Ryan White CARE Act Amendments of 2000
PL 106-345 (S.2311), enacted 10/20/2000

PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1319 
Public Law 106-345 
106th Congress 
An Act 
To amend the Public Health Service Act to revise and extend programs established 
rj t 9(1 9/lftn 
under the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, 
——'. 
and for other purposes. 
fS. 2311] 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
Ryan White 
CARE Act 
SECTION 1. SHORT TITLE. 
Amendments of 
This Act may be cited as the "Ryan White CARE Act Amend- 42^3^ 201 note 
ments of 2000". 
SEC. 2. TABLE OF CONTENTS. 
The table of contents for this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
TITLE I—EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR 
SERVICES 
Subtitle A—HIV Health Services Planning Councils 
Sec. 101. Membership of councils. 
Sec. 102. Duties of councils. 
Sec. 103. Open meetings; other additional provisions. 
Subtitle B—^Type and Distribution of Grants 
Sec. 111. Formula grants. 
Sec. 112. Supplemental grants. 
Subtitle C—Other Provisions 
Sec. 121. Use of amounts. 
Sec. 122. Application. 
TITLE II—CARE GRANT PROGRAM 
Subtitle A—General Grant Provisions 
Sec. 201. Priority for women, infants, and children. 
Sec. 202. Use of grants. 
Sec. 203. Grants to establish HIV care consortia. 
Sec. 204. Provision of treatments. 
Sec. 205. State application. 
Sec. 206. Distribution of funds. 
Sec. 207. Supplemental grants for certain States. 
Subtitle B—Provisions Concerning Pregnancy and Perinatal Transmission of HIV 
Sec. 211. Repeals. 
Sec. 212. Grants. 
Sec. 213. Study by Institute of Medicine. 
Subtitle C—Certain Partner Notification Programs 
Sec. 221. Grants for compliant partner notification programs. 
114 STAT. 1320 
PUBLIC LAW 106-345—OCT. 20, 2000 
TITLE III—EARLY INTERVENTION SERVICES 
Subtitle A—Formula Grants for States 
Sec. 301. Repeal of program. 
Subtitle B—Categorical Grants 
Sec. 311. Preferences in making grants. 
Sec. 312. Planning and development grants. 
Sec. 313. Authorization of appropriations. 
Subtitle C—General Provisions 
Sec. 321. Provision of certain counseling services. 
Sec. 322. Additional required agreements. 
TITLE rV—OTHER PROGRAMS AND ACTIVITIES 
Subtitle A—Certain Programs for Research, Demonstrations, or Training 
Sec. 401. Grants for coordinated services and access to research for women, infants, 
children, and youth. 
Sec. 402. AIDS education and training centers. 
Subtitle B—General Provisions in Title XXVI 
Sec. 411. Evaluations and reports. 
Sec. 412. Data collection through Centers for Disease Control and Prevention. 
>
» 
Sec. 413. Coordination. 
Sec. 414. Plan regarding release of prisoners with HFV disease. 
Sec. 415. Audits. 
Sec. 416. Administrative simplification. 
Sec. 417. Authorization of appropriations for parts A and B. 
TITLE V—GENERAL PROVISIONS 
Sec. 501. Studies by Institute of Medicine. 
Sec. 502. Development of rapid HIV test. 
Sec. 503. Technical corrections. 
TITLE VI—EFFECTIVE DATE 
Sec. 601. Effective date. 
TITLE 
I—EMERGENCY 
RELIEF 
FOR 
AREAS WITH SUBSTANTIAL NEED FOR 
SERVICES 
Subtitle A—HIV Health Services Planning 
Councils 
SEC. 101. MEMBERSHIP OF COUNCILS. 
(a) IN GENERAL.—Section 2602(b) of the Public Health Service 
Act (42 U.S.C. 300ff-12(b)) is amended— 
(1) in paragraph (1), by striking "demographics of the epi-
demic in the eligible area involved," and inserting "demo-
graphics of the population of individuals with HIV disease 
in the eligible area involved,"; and 
(2) in paragraph (2)— 
(A) in subparagraph (C), by inserting before the semi-
colon the following: ", including providers of housing and 
homeless services"; 
(B) in subparagraph (G), by striking "or AIDS"; 
(C) in subparagraph (K), by striking "and" at the end;' 
(D) in subparagraph (L), by striking the period and 
inserting the following: ", including but not limited to pro-
viders of HIV prevention services; and"; and 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1321 
(E) by adding at the end the following subparagraph: 
"(M) representatives of individuals who formerly were 
Federal, State, or local prisoners, were released from the 
custody of the penal system during the preceding 3 years, 
and had HIV disease as of the date on which the individuals 
were so released.". 
(b) CONFLICTS OF INTERESTS.—Section 2602(b)(5) of the Public 
Health Service Act (42 U.S.C. 300ff-12(b)(5)) is amended by adding 
at the end the following subparagraph: 
"(C) COMPOSITION OF COUNCIL.—The following applies 
regarding the membership of a planning council under 
paragraph (1): 
"(i) Not less than 33 percent of the council shall 
be individuals who are receiving HIV-related services 
pursuant to a grant under section 2601(a), are not 
officers, employees, or consultants to any entity that 
receives amounts from such a grant, and do not rep-
resent any such entity, and reflect the demographics 
of the population of individuals with HIV disease as 
determined under paragraph (4)(A). For purposes of 
the preceding sentence, an individual shall be consid-
ered to be receiving such services if the individual 
is a parent of, or a caregiver for, a minor child who 
is receiving such services. 
"(ii) With respect to membership on the planning 
council, clause (i) may not be construed as having 
any effect on entities that receive funds from grants 
under any of parts B through F but do not receive 
funds from grants under section 2601(a), on officers 
or employees of such entities, or on individuals who 
represent such entities.". 
SEC. 102. DUTIES OF COUNCILS. 
(a) IN GENERAL.—Section 2602(b)(4) of the Public Health 
Service Act (42 U.S.C. 300ff'-12(b)(4)) is amended— 
(1) by redesignating subparagraphs (A) through (E) as sub-
paragraphs (C) through (G), respectively; 
(2) by inserting before subparagraph (C) (as so redesig-
nated) the following subparagraphs: 
"(A) determine the size and demographics of the popu-
lation of individuals with HIV disease; 
"(B) determine the needs of such population, with par-
ticular attention to— 
"(i) individuals with HIV disease who know their 
HIV status and are not receiving HIV-related services; 
and 
"(ii) disparities in access and services among 
affected subpopulations and historically underserved 
communities;"; 
(3) in subparagraph (C) (as so redesignated), by striking 
clauses (i) through (iv) and inserting the following: 
"(i) size and demographics of the population of 
individuals with HIV disease (as determined under 
subparagraph (A)) and the needs of such population 
(as determined under subparagraph (B)); 
"(ii) demonstrated (or probable) cost effectiveness 
and outcome effectiveness of proposed strategies and 
114 STAT. 1322 
PUBLIC LAW 106-345—OCT. 20, 2000 
interventions, to the extent that data are reasonably 
available; 
"(iii) priorities of the communities with HIV dis-
ease for whom the services are intended; 
"(iv) coordination in the provision of services to 
such individuals with programs for HIV prevention 
and for the prevention and treatment of substance 
abuse, including programs that provide comprehensive 
treatment for such abuse; 
"(v) availability of other governmental and non-
governmental resources, including the State medicaid 
plan under title XIX of the Social Security Act and 
the State Children's Health Insurance Program under 
title XXI of such Act to cover health care costs of 
eligible individuals and families with HIV disease; and 
"(vi) capacity development needs resulting from 
disparities in the availability of HIV-related services 
in historically underserved communities;"; 
(4) in subparagraph (D) (as so redesignated), by amending 
the subparagraph to read as follows: 
"(D) develop a comprehensive plan for the organization 
and delivery of health and support services described in 
section 2604 that— 
"(i) includes a strategy for identifying individuals 
who know their HIV status and are not receiving such 
services and for informing the individuals of and 
enabling the individuals to utilize the services, giving 
particular attention to eliminating disparities in access 
and 
services among affected 
subpopulations 
and 
historically underserved communities, and including 
discrete goals, a timetable, and an appropriate alloca-
tion of funds; 
"(ii) includes a strategy to coordinate the provision 
of such services with programs for HIV prevention 
(including outreach and early intervention) and for 
the prevention and treatment of substance abuse 
(including programs that provide comprehensive treat-
ment services for such abuse); and 
"(iii) is compatible with any State or local plan 
for the provision of services to individuals with HIV 
disease;"; 
(5) in subparagraph (F) (as so redesignated), by striking 
"and" at the end; 
(.6) in subparagraph (G) (as so redesignated)— 
(A) by striking "public meetings," and inserting "public 
meetings (in accordance with paragraph (7)),"; and 
(B) by striking the period and inserting "; and"; and 
(7) by adding at the end the following subparagraph: 
"(H) coordinate with Federal grantees that provide 
HIV-related services within the eligible area.", 
(b) PROCESS FOR ESTABLISHING ALLOCATION PRIORITIES.—Sec-
tion 2602 of the Public Health Service Act (42 U.S.C. 300ff-12) 
is amended by adding at the end the following subsection: 
"(d) 
PROCESS FOR ESTABLISHING ALLOCATION PRIORITIES.— 
Promptly after the date of the submission of the report required 
in section 501(b) of the Ryan White CARE Act Amendments of 
2000 (relating to the relationship between epidemiological measures 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1323 
and health care for certain individuals with HIV disease), the 
Secretary, in consultation with planning councils and entities that 
receive amounts from grants under section 2601(a) or 2611, shall 
develop epidemiologic measures— 
"(1) for establishing the number of individuals living with 
HIV disease who are not receiving HIV-related health services; 
and 
"(2) for carrying out the duties under subsection (b)(4) 
and section 2617(b).". 
(c) TRAINING.—Section 2602 of the Public Health Service Act 
(42 U.S.C. 300ff-12), as amended by subsection (b) of this section, 
is amended by adding at the end the following subsection: 
"(e) TRAINING GUIDANCE AND MATERIALS.—The Secretary shall 
provide to each chief elected official receiving a grant under section 
2601(a) guidelines and materials for training members of the plan-
ning council under paragraph (1) regarding the duties of the 
council.". 
(d) CONFORMING AMENDMENT.—Section 2603(c) of the Public 
42 use 300ff-i3. 
Health Service Act (42 U.S.C. 300ff-12(b)) is amended by striking 
"section 2602(b)(3)(A)" and inserting "section 2602(b)(4)(C)". 
SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVISIONS. 
Section 2602(b) of the Pubhc Health Service Act (42 U.S.C. 
300ff-12(b)) is amended— 
(1) in paragraph (3), by striking subparagraph (C); and 
(2) by adding at the end the following paragraph: 
"(7) PUBLIC DELIBERATIONS.—^With respect to a planning 
council under paragraph (1), the following applies: 
"(A) The council may not be chaired solely by an 
employee of the grantee under section 2601(a). 
"(B) In accordance with criteria established by the 
Secretary: 
"(i) The meetings of the council shall be open to Public notice, 
the public and shall be held only after adequate notice 
to the public. 
"(ii) The records, reports, transcripts, minutes. Records, 
agenda, or other documents which were made available Reports, 
to or prepared for or by the council shall be available 
for public inspection and copying at a single location. 
