(4) in paragraph (4) (as so redesignated)— 
(A) by striking ‘‘paragraph (6)’’ and in-
serting ‘‘paragraph (5)’’; and 
(B) by striking ‘‘paragraphs (3) and (4)’’ 
and inserting ‘‘paragraphs (2) and (3)’’; and 
(5) in paragraph (5) (as so redesignated), by 
striking ‘‘paragraph (3)’’ and all that follows 
through ‘‘(5),’’ and inserting the following: ‘‘para-
graphs (2) and (3), may, notwithstanding para-
graphs (2) through (4),’’. 
(f) REALLOCATION FOR SUPPLEMENTAL GRANTS.— 
Section 2618(d) of the Public Health Service Act (42 
U.S.C. 300ff–28(d)) is amended to read as follows: 
‘‘(d) REALLOCATION.—Any portion of a grant made 
to a State under section 2611 for a fiscal year that has 
not been obligated as described in subsection (c) ceases 
to be available to the State and shall be made available 
by the Secretary for grants under section 2620, in addi-
tion to amounts made available for such grants under sec-
tion 2623(b)(2).’’. 
(g) DEFINITIONS; OTHER
TECHNICAL
AMEND-
MENTS.—Section 2618(a) of the Public Health Service 
Act (42 U.S.C. 300ff–28(a)) is amended— 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00083
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
(1) in paragraph (1), in the matter preceding 
subparagraph (A), by striking ‘‘section 2677’’ and 
inserting ‘‘section 2623’’; 
(2) in paragraph (1)(A)— 
(A) in the matter preceding clause (i), by 
striking ‘‘each of the several States and the 
District of Columbia’’ and inserting ‘‘each of 
the 50 States, the District of Columbia, Guam, 
and the Virgin Islands (referred to in this para-
graph as a ‘covered State’)’’; and 
(B) in clause (i)— 
(i) in subclause (I), by striking ‘‘State 
or District’’ and inserting ‘‘covered State’’; 
and 
(ii) in subclause (II)— 
(I) by striking ‘‘State or Dis-
trict’’ and inserting ‘‘covered State’’; 
and 
(II) by inserting ‘‘and’’ after the 
semicolon; and 
(3) in paragraph (1)(B), by striking ‘‘each ter-
ritory of the United States, as defined in paragraph 
(3),’’ and inserting ‘‘each territory other than Guam 
and the Virgin Islands’’; 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00084
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
(4) in paragraph (2)(C)(i), by striking ‘‘or ter-
ritory’’; and 
(5) by striking paragraph (3). 
SEC. 204. ADDITIONAL AMENDMENTS TO SUBPART I OF 
PART B. 
(a) REFERENCES TO PART B.—Subpart I of part B 
of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff–21 et seq.) is amended by striking ‘‘this part’’ each 
place such term appears and inserting ‘‘section 2611’’. 
(b) HEPATITIS.—Section 2614(a)(3) of the Public 
Health Service Act (42 U.S.C. 300ff–24(a)(3)) is amend-
ed by inserting ‘‘, including specialty care and vaccinations 
for hepatitis co-infection,’’ after ‘‘health services’’. 
