I 
109TH CONGRESS 
2D SESSION 
H. R. 5009 
To reauthorize the HIV Health Care Services Program under title XXVI 
of the Public Health Service Act. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 16, 2006 
Mr. WELDON of Florida (for himself and Mr. SOUDER) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Financial Services, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To reauthorize the HIV Health Care Services Program under 
title XXVI of the Public Health Service Act. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Ryan White CARE 
Act Amendments of 2006’’. 
SEC. 2. REAUTHORIZATION OF APPROPRIATIONS. 
Title XXVI of the Public Health Service Act (42 
U.S.C. 300ff–11 et seq.) is amended— 
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(1) in section 2677— 
(A) in subsection (a), by striking ‘‘2001 
through 2005’’ and inserting ‘‘2006 through 
2010’’; and 
(B) in subsection (b), by striking ‘‘2001 
through 2005’’ and inserting ‘‘2006 through 
2010’’; 
(2) in section 2625(c)(2)(A), by striking ‘‘2001 
through 2005’’ and inserting ‘‘2006 through 2010’’; 
(3) in section 2631(d), by striking ‘‘2005’’ and 
inserting ‘‘2010’’; 
(4) in section 2655, by striking ‘‘2001 through 
2005’’ and inserting ‘‘2006 through 2010’’; 
(5) in section 2671(l), as redesignated by sec-
tion 4(d)(1) of this Act, by striking ‘‘for each of’’ 
and all that follows through the period and inserting 
‘‘for each of the fiscal years 2006 through 2010.’’; 
and 
(6) in section 2692(c)— 
(A) in paragraph (1), by striking ‘‘2001 
through 2005’’ and inserting ‘‘2006 through 
2010’’; and 
(B) in paragraph (2)— 
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(i) in subparagraph (A), by striking 
‘‘2001 through 2005’’ and inserting ‘‘2006 
through 2010’’; and 
(ii) in subparagraph (B), by striking 
‘‘2001 through 2005’’ and inserting ‘‘2006 
through 2010’’. 
SEC. 3. DEFINITIONS. 
Section 2676 of the Public Health Service Act (42 
U.S.C. 300ff–76) is amended— 
(1) by redesignating paragraphs (11) and (12), 
as paragraphs (12) and (15), respectively; 
(2) by inserting after paragraph (10) the fol-
lowing: 
‘‘(11) PARTNER
NOTIFICATION.—The term 
‘partner notification’ means the process by which— 
‘‘(A) an HIV-positive individual provides 
the names of such individual’s sex and needle- 
sharing partners to health care providers or 
other health workers, who then confidentially 
notify the partners directly of the partners’ ex-
posure to HIV; and 
‘‘(B) current and past partners of an HIV- 
positive individual (index person) are confiden-
tially notified of the partners’ exposure to HIV, 
counseled about the partners’ exposure, and of-
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fered services, including testing, referrals for 
treatment, and notification of the partners’ sex 
and needle-sharing partners.’’; and 
(3) by inserting after paragraph (12) (as redes-
ignated by paragraph (1)) the following: 
‘‘(13) PRIMARY
MEDICAL
CARE.—The term 
‘primary medical care’ means medical care that con-
sists of medication, prescription drugs, diagnostic 
tests, 
visits 
with 
physicians 
and 
medically 
credentialed health care providers, treatment for oral 
health, treatment for psychiatric conditions, and 
treatment for other health care conditions directly 
related to HIV/AIDS infection, as well as the cost 
of health insurance premiums, co-payments, and 
deductibles. Such term does not include case man-
agement for non-medical services or short-term tran-
sitional housing. 
‘‘(14) ROUTINE TESTING.—The term ‘routine 
testing’ means HIV testing— 
‘‘(A) that is administered automatically to 
those accessing health care services for any rea-
son; and 
‘‘(B) in which— 
‘‘(i) pre-test counseling is not required 
but the subject is notified that the subject 
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will receive an HIV test and the subject 
may opt out of such testing; and 
‘‘(ii) for those individuals with a posi-
tive test result, post-test counseling, in-
cluding referrals to care, is provided and 
confidentiality is protected.’’. 
SEC. 4. FUNDING FOR PRIMARY MEDICAL CARE. 
(a) PART A.—Section 2604 of the Public Health 
Service Act (42 U.S.C. 300ff–14) is amended by adding 
at the end the following: 
‘‘(h) REQUIRED FUNDING FOR PRIMARY MEDICAL 
CARE.—Notwithstanding any other provision of law, a 
grantee under this part shall expend not less than 75 per-
cent of the funds received under the grant on primary 
medical care.’’. 