"(iii) Detailed minutes of each meeting of the 
council shall be kept. The accuracy of all minutes shall 
be certified to by the chair of the council. 
"(iv) This subparagraph does not apply to any 
disclosure of information of a personal nature that 
would constitute a clearly unwarranted invasion of 
personal privacy, including any disclosure of medical 
information or personnel matters.". 
Subtitle B—Type and Distribution of 
Grants 
SEC. 111. FORMULA GRANTS. 
(a) EXPEDITED DISTRIBUTION.—Section 2603(a)(2) of the Public 
Health Service Act (42 U.S.C. 300ff-13(a)(2)) is amended in the 
first sentence by striking "for each of the fiscal years 1996 through 
2000" and inserting "for a fiscal year". 
114 STAT. 1324 
PUBLIC LAW 106-345—OCT. 20, 2000 
(b) AMOUNT OF GRANT; ESTIMATE OF LIVING CASES.— 
(1) IN GENERAL.—Section 2603(a)(3) of the Public Health 
Service Act (42 U.S.C. 300ff-13(a)(3)) is amended— 
(A) in subparagraph (C)(i), by inserting before the semi-
colon the following: ", except that (subject to subparagraph 
(D)), for grants made pursuant to this paragraph for fiscal 
year 2005 and subsequent fiscal years, the cases counted 
for each 12-month period beginning on or after July 1, 
2004, shall be cases of HIV disease (as reported to and 
confirmed by such Director) rather than cases of acquired 
immune deficiency syndrome"; and 
(B) in subparagraph (C), in the matter after and below 
clause (ii)(X)— 
(i) in the first sentence, by inserting before the 
period the following: ", and shall be reported to the 
congressional committees of 
jurisdiction"; and 
(ii) by adding at the end the following sentence: 
"Updates shall as applicable take into account the 
counting of cases of HIV disease pursuant to clause 
(i).". 
(2) DETERMINATION OF SECRETARY REGARDING DATA ON HIV 
CASES.—Section 2603(a)(3) of the Public Health Service Act 
(42 U.S.C. 300ff-13(a)(3)) is amended— 
(A) by redesignating subparagraph (D) as subpara-
graph (E); and 
(B) by inserting after subparagraph (C) the following 
subparagraph: 
"(D) DETERMINATION OF SECRETARY REGARDING DATA 
ON HIV CASES.— 
DeadHne. 
"(i) IN GENERAL.—^Not later than July 1, 2004, 
the Secretary shall determine whether there is data 
on cases of HIV disease from all eligible areas (reported 
to and confirmed by the Director of the Centers for 
Disease Control and Prevention) sufficiently accurate 
and reliable for use for purposes of subparagraph (C)(i). 
In making such a determination, the Secretary shall 
take into consideration the findings of the study under 
section 501(b) of the Ryan White CARE Act Amend-
ments of 2000 (relating to the relationship between 
epidemiological measures and health care for certain 
individuals with HIV disease). 
"(ii) 
EFFECT 
OF 
ADVERSE 
DETERMINATION.—If 
under clause (i) the Secretary determines that data 
on cases of HIV disease is not sufficiently accurate 
and reliable for use for purposes of subparagraph (C)(i), 
then notwithstanding such subparagraph, for any fiscal 
year prior to fiscal year 2007 the references in such 
subparagraph to cases of HIV disease do not have 
any legal effect. 
"(iii) 
GRANTS 
AND 
TECHNICAL 
ASSISTANCE 
REGARDING COUNTING OF HIV CASES.—Of the amounts 
appropriated under section 318B for a fiscal year, the 
Secretary shall reserve amounts to make grants and 
provide technical assistance to States and eligible areas 
with respect to obtaining data on cases of HIV disease 
to ensure that data on such cases is available from 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1325 
all States and eligible areas as soon as is practicable 
but not later than the beginning of fiscal year 2007.". 
(c) INCREASES IN GRANT.—Section 2603(a)(4) of the Public 
Health Service Act (42 U.S.C. 300ff-13(a)(4)) is amended to read 
as follows: 
"(4) INCREASES IN GRANT.— 
"(A) IN GENERAL.—For each fiscal year in a protection 
period for an eligible area, the Secretary shall increase 
the amount of the grant made pursuant to paragraph (2) 
for the area to ensure that— 
"(i) for the first fiscal year in the protection period, 
the grant is not less than 98 percent of the amount 
of the grant made for the eligible area pursuant to 
such paragraph for the base year for the protection 
period; 
"(ii) for any second fiscal year in such period, the 
grant is not less than 95 percent of the amount of 
such base year grant; 
"(iii) for any third fiscal year in such period, the 
grant is not less than 92 percent of the amount of 
the base year grant; 
"(iv) for any fourth fiscal year in such period, the 
grant is not less than 89 percent of the amount of 
' 
the base year grant; and 
"(v) for any fifth or subsequent fiscal year in such 
period, if, pursuant to paragraph (3)(D)(ii), the ref-
erences in paragraph (3)(C)(i) to HIV disease do not 
have any legal effect, the grant is not less than 85 
percent of the amount of the base year grant. 
"(B) SPECIAL RULE.—If for fiscal year 2005, pursuant 
to paragraph (3)(D)(ii), data on cases of HIV disease are 
used for purposes of paragraph (3)(C)(i), the Secretary shall 
increase the amount of a grant made pursuant to paragraph 
(2) for an eligible area to ensure that the grant is not 
less than 98 percent of the amount of the grant made 
for the area in fiscal year 2004. 
"(C) BASE YEAR; PROTECTION PERIOD.—^With respect to 
grants made pursuant to paragraph (2) for an eligible 
area: 
"(i) The base year for a protection period is the 
fiscal year preceding the trigger grant-reduction year. 
"(ii) The first trigger grant-reduction year is the 
first fiscal year (after fiscal year 2000) for which the 
grant for the area is less than the grant for the area 
for the preceding fiscal year. 
"(iii) A protection period begins with the trigger 
grant-reduction year and continues until the beginning 
of the first fiscal year for which the amount of the 
grant determined pursuant to paragraph (2) for the 
area equals or exceeds the amount of the grant deter-
mined under subparagraph (A). 
"(iv) Any subsequent trigger grant-reduction year 
is the first fiscal year, after the end of the preceding 
protection period, for which the amount of the grant 
is less than the amount of the grant for the preceding 
fiscal year.". 
114 STAT. 1326 
PUBLIC LAW 106-345—OCT. 20, 2000 
SEC. 112. SUPPLEMENTAL GRANTS. 
(a) IN GENERAL.—Section 2603(b)(2) of the Public Health 
Service Act (42 U.S.C. 300ff-13(b)(2)) is amended— 
(1) in the heading for the paragraph, by striking "DEFINI-
TION" and inserting "AMOUNT OF GRANT"; 
(2) by redesignating subparagraphs (A) through (C) as sub-
paragraphs (B) through (D), respectively; 
(3) by inserting before subparagraph (B) (as so redesig-
nated) the following subparagraph: 
"(A) IN GENERAL.—^The amount of each grant made 
for purposes of this subsection shall be determined by 
the Secretary based on a weighting of factors under para-
graph (1), with severe need under subparagraph (B) of 
such paragraph counting one-third."; 
(4) in subparagraph (B) (as so redesignated)— 
(A) in clause (ii), by striking "and" at the end; 
(B) in clause (iii), by striking the period and inserting 
a semicolon; and 
(C) by adding at the end the following clauses: 
"(iv) the current prevalence of HIV disease; 
"(v) an increasing need for HIV-related services, 
including relative rates of increase in the number of 
cases of HIV disease; and 
"(vi) unmet need for such services, as determined 
under section 2602(b)(4)."; 
(5) in subparagraph (C) (as so redesignated)— 
(A) by striking "subparagraph (A)" each place such 
term appears and inserting "subparagraph (B)"; 
(B) in the second sentence, by striking "2 years after 
the date of enactment of this paragraph" and inserting 
"18 months after the date of the enactment of the Ryan 
White CARE Act Amendments of 2000"; and 
(C) by inserting after the second sentence the following 
sentence: "Such a mechanism shall be modified to reflect 
the findings of the study under section 501(b) of the Ryan 
White CARE Act Amendments of 2000 (relating to the 
relationship between epidemiological measures and health 
care for certain individuals with HIV disease)."; and 
(6) in subparagraph (D) (as so redesignated), by striking 
"subparagraph (B)" and inserting "subparagraph (C)". 
(b) REQUIREMENTS FOR APPLICATION.—Section 2603(b)(1)(E) of 
the Public Health Service Act (42 U.S.C. 300ff-13(b)(1)(E)) is 
amended by inserting "youth," after "children,". 
(c) TECHNICAL AND CONFORMING AMENDMENT.—Section 2603(b) 
of the Public Health Service Act (42 U.S.C. 300ff-13(b)) is 
amended— 
(1) by striking paragraph (4); 
(2) by redesignating paragraph (5) as paragraph (4); and 
(3) in paragraph (4) (as so redesignated), in subparagraph 
(B), by striking "grants" and inserting "grant". 
Subtitle C—Other Provisions 
SEC 121. USE OF AMOUNTS. 
(a) PRIMARY PURPOSES.—Section 2604(b)(1) of the Public Health 
Service Act (42 U.S.C. 300ff-14(b)(1)) is amended— 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1327 
(1) in the matter preceding subparagraph (A), by striking 
"HIV-related—" and inserting "HIV-related services, as fol-
lows:"; 
(2) in subparagraph (A)— 
(A) by striking "outpatient" and all that follows through 
"substance abuse treatment and" and inserting the fol-
lowing: "Outpatient and ambulatory health 
services, 
including substance abuse treatment,"; and 
(B) by striking "; and" and inserting a period; 
(3) in subparagraph (B), by striking "(B) inpatient case 
management" and inserting "(C) Inpatient case management"; 
(4) by inserting after subparagraph (A) the following 
subparagraph: 
"(B) Outpatient and ambulatory support services 
(including case management), to the extent that such serv-
ices facilitate, enhance, support, or sustain the delivery, 
continuity, or benefits of health services for individuals 
and families with HIV disease."; and 
(5) by adding at the end the following: 
"(D) Outreach activities that are intended to identify 
individuals with HIV disease who know their HIV status 
and are not receiving HIV-related services, and that are— 
"(i) necessary to implement the strategy under sec-
tion 2602(b)(4)(D), including activities facilitating the 
access of such individuals to HIV-related primary care 
services at entities described in paragraph (3)(A); 
"(ii) conducted in a manner consistent with the 
requirements under sections 2605(a)(3) and 2651(b)(2); 
and 
"(iii) supplement, and do not supplant, such actiAd-
ties that are carried out with amounts appropriated 
under section 317.". 
(b) EARLY INTERVENTION SERVICES.—Section 2604(b) (42 U.S.C. 
300ff-14(b)) of the Public Health Service Act is amended— 
(1) by redesignating paragraph (3) as paragraph (4); and 
(2) by inserting after paragraph (2) the following: 
"(3) EARLY INTERVENTION SERVICES.— 
"(A) IN GENERAL.—^The purposes for which a grant 
under section 2601 may be used include providing to 
individuals with HIV disease early intervention services 
described in section 2651(b)(2), with follow-up referral pro-
vided for the purpose of facilitating the access of individuals 
receiving the services to HIV-related health services. The 
entities through which such services may be provided under 
the grant include public health departments, emergency 
rooms, substance abuse and mental health treatment pro-
grams, detoxification centers, detention facilities, clinics 
regarding sexually transmitted diseases, homeless shelters, 
HIV disease counseling and 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. 