(c) APPLICATION FOR GRANT.— 
(1) COORDINATION.—Section 2617(b) of the 
Public Health Service Act (42 U.S.C. 300ff–27(b)) 
is amended— 
(A) 
by 
redesignating 
paragraphs 
(4) 
through (6) as paragraphs (5) through (7), re-
spectively; 
(B) by inserting after paragraph (3), the 
following: 
‘‘(4) the designation of a lead State agency that 
shall— 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00085
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
‘‘(A) administer all assistance received 
under this part; 
‘‘(B) conduct the needs assessment and 
prepare the State plan under paragraph (3); 
‘‘(C) prepare all applications for assistance 
under this part; 
‘‘(D) receive notices with respect to pro-
grams under this title; 
‘‘(E) every 2 years, collect and submit to 
the Secretary all audits, consistent with Office 
of Management and Budget circular A133, 
from grantees within the State, including audits 
regarding funds expended in accordance with 
this part; and 
‘‘(F) carry out any other duties determined 
appropriate by the Secretary to facilitate the 
coordination of programs under this title.’’; 
(C) in paragraph (5) (as so redesig-
nated)— 
(i) in subparagraph (E), by striking 
‘‘and’’ at the end; and 
(ii) by inserting after subparagraph 
(F) the following: 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00086
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
‘‘(G) includes key outcomes to be measured 
by all entities in the State receiving assistance 
under this title; and’’; and 
(D) in paragraph (7) (as so redesignated), 
in subparagraph (A)— 
(i) by striking ‘‘paragraph (5)’’ and 
inserting ‘‘paragraph (6)’’; and 
(ii) by striking ‘‘paragraph (4)’’ and 
inserting ‘‘paragraph (5)’’. 
(2) NATIVE
AMERICAN
REPRESENTATION.— 
Section 2617(b)(6) of the Public Health Service Act, 
as redesignated by paragraph (1)(A) of this sub-
section, is amended by inserting before ‘‘representa-
tives of grantees’’ the following: ‘‘members of a Fed-
erally recognized Indian tribe as represented in the 
State,’’. 
(3) 
PAYER
OF
LAST
RESORT.—Section 
2617(b)(7)(F)(ii) of the Public Health Service Act, 
as redesignated by paragraph (1)(A) of this sub-
section, is amended by inserting before the semicolon 
the following: ‘‘(except for a program administered 
by or providing the services of the Indian Health 
Service)’’. 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00087
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
(d) MATCHING FUNDS; APPLICABILITY OF REQUIRE-
MENT.—Section 2617(d)(3) of the Public Health Service 
Act (42 U.S.C. 300ff–27(d)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘acquired 
immune deficiency syndrome’’ and inserting ‘‘HIV/ 
AIDS’’; and 
(2) in subparagraph (C), by striking ‘‘acquired 
immune deficiency syndrome’’ and inserting ‘‘HIV/ 
AIDS’’. 
SEC. 205. SUPPLEMENTAL GRANTS ON BASIS OF DEM-
ONSTRATED NEED. 
Subpart I of part B of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff–21 et seq.) is amend-
ed— 
(1) by redesignating section 2620 as section 
2621; and 
(2) by inserting after section 2619 the fol-
lowing: 
‘‘SEC. 2620. SUPPLEMENTAL GRANTS. 
‘‘(a) IN GENERAL.—For the purpose of providing 
services described in section 2612(a), the Secretary shall 
make grants to States— 
‘‘(1) whose applications under section 2617 
have demonstrated the need in the State, on an ob-
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00088
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
jective and quantified basis, for supplemental finan-
cial assistance to provide such services; and 
‘‘(2) that did not, for the most recent grant 
year 
pursuant 
to 
section 
2618(a)(1) 
or 
2618(a)(2)(G)(i) for which data is available, have 
more than 2 percent of grant funds under such sec-
tions canceled or covered by any waivers under sec-
tion 2622(c). 
‘‘(b) DEMONSTRATED NEED.—The factors consid-
ered by the Secretary in determining whether an eligible 
area has a demonstrated need for purposes of subsection 
(a)(1) may include any or all of the following: 
‘‘(1) The unmet need for such services, as de-
termined under section 2617(b). 
‘‘(2) An increasing need for HIV/AIDS-related 
services, including relative rates of increase in the 
number of cases of HIV/AIDS. 
‘‘(3) The relative rates of increase in the num-
ber of cases of HIV/AIDS within new or emerging 
subpopulations. 
‘‘(4) The current prevalence of HIV/AIDS. 
‘‘(5) Relevant factors related to the cost and 
complexity of delivering health care to individuals 
with HIV/AIDS in the eligible area. 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00089
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
‘‘(6) The impact of co-morbid factors, including 
co-occurring conditions, determined relevant by the 
Secretary. 