(b) PART B.—Section 2612 of the Public Health 
Service Act (42 U.S.C. 300ff–22) is amended by adding 
at the end the following: 
‘‘(e) REQUIRED FUNDING FOR PRIMARY MEDICAL 
CARE.—Notwithstanding any other provision of law, a 
grantee under this part shall expend not less than 75 per-
cent of the funds received under the grant on primary 
medical care.’’. 
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(c) PART C.—Subpart II of part C of title XXVI of 
the Public Health Service Act (42 U.S.C. 300ff–61 et 
seq.) is amended by adding at the end the following: 
‘‘SEC. 2668. REQUIRED FUNDING FOR PRIMARY MEDICAL 
CARE. 
‘‘Notwithstanding any other provision of law, a grant-
ee under this part shall expend not less than 75 percent 
of the funds received under the grant on primary medical 
care. Grant funds expended for the services described in 
subparagraphs (B) through (E) of section 2651(b)(2) 
shall count as expenditures on primary medical care.’’. 
(d) GRANTS FOR COORDINATED SERVICES AND AC-
CESS TO RESEARCH FOR WOMEN, INFANTS, CHILDREN, 
AND YOUTH.—Section 2671 of the Public Health Service 
Act (42 U.S.C. 300ff–71) is amended— 
(1) by redesignating subsection (k) as sub-
section (l); and 
(2) by inserting after subsection (j) the fol-
lowing: 
‘‘(k) REQUIRED FUNDING FOR PRIMARY MEDICAL 
CARE.—Notwithstanding any other provision of law, a 
grantee under this section shall expend not less than 75 
percent of the funds received under the grant on primary 
medical care.’’. 
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SEC. 5. SUPPLEMENTAL TREATMENT DRUG GRANTS SAFE-
TY NET. 
(a) IN GENERAL.—Section 2618(a)(2)(I)(ii) of the 
Public 
Health 
Service 
Act 
(42 
U.S.C. 
300ff– 
28(a)(2)(I)(ii)) is amended by striking subclauses (V) and 
(VI) and inserting the following: 
‘‘(V) FUNDING.— 
‘‘(aa) AUTHORIZATION
OF 
APPROPRIATIONS.—There is au-
thorized to be appropriated to 
carry out this clause for a fiscal 
year an amount that is not more 
than 8 percent of the amount ap-
propriated to carry out section 
2616 for such fiscal year. 
‘‘(bb) TRANSFER OF FUNDS 
WHEN APPROPRIATIONS ARE IN-
SUFFICIENT.— 
‘‘(AA) IN
GENERAL.— 
For any fiscal year for 
which the amount appro-
priated to carry out this 
clause and the amount redis-
tributed to carry out this 
clause pursuant to section 
2679 total less than 5 per-
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cent of the amount appro-
priated to carry out section 
2616 for such fiscal year, 
the Secretary shall transfer 
from funds appropriated to 
carry out this part (except 
this section) and parts A, C, 
D, E, and F, for the fiscal 
year and in accordance with 
subitem (BB), such amounts 
as are necessary to make the 
lesser of $35,000,000 or 5 
percent of the amount ap-
propriated to carry out sec-
tion 2616 for such fiscal 
year, available to carry out 
this clause for such fiscal 
year. 
‘‘(BB) FORMULA
FOR 
THE
TRANSFER
OF 
FUNDS.—In 
carrying 
out 
subitem (AA) for a fiscal 
year, the Secretary shall 
transfer 
from 
each 
part 
under this title an amount, 
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from the amount of funds 
appropriated for such part 
for the fiscal year, that 
bears the same relation to 
the total amount required to 
be 
transferred 
under 
subitem (AA) for the fiscal 
year, as the amount of funds 
appropriated to carry out 
such part for the fiscal year 
bears to the total amount of 
funds appropriated to carry 
out this title for such fiscal 
year. 
‘‘(CC) 
ADDITIONAL 
AMOUNTS
FROM
HRSA.—In 
addition 
to 
transferring 
funds under subitem (AA), 
the Secretary may transfer, 
for any fiscal year for which 
the amount appropriated to 
carry out this clause is less 
than $35,000,000, not more 
than $5,000,000 from ad-
ministrative funds of the 
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Health Resources and Serv-
ices Administration of the 
Department of Health and 
Human Services to carry out 
this clause.’’. 
(b) RETURN OF UNOBLIGATED FUNDS.— 
(1) IN GENERAL.—Part D of title XXVI of the 
Public Health Service Act (42 U.S.C. 300ff–71 et 
seq.) is amended by adding at the end the following: 
‘‘SEC. 2679. UNOBLIGATED FUNDS USED FOR SUPPLE-
MENTAL TREATMENT DRUG GRANTS. 