"(B) CONDITIONS.—^With respect to an entity that pro-
poses to provide early intervention services under subpara-
graph (A), such subparagraph applies only if the entity 
114 STAT. 1328 
PUBLIC LAW 106-345—OCT. 20, 2000 
demonstrates to the satisfaction of the chief elected official 
for the eligible area involved that— 
"(i) Federal, State, or local funds are otherwise 
inadequate for the early intervention services the 
entity proposes to provide; and 
"(ii) the entity will expend funds pursuant to such 
subparagraph to supplement and riot supplant other 
funds available to the entity for the provision of early 
intervention services for the fiscal year involved.". 
(c) PRIORITY FOR WOMEN, INFANTS, AND CHILDREN.—Section 
2604(b) (42 U.S.C. 300ff-14(b)) of the Public Health Service Act 
is amended in paragraph (4) (as redesignated by subsection (b)(1) 
of this section) by amending the paragraph to read as follows: 
"(4) PRIORITY FOR WOMEN, INFANTS AND CHILDREN.— 
"(A) IN GENERAL.—^For the purpose of providing health 
and support services to infants, children, youth, and women 
with HIV disease, including treatment measures to prevent 
the perinatal transmission of HIV, the chief elected official 
of an eligible area, in accordance with the established prior-
ities of the planning council, shall for each of such popu-
lations 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 acquired immune deficiency syndrome 
to the general population in such area of individuals with 
such S3nidrome. 
"(B) 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 subpara-
graph (A) 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 Security Act, the State chil-
dren's health insurance program under title XXI of such 
Act, or other Federal or State programs.". 
(d) QUALITY MANAGEMENT.—Section 2604 of the Public Health 
Service Act (42 U.S.C. 300ff-14) is amended— 
(1) by redesignating subsections (c) through (f) as sub-
sections (d) through (g), respectively; and 
(2) by inserting after subsection (b) the following: 
"(c) QUALITY MANAGEMENT.— 
"(1) REQUIREMENT.—^The chief elected official of an eligible 
area that receives a grant under this part shall provide for 
the establishment of a quality management program to assess 
the extent to which HIV health services provided to patients 
under the grant are consistent with the most recent Public 
Health Service guidelines for the treatment of HIV disease 
and related opportunistic infection, and as applicable, to develop 
strategies for ensuring that such services are consistent with 
the guidelines for improvement in the access to and quality 
of HIV health services. 
"(2) USE OF FUNDS.—From amounts received under a grant 
awarded under this part for a fiscal year, the chief elected 
official of an eligible area may (in addition to amounts to 
which subsection (f)(1) applies) use for activities associated 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1329 
with the quality management program required in paragraph 
(l)not more than the lesser of— 
"(A) 5 percent of amounts received under the grant; 
or 
"(B) $3,000,000.". 
SEC. 122. APPLICATION. 
(a) IN GENERAL.—Section 2605(a) of the Public Health Service 
Act (42 U.S.C. 300ff-15(a)) is amended— 
(1) by redesignating paragraphs (3) through (6) as para-
graphs (5) through (8), respectively; and 
(2) by inserting after paragraph (2) the following para-
graphs: 
"(3) that entities within the eligible area that receive funds 
under a grant under this part will maintain appropriate rela-
tionships with entities in the eligible area served that constitute 
key points of access to the health care system for individuals 
with HIV disease (including emergency rooms, substance abuse 
treatment programs, detoxification centers, adult £md juvenile 
detention facilities, sexually transmitted disease clinics, HIV 
counseling and testing sites, mental health programs, and 
homeless shelters), and other entities under section 2604(b)(3) 
and 2652(a), for the purpose of facilitating early intervention 
for individuals newly diagnosed with HIV disease and individ-
uals knowledgeable of their HIV status but not in care; 
"(4) that the chief elected official of the eligible area will 
satisfy all requirements under section 2604(c);". 
(b) CONFORMING AMENDMENTS.—Section 2605(a) (42 U.S.C. 
300ff-15(a)(l)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A), by striking "services to 
individuals with HIV disease" and inserting "services as 
described in section 2604(b)(1)"; and 
(B) in subparagraph (B), by striking "services for 
individuals with HIV disease" and inserting "services as 
described in section 2604(b)( 1)"; 
(2) in paragraph (7) (as redesignated by subsection (a)(1) 
of this section), by striking "and" at the end; 
(3) in paragraph (8) (as so redesignated), by striking the 
period and inserting "; and"; and 
(4) by adding at the end the following paragraph: 
"(9) that the eligible area has procedures in place to ensure 
that services provided with fiinds received under this part 
meet the criteria specified in section 2604(b)(1).". 
TITLE II—CARE GRANT PROGRAM 
Subtitle A—General Grant Provisions 
SEC. 201. PRIORITY FOR WOMEN, INFANTS, AND CHILDREN. 
Section 2611(b) of the PubUc Health Service Act (42 U.S.C. 
300ff-21(b)) is amended to read as follows: 
"(b) PRIORITY FOR WOMEN, INFANTS AND CHILDREN.— 
"(1) IN GENERAL.—For the purpose of providing health and 
support services to infants, children, youth, and women with 
HIV disease, including treatment measures to prevent the 
114 STAT. 1330 
PUBLIC LAW 106-345—OCT. 20, 2000 
perinatal transmission of HIV, a State shall for each of such 
populations use, of the funds allocated under this part to the 
State for a fiscal year, not less than the percentage constituted 
by the ratio of the population involved (infants, children, youth, 
or women in the State) with acquired immune deficiency syn-
drome to the general population in the State of individuals 
with such sjnidrome. 
"(2) WAIVER.—^With respect to the population involved, the 
Secretary may provide to a State a waiver of the requirement 
pf paragraph (1) if the 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.". 
SEC. 202. USE OF GRANTS. 
Section 2612 of the Public Health Service Act (42 U.S.C. SOOff-
22) is amended— 
(1) by striking "A State may use" and inserting "(a) IN 
GENERAL.—^A State may use"; 
and 
(2) by adding at the end the following subsections: 
"(b) SUPPORT SERVICES; OUTREACH.—^The purposes for which 
a grant under this part may be used include delivering or enhancing 
the following: 
"(1) Outpatient and ambulatory support services under sec-
tion 2611(a) (including case management) to the extent that 
such services facilitate, enhance, support, or sustain the 
delivery, continuity, or benefits of health services for individuals 
and families with HIV disease. 
"(2) Outreach activities that are intended to identify 
individuals with HIV disease who know their HIV status and 
are not receiving HIV-related services, and that are— 
"(A) necessary to implement the strategy under section 
2617(b)(4)(B), including activities facilitating the access of 
such individuals to HIV-related primary care services at 
entities described in subsection (c)(1); 
"(B) conducted in a manner consistent with the require-
ment under section 2617(b)(6)(G) and 2651(b)(2); and 
"(C) supplement, and do not supplant, such activities 
that are carried out with amounts appropriated under sec-
tion 317. 
"(c) EARLY INTERVENTION SERVICES.— 
"(1) IN GENERAL.—^The purposes for which a grant under 
this part may be used include providing to individuals with 
HIV disease early intervention services described in section 
2651(b)(2), with follow-up referral provided for the purpose 
of facilitating the access of individuals receiving the services 
to HIV-related health services. The entities through which such 
services may be provided under the grant include public health 
departments, emergency rooms, substance abuse and mental 
health treatment programs, detoxification centers, detention 
facilities, clinics regarding sexually transmitted diseases, home-
less shelters, HIV disease counseling and testing sites, health 
care points of entry specified by States or eligible areas, feder-
ally qualified health centers, and entities described in section 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1331 
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 applies only if the entity demonstrates to the satis-
faction of 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 
paragraph to supplement and not supplant other funds 
available to the entity for the provision of early intervention 
services for the fiscal year involved. 
"(d) QUALITY MANAGEMENT.— 
"(1) REQUIREMENT.—Each State that receives a grant under 
this part shall provide for the establishment of a quality 
management program to assess the extent to which HIV health 
services provided to patients under the grant are consistent 
with the most recent Public Health Service guidelines for the 
treatment of HIV disease and related opportunistic infection, 
and as applicable, to develop strategies for ensuring that such 
services are consistent with the guidelines for improvement 
in the access to and quality of HIV health services. 
"(2) USE OF FUNDS.—From amounts received under a grant 
awarded under this part for a fiscal year, the State may (in 
addition to amounts to which section 2618(b)(5) applies) use 
for activities associated with the quality management program 
required in paragraph (1) not more than the lesser of— 
"(A) 5 percent of amounts received under the grant; 
or 
"(B) $3,000,000.". 
SEC. 203. GRANTS TO ESTABLISH HIV CARE CONSORTIA. 
Section 2613 of the Public Health Service Act (42 U.S.C. 300ff-
23) is amended— 
(1) in subsection (b)(1)— 
(A) in subparagraph (A), by inserting before the semi-
colon the following: ", particularly those experiencing 
disparities in access and services and those who reside 
in historically underserved communities"; and 
(B) in subparagraph (B), by inserting after "by such 
consortium" the following: "is consistent with the com-
prehensive plan under section 2617(b)(4) and"; 
(2) in subsection (c)(1)— 
(A) in subparagraph (D), by striking "and" after the 
semicolon at the end; 
(B) in subparagraph (E), by striking the period and 
inserting "; and"; and 
(C) by adding at the end the following subparagraph: 
"(F) demonstrates that adequate planning occurred to 
address disparities in access and services and historically 
underserved communities."; and 
(3) in subsection (c)(2)— 
(A) in subparagraph (B), by striking "and" after the 
semicolon; 
(B) in subparagraph (C), by striking the period and 
inserting "; and"; and 
79-194 O - 00 - 15 : QL 3 Part 2 
114 STAT. 1332 
PUBLIC LAW 106-345—OCT. 20, 2000 
(C) by inserting after subparagraph (C) the following 
subparagraph: 
"(D) the types 
of entities 
described 
in 
section 
2602(b)(2).". 
SEC. 204. PROVISION OF TREATMENTS. 
(a) IN GENERAL.—Section 2616(c) of the Public Health Service 
Act (42 U.S.C. 300fif-26(c)) is amended— 
(1) in paragraph (4), by striking "and" after the semicolon 
at the end; 
(2) in paragraph (5), by striking the period and inserting 
"; and"; and 
(3) by inserting after paragraph (5) the following: 
"(6) encourage, support, and enhance adherence to and 
compliance with treatment regimens, including related medical 
monitoring. 
Of the amount reserved by a State for a fiscal year for use under 
this section, the State may not use more than 5 percent to carry 
out services under paragraph (6), except that the percentage 
applicable with respect to such paragraph is 10 percent if the 
State demonstrates to the Secretary that such additional services 
are essential and in no way diminish access to the therapeutics 
described in subsection (a).". 
(b) HEALTH INSURANCE AND PLANS.—Section 2616 of the Public 
Health Service Act (42 U.S.C. 300fF-26) is amended by adding 
at the end the following subsection: 
"(e) USE OF HEALTH INSURANCE AND PLANS.— 
"(1) IN GENERAL.—In carrying out subsection (a), a State 
may expend a grant under this part to provide the therapeutics 
described in such subsection by paying on behalf of individuals 
with HIV disease the costs of purchasing or maintaining health 
insurance or plans whose coverage includes a full range of 
such therapeutics and appropriate primary care services. 