‘‘(7) The prevalence of homelessness. 
‘‘(8) The prevalence of individuals described 
under section 2602(b)(2)(M). 
‘‘(9) The relevant factors that limit access to 
health care, including geographic variation, adequacy 
of health insurance coverage, and language barriers. 
‘‘(10) The impact of a decline in the amount re-
ceived pursuant to section 2618 on services available 
to all individuals with HIV/AIDS identified and eli-
gible under this title. 
‘‘(c) PRIORITY IN MAKING GRANTS.—The Secretary 
shall provide funds under this section to a State to address 
the decline in services related to the decline in the amounts 
received pursuant to section 2618 consistent with the 
grant award to the State for fiscal year 2006, to the extent 
that the factor under subsection (b)(10) (relating to a de-
cline in funding) applies to the State. 
‘‘(d) CORE MEDICAL SERVICES.—The provisions of 
section 2612(b) apply with respect to a grant under this 
section to the same extent and in the same manner as 
such provisions apply with respect to a grant made pursu-
ant to section 2618(a)(1). 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00090
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
‘‘(e) APPLICABILITY OF GRANT AUTHORITY.—The 
authority to make grants under this section applies begin-
ning with the first fiscal year for which amounts are made 
available for such grants under section 2623(b)(1).’’. 
SEC. 206. EMERGING COMMUNITIES. 
Section 2621 of the Public Health Service Act, as re-
designated by section 205(1) of this Act, is amended— 
(1) in the heading for the section, by striking 
‘‘SUPPLEMENTAL
GRANTS’’ 
and 
inserting 
‘‘EMERGING COMMUNITIES’’; 
(2) in subsection (b)— 
(A) in paragraph (2), by striking ‘‘and’’ at 
the end; 
(B) by redesignating paragraph (3) as 
paragraph (4); and 
(C) by inserting after paragraph (2) the 
following: 
‘‘(3) agree that the grant will be used to pro-
vide funds directly to emerging communities in the 
State, separately from other funds under this title 
that are provided by the State to such communities; 
and’’; and 
(3) by striking subsections (d) and (e) and in-
serting the following: 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00091
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
‘‘(d) DEFINITIONS OF EMERGING COMMUNITY.—For 
purposes of this section, the term ‘emerging community’ 
means a metropolitan area (as defined in section 2607) 
for which there has been reported to and confirmed by 
the Director of the Centers for Disease Control and Pre-
vention a cumulative total of at least 500, but fewer than 
1,000, cases of AIDS during the most recent period of 
5 calendar years for which such data are available. 
‘‘(e) CONTINUED STATUS
AS EMERGING COMMU-
NITY.—Notwithstanding any other provision of this sec-
tion, a metropolitan area that is an emerging community 
for a fiscal year continues to be an emerging community 
until the metropolitan area fails, for three consecutive fis-
cal years— 
‘‘(1) to meet the requirements of subsection (d); 
and 
‘‘(2) to have a cumulative total of 750 or more 
living cases of AIDS (reported to and confirmed by 
the Director of the Centers for Disease Control and 
Prevention) as of December 31 of the most recent 
calendar year for which such data is available. 
‘‘(f) DISTRIBUTION.—The amount of a grant under 
subsection (a) for a State for a fiscal year shall be an 
amount equal to the product of— 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00092
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
‘‘(1) the amount available under section 
2623(b)(1) for the fiscal year; and 
‘‘(2) a percentage equal to the ratio constituted 
by the number of living cases of HIV/AIDS in 
emerging communities in the State to the sum of the 
respective numbers of such cases in such commu-
nities for all States.’’. 
SEC. 207. TIMEFRAME FOR OBLIGATION AND EXPENDI-
TURE OF GRANT FUNDS. 
Subpart I of part B of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff–21 et seq.), as 
amended by section 205, is further amended by adding 
at the end the following: 
‘‘SEC. 2622. TIMEFRAME FOR OBLIGATION AND EXPENDI-
TURE OF GRANT FUNDS. 
