and insert10 ing ‘‘, subject to the conditions and limitations that apply

11 under such section’’.

12 (c) CONFORMING AMENDMENT TO STATE APPLICATION

13 REQUIREMENT.—Section 2617(b)(2) (42 U.S.C. 300ff–

14 27(b)(2)), as amended by section 121(b), is further amended

15 by inserting after subparagraph (D) the following:

16 ‘‘(E) an assurance that the State has proce17 dures in place to ensure that services provided

18 with funds received under this section meet the

19 criteria specified in section 2604(b)(1)(B); and’’.

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

21 SERVICES.

22 Section 2612(a) (42 U.S.C. 300ff–22(a)), as amended

23 by section 121, is further amended—

24 (1) in paragraph (4), by striking ‘‘and’’ at the

25 end;
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1 (2) in paragraph (5), by striking the period and

2 inserting ‘‘; and’’; and

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

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

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

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

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

8 for the purpose of facilitating the access of individuals

9 receiving the services to HIV-related health services,

10 but only if the entity providing such services—

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

12 2612(a)(1); or

13 ‘‘(ii) is an entity constituting a point of ac14 cess to services, as described in section

15 2617(b)(4), that maintains a referral relation16 ship with an entity described in clause (i) and

17 that is serving individuals at elevated risk of

18 HIV disease;

19 ‘‘(B) demonstrates to the State’s satisfaction

20 that other Federal, State, or local funds are in21 adequate for the early intervention services the

22 entity will provide with funds received under

23 this paragraph; and

24 ‘‘(C) demonstrates to the satisfaction of the

25 State that funds will be utilized under this para-
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1 graph to supplement not supplant other funds

2 available for such services in the year for which

3 such funds are being utilized.’’.

4 SEC. 126. AUTHORIZATION OF APPROPRIATIONS FOR HIV5 RELATED SERVICES FOR WOMEN AND CHIL6 DREN.

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

8 amended by striking ‘‘fiscal years 1996 through 2000’’ and

9 inserting ‘‘fiscal years 2001 through 2005’’.

10 SEC. 127. REPEAL OF REQUIREMENT FOR COMPLETED IN11 STITUTE OF MEDICINE REPORT.

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

13 SEC. 128. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

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

15 Service Act (42 U.S.C. 300ff–11 et seq.) is amended by add16 ing at the end the following:

17 ‘‘SEC. 2622. SUPPLEMENTAL GRANTS.

18 ‘‘(a) IN GENERAL.—The Secretary shall award supple19 mental grants to States determined to be eligible under sub20 section (b) to enable such States to provide comprehensive

21 services of the type described in section 2612(a) to supple22 ment the services otherwise provided by the State under a

23 grant under this subpart in emerging communities within

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

25 A.
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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a supple2 mental grant under subsection (a) a State shall—

3 ‘‘(1) be eligible to receive a grant under this sub4 part;

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

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

7 and

8 ‘‘(3) submit the information described in sub9 section (c).

10 ‘‘(c) REPORTING REQUIREMENTS.—A State that de11 sires a grant under this section shall, as part of the State

12 application submitted under section 2617, submit a detailed

13 description of the manner in which the State will use

14 amounts received under the grant and of the severity of

15 need. Such description shall include—

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

17 supplemental funds under this section and the plan

18 for the utilization of such funds in the emerging com19 munity;

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

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

22 ‘‘(3) a demonstration that the State will main23 tain HIV-related activities at a level that is equal to

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

25 for the 1-year period preceding the fiscal year for
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1 which the State is applying to receive a grant under

2 this part;

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

4 to utilize such supplemental financial resources in a

5 manner that is immediately responsive and cost effec6 tive;

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

8 allocated in accordance with the local demographic

9 incidence of AIDS including appropriate allocations

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

11 with HIV disease;

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

13 planning process, with particular emphasis on af14 fected communities and individuals with HIV disease;

15 and

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

17 proposed services are consistent with local needs as18 sessments and the statewide coordinated statement of

19 need.