‘‘Notwithstanding any other provision of this title, 
any funds received under this title during a fiscal year 
that remain unobligated at the end of the second fiscal 
year succeeding the fiscal year during which the funds 
were received shall be returned to the Administrator of 
the Health Resources and Services Administration who 
shall redistribute such funds to carry out section 
2618(a)(2)(C)(ii).’’. 
(2) CONFORMING AMENDMENTS.—Section 2618 
of the Public Health Service Act (42 U.S.C. 300ff– 
28) is amended— 
(A) in subsection (a)(2)(I)(ii)(I) by strik-
ing ‘‘subclause (V)’’ and inserting ‘‘subclause 
(V) and section 2679’’; and 
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(B) by striking subsection (d). 
SEC. 6. ENSURING EQUITABLE PER CASE FUNDING. 
(a) DISTRIBUTION OF FUNDS.—Section 2618(a) of 
the Public Health Service Act (42 U.S.C. 300ff–28(a)) is 
amended— 
(1) in paragraph (1)(A)— 
(A) in clause (i)— 
(i) in subclause (I), by striking ‘‘cases 
of acquired immune deficiency syndrome, 
as determined under paragraph (2)(D)’’ 
and inserting ‘‘cases of HIV disease (re-
ported to and confirmed as accurate by the 
Director of the Centers for Disease Control 
and Prevention)’’; and 
(ii) in subclause (II)— 
(I) by striking ‘‘cases of acquired 
immune deficiency syndrome, as de-
termined under paragraph (2)(D)’’ 
and inserting ‘‘cases of HIV disease 
(reported to and confirmed as accu-
rate by the Director of the Centers for 
Disease Control and Prevention)’’; 
and 
(II) by inserting ‘‘and’’ after the 
semicolon; and 
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(B) in clause (ii), by striking ‘‘paragraph 
(2)(H)’’ and inserting ‘‘paragraph (2)(B)’’; and 
(2) in paragraph (2)— 
(A) by striking subparagraphs (A) through 
(G) and inserting the following: 
‘‘(A) FORMULA.— 
‘‘(i) IN
GENERAL.—The amount re-
ferred to in paragraph (1)(A)(ii) for a 
State and paragraph (1)(B) for a territory 
of the United States shall be determined— 
‘‘(I) for fiscal year 2007, accord-
ing to the formula under this para-
graph as in effect on the day before 
the date of enactment of the Ryan 
White CARE Act Amendments of 
2006; and 
‘‘(II) for fiscal year 2008 and 
each succeeding fiscal year, according 
to the formula described in clause (ii). 
‘‘(ii) AMOUNT BASED ON CASES NOT 
COUNTED UNDER PART A.—A State or ter-
ritory of the United States shall receive an 
amount under this part for a fiscal year 
that bears the same relation to the amount 
appropriated under section 2677(b) for 
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grants under this part for the fiscal year 
as the number of cases determined under 
clause (iii) for the State or territory for 
such fiscal year bears to the total number 
of cases determined under clause (iii) for 
all States and territories for such fiscal 
year. 
‘‘(iii) NUMBER OF CASES.— 
‘‘(I) REPORTING SYSTEM IN EF-
FECT
PRIOR
TO
OCTOBER
2000.—In 
the case of a State or territory that 
has enacted an HIV reporting system 
that has been confirmed as accurate 
and reliable by the Director of the 
Centers for Disease Control and Pre-
vention prior to October 1, 2000, the 
number of cases under this clause for 
such State or territory for a fiscal 
year shall be equal to the total num-
ber of reported cases of HIV disease 
(reported to and confirmed as accu-
rate by the Director of the Centers for 
Disease Control and Prevention) liv-
ing in the State or territory during 
such year, minus the number of re-
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ported cases of HIV disease (reported 
to and confirmed as accurate by the 
Director of the Centers for Disease 
Control and Prevention) living in such 
State or territory that are within an 
eligible area (as determined under 
part A). 
‘‘(II) REPORTING SYSTEM IN EF-
FECT
PRIOR
TO
OCTOBER
2006
BUT 
AFTER OCTOBER 2000.—In the case of 
a State or territory that has enacted 
an HIV reporting system that has 
been confirmed as accurate and reli-
able by the Director of the Centers for 
Disease Control and Prevention prior 
to October 1, 2006, but on or after 
October 1, 2000, the number of cases 
under this clause for such State or 
territory for a fiscal year shall be 
equal to the total number of cases of 
HIV disease (estimated by the Direc-
tor of the Centers for Disease Control 
and Prevention) living in the State or 
territory during such year, minus the 
number of cases of HIV disease (esti-
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mated by the Director of the Centers 
for Disease Control and Prevention) 
living in such State or territory that 
are within an eligible area (as deter-
mined under part A). 