‘‘(a) OBLIGATION BY END OF GRANT YEAR.—Effec-
tive for fiscal year 2007 and subsequent fiscal years, funds 
from a grant award made to a State for a fiscal year pur-
suant to section 2618(a)(1) or 2618(a)(2)(G), or under 
section 2620 or 2621, are available for obligation by the 
State through the end of the one-year period beginning 
on the date in such fiscal year on which funds from the 
award first become available to the State (referred to in 
this section as the ‘grant year for the award’), except as 
provided in subsection (c)(1). 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00093
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
‘‘(b) SUPPLEMENTAL GRANTS; CANCELLATION OF 
UNOBLIGATED BALANCE OF GRANT AWARD.—Effective 
for fiscal year 2007 and subsequent fiscal years, if a grant 
award made to a State for a fiscal year pursuant to section 
2618(a)(2)(G)(ii), or under section 2620 or 2621, has an 
unobligated balance as of the end of the grant year for 
the award— 
‘‘(1) the Secretary shall cancel that unobligated 
balance of the award, and shall require the State to 
return any amounts from such balance that have 
been disbursed to the State; and 
‘‘(2) the funds involved shall be made available 
by the Secretary as additional amounts for grants 
pursuant to section 2620 for the first fiscal year be-
ginning after the fiscal year in which the Secretary 
obtains the information necessary for determining 
that the balance is required under paragraph (1) to 
be canceled, except that the availability of the funds 
for such grants is subject to section 2618(a)(2)(H) 
as applied for such year. 
‘‘(c) FORMULA GRANTS; CANCELLATION OF UNOBLI-
GATED BALANCE OF GRANT AWARD; WAIVER PERMIT-
TING CARRYOVER.— 
‘‘(1) IN
GENERAL.—Effective for fiscal year 
2007 and subsequent fiscal years, if a grant award 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00094
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
made to a State for a fiscal year pursuant to section 
2618(a)(1) or 2618(a)(2)(G)(i) has an unobligated 
balance as of the end of the grant year for the 
award, the Secretary shall cancel that unobligated 
balance of the award, and shall require the State to 
return any amounts from such balance that have 
been disbursed to the State, unless— 
‘‘(A) before the end of the grant year, the 
State submits to the Secretary a written appli-
cation for a waiver of the cancellation, which 
application includes a description of the pur-
poses for which the State intends to expend the 
funds involved; and 
‘‘(B) the Secretary approves the waiver. 
‘‘(2) EXPENDITURE
BY
END
OF
CARRYOVER 
YEAR.—With respect to a waiver under paragraph 
(1) that is approved for a balance that is unobli-
gated as of the end of a grant year for an award: 
‘‘(A) The unobligated funds are available 
for expenditure by the State involved for the 
one-year period beginning upon the expiration 
of the grant year (referred to in this section as 
the ‘carryover year’). 
‘‘(B) If the funds are not expended by the 
end of the carryover year, the Secretary shall 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00095
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
cancel that unexpended balance of the award, 
and shall require the State to return any 
amounts from such balance that have been dis-
bursed to the State. 
‘‘(3) USE OF CANCELLED BALANCES.—In the 
case of any balance of a grant award that is can-
celled under paragraph (1) or (2)(B), the grant 
funds involved shall be made available by the Sec-
retary as additional amounts for grants under sec-
tion 2620 for the first fiscal year beginning after the 
fiscal year in which the Secretary obtains the infor-
mation necessary for determining that the balance is 
required under such paragraph to be canceled, ex-
cept that the availability of the funds for such 
grants is subject to section 2618(a)(2)(H) as applied 
for such year. 
‘‘(4) CORRESPONDING REDUCTION IN FUTURE 
GRANT.— 
‘‘(A) IN GENERAL.—In the case of a State 
for which a balance from a grant award made 
pursuant 
to 
section 
2618(a)(1) 
or 
2618(a)(2)(G)(i) is unobligated as of the end of 
the grant year for the award— 
‘‘(i) the Secretary shall reduce, by the 
same amount as such unobligated balance, 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00096
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
the amount of the grant under such sec-
tion for the first fiscal year beginning after 
the fiscal year in which the Secretary ob-
tains the information necessary for deter-
mining that such balance was unobligated 
as of the end of the grant year (which re-
quirement for a reduction applies without 
regard to whether a waiver under para-
graph (1) has been approved with respect 
to such balance); and 
‘‘(ii) the grant funds involved in such 
reduction shall be made available by the 
Secretary as additional funds for grants 
under section 2620 for such first fiscal 
year, subject to section 2618(a)(2)(H); 
except that this subparagraph does not apply to 
the State if the amount of the unobligated bal-
ance was 2 percent or less. 
‘‘(B) 
RELATION
TO
INCREASES
IN 
GRANT.—A reduction under subparagraph (A) 
for a State for a fiscal year may not be taken 
into account in applying section 2618(a)(2)(H) 
with respect to the State for the subsequent fis-
cal year. 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00097
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
‘‘(d) TREATMENT
OF DRUG REBATES.—For pur-
poses of this section, funds that are drug rebates referred 
to in section 2616(g) may not be considered part of any 
grant award referred to in subsection (a).’’. 
SEC. 208. AUTHORIZATION OF APPROPRIATIONS FOR SUB-
PART I OF PART B. 
Subpart I of part B of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff–21 et seq.), as 
amended by section 207, is further amended by adding 
at the end the following: 
‘‘SEC. 2623. AUTHORIZATION OF APPROPRIATIONS. 
‘‘(a) IN GENERAL.—For the purpose of carrying out 
this subpart, there are authorized to be appropriated 
$1,195,500,000 for fiscal year 2007, $1,239,500,000 for 
fiscal year 2008, $1,285,200,000 for fiscal year 2009, 
$1,332,600,000 for fiscal year 2010, and $1,381,700,000 
for fiscal year 2011. Amounts appropriated under the pre-
ceding sentence for a fiscal year are available for obliga-
tion by the Secretary until the end of the second suc-
ceeding fiscal year. 
‘‘(b) RESERVATION OF AMOUNTS.— 
‘‘(1) EMERGING COMMUNITIES.—Of the amount 
appropriated under subsection (a) for a fiscal year, 
the Secretary shall reserve $5,000,000 for grants 
under section 2621. 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00098
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS
‘‘(2) SUPPLEMENTAL GRANTS.— 
‘‘(A) IN GENERAL.—Of the amount appro-
priated under subsection (a) for a fiscal year in 
excess of the 2006 adjusted amount, the Sec-
retary shall reserve 1⁄3 for grants under section 
2620, except that the availability of the re-
served funds for such grants is subject to sec-
tion 2618(a)(2)(H) as applied for such year, 
and except that any amount appropriated exclu-
sively for carrying out section 2616 (and, ac-
cordingly, 
distributed 
under 
section 
2618(a)(2)(G)) is not subject to this subpara-
graph. 
‘‘(B) 2006 ADJUSTED AMOUNT.—For pur-
poses of subparagraph (A), the term ‘2006 ad-
justed amount’ means the amount appropriated 
for fiscal year 2006 under section 2677(b) (as 
such section was in effect for such fiscal year), 
excluding any amount appropriated for such 
year exclusively for carrying out section 2616 
(and, accordingly, distributed under section 
2618(a)(2)(I), as so in effect).’’. 
SEC. 209. EARLY DIAGNOSIS GRANT PROGRAM. 
Section 2625 of the Public Health Service Act (42 
U.S.C. 300ff–33) is amended to read as follows: 
VerDate Aug 31 2005 
03:38 Sep 29, 2006
Jkt 049200
PO 00000
Frm 00099
Fmt 6652
Sfmt 6201
E:\BILLS\H6143.RH
H6143
mmaher on PROD1PC77 with BILLS