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

21 section, the term ‘emerging community’ means a metropoli22 tan area—

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

24 A; and
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1 ‘‘(2) for which there has been reported to the Di2 rector of the Centers for Disease Control and Preven3 tion a cumulative total of between 500 and 1999 cases

4 of acquired immune deficiency syndrome for the most

5 recent period of 5 calendar years for which such data

6 are available.

7 ‘‘(e) FUNDING.—

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

9 with respect to each fiscal year beginning with fiscal

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

11 shall utilize—

12 ‘‘(A) the greater of—

13 ‘‘(i) 25 percent of the amount appro14 priated under 2677 to carry out part B, ex15 cluding the amount appropriated under sec16 tion 2618(b)(2)(H), for such fiscal year that

17 is in excess of the amount appropriated to

18 carry out such part in fiscal year preceding

19 the fiscal year involved; or

20 ‘‘(ii) $5,000,000;

21 to provide funds to States for use in emerging

22 communities with at least 1000, but less than

23 2000, cases of AIDS as reported to and con24 firmed by the Director of the Centers for Disease

25 Control and Prevention for the five year period
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1 preceding the year for which the grant is being

2 awarded; and

3 ‘‘(B) the greater of—

4 ‘‘(i) 25 percent of the amount appro5 priated under 2677 to carry out part B, ex6 cluding the amount appropriated under sec7 tion 2618(b)(2)(H), for such fiscal year that

8 is in excess of the amount appropriated to

9 carry out such part in fiscal year preceding

10 the fiscal year involved; or

11 ‘‘(ii) $5,000,000;

12 to provide funds to States for use in emerging

13 communities with at least 500, but less than

14 1000, cases of AIDS reported to and confirmed

15 by the Director of the Centers for Disease Control

16 and Prevention for the five year period preceding

17 the year for which the grant is being awarded.

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

19 be effective only for fiscal years beginning in the first

20 fiscal year in which the amount appropriated under

21 2677 to carry out part B, excluding the amount ap22 propriated under section 2618(b)(2)(H), exceeds by at

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

24 2677 to carry out part B in fiscal year 2000, exclud-
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1 ing the amount appropriated under section

2 2618(b)(2)(H).

3 ‘‘(3) MINIMUM AMOUNT IN FUTURE YEARS.—Be4 ginning with the first fiscal year in which amounts

5 provided for emerging communities under paragraph

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

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

8 amounts made available under this section for the

9 types of emerging communities described in each such

10 paragraph in subsequent fiscal years is at least

11 $5,000,000.

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

13 awarded to a State under this section shall be deter14 mined by the Secretary based on the formula de15 scribed in section 2618(b)(2), except that in applying

16 such formula, the Secretary shall—

17 ‘‘(A) substitute ‘1.0’ for ‘.80’ in subpara18 graph (A)(ii)(I) of such section; and

19 ‘‘(B) not consider the provisions of subpara20 graphs (A)(ii)(II) and (C) of such section.’’.

21 SEC. 129. USE OF TREATMENT FUNDS.

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

23 300ff–26(c)) is amended—
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1 (1) in the matter preceding paragraph (1), by

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

3 made available under this section to—’’;

4 (2) by redesignating paragraphs (1) through (5)

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

6 realigning the margins of such subparagraphs appro7 priately;

8 (3) in subparagraph (D) (as so redesignated), by

9 striking ‘‘and’’ at the end;

10 (4) in subparagraph (E) (as so redesignated), by

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

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

13 ‘‘(F) encourage, support, and enhance adherence

14 to and compliance with treatment regimens, includ15 ing related medical monitoring.’’;

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

17 following:

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

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

20 ‘‘(2) LIMITATIONS.—

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

22 funds under paragraph (1)(F) unless the limita23 tions on access to HIV/AIDS therapeutic regi24 mens as defined in subsection (e)(2) are elimi25 nated.
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1 ‘‘(B) AMOUNT OF FUNDING.—No State shall

2 use in excess of 10 percent of the amount set3 aside for use under this section in any fiscal

4 year to carry out activities under paragraph

5 (1)(F) unless the State demonstrates to the Sec6 retary that such additional services are essential

7 and in no way diminish access to therapeutics.’’.