‘‘(III) REPORTING
SYSTEM
NOT 
IN EFFECT BY OCTOBER 2006.—In the 
case of a State or territory that has 
not enacted an HIV reporting system 
that has been confirmed as accurate 
and reliable by the Director of the 
Centers for Disease Control and Pre-
vention prior to October 1, 2006, the 
number of cases under this clause for 
such State or territory for a fiscal 
year shall be equal to— 
‘‘(aa) until such time as 
such State or territory has en-
acted an HIV reporting system 
that has been confirmed as accu-
rate and reliable by the Director 
of the Centers for Disease Con-
trol and Prevention, the total 
number of reported cases of ac-
quired immune deficiency syn-
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drome (reported to and con-
firmed as accurate by the Direc-
tor of the Centers for Disease 
Control and Prevention) living in 
the State or territory during such 
year, minus the number of re-
ported cases of acquired immune 
deficiency syndrome (reported to 
and confirmed as accurate by the 
Director of the Centers for Dis-
ease Control and Prevention) liv-
ing in such State or territory 
that are within an eligible area 
(as determined under part A); 
and 
‘‘(bb) once such State or 
territory has enacted an HIV re-
porting system that has been 
confirmed as accurate and reli-
able by the Director of the Cen-
ters for Disease Control and Pre-
vention, the total number of 
cases of HIV disease (estimated 
by the Director of the Centers 
for Disease Control and Preven-
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tion) living in the State or terri-
tory during such year, minus the 
number of cases of HIV disease 
(estimated by the Director of the 
Centers for Disease Control and 
Prevention) living in such State 
or territory that are within an el-
igible area (as determined under 
part A).’’; 
(B) by redesignating subparagraphs (H) 
and (I) as subparagraphs (B) and (C), respec-
tively; 
(C) in subparagraph (B) (as redesignated 
by subparagraph (B))— 
(i) by striking ‘‘subparagraph (I)(i)’’ 
each place the term appears and inserting 
‘‘subparagraph (C)(i)’’; and 
(ii) by adding at the end the fol-
lowing: 
‘‘(iii) EFFECTIVE
DATE.—This sub-
paragraph shall be effective through Sep-
tember 30, 2008.’’; and 
(D) in subparagraph (C)(i) (as redesig-
nated by subparagraph (B)), by striking sub-
clauses (I) and (II) and inserting the following: 
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‘‘(I) 100 percent of such amount; 
and 
‘‘(II) the percentage constituted 
by the ratio of the total number of re-
ported cases of HIV disease (reported 
to an confirmed as accurate by the 
Director of the Centers for Disease 
Control and Prevention) living in the 
State to the total number of reported 
cases of HIV disease (reported to an 
confirmed as accurate by the Director 
of the Centers for Disease Control 
and Prevention) living in all States.’’. 
(b) CONFORMING AMENDMENTS.—Section 2631(c) 
of the Public Health Service Act (42 U.S.C. 300ff–38(c)) 
is amended by striking ‘‘for use for purposes of section 
2618(a)(2)(D)(i)’’ and inserting ‘‘as reported to and con-
firmed as accurate and reliable by the Director of the Cen-
ters for Disease Control and Prevention’’. 
(c) STRIKING
OF
SUPPLEMENTAL
GRANTS
IN 
EMERGING COMMUNITIES.—Title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff–11 et seq.) is amend-
ed by striking section 2620. 
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SEC. 7. ENSURING FUNDING CORRESPONDS WITH EPIDE-
MIOLOGICAL TRENDS. 
(a) ESTABLISHMENT OF PROGRAMS OF GRANTS.— 
(1) IN GENERAL.—Section 2601 of the Public 
Health Service Act (42 U.S.C. 300ff–11) is amend-
ed— 
(A) in subsection (a), by striking ‘‘for 
which there’’ and all that follows through the 
period and inserting ‘‘for which there is a cu-
mulative total of more than 2,500 living cases 
of HIV disease (reported to and confirmed as 
accurate by the Director of the Centers for Dis-
ease Control and Prevention). The Secretary 
shall make grants in accordance with section 
2603 to not more than 60 metropolitan areas 
that are eligible for such grants pursuant to 
this subsection.’’; 
(B) in subsection (b), by striking ‘‘cases of 
acquired immune deficiency syndrome’’ and in-
serting ‘‘living cases of HIV disease’’; 
(C) by striking subsection (c) and inserting 
the following: 
‘‘(c) REQUIREMENTS REGARDING POPULATION.— 
‘‘(1) NUMBER OF INDIVIDUALS.—The Secretary 
may not make a grant under this section for a met-
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