H. R. 6143
One Hundred Ninth Congress
of the
United States of America 
AT THE SECOND SESSION 
Begun and held at the City of Washington on Tuesday, 
the third day of January, two thousand and six 
An Act 
To amend title XXVI of the Public Health Service Act to revise and extend the 
program for providing life-saving care for those with HIV/AIDS.
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘Ryan White 
HIV/AIDS Treatment Modernization Act of 2006’’. 
(b) TABLE OF CONTENTS.—The table of contents of this Act 
is as follows:
Sec. 1. Short title; table of contents. 
TITLE I—EMERGENCY RELIEF FOR ELIGIBLE AREAS 
Sec. 101. Establishment of program; general eligibility for grants. 
Sec. 102. Type and distribution of grants; formula grants. 
Sec. 103. Type and distribution of grants; supplemental grants. 
Sec. 104. Timeframe for obligation and expenditure of grant funds. 
Sec. 105. Use of amounts. 
Sec. 106. Additional amendments to part A. 
Sec. 107. New program in part A; transitional grants for certain areas ineligible 
under section 2601. 
Sec. 108. Authorization of appropriations for part A. 
TITLE II—CARE GRANTS 
Sec. 201. General use of grants. 
Sec. 202. AIDS Drug Assistance Program. 
Sec. 203. Distribution of funds. 
Sec. 204. Additional amendments to subpart I of part B. 
Sec. 205. Supplemental grants on basis of demonstrated need. 
Sec. 206. Emerging communities. 
Sec. 207. Timeframe for obligation and expenditure of grant funds. 
Sec. 208. Authorization of appropriations for subpart I of part B. 
Sec. 209. Early diagnosis grant program. 
Sec. 210. Certain partner notification programs; authorization of appropriations. 
TITLE III—EARLY INTERVENTION SERVICES 
Sec. 301. Establishment of program; core medical services. 
Sec. 302. Eligible entities; preferences; planning and development grants. 
Sec. 303. Authorization of appropriations. 
Sec. 304. Confidentiality and informed consent. 
Sec. 305. Provision of certain counseling services. 
Sec. 306. General provisions. 
TITLE IV—WOMEN, INFANTS, CHILDREN, AND YOUTH 
Sec. 401. Women, infants, children, and youth. 
Sec. 402. GAO Report. 
TITLE V—GENERAL PROVISIONS 
Sec. 501. General provisions. 
TITLE VI—DEMONSTRATION AND TRAINING 
Sec. 601. Demonstration and training.
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Sec. 602. AIDS education and training centers. 
Sec. 603. Codification of minority AIDS initiative. 
TITLE VII—MISCELLANEOUS PROVISIONS 
Sec. 701. Hepatitis; use of funds. 
Sec. 702. Certain references. 
Sec. 703. Repeal.
TITLE I—EMERGENCY RELIEF FOR 
ELIGIBLE AREAS 
SEC. 101. ESTABLISHMENT OF PROGRAM; GENERAL ELIGIBILITY FOR 
GRANTS. 
(a) IN GENERAL.—Section 2601 of the Public Health Service 
Act (42 U.S.C. 300ff–11) is amended by striking subsections (b) 
through (d) and inserting the following: 
‘‘(b) CONTINUED STATUS AS ELIGIBLE AREA.—Notwithstanding 
any other provision of this section, a metropolitan area that is 
an eligible area for a fiscal year continues to be an eligible area 
until the metropolitan area fails, for three consecutive fiscal years—
‘‘(1) to meet the requirements of subsection (a); and 
‘‘(2) to have a cumulative total of 3,000 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. 
‘‘(c) BOUNDARIES.—For purposes of determining eligibility under 
this part—
‘‘(1) with respect to a metropolitan area that received 
funding under this part in fiscal year 2006, the boundaries 
of such metropolitan area shall be the boundaries that were 
in effect for such area for fiscal year 1994; or 
‘‘(2) with respect to a metropolitan area that becomes 
eligible to receive funding under this part in any fiscal year 
after fiscal year 2006, the boundaries of such metropolitan 
area shall be the boundaries that are in effect for such area 
when such area initially receives funding under this part.’’. 
(b) 
TECHNICAL
AND
CONFORMING
AMENDMENTS.—Section 
2601(a) of the Public Health Service Act (42 U.S.C. 300ff–11(a)) 
is amended—
(1) by striking ‘‘through (d)’’ and inserting ‘‘through (c)’’; 
and 
(2) by inserting ‘‘and confirmed by’’ after ‘‘reported to’’. 
(c) DEFINITION
OF METROPOLITAN AREA.—Section 2607(2) of 
the Public Health Service Act (42 U.S.C. 300ff–17(2)) is amended—
(1) by striking ‘‘area referred’’ and inserting ‘‘area that 
is referred’’; and 
(2) by inserting before the period the following: ‘‘, and 
that has a population of 50,000 or more individuals’’. 
SEC. 102. TYPE AND DISTRIBUTION OF GRANTS; FORMULA GRANTS. 
(a) DISTRIBUTION
PERCENTAGES.—Section 2603(a)(2) of the 
Public Health Service Act (42 U.S.C. 300ff–13(a)(2)) is amended—
(1) in the first sentence—
(A) by striking ‘‘50 percent of the amount appropriated 
under section 2677’’ and inserting ‘‘662⁄3 percent of the
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amount made available under section 2610(b) for carrying 
out this subpart’’; and 
(B) by striking ‘‘paragraph (3)’’ and inserting ‘‘para-
graphs (3) and (4)’’. 
(2) by striking the last sentence. 
(b) DISTRIBUTION BASED ON LIVING CASES OF HIV/AIDS.—Sec-
tion 2603(a)(3) of the Public Health Service Act (42 U.S.C. 300ff–
13(a)(3)) is amended—
(1) in subparagraph (B), by striking ‘‘estimated living cases 
of acquired immune deficiency syndrome’’ and inserting ‘‘living 
cases of HIV/AIDS (reported to and confirmed by the Director 
of the Centers for Disease Control and Prevention)’’; and 
(2) by striking subparagraphs (C) through (E) and inserting 
the following: 
‘‘(C) LIVING CASES OF HIV/AIDS.—
‘‘(i) REQUIREMENT OF NAMES-BASED REPORTING.—
Except as provided in clause (ii), the number deter-
mined under this subparagraph for an eligible area 
for a fiscal year for purposes of subparagraph (B) is 
the number of living names-based cases of HIV/AIDS 
that, as of December 31 of the most recent calendar 
year for which such data is available, have been 
reported to and confirmed by the Director of the Cen-
ters for Disease Control and Prevention. 
‘‘(ii) TRANSITION
PERIOD; EXEMPTION
REGARDING 
NON-AIDS CASES.—For each of the fiscal years 2007 
through 2009, an eligible area is, subject to clauses 
(iii) through (v), exempt from the requirement under 
clause (i) that living names-based non-AIDS cases of 
HIV be reported unless—
‘‘(I) a system was in operation as of December 
31, 2005, that provides sufficiently accurate and 
reliable names-based reporting of such cases 
throughout the State in which the area is located, 
subject to clause (viii); or 
‘‘(II) no later than the beginning of fiscal year 
2008 or 2009, the Secretary, in consultation with 
the chief executive of the State in which the area 
is located, determines that a system has become 
operational in the State that provides sufficiently 
accurate and reliable names-based reporting of 
such cases throughout the State. 
‘‘(iii) REQUIREMENTS FOR EXEMPTION FOR FISCAL 
YEAR 2007.—For fiscal year 2007, an exemption under 
clause (ii) for an eligible area applies only if, by October 
1, 2006—
‘‘(I)(aa) the State in which the area is located 
had submitted to the Secretary a plan for making 
the transition to sufficiently accurate and reliable 
names-based reporting of living non-AIDS cases 
of HIV; or 
‘‘(bb) all statutory changes necessary to pro-
vide for sufficiently accurate and reliable reporting 
of such cases had been made; and 
‘‘(II) the State had agreed that, by April 1, 
2008, the State will begin accurate and reliable 
names-based reporting of such cases, except that
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such agreement is not required to provide that, 
as of such date, the system for such reporting 
be fully sufficient with respect to accuracy and 
reliability throughout the area. 
‘‘(iv) REQUIREMENT FOR EXEMPTION AS OF FISCAL 
YEAR 2008.—For each of the fiscal years 2008 through 
2010, an exemption under clause (ii) for an eligible 
area applies only if, as of April 1, 2008, the State 
in which the area is located is substantially in compli-
ance with the agreement under clause (iii)(II). 
‘‘(v) PROGRESS TOWARD NAMES-BASED REPORTING.—
For fiscal year 2009, the Secretary may terminate an 
exemption under clause (ii) for an eligible area if the 
State in which the area is located submitted a plan 
under clause (iii)(I)(aa) and the Secretary determines 
that the State is not substantially following the plan. 
‘‘(vi) COUNTING OF CASES IN AREAS WITH EXEMP-
TIONS.—
‘‘(I) IN GENERAL.—With respect to an eligible 
area that is under a reporting system for living 
non-AIDS cases of HIV that is not names-based 
(referred to in this subparagraph as ‘code-based 
reporting’), the Secretary shall, for purposes of 
this subparagraph, modify the number of such 
cases reported for the eligible area in order to 
adjust for duplicative reporting in and among sys-
tems that use code-based reporting. 
‘‘(II) ADJUSTMENT RATE.—The adjustment rate 
under subclause (I) for an eligible area shall be 
a reduction of 5 percent in the number of living 
non-AIDS cases of HIV reported for the area. 
‘‘(vii) MULTIPLE
POLITICAL
JURISDICTIONS.—With 
respect to living non-AIDS cases of HIV, if an eligible 
area is not entirely within one political jurisdiction 
and as a result is subject to more than one reporting 
system for purposes of this subparagraph: 
‘‘(I) Names-based reporting under clause (i) 
applies in a jurisdictional portion of the area, or 
an exemption under clause (ii) applies in such 
portion (subject to applicable provisions of this 
subparagraph), according to whether names-based 
reporting or code-based reporting is used in such 
portion. 
‘‘(II) If under subclause (I) both names-based 
reporting and code-based reporting apply in the 
area, the number of code-based cases shall be 
reduced under clause (vi). 
‘‘(viii) LIST OF ELIGIBLE AREAS MEETING STANDARD 
REGARDING DECEMBER 31, 2005.—
‘‘(I) IN GENERAL.—If an eligible area or portion 
thereof is in a State specified in subclause (II), 
the eligible area or portion shall be considered 
to meet the standard described in clause (ii)(I). 
No other eligible area or portion thereof may be 
considered to meet such standard. 
‘‘(II) RELEVANT STATES.—For purposes of sub-
clause (I), the States specified in this subclause
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are the following: Alaska, Alabama, Arkansas, 
Arizona, Colorado, Florida, Indiana, Iowa, Idaho, 
Kansas, Louisiana, Michigan, Minnesota, Missouri, 
Mississippi, 
North 
Carolina, 
North 
Dakota, 
Nebraska, New Jersey, New Mexico, New York, 
Nevada, Ohio, Oklahoma, South Carolina, South 
Dakota, Tennessee, Texas, Utah, Virginia, Wis-
consin, West Virginia, Wyoming, Guam, and the 
Virgin Islands. 
‘‘(ix) RULES OF CONSTRUCTION REGARDING ACCEPT-
ANCE OF REPORTS.—
‘‘(I) CASES OF AIDS.—With respect to an eligible 
area that is subject to the requirement under 
clause (i) and is not in compliance with the require-
ment for names-based reporting of living non-AIDS 
cases of HIV, the Secretary shall, notwithstanding 
such noncompliance, accept reports of living cases 
of AIDS that are in accordance with such clause. 
‘‘(II) APPLICABILITY
OF
EXEMPTION
REQUIRE-
MENTS.—The provisions of clauses (ii) through (viii) 
may not be construed as having any legal effect 
for fiscal year 2010 or any subsequent fiscal year, 
and accordingly, the status of a State for purposes 
of such clauses may not be considered after fiscal 
year 2009. 
‘‘(x) PROGRAM
FOR
DETECTING
INACCURATE
OR 
FRAUDULENT COUNTING.—The Secretary shall carry out 
a program to monitor the reporting of names-based 
cases for purposes of this subparagraph and to detect 
instances of inaccurate reporting, including fraudulent 
reporting.’’. 
(c) CODE-BASED AREAS; LIMITATION ON INCREASE IN GRANT.—
Section 2603(a)(3) of the Public Health Service Act (42 U.S.C. 
300ff–13(a)), as amended by subsection (b)(2) of this section, is 
amended by adding at the end the following subparagraph: 
‘‘(D) CODE-BASED AREAS; LIMITATION ON INCREASE IN 
GRANT .—
‘‘(i) IN GENERAL.—For each of the fiscal years 2007 
through 2009, if code-based reporting (within the 
meaning of subparagraph (C)(vi)) applies in an eligible 
area or any portion thereof as of the beginning of 
the fiscal year involved, then notwithstanding any 
other provision of this paragraph, the amount of the 
grant pursuant to this paragraph for such area for 
such fiscal year may not—
‘‘(I) for fiscal year 2007, exceed by more than 
5 percent the amount of the grant for the area 
that would have been made pursuant to this para-
graph and paragraph (4) for fiscal year 2006 (as 
such paragraphs were in effect for such fiscal year) 
if paragraph (2) (as so in effect) had been applied 
by substituting ‘662⁄3 percent’ for ‘50 percent’; and 
‘‘(II) for each of the fiscal years 2008 and 2009, 
exceed by more than 5 percent the amount of 
the grant pursuant to this paragraph and para-
graph (4) for the area for the preceding fiscal year.
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‘‘(ii) USE OF AMOUNTS INVOLVED.—For each of the 
fiscal years 2007 through 2009, amounts available as 
a result of the limitation under clause (i) shall be 
made available by the Secretary as additional amounts 
for grants pursuant to subsection (b) for the fiscal 
year involved, subject to paragraph (4) and section 
2610(d)(2).’’. 
(d) HOLD HARMLESS.—Section 2603(a) of the Public Health 
Service Act (42 U.S.C. 300ff–13(a)) is amended—
(1) in paragraph (3)(A)—
(A) in clause (ii), by striking the period at the end 
and inserting a semicolon; and 
(B) by inserting after and below clause (ii) the fol-
lowing: 
‘‘which product shall then, as applicable, be increased under 
paragraph (4).’’. 
(2) by amending paragraph (4) to read as follows: 
‘‘(4) INCREASES IN GRANT.—
‘‘(A) IN GENERAL.—For each eligible area that received 
a grant pursuant to this subsection for fiscal year 2006, 
the Secretary shall, for each of the fiscal years 2007 through 
2009, increase the amount of the grant made pursuant 
to paragraph (3) for the area to ensure that the amount 
of the grant for the fiscal year involved is not less than 
the following amount, as applicable to such fiscal year: 
‘‘(i) For fiscal year 2007, an amount equal to 95 
percent of the amount of the grant that would have 
been made pursuant to paragraph (3) and this para-
graph for fiscal year 2006 (as such paragraphs were 
in effect for such fiscal year) if paragraph (2) (as so 
in effect) had been applied by substituting ‘662⁄3 per-
cent’ for ‘50 percent’. 
‘‘(ii) For each of the fiscal years 2008 and 2009, 
an amount equal to 100 percent of the amount of 
the grant made pursuant to paragraph (3) and this 
paragraph for fiscal year 2007. 
‘‘(B) SOURCE OF FUNDS FOR INCREASE.—
‘‘(i) IN GENERAL.—From the amounts available for 
carrying out the single program referred to in section 
2609(d)(2)(C) for a fiscal year (relating to supplemental 
grants), the Secretary shall make available such 
amounts as may be necessary to comply with subpara-
graph (A), subject to section 2610(d)(2). 
‘‘(ii) PRO
RATA
REDUCTION.—If the amounts 
referred to in clause (i) for a fiscal year are insufficient 
to fully comply with subparagraph (A) for the year, 
the Secretary, in order to provide the additional funds 
necessary for such compliance, shall reduce on a pro 
rata basis the amount of each grant pursuant to this 
subsection for the fiscal year, other than grants for 
eligible areas for which increases under subparagraph 
(A) apply. A reduction under the preceding sentence 
may not be made in an amount that would result 
in the eligible area involved becoming eligible for such 
an increase. 
‘‘(C) LIMITATION.—This paragraph may not be con-
strued as having any applicability after fiscal year 2009.’’.
H. R. 6143—7
SEC. 103. TYPE AND DISTRIBUTION OF GRANTS; SUPPLEMENTAL 
GRANTS. 
Section 2603(b) of the Public Health Service Act (42 U.S.C. 