"(2) LIMITATION.—^The authority established in paragraph 
(1) applies only to the extent that, for the fiscal year involved, 
the costs of the health insurance or plans to be purchased 
or maintained under such paragraph do not exceed the costs 
of otherwise providing therapeutics described in subsection (a).". 
SEC. 205. STATE APPLICATION. 
(a) DETERMINATION OF SIZE AND NEEDS OF POPULATION; COM-
PREHENSIVE PLAN.—Section 2617(b) of the Public Health Service 
Act (42 U.S.C. 300fF-27(b)) is amended— 
(1) by redesignating paragraphs (2) through (4) as para-
graphs (4) through (6), respectively; 
(2) by inserting after paragraph (1) the following para-
graphs: 
"(2) a determination of the size and demographics of the 
population of individuals with HIV disease in the State; 
"(3) a determination of the needs of such population, with 
particular attention to— 
"(A) individuals with HIV disease who know their HIV 
status and are not receiving HIV-related services; and 
"(B) disparities in access and services among affected 
subpopulations and historically underserved communities;"; 
and 
(3) in paragraph (4) (as so redesignated)— 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1333 
(A) by striking "comprehensive plan for the organiza-
tion" and inserting "comprehensive plan that describes the 
organization"; 
(B) by striking ", including—" and inserting ", and 
that—"; 
(C) by redesignating subparagraphs (A) through (C) 
as subparagraphs (D) through (F), respectively; 
(D) by inserting before subparagraph (C) the following 
subparagraphs: 
"(A) establishes priorities for the allocation of funds 
within the State based on— 
"(i) size and demographics of the population of 
individuals with HIV disease (as determined under 
paragraph (2)) and the needs of such population (as 
determined under paragraph (3)); 
"(ii) availability of other governmental and non-
governmental resources, including the State medicaid 
plan under title XIX of the Social Security Act and 
the State Children's Health Insurance Program under 
title XXI of such Act to cover health care costs of 
eligible individuals and families with HIV disease; 
"(iii) capacity development needs resulting from 
disparities in the availability of HIV-related services 
in historically underserved communities and rural 
communities; and 
"(iv) the efficiency of the administrative mecha-
nism of the State for rapidly allocating funds to the 
areas of greatest need within the State; 
"(B) includes a strategy for identifying individuals who 
know their HFV status and are not receiving such services 
and for informing the individuals of and enabling the 
individuals to utilize the services, giving particular atten-
tion to eliminating disparities in access and services among 
affected 
subpopulations 
and historically 
underserved 
communities, and including discrete goals, a timetable, and 
an appropriate allocation of funds; 
"(C) includes a strategy to coordinate the provision 
of such services with programs for HIV prevention 
(including outreach and early intervention) and for the 
prevention and treatment of substance abuse (including 
programs that provide comprehensive treatment services 
for such abuse);"; 
(E) in subparagraph (D) (as redesignated by subpara-
graph (C) of this paragraph), by inserting "describes" before 
"the services and activities"; 
(F) in subparagraph (E) (as so redesignated), by 
inserting "provides" before "a description"; and 
(G) in subparagraph (F) (as so redesignated), by 
inserting "provides" before "a description". 
(b) PUBLIC PARTICIPATION.—Section 2617(b) of the Public 
Health Service Act, as amended by subsection (a) of this section, 42 USC 300fr-27. 
is amended— 
(1) in paragraph (5), by striking "HIV" and inserting "HIV 
disease"; and 
(2) in paragraph (6), by amending subparagraph (A) to 
read as follows: 
114 STAT. 1334 
PUBLIC LAW 106-345—OCT. 20, 2000 
"(A) the public health agency that is administering 
the grant for the State engages in a public advisory plan-
ning process, including public hearings, that includes the 
participants under paragraph (5), and the types of entities 
described in section 2602(b)(2), in developing the com-
prehensive plan under paragraph (4) and commenting on 
the implementation of such plan;", 
(c) HEALTH CARE RELATIONSHIPS.—Section 2617(b) of the PubUc 
42 use 300fr-27. Health Service Act, as amended by subsection (a) of this section, 
is amended in paragraph (6)— 
(1) in subparagraph (E), by striking "and" at the end; 
(2) in subparagraph (F), by striking the period and inserting 
"; and"; and 
(3) by adding at the end the following subparagraph: 
"(G) entities within areas in which activities under 
the grant are carried out will maintain appropriate rela-
tionships with entities in the area served that constitute 
key points of access to the health care system for individ-
uals with HIV disease (including emergency rooms, sub-
stance abuse treatment programs, detoxification centers, 
adult and juvenile detention facilities, sexually transmitted 
disease clinics, HIV counseling and testing sites, mental 
health programs, and homeless shelters), and other entities 
under section 2612(c) and 2652(a), for the purpose of facili-
tating early intervention for individuals newly diagnosed 
with HIV disease and individuals knowledgeable of their 
HIV status but not in care.". 
SEC. 206. DISTRIBUTION OF FUNDS. 
(a) MINIMUM ALLOTMENT.—Section 2618 of the Public Health 
Service Act (42 U.S.C. 300ff-28) is amended— 
(1) by redesignating subsections (b) through (e) as sub-
sections (a) through (d), respectively; and 
(2) in subsection (a) (as so redesignated), in paragraph 
(lXA)(i)-
(A) in subclause (I), by striking "$100,000" and 
inserting "$200,000"; and 
(B) in subclause (II), by striking "$250,000" and 
inserting "$500,000". 
(b) AMOUNT OF GRANT; ESTIMATE OF LIVING CASES.—Section 
2618(a) of the Public Health Service Act (as redesignated by sub-
section (a)(1) of this section) is amended in paragraph (2)— 
(1) in subparagraph (D)(i), by inserting before the semicolon 
the following: ", except that (subject to subparagraph (E)), for 
grants made pursuant to this paragraph or section 2620 for 
fiscal year 2005 and subsequent fiscal years, the cases counted 
for each 12-month period beginning on or after July 1, 2004, 
shall be cases of HIV disease (as reported to and confirmed 
by such Director) rather than cases of acquired immune defi-
ciency syndrome"; 
(2) by redesignating subparagraphs (E) through (H) as 
subparagraphs (F) through (I), respectively; and 
(3) by inserting after subparagraph (D) the following 
subparagraph: 
"(E) DETERMINATION OF SECRETARY REGARDING DATA 
ON HIV CASES.—If under section 2603(a)(3)(D)(i) the Sec-
retary determines that data on cases of HIV disease are 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1335 
not sufficiently accurate and reliable, then notwithstanding 
subparagraph (D) of this paragraph, for any fiscal year 
prior to fiscal year 2007 the references in such subpara-
graph to cases of HIV disease do not have any legal effect.". 
(c) INCREASES IN FORMULA AMOUNT.—Section 2618(a) of the 
Public Health Service Act (as redesignated by subsection (a)(1) 
42 USC 300fr-28. 
of this section) is amended— 
(1) in paragraph (l)(A)(ii), by inserting before the semicolon 
the following: "and then, as applicable, increased under para-
graph (2)(H)"; and 
(2) in paragraph (2)— 
(A) in subparagraph (A)(i), by striking "subparagraph 
(H)" and inserting "subparagraphs (H) and (I)"; and 
(B) in subparagraph (H) (as redesignated by subsection 
(b)(2) of this section), by amending the subparagraph to 
read as follows: 
"(H) LIMITATION.— 
"(i) IN GENERAL.—^The Secretary shall ensure that 
the amount of a grant awarded to a State or territory 
under section 2611 or subparagraph (I)(i) for a fiscal 
year is not less than— 
"(I) with respect to fiscal year 2001, 99 percent; 
"(II) with respect to fiscal year 2002, 98 per-
cent; 
"(III) with respect to fiscal year 2003, 97 per-
cent; 
"(IV) with respect to fiscal year 2004, 96 per-
cent; and 
"(V) with respect to fiscal year 2005, 95 per-
cent, 
of the amount such State or territory received for fiscal 
year 2000 under section 2611 or subparagraph (I)(i), 
respectively (notwithstanding such subparagraph). In 
administering this subparagraph, the Secretary shall, 
with respect to States or territories that will under 
such section receive grants in amounts that exceed 
the amounts that such States received under such 
section or subparagraph for fiscal year 2000, propor-
tionally reduce such amounts to ensure compliance 
with this subparagraph. In making such reductions, 
the Secretary shall ensure that no such State receives 
less than that State received for fiscal year 2000. 
"(ii) RATABLE REDUCTION.—If the amount appro-
priated under section 2677 for a fiscal year and avail-
able for grants under section 2611 or subparagraph 
(I)(i) is less than the amount appropriated and avail-
able for fiscal year 2000 under section 2611 or subpara-
graph (I)(i), respectively, the limitation contained in 
clause (i) for the grants involved shall be reduced by 
a percentage equal to the percentage of the reduction 
in such amounts appropriated and available.". 
(d) TERRITORIES.—Section 2618(a) of the Public Health Service 
Act (as redesignated by subsection (a)(1) of this section) is amended 
in paragraph (1)(B) by inserting "the greater of $50,000 or" after 
"shall be". 
(e) SEPARATE TREATMENT DRUG GRANTS.—Section 2618(a) of 
the Public Health Service Act (as redesignated by subsection (a)(1) 
X 
114 STAT. 1336 
PUBLIC LAW 106-345—OCT. 20, 2000 
of this section and amended by subsection (b)(2) of this section) 
is amended in paragraph (2)(I)— 
(1) by redesignating clauses (i) and (ii) as subclauses (I) 
and (II), respectively; 
(2) by striking "(D APPROPRIATIONS" and all that follows 
through "With respect to" and inserting the following: 
"(I) APPROPRIATIONS FOR TREATMENT DRUG PROGRAM.— 
"(i) FORMULA GRANTS.—^With respect to"; 
(3) in subclause (I) of clause (i) (as designated by para-
graphs (1) and (2)), by inserting before the semicolon the fol-
lowing: ", less the percentage reserved under clause (ii)(V)"; 
and 
(4) by adding at the end the following clause: 
"(ii) SUPPLEMENTAL TREATMENT DRUG GRANTS.— 
"(I) IN GENERAL.—From amounts made avail-
able under subclause (V), the Secretary shall make 
supplemental grants to States described in sub-
clause (II) to enable such States to increase access 
to therapeutics described in section 2616(a), as 
provided by the State under section 2616(c)(2). 
"(II) ELIGIBLE STATES.—For purposes of sub-
clause (I), a State described in this subclause is 
a State that, in accordance with criteria estab-
lished by the Secretary, demonstrates a severe 
need for a grant under such subclause. In devel-
oping such criteria, the Secretary shall consider 
eligibility standards, formulary composition, and 
the number of eligible individuals at or below 200 
percent of the official poverty line to whom the 
State is unable to provide therapeutics described 
in section 2616(a). 
"(Ill) STATE REQUIREMENTS.—The Secretary 
may not make a grant to a State under this clause 
unless the State agrees that— 
"(aa) the State 
will make 
available 
(directly or through donations from 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; 
and 
Effective date. 
"(bb) the State will not impose eligibility 
requirements for services or scope of benefits 
limitations under section 2616(a) that are 
more restrictive than such requirements in 
effect as of January 1, 2000. 
"(IV) USE AND COORDINATION.—^Amounts 
made available under a grant under this 
clause shall only be used by the State to pro-
vide HIV/AIDS-related medications. The State 
shall coordinate the use of such amounts with 
the amounts otherwise provided under section 
2616(a) in order to maximize drug coverage. 
"(V) FUNDING.—^For the purpose of making 
grants under this clause, the Secretary shall each 
fiscal year reserve 3 percent of the amount referred 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1337 
to in clause (i) with respect to section 2616, subject 
to subclause (VI). 
"(VI) 
LIMITATION.—In 
reserving 
amounts 
under subclause (V) and making grants under this 
clause for a fiscal year, the Secretary shall ensure 
for each State that the total of the grant under 
section 2611 for the State for the fiscal year and 
the grant under clause (i) for the State for the 
fiscal year is not less than such total for the State 
for the preceding fiscal year.". 
(f) TECHNICAL AMENDMENT.—Section 2618(a) of the Public 
Health Service Act (as redesignated by subsection (a)(1) of this 
42 USC 300fF-28. 
section) is amended in paragraph (3)(B) by striking "and the 
Republic of the Marshall Islands" and inserting "the Republic of 
the Marshall Islands, the Federated States of Micronesia, and the 
Republic of Palau, and only for purposes of paragraph (1) the 
Commonwealth of Puerto Rico". 
SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES. 
Subpart I of part B of title XXVI of the Public Health Service 
Act (42 U.S.C. 300ff'-ll et seq.) is amended— 
42 USC 300ff-31. 
(1) by striking section 2621; and 
(2) by inserting after section 2619 the following section: 
"SEC. 2620. SUPPLEMENTAL GRANTS. 
42 USC 300ff-30. 
"(a) IN GENERAL.—The Secretary shall award supplemental 
grants to States determined to be eligible under subsection (b) 
to enable such States to provide comprehensive services of the 
type described in section 2612(a) to supplement the services other-
wise provided by the State under a grant under this subpart in 
emerging communities within the State that are not eligible to 
receive grants under part A. 
"(b) ELIGIBILITY.—^To be eligible to receive a supplemental grant 
under subsection (a), a State shall— 
"(1) be eligible to receive a grant under this subpart; 
"(2) demonstrate the existence in the State of an emerging 
community as defined in subsection (d)(1); and 
"(3) submit the information described in subsection (c). 
"(c) REPORTING REQUIREMENTS.—^A State that desires a grant 
under this section shall, as part of the State application submitted 
under section 2617, submit a detailed description of the manner 
in which the State will use amounts received under the grant 
and of the severity of need. Such description shall include— 
"(1) a report concerning the dissemination of supplemental Reports, 
funds under this section and the plan for the utilization of 
such funds in the emerging community; 
"(2) a demonstration of the existing commitment of local 
resources, both financial and in-kind; 
"(3) a demonstration that the State will maintain HIV-
related activities at a level that is equal to not less than 
the level of such activities in the State for the 1-year period 
preceding the fiscal year for which the State is applying to 
receive a grant under this part; 
"(4) a demonstration of the ability of the State to utilize 
such supplemental financial resources in a manner that is 
immediately responsive and cost effective; 
"(5) a demonstration that the resources will be allocated 
in accordance with the local demographic incidence of AIDS 
114 STAT. 1338 
PUBLIC LAW 106-345—OCT. 20, 2000 
including appropriate allocations for services for infants, chil-
dren, women, and families with HIV disease; 
"(6) a demonstration of the inclusiveness of the planning 
process, with particular emphasis on affected communities and 
individuals with HIV disease; and 
"(7) a demonstration of the manner in which the proposed 
services are consistent with local needs assessments and the 
statewide coordinated statement of need. 
"(d) DEFINITION OF EMERGING COMMUNITY.—In this section, 
the term 'emerging community' means a metropolitan area— 
"(1) that is not eligible for a grant under part A; and 
"(2) for which there has been reported to the Director 
of the Centers for Disease Control and Prevention a cumulative 
total of between 500 and 1,999 cases of acquired immune defi-
ciency s3aidrome for the most recent period of 5 calendar years 
for which such data are available (except that, for fiscal year 
2005 and subsequent fiscal years, cases of HIV disease shall 
be counted rather than cases of acquired immune deficiency 
syndrome if cases of HIV disease are being counted for purposes 
of section 2618(a)(2)(D)(i)). 
"(e) FUNDING.— 
"(1) IN GENERAL.—Subject to paragraph (2), with respect 
to each fiscal year beginning with fiscal year 2001, the Sec-
retary, to carry out this section, shall utilize— 
"(A) the greater of— 
"(i) 25 percent of the amount appropriated under 
section 2677 to carry out part B, excluding the amount 
appropriated under section 2618(a)(2)(I), for such fiscal 
year that is in excess of the amount appropriated to 
carry out such part in the fiscal year preceding the 
fiscal year involved; or 
"(ii) $5,000,000, 
to provide funds to States for use in emerging communities 
with at least 1,000, but less than 2,000, cases of AIDS 
as reported to and confirmed by the Director of the Centers 
for Disease Control and Prevention for the five year period 
preceding the year for which the grant is being awarded; 
and 
"(B) the greater of— 
"(i) 25 percent of the amount appropriated under 
section 2677 to carry out part B, excluding the amount 
appropriated under section 2618(a)(2)(I), for such fiscal 
year that is in excess of the amount appropriated to 
carry out such part in the fiscal year preceding the 
fiscal year involved; or 
"(ii) $5,000,000, 
to provide funds to States for use in emerging communities 
with at least 500, but less than 1,000, cases of AIDS 
reported to and confirmed by the Director of the Centers 
for Disease Control and Prevention for the five year period 
preceding the year for which the grant is being awarded. 
Effective date. 
"(2) TRIGGER OF FUNDING.—This section shall be effective 
only for fiscal years beginning in the first fiscal year in which 
the amount appropriated under section 2677 to carry out part 
B, 
excluding 
the 
amount 
appropriated 
under 
section 
2618(a)(2)(I), exceeds by at least $20,000,000 the amount appro-
priated under section 2677 to carry out part B in fiscal year 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1339 
2000, excluding the amount 
appropriated 
under 
section 
2618(a)(2)(I). 
"(3) MINIMUM AMOUNT IN FUTURE YEARS.—Beginning with 
the first fiscal year in which amounts provided for emerging 
communities under paragraph (1)(A) equals $5,000,000 and 
under paragraph (1)(B) equals $5,000,000, the Secretary shall 
ensure that amounts made available under this section for 
the types of emerging communities described in each such 
paragraph in subsequent fiscal years is at least $5,000,000. 
"(4) DISTRIBUTION.—Grants under this section for emerging 
communities shall be formula grants. There shall be two cat-
egories of such formula grants, as follows: 
"(A) One category of such grants shall be for emerging 
communities for which the cumulative total of cases for 
purposes of subsection (d)(2) is 999 or fewer cases. The 
grant made to such an emerging community for a fiscal 
year shall be the product of— 
"(i) an amount equal to 50 percent of the amount 
available pursuant to this subsection for the fiscal 
year involved; and 
"(ii) a percentage equal to the ratio constituted 
by the number of cases for such emerging community 
for the fiscal year over the aggregate number of such 
cases for such year for all emerging communities to 
which this subparagraph applies. 
"(B) The other category of formula grants shall be 
for emerging communities for which the cumulative total 
of cases for purposes of subsection (d)(2) is 1,000 or more 
cases. The grant made to such an emerging community 
for a fiscal year shall be the product of— 
"(i) an amount equal to 50 percent of the amount 
available pursuant to this subsection for the fiscal 
year involved; and 
"(ii) a percentage equal to the ratio constituted 
by the number of cases for such community for the 
fiscal year over the aggregate number of such cases 
for the fiscal year for all emerging communities to 
which this subparagraph applies.". 
Subtitle B-—Provisions Concerning Preg-
nancy and Perinatal Transmission of 
HIV 
SEC. 211. REPEALS. 
Subpart II of part B of title XXVI of the Public Health Service 
Act (42 U.S.C. 300ff-33 et seq.) is amended— 
(1) in section 2626, by striking each of subsections (d) 
through (f); 
(2) by striking sections 2627 and 2628; and 
(3) by redesignating section 2629 as section 2627. 
SEC. 212. GRANTS. 
(a) IN GENERAL.—Section 2625(c) of the Public Health Service 
Act (42 U.S.C. 300ff-33) is amended— 
42 use 300ff-34. 
42 use 300ff-35, 
300fif-36. 
42 use 300fr-37. 
\ 
114 STAT. 1340 
PUBLIC LAW 106-345—OCT. 20, 2000 
(1) in paragraph (1), by inserting at the end the following 
subparagraph: 
"(F) Making available to pregnant women with HIV 
disease, and to the infants of women with such disease, 
treatment services for such disease in accordance with 
applicable recommendations of the Secretary."; 
(2) by amending paragraph (2) to read as follows: 
"(2) FUNDING.— 
"(A) AUTHORIZATION OF APPROPRIATIONS.—For the pur-
pose of carrying out this subsection, there are authorized 
to be appropriated $30,000,000 for each of the fiscal years 
2001 through 2005. Amounts made available under section 
2677 for carrying out this part are not available for carrying 
out this section unless otherwise authorized. 
"(B) ALLOCATIONS FOR CERTAIN STATES.— 
"(i) IN GENERAL.—Of the amounts appropriated 
under subparagraph (A) for a fiscal year in excess 
of $10,000,000— 
"(I) the Secretary shall reserve the applicable 
percentage under clause (iv) for mgiking grants 
under paragraph (1) both to States described in 
clause (ii) and States described in clause (iii); and 
"(II) the Secretary shall reserve the remaining 
amounts for other States, taking into consideration 
the factors described in subparagraph (C)(iii), 
except that this subclause does not apply to any 
State that for the fiscal year involved is receiving 
amounts pursuant to subclause (I), 
"(ii) REQUIRED TESTING OF NEWBORNS.—For pur-
poses of clause (i)(I), the States described in this clause 
are States that under law (including under regulations 
or the discretion of State officials) have— 
"(I) a requirement that all newborn infants 
bom in the State be tested for HIV disease and 
that the biological mother of each such infant, 
and the legal guardian of the infant (if other than 
the biological mother), be informed of the results 
of the testing; or 
"(II) a requirement that newborn infants bom 
in the State be tested for HIV disease in cir-
cumstances in which the attending obstetrician 
for the birth does not know the HIV status of 
the mother of the infant, and that the biological 
mother of each such infant, and the legal guardian 
of the infant (if other than the biological mother), 
be informed of the results of the testing, 
"(iii) MOST SIGNIFICANT REDUCTION IN CASES OF 
PERINATAL 
TRANSMISSION.—^For purposes of clause 
(i)(I), the States described in this clause are the fol-
lowing (exclusive of States described in clause (ii)), 
as applicable: 
"(I) For fiscal years 2001 and 2002, the two 
States that, relative to other States, have the most 
significant reduction in the rate of new cases of 
the perinatal transmission of HIV (as indicated 
by the number of such cases reported to the 
Director of the Centers for Disease Control and 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1341 
Prevention for the most recent periods for which 
the data are available). 
"(II) For fiscal years 2003 and 2004, the three 
States that have the most significant such reduc-
tion. 
"(Ill) For fiscal year 2005, the four States 
that have the most significant such reduction. 
"(iv) APPLICABLE PERCENTAGE.—For purposes of 
clause (i), the applicable amount for a fiscal year is 
as follows: 
"(I) For fiscal year 2001, 33 percent. 
"(II) For fiscal year 2002, 50 percent. 
"(Ill) For fiscal year 2003, 67 percent. 
"(IV) For fiscal year 2004, 75 percent. 
"(V) For fiscal year 2005, 75 percent. 
"(C) CERTAIN PROVISIONS.—With respect to grants 
under paragraph (1) that are made with amounts reserved 
under subparagraph (B) of this paragraph: 
"(i) Such a grant may not be made in an amount 
exceeding $4,000,000. 
"(ii) If pursuant to clause (i) or pursuant to an 
insufficient number of qualifying applications for such 
grants (or both), the full amount reserved under 
subparagraph (B) for a fiscal year is not obligated, 
the requirement under such subparagraph to reserve 
amounts ceases to apply. 
"(iii) In the case of a State that meets the condi-
tions to receive gimounts reserved under subparagraph 
(B)(i)(II), the Secretary shall in making grants consider 
the following factors: 
"(I) The extent of the reduction in the rate 
of new cases of the perinatal transmission of HIV. 
"(II) The extent of the reduction in the rate 
of new cases of perinatal cases of acquired immune 
deficiency sjmdrome. 
"(Ill) The overall incidence of cases of infection 
with HIV among women of childbearing age. 
"(TV) The overall incidence of cases of acquired 
immune deficiency syndrome among women of 
childbearing age. 
"(V) The higher acceptance rate of HIV testing 
of pregnant women. 
"(VI) The extent to which women and children 
with HIV disease are receiving HlV-related health 
services. 
"(VII) The extent to which HIV-exposed chil-
dren are receiving health services appropriate to 
such exposure."; and 
(3) by adding at the end the following paragraph: 
"(4) MAINTENANCE OF EFFORT.—A condition for the receipt 
of a grant under paragraph (1) is that the State involved 
agree that the grant will be used to supplement and not sup-
plant other funds available to the State to carry out the pur-
poses of the grant.", 
(b) SPECIAL FUNDING RULE FOR FISCAL YEAR 2001.— 
114 STAT. 1342 
PUBLIC LAW 106-345—OCT. 20, 2000 
(1) IN GENERAL.—If for fiscal year 2001 the amount appro-
priated under paragraph (2)(A) of section 2625(c) of the PubHc 
Health Service Act is less than $14,000,000— 
(A) the Secretary of Health and Human Services shall, 
for the purpose of making grants under paragraph (1) 
of such section, reserve from the amount specified in para-
graph (2) of this subsection an amount equal to the dif-
ference between $14,000,000 and the amount appropriated 
under paragraph (2)(A) of such section for such fiscal year 
(notwithstanding any other provision of this Act or the 
amendments made by this Act); 
(B) the amount so reserved shall, for purposes of para-
graph (2)(B)(i) of such section, be considered to have been 
appropriated under paragraph (2)(A) of such section; and 
(C) the percentage specified in paragraph (2)(B)(iv)(I) 
of such section is deemed to be 50 percent. 
(2) ALLOCATION FROM INCREASES IN FUNDING FOR PART 
B.—^For purposes of paragraph (1), the amount specified in 
this paragraph is the amount by which the .amount appro-
priated under section 2677 of the Public Health Service Act 
for fiscal year 2001 and available for grants under section 
2611 of such Act is an increase over the amount so appropriated 
and available for fiscal year 2000. 
SEC. 213. STUDY BY INSTITUTE OF MEDICINE. 
Subpart II of part B of title XXVI of the Public Health Service 
Act, as amended by section 211(3), is amended by adding at the 
end the following section: 
42USC300ff- 
"SEC. 2628. RECOMMENDATIONS 
FOR 
REDUCING 
INCIDENCE 
OF 
37a. 
PERINATAL TRANSMISSION. 
"(a) STUDY BY INSTITUTE OF MEDICINE.— 
"(1) IN GENERAL.—^The Secretary shall request the Institute 
of Medicine to enter into an agreement with the Secretary 
under which such Institute conducts a study to provide the 
following: 
"(A) For the most recent fiscal year for which the 
information is available, a determination of the number 
of newborn infants with HIV bom in the United States 
with respect to whom the attending obstetrician for the 
birth did not know the HIV status of the mother. 
"(B) A determination for each State of any barriers, 
including legal barriers, that prevent or discourage an 
obstetrician from making it a routine practice to offer preg-
nant women an HIV test and a routine practice to test 
newborn infamts for HIV disease in circumstances in which 
the obstetrician does not know the HIV status of the mother 
of the infant. 
"(C) Recommendations for each State for reducing the 
incidence of cases of the perinatal transmission of HFV, 
including recommendations on removing the 
barriers 
identified under subparagraph (B). 
If such Institute declines to conduct the study, the Secretary 
shall enter into an agreement with another appropriate public 
or nonprofit private entity to conduct the study. 
Deadline. 
"(2) REPORT.—^The Secretary shall ensure that, not later 
than 18 months after the effective date of this section, the 
study required in paragraph (1) is completed and a report 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1343 
describing the findings made in the study is submitted to 
the appropriate committees of the Congress, the Secretary, 
and the chief pubHc health official of each of the States. 
"(b) PROGRESS TOWARD RECOMMENDATIONS.—In fiscal year 
2004, the Secretary shall collect information from the States 
describing the actions taken by the States toward meeting the 
recommendations specified for the States under subsection (a)(1)(C). 
"(c) SUBMISSION OF REPORTS TO CONGRESS.—The Secretary 
shall submit to the appropriate committees of the Congress reports 
describing the information collected under subsection (b).". 
Subtitle C—Certain Partner Notification 
Programs 
SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICATION PRO-
GRAMS. 
Part B of title XXVI of the Public Health Service Act (42 
U.S.C. 300ff-21 et seq.) is amended by adding at the end the 
following subpart: 
"Subpart III—Certain Partner Notification 
Programs 
"SEC. 2631. GRANTS FOR PARTNER NOTIFICATION PROGRAMS. 
42 USC 300fr-38. 
"(a) IN GENERAL.—In the case of States whose laws or regula-
tions are in accordance with subsection (b), the Secretary, subject 
to subsection (c)(2), may make grants to the States for carrying 
out programs to provide partner counseling and referral services. 
"(b) DESCRIPTION OF COMPLIANT STATE PROGRAMS.—For pur-
poses of subsection (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) the following policies are in effect: 
"(1) The State requires that the public health ofHcer of 
the State carry out a program of partner notification to inform 
partners of individuals with HIV disease that the partners 
may have been exposed to the disease. 
"(2)(A) In the case of a health entity that provides for 
the performance on an individual of a test for HIV disease, 
or that treats the individual for the disease, the State requires, 
subject to subparagraph (B), that the entity confidentially 
report the positive test results to the State public health officer 
in a manner recommended and approved by the Director of 
the Centers for Disease Control and Prevention, together with 
such additional information as may be necessary for carrying 
out such program. 
"(B) The State may provide that the requirement of 
subparagraph (A) does not apply to the testing of an individual 
for HIV disease if the individual underwent the testing through 
a program designed to perform the test and provide the results 
to the individual without the individual disclosing his or her 
identity to the program. This subparagraph may not be con-
strued as affecting the requirement of subparagraph (A) with 
respect to a health entity that treats an individual for HIV 
disease. 
114 STAT. 1344 
PUBLIC LAW 106-345—OCT. 20, 2000 
"(3) The program under paragraph (1) is carried out in 
accordance with the following: 
"(A) Partners are provided with an appropriate oppor-
tunity to learn that the partners have been exposed to 
HIV disease, subject to subparagraph (B). 
"(B) The State does not inform partners of the identity 
of the infected individuals involved. 
"(C) Counseling and testing for HIV disease are made 
available to the partners and to infected individuals, and 
such counseling includes information on modes of trans-
mission for the disease, including information on prenatal 
and perinatal transmission and preventing transmission. 
"(D) Counseling of infected individuals and their part-
ners includes the provision of information regarding thera-
peutic measures for preventing and treating the deteriora-
tion of the immune system and conditions arising from 
the disease, and the provision of other prevention-related 
information. 
"(E) Referrals for appropriate services are provided 
to partners and infected individuals, including referrals 
for support services and legal aid. 
"(F) Notifications under subparagraph (A) are provided 
in person, unless doing so is an unreasonable burden on 
the State. 
"(G) There is no criminal or civil penalty on, or civil 
liability for, an infected individual if the individuEil chooses 
not to identify the partners of the individual, or the indi-
vidual does not otherwise cooperate with such program. 
"(H) The failure of the State to notify partners is 
not a basis for the civil liability of any health entity who 
under the program reported to the State the identity of 
the infected individual involved. 
"(I) The State provides that the provisions of the pro-
gram may not be construed as prohibiting the State from 
providing a notification under subparagraph (A) without 
the consent of the infected individual involved. 
"(4) The State annually reports to the Director of the Cen-
ters for Disease Control and Prevention the number of individ-
uals from whom the names of partners have been sought under 
the program under paragraph (1), the number of such individ-
uals who provided the names of partners, and the number 
of partners so named who were notified under the program. 
"(5) The State cooperates with such Director in carrying 
out a national program of partner notification, including the 
sharing of information between the public health officers of 
the States. 
"(c) REPORTING SYSTEM FOR CASES OF HIV 
DISEASE; PREF-
ERENCE IN MAKING GRANTS.—In making grants under subsection 
(a), the Secretary shall give preference to States whose reporting 
systems for cases of HIV disease produce data on such cases that 
is sufficiently accurate and reliable for use for purposes of section 
2618(a)(2)(D)(i). 
"(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there are authorized to be appropriated 
$30,000,000 for fiscal year 2001, and such sums as may be necessary 
for each of the fiscal years 2002 through 2005.". 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1345 
TITLE III—EARLY INTERVENTION 
SERVICES 
Subtitle A—Formula Grants for States 
SEC. 301. REPEAL OF PROGRAM. 
(a) REPEAL.—Subpart I of part C of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff-41 et seq.) is repealed. 
(b) CONFORMING AMENDMENTS.—Part C of title XXVI of the 
Public Health Service Act (42 U.S.C. 300ff-41 et seq.), as amended 
by subsection (a) of this section, is amended— 
(1) by redesignating subparts II and III as subparts I 
and II, respectively; 
(2) in section 2661(a), by striking "unless—" and all that 
follows through "(2) in the case of and inserting "unless, in 
the case of; and 
(3) in section 2664— 
(A) in subsection (e)(5), by striking "2642(b) or"; 
(B) in subsection (f)(2), by striking "2642(b) or"; and 
(C) by striking subsection (h). 
Subtitle B—Categorical Grants 
SEC. 311. PREFERENCES IN MAKING GRANTS. 
Section 2653 of the Public Health Service Act (42 U.S.C. 300ff-
53) is amended by adding at the end the following subsection: 
"(d) CERTAIN AREAS.—Of the applicants who qualify for pref-
erence under this section— 
"(1) the Secretary shall give preference to applicants that 
will expend the grant under section 2651 to provide early 
intervention under such section in rural areas; and 
"(2) the Secretary shall give special consideration to areas 
that are underserved with respect to such services.". 
SEC. 312. PLANNING AND DEVELOPMENT GRANTS. 
(a) IN GENERAL.—Section 2654(c)(1) of the Public Health Service 
Act (42 U.S.C. 300fiF-54(c)(l)) is amended by striking "planning 
grants" and all that follows and inserting the following: "planning 
grants to public and nonprofit private entities for purposes of— 
"(A) enabling such entities to provide HIV early inter-
vention services; and 
"(B) assisting the entities in expanding their capacity 
to provide HIV-related health services, including early 
intervention services, in low-income communities and 
affected subpopulations that are underserved with respect 
to such services (subject to the condition that a grant 
pursuant to this subparagraph may not be expended to 
purchase or improve land, or to purchase, construct, or 
permanently improve, other than minor remodeling, any 
building or other facility),". 
(b) AMOUNT; DURATION.—Section 2654(c) of the Public Health 
Service Act (42 U.S.C. 300fF-54(c)) is further amended— 
(1) by redesignating paragraph (4) as paragraph (5); and 
(2) by inserting after paragraph (3) the following: 
"(4) AMOUNT AND DURATION OF GRANTS.— 
42 use 300ff-61. 
42 use 300ff-64. 
114 STAT. 1346 
PUBLIC LAW 106-345—OCT. 20, 2000 
"(A) EARLY INTERVENTION SERVICES.—^A grant under 
paragraph (1)(A) may be made in an amount not to exceed 
$50,000. 
"(B) CAPACITY DEVELOPMENT.— 
"(i) AMOUNT.—^A grant under paragraph (1)(B) may 
be made in an amount not to exceed $150,000. 
"(ii) DURATION.—^The total duration of a grant 
under paragraph (1)(B), including any renewal, may 
not exceed 3 years.". 
(c) INCREASE IN LIMITATION.—Section 2654(c)(5) of the PubUc 
Health Service Act (42 U.S.C. 300ff-54(c)(5)), as redesignated by 
subsection (b), is amended by striking "1 percent" and inserting 
"5 percent". 
SEC. 313. AUTHORIZATION OF APPROPRIATIONS. 
Section 2655 of the Public Health Service Act (42 U.S.C. 300ff-
55) is amended by striking "in each of and all that follows and 
inserting "for each of the fiscal years 2001 through 2005.". 
Subtitle C—General Provisions 
SEC. 321. PROVISION OF CERTAIN COUNSELING SERVICES. 
Section 2662(c)(3) of the Public Health Service Act (42 U.S.C. 
300ff-62(c)(3)) is amended— 
(1) in the matter preceding subparagraph (A), by striking 
"counseling on—" and inserting "counseling—"; 
(2) in each of subparagraphs (A), (B), and (D), by inserting 
"on" after the subparagraph designation; and 
(3) in subparagraph (C)— 
(A) by striking "(C) the benefits" and inserting "(C)(i) 
that explains the benefits"; and 
(B) by inserting after clause (i) (as designated by 
subparagraph (A) of this paragraph) the following clause: 
"(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.". 
SEC. 322. ADDITIONAL REQUIRED AGREEMENTS. 
Section 2664(g) of the PubUc Health Service Act (42 U.S.C. 
300ff-64(g)) is amended— 
(1) in paragraph (3)— 
(A) by striking "7.5 percent" and inserting "10 percent"; 
and 
(B) by striking "and" after the semicolon at the end; 
(2) in paragraph (4), by striking the period and inserting 
"; and"; and 
(3) by adding at the end the following paragraph: 
"(5) the applicant will provide for the establishment of 
a quality management program— 
"(A) to assess the extent to which medical services 
funded under this title that are provided to patients are 
consistent with the most recent Public Health Service 
guidelines for the treatment of HIV disease and related 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1347 
opportunistic infections, and as applicable, to develop 
strategies for ensuring that such services are consistent 
with the guidelines; and 
"(B) to ensure that improvements in the access to 
and quality of HIV health services are addressed.". 
TITLE IV—OTHER PROGRAMS AND 
ACTIVITIES 
Subtitle A—Certain Programs for 
Research, Demonstrations, or Training 
SEC. 401. GRANTS FOR COORDINATED SERVICES AND ACCESS TO 
RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND YOUTH. 
(a) ELIMINATION OF REQUIREMENT TO ENROLL SIGNIFICANT 
NUMBERS OF WOMEN AND CHILDREN.—Section 2671(b) (42 U.S.C. 
300ff-7Kb)) is amended— 
(1) in paragraph (1), by striking subparagraphs (C) and 
(D) and inserting the following: 
"(C) The applicant will demonstrate linkages to 
research and how access to such research is being offered 
to patients."; and 
(2) by striking paragraphs (3) and (4). 
(b) INFORMATION AND EDUCATION.—Section 2671(d) (42 U.S.C. 
300ff-71(d)) is amended by adding at the end the following: 
"(4) The applicant will provide individuals with information 
and education on opportunities to participate in HIV/AIDS-
related clinical research.". 
(c) 
QUALITY 
MANAGEMENT; 
ADMINISTRATIVE 
EXPENSES 
CEILING.—Section 2671(f) (42 U.S.C. 300flF-71(f)) is amended— 
(1) by striking the subsection heading and designation and 
inserting the following: 
"(f) ADMINISTRATION.— 
"(1) APPLICATION.—"; and 
(2) by adding at the end the following: 
"(2) QUALITY MANAGEMENT PROGRAM.—^A grantee under 
this section shall implement a quality management program 
to assess the extent to which HIV health services provided 
to patients under the grant are consistent with the most recent 
Public Health Service guidelines for the treatment of HIV dis-
ease and related opportunistic infection, and as applicable, 
to develop strategies for ensuring that such services are con-
sistent with the guidelines for improvement in the access to 
and quality of HIV health services.". 
(d) COORDINATION.—Section 2671(g) (42 U.S.C. 300ff-71(g)) is 
amended by adding at the end the following: "The Secretary acting 
through the Director of NIH, shall examine the distribution and 
availability of ongoing and appropriate HIV/AIDS-related research 
projects to existing sites under this section for purposes of 
enhancing and expanding voluntary access to HIV-related research, 
especially within communities that are not reasonably served by 
such projects. Not later than 12 months after the date of the Deadline, 
enactment of the Ryan White CARE Act Amendments of 2000, Reports, 
the Secretary shall prepare and submit to the appropriate commit-
tees of Congress a report that describes the findings made by 
114 STAT. 1348 
PUBLIC LAW 106-345—OCT. 20, 2000 
the Director and the manner in which the conclusions based on 
those findings can be addressed.". 
(e) ADMINISTRATIVE EXPENSES.—Section 2671 of the PubHc 
Health Service Act (42 U.S.C. 300ff-71) is amended— 
(1) by redesignating subsections (i) and (j) as subsections 
(j) and (k), respectively; and 
(2) by inserting after subsection (h) the following sub-
section: 
Deadlines. 
"(i) LIMITATION ON ADMINISTRATIVE EXPENSES.— 
"(1) DETERMINATION BY SECRETARY.—Not later than 12 
months after the date of the enactment of the Ryan White 
CARE Act Amendments of 2000, the Secretary, in consultation 
with grantees under this part, shall conduct a review of the 
administrative, program support, and direct service-related 
activities that are carried out under this part to ensure that 
eligible individuals have access to quality, HFV-related health 
and support services and research opportunities under this 
part, and to support the provision of such services. 
"(2) REQUIREMENTS.— 
"(A) IN GENERAL.—^Not later than 180 days after the 
expiration of the 12-month period referred to in paragraph 
(1) the Secretary, in consultation with grantees under this 
part, shall determine the relationship between the costs 
of the activities referred to in paragraph (1) and the access 
of eligible individuals to the services and 
research 
opportunities described in such paragraph. 
"(B) LIMITATION.—^After a final determination under 
subparagraph (A), the Secretary may not make a grant 
under this part unless the grantee complies with such 
requirements as may be included in such determination.". 
(f) AUTHORIZATION OF APPROPRIATIONS.—Section 2671 of the 
Public Health Service Act (42 U.S.C. 300ff-71) is amended in sub-
section (j) (as redesignated by subsection (e)(1) of this section) 
by striking "fiscal years 1996 through 2000" and inserting "fiscal 
years 2001 through 2005". 
SEC. 402. ATOS EDUCATION AND TRAINING CENTERS. 
(a) SCHOOLS; CENTERS.— 
(1) IN GENERAL.—Section 2692(a)(1) of the Public Health 
Service Act (42 U.S.C. 300ff-lll(a)(l)) is amended— 
(A) in subparagraph (A)— 
(i) by striking "training" and inserting "to train"; 
(ii) by striking "and including" and inserting ", 
including"; and 
(iii) by inserting before the semicolon the following: 
", and including (as applicable to the t5^e of health 
professional involved), prenatal and other gynecological 
care for women with HIV disease"; 
(B) in subparagraph (B), by striking "and" after the 
semicolon at the end; 
(C) in subparagraph (C), by striking the period and 
inserting "; and"; and 
(D) by adding at the end the following: 
"(D) to develop protocols for the medical care of women 
with HIV disease, including prenatal and other gjmeco-
logical care for such women.". 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1349 
(2) DISSEMINATION OF TREATMENT GUIDELINES; MEDICAL 42USC300ff-
CONSULTATION ACTIVITIES.—Not later than 90 days after the iiinote. 
date of the enactment of this Act, the Secretary of Health Deadline, 
and Human Services shall issue and begin implementation 
of a strategy for the dissemination of HIV treatment informa-
tion to health care providers and patients. 
(b) DENTAL SCHOOLS.—Section 2692(b) of the Public Health 
Service Act (42 U.S.C. 300ff-lll(b)) is amended— 
(1) by amending paragraph (1) to read as follows: 
"(1) IN GENERAL.— 
"(A) GRANTS.—The Secretary may make grants to 
dental schools and programs described in subparagraph 
(B) to assist such schools and programs with respect to 
oral health care to patients with HIV disease. 
"(B) ELIGIBLE APPLICANTS.—For purposes of this sub-
section, the dental schools and programs referred to in 
this subparagraph are dental schools and programs that 
were described in section 777(b)(4)(B) as such section was 
in effect on the day before the date of the enactment 
of the Health Professions Education Partnerships Act of 
1998 (Public Law 105-392) and in addition dental hygiene 
programs that are accredited by the Commission on Dental 
Accreditation."; 
(2) in paragraph (2), by striking "777(b)(4)(B)" and inserting 
"the section referred to in paragraph (1)(B)"; and 
(3) by inserting after paragraph (4) the following para-
graph: 
"(5) COMMUNITY-BASED CARE.—The Secretary may make 
grants to dental schools and programs described in paragraph 
(1)(B) that partner with community-based dentists to provide 
oral health care to patients with HIV disease in unserved 
areas. Such partnerships shall permit the training of dental 
students and residents and the participation of community 
dentists as adjunct faculty.". 
(c) AUTHORIZATION OF APPROPRIATIONS.— 
(1) SCHOOLS; CENTERS.—Section 2692(c)(1) of the Public 
Health Service Act (42 U.S.C. 300ff-111(c)(1)) is amended by 
striking "fiscal years 1996 through 2000" and inserting "fiscal 
years 2001 through 2005". 