8 (b) SUPPLEMENT GRANTS.—Section 2616 (42 U.S.C.

9 300ff–26) is amended by adding at the end the following:

10 ‘‘(e) SUPPLEMENTAL GRANTS FOR THE PROVISION OF

11 TREATMENTS.—

12 ‘‘(1) IN GENERAL.—From amounts made avail13 able under paragraph (5), the Secretary shall award

14 supplemental grants to States determined to be eligi15 ble under paragraph (2) to enable such States to in16 crease access to therapeutics to treat HIV disease as

17 provided by the State under subsection (c)(1)(B) for

18 individuals at or below 200 percent of the Federal

19 poverty line.

20 ‘‘(2) CRITERIA.—The Secretary shall develop cri21 teria for the awarding of grants under paragraph (1)

22 to States that demonstrate a severe need. In deter23 mining the criteria for demonstrating State severity

24 of need, the Secretary shall consider eligibility stand25 ards and formulary composition.
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1 ‘‘(3) STATE REQUIREMENT.—The Secretary may

2 not make a grant to a State under this subsection un3 less the State agrees that—

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

5 or through donations from public or private enti6 ties) non-Federal contributions toward the ac7 tivities to be carried out under the grant in an

8 amount equal to $1 for each $4 of Federal funds

9 provided in the grant; and

10 ‘‘(B) the State will not impose eligibility re11 quirements for services or scope of benefits limi12 tations under subsection (a) that are more re13 strictive than such requirements in effect as of

14 January 1, 2000.

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

16 available under a grant under this subsection shall

17 only be used by the State to provide HIV/AIDS-re18 lated medications. The State shall coordinate the use

19 of such amounts with the amounts otherwise provided

20 under this section in order to maximize drug cov21 erage.

22 ‘‘(5) FUNDING.—

23 ‘‘(A) RESERVATION OF AMOUNT.—The Sec24 retary shall reserve 3 percent of any amount re25 ferred to in section 2618(b)(2)(H) that is appro-
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1 priated for a fiscal year, to carry out this sub2 section.

3 ‘‘(B) MINIMUM AMOUNT.—In providing

4 grants under this subsection, the Secretary shall

5 ensure that the amount of a grant to a State

6 under this part is not less than the amount the

7 State received under this part in the previous

8 fiscal year, as a result of grants provided under

9 this subsection.’’.

10 (c) SUPPLEMENT AND NOT SUPPLANT.—Section 2616

11 (42 U.S.C. 300ff–26(c)), as amended by subsection (b), is

12 further amended by adding at the end the following:

13 ‘‘(f) SUPPLEMENT NOT SUPPLANT.—Notwithstanding

14 any other provision of law, amounts made available under

15 this section shall be used to supplement and not supplant

16 other funding available to provide treatments of the type

17 that may be provided under this section.’’.

18 SEC. 130. INCREASE IN MINIMUM ALLOTMENT.

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

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

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

22 inserting ‘‘$200,000’’; and

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

24 inserting ‘‘$500,000’’.
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1 (b) TERRITORIES.—Section 2618(b)(1)(B) (42 U.S.C.

2 300ff–28(b)(1)(B)) is amended by inserting ‘‘the greater of

3 $50,000 or’’ after ‘‘shall be’’.

4 (c) TECHNICAL AMENDMENT.—Section 2618(b)(3)(B)

5 (42 U.S.C. 300ff–28(b)(3)(B)) is amended by striking ‘‘and

6 the Republic of the Marshall Islands’’ and inserting ‘‘, the

7 Republic of the Marshall Islands, the Federated States of

8 Micronesia, and the Republic of Palau, and only for pur9 poses of paragraph (1) the Commonwealth of Puerto Rico’’.

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

11 WOMEN.

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

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

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

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

16 ‘‘ratio of each’’.

17 Subtitle C—Amendments to Part C

18 (Early Intervention Services)

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

20 GRANT PROGRAM.

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

22 C of title XXVI is amended to read as follows:
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1 ‘‘PART C—EARLY INTERVENTION AND PRIMARY CARE

2 SERVICES’’.

3 (b) REPEAL.—Part C of title XXVI (42 U.S.C. 300ff–

4 41 et seq.) is amended—

5 (1) by repealing subpart I; and

6 (2) by redesignating subparts II and III as sub7 parts I and II.

8 (c) CONFORMING AMENDMENTS.—

9 (1) INFORMATION REGARDING RECEIPT OF SERV10 ICES.—Section 2661(a) (42 U.S.C. 300ff–61(a)) is

11 amended by striking ‘‘unless—’’ and all that follows

12 through ‘‘(2) in the case of’’ and inserting ‘‘unless, in

13 the case of’’.

14 (2) ADDITIONAL AGREEMENTS.—Section 2664

15 (42 U.S.C. 300ff–64) is amended—

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

17 ‘‘2642(b) or’’;

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

19 ‘‘2642(b) or’’; and

20 (C) by striking subsection (h).

21 SEC. 142. PLANNING AND DEVELOPMENT GRANTS.

22 (a) ALLOWING PLANNING AND DEVELOPMENT GRANT

23 TO EXPAND ABILITY TO PROVIDE PRIMARY CARE SERV24 ICES.—Section 2654(c) (42 U.S.C. 300ff–54(c)) is

25 amended—
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1 (1) in paragraph (1), to read as follows:

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

3 planning and development grants to public and non4 profit private entities for the purpose of—

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

6 early intervention services; or

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

8 capacity, preparedness, and expertise to deliver

9 primary care services to individuals with HIV

10 disease in underserved low-income communities

11 on the condition that the funds are not used to

12 purchase or improve land or to purchase, con13 struct, or permanently improve (other than

14 minor remodeling) any building or other facil15 ity.’’; and

16 (2) in paragraphs (2) and (3) by striking ‘‘para17 graph (1)’’ each place that such appears and insert18 ing ‘‘paragraph (1)(A)’’.

19 (b) AMOUNT; DURATION.—Section 2654(c) (42 U.S.C.

20 300ff–54(c)), as amended by subsection (a), is further

21 amended—

22 (1) by redesignating paragraph (4) as para23 graph (5); and

24 (2) by inserting after paragraph (3) the fol25 lowing:
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1 ‘‘(4) AMOUNT AND DURATION OF GRANTS.—

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

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

4 an amount not to exceed $50,000.

5 ‘‘(B) CAPACITY DEVELOPMENT.—

6 ‘‘(i) AMOUNT.—A grant under para7 graph (1)(B) may be made in an amount

8 not to exceed $150,000.

9 ‘‘(ii) DURATION.—The total duration

10 of a grant under paragraph (1)(B), includ11 ing any renewal, may not exceed 3 years.’’.

12 (c) INCREASE IN LIMITATION.—Section 2654(c)(5) (42

13 U.S.C. 300ff–54(c)(5)), as so redesignated by subsection (b),

14 is amended by striking ‘‘1 percent’’ and inserting ‘‘5 per15 cent’’.

16 SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CAT17 EGORICAL GRANTS.

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

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

20 inserting ‘‘2001 through 2005’’.

21 SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY

22 MANAGEMENT PROGRAM.

23 Section 2664(g) (42 U.S.C. 300ff–64(g)) is amended—

24 (1) in paragraph (3), to read as follows:
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1 ‘‘(3) the applicant will not expend more than 10

2 percent of the grant for costs of administrative activi3 ties with respect to the grant;’’;

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

5 inserting ‘‘; and’’; and

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

7 ‘‘(5) the applicant will provide for the establish8 ment of a quality management program to assess the

9 extent to which medical services funded under this

10 title that are provided to patients are consistent with

11 the most recent Public Health Service guidelines for

12 the treatment of HIV disease and related opportun13 istic infections and that improvements in the access

14 to and quality of medical services are addressed.’’.

15 SEC. 145. PREFERENCE FOR CERTAIN AREAS.

16 Section 2651 (42 U.S.C. 300ff–51) is amended by add17 ing at the end the following:

18 ‘‘(d) PREFERENCE IN AWARDING GRANTS.—In award19 ing new grants under this section, the Secretary shall give

20 preference to applicants that will use amounts received

21 under the grant to serve areas that are determined to be

22 rural and underserved for the purposes of providing health

23 care to individuals infected with HIV or diagnosed with

24 AIDS.’’.
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1 SEC. 146. TECHNICAL AMENDMENT.

2 Section 2652(a) (42 U.S.C. 300ff–52(a)) is amended—

3 (1) by striking paragraphs (1) and (2) and in4 serting the following:

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

6 (2) by redesignating paragraphs (3) through (6)

7 as paragraphs (2) through (5), respectively.

8 Subtitle D—Amendments to Part D

9 (General Provisions)

10 SEC. 151. RESEARCH INVOLVING WOMEN, INFANTS, CHIL11 DREN, AND YOUTH.

12 (a) ELIMINATION OF REQUIREMENT TO ENROLL SIG13 NIFICANT NUMBERS OF WOMEN AND CHILDREN.—Section

14 2671(b) (42 U.S.C. 300ff–71(b)) is amended—

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

16 (C) and (D); and

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

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

19 (42 U.S.C. 300ff–71(d)) is amended by adding at the end

20 the following:

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

22 information and education on opportunities to par23 ticipate in HIV/AIDS-related clinical research.’’.

24 (c) QUALITY MANAGEMENT; ADMINISTRATIVE EX25 PENSES CEILING.—Section 2671(f) (42 U.S.C. 300ff–71(f))

26 is amended—
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1 (1) by striking the subsection heading and des2 ignation and inserting the following:

3 ‘‘(f) ADMINISTRATION.—

4 ‘‘(1) APPLICATION.—’’; and

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

6 ‘‘(2) QUALITY MANAGEMENT PROGRAM.—A

7 grantee under this section shall implement a quality

8 management program.’’.

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

10 300ff–71(g)) is amended by adding at the end the following:

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

12 examine the distribution and availability of ongoing and

13 appropriate HIV/AIDS-related research projects to existing

14 sites under this section for purposes of enhancing and ex15 panding voluntary access to HIV-related research, espe16 cially within communities that are not reasonably served

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

18 of enactment of the Ryan White CARE Act Amendments

19 of 2000, the Secretary shall prepare and submit to the ap20 propriate committees of Congress a report that describes the

21 findings made by the Director and the manner in which

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

23 (e) AUTHORIZATION OF APPROPRIATIONS.—Section

24 2671(j) (42 U.S.C. 300ff–71(j)) is amended by striking ‘‘fis-
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1 cal years 1996 through 2000’’ and inserting ‘‘fiscal years

2 2001 through 2005’’.

3 SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.

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

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

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

7 (2) by inserting after subsection (h), the fol8 lowing:

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

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

11 than 12 months after the date of enactment of the

12 Ryan White CARE Act Amendments of 2000, the Sec13 retary, in consultation with grantees under this part,

14 shall conduct a review of the administrative, program

15 support, and direct service-related activities that are

16 carried out under this part to ensure that eligible in17 dividuals have access to quality, HIV-related health

18 and support services and research opportunities under

19 this part, and to support the provision of such serv20 ices.

21 ‘‘(2) REQUIREMENTS.—

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

23 days after the expiration of the 12-month period

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

25 consultation with grantees under this part, shall
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1 determine the relationship between the costs of

2 the activities referred to in paragraph (1) and

3 the access of eligible individuals to the services

4 and research opportunities described in such

5 paragraph.

6 ‘‘(B) LIMITATION.—After a final determina7 tion under subparagraph (A), the Secretary may

8 not make a grant under this part unless the

9 grantee complies with such requirements as may

10 be included in such determination.’’.

11 SEC. 153. EVALUATIONS AND REPORTS.

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

13 striking ‘‘1991 through 1995’’ and inserting ‘‘2001 through

14 2005’’.

15 SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR

16 GRANTS UNDER PARTS A AND B.

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

18 as follows:

19 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

20 ‘‘There are authorized to be appropriated—

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

22 part A for each of the fiscal years 2001 through 2005;

23 and
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1 ‘‘(2) such sums as may be necessary to carry out

2 part B for each of the fiscal years 2001 through

3 2005.’’.

4 Subtitle E—Amendments to Part F

5 (Demonstration and Training)

6 SEC. 161. AUTHORIZATION OF APPROPRIATIONS.

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

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

9 years 1996 through 2000’’ and inserting ‘‘fiscal years 2001

10 through 2005’’.

11 (b) DENTAL SCHOOLS.—Section 2692(c)(2) (42 U.S.C.

12 300ff–111(c)(2)) is amended by striking ‘‘fiscal years 1996

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

14 2005’’.

15 (c) DENTAL SCHOOLS AND PROGRAMS.—Section

16 2692(b) of the Public Health Service Act (42 U.S.C. 300ff17 111(b)) is amended—

18 (1) in paragraph (1), by striking ‘‘777(b)(4)(B)’’

19 and inserting ‘‘777(b)(4)(B) (as such section existed

20 on the day before the date of enactment of the Health

21 Professions Education Partnerships Act of 1998 (Pub22 lic Law 105–392)) and dental hygiene programs that

23 are accredited by the Commission on Dental Accredi24 tation’’; and
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1 (2) in paragraph (2), by striking ‘‘777(b)(4)(B)’’

2 and inserting ‘‘777(b)(4)(B) (as such section existed

3 on the day before the date of enactment of the Health

4 Professions Education Partnerships Act of 1998 (Pub5 lic Law 105–392))’’.

6 TITLE II—MISCELLANEOUS

7 PROVISIONS

8 SEC. 201. INSTITUTE OF MEDICINE STUDY.

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

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

11 Human Services shall enter into a contract with the Insti12 tute of Medicine for the conduct of a study concerning the

13 appropriate epidemiological measures and their relation14 ship to the financing and delivery of primary care and

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

16 and under-insured individuals with HIV disease.

17 (b) REQUIREMENTS.—

18 (1) COMPLETION.—The study under subsection

19 (a) shall be completed not later than 21 months after

20 the date on which the contract referred to in such sub21 section is entered into.

22 (2) ISSUES TO BE CONSIDERED.—The study con23 ducted under subsection (a) shall consider—

24 (A) the availability and utility of health

25 outcomes measures and data for HIV primary
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1 care and support services and the extent to which

2 those measures and data could be used to meas3 ure the quality of such funded services;

4 (B) the effectiveness and efficiency of service

5 delivery (including the quality of services, health

6 outcomes, and resource use) within the context of

7 a changing health care and therapeutic environ8 ment as well as the changing epidemiology of the

9 epidemic;

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; and

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

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

21 Secretary of Health and Human Services shall prepare and

22 submit to the appropriate committees of Congress a report

23 describing the manner in which the conclusions and rec24 ommendations of the Institute of Medicine can be addressed

25 and implemented.

Calendar No. 548

106TH CONGRESS

2D SESSION S. 2311

[Report No. 106–294]

A BILL

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.

MAY 15, 2000

Reported with an amendment