300ff–13(b)) is amended—
(1) in paragraph (1)—
(A) in the matter preceding subparagraph (A), by 
striking ‘‘Not later than’’ and all that follows through ‘‘the 
Secretary shall’’ and inserting the following: ‘‘Subject to 
subsection (a)(4)(B)(i) and section 2610(d), the Secretary 
shall’’; 
(B) in subparagraph (B), by striking ‘‘demonstrates 
the severe need in such area’’ and inserting ‘‘demonstrates 
the need in such area, on an objective and quantified 
basis,’’; 
(C) by striking subparagraph (F) and inserting the 
following: 
‘‘(F) demonstrates the inclusiveness of affected commu-
nities and individuals with HIV/AIDS;’’; 
(D) in subparagraph (G), by striking the period and 
inserting ‘‘; and’’; and 
(E) by adding at the end the following: 
‘‘(H) demonstrates the ability of the applicant to expend 
funds efficiently by not having had, for the most recent 
grant year under subsection (a) for which data is available, 
more than 2 percent of grant funds under such subsection 
canceled or covered by any waivers under subsection 
(c)(3).’’; and 
(2) in paragraph (2)—
(A) in subparagraph (A), by striking ‘‘severe need’’ and 
inserting ‘‘demonstrated need’’; 
(B) by striking subparagraph (B) and inserting the 
following: 
‘‘(B) DEMONSTRATED NEED.—The factors considered by 
the Secretary in determining whether an eligible area has 
a demonstrated need for purposes of paragraph (1)(B) may 
include any or all of the following: 
‘‘(i) The unmet need for such services, as deter-
mined under section 2602(b)(4) or other community 
input process as defined under section 2609(d)(1)(A). 
‘‘(ii) An increasing need for HIV/AIDS-related serv-
ices, including relative rates of increase in the number 
of cases of HIV/AIDS. 
‘‘(iii) The relative rates of increase in the number 
of cases of HIV/AIDS within new or emerging sub-
populations. 
‘‘(iv) The current prevalence of HIV/AIDS. 
‘‘(v) Relevant factors related to the cost and com-
plexity of delivering health care to individuals with 
HIV/AIDS in the eligible area. 
‘‘(vi) The impact of co-morbid factors, including 
co-occurring conditions, determined relevant by the 
Secretary. 
‘‘(vii) The prevalence of homelessness. 
‘‘(viii) The prevalence of individuals described 
under section 2602(b)(2)(M).
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‘‘(ix) The relevant factors that limit access to health 
care, including geographic variation, adequacy of 
health insurance coverage, and language barriers. 
‘‘(x) The impact of a decline in the amount received 
pursuant to subsection (a) on services available to all 
individuals with HIV/AIDS identified and eligible 
under this title.’’; and 
(C) by striking subparagraphs (C) and (D) and inserting 
the following: 
‘‘(C) PRIORITY IN MAKING GRANTS.—The Secretary shall 
provide funds under this subsection to an eligible area 
to address the decline or disruption of all EMA-provided 
services related to the decline in the amounts received 
pursuant to subsection (a) consistent with the grant award 
for the eligible area for fiscal year 2006, to the extent 
that the factor under subparagraph (B)(x) (relating to a 
decline in funding) applies to the eligible area.’’. 
SEC. 104. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT 
FUNDS. 
Section 2603 of the Public Health Service Act (42 U.S.C. 300ff–
13) is amended—
(1) by redesignating subsection (c) as subsection (d); 
(2) by inserting after subsection (b) the following: 
‘‘(c) TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT 
FUNDS.—
‘‘(1) OBLIGATION
BY
END
OF
GRANT
YEAR.—Effective for 
fiscal year 2007 and subsequent fiscal years, funds from a 
grant award made pursuant to subsection (a) or (b) for a fiscal 
year are available for obligation by the eligible area involved 
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 area (referred to in this subsection as the 
‘grant year for the award’), except as provided in paragraph 
(3)(A). 
‘‘(2) SUPPLEMENTAL
GRANTS; CANCELLATION
OF
UNOBLI-
GATED
BALANCE
OF
GRANT
AWARD.—Effective for fiscal year 
2007 and subsequent fiscal years, if a grant award made pursu-
ant to subsection (b) for an eligible area for a fiscal year 
has an unobligated balance as of the end of the grant year 
for the award—
‘‘(A) the Secretary shall cancel that unobligated balance 
of the award, and shall require the eligible area to return 
any amounts from such balance that have been disbursed 
to the area; and 
‘‘(B) the funds involved shall be made available by 
the Secretary as additional amounts for grants pursuant 
to subsection (b) for the first fiscal year beginning after 
the fiscal year in which the Secretary obtains the informa-
tion necessary for determining that the balance is required 
under subparagraph (A) to be canceled, except that the 
availability of the funds for such grants is subject to sub-
section (a)(4) and section 2610(d)(2) as applied for such 
year. 
‘‘(3) FORMULA GRANTS; CANCELLATION OF UNOBLIGATED BAL-
ANCE OF GRANT AWARD; WAIVER PERMITTING CARRYOVER.—
H. R. 6143—9
‘‘(A) IN GENERAL.—Effective for fiscal year 2007 and 
subsequent fiscal years, if a grant award made pursuant 
to subsection (a) for an eligible area for a fiscal year 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 eligible area 
to return any amounts from such balance that have been 
disbursed to the area, unless—
‘‘(i) before the end of the grant year, the chief 
elected official of the area submits to the Secretary 
a written application for a waiver of the cancellation, 
which application includes a description of the purposes 
for which the area intends to expend the funds 
involved; and 
‘‘(ii) the Secretary approves the waiver. 
‘‘(B) EXPENDITURE BY END OF CARRYOVER YEAR.—With 
respect to a waiver under subparagraph (A) that is 
approved for a balance that is unobligated as of the end 
of a grant year for an award: 
‘‘(i) The unobligated funds are available for 
expenditure by the eligible area involved for the one-
year period beginning upon the expiration of the grant 
year (referred to in this subsection as the ‘carryover 
year’). 
‘‘(ii) If the funds are not expended by the end 
of the carryover year, the Secretary shall cancel that 
unexpended balance of the award, and shall require 
the eligible area to return any amounts from such 
balance that have been disbursed to the area. 
‘‘(C) USE
OF
CANCELLED
BALANCES.—In the case of 
any balance of a grant award that is cancelled under 
subparagraph (A) or (B)(ii), the grant funds involved shall 
be made available by the Secretary as additional amounts 
for grants pursuant to subsection (b) for the first fiscal 
year beginning after the fiscal year in which the Secretary 
obtains the information necessary for determining that the 
balance is required under such subparagraph to be can-
celed, except that the availability of the funds for such 
grants is subject to subsection (a)(4) and section 2610(d)(2) 
as applied for such year. 
‘‘(D) CORRESPONDING REDUCTION IN FUTURE GRANT.—
‘‘(i) IN GENERAL.—In the case of an eligible area 
for which a balance from a grant award under sub-
section (a) 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, the amount 
of the grant under such subsection for the first 
fiscal year beginning after the fiscal year in which 
the Secretary obtains the information necessary 
for determining that such balance was unobligated 
as of the end of the grant year (which requirement 
for a reduction applies without regard to whether 
a waiver under subparagraph (A) has been 
approved with respect to such balance); and
H. R. 6143—10
‘‘(II) the grant funds involved in such reduction 
shall be made available by the Secretary as addi-
tional funds for grants pursuant to subsection (b) 
for such first fiscal year, subject to subsection (a)(4) 
and section 2610(d)(2); 
except that this clause does not apply to the eligible 
area if the amount of the unobligated balance was 
2 percent or less. 
‘‘(ii) RELATION TO INCREASES IN GRANT.—A reduc-
tion under clause (i) for an eligible area for a fiscal 
year may not be taken into account in applying sub-
section (a)(4) with respect to the area for the subse-
quent fiscal year.’’; and 
(3) by adding at the end the following: 
‘‘(e) REPORT ON THE AWARDING OF SUPPLEMENTAL FUNDS.—
Not later than 45 days after the awarding of supplemental funds 
under this section, the Secretary shall submit to Congress a report 
concerning such funds. Such report shall include information 
detailing—
‘‘(1) the total amount of supplemental funds available under 
this section for the year involved; 
‘‘(2) the amount of supplemental funds used in accordance 
with the hold harmless provisions of subsection (a)(4); 
‘‘(3) the amount of supplemental funds disbursed pursuant 
to subsection (b)(2)(C); 
‘‘(4) the disbursement of the remainder of the supplemental 
funds after taking into account the uses described in paragraphs 
(2) and (3); and 
‘‘(5) the rationale used for the amount of funds disbursed 
as described under paragraphs (2), (3), and (4).’’. 
SEC. 105. USE OF AMOUNTS. 
Section 2604 of the Public Health Service Act (42 U.S.C. 300ff–
14) is amended to read as follows: 
‘‘SEC. 2604. USE OF AMOUNTS. 
‘‘(a) REQUIREMENTS.—The Secretary may not make a grant 
under section 2601(a) to the chief elected official of an eligible 
area unless such political subdivision agrees that—
‘‘(1) subject to paragraph (2), the allocation of funds and 
services within the eligible area will be made in accordance 
with 
the 
priorities 
established, 
pursuant 
to 
section 
2602(b)(4)(C), by the HIV health services planning council that 
serves such eligible area; 
‘‘(2) funds provided under section 2601 will be expended 
only for—
‘‘(A) core medical services described in subsection (c); 
‘‘(B) support services described in subsection (d); and 
‘‘(C) administrative expenses described in subsection 
(h); and 
‘‘(3) the use of such funds will comply with the requirements 
of this section. 
‘‘(b) DIRECT FINANCIAL ASSISTANCE TO APPROPRIATE ENTITIES.—
‘‘(1) IN GENERAL.—The chief elected official of an eligible 
area shall use amounts from a grant under section 2601 to 
provide direct financial assistance to entities described in para-
graph (2) for the purpose of providing core medical services 
and support services.
H. R. 6143—11
‘‘(2) APPROPRIATE
ENTITIES.—Direct financial assistance 
may be provided under paragraph (1) to public or nonprofit 
private entities, or private for-profit entities if such entities 
are the only available provider of quality HIV care in the 
area. 
‘‘(c) REQUIRED FUNDING FOR CORE MEDICAL SERVICES.—
‘‘(1) IN GENERAL.—With respect to a grant under section 
2601 for an eligible area for a grant year, the chief elected 
official of the area shall, of the portion of the grant remaining 
after reserving amounts for purposes of paragraphs (1) and 
(5)(B)(i) of subsection (h), use not less than 75 percent to 
provide core medical services that are needed in the eligible 
area for individuals with HIV/AIDS who are identified and 
eligible under this title (including services regarding the co-
occurring conditions of the individuals). 
‘‘(2) WAIVER.—
‘‘(A) IN
GENERAL.—The Secretary shall waive the 
application of paragraph (1) with respect to a chief elected 
official for a grant year if the Secretary determines that, 
within the eligible area involved—
‘‘(i) there are no waiting lists for AIDS Drug Assist-
ance Program services under section 2616; and 
‘‘(ii) core medical services are available to all 
individuals with HIV/AIDS identified and eligible 
under this title. 
‘‘(B) 
NOTIFICATION
OF
WAIVER
STATUS.—When 
informing the chief elected official of an eligible area that 
a grant under section 2601 is being made for the area 
for a grant year, the Secretary shall inform the official 
whether a waiver under subparagraph (A) is in effect for 
such year. 
‘‘(3) CORE MEDICAL SERVICES.—For purposes of this sub-
section, the term ‘core medical services’, with respect to an 
individual with HIV/AIDS (including the co-occurring conditions 
of the individual), means the following services: 
‘‘(A) Outpatient and ambulatory health services. 
‘‘(B) AIDS Drug Assistance Program treatments in 
accordance with section 2616. 
‘‘(C) AIDS pharmaceutical assistance. 
‘‘(D) Oral health care. 
‘‘(E) Early intervention services described in subsection 
(e). 
‘‘(F) Health insurance premium and cost sharing assist-
ance for low-income individuals in accordance with section 
2615. 
‘‘(G) Home health care. 
‘‘(H) Medical nutrition therapy. 
‘‘(I) Hospice services. 
‘‘(J) Home and community-based health services as 
defined under section 2614(c). 
‘‘(K) Mental health services. 
‘‘(L) Substance abuse outpatient care. 
‘‘(M) Medical case management, including treatment 
adherence services. 
‘‘(d) SUPPORT SERVICES.—
‘‘(1) IN GENERAL.—For purposes of this section, the term 
‘support services’ means services, subject to the approval of
H. R. 6143—12
the Secretary, that are needed for individuals with HIV/AIDS 
to achieve their medical outcomes (such as respite care for 
persons caring for individuals with HIV/AIDS, outreach serv-
ices, medical transportation, linguistic services, and referrals 
for health care and support services). 
‘‘(2) MEDICAL
OUTCOMES.—In this subsection, the term 
‘medical outcomes’ means those outcomes affecting the HIV-
related clinical status of an individual with HIV/AIDS. 
‘‘(e) EARLY INTERVENTION SERVICES.—
‘‘(1) IN GENERAL.—For purposes of this section, the term 
‘early intervention services’ means HIV/AIDS early intervention 
services described in section 2651(e), with follow-up referral 
provided for the purpose of facilitating the access of individuals 
receiving the services to HIV-related health services. The enti-
ties through which such services may be provided under the 
grant include public health departments, emergency rooms, 
substance abuse and mental health treatment programs, detoxi-
fication centers, detention facilities, clinics regarding sexually 
transmitted diseases, homeless shelters, HIV/AIDS counseling 
and testing sites, health care points of entry specified by eligible 
areas, federally qualified health centers, and entities described 
in section 2652(a) that constitute a point of access to services 
by maintaining referral relationships. 
‘‘(2) CONDITIONS.—With respect to an entity that proposes 
to provide early intervention services under paragraph (1), such 
paragraph shall apply only if the entity demonstrates to the 
satisfaction of the chief elected official for the eligible area 
involved that—
‘‘(A) Federal, State, or local funds are otherwise inad-
equate for the early intervention services the entity pro-
poses to provide; and 
‘‘(B) the entity will expend funds pursuant to such 
paragraph to supplement and not supplant other funds 
available to the entity for the provision of early intervention 
services for the fiscal year involved. 
‘‘(f) PRIORITY FOR WOMEN, INFANTS, CHILDREN, AND YOUTH.—
‘‘(1) IN GENERAL.—For the purpose of providing health and 
support services to infants, children, youth, and women with 
HIV/AIDS, including treatment measures to prevent the 
perinatal transmission of HIV, the chief elected official of an 
eligible area, in accordance with the established priorities of 
the planning council, shall for each of such populations in 
the eligible area use, from the grants made for the area under 
section 2601(a) for a fiscal year, not less than the percentage 
constituted by the ratio of the population involved (infants, 
children, youth, or women in such area) with HIV/AIDS to 
the general population in such area of individuals with HIV/
AIDS. 
‘‘(2) WAIVER.—With respect to the population involved, the 
Secretary may provide to the chief elected official of an eligible 
area a waiver of the requirement of paragraph (1) if such 
official demonstrates to the satisfaction of the Secretary that 
the population is receiving HIV-related health services through 
the State medicaid program under title XIX of the Social Secu-
rity Act, the State children’s health insurance program under 
title XXI of such Act, or other Federal or State programs. 
‘‘(g) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.—
H. R. 6143—13
‘‘(1) PROVISION OF SERVICE.—Subject to paragraph (2), the 
Secretary may not make a grant under section 2601(a) for 
the provision of services under this section in a State unless, 
in the case of any such service that is available pursuant 
to the State plan approved under title XIX of the Social Security 
Act for the State—
‘‘(A) the political subdivision involved will provide the 
service directly, and the political subdivision has entered 
into a participation agreement under the State plan and 
is qualified to receive payments under such plan; or 
‘‘(B) the political subdivision will enter into an agree-
ment with a public or nonprofit private entity under which 
the entity will provide the service, and the entity has 
entered into such a participation agreement and is qualified 
to receive such payments. 
‘‘(2) WAIVER.—
‘‘(A) IN GENERAL.—In the case of an entity making 
an agreement pursuant to paragraph (1)(B) regarding the 
provision of services, the requirement established in such 
paragraph shall be waived by the HIV health services 
planning council for the eligible area if the entity does 
not, in providing health care services, impose a charge 
or accept reimbursement available from any third-party 
payor, including reimbursement under any insurance policy 
or under any Federal or State health benefits program. 
‘‘(B) DETERMINATION.—A determination by the HIV 
health services planning council of whether an entity 
referred to in subparagraph (A) meets the criteria for a 
waiver under such subparagraph shall be made without 
regard to whether the entity accepts voluntary donations 
for the purpose of providing services to the public. 
‘‘(h) ADMINISTRATION.—
‘‘(1) LIMITATION.—The chief elected official of an eligible 
area shall not use in excess of 10 percent of amounts received 
under a grant under this part for administrative expenses. 