(2) DENTAL SCHOOLS.—Section 2692(c)(2) of the Public 
Health Service Act (42 U.S.C. 300ff-lll(c)(2)) is amended to 
read as follows: 
"(2) DENTAL SCHOOLS.— 
"(A) IN GENERAL.—For the purpose of grants under 
paragraphs (1) through (4) of subsection (b), there are 
authorized to be appropriated such sums as may be nec-
essary for each of the fiscal years 2001 through 2005. 
"(B) COMMUNITY-BASED CARE.—For the purpose of 
grants under subsection (b)(5), there are authorized to be 
appropriated such sums as may be necessary for each of 
the fiscal years 2001 through 2005.". 
114 STAT. 1350 
PUBLIC LAW 106-345—OCT. 20, 2000 
Subtitle B—General Provisions in Title 
XXVI 
SEC. 411. EVALUATIONS AND REPORTS. 
Section 2674(c) of the Public Health Service Act (42 U.S.C. 
300ff-74(c)) is amended by striking "1991 through 1995" and 
inserting "2001 through 2005". 
SEC. 412. DATA COLLECTION THROUGH CENTERS FOR DISEASE CON-
TROL AND PREVENTION. 
Part B of title III of the Public Health Service Act (42 U.S.C. 
243 et seq.) is amended by inserting after section 318A the following 
section: 
"DATA COLLECTION REGARDING PROGRAMS UNDER TITLE XXVI 
42USC247C-2. 
"SEC. 318B. For the purpose of collecting and providing data 
for program planning and evaluation activities under title XXVI, 
there are authorized to be appropriated to the Secretary (acting 
through the Director of the Centers for Disease Control and Preven-
tion) such sums as may be necessary for each of the fiscal years 
2001 through 2005. Such authorization of appropriations is in addi-
tion to other authorizations of appropriations that are available 
for such purpose.". 
SEC. 413. COORDINATION. 
Section 2675 of the Public Health Service Act (42 U.S.C. 300fF-
75) is amended— 
(1) by amending subsection (a) to read as follows: 
"(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 Health Care Financing Adminis-
tration coordinate the planning, funding, and implementation of 
Federal HIV programs to enhance the continuity of care and preven-
tion services for individuals with HIV disease 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 submitted to such agencies by 
the States and entities eligible for support."; 
(2) by redesignating subsections (b) and (c) as subsections 
(c) and (d), respectively; 
(3) by inserting after subsection (b) the following sub-
section: 
"(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 disease or those at risk of such 
disease."; and 
(4) in each of subsections (c) and (d) (as redesignated by 
paragraph (2) of this section), by inserting "and prevention 
services" after "continuity of care" each place such term 
appears. 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1351 
42 use 300fr-
75a. 
SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH HIV DIS-
EASE. 
Section 2675 of the Public Health Service Act, as amended 
by section 413(2) of this Act, is amended by adding at the end 42 USC 300ff-75. 
the following subsection: 
"(e) RECOMMENDATIONS REGARDING RELEASE OF PRISONERS.— 
After consultation with the Attorney General and the Director 
of the Bureau of Prisons, with States, with eligible areas under 
part A, and with entities that receive amounts from grants under 
part A or B, the Secretary, consistent with the coordination required 
in subsection (a), shall develop a plan for the medical case manage-
ment of and the provision of support services to individuals who 
were Federal or State prisoners and had HIV disease as of the 
date on which the individuals were released from the custody of 
the penal system. The Secretary shall submit the plan to the Deadline. 
Congress not later than 2 years after the date of the enactment 
of the Ryan White CARE Act Amendments of 2000.". 
SEC. 415. AUDITS. 
Part D of title XXVI of the Public Health Service Act (42 
U.S.C. 300ff-71 et seq.) is amended by inserting after section 2675 
the following section: 
"SEC. 2675A. AUDITS. 
"For fiscal year 2002 and subsequent fiscal years, 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.". 
SEC. 416. ADMINISTRATIVE SIMPLIFICATION. 
Part D of title XXVI of the Public Health Service Act, as 
amended by section 415 of this Act, is amended by inserting after 
section 2675A the following section: 
"SEC. 2675B. ADMINISTRATIVE SIMPLIFICATION REGARDING PARTS A 
ANDB. 
"(a) COORDINATED DISBURSEMENT.—^After consultation with the 
States, with eligible areas under part A, and with entities that 
receive amounts from grants under part A or B, the Secretary 
shall develop a plan for coordinating the disbursement of appropria-
tions for grants under part A with the disbursement of appropria-
tions for grants under part B in order to assist grantees and 
other recipients of amounts from such grants in compl5dng with 
the requirements of such parts. The Secretary shall submit the Deadline, 
plan to the Congress not later than 18 months after the date 
of the enactment of the Ryan White CARE Act Amendments of 
2000. Not later than 2 years after the date on which the plan 
is so submitted, the Secretary shall complete the implementation 
of the plan, notwithstanding any provision of this title that is 
inconsistent with the plan. 
"(b) 
BIENNIAL APPLICATIONS.—^After consultation with the 
States, with eligible areas under part A, and with entities that 
receive amounts from grants under part A or B, the Secretary 
42 USC 300fr-
75b. 
X 
114 STAT. 1352 
PUBLIC LAW 106-345—OCT. 20, 2000 
shall make a determination of whether the administration of parts 
A and B by the Secretary, and the efficiency of grantees under 
such parts in complying with the requirements of such parts, would 
be improved by requiring that applications for grants under such 
Deadline. 
parts be submitted biennially rather than annually. The Secretary 
shall submit such determination to the Congress not later than 
2 years after the date of the enactment of the Ryan White CARE 
Act Amendments of 2000. 
"(c) APPLICATION SIMPLIFICATION.—After consultation with the 
States, with eligible areas imder part A, and with entities that 
receive amounts from grants under part A or B, the Secretary 
shall develop a plan for simplifying the process for applications 
Deadline. 
under parts A and B. The Secretary shall submit the plan to 
the Congress not later than 18 months after the date of the enact-
ment of the Ryan White CARE Act Amendments of 2000. Not 
later than 2 years after the date on which the plan is so submitted, 
the Secretary shall complete the implementation of the plan, not-
withstanding any provision of this title that is inconsistent with 
the plan.". 
SEC. 417. AUTHORIZATION OF APPROPRIATIONS FOR PARTS A 
ANDB. 
Section 2677 of the Public Health Service Act (42 U.S.C. SOOff-
77) is amended to read as follows: 
"SEC. 2677. AUTHORIZATION OF APPROPRIATIONS. 
"(a) PART A.—^For the purpose of carrying out part A, there 
are authorized to be appropriated such sums as may be necessary 
for each of the fiscal years 2001 through 2005. 
"(b) PART B.—^For the purpose of carrying out part B, there 
are authorized to be appropriated such sums as may be necessary 
for each of the fiscal years 2001 through 2005.". 
TITLE V—GENERAL PROVISIONS 
42 use 300ff-ll 
note. 
SEC. 501. STUDIES BY INSTITUTE OF MEDICINE. 
(a) STATE SURVEILLANCE SYSTEMS ON PREVALENCE OF HIV.— 
The Secretary of Health and Human Services (referred to in this 
section as the "Secretary") shall request the Institute of Medicine 
to enter into an agreement with the Secretary under which such 
Institute conducts a study to provide the following: 
(1) A determination of whether the surveillance system 
of each of the States regarding the human immunodeficiency 
virus provides for the reporting of cases of infection with the 
virus in a manner that is sufficient to provide adequate and 
reliable information on the number of such cases and the demo-
graphic characteristics of such cases, both for the State in 
general and for specific geographic areas in the State. 
(2) A determination of whether such information is suffi-
ciently accurate for purposes of formula grants under parts 
A and B of title XXVI of the Public Health Service Act. 
(3) With respect to any State whose surveillance system 
does not provide adequate and reliable information on cases 
of infection with the virus, recommendations regarding the 
manner in which the State can improve the system. 
(b) RELATIONSHIP BETWEEN EPIDEMIOLOGICAL MEASURES AND 
HEALTH CARE FOR CERTAIN INDIVIDUALS WITH HIV 
DISEASE.— 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1353 
(1) IN GENERAL.—^The Secretary shall request the Institute 
of Medicine to enter into an agreement with the Secretary 
under which such Institute conducts a study concerning the 
appropriate epidemiological measures and their relationship 
to the financing and delivery of primary care and health-related 
support services for low-income, uninsured, and under-insured 
individuals with HIV disease. 
(2) ISSUES TO BE CONSIDERED.—The Secretary shall ensure 
that the study under paragraph (1) considers the following: 
(A) The availability and utility of health outcomes 
measures and data for HIV primary care and support serv-
ices and the extent to which those measures and data 
could be used to measure the quality of such funded serv-
ices. 
(B) The effectiveness and efficiency of service delivery 
(including the quality of services, health outcomes, and 
resource use) within the context of a changing health care 
and therapeutic environment, as well as the changing 
epidemiology of the epidemic, including determining the 
actual costs, potential savings, and overall financial impact 
of modifying the program under title XIX of the Social 
Security Act to establish eligibility for medical assistance 
under such title on the basis of infection with the human 
immunodeficiency virus rather than providing such assist-
ance only if the infection has progressed to acquired 
immune deficiency syndrome. 
(C) Existing and needed epidemiological data and other 
analytic 
tools for resource 
planning and allocation 
decisions, specifically for estimating severity of need of 
a community and the relationship to the allocations process. 
(D) Other factors determined to be relevant to 
assessing an individual's or community's ability to gain 
and sustain access to quality HIV services. 
(c) OTHER ENTITIES.—If the Institute of Medicine declines to 
conduct a study under this section, the Secretary shall enter into 
an agreement with another appropriate public or nonprofit private 
entity to conduct the study. 
(d) REPORT.—The Secretary shall ensure that— 
(1) not later than 3 years after the date of the enactment Deadline, 
of this Act, the study required in subsection (a) is completed 
and a report describing the findings made in the study is 
submitted to the appropriate committees of the Congress; and 
(2) not later than 2 years after the date of the enactment 
of this Act, the study required in subsection (b) is completed 
and a report describing the findings made in the study is 
submitted to such committees. 
SEC. 502. DEVELOPMENT OF RAPID HIV TEST. 
42 USC 300cc 
(a) 
EXPANSION, 
INTENSIFICATION, AND COORDINATION OF 
RESEARCH AND OTHER ACTIVITIES.— 
(1) IN GENERAL.—The Director of NIH shall expand, inten-
sify, and coordinate research and other activities of the National 
Institutes of Health with respect to the development of reliable 
and affordable tests for HIV disease that can rapidly be 
administered and whose results can rapidly be obtained (in 
this section referred to as "rapid HIV test"). 
114 STAT. 1354 
PUBLIC LAW 106-345—OCT. 20, 2000 
(2) REPORT TO CONGRESS.—The Director of NIH shall 
periodically submit to the appropriate committees of Congress 
a report describing the research and other activities conducted 
or supported under paragraph (1). 
(3) AUTHORIZATION OF APPROPRIATIONS.—For the purpose 
of carrying out this subsection, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 2001 through 2005. 
(b) PREMARKET REVIEