I
106TH CONGRESS
2D SESSION
H. R. 4807
To amend the Public Health Service Act to revise and extend programs
established under the Ryan White Comprehensive AIDS Resources Emer-
gency Act of 1990, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 29, 2000
Mr. COBURN (for himself, Mr. WAXMAN, Mr. BILIRAKIS, Mr. GREENWOOD,
Mr. BROWN of Ohio, Mr. STUPAK, Mr. ARMEY, Mr. BILBRAY, Mr. NOR-
WOOD, Mr. COX, Mr. ROGAN, Mr. BARRETT of Wisconsin, Mrs. BONO,
Mr. FOLEY, Mr. SHAYS, Mr. HINCHEY, Mr. WEYGAND, Mr. DEUTSCH,
Mr. BURR of North Carolina, Mrs. MORELLA, Mr. WELDON of Florida,
Mr. SHADEGG, and Mr. STEARNS) introduced the following bill; which
was referred to the Committee on Commerce
A BILL
To amend the Public Health Service Act to revise and extend
programs established under the Ryan White Comprehen-
sive AIDS Resources Emergency Act of 1990, and for
other purposes.
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 2000’’.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
TITLE I—EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL
NEED FOR SERVICES
Subtitle A—HIV Health Services Planning Councils
Sec. 101. Membership of councils.
Sec. 102. Duties of councils.
Sec. 103. Open meetings; other additional provisions.
Subtitle B—Type and Distribution of Grants
Sec. 111. Formula grants.
Sec. 112. Supplemental grants.
Subtitle C—Other Provisions
Sec. 121. Use of amounts.
Sec. 122. Application.
Sec. 123. Review of administrative costs and compensation.
TITLE II—CARE GRANT PROGRAM
Subtitle A—General Grant Provisions
Sec. 201. Priority for women, infants, and children.
Sec. 202. Use of grants.
Sec. 203. Grants to establish HIV care consortia.
Sec. 204. Provision of treatments.
Sec. 205. State application.
Sec. 206. Distribution of funds.
Sec. 207. Supplemental grants for certain States.
Subtitle B—Provisions Concerning Pregnancy and Perinatal Transmission of
HIV
Sec. 211. Authorization of appropriations; repeals.
Sec. 212. Grants.
Sec. 213. Study by Institute of Medicine.
Subtitle C—Certain Partner Notification Programs
Sec. 221. Grants for compliant partner notification programs.
TITLE III—EARLY INTERVENTION SERVICES
Subtitle A—Formula Grants for States
Sec. 301. Repeal of program.
Subtitle B—Categorical Grants
Sec. 311. Preferences in making grants.
Sec. 312. Planning and development grants.
Sec. 313. Authorization of appropriations.
Subtitle C—General Provisions
Sec. 321. Provision of certain counseling services.
Sec. 322. Additional required agreements.
TITLE IV—OTHER PROGRAMS AND ACTIVITIES
Subtitle A—Certain Programs for Research, Demonstrations, or Training
Sec. 401. Grants for coordinated services and access to research for women, in-
fants, children, and youth.
Sec. 402. AIDS education and training centers.
Subtitle B—General Provisions in Title XXVI
Sec. 411. Evaluations and reports.
Sec. 412. Data collection through Centers for Disease Control and Prevention.
Sec. 413. Coordination.
Sec. 414. Plan regarding release of prisoners with HIV disease.
Sec. 415. Audits.
Sec. 416. Administrative simplification.
Sec. 417. Authorization of appropriations for parts A and B.
TITLE V—GENERAL PROVISIONS
Sec. 501. Studies by Institute of Medicine.
Sec. 502. Development of rapid HIV test.
Sec. 503. Program management.
TITLE VI—EFFECTIVE DATE
Sec. 601. Effective date.
TITLE 
I—EMERGENCY 
RELIEF
FOR AREAS WITH SUBSTAN-
TIAL NEED FOR SERVICES
Subtitle A—HIV Health Services
Planning Councils
SEC. 101. MEMBERSHIP OF COUNCILS.
(a) IN GENERAL.—Section 2602(b) of the Public
Health Service Act (42 U.S.C. 300ff–12(b)) is amended—
(1) in paragraph (1), by striking ‘‘demographics
of the epidemic in the eligible area involved,’’ and in-
serting ‘‘demographics of the population of individ-
uals with HIV disease in the eligible area involved,’’;
and
(2) in paragraph (2)—
(A) in subparagraph (G), striking ‘‘or
AIDS’’;
(B) in subparagraph (K), by striking
‘‘and’’ at the end;
(C) in subparagraph (L), by striking the
period and inserting the following: ‘‘, including
but not limited to providers of HIV prevention
services; and’’; and
(D) by adding at the end the following
subparagraph:
‘‘(M) representatives of individuals who
formerly were Federal, State, or local prisoners,
were released from the custody of the penal sys-
tem during the preceding three years, and had
HIV disease as of the date on which the indi-
viduals were so released.’’.
(b) CONFLICTS OF INTERESTS.—Section 2602(b)(5)
of the Public Health Service Act (42 U.S.C. 300ff–
12(b)(5)) is amended by adding at the end the following
subparagraph:
‘‘(C) COMPOSITION OF COUNCIL.—The fol-
lowing applies regarding the membership of a
planning council under paragraph (1):
‘‘(i) Not less than 33 percent of the
council shall be individuals who are receiv-
ing HIV-related services pursuant to a
grant under section 2601(a), are not offi-
cers, employees, or consultants to any enti-
ty that receives amounts from such a
grant, and do not represent any such enti-
ty. For purposes of the preceding sentence,
an individual shall be considered to be re-
ceiving such services if the individual is a
parent of, or a caregiver for, a minor child
who is receiving such services.
‘‘(ii) With respect to membership on
the planning council, clause (i) may not be
construed as having any effect on entities
that receive funds from grants under any
of parts B through F but do not receive
funds from grants under section 2601(a),
on officers or employees of such entities, or
on individuals who represent such enti-
ties.’’.
SEC. 102. DUTIES OF COUNCILS.
(a) IN GENERAL.—Section 2602(b)(4) of the Public
Health Service Act (42 U.S.C. 300ff–12(b)(4)) is
amended—
(1) by redesignating subparagraphs (A) through
(E) as subparagraphs (C) through (G), respectively;
(2) by inserting before subparagraph (C) (as so
redesignated) the following subparagraphs:
‘‘(A) determine the size and demographics
of the population of individuals with HIV dis-
ease;
‘‘(B) determine the needs of such popu-
lation, with particular attention to—
‘‘(i) individuals with HIV disease who
are not receiving HIV-related services; and
‘‘(ii) disparities in access and services
among affected subpopulations and histori-
cally underserved communities;’’;
(3) in subparagraph (C) (as so redesignated),
by striking clauses (i) through (iv) and inserting the
following:
‘‘(i) size and demographics of the pop-
ulation of individuals with HIV disease (as
determined under subparagraph (A)) and
the needs of such population (as deter-
mined under subparagraph (B));
‘‘(ii) demonstrated (or probable) cost
effectiveness and outcome effectiveness of
proposed strategies and interventions, to
the extent that data are reasonably avail-
able;
‘‘(iii) priorities of the communities
with HIV disease for whom the services
are intended;
‘‘(iv) availability of other govern-
mental and nongovernmental resources to
provide HIV-related services to individuals
and families with HIV disease, including
the State plan under title XIX of the So-
cial Security Act (relating to the Medicaid
program) and the program under title XXI
of such Act (relating to the program for
State children’s health insurance); and
‘‘(v) capacity development needs re-
sulting from disparities in the availability
of HIV-related services in historically un-
derserved communities;’’;
(4) in subparagraph (D) (as so redesignated),
by amending the subparagraph to read as follows:
‘‘(D) develop a comprehensive plan for the
organization and delivery of health and support
services described in section 2604 that—
‘‘(i) includes a strategy for identifying
individuals with HIV disease who are not
receiving such services and for informing
the individuals of and enabling the individ-
uals to utilize the services, giving par-
ticular attention to eliminating disparities
in access and services among affected sub-
populations and historically underserved
communities, and including discrete goals,
a timetable, and an appropriate allocation
of funds;
‘‘(ii) includes a strategy to coordinate
the provision of such services with pro-
grams for HIV prevention and for the pre-
vention and treatment of substance abuse,
including programs that provide com-
prehensive treatment services for such
abuse; and
certain individuals with HIV disease), the Secretary, in
consultation with entities that receive amounts from
grants under section 2601(a) or 2611, shall develop epi-
demiologic measures—
‘‘(1) for establishing the number of individuals
living with HIV disease who are not receiving HIV-
related health services; and
‘‘(2) for carrying out the duties under sub-
section (b)(4).’’.
(c) TRAINING.—Section 2602(b) of the Public Health
Service Act (42 U.S.C. 300ff–12(b)) is amended by adding
at the end the following subsection:
‘‘(d) TRAINING GUIDANCE AND MATERIALS.—The
Secretary shall provide to each chief elected official receiv-
ing a grant under 2601(a) guidelines and materials for
training members of the planning council under paragraph
(1) regarding the duties of the council.’’.
SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVI-
SIONS.
Section 2602(b) of the Public Health Service Act (42
U.S.C. 300ff–12(b)) is amended—
(1) in paragraph (3), by striking subparagraph
(C); and
(2) by adding at the end the following para-
graph:
‘‘(7) PUBLIC DELIBERATIONS.—With respect to
a planning council under paragraph (1), the fol-
lowing applies:
‘‘(A) The council may not be chaired solely
by an employee of the grantee under section
2601(a).
‘‘(B) In accordance with criteria estab-
lished by the Secretary:
‘‘(i) The meetings of the council shall
be open to the public and shall be held
only after adequate notice to the public.
‘‘(ii) The records, reports, transcripts,
minutes, agenda, or other documents which
were made available to or prepared for or
by the council shall be available for public
inspection and copying at a single location.
‘‘(iii) Detailed minutes of each meet-
ing of the council shall be kept. The accu-
racy of all minutes shall be certified to by
the chair of the council.
‘‘(iv) This subparagraph does not
apply to any disclosure of information of a
personal nature that would constitute a
clearly unwarranted invasion of personal
privacy, including any disclosure of medical
information or personnel matters.’’.
Subtitle B—Type and Distribution
of Grants
SEC. 111. FORMULA GRANTS.
(a) EXPEDITED DISTRIBUTION.—Section 2603(a)(2)
of the Public Health Service Act (42 U.S.C. 300ff–
13(a)(2)) is amended in the first sentence by striking ‘‘for
each of the fiscal years 1996 through 2000’’ and inserting
‘‘for a fiscal year’’.
(b) AMOUNT
OF GRANT; ESTIMATE
OF LIVING
CASES.—
(1) IN GENERAL.—Section 2603(a)(3)) of the
Public Health Service Act (42 U.S.C. 300ff–
13(a)(3)) is amended—
(A) in subparagraph (C)(i), by inserting
before the semicolon the following: ‘‘, except
that (subject to subparagraph (D)), for grants
made pursuant to this paragraph for fiscal year
2005 and subsequent fiscal years, the cases
counted for each 12-month period beginning on
or after July 1, 2004, shall be cases of HIV
disease (as reported to and confirmed by such
Director) rather than cases of acquired immune
deficiency syndrome’’; and
(B) in subparagraph (C), in the matter
after and below clause (ii)(X)—
(i) in the first sentence, by inserting
before the period the following: ‘‘, and
shall be reported to the congressional com-
mittees of jurisdiction’’; and
(ii) by adding at the end the following
sentence: ‘‘Updates shall as applicable take
into account the counting of cases of HIV
disease pursuant to clause (i).’’
(2) DETERMINATION OF SECRETARY REGARD-
ING DATA ON HIV CASES.—Section 2603(a)(3)) of
the Public Health Service Act (42 U.S.C. 300ff–
13(a)(3)) is amended—
(A) by redesignating subparagraph (D) as
subparagraph (E); and
(B) by inserting after subparagraph (C)
the following subparagraph:
‘‘(D) DETERMINATION OF SECRETARY RE-
GARDING DATA ON HIV CASES.—
‘‘(i) IN
GENERAL.—Not later than
July 1, 2004, the Secretary shall deter-
mine whether there is data on cases of
HIV disease from all eligible areas (re-
ported to and confirmed by the Director of
the Centers for Disease Control and Pre-
vention) sufficiently accurate and reliable
for use for purposes of subparagraph
(C)(i). In making such a determination,
the Secretary shall take into consideration
the findings of the study under section
501(b) of the Ryan White CARE Act
Amendments of 2000 (relating to the rela-
tionship between epidemiological measures
and health care for certain individuals with
HIV disease), the fiscal impact of the use
of such data, the impact of the use of such
data on the organization and delivery of
HIV-related services in eligible areas, and
the fiscal impact of not using such data.
‘‘(ii) EFFECT
OF
ADVERSE
DETER-
MINATION.—If under clause (i) the Sec-
retary determines that data on cases of
HIV disease is not sufficiently accurate
and reliable for use for purposes of sub-
paragraph (C)(i), then notwithstanding
such subparagraph, for any fiscal year
prior to fiscal year 2007 the references in
such subparagraph to cases of HIV disease
do not have any legal effect.
‘‘(iii) GRANTS
AND
TECHNICAL
AS-
SISTANCE REGARDING COUNTING OF HIV
CASES.—Of the amounts appropriated
under section 2675 for a fiscal year, the
Secretary shall reserve amounts to make
grants and provide technical assistance to
States and eligible areas with respect to
obtaining data on cases of HIV disease to
ensure that data on such cases is available
from all States and eligible areas as soon
as is practicable but not later than the be-
ginning of fiscal year 2007.’’.
(c) INCREASES IN GRANT.—Section 2603(a)(4)) of
the Public Health Service Act (42 U.S.C. 300ff–13(a)(4))
is amended to read as follows:
‘‘(4) INCREASES IN GRANT.—
‘‘(A) IN GENERAL.—For each fiscal year in
a protection period for an eligible area, the Sec-
retary shall increase the amount of the grant
made pursuant to paragraph (2) for the area to
ensure that—
‘‘(i) for the first fiscal year in the pro-
tection period, the grant is not less than
98 percent of the amount of the grant
made for the eligible area pursuant to such
paragraph for the base year for the protec-
tion period;
‘‘(ii) for any second fiscal year in such
period, the grant is not less than 95.7 per-
cent of the amount of such base year
grant;
‘‘(iii) for any third fiscal year in such
period, the grant is not less than 91.1 per-
cent of the amount of the base year grant;
‘‘(iv) for any fourth fiscal year in such
period, the grant is not less than 84.2 per-
cent of the amount of the base year grant;
and
‘‘(v) for any fifth or subsequent fiscal
year in such period, the grant is not less
than 75 percent of the amount of the base
year grant.
‘‘(B) BASE YEAR; PROTECTION PERIOD.—
With respect to grants made pursuant to para-
graph (2) for an eligible area:
‘‘(i) The base year for a protection pe-
riod is the fiscal year preceding the trigger
grant-reduction year.
‘‘(ii) The first trigger grant-reduction
year is the first fiscal year (after fiscal
year 2000) for which the grant for the
area is less than the grant for the area for
the preceding fiscal year.
‘‘(iii) A protection period begins with
the trigger grant-reduction year and con-
tinues until the beginning of the first fiscal
year for which the amount of the grant for
the area equals or exceeds the amount of
the grant for the base year for the period.
‘‘(iv) Any subsequent trigger grant-re-
duction year is the first fiscal year, after
the end of the preceding protection period,
for which the amount of the grant is less
than the amount of the grant for the pre-
ceding fiscal year.’’.
SEC. 112. SUPPLEMENTAL GRANTS.
(a) IN GENERAL.—Section 2603(b)(2) of the Public
Health Service Act (42 U.S.C. 300ff–13(b)(2)) is
amended—
(1) in the heading for the paragraph, by strik-
ing ‘‘DEFINITION’’ and inserting ‘‘AMOUNT
OF
GRANT’’;
(2) by redesignating subparagraphs (A) through
(C) as subparagraphs (B) through (D), respectively;
(3) by inserting before subparagraph (B) (as so
redesignated) the following subparagraph:
‘‘(A) IN GENERAL.—The amount of each
grant made for purposes of this subsection shall
be determined by the Secretary based on a
weighting of factors under paragraph (1), with
severe need under subparagraph (B) of such
paragraph counting one-third.’’;
(4) in subparagraph (B) (as so redesignated)—
(A) in clause (ii), by striking ‘‘and’’ at the
end;
(B) in clause (iii), by striking the period
and inserting a semicolon; and
(C) by adding at the end the following
clauses:
‘‘(iv) the current prevalence of HIV
disease;
‘‘(v) an increasing need for HIV-re-
lated services, including relative rates of
increase in the number of cases of HIV
disease; as
‘‘(vi) unmet need for such services, as
determined under section 2602(b)(4).’’;
(5) in subparagraph (C) (as so redesignated)—
(A) by striking ‘‘subparagraph (A)’’ each
place such term appears and inserting ‘‘sub-
paragraph (B)’’’;
(B) in the second sentence, by striking ‘‘2
years after the date of enactment of this para-
graph’’ and inserting ‘‘18 months after the date
of the enactment of the Ryan White CARE Act
Amendments of 2000’’; and
(C) by inserting after the second sentence
the following sentence: ‘‘Such a mechanism
shall be modified to reflect the findings of the
study under section 501(b) of the Ryan White
CARE Act Amendments of 2000 (relating to
the relationship between epidemiological meas-
ures and health care for certain individuals with
HIV disease).’’; and
(6) in subparagraph (D) (as so redesignated),
by striking ‘‘subparagraph (B)’’ and inserting ‘‘sub-
paragraph (C)’’’.
(b) CONFORMING AMENDMENT.—Section 2603(b) of
the Public Health Service Act (42 U.S.C. 300ff–13(b)) is
amended—
(1) by striking paragraph (4); and
(2) by redesignating paragraph (5) as para-
graph (4).
Subtitle C—Other Provisions
SEC. 121. USE OF AMOUNTS.
(a) PRIMARY PURPOSES.—Section 2604(b)(1) of the
Public Health Service Act (42 U.S.C. 300ff–14(b)(1)) is
amended—
(1) in the matter preceding subparagraph (A),
by striking ‘‘HIV-related—’’ and inserting ‘‘HIV-re-
lated services, as follows:’’;
(2) in subparagraph (A)—
(A) by striking ‘‘outpatient’’ and all that
follows through ‘‘substance abuse treatment
and’’ and inserting the following: ‘‘Outpatient
and ambulatory health services, including sub-
stance abuse treatment,’’; and
(B) by striking ‘‘; and’’ and inserting a pe-
riod;
(3) in subparagraph (B), by striking ‘‘(B) inpa-
tient case management’’ and inserting ‘‘(C) Inpa-
tient case management’’;
(4) by inserting after subparagraph (A) the fol-
lowing subparagraph:
‘‘(B) Outpatient and ambulatory support
services (including case management), to the
extent that such services facilitate, support, or
sustain the delivery, or benefits of health serv-
ices for individuals and families with HIV dis-
ease.’’; and
(5) by adding at the end the following:
‘‘(D) Outreach activities that are intended
to identify individuals with HIV disease who are
not receiving HIV-related services, and that
are—
‘‘(i) necessary to implement the strat-
egy under section 2602(b)(4)(D);
‘‘(ii) conducted in a manner consistent
with 
the 
requirement 
under 
section
2605(a)(3); and
‘‘(iii) supplement, and do not sup-
plant, such activities that are carried out
with amounts appropriated under section
317.’’.
(b) ADDITIONAL PURPOSES.—Section 2604(b) (42
U.S.C. 300ff–14(b)) of the Public Health Service Act is
amended—
(1) by redesignating paragraph (3) as para-
graph (4);
(2) by inserting after paragraph (2) the fol-
lowing:
‘‘(3) EARLY INTERVENTION SERVICES.—
‘‘(A) IN
GENERAL.—The purposes for
which a grant under section 2601 may be used
include providing to individuals with HIV dis-
ease early intervention services described in sec-
tion 2651(b)(2) (including referrals under sub-
paragraph (C) of such section), subject to sub-
paragraph (B). The entities through which such
services may be provided under the grant in-
clude public health departments, emergency
rooms, substance abuse and mental health
treatment programs, detoxification centers, de-
tention facilities, clinics regarding sexually
transmitted diseases, homeless shelters, HIV
disease counseling and testing sites, health care
points of entry specified by States or eligible
areas, federally qualified health centers, and en-
tities described in section 2652(a).
‘‘(B) CONDITIONS.—With respect to an en-
tity that proposes to provide early intervention
services under subparagraph (A), such subpara-
graph applies only if the entity demonstrates to
the satisfaction of the chief elected official for
the eligible area involved that—
‘‘(i) Federal, State, or local funds are
otherwise inadequate for the early inter-
vention services the entity proposes to pro-
vide; and
‘‘(ii) the entity will expend funds pur-
suant to such subparagraph to supplement
and not supplant other funds available to
the entity for the provision of early inter-
vention services for the fiscal year in-
volved.’’; and
(3) in paragraph (4) (as so redesignated), by
inserting ‘‘youth,’’ after ‘‘children,’’ each place such
term appears;
(c) QUALITY MANAGEMENT.—Section 2604 of the
Public Health Service Act (42 U.S.C. 300ff–14) is
amended—
(1) by redesignating subsections (c) through (f)
as subsections (d) through (g), respectively; and
(2) by inserting after subsection (b) the fol-
lowing:
‘‘(c) QUALITY MANAGEMENT.—
‘‘(1) REQUIREMENT.—The chief elected official
of an eligible area that receives a grant under this
part shall provide for the establishment of a quality
management program to assess the extent to which
HIV health services provided to patients under the
grant are consistent with the most recent Public
Health Service guidelines for the treatment of HIV
disease and related opportunistic infection, and as
applicable, to develop strategies for ensuring that
such services are consistent with the guidelines.
‘‘(2) USE OF FUNDS.—From amounts received
under a grant awarded under this part for a fiscal
year, the chief elected official of an eligible area may
(in addition to amounts to which section 2604(e)(1)
applies) use for activities associated with the quality
management program required in paragraph (1) not
more than the lesser of—
‘‘(A) 5 percent of amounts received under
the grant; or
‘‘(B) $3,000,000.’’.
SEC. 122. APPLICATION.
Section 2605(a) of the Public Health Service Act (42
U.S.C. 300ff–15(a)) is amended—
(1) by redesignating paragraphs (3) through
(6) as paragraphs (4) through (7), respectively; and
(2) by inserting after paragraph (2) the fol-
lowing paragraph:
‘‘(3) that entities within the eligible area that
receive funds under a grant under section 2601(a)
will maintain relationships with appropriate entities
in the area, including entities described in section
2604(b)(3);’’.
SEC. 123. REVIEW OF ADMINISTRATIVE COSTS AND COM-
PENSATION.
Each chief elected official of an eligible area (as de-
fined in section 2607 of the Public Health Service Act)
shall ensure that, not later than one year after the date
of the enactment of this Act, the planning council for the
eligible area—
(1) conducts a review of the existing, available
data on the extent to which entities in the area that
receive amounts from a grant under section 2601(a)
of the Public Health Service Act have from their
overall budget expended amounts for administrative
costs (including financial compensation and bene-
fits), expressed as a proportion and indicating the
growth in such expenditures, including a statement
of the average amount expended for such costs per
client served and the average amount expended for
such costs per client served in providing HIV-related
services; and
(2) makes a determination of whether the fi-
nancial compensation of any officers or employees of
such entities exceeds that of the chief elected official
of the eligible area.
TITLE II—CARE GRANT
PROGRAM
Subtitle A—General Grant
Provisions
SEC. 201. PRIORITY FOR WOMEN, INFANTS, AND CHILDREN.
Section 2611(b) of the Public Health Service Act (42
U.S.C. 300ff–21(b)) is amended by inserting ‘‘youth,’’
after ‘‘children,’’ each place such term appears.
SEC. 202. USE OF GRANTS.
Section 2612 of the Public Health Service Act (42
U.S.C. 300ff–22) is amended—
(1) by striking ‘‘A State may use’’ and insert-
ing ‘‘(a) IN GENERAL.—A State may use’’; and
(2) by adding at the end the following sub-
sections:
‘‘(b) SUPPORT SERVICES; OUTREACH.—The pur-
poses for which a grant under this part may be used in-
clude delivering or enhancing the following:
‘‘(1) Support services under section 2611(a)
(including case management) to the extent that such
services facilitate, support, or sustain the delivery, or
benefits of health services for individuals and fami-
lies with HIV disease.
‘‘(2) Outreach activities that are intended to
identify individuals with HIV disease who are not re-
ceiving HIV-related services, and that are—
‘‘(A) necessary to implement the strategy
under section 2617(b)(4)(B);
‘‘(B) conducted in a manner consistent
with 
the 
requirement 
under 
section
2617(b)(6)(G); and
‘‘(C) supplement, and do not supplant,
such activities that are carried out with
amounts appropriated under section 317.’’.
‘‘(c) EARLY INTERVENTION SERVICES.—
‘‘(1) IN GENERAL.—The purposes for which a
grant under this part may be used include providing
to individuals with HIV disease early intervention
services described in section 2651(b)(2) (including
referrals under subparagraph (C) of such section),
subject to paragraph (2). The entities through which
such services may be provided under the grant in-
clude public health departments, emergency rooms,
substance abuse and mental health treatment pro-
grams, detoxification centers, detention facilities,
clinics regarding sexually transmitted diseases,
homeless shelters, HIV disease counseling and test-
ing sites, health care points of entry specified by
States or eligible areas, federally qualified health
centers, and entities described in section 2652(a).
‘‘(2) CONDITIONS.—With respect to an entity
that proposes to provide early intervention services
under paragraph (1), such paragraph applies only if
the entity demonstrates to the satisfaction of the
State area involved that—
‘‘(A) Federal, State, or local funds are oth-
erwise inadequate for the early intervention
services the entity proposes to provide; and
‘‘(B) the entity will expend funds pursuant
to such paragraph to supplement and not sup-
plant other funds available to the entity for the
provision of early intervention services for the
fiscal year involved.
‘‘(d) QUALITY MANAGEMENT.—
‘‘(1) REQUIREMENT.—Each State that receives
a grant under this part shall provide for the estab-
lishment of a quality management program to assess
the extent to which HIV health services provided to
patients under the grant are consistent with the
most recent Public Health Service guidelines for the
treatment of HIV disease and related opportunistic
infection, and as applicable, to develop strategies for
ensuring that such services are consistent with the
guidelines.
‘‘(2) USE OF FUNDS.—From amounts received
under a grant awarded under this part for a fiscal
year, the State may (in addition to amounts to
which section 2618(c)(5) applies) use for activities
associated with the quality management program re-
quired in paragraph (1) not more than the lesser
of—
‘‘(A) 5 percent of amounts received under
the grant; or
‘‘(B) $3,000,000.’’.
SEC. 203. GRANTS TO ESTABLISH HIV CARE CONSORTIA.
Section 2613 of the Public Health Service Act (42
U.S.C. 300ff–23) is amended—
(1) in subsection (b)(1)—
(A) in subparagraph (A), by inserting be-
fore the semicolon the following: ‘‘, particularly
those experiencing disparities in access and
services and those who reside in historically un-
derserved communities’’; and
(B) in subparagraph (B), by inserting
after ‘‘by such consortium’’ the following: ‘‘is
consistent with the comprehensive plan under
2617(b)(4) and’’; and
(2) in subsection (c)(1)—
(A) in subparagraph (D), by striking
‘‘and’’ after the semicolon at the end;
(B) in subparagraph (E), by striking the
period and inserting ‘‘; and’’; and
(C) by adding at the end the following sub-
paragraph:
‘‘(F) demonstrates that adequate planning
occurred to address disparities in access and
services and historically underserved commu-
nities.’’.
SEC. 204. PROVISION OF TREATMENTS.
Section 2616 of the Public Health Service Act (42
U.S.C. 300ff–26) is amended by adding at the end the
following subsection:
‘‘(e) USE OF HEALTH INSURANCE AND PLANS.—In
carrying out subsection (a), a State may expend a grant
under this part to provide the therapeutics described in
such subsection by paying on behalf of individuals with
HIV disease the costs of purchasing or maintaining health
insurance or plans whose coverage includes a full range
of such therapeutics and appropriate primary care serv-
ices.’’.
SEC. 205. STATE APPLICATION.
(a) DETERMINATION OF SIZE AND NEEDS OF POPU-
LATION; COMPREHENSIVE PLAN.—Section 2617(b) of the
Public Health Service Act (42 U.S.C. 300ff–27(b)) is
amended—
(1) by redesignating paragraphs (2) through
(4) as paragraphs (4) through (6), respectively;
(2) by inserting after paragraph (1) the fol-
lowing paragraphs:
‘‘(2) a determination of the size and demo-
graphics of the population of individuals with HIV
disease in the State;
‘‘(3) a determination of the needs of such popu-
lation, with particular attention to—
‘‘(A) individuals with HIV disease who are
not receiving HIV-related services; and
‘‘(B) disparities in access and services
among affected subpopulations and historically
underserved communities;’’; and
(3) in paragraph (4) (as so redesignated)—
(A) by striking ‘‘comprehensive plan for
the organization’’ and inserting ‘‘comprehensive
plan that describes the organization’’;
(B) by striking ‘‘, including—’’ and insert-
ing ‘‘, and that—’’;
(C) by redesignating subparagraphs (A)
through (C) as subparagraphs (D) through (F),
respectively;
(D) by inserting before subparagraph (C)
the following subparagraphs:
‘‘(A) establishes priorities for the allocation
of funds within the State based on—
‘‘(i) size and demographics of the pop-
ulation of individuals with HIV disease (as
determined under paragraph (2)) and the
needs of such population (as determined
under paragraph (3));
‘‘(ii) availability of other governmental
and nongovernmental resources to provide
HIV-related services to individuals and
families with HIV disease;
‘‘(iii) capacity development needs re-
sulting from disparities in the availability
of HIV-related services in historically un-
derserved communities and rural commu-
nities; and
‘‘(iv) the efficiency of the administra-
tive mechanism of the State for rapidly al-
locating funds to the areas of greatest need
within the State;
‘‘(B) includes a strategy for identifying in-
dividuals with HIV disease who are not receiv-
ing such services and for informing the individ-
uals of and enabling the individuals to utilize
the services, giving particular attention to elimi-
nating disparities in access and services among
affected subpopulations and historically under-
served communities, and including discrete
goals, a timetable, and an appropriate alloca-
tion of funds;
‘‘(C) includes a strategy to coordinate the
provision of such services with programs for
HIV prevention and for the prevention and
treatment of substance abuse, including pro-
grams that provide comprehensive treatment
services for such abuse;’’;
(E) in subparagraph (D) (as redesignated
by subparagraph (C) of this paragraph), by in-
serting ‘‘describes’’ before ‘‘the services and ac-
tivities’’;
(F) in subparagraph (E) (as so redesig-
nated), by inserting ‘‘provides’’ before ‘‘a de-
scription’’; and
(G) in subparagraph (F) (as so redesig-
nated), by inserting ‘‘provides’’ before ‘‘a de-
scription’’.
(b) PUBLIC PARTICIPATION.—Section 2617(b) of the
Public Health Service Act, as amended by subsection (a)
of this section, is amended—
(1) in paragraph (5), by striking ‘‘HIV’’ and in-
serting ‘‘HIV disease’’; and
(2) in paragraph (6), by amending subpara-
graph (A) to read as follows:
‘‘(A) the public health agency that is ad-
ministering the grant for the State engages in
a public advisory planning process, including
public hearings, that includes the participants
under paragraph (5) in developing the com-
prehensive plan under paragraph (4) and com-
menting on the implementation of such plan;’’.
(c) 
HEALTH
CARE
RELATIONSHIPS.—Section
2617(b) of the Public Health Service Act, as amended by
subsection (a) of this section, is amended in paragraph
(6)—
(1) in subparagraph (E), by striking ‘‘and’’ at
the end;
(2) in subparagraph (F), by striking the period
and inserting ‘‘; and’’; and
(3) by adding at the end the following subpara-
graph:
‘‘(G) entities within areas in which activi-
ties under the grant are carried out will main-
tain relationships with appropriate entities in
the area, including entities described in section
2612(c);’’.
SEC. 206. DISTRIBUTION OF FUNDS.
(a) MINIMUM ALLOTMENT.— Section 2618(b)(1) of
the Public Health Service Act (42 U.S.C. 300ff–28(b)(1))
is amended—
(1) in subparagraph (A)(i)—
(A) 
in 
subclause 
(I), 
by 
striking
‘‘$100,000’’ and inserting ‘‘$200,000’’; and
(B) 
in 
subclause 
(II), 
by 
striking
‘‘$250,000’’ and inserting ‘‘$500,000’’; and
(2) in subparagraph (B), by inserting after
‘‘shall be’’ the following: ‘‘the greater of $50,000
or’’.
(b) AMOUNT
OF GRANT; ESTIMATE
OF LIVING
CASES.—Section 2618(b)(2) of the Public Health Service
Act (42 U.S.C. 300ff–28(b)(2)) is amended—
(1) in subparagraph (A)(i), by striking ‘‘sub-
paragraph (H)’’ and inserting ‘‘subparagraph (I)’’;
(2) in subparagraph (D)(i), by inserting before
the semicolon the following: ‘‘, except that (subject
to subparagraph (E)), for grants made pursuant to
this paragraph for fiscal year 2005 and subsequent
fiscal years, the cases counted for each 12-month pe-
riod beginning on or after July 1, 2004, shall be
cases of HIV disease (as reported to and confirmed
by such Director) rather than cases of acquired im-
mune deficiency syndrome’’;
(3) 
by 
redesignating 
subparagraphs 
(E)
through (H) as subparagraphs (F) through (I), re-
spectively; and
(4) by inserting after subparagraph (D) the fol-
lowing subparagraph:
‘‘(E) DETERMINATION OF SECRETARY RE-
GARDING
DATA
ON
HIV
CASES.—If under
2603(a)(3)(D)(i) the Secretary determines that
data on cases of HIV disease is not sufficiently
accurate and reliable, then notwithstanding sub-
paragraph (D) of this paragraph, for any fiscal
year prior to fiscal year 2007 the references in
such subparagraph to cases of HIV disease do
not have any legal effect.’’.
(c) INCREASES
IN
FORMULA
AMOUNT.—Section
2618(b) of the Public Health Service Act (42 U.S.C.
300ff–28(b)) is amended—
(1) in paragraph (1)(A)(ii), by inserting before
the semicolon the following: ‘‘and then, as applica-
ble, increased under paragraph (3)’’;
(2) in paragraph (2)(A)(i), by inserting before
the semicolon the following: ‘‘and paragraph (3)’’;
(3) by redesignating paragraph (3) as para-
graph (4); and
(4) by inserting after paragraph (2) the fol-
lowing paragraph:
‘‘(3) INCREASES IN FORMULA AMOUNT.—
‘‘(A) ALLOCATION.—Of the amount appro-
priated under section 2677 for the fiscal year
involved for grants under part B, the Secretary
shall reserve a percentage to increase, in ac-
cordance with this paragraph, the amounts de-
termined for the States for the fiscal year under
paragraph ((2)(A) (in this paragraph referred
to as the ‘formula amount’).
‘‘(B) INCREASES FOR CERTAIN STATES.—
For each fiscal year in a protection period for
a State, the Secretary shall increase the for-
mula amount for the State to ensure that—