‘‘(2) ALLOCATIONS BY CHIEF ELECTED OFFICIAL.—In the case 
of entities and subcontractors to which the chief elected official 
of an eligible area allocates amounts received by the official 
under a grant under this part, the official shall ensure that, 
of the aggregate amount so allocated, the total of the expendi-
tures by such entities for administrative expenses does not 
exceed 10 percent (without regard to whether particular entities 
expend more than 10 percent for such expenses). 
‘‘(3) ADMINISTRATIVE
ACTIVITIES.—For purposes of para-
graph (1), amounts may be used for administrative activities 
that include—
‘‘(A) routine grant administration and monitoring 
activities, including the development of applications for 
part A funds, the receipt and disbursal of program funds, 
the development and establishment of reimbursement and 
accounting systems, the development of a clinical quality 
management program as described in paragraph (5), the 
preparation of routine programmatic and financial reports, 
and compliance with grant conditions and audit require-
ments; and 
‘‘(B) all activities associated with the grantee’s contract 
award procedures, including the activities carried out by
H. R. 6143—14
the HIV health services planning council as established 
under section 2602(b), the development of requests for pro-
posals, contract proposal review activities, negotiation and 
awarding of contracts, monitoring of contracts through tele-
phone consultation, written documentation or onsite visits, 
reporting on contracts, and funding reallocation activities. 
‘‘(4) SUBCONTRACTOR ADMINISTRATIVE ACTIVITIES.—For the 
purposes of this subsection, subcontractor administrative activi-
ties include—
‘‘(A) usual and recognized overhead activities, including 
established indirect rates for agencies; 
‘‘(B) management oversight of specific programs funded 
under this title; and 
‘‘(C) other types of program support such as quality 
assurance, quality control, and related activities. 
‘‘(5) CLINICAL QUALITY MANAGEMENT.—
‘‘(A) REQUIREMENT.—The chief elected official of an 
eligible area that receives a grant under this part shall 
provide for the establishment of a clinical quality manage-
ment 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/AIDS and related opportunistic infec-
tion, and as applicable, to develop strategies for ensuring 
that such services are consistent with the guidelines for 
improvement in the access to and quality of HIV health 
services. 
‘‘(B) USE OF FUNDS.—
‘‘(i) IN GENERAL.—From amounts received under 
a grant awarded under this subpart for a fiscal year, 
the chief elected official of an eligible area may use 
for activities associated with the clinical quality 
management program required in subparagraph (A) 
not to exceed the lesser of—
‘‘(I) 5 percent of amounts received under the 
grant; or 
‘‘(II) $3,000,000. 
‘‘(ii) RELATION TO LIMITATION ON ADMINISTRATIVE 
EXPENSES.—The costs of a clinical quality management 
program under subparagraph (A) may not be consid-
ered administrative expenses for purposes of the limita-
tion established in paragraph (1). 
‘‘(i) CONSTRUCTION.—A chief elected official may not use 
amounts received under a grant awarded under this part to pur-
chase or improve land, or to purchase, construct, or permanently 
improve (other than minor remodeling) any building or other 
facility, or to make cash payments to intended recipients of serv-
ices.’’. 
SEC. 106. ADDITIONAL AMENDMENTS TO PART A. 
(a) REPORTING OF CASES.—Section 2601(a) of the Public Health 
Service Act (42 U.S.C. 300ff–11(a)) is amended by striking ‘‘for 
the most recent period’’ and inserting ‘‘during the most recent 
period’’. 
(b) 
PLANNING
COUNCIL
REPRESENTATION.—Section 
2602(b)(2)(G) of the Public Health Service Act (42 U.S.C. 300ff–
12(b)(2)(G)) is amended by inserting ‘‘, members of a Federally
H. R. 6143—15
recognized Indian tribe as represented in the population, individuals 
co-infected with hepatitis B or C’’ after ‘‘disease’’. 
(c) APPLICATION FOR GRANT.—
(1) PAYER OF LAST RESORT.—Section 2605(a)(6)(A) of the 
Public Health Service Act (42 U.S.C. 300ff–15(a)(6)(A)) is 
amended by inserting ‘‘(except for a program administered by 
or providing the services of the Indian Health Service)’’ before 
the semicolon. 
(2) AUDITS.—Section 2605(a) of the Public Health Service 
Act (42 U.S.C. 300ff–15(a)) is amended—
(A) in paragraph (8), by striking ‘‘and’’ at the end; 
(B) in paragraph (9), by striking the period and 
inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(10) that the chief elected official will submit to the lead 
State agency under section 2617(b)(4), audits, consistent with 
Office of Management and Budget circular A133, regarding 
funds expended in accordance with this part every 2 years 
and shall include necessary client-based data to compile unmet 
need calculations and Statewide coordinated statements of need 
process.’’. 
(3) COORDINATION.—Section 2605(b) of the Public Health 
Service Act (42 U.S.C. 300ff–15(b)) is amended—
(A) in paragraph (3), by striking ‘‘and’’ at the end; 
(B) in paragraph (4), by striking the period and 
inserting a semicolon; and 
(C) by adding at the end the following: 
‘‘(5) the manner in which the expected expenditures are 
related to the planning process for States that receive funding 
under part B (including the planning process described in sec-
tion 2617(b)); and 
‘‘(6) the expected expenditures and how those expenditures 
will improve overall client outcomes, as described under the 
State plan under section 2617(b), and through additional out-
comes measures as identified by the HIV health services plan-
ning council under section 2602(b).’’. 
SEC. 107. NEW PROGRAM IN PART A; TRANSITIONAL GRANTS FOR CER-
TAIN AREAS INELIGIBLE UNDER SECTION 2601. 
(a) IN GENERAL.—Part A of title XXVI of the Public Health 
Service Act (42 U.S.C. 300ff–11) is amended—
(1) by inserting after the part heading the following: 
‘‘Subpart I—General Grant Provisions’’; and 
(2) by adding at the end the following: 
‘‘Subpart II—Transitional Grants 
‘‘SEC. 2609. ESTABLISHMENT OF PROGRAM. 
‘‘(a) IN GENERAL.—The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration, shall 
make grants for the purpose of providing services described in 
section 2604 in transitional areas, subject to the same provisions 
regarding the allocation of grant funds as apply under subsection 
(c) of such section.
H. R. 6143—16
‘‘(b) TRANSITIONAL AREAS.—For purposes of this section, the 
term ‘transitional area’ means, subject to subsection (c), a metropoli-
tan area for which there has been reported to and confirmed by 
the Director of the Centers for Disease Control and Prevention 
a cumulative total of at least 1,000, but fewer than 2,000, cases 
of AIDS during the most recent period of 5 calendar years for 
which such data are available. 
‘‘(c) CERTAIN ELIGIBILITY RULES.—
‘‘(1) FISCAL YEAR 2007.—With respect to grants under sub-
section (a) for fiscal year 2007, a metropolitan area that received 
funding under subpart I for fiscal year 2006 but does not 
for fiscal year 2007 qualify under such subpart as an eligible 
area and does not qualify under subsection (b) as a transitional 
area shall, notwithstanding subsection (b), be considered a 
transitional area. 
‘‘(2) CONTINUED STATUS AS TRANSITIONAL AREA.—
‘‘(A) IN GENERAL.—Notwithstanding subsection (b), a 
metropolitan area that is a transitional area for a fiscal 
year continues, except as provided in subparagraph (B), 
to be a transitional area until the metropolitan area fails, 
for three consecutive fiscal years—
‘‘(i) to qualify under such subsection as a transi-
tional area; and 
‘‘(ii) to have a cumulative total of 1,500 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 cal-
endar year for which such data is available. 
‘‘(B) EXCEPTION REGARDING STATUS AS ELIGIBLE AREA.—
Subparagraph (A) does not apply for a fiscal year if the 
metropolitan area involved qualifies under subpart I as 
an eligible area. 
‘‘(d) APPLICATION OF CERTAIN PROVISIONS OF SUBPART I.—
‘‘(1) ADMINISTRATION; PLANNING COUNCIL.—
‘‘(A) IN GENERAL.—The provisions of section 2602 apply 
with respect to a grant under subsection (a) for a transi-
tional area to the same extent and in the same manner 
as such provisions apply with respect to a grant under 
subpart I for an eligible area, except that, subject to 
subparagraph (B), the chief elected official of the transi-
tional area may elect not to comply with the provisions 
of section 2602(b) if the official provides documentation 
to the Secretary that details the process used to obtain 
community input (particularly from those with HIV) in 
the transitional area for formulating the overall plan for 
priority setting and allocating funds from the grant under 
subsection (a). 
‘‘(B) EXCEPTION.—For each of the fiscal years 2007 
through 2009, the exception described in subparagraph 
(A) does not apply if the transitional area involved received 
funding under subpart I for fiscal year 2006. 
‘‘(2) TYPE AND DISTRIBUTION OF GRANTS; TIMEFRAME FOR 
OBLIGATION AND EXPENDITURE OF GRANT FUNDS.—
‘‘(A) FORMULA GRANTS; SUPPLEMENTAL GRANTS.—The 
provisions of section 2603 apply with respect to grants 
under subsection (a) to the same extent and in the same
H. R. 6143—17
manner as such provisions apply with respect to grants 
under subpart I, subject to subparagraphs (B) and (C). 
‘‘(B) FORMULA GRANTS; INCREASE IN GRANT.—For pur-
poses of subparagraph (A), section 2603(a)(4) does not 
apply. 
‘‘(C) SUPPLEMENTAL
GRANTS; SINGLE
PROGRAM
WITH 
SUBPART I PROGRAM.—With respect to section 2603(b) as 
applied for purposes of subparagraph (A): 
‘‘(i) The Secretary shall combine amounts available 
pursuant to such subparagraph with amounts available 
for carrying out section 2603(b) and shall administer 
the two programs as a single program. 
‘‘(ii) In the single program, the Secretary has 
discretion in allocating amounts between eligible areas 
under subpart I and transitional areas under this sec-
tion, subject to the eligibility criteria that apply under 
such section, and subject to section 2603(b)(2)(C) 
(relating to priority in making grants). 
‘‘(iii) Pursuant to section 2603(b)(1), amounts for 
the single program are subject to use under sections 
2603(a)(4) and 2610(d)(1). 
‘‘(3) APPLICATION; TECHNICAL ASSISTANCE; DEFINITIONS.—
The provisions of sections 2605, 2606, and 2607 apply with 
respect to grants under subsection (a) to the same extent and 
in the same manner as such provisions apply with respect 
to grants under subpart I.’’. 
(b) CONFORMING AMENDMENTS.—Subpart I of part A of title 
XXVI of the Public Health Service Act, as designated by subsection 
(a)(1) of this section, is amended by striking ‘‘this part’’ each place 
such term appears and inserting ‘‘this subpart’’. 
SEC. 108. AUTHORIZATION OF APPROPRIATIONS FOR PART A. 
Part A of title XXVI of the Public Health Service Act, as 
amended by section 106(a), is amended by adding at the end the 
following: 
‘‘Subpart III—General Provisions 
‘‘SEC. 2610. AUTHORIZATION OF APPROPRIATIONS. 
‘‘(a) IN GENERAL.—For the purpose of carrying out this part, 
there are authorized to be appropriated $604,000,000 for fiscal 
year 2007, $626,300,000 for fiscal year 2008, and $649,500,000 
for fiscal year 2009. Amounts appropriated under the preceding 
sentence for a fiscal year are available for obligation by the Sec-
retary until the end of the second succeeding fiscal year. 
‘‘(b) RESERVATION OF AMOUNTS.—
‘‘(1) FISCAL YEAR 2007.—Of the amount appropriated under 
subsection (a) for fiscal year 2007, the Secretary shall reserve—
‘‘(A) $458,310,000 for grants under subpart I; and 
‘‘(B) $145,690,000 for grants under section 2609. 
‘‘(2) SUBSEQUENT
FISCAL
YEARS.—Of the amount appro-
priated under subsection (a) for fiscal year 2008 and each 
subsequent fiscal year—
‘‘(A) the Secretary shall reserve an amount for grants 
under subpart I; and 
‘‘(B) the Secretary shall reserve an amount for grants 
under section 2609.
H. R. 6143—18
‘‘(c) TRANSFER OF CERTAIN AMOUNTS; CHANGE IN STATUS AS 
ELIGIBLE AREA
OR TRANSITIONAL AREA.—Notwithstanding sub-
section (b): 
‘‘(1) If a metropolitan area is an eligible area under subpart 
I for a fiscal year, but for a subsequent fiscal year ceases 
to be an eligible area by reason of section 2601(b)—
‘‘(A)(i) the amount reserved under paragraph (1)(A) 
or (2)(A) of subsection (b) of this section for the first such 
subsequent year of not being an eligible area is deemed 
to be reduced by an amount equal to the amount of the 
grant made pursuant to section 2603(a) for the metropoli-
tan area for the preceding fiscal year; and 
‘‘(ii)(I) if the metropolitan area qualifies for such first 
subsequent fiscal year as a transitional area under 2609, 
the amount reserved under paragraph (1)(B) or (2)(B) of 
subsection (b) for such fiscal year is deemed to be increased 
by an amount equal to the amount of the reduction under 
subparagraph (A) for such year; or 
‘‘(II) if the metropolitan area does not qualify for such 
first subsequent fiscal year as a transitional area under 
2609, an amount equal to the amount of such reduction 
is, notwithstanding subsection (a), transferred and made 
available for grants pursuant to section 2618(a)(1), in addi-
tion to amounts available for such grants under section 
2623; and 
‘‘(B) if a transfer under subparagraph (A)(ii)(II) is made 
with respect to the metropolitan area for such first subse-
quent fiscal year, then—
‘‘(i) the amount reserved under paragraph (1)(A) 
or (2)(A) of subsection (b) of this section for such year 
is deemed to be reduced by an additional $500,000; 
and 
‘‘(ii) an amount equal to the amount of such addi-
tional reduction is, notwithstanding subsection (a), 
transferred and made available for grants pursuant 
to section 2618(a)(1), in addition to amounts available 
for such grants under section 2623. 
‘‘(2) If a metropolitan area is a transitional area under 
section 2609 for a fiscal year, but for a subsequent fiscal year 
ceases to be a transitional area by reason of section 2609(c)(2) 
(and does not qualify for such subsequent fiscal year as an 
eligible area under subpart I)—
‘‘(A) the amount reserved under subsection (b)(2)(B) 
of this section for the first such subsequent fiscal year 
of not being a transitional area is deemed to be reduced 
by an amount equal to the total of—
‘‘(i) the amount of the grant that, pursuant to 
section 2603(a), was made under section 2609(d)(2)(A) 
for the metropolitan area for the preceding fiscal year; 
and 
‘‘(ii) $500,000; and 
‘‘(B) an amount equal to the amount of the reduction 
under subparagraph (A) for such year is, notwithstanding 
subsection (a), transferred and made available for grants 
pursuant to section 2618(a)(1), in addition to amounts avail-
able for such grants under section 2623.
H. R. 6143—19
‘‘(3) If a metropolitan area is a transitional area under 
section 2609 for a fiscal year, but for a subsequent fiscal year 
qualifies as an eligible area under subpart I—
‘‘(A) the amount reserved under subsection (b)(2)(B) 
of this section for the first such subsequent fiscal year 
of becoming an eligible area is deemed to be reduced by 
an amount equal to the amount of the grant that, pursuant 
to section 2603(a), was made under section 2609(d)(2)(A) 
for the metropolitan area for the preceding fiscal year; 
and 
‘‘(B) the amount reserved under subsection (b)(2)(A) 
for such fiscal year is deemed to be increased by an amount 
equal to the amount of the reduction under subparagraph 
(A) for such year. 
‘‘(d) CERTAIN TRANSFERS; ALLOCATIONS BETWEEN PROGRAMS 
UNDER
SUBPART
I.—With respect to paragraphs (1)(B)(i) and 
(2)(A)(ii) of subsection (c), the Secretary shall administer any reduc-
tions under such paragraphs for a fiscal year in accordance with 
the following: 
‘‘(1) The reductions shall be made from amounts available 
for the single program referred to in section 2609(d)(2)(C) 
(relating to supplemental grants). 
‘‘(2) The reductions shall be made before the amounts 
referred to in paragraph (1) are used for purposes of section 
2603(a)(4). 
‘‘(3) If the amounts referred to in paragraph (1) are not 
sufficient for making all the reductions, the reductions shall 
be reduced until the total amount of the reductions equals 
the total of the amounts referred to in such paragraph. 
‘‘(e) RULES OF CONSTRUCTION REGARDING FIRST SUBSEQUENT 
FISCAL YEAR.—Paragraphs (1) and (2) of subsection (c) apply with 
respect to each series of fiscal years during which a metropolitan 
area is an eligible area under subpart I or a transitional area 
under section 2609 for a fiscal year and then for a subsequent 
fiscal year ceases to be such an area by reason of section 2601(b) 
or 2609(c)(2), respectively, rather than applying to a single such 
series. Paragraph (3) of subsection (c) applies with respect to each 
series of fiscal years during which a metropolitan area is a transi-
tional area under section 2609 for a fiscal year and then for a 
subsequent fiscal year becomes an eligible area under subpart I, 
rather than applying to a single such series.’’. 
TITLE II—CARE GRANTS 
SEC. 201. GENERAL USE OF GRANTS. 
(a) IN GENERAL.—Section 2612 of the Public Health Service 
Act (42 U.S.C. 300ff–22) is amended to read as follows: 
‘‘SEC. 2612. GENERAL USE OF GRANTS. 
‘‘(a) IN GENERAL.—A State may use amounts provided under 
grants made under section 2611 for—
‘‘(1) core medical services described in subsection (b); 
‘‘(2) support services described in subsection (c); and 
‘‘(3) administrative expenses described in section 2618(b)(3). 
‘‘(b) REQUIRED FUNDING FOR CORE MEDICAL SERVICES.—
H. R. 6143—20
‘‘(1) IN GENERAL.—With respect to a grant under section 
2611 for a State for a grant year, the State shall, of the 
portion of the grant remaining after reserving amounts for 
purposes of subparagraphs (A) and (E)(ii)(I) of section 
2618(b)(3), use not less than 75 percent to provide core medical 
services that are needed in the State for individuals with HIV/
AIDS who are identified and eligible under this title (including 
services regarding the co-occurring conditions of the individ-
uals). 
‘‘(2) WAIVER.—
‘‘(A) IN
GENERAL.—The Secretary shall waive the 
application of paragraph (1) with respect to a State for 
a grant year if the Secretary determines that, within the 
State—
‘‘(i) there are no waiting lists for AIDS Drug Assist-
ance Program services under section 2616; and 
‘‘(ii) core medical services are available to all 
individuals with HIV/AIDS identified and eligible 
under this title. 
‘‘(B) 
NOTIFICATION
OF
WAIVER
STATUS.—When 
informing a State that a grant under section 2611 is being 
made to the State for a fiscal year, the Secretary shall 
inform the State whether a waiver under subparagraph 
(A) is in effect for the fiscal year. 
‘‘(3) CORE MEDICAL SERVICES.—For purposes of this sub-
section, the term ‘core medical services’, with respect to an 
individual infected with HIV/AIDS (including the co-occurring 
conditions of the individual) means the following services: 
‘‘(A) Outpatient and ambulatory health services. 
‘‘(B) AIDS Drug Assistance Program treatments in 
accordance with section 2616. 
‘‘(C) AIDS pharmaceutical assistance. 
‘‘(D) Oral health care. 
‘‘(E) Early intervention services described in subsection 
(d). 
‘‘(F) Health insurance premium and cost sharing assist-
ance for low-income individuals in accordance with section 
2615. 
‘‘(G) Home health care. 
‘‘(H) Medical nutrition therapy. 
‘‘(I) Hospice services. 
‘‘(J) Home and community-based health services as 
defined under section 2614(c). 
‘‘(K) Mental health services. 
‘‘(L) Substance abuse outpatient care. 
‘‘(M) Medical case management, including treatment 
adherence services. 
‘‘(c) SUPPORT SERVICES.—
‘‘(1) IN GENERAL.—For purposes of this subsection, the term 
‘support services’ means services, subject to the approval of 
the Secretary, that are needed for individuals with HIV/AIDS 
to achieve their medical outcomes (such as respite care for 
persons caring for individuals with HIV/AIDS, outreach serv-
ices, medical transportation, linguistic services, and referrals 
for health care and support services).
H. R. 6143—21
‘‘(2) DEFINITION OF MEDICAL OUTCOMES.—In this subsection, 
the term ‘medical outcomes’ means those outcomes affecting 
the HIV-related clinical status of an individual with HIV/AIDS. 
‘‘(d) EARLY INTERVENTION SERVICES.—
‘‘(1) IN GENERAL.—For purposes of this section, the term 
‘early intervention services’ means HIV/AIDS early intervention 
services described in section 2651(e), with follow-up referral 
provided for the purpose of facilitating the access of individuals 
receiving the services to HIV-related health services. The enti-
ties through which such services may be provided under the 
grant include public health departments, emergency rooms, 
substance abuse and mental health treatment programs, detoxi-
fication centers, detention facilities, clinics regarding sexually 
transmitted diseases, homeless shelters, HIV/AIDS counseling 
and testing sites, health care points of entry specified by States, 
federally qualified health centers, and entities described in 
section 2652(a) that constitute a point of access to services 
by maintaining referral relationships. 
‘‘(2) CONDITIONS.—With respect to an entity that proposes 
to provide early intervention services under paragraph (1), such 
paragraph shall apply only if the entity demonstrates to the 
satisfaction of the chief elected official for the State involved 
that—
‘‘(A) Federal, State, or local funds are otherwise inad-
equate for the early intervention services the entity pro-
poses to provide; and 
‘‘(B) the entity will expend funds pursuant to such 
subparagraph to supplement and not supplant other funds 
available to the entity for the provision of early intervention 
services for the fiscal year involved. 
‘‘(e) PRIORITY FOR WOMEN, INFANTS, CHILDREN, AND YOUTH.—
‘‘(1) IN GENERAL.—For the purpose of providing health and 
support services to infants, children, youth, and women with 
HIV/AIDS, including treatment measures to prevent the 
perinatal transmission of HIV, a State shall for each of such 
populations in the eligible area use, from the grants made 
for the area under section 2601(a) for a fiscal year, not less 
than the percentage constituted by the ratio of the population 
involved (infants, children, youth, or women in such area) with 
HIV/AIDS to the general population in such area of individuals 
with HIV/AIDS. 
‘‘(2) WAIVER.—With respect to the population involved, the 
Secretary may provide to a State a waiver of the requirement 
of paragraph (1) if such State demonstrates to the satisfaction 
of the Secretary that the population is receiving HIV-related 
health services through the State medicaid program under title 
XIX of the Social Security Act, the State children’s health 
insurance program under title XXI of such Act, or other Federal 
or State programs. 
‘‘(f) CONSTRUCTION.—A State may not use amounts received 
under a grant awarded under section 2611 to purchase or improve 
land, or to purchase, construct, or permanently improve (other 
than minor remodeling) any building or other facility, or to make 
cash payments to intended recipients of services.’’. 
(b) HIV CARE CONSORTIA.—Section 2613 of the Public Health 
Service Act (42 U.S.C. 300ff–23) is amended—
H. R. 6143—22
(1) in subsection (a), in the matter preceding paragraph 
(1)—
(A) by striking ‘‘may use’’ and inserting ‘‘may, subject 
to subsection (f), use’’; and 
(B) by striking ‘‘section 2612(a)(1)’’ and inserting ‘‘sec-
tion 2612(a)’’; and 
(2) by adding at the end the following subsection: 
‘‘(f) ALLOCATION
OF FUNDS; TREATMENT
AS SUPPORT SERV-
ICES.—For purposes of the requirement of section 2612(b)(1), 
expenditures of grants under section 2611 for or through consortia 
under this section are deemed to be support services, not core 
medical services. The preceding sentence may not be construed 
as having any legal effect on the provisions of subsection (a) that 
relate to authorized expenditures of the grant.’’. 
(c) TECHNICAL AMENDMENTS.—Part B of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff–21 et seq.) is amended—
(1) in section 2611—
(A) in subsection (a), by striking the subsection des-
ignation and heading; and 
(B) by striking subsection (b); 
(2) in section 2614—
(A) in subsection (a), in the matter preceding paragraph 
(1), by striking ‘‘section 2612(a)(2)’’ and inserting ‘‘section 
2612(b)(3)(J)’’; and 
(B) in subsection (c)(2)(B), by striking ‘‘homemaker or’’; 
(3) in section 2615(a) by striking ‘‘section 2612(a)(3)’’ and 
inserting ‘‘section 2612(b)(3)(F)’’; and 
(4) in section 2616(a) by striking ‘‘section 2612(a)(5)’’ and 
inserting ‘‘section 2612(b)(3)(B)’’. 
SEC. 202. AIDS DRUG ASSISTANCE PROGRAM. 
(a) REQUIREMENT OF MINIMUM DRUG LIST.—Section 2616 of 
the Public Health Service Act (42 U.S.C. 300ff–26) is amended—
(1) in subsection (c), by striking paragraph (1) and inserting 
the following: 
‘‘(1) ensure that the therapeutics included on the list of 
classes of core antiretroviral therapeutics established by the 
Secretary under subsection (e) are, at a minimum, the treat-
ments provided by the State pursuant to this section;’’; 
(2) by redesignating subsection (e) as subsection (f); and 
(3) by inserting after subsection (d) the following: 
‘‘(e) LIST
OF
CLASSES
OF
CORE
ANTIRETROVIRAL
THERA-
PEUTICS.—For purposes of subsection (c)(1), the Secretary shall 
develop and maintain a list of classes of core antiretroviral thera-
peutics, which list shall be based on the therapeutics included 
in the guidelines of the Secretary known as the Clinical Practice 
Guidelines for Use of HIV/AIDS Drugs, relating to drugs needed 
to manage symptoms associated with HIV. The preceding sentence 
does not affect the authority of the Secretary to modify such Guide-
lines.’’. 
(b) DRUG REBATE PROGRAM.—Section 2616 of the Public Health 
Service Act, as amended by subsection (a)(2) of this section, is 
amended by adding at the end the following: 
‘‘(g) DRUG REBATE PROGRAM.—A State shall ensure that any 
drug rebates received on drugs purchased from funds provided 
pursuant to this section are applied to activities supported under
H. R. 6143—23
this subpart, with priority given to activities described under this 
section.’’. 
SEC. 203. DISTRIBUTION OF FUNDS. 
(a) DISTRIBUTION BASED ON LIVING CASES OF HIV/AIDS.—
(1) STATE DISTRIBUTION FACTOR.—Section 2618(a)(2) of the 
Public Health Service Act (42 U.S.C. 300ff–28(a)(2)) is 
amended—
(A) in subparagraph (B), by striking ‘‘estimated number 
of living cases of acquired immune deficiency syndrome 
in the eligible area involved’’ and inserting ‘‘number of 
living cases of HIV/AIDS in the State involved’’; and 
(B) by amending subparagraph (D) to read as follows: 
‘‘(D) LIVING CASES OF HIV/AIDS.—
‘‘(i) REQUIREMENT OF NAMES-BASED REPORTING.—
Except as provided in clause (ii), the number deter-
mined under this subparagraph for a State for a fiscal 
year for purposes of subparagraph (B) is the number 
of living names-based cases of HIV/AIDS in the State 
that, as of December 31 of the most recent calendar 
year for which such data is available, have been 
reported to and confirmed by the Director of the Cen-
ters for Disease Control and Prevention. 
‘‘(ii) TRANSITION
PERIOD; EXEMPTION
REGARDING 
NON-AIDS CASES.—For each of the fiscal years 2007 
through 2009, a State is, subject to clauses (iii) through 
(v), exempt from the requirement under clause (i) that 
living non-AIDS names-based cases of HIV be reported 
unless—
‘‘(I) a system was in operation as of December 
31, 2005, that provides sufficiently accurate and 
reliable names-based reporting of such cases 
throughout the State, subject to clause (vii); or 
‘‘(II) no later than the beginning of fiscal year 
2008 or 2009, the Secretary, after consultation 
with the chief executive of the State, determines 
that a system has become operational in the State 
that provides sufficiently accurate and reliable 
names-based reporting of such cases throughout 
the State. 
‘‘(iii) REQUIREMENTS FOR EXEMPTION FOR FISCAL 
YEAR 2007.—For fiscal year 2007, an exemption under 
clause (ii) for a State applies only if, by October 1, 
2006—
‘‘(I)(aa) the State had submitted to the Sec-
retary a plan for making the transition to suffi-
ciently 
accurate 
and 
reliable 
names-based 
reporting of living non-AIDS cases of HIV; or 
‘‘(bb) all statutory changes necessary to pro-
vide for sufficiently accurate and reliable reporting 
of such cases had been made; and 
‘‘(II) the State had agreed that, by April 1, 
2008, the State will begin accurate and reliable 
names-based reporting of such cases, except that 
such agreement is not required to provide that, 
as of such date, the system for such reporting
H. R. 6143—24
be fully sufficient with respect to accuracy and 
reliability throughout the area. 
‘‘(iv) REQUIREMENT FOR EXEMPTION AS OF FISCAL 
YEAR 2008.—For each of the fiscal years 2008 through 
2010, an exemption under clause (ii) for a State applies 
only if, as of April 1, 2008, the State is substantially 
in compliance with the agreement under clause (iii)(II). 
‘‘(v) PROGRESS TOWARD NAMES-BASED REPORTING.—
For fiscal year 2009, the Secretary may terminate an 
exemption under clause (ii) for a State if the State 
submitted a plan under clause (iii)(I)(aa) and the Sec-
retary determines that the State is not substantially 
following the plan. 
‘‘(vi) COUNTING OF CASES IN AREAS WITH EXEMP-
TIONS.—
‘‘(I) IN GENERAL.—With respect to a State that 
is under a reporting system for living non-AIDS 
cases of HIV that is not names-based (referred 
to in this subparagraph as ‘code-based reporting’), 
the Secretary shall, for purposes of this subpara-
graph, modify the number of such cases reported 
for the State in order to adjust for duplicative 
reporting in and among systems that use code-
based reporting. 
‘‘(II) ADJUSTMENT RATE.—The adjustment rate 
under subclause (I) for a State shall be a reduction 
of 5 percent in the number of living non-AIDS 
cases of HIV reported for the State. 
‘‘(vii) 
LIST
OF
STATES
MEETING
STANDARD 
REGARDING DECEMBER 31, 2005.—
‘‘(I) IN
GENERAL.—If a State is specified in 
subclause (II), the State shall be considered to 
meet the standard described in clause (ii)(I). No 
other State may be considered to meet such 
standard. 
‘‘(II) RELEVANT STATES.—For purposes of sub-
clause (I), the States specified in this subclause 
are the following: Alaska, Alabama, Arkansas, 
Arizona, Colorado, Florida, Indiana, Iowa, Idaho, 
Kansas, Louisiana, Michigan, Minnesota, Missouri, 
Mississippi, 
North 
Carolina, 
North 
Dakota, 
Nebraska, New Jersey, New Mexico, New York, 
Nevada, Ohio, Oklahoma, South Carolina, South 
Dakota, Tennessee, Texas, Utah, Virginia, Wis-
consin, West Virginia, Wyoming, Guam, and the 
Virgin Islands. 
‘‘(viii) RULES OF CONSTRUCTION REGARDING ACCEPT-
ANCE OF REPORTS.—
‘‘(I) CASES OF AIDS.—With respect to a State 
that is subject to the requirement under clause 
(i) and is not in compliance with the requirement 
for names-based reporting of living non-AIDS cases 
of HIV, the Secretary shall, notwithstanding such 
noncompliance, accept reports of living cases of 
AIDS that are in accordance with such clause. 
‘‘(II) APPLICABILITY
OF
EXEMPTION
REQUIRE-
MENTS.—The provisions of clauses (ii) through (vii)
H. R. 6143—25
may not be construed as having any legal effect 
for fiscal year 2010 or any subsequent fiscal year, 
and accordingly, the status of a State for purposes 
of such clauses may not be considered after fiscal 
year 2009. 
‘‘(ix) PROGRAM
FOR
DETECTING
INACCURATE
OR 
FRAUDULENT COUNTING.—The Secretary shall carry out 
a program to monitor the reporting of names-based 
cases for purposes of this subparagraph and to detect 
instances of inaccurate reporting, including fraudulent 
reporting.’’. 
(2) NON-EMA DISTRIBUTION FACTOR.—Section 2618(a)(2)(C) 
of the Public Health Service Act (42 U.S.C. 300ff–28(a)(2)(C)) 
is amended—
(A) in clause (i), by striking ‘‘estimated number of 
living cases of acquired immune deficiency syndrome’’ each 
place such term appears and inserting ‘‘number of living 
cases of HIV/AIDS’’; and 
(B) in clause (ii), by amending such clause to read 
as follows: 
‘‘(ii) a number equal to the sum of—
‘‘(I) the total number of living cases of HIV/
AIDS that are within areas in such State that 
are eligible areas under subpart I of part A for 
the fiscal year involved, which individual number 
for an area is the number that applies under sec-
tion 2601 for the area for such fiscal year; and 
‘‘(II) the total number of such cases that are 
within areas in such State that are transitional 
areas under section 2609 for such fiscal year, which 
individual number for an area is the number that 
applies under such section for the fiscal year.’’. 
(b) FORMULA AMENDMENTS GENERALLY.—Section 2618(a)(2) of 
the Public Health Service Act (42 U.S.C. 300ff–28(a)(2)) is 
amended—
(1) in subparagraph (A)—
(A) by striking ‘‘The amount referred to’’ in the matter 
preceding clause (i) and all that follows through the end 
of clause (i) and inserting the following: ‘‘For purposes 
of paragraph (1), the amount referred to in this paragraph 
for a State (including a territory) for a fiscal year is, subject 
to subparagraphs (E) and (F)—
‘‘(i) an amount equal to the amount made available 
under section 2623 for the fiscal year involved for 
grants pursuant to paragraph (1), subject to subpara-
graph (G); and’’; and 
(B) in clause (ii)—
(i) in subclause (I)—
(I) by striking ‘‘.80’’ and inserting ‘‘0.75’’; and 
(II) by striking ‘‘and’’ at the end; 
(ii) in subclause (II)—
(I) by inserting ‘‘non-EMA’’ after ‘‘respective’’; 
and 
(II) by striking the period and inserting ‘‘; 
and’’; and 
(iii) by adding at the end the following:
H. R. 6143—26
‘‘(III) if the State does not for such fiscal year 
contain any area that is an eligible area under 
subpart I of part A or any area that is a transi-
tional area under section 2609 (referred to in this 
subclause as a ‘no-EMA State’), the product of 
0.05 and the ratio of the number of cases that 
applies for the State under subparagraph (D) to 
the sum of the respective numbers of cases that 
so apply for all no-EMA States.’’; 
(2) by striking subparagraphs (E) through (H); 
(3) by inserting after subparagraph (D) the following sub-
paragraphs: 
‘‘(E) CODE-BASED STATES; LIMITATION ON INCREASE IN 
GRANT.—
‘‘(i) IN GENERAL.—For each of the fiscal years 2007 
through 2009, if code-based reporting (within the 
meaning of subparagraph (D)(vi)) applies in a State 
as of the beginning of the fiscal year involved, then 
notwithstanding any other provision of this paragraph, 
the amount of the grant pursuant to paragraph (1) 
for the State may not for the fiscal year involved exceed 
by more than 5 percent the amount of the grant pursu-
ant to this paragraph for the State for the preceding 
fiscal year, except that the limitation under this clause 
may not result in a grant pursuant to paragraph (1) 
for a fiscal year that is less than the minimum amount 
that applies to the State under such paragraph for 
such fiscal year. 
‘‘(ii) USE OF AMOUNTS INVOLVED.—For each of the 
fiscal years 2007 through 2009, amounts available as 
a result of the limitation under clause (i) shall be 
made available by the Secretary as additional amounts 
for grants pursuant to section 2620, subject to subpara-
graph (H).’’; and 
(4) by redesignating subparagraph (I) as subparagraph (F). 
(c) SEPARATE ADAP GRANTS.—Section 2618(a)(2)(G) of the 
Public Health Service Act (42 U.S.C. 300ff–28(a)(2)(G)), as redesig-
nated by subsection (b)(4) of this section, is amended—
(1) in clause (i)—
(A) in the matter preceding subclause (I), by striking 
‘‘section 2677’’ and inserting ‘‘section 2623’’; 
(B) in subclause (II), by striking the period at the 
end and inserting a semicolon; and 
(C) by adding after and below subclause (II) the fol-
lowing: 
‘‘which product shall then, as applicable, be increased 
under subparagraph (H).’’; 
(2) in clause (ii)—
(A) by striking subclauses (I) through (III) and 
inserting the following: 
‘‘(I) IN GENERAL.—From amounts made avail-
able under subclause (V), the Secretary shall 
award supplemental grants to States described in 
subclause (II) to enable such States to purchase 
and distribute to eligible individuals under section 
2616(b) pharmaceutical therapeutics described 
under subsections (c)(2) and (e) of such section.
H. R. 6143—27
‘‘(II) ELIGIBLE STATES.—For purposes of sub-
clause (I), a State shall be an eligible State if 
the State did not have unobligated funds subject 
to reallocation under section 2618(d) in the pre-
vious fiscal year and, in accordance with criteria 
established by the Secretary, demonstrates a 
severe need for a grant under this clause. For 
purposes of determining severe need, the Secretary 
shall consider eligibility standards, formulary com-
position, the number of eligible individuals to 
whom a State is unable to provide therapeutics 
described in section 2616(a), and an unanticipated 
increase of eligible individuals with HIV/AIDS. 
‘‘(III) STATE
REQUIREMENTS.—The Secretary 
may not make a grant to a State under this clause 
unless the State agrees that the State will make 
available (directly or through donations of public 
or private entities) non-Federal contributions 
toward the activities to be carried out under the 
grant in an amount equal to $1 for each $4 of 
Federal funds provided in the grant, except that 
the Secretary may waive this subclause if the State 
has otherwise fully complied with section 2617(d) 
with respect to the grant year involved. The provi-
sions of this subclause shall apply to States that 
are not required to comply with such section 
2617(d).’’. 
(B) in subclause (IV), by moving the subclause two 
ems to the left; 
(C) in subclause (V), by striking ‘‘3 percent’’ and 
inserting ‘‘5 percent’’; and 
(D) by striking subclause (VI); and 
(3) by adding at the end the following clause: 
‘‘(iii) CODE-BASED STATES; LIMITATION ON INCREASE 
IN FORMULA GRANT.—The limitation under subpara-
graph (E)(i) applies to grants pursuant to clause (i) 
of this subparagraph to the same extent and in the 
same manner as such limitation applies to grants 
pursuant to paragraph (1), except that the reference 
to minimum grants does not apply for purposes of 
this clause. Amounts available as a result of the limita-
tion under the preceding sentence shall be made avail-
able by the Secretary as additional amounts for grants 
under clause (ii) of this subparagraph.’’. 
(d) HOLD HARMLESS.—Section 2618(a)(2) of the Public Health 
Service Act (42 U.S.C. 300ff–28(a)(2)), as amended by subsection 
(b)(4) of this section, is amended by adding at the end the following 
subparagraph: 
‘‘(H) INCREASE IN FORMULA GRANTS.—
‘‘(i) ASSURANCE OF AMOUNT.—
‘‘(I) GENERAL RULE.—For fiscal year 2007, the 
Secretary shall ensure, subject to clauses (ii) 
through (iv), that the total for a State of the grant 
pursuant to paragraph (1) and the grant pursuant 
to subparagraph (G) is not less than 95 percent 
of such total for the State for fiscal year 2006.
H. R. 6143—28
‘‘(II) RULE
OF
CONSTRUCTION.—With respect 
to the application of subclause (I), the 95 percent 
requirement under such subclause shall apply with 
respect to each grant awarded under paragraph 
(1) and with respect to each grant awarded under 
subparagraph (G). 
‘‘(ii) FISCAL YEAR 2007.—For purposes of clause 
(i) as applied for fiscal year 2007, the references in 
such clause to subparagraph (G) are deemed to be 
references to subparagraph (I) as such subparagraph 
was in effect for fiscal year 2006. 
‘‘(iii) FISCAL YEARS 2008 AND 2009.—For each of 
the fiscal years 2008 and 2009, the Secretary shall 
ensure that the total for a State of the grant pursuant 
to paragraph (1) and the grant pursuant to subpara-
graph (G) is not less than 100 percent of such total 
for the State for fiscal year 2007. 
‘‘(iv) SOURCE OF FUNDS FOR INCREASE.—
‘‘(I) IN GENERAL.—From the amount reserved 
under section 2623(b)(2) for a fiscal year, and from 
amounts available for such section pursuant to 
subsection (d) of this section, the Secretary shall 
make available such amounts as may be necessary 
to comply with clause (i). 
‘‘(II) PRO RATA REDUCTION.—If the amounts 
referred to in subclause (I) for a fiscal year are 
insufficient to fully comply with clause (i) for the 
year, the Secretary, in order to provide the addi-
tional funds necessary for such compliance, shall 
reduce on a pro rata basis the amount of each 
grant pursuant to paragraph (1) for the fiscal year, 
other than grants for States for which increases 
under clause (i) apply and other than States 
described in paragraph (1)(A)(i)(I). A reduction 
under the preceding sentence may not be made 
in an amount that would result in the State 
involved becoming eligible for such an increase. 
‘‘(v) APPLICABILITY.—This paragraph may not be 
construed as having any applicability after fiscal year 
2009.’’. 
(e) ADMINISTRATIVE EXPENSES; CLINICAL QUALITY MANAGE-
MENT.—Section 2618(b) of the Public Health Service Act (42 U.S.C. 
300ff–28(b)) is amended—
(1) by redesignating paragraphs (2) through (7) as para-
graphs (1) through (6); 
(2) in paragraph (2) (as so redesignated)—
(A) by striking ‘‘paragraph (5)’’ and inserting ‘‘para-
graph (4)’’; and 
(B) by striking ‘‘paragraph (6)’’ and inserting ‘‘para-
graph (5)’’; 
(3) in paragraph (3) (as so redesignated)—
(A) by amending subparagraph (A) to read as follows: 
‘‘(A) IN GENERAL.—Subject to paragraph (4), and except 
as provided in paragraph (5), a State may not use more 
than 10 percent of amounts received under a grant awarded 
under section 2611 for administration.’’;
H. R. 6143—29
(B) by redesignating subparagraphs (B) and (C) as 
subparagraphs (C) and (D), respectively; 
(C) by inserting after subparagraph (A) the following: 
‘‘(B) ALLOCATIONS.—In the case of entities and sub-
contractors to which a State allocates amounts received 
by the State under a grant under section 2611, the State 
shall ensure that, of the aggregate amount so allocated, 
the total of the expenditures by such entities for adminis-
trative expenses does not exceed 10 percent (without regard 
to whether particular entities expend more than 10 percent 
for such expenses).’’; 
(D) in subparagraph (C) (as so redesignated), by 
inserting before the period the following: ‘‘, including a 
clinical quality management program under subparagraph 
(E)’’; and 
(E) by adding at the end the following: 
‘‘(E) CLINICAL QUALITY MANAGEMENT.—
‘‘(i) REQUIREMENT.—Each State that receives a 
grant under section 2611 shall provide for the 
establishment of a clinical quality management pro-
gram 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/AIDS and related opportun-
istic infection, and as applicable, to develop strategies 
for ensuring that such services are consistent with 
the guidelines for improvement in the access to and 
quality of HIV health services. 
‘‘(ii) USE OF FUNDS.—
‘‘(I) IN
GENERAL.—From amounts received 
under a grant awarded under section 2611 for 
a fiscal year, a State may use for activities associ-
ated with the clinical quality management pro-
gram required in clause (i) not to exceed the lesser 
of—
‘‘(aa) 5 percent of amounts received under 
the grant; or 
‘‘(bb) $3,000,000. 
‘‘(II) RELATION TO LIMITATION ON ADMINISTRA-
TIVE
EXPENSES.—The costs of a clinical quality 
management program under clause (i) may not 
be considered administrative expenses for purposes 
of the limitation established in subparagraph (A).’’; 
(4) in paragraph (4) (as so redesignated)—
(A) by striking ‘‘paragraph (6)’’ and inserting ‘‘para-
graph (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 ‘‘para-
graphs (3)’’ and all that follows through ‘‘(5),’’ and inserting 
the following: ‘‘paragraphs (2) and (3), may, notwithstanding 
paragraphs (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
H. R. 6143—30
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 addition to amounts made available for such grants 
under section 2623(b)(2).’’. 
(g) DEFINITIONS; OTHER TECHNICAL AMENDMENTS.—Section 
2618(a) of the Public Health Service Act (42 U.S.C. 300ff–28(a)) 
is amended—
(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 paragraph 
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 District’’ and inserting 
‘‘covered State’’; and 
(II) by inserting ‘‘and’’ after the semicolon; 
and 
(3) in paragraph (1)(B), by striking ‘‘each territory of the 
United States, as defined in paragraph (3),’’ and inserting ‘‘each 
territory other than Guam and the Virgin Islands’’; 
(4) in paragraph (2)(C)(i), by striking ‘‘or territory’’; 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 amended 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), respectively; 
(B) by inserting after paragraph (3), the following: 
‘‘(4) the designation of a lead State agency that shall—
‘‘(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 programs 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
H. R. 6143—31
‘‘(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 redesignated)—
(i) in subparagraph (E), by striking ‘‘and’’ at the 
end; and 
(ii) by inserting after subparagraph (F) the fol-
lowing: 
‘‘(G) includes key outcomes to be measured by all enti-
ties in the State receiving assistance under this title; and’’; 
and 
(D) in paragraph (7) (as so redesignated), in subpara-
graph (A)—
(i) by striking ‘‘paragraph (5)’’ and inserting ‘‘para-
graph (6)’’; and 
(ii) by striking ‘‘paragraph (4)’’ and inserting ‘‘para-
graph (5)’’. 
(2) NATIVE AMERICAN REPRESENTATION.—Section 2617(b)(6) 
of the Public Health Service Act, as redesignated by paragraph 
(1)(A) of this subsection, is amended by inserting before ‘‘rep-
resentatives of grantees’’ the following: ‘‘members of a Federally 
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 subsection, is amended by inserting before the semicolon 
the following: ‘‘(except for a program administered by or pro-
viding the services of the Indian Health Service)’’. 
(d) MATCHING FUNDS; APPLICABILITY OF REQUIREMENT.—Sec-
tion 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 DEMONSTRATED 
NEED. 
Subpart I of part B of title XXVI of the Public Health Service 
Act (42 U.S.C. 300ff–21 et seq.) is amended—
(1) by redesignating section 2620 as section 2621; and 
(2) by inserting after section 2619 the following: 
‘‘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 dem-
onstrated the need in the State, on an objective and quantified 
basis, for supplemental financial 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 avail-
able, have more than 2 percent of grant funds under such 
sections canceled or covered by any waivers under section 
2622(c). 
‘‘(b) DEMONSTRATED NEED.—The factors considered by the Sec-
retary in determining whether an eligible area has a demonstrated
H. R. 6143—32
need for purposes of subsection (a)(1) may include any or all of 
the following: 
‘‘(1) The unmet need for such services, as determined 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 number 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. 
‘‘(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 received pursu-
ant to section 2618 on services available to all individuals 
with HIV/AIDS identified and eligible 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 decline in funding) applies to the State. 
‘‘(d) REPORT ON THE AWARDING OF SUPPLEMENTAL FUNDS.—
Not later than 45 days after the awarding of supplemental funds 
under this section, the Secretary shall submit to Congress a report 
concerning such funds. Such report shall include information 
detailing—
‘‘(1) the total amount of supplemental funds available under 
this section for the year involved; 
‘‘(2) the amount of supplemental funds used in accordance 
with the hold harmless provisions of section 2618(a)(2); 
‘‘(3) the amount of supplemental funds disbursed pursuant 
to subsection (c); 
‘‘(4) the disbursement of the remainder of the supplemental 
funds after taking into account the uses described in paragraphs 
(2) and (3); and 
‘‘(5) the rationale used for the amount of funds disbursed 
as described under paragraphs (2), (3), and (4). 
‘‘(e) 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 pursuant to section 2618(a)(1). 
‘‘(f) APPLICABILITY
OF GRANT AUTHORITY.—The authority to 
make grants under this section applies beginning with the first 
fiscal year for which amounts are made available for such grants 
under section 2623(b)(1).’’.
H. R. 6143—33
SEC. 206. EMERGING COMMUNITIES. 
Section 2621 of the Public Health Service Act, as redesignated 
by section 205(1) of this Act, is amended—
(1) in the heading for the section, by striking ‘‘SUPPLE-
MENTAL
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 provide 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’’. 
(3) by striking subsections (d) and (e) and inserting the 
following: 
‘‘(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 Prevention 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 COMMUNITY.—Notwith-
standing any other provision of this section, 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 fiscal 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—
‘‘(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 communities for all States.’’. 
SEC. 207. TIMEFRAME FOR OBLIGATION AND EXPENDITURE 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 EXPENDITURE OF 
GRANT FUNDS. 
‘‘(a) OBLIGATION BY END OF GRANT YEAR.—Effective for fiscal 
year 2007 and subsequent fiscal years, funds from a grant award 
made to a State for a fiscal year pursuant 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
H. R. 6143—34
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). 
‘‘(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 beginning 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 UNOBLIGATED BAL-
ANCE OF GRANT AWARD; WAIVER PERMITTING CARRYOVER.—
‘‘(1) IN GENERAL.—Effective for fiscal year 2007 and subse-
quent fiscal years, if a grant award 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 bal-
ance 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 application for a waiver of the 
cancellation, which application includes a description of 
the purposes 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 unobligated as of the end of a grant year 
for an award: 
‘‘(A) The unobligated funds are available for expendi-
ture 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 cancel that unexpended 
balance of the award, and shall require the State to return 
any amounts from such balance that have been disbursed 
to the State. 
‘‘(3) USE
OF
CANCELLED
BALANCES.—In the case of any 
balance of a grant award that is cancelled under paragraph 
(1) or (2)(B), the grant funds involved shall be made available 
by the Secretary as additional amounts for grants under section 
2620 for the first fiscal year beginning after the fiscal year 
in which the Secretary obtains the information necessary for 
determining that the balance is required under such paragraph
H. R. 6143—35
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. 
‘‘(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, the amount of the grant 
under such section for the first fiscal year beginning 
after the fiscal year in which the Secretary obtains 
the information necessary for determining that such 
balance was unobligated as of the end of the grant 
year (which requirement for a reduction applies with-
out regard to whether a waiver under paragraph (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 balance 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 fiscal year. 
‘‘(d) TREATMENT OF DRUG REBATES.—For purposes of this sec-
tion, 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 SUBPART 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, and $1,285,200,000 
for fiscal year 2009. Amounts appropriated under the preceding 
sentence for a fiscal year are available for obligation by the Sec-
retary until the end of the second succeeding 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. 
‘‘(2) SUPPLEMENTAL GRANTS.—
‘‘(A) IN GENERAL.—Of the amount appropriated under 
subsection (a) for a fiscal year in excess of the 2006 adjusted 
amount, the Secretary shall reserve 1⁄3 for grants under 
section 2620, except that the availability of the reserved 
funds for such grants is subject to section 2618(a)(2)(H) 
as applied for such year, and except that any amount 
appropriated exclusively for carrying out section 2616 (and,
H. R. 6143—36
accordingly, distributed under section 2618(a)(2)(G)) is not 
subject to this subparagraph. 
‘‘(B) 
2006 
ADJUSTED
AMOUNT.—For 
purposes 
of 
subparagraph (A), the term ‘2006 adjusted 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 exclu-
sively 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: 
‘‘SEC. 2625. EARLY DIAGNOSIS GRANT PROGRAM. 
‘‘(a) IN GENERAL.—In the case of States whose laws or regula-
tions are in accordance with subsection (b), the Secretary, acting 
through the Centers for Disease Control and Prevention, shall make 
grants to such States for the purposes described in subsection 
(c). 
‘‘(b) DESCRIPTION OF COMPLIANT STATES.—For purposes of sub-
section (a), the laws or regulations of a State are in accordance 
with this subsection if, under such laws or regulations (including 
programs carried out pursuant to the discretion of State officials), 
both of the policies described in paragraph (1) are in effect, or 
both of the policies described in paragraph (2) are in effect, as 
follows: 
‘‘(1)(A) Voluntary opt-out testing of pregnant women. 
‘‘(B) Universal testing of newborns. 
‘‘(2)(A) Voluntary opt-out testing of clients at sexually 
transmitted disease clinics. 
‘‘(B) Voluntary opt-out testing of clients at substance abuse 
treatment centers. 
The Secretary shall periodically ensure that the applicable policies 
are being carried out and recertify compliance. 
‘‘(c) USE OF FUNDS.—A State may use funds provided under 
subsection (a) for HIV/AIDS testing (including rapid testing), 
prevention counseling, treatment of newborns exposed to HIV/AIDS, 
treatment of mothers infected with HIV/AIDS, and costs associated 
with linking those diagnosed with HIV/AIDS to care and treatment 
for HIV/AIDS. 
‘‘(d) APPLICATION.—A State that is eligible for the grant under 
subsection (a) shall submit an application to the Secretary, in 
such form, in such manner, and containing such information as 
the Secretary may require. 
‘‘(e) LIMITATION ON AMOUNT OF GRANT.—A grant under sub-
section (a) to a State for a fiscal year may not be made in an 
amount exceeding $10,000,000. 
‘‘(f) RULE
OF CONSTRUCTION.—Nothing in this section shall 
be construed to pre-empt State laws regarding HIV/AIDS counseling 
and testing. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) The term ‘voluntary opt-out testing’ means HIV/AIDS 
testing—
‘‘(A) that is administered to an individual seeking other 
health care services; and 
‘‘(B) in which—
H. R. 6143—37
‘‘(i) pre-test counseling is not required but the indi-
vidual is informed that the individual will receive an 
HIV/AIDS test and the individual may opt out of such 
testing; and 
‘‘(ii) for those individuals with a positive test result, 
post-test counseling (including referrals for care) is 
provided and confidentiality is protected. 
‘‘(2) The term ‘universal testing of newborns’ means HIV/
AIDS testing that is administered within 48 hours of delivery 
to—
‘‘(A) all infants born in the State; or 
‘‘(B) all infants born in the State whose mother’s HIV/
AIDS status is unknown at the time of delivery. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—Of the funds appro-
priated annually to the Centers for Disease Control and Prevention 
for HIV/AIDS prevention activities, $30,000,000 shall be made avail-
able for each of the fiscal years 2007 through 2009 for grants 
under subsection (a), of which $20,000,000 shall be made available 
for grants to States with the policies described in subsection (b)(1), 
and $10,000,000 shall be made available for grants to States with 
the policies described in subsection (b)(2). Funds provided under 
this section are available until expended.’’. 
SEC. 210. CERTAIN PARTNER NOTIFICATION PROGRAMS; AUTHORIZA-
TION OF APPROPRIATIONS. 
Section 2631(d) of the Public Health Service Act (42 U.S.C. 
300ff–38(d)) is amended by striking ‘‘there are’’ and all that follows 
and inserting the following: ‘‘there is authorized to be appropriated 
$10,000,000 for each of the fiscal years 2007 through 2009.’’. 
TITLE III—EARLY INTERVENTION 
SERVICES 
SEC. 301. ESTABLISHMENT OF PROGRAM; CORE MEDICAL SERVICES. 
(a) IN GENERAL.—Section 2651 of the Public Health Service 
Act (42 U.S.C. 300ff–51) is amended to read as follows: 
‘‘SEC. 2651. ESTABLISHMENT OF A PROGRAM. 
‘‘(a) IN GENERAL.—For the purposes described in subsection 
(b), the Secretary, acting through the Administrator of the Health 
Resources and Services Administration, may make grants to public 
and nonprofit private entities specified in section 2652(a). 
‘‘(b) REQUIREMENTS.—
‘‘(1) IN GENERAL.—The Secretary may not make a grant 
under subsection (a) unless the applicant for the grant agrees 
to expend the grant only for—
‘‘(A) core medical services described in subsection (c); 
‘‘(B) support services described in subsection (d); and 
‘‘(C) administrative expenses as described in section 
2664(g)(3). 
‘‘(2) EARLY INTERVENTION SERVICES.—An applicant for a 
grant under subsection (a) shall expend not less than 50 percent 
of the amount received under the grant for the services 
described in subparagraphs (B) through (E) of subsection (e)(1) 
for individuals with HIV/AIDS. 
‘‘(c) REQUIRED FUNDING FOR CORE MEDICAL SERVICES.—
H. R. 6143—38
‘‘(1) IN GENERAL.—With respect to a grant under subsection 
(a) to an applicant for a fiscal year, the applicant shall, of 
the portion of the grant remaining after reserving amounts 
for purposes of paragraphs (3) and (5) of section 2664(g), use 
not less than 75 percent to provide core medical services that 
are needed in the area involved for individuals with HIV/
AIDS who are identified and eligible under this title (including 
services regarding the co-occurring conditions of the individ-
uals). 
‘‘(2) WAIVER.—
‘‘(A) The Secretary shall waive the application of para-
graph (1) with respect to an applicant for a grant if the 
Secretary determines that, within the service area of the 
applicant—
‘‘(i) there are no waiting lists for AIDS Drug Assist-
ance Program services under section 2616; and 
‘‘(ii) core medical services are available to all 
individuals with HIV/AIDS identified and eligible 
under this title. 
‘‘(B) 
NOTIFICATION
OF
WAIVER
STATUS.—When 
informing an applicant that a grant under subsection (a) 
is being made for a fiscal year, the Secretary shall inform 
the applicant whether a waiver under subparagraph (A) 
is in effect for the fiscal year. 
‘‘(3) CORE MEDICAL SERVICES.—For purposes of this sub-
section, the term ‘core medical services’, with respect to an 
individual with HIV/AIDS (including the co-occurring conditions 
of the individual) means the following services: 
‘‘(A) Outpatient and ambulatory health services. 
‘‘(B) AIDS Drug Assistance Program treatments under 
section 2616. 
‘‘(C) AIDS pharmaceutical assistance. 
‘‘(D) Oral health care. 
‘‘(E) Early intervention services described in subsection 
(e). 
‘‘(F) Health insurance premium and cost sharing assist-
ance for low-income individuals in accordance with section 
2615. 
‘‘(G) Home health care. 
‘‘(H) Medical nutrition therapy. 
‘‘(I) Hospice services. 
‘‘(J) Home and community-based health services as 
defined under section 2614(c). 
‘‘(K) Mental health services. 
‘‘(L) Substance abuse outpatient care. 
‘‘(M) Medical case management, including treatment 
adherence services. 
‘‘(d) SUPPORT SERVICES.—
‘‘(1) IN GENERAL.—For purposes of this section, the term 
‘support services’ means services, subject to the approval of 
the Secretary, that are needed for individuals with HIV/AIDS 
to achieve their medical outcomes (such as respite care for 
persons caring for individuals with HIV/AIDS, outreach serv-
ices, medical transportation, linguistic services, and referrals 
for health care and support services).
H. R. 6143—39
‘‘(2) DEFINITION OF MEDICAL OUTCOMES.—In this section, 
the term ‘medical outcomes’ means those outcomes affecting 
the HIV-related clinical status of an individual with HIV/AIDS. 
‘‘(e) SPECIFICATION OF EARLY INTERVENTION SERVICES.—
‘‘(1) IN GENERAL.—The early intervention services referred 
to in this section are—
‘‘(A) counseling individuals with respect to HIV/AIDS 
in accordance with section 2662; 
‘‘(B) testing individuals with respect to HIV/AIDS, 
including tests to confirm the presence of the disease, tests 
to diagnose the extent of the deficiency in the immune 
system, and tests to provide information on appropriate 
therapeutic measures for preventing and treating the 
deterioration of the immune system and for preventing 
and treating conditions arising from HIV/AIDS; 
‘‘(C) referrals described in paragraph (2); 
‘‘(D) other clinical and diagnostic services regarding 
HIV/AIDS, and periodic medical evaluations of individuals 
with HIV/AIDS; and 
‘‘(E) providing the therapeutic measures described in 
subparagraph (B). 
‘‘(2) REFERRALS.—The services referred to in paragraph 
(1)(C) are referrals of individuals with HIV/AIDS to appropriate 
providers of health and support services, including, as appro-
priate—
‘‘(A) to entities receiving amounts under part A or 
B for the provision of such services; 
‘‘(B) to biomedical research facilities of institutions of 
higher education that offer experimental treatment for such 
disease, or to community-based organizations or other enti-
ties that provide such treatment; or 
‘‘(C) to grantees under section 2671, in the case of 
a pregnant woman. 
‘‘(3) REQUIREMENT OF AVAILABILITY OF ALL EARLY INTERVEN-
TION SERVICES THROUGH EACH GRANTEE.—
‘‘(A) IN GENERAL.—The Secretary may not make a grant 
under subsection (a) unless the applicant for the grant 
agrees that each of the early intervention services specified 
in paragraph (2) will be available through the grantee. 
With respect to compliance with such agreement, such 
a grantee may expend the grant to provide the early inter-
vention services directly, and may expend the grant to 
enter into agreements with public or nonprofit private enti-
ties, or private for-profit entities if such entities are the 
only available provider of quality HIV care in the area, 
under which the entities provide the services. 
‘‘(B) OTHER REQUIREMENTS.—Grantees described in—
‘‘(i) subparagraphs (A), (D), (E), and (F) of section 
2652(a)(1) shall use not less than 50 percent of the 
amount of such a grant to provide the services 
described in subparagraphs (A), (B), (D), and (E) of 
paragraph (1) directly and on-site or at sites where 
other primary care services are rendered; and 
‘‘(ii) 
subparagraphs 
(B) 
and 
(C) 
of 
section 
2652(a)(1) shall ensure the availability of early inter-
vention services through a system of linkages to
H. R. 6143—40
community-based primary care providers, and to estab-
lish mechanisms for the referrals described in para-
graph (1)(C), and for follow-up concerning such refer-
rals.’’. 
(b) ADMINISTRATIVE EXPENSES; CLINICAL QUALITY MANAGEMENT 
PROGRAM.—Section 2664(g) of the Public Health Service Act (42 
U.S.C. 300ff–64(g)) is amended—
(1) in paragraph (3), by amending the paragraph to read 
as follows: 
‘‘(3) the applicant will not expend more than 10 percent 
of the grant for administrative expenses with respect to the 
grant, including planning and evaluation, except that the costs 
of a clinical quality management program under paragraph 
(5) may not be considered administrative expenses for purposes 
of such limitation;’’; and 
(2) in paragraph (5), by inserting ‘‘clinical’’ before ‘‘quality 
management’’. 
SEC. 
302. 
ELIGIBLE 
ENTITIES; 
PREFERENCES; 
PLANNING 
AND 
DEVELOPMENT GRANTS. 
(a) MINIMUM QUALIFICATION OF GRANTEES.—Section 2652(a) 
of the Public Health Service Act (42 U.S.C. 300ff–52(a)) is amended 
to read as follows: 
‘‘(a) ELIGIBLE ENTITIES.—
‘‘(1) IN GENERAL.—The entities referred to in section 2651(a) 
are public entities and nonprofit private entities that are—
‘‘(A) federally-qualified health centers under section 
1905(l)(2)(B) of the Social Security Act; 
‘‘(B) grantees under section 1001 (regarding family 
planning) other than States; 
‘‘(C) comprehensive hemophilia diagnostic and treat-
ment centers; 
‘‘(D) rural health clinics; 
‘‘(E) health facilities operated by or pursuant to a con-
tract with the Indian Health Service; 
‘‘(F) community-based organizations, clinics, hospitals 
and other health facilities that provide early intervention 
services to those persons infected with HIV/AIDS through 
intravenous drug use; or 
‘‘(G) nonprofit private entities that provide comprehen-
sive primary care services to populations at risk of HIV/
AIDS, 
including 
faith-based 
and 
community-based 
organizations. 
‘‘(2) UNDERSERVED
POPULATIONS.—Entities described in 
paragraph (1) shall serve underserved populations which may 
include minority populations and Native American populations, 
ex-offenders, individuals with comorbidities including hepatitis 
B or C, mental illness, or substance abuse, low-income popu-
lations, inner city populations, and rural populations.’’. 
(b) PREFERENCES
IN MAKING GRANTS.—Section 2653 of the 
Public Health Service Act (42 U.S.C. 300ff–53) is amended—
(1) in subsection (b)(1)—
(A) in subparagraph (A), by striking ‘‘acquired immune 
deficiency syndrome’’ and inserting ‘‘HIV/AIDS’’; and 
(B) in subparagraph (D), by inserting before the semi-
colon the following: ‘‘and the number of cases of individuals 
co-infected with HIV/AIDS and hepatitis B or C’’; and
H. R. 6143—41
(2) in subsection (d)(2), by striking ‘‘special consideration’’ 
and inserting ‘‘preference’’. 
(c) PLANNING AND DEVELOPMENT GRANTS.—Section 2654(c) of 
the Public Health Service Act (42 U.S.C. 300ff–54(c)) is amended—
(1) in paragraph (1)—
(A) in subparagraph (A), by striking ‘‘HIV’’; and 
(B) in subparagraph (B), by striking ‘‘HIV’’ and 
inserting ‘‘HIV/AIDS’’; and 
(2) in paragraph (3), by striking ‘‘or underserved commu-
nities’’ and inserting ‘‘areas or to underserved populations’’. 
SEC. 303. AUTHORIZATION OF APPROPRIATIONS. 
Section 2655 of the Public Health Service Act (42 U.S.C. 300ff–
55) is amended by striking ‘‘such sums’’ and all that follows through 
‘‘2005’’ and inserting ‘‘, $218,600,000 for fiscal year 2007, 
$226,700,000 for fiscal year 2008, and $235,100,000 for fiscal year 
2009’’. 
SEC. 304. CONFIDENTIALITY AND INFORMED CONSENT. 
Section 2661 of the Public Health Service Act (42 U.S.C. 300ff–
61) is amended to read as follows: 
‘‘SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT. 
‘‘(a) CONFIDENTIALITY.—The Secretary may not make a grant 
under this part unless, in the case of any entity applying for 
a grant under section 2651, the entity agrees to ensure that informa-
tion regarding the receipt of early intervention services pursuant 
to the grant is maintained confidentially in a manner not incon-
sistent with applicable law. 
‘‘(b) INFORMED CONSENT.—The Secretary may not make a grant 
under this part unless the applicant for the grant agrees that, 
in testing an individual for HIV/AIDS, the applicant will test an 
individual only after the individual confirms that the decision of 
the individual with respect to undergoing such testing is voluntarily 
made.’’. 
SEC. 305. PROVISION OF CERTAIN COUNSELING SERVICES. 
Section 2662 of the Public Health Service Act (42 U.S.C. 300ff–
62) is amended to read as follows: 
‘‘SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES. 
‘‘(a) COUNSELING
OF
INDIVIDUALS
WITH
NEGATIVE
TEST 
RESULTS.—The Secretary may not make a grant under this part 
unless the applicant for the grant agrees that, if the results of 
testing conducted for HIV/AIDS indicate that an individual does 
not have such condition, the applicant will provide the individual 
information, including—
‘‘(1) measures for prevention of, exposure to, and trans-
mission of HIV/AIDS, hepatitis B, hepatitis C, and other sexu-
ally transmitted diseases; 
‘‘(2) the accuracy and reliability of results of testing for 
HIV/AIDS, hepatitis B, and hepatitis C; 
‘‘(3) the significance of the results of such testing, including 
the potential for developing AIDS, hepatitis B, or hepatitis 
C; 
‘‘(4) the appropriateness of further counseling, testing, and 
education of the individual regarding HIV/AIDS and other sexu-
ally transmitted diseases;
H. R. 6143—42
‘‘(5) if diagnosed with chronic hepatitis B or hepatitis C 
co-infection, the potential of developing hepatitis-related liver 
disease and its impact on HIV/AIDS; and 
‘‘(6) information regarding the availability of hepatitis B 
vaccine and information about hepatitis treatments. 
‘‘(b) COUNSELING
OF
INDIVIDUALS
WITH
POSITIVE
TEST 
RESULTS.—The Secretary may not make a grant under this part 
unless the applicant for the grant agrees that, if the results of 
testing for HIV/AIDS indicate that the individual has such condi-
tion, the applicant will provide to the individual appropriate coun-
seling regarding the condition, including—
‘‘(1) information regarding—
‘‘(A) measures for prevention of, exposure to, and trans-
mission of HIV/AIDS, hepatitis B, and hepatitis C; 
‘‘(B) the accuracy and reliability of results of testing 
for HIV/AIDS, hepatitis B, and hepatitis C; and 
‘‘(C) the significance of the results of such testing, 
including the potential for developing AIDS, hepatitis B, 
or hepatitis C; 
‘‘(2) reviewing the appropriateness of further counseling, 
testing, and education of the individual regarding HIV/AIDS 
and other sexually transmitted diseases; and 
‘‘(3) providing counseling—
‘‘(A) on the availability, through the applicant, of early 
intervention services; 
‘‘(B) on the availability in the geographic area of appro-
priate health care, mental health care, and social and sup-
port services, including providing referrals for such serv-
ices, as appropriate; 
‘‘(C)(i) that explains the benefits of locating and coun-
seling any individual by whom the infected individual may 
have been exposed to HIV/AIDS, hepatitis B, or hepatitis 
C and any individual whom the infected individual may 
have exposed to HIV/AIDS, hepatitis B, or hepatitis C; 
and 
‘‘(ii) that emphasizes it is the duty of infected individ-
uals to disclose their infected status to their sexual partners 
and their partners in the sharing of hypodermic needles; 
that provides advice to infected individuals on the manner 
in which such disclosures can be made; and that empha-
sizes that it is the continuing duty of the individuals to 
avoid any behaviors that will expose others to HIV/AIDS, 
hepatitis B, or hepatitis C; and 
‘‘(D) on the availability of the services of public health 
authorities with respect to locating and counseling any 
individual described in subparagraph (C); 
‘‘(4) if diagnosed with chronic hepatitis B or hepatitis C 
co-infection, the potential of developing hepatitis-related liver 
disease and its impact on HIV/AIDS; and 
‘‘(5) information regarding the availability of hepatitis B 
vaccine. 
‘‘(c) ADDITIONAL
REQUIREMENTS
REGARDING
APPROPRIATE 
COUNSELING.—The Secretary may not make a grant under this 
part unless the applicant for the grant agrees that, in counseling 
individuals with respect to HIV/AIDS, the applicant will ensure 
that the counseling is provided under conditions appropriate to 
the needs of the individuals.
H. R. 6143—43
‘‘(d) COUNSELING OF EMERGENCY RESPONSE EMPLOYEES.—The 
Secretary may not make a grant under this part to a State unless 
the State agrees that, in counseling individuals with respect to 
HIV/AIDS, the State will ensure that, in the case of emergency 
response employees, the counseling is provided to such employees 
under conditions appropriate to the needs of the employees 
regarding the counseling. 
‘‘(e) RULE OF CONSTRUCTION REGARDING COUNSELING WITHOUT 
TESTING.—Agreements made pursuant to this section may not be 
construed to prohibit any grantee under this part from expending 
the grant for the purpose of providing counseling services described 
in this section to an individual who does not undergo testing for 
HIV/AIDS as a result of the grantee or the individual determining 
that such testing of the individual is not appropriate.’’. 
SEC. 306. GENERAL PROVISIONS. 
(a) APPLICABILITY OF CERTAIN REQUIREMENTS.—Section 2663 
of the Public Health Service Act (42 U.S.C. 300ff–63) is amended 
by striking ‘‘will, without’’ and all that follows through ‘‘be carried’’ 
and inserting ‘‘with funds appropriated through this Act will be 
carried’’. 
(b) ADDITIONAL REQUIRED AGREEMENTS.—Section 2664(a) of the 
Public Health Service Act (42 U.S.C. 300ff–64(a)) is amended—
(1) in paragraph (1)—
(A) in subparagraph (A), by striking ‘‘and’’ at the end; 
(B) in subparagraph (B), by striking ‘‘and’’ at the end; 
and 
(C) by adding at the end the following: 
‘‘(C) information regarding how the expected expendi-
tures of the grant are related to the planning process 
for localities funded under part A (including the planning 
process described in section 2602) and for States funded 
under part B (including the planning process described 
in section 2617(b)); and 
‘‘(D) a specification of the expected expenditures and 
how those expenditures will improve overall client out-
comes, as described in the State plan under section 
2617(b);’’; 
(2) in paragraph (2), by striking the period and inserting 
a semicolon; and 
(3) by adding at the end the following: 
‘‘(3) the applicant agrees to provide additional documenta-
tion to the Secretary regarding the process used to obtain 
community input into the design and implementation of activi-
ties related to such grant; and 
‘‘(4) the applicant agrees to submit, every 2 years, to the 
lead State agency under section 2617(b)(4) audits, consistent 
with Office of Management and Budget circular A133, regarding 
funds expended in accordance with this title and shall include 
necessary client level data to complete unmet need calculations 
and Statewide coordinated statements of need process.’’. 
(c) PAYER OF LAST RESORT.—Section 2664(f)(1)(A) of the Public 
Health Service Act (42 U.S.C. 300ff–64(f)(1)(A)) is amended by 
inserting ‘‘(except for a program administered by or providing the 
services of the Indian Health Service)’’ before the semicolon.
H. R. 6143—44
TITLE IV—WOMEN, INFANTS, 
CHILDREN, AND YOUTH 
SEC. 401. WOMEN, INFANTS, CHILDREN, AND YOUTH. 
Part D of title XXVI of the Public Health Service Act (42 
U.S.C. 300ff–71 et seq.) is amended to read as follows: 
‘‘PART D—WOMEN, INFANTS, CHILDREN, AND 
YOUTH 
‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO 
RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND 
YOUTH. 
‘‘(a) IN GENERAL.—The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration, shall 
award grants to public and nonprofit private entities (including 
a health facility operated by or pursuant to a contract with the 
Indian Health Service) for the purpose of providing family-centered 
care involving outpatient or ambulatory care (directly or through 
contracts) for women, infants, children, and youth with HIV/AIDS. 
‘‘(b) ADDITIONAL SERVICES FOR PATIENTS AND FAMILIES.—Funds 
provided under grants awarded under subsection (a) may be used 
for the following support services: 
‘‘(1) Family-centered care including case management. 
‘‘(2) Referrals for additional services including—
‘‘(A) referrals for inpatient hospital services, treatment 
for substance abuse, and mental health services; and 
‘‘(B) referrals for other social and support services, 
as appropriate. 
‘‘(3) Additional services necessary to enable the patient 
and the family to participate in the program established by 
the applicant pursuant to such subsection including services 
designed to recruit and retain youth with HIV. 
‘‘(4) The provision of information and education on 
opportunities to participate in HIV/AIDS-related clinical 
research. 
‘‘(c) COORDINATION WITH OTHER ENTITIES.—A grant awarded 
under subsection (a) may be made only if the applicant provides 
an agreement that includes the following: 
‘‘(1) The applicant will coordinate activities under the grant 
with other providers of health care services under this Act, 
and under title V of the Social Security Act, including programs 
promoting the reduction and elimination of risk of HIV/AIDS 
for youth. 
‘‘(2) The applicant will participate in the statewide coordi-
nated statement of need under part B (where it has been 
initiated by the public health agency responsible for admin-
istering grants under part B) and in revisions of such state-
ment. 
‘‘(3) The applicant will every 2 years submit to the lead 
State agency under section 2617(b)(4) audits regarding funds 
expended in accordance with this title and shall include nec-
essary client-level data to complete unmet need calculations 
and Statewide coordinated statements of need process.
H. R. 6143—45
‘‘(d) ADMINISTRATION; APPLICATION.—A grant may only be 
awarded to an entity under subsection (a) if an application for 
the grant is submitted to the Secretary and the application is 
in such form, is made in such manner, and contains such agree-
ments, assurances, and information as the Secretary determines 
to be necessary to carry out this section. Such application shall 
include the following: 
‘‘(1) Information regarding how the expected expenditures 
of the grant are related to the planning process for localities 
funded under part A (including the planning process outlined 
in section 2602) and for States funded under part B (including 
the planning process outlined in section 2617(b)). 
‘‘(2) A specification of the expected expenditures and how 
those expenditures will improve overall patient outcomes, as 
outlined as part of the State plan (under section 2617(b)) or 
through additional outcome measures. 
‘‘(e) ANNUAL REVIEW OF PROGRAMS; EVALUATIONS.—
‘‘(1) REVIEW REGARDING ACCESS TO AND PARTICIPATION IN 
PROGRAMS.—With respect to a grant under subsection (a) for 
an entity for a fiscal year, the Secretary shall, not later than 
180 days after the end of the fiscal year, provide for the conduct 
and completion of a review of the operation during the year 
of the program carried out under such subsection by the entity. 
The purpose of such review shall be the development of rec-
ommendations, as appropriate, for improvements in the fol-
lowing: 
‘‘(A) Procedures used by the entity to allocate 
opportunities and services under subsection (a) among 
patients of the entity who are women, infants, children, 
or youth. 
‘‘(B) Other procedures or policies of the entity regarding 
the participation of such individuals in such program. 
‘‘(2) EVALUATIONS.——The Secretary shall, directly or 
through contracts with public and private entities, provide for 
evaluations of programs carried out pursuant to subsection 
(a). 
‘‘(f) ADMINISTRATIVE EXPENSES.—
‘‘(1) LIMITATION.—A grantee may not use more than 10 
percent of amounts received under a grant awarded under 
this section for administrative expenses. 
‘‘(2) CLINICAL QUALITY MANAGEMENT PROGRAM.—A grantee 
under this section shall implement a clinical quality manage-
ment 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/AIDS and related opportunistic infection, and as 
applicable, to develop strategies for ensuring that such services 
are consistent with the guidelines for improvement in the access 
to and quality of HIV health services. 
‘‘(g) TRAINING AND TECHNICAL ASSISTANCE.—From the amounts 
appropriated under subsection (i) for a fiscal year, the Secretary 
may use not more than 5 percent to provide, directly or through 
contracts with public and private entities (which may include 
grantees under subsection (a)), training and technical assistance 
to assist applicants and grantees under subsection (a) in complying 
with the requirements of this section. 
‘‘(h) DEFINITIONS.—In this section:
H. R. 6143—46
‘‘(1) ADMINISTRATIVE EXPENSES.—The term ‘administrative 
expenses’ means funds that are to be used by grantees for 
grant management and monitoring activities, including costs 
related to any staff or activity unrelated to services or indirect 
costs. 
‘‘(2) INDIRECT COSTS.—The term ‘indirect costs’ means costs 
included in a Federally negotiated indirect rate. 
‘‘(3) SERVICES.—The term ‘services’ means—
‘‘(A) services that are provided to clients to meet the 
goals and objectives of the program under this section, 
including the provision of professional, diagnostic, and 
therapeutic services by a primary care provider or a referral 
to and provision of specialty care; and 
‘‘(B) services that sustain program activity and con-
tribute to or help improve services under subparagraph 
(A). 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there are authorized to be appropriated, 
$71,800,000 for each of the fiscal years 2007 through 2009.’’. 
SEC. 402. GAO REPORT. 
Not later than 24 months after the date of enactment of this 
Act, the Comptroller General of the Government Accountability 
Office shall conduct an evaluation, and submit to Congress a report, 
concerning the funding provided for under part D of title XXVI 
of the Public Health Service Act to determine—
(1) how funds are used to provide the administrative 
expenses, indirect costs, and services, as defined in section 
2671(h) of such title, for individuals with HIV/AIDS; 
(2) how funds are used to provide the administrative 
expenses, indirect costs, and services, as defined in section 
2671(h) of such title, to family members of women, infants, 
children, and youth infected with HIV/AIDS; 
(3) how funds are used to provide family-centered care 
involving outpatient or ambulatory care authorized under sec-
tion 2671(a) of such title; 
(4) how funds are used to provide additional services 
authorized under section 2671(b) of such title; and 
(5) how funds are used to help identify HIV-positive preg-
nant women and their children who are exposed to HIV and 
connect them with care that can improve their health and 
prevent perinatal transmission. 
TITLE V—GENERAL PROVISIONS 
SEC. 501. GENERAL PROVISIONS. 
Part E of title XXVI of the Public Health Service Act (42 
U.S.C. 300ff–80 et seq.) is amended to read as follows: 
‘‘PART E—GENERAL PROVISIONS 
‘‘SEC. 2681. COORDINATION. 
‘‘(a) REQUIREMENT.—The Secretary shall ensure that the Health 
Resources and Services Administration, the Centers for Disease 
Control and Prevention, the Substance Abuse and Mental Health 
Services Administration, and the Centers for Medicare & Medicaid
H. R. 6143—47
Services coordinate the planning, funding, and implementation of 
Federal HIV programs (including all minority AIDS initiatives of 
the Public Health Service, including under section 2693) to enhance 
the continuity of care and prevention services for individuals with 
HIV/AIDS or those at risk of such disease. The Secretary shall 
consult with other Federal agencies, including the Department of 
Veterans Affairs, as needed and utilize planning information sub-
mitted to such agencies by the States and entities eligible for 
assistance under this title. 
‘‘(b) REPORT.—The Secretary shall biennially prepare and 
submit to the appropriate committees of the Congress a report 
concerning the coordination efforts at the Federal, State, and local 
levels described in this section, including a description of Federal 
barriers to HIV program integration and a strategy for eliminating 
such barriers and enhancing the continuity of care and prevention 
services for individuals with HIV/AIDS or those at risk of such 
disease. 
‘‘(c) INTEGRATION BY STATE.—As a condition of receipt of funds 
under this title, a State shall provide assurances to the Secretary 
that health support services funded under this title will be 
integrated with other such services, that programs will be coordi-
nated with other available programs (including Medicaid), and that 
the continuity of care and prevention services of individuals with 
HIV/AIDS is enhanced. 
‘‘(d) INTEGRATION BY LOCAL OR PRIVATE ENTITIES.—As a condi-
tion of receipt of funds under this title, a local government or 
private nonprofit entity shall provide assurances to the Secretary 
that services funded under this title will be integrated with other 
such services, that programs will be coordinated with other avail-
able programs (including Medicaid), and that the continuity of 
care and prevention services of individuals with HIV is enhanced. 
‘‘SEC. 2682. AUDITS. 
‘‘(a) IN GENERAL.—For fiscal year 2009, and each subsequent 
fiscal year, the Secretary may reduce the amounts of grants under 
this title to a State or political subdivision of a State for a fiscal 
year if, with respect to such grants for the second preceding fiscal 
year, the State or subdivision fails to prepare audits in accordance 
with the procedures of section 7502 of title 31, United States Code. 
The Secretary shall annually select representative samples of such 
audits, prepare summaries of the selected audits, and submit the 
summaries to the Congress. 
‘‘(b) POSTING ON THE INTERNET.—All audits that the Secretary 
receives from the State lead agency under section 2617(b)(4) shall 
be posted, in their entirety, on the Internet website of the Health 
Resources and Services Administration. 
‘‘SEC. 2683. PUBLIC HEALTH EMERGENCY. 
‘‘(a) IN GENERAL.—In an emergency area and during an emer-
gency period, the Secretary shall have the authority to waive such 
requirements of this title to improve the health and safety of 
those receiving care under this title and the general public, except 
that the Secretary may not expend more than 5 percent of the 
funds allocated under this title for sections 2620 and section 2603(b). 
‘‘(b) EMERGENCY AREA AND EMERGENCY PERIOD.—In this sec-
tion: 
‘‘(1) EMERGENCY AREA.—The term ‘emergency area’ means 
a geographic area in which there exists—
H. R. 6143—48
‘‘(A) an emergency or disaster declared by the President 
pursuant to the National Emergencies Act or the Robert 
T. Stafford Disaster Relief and Emergency Assistance Act; 
or 
‘‘(B) a public health emergency declared by the Sec-
retary pursuant to section 319. 
‘‘(2) EMERGENCY
PERIOD.—The term ‘emergency period’ 
means the period in which there exists—
‘‘(A) an emergency or disaster declared by the President 
pursuant to the National Emergencies Act or the Robert 
T. Stafford Disaster Relief and Emergency Assistance Act; 
or 
‘‘(B) a public health emergency declared by the Sec-
retary pursuant to section 319. 
‘‘(c) UNOBLIGATED FUNDS.—If funds under a grant under this 
section are not expended for an emergency in the fiscal year in 
which the emergency is declared, such funds shall be returned 
to the Secretary for reallocation under sections 2603(b) and 2620. 
‘‘SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES. 
‘‘None of the funds appropriated under this title shall be used 
to fund AIDS programs, or to develop materials, designed to promote 
or encourage, directly, intravenous drug use or sexual activity, 
whether homosexual or heterosexual. Funds authorized under this 
title may be used to provide medical treatment and support services 
for individuals with HIV. 
‘‘SEC. 2685. PRIVACY PROTECTIONS. 
‘‘(a) IN GENERAL.—The Secretary shall ensure that any informa-
tion submitted to, or collected by, the Secretary under this title 
excludes any personally identifiable information. 
‘‘(b) DEFINITION.—In this section, the term ‘personally identifi-
able information’ has the meaning given such term under the regu-
lations promulgated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996. 
‘‘SEC. 2686. GAO REPORT. 
‘‘The Comptroller General of the Government Accountability 
Office shall biennially submit to the appropriate committees of 
Congress a report that includes a description of Federal, State, 
and local barriers to HIV program integration, particularly for 
racial and ethnic minorities, including activities carried out under 
subpart III of part F, and recommendations for enhancing the 
continuity of care and the provision of prevention services for 
individuals with HIV/AIDS or those at risk for such disease. Such 
report shall include a demonstration of the manner in which funds 
under this subpart are being expended and to what extent the 
services provided with such funds increase access to prevention 
and care services for individuals with HIV/AIDS and build stronger 
community linkages to address HIV prevention and care for racial 
and ethnic minority communities. 
‘‘SEC. 2687. SEVERITY OF NEED INDEX. 
‘‘(a) DEVELOPMENT OF INDEX.—Not later than September 30, 
2008, the Secretary shall develop and submit to the appropriate 
committees of Congress a severity of need index in accordance 
with subsection (c).
H. R. 6143—49
‘‘(b) DEFINITION OF SEVERITY OF NEED INDEX.—In this section, 
the term ‘severity of need index’ means the index of the relative 
needs of individuals within a State or area, as identified by a 
number of different factors, and is a factor or set of factors that 
is multiplied by the number of living HIV/AIDS cases in a State 
or area, providing different weights to those cases based on needs. 
Such factors or set of factors may be different for different compo-
nents of the provisions under this title. 
‘‘(c) REQUIREMENTS FOR SECRETARIAL SUBMISSION.—When the 
Secretary submits to the appropriate committees of Congress the 
severity of need index under subsection (a), the Secretary shall 
provide the following: 
‘‘(1) Methodology for and rationale behind developing the 
severity of need index, including information related to the 
field testing of the severity of need index. 
‘‘(2) An independent contractor analysis of activities carried 
out under paragraph (1). 
‘‘(3) Information regarding the process by which the Sec-
retary received community input regarding the application and 
development of the severity of need index. 
‘‘(d) ANNUAL REPORTS.—If the Secretary fails to submit the 
severity of need index under subsection (a) in either of fiscal years 
2007 or 2008, the Secretary shall prepare and submit to the appro-
priate committees of Congress a report for such fiscal year—
‘‘(1) that updates progress toward having client level data; 
‘‘(2) that updates the progress toward having a severity 
of need index, including information related to the methodology 
and process for obtaining community input; and 
‘‘(3) that, as applicable, states whether the Secretary could 
develop a severity of need index before fiscal year 2009. 
‘‘SEC. 2688. DEFINITIONS. 
‘‘For purposes of this title: 
‘‘(1) AIDS.—The term ‘AIDS’ means acquired immune defi-
ciency syndrome. 
‘‘(2) CO-OCCURRING
CONDITIONS.—The term ‘co-occurring 
conditions’ means one or more adverse health conditions in 
an individual with HIV/AIDS, without regard to whether the 
individual has AIDS and without regard to whether the condi-
tions arise from HIV. 
‘‘(3) COUNSELING.—The term ‘counseling’ means such coun-
seling provided by an individual trained to provide such coun-
seling. 
‘‘(4) FAMILY-CENTERED
CARE.—The term ‘family-centered 
care’ means the system of services described in this title that 
is targeted specifically to the special needs of infants, children, 
women and families. Family-centered care shall be based on 
a partnership between parents, professionals, and the commu-
nity designed to ensure an integrated, coordinated, culturally 
sensitive, and community-based continuum of care for children, 
women, and families with HIV/AIDS. 
‘‘(5) FAMILIES WITH HIV/AIDS.—The term ‘families with HIV/
AIDS’ means families in which one or more members have 
HIV/AIDS. 
‘‘(6) HIV.—The term ‘HIV’ means infection with the human 
immunodeficiency virus. 
‘‘(7) HIV/AIDS.—
H. R. 6143—50
‘‘(A) IN GENERAL.—The term ‘HIV/AIDS’ means HIV, 
and includes AIDS and any condition arising from AIDS. 
‘‘(B) COUNTING OF CASES.—The term ‘living cases of 
HIV/AIDS’, with respect to the counting of cases in a 
geographic area during a period of time, means the sum 
of—
‘‘(i) the number of living non-AIDS cases of HIV 
in the area; and 
‘‘(ii) the number of living cases of AIDS in the 
area. 
‘‘(C) NON-AIDS
CASES.—The term ‘non-AIDS’, with 
respect to a case of HIV, means that the individual involved 
has HIV but does not have AIDS. 
‘‘(8) HUMAN IMMUNODEFICIENCY VIRUS.—The term ‘human 
immunodeficiency virus’ means the etiologic agent for AIDS. 
‘‘(9) OFFICIAL
POVERTY
LINE.—The term ‘official poverty 
line’ means the poverty line established by the Director of 
the Office of Management and Budget and revised by the 
Secretary in accordance with section 673(2) of the Omnibus 
Budget Reconciliation Act of 1981. 
‘‘(10) PERSON.—The term ‘person’ includes one or more 
individuals, governments (including the Federal Government 
and the governments of the States), governmental agencies, 
political subdivisions, labor unions, partnerships, associations, 
corporations, legal representatives, mutual companies, joint-
stock 
companies, 
trusts, 
unincorporated 
organizations, 
receivers, trustees, and trustees in cases under title 11, United 
States Code. 
‘‘(11) STATE.—
‘‘(A) IN GENERAL.—The term ‘State’ means each of the 
50 States, the District of Columbia, and each of the terri-
tories. 
‘‘(B) TERRITORIES.—The term ‘territory’ means each of 
American Samoa, Guam, the Commonwealth of Puerto 
Rico, the Commonwealth of the Northern Mariana Islands, 
the Virgin Islands, the Republic of the Marshall Islands, 
the Federated States of Micronesia, and Palau. 
‘‘(12) YOUTH WITH HIV.—The term ‘youth with HIV’ means 
individuals who are 13 through 24 years old and who have 
HIV/AIDS.’’. 
TITLE VI—DEMONSTRATION AND 
TRAINING 
SEC. 601. DEMONSTRATION AND TRAINING. 
Subpart I of part F of title XXVI of the Public Health Service 
Act (42 U.S.C. 300ff–101 et seq.) is amended to read as follows: 
‘‘Subpart I—Special Projects of National 
Significance 
‘‘SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE. 
‘‘(a) IN GENERAL.—Of the amount appropriated under each 
of parts A, B, C, and D for each fiscal year, the Secretary shall 
use the greater of $20,000,000 or an amount equal to 3 percent
H. R. 6143—51
of such amount appropriated under each such part, but not to 
exceed $25,000,000, to administer special projects of national signifi-
cance to—
‘‘(1) quickly respond to emerging needs of individuals 
receiving assistance under this title; and 
‘‘(2) to fund special programs to develop a standard elec-
tronic client information data system to improve the ability 
of grantees under this title to report client-level data to the 
Secretary. 
‘‘(b) GRANTS.—The Secretary shall award grants under sub-
section (a) to entities eligible for funding under parts A, B, C, 
and D based on—
‘‘(1) whether the funding will promote obtaining client level 
data as it relates to the creation of a severity of need index, 
including funds to facilitate the purchase and enhance the 
utilization of qualified health information technology systems; 
‘‘(2) demonstrated ability to create and maintain a qualified 
health information technology system; 
‘‘(3) the potential replicability of the proposed activity in 
other similar localities or nationally; 
‘‘(4) the demonstrated reliability of the proposed qualified 
health information technology system across a variety of pro-
viders, geographic regions, and clients; and 
‘‘(5) the demonstrated ability to maintain a safe and secure 
qualified health information system; or 
‘‘(6) newly emerging needs of individuals receiving assist-
ance under this title. 
‘‘(c) COORDINATION.—The Secretary may not make a grant 
under this section unless the applicant submits evidence that the 
proposed program is consistent with the statewide coordinated 
statement of need, and the applicant agrees to participate in the 
ongoing revision process of such statement of need. 
‘‘(d) PRIVACY PROTECTION.—The Secretary may not make a 
grant under this section for the development of a qualified health 
information technology system unless the applicant provides assur-
ances to the Secretary that the system will, at a minimum, comply 
with the privacy regulations promulgated under section 264(c) of 
the Health Insurance Portability and Accountability Act of 1996. 
‘‘(e) REPLICATION.—The Secretary shall make information con-
cerning successful models or programs developed under this part 
available to grantees under this title for the purpose of coordination, 
replication, and integration. To facilitate efforts under this sub-
section, the Secretary may provide for peer-based technical assist-
ance for grantees funded under this part.’’. 
SEC. 602. AIDS EDUCATION AND TRAINING CENTERS. 
(a) AMENDMENTS REGARDING SCHOOLS AND CENTERS.—Section 
2692(a)(2) of the Public Health Service Act (42 U.S.C. 300ff–
111(a)(2)) is amended—
(1) in subparagraph (A)—
(A) by inserting ‘‘and Native Americans’’ after 
‘‘minority individuals’’; and 
(B) by striking ‘‘and’’ at the end; 
(2) in subparagraph (B), by striking the period and 
inserting ‘‘; and’’; and 
(3) by adding at the end the following:
H. R. 6143—52
‘‘(C) train or result in the training of health profes-
sionals and allied health professionals to provide treatment 
for hepatitis B or C co-infected individuals.’’. 
(b) AUTHORIZATIONS OF APPROPRIATIONS FOR SCHOOLS, CEN-
TERS, AND DENTAL PROGRAMS.—Section 2692(c) of the Public Health 
Service Act (42 U.S.C. 300ff–111(c)) is amended to read as follows: 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) SCHOOLS; CENTERS.—For the purpose of awarding 
grants under subsection (a), there is authorized to be appro-
priated $34,700,000 for each of the fiscal years 2007 through 
2009. 
‘‘(2) DENTAL SCHOOLS.—For the purpose of awarding grants 
under subsection (b), there is authorized to be appropriated 
$13,000,000 for each of the fiscal years 2007 through 2009.’’. 
SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE. 
Part F of title XXVI of the Public Health Service Act (42 
U.S.C. 300ff–101 et seq.) is amended by adding at the end the 
following: 
‘‘Subpart III—Minority AIDS Initiative 
‘‘SEC. 2693. MINORITY AIDS INITIATIVE. 
‘‘(a) IN GENERAL.—For the purpose of carrying out activities 
under this section to evaluate and address the disproportionate 
impact of HIV/AIDS on, and the disparities in access, treatment, 
care, and outcomes for, racial and ethnic minorities (including Afri-
can Americans, Alaska Natives, Latinos, American Indians, Asian 
Americans, Native Hawaiians, and Pacific Islanders), there are 
authorized to be appropriated $131,200,000 for fiscal year 2007, 
$135,100,000 for fiscal year 2008, and $139,100,000 for fiscal year 
2009. 
‘‘(b) CERTAIN ACTIVITIES.—
‘‘(1) IN GENERAL.—In carrying out the purpose described 
in subsection (a), the Secretary shall provide for—
‘‘(A) emergency assistance under part A; 
‘‘(B) care grants under part B; 
‘‘(C) early intervention services under part C; 
‘‘(D) services through projects for HIV-related care 
under part D; and 
‘‘(E) activities through education and training centers 
under section 2692. 
‘‘(2) ALLOCATIONS
AMONG
ACTIVITIES.—Activities under 
paragraph (1) shall be carried out by the Secretary in accord-
ance with the following: 
‘‘(A) For competitive, supplemental grants to improve 
HIV-related health outcomes to reduce existing racial and 
ethnic health disparities, the Secretary shall, of the amount 
appropriated under subsection (a) for a fiscal year, reserve 
the following, as applicable: 
‘‘(i) For fiscal year 2007, $43,800,000. 
‘‘(ii) For fiscal year 2008, $45,400,000. 
‘‘(iii) For fiscal year 2009, $47,100,000. 
‘‘(B) For competitive grants used for supplemental sup-
port education and outreach services to increase the 
number of eligible racial and ethnic minorities who have 
access to treatment through the program under section
H. R. 6143—53
2616 for therapeutics, the Secretary shall, of the amount 
appropriated for a fiscal year under subsection (a), reserve 
the following, as applicable: 
‘‘(i) For fiscal year 2007, $7,000,000. 
‘‘(ii) For fiscal year 2008, $7,300,000. 
‘‘(iii) For fiscal year 2009, $7,500,000. 
‘‘(C) For planning grants, capacity-building grants, and 
services grants to health care providers who have a history 
of providing culturally and linguistically appropriate care 
and services to racial and ethnic minorities, the Secretary 
shall, of the amount appropriated for a fiscal year under 
subsection (a), reserve the following, as applicable: 
‘‘(i) For fiscal year 2007, $53,400,000. 
‘‘(ii) For fiscal year 2008, $55,400,000. 
‘‘(iii) For fiscal year 2009, $57,400,000. 
‘‘(D) For eliminating racial and ethnic disparities in 
the delivery of comprehensive, culturally and linguistically 
appropriate care services for HIV disease for women, 
infants, children, and youth, the Secretary shall, of the 
amount 
appropriated 
under 
subsection 
(a), 
reserve 
$18,500,000 for each of the fiscal years 2007 through 2009. 
‘‘(E) For increasing the training capacity of centers 
to expand the number of health care professionals with 
treatment expertise and knowledge about the most appro-
priate standards of HIV disease-related treatments and 
medical care for racial and ethnic minority adults, adoles-
cents, and children with HIV disease, the Secretary shall, 
of the amount appropriated under subsection (a), reserve 
$8,500,000 for each of the fiscal years 2007 through 2009. 
‘‘(c) CONSISTENCY WITH PRIOR PROGRAM.—With respect to the 
purpose described in subsection (a), the Secretary shall carry out 
this section consistent with the activities carried out under this 
title by the Secretary pursuant to the Departments of Labor, Health 
and Human Services, and Education, and Related Agencies Appro-
priations Act, 2002 (Public Law 107–116).’’. 
TITLE VII—MISCELLANEOUS 
PROVISIONS 
SEC. 701. HEPATITIS; USE OF FUNDS. 
Section 2667 of the Public Health Service Act (42 U.S.C. 300ff–
67) is amended—
(1) in paragraph (2), by striking ‘‘and’’ at the end; 
(2) in paragraph (3), by striking the period and inserting 
‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(4) shall provide information on the transmission and 
prevention of hepatitis A, B, and C, including education about 
the availability of hepatitis A and B vaccines and assisting 
patients in identifying vaccination sites.’’. 
SEC. 702. CERTAIN REFERENCES. 
Title XXVI of the Public Health Service Act (42 U.S.C. 300ff 
et seq.) is amended—
H. R. 6143—54
(1) by striking ‘‘acquired immune deficiency syndrome’’ each 
place such term appears, other than in section 2687(1) (as 
added by section 501 of this Act), and inserting ‘‘AIDS’’; 
(2) by striking ‘‘such syndrome’’ and inserting ‘‘AIDS’’; and 
(3) by striking ‘‘HIV disease’’ each place such term appears 
and inserting ‘‘HIV/AIDS’’. 
SEC. 703. REPEAL. 
Effective on October 1, 2009, title XXVI of the Public Health 
Service Act (42 U.S.C. 300ff et seq.) is repealed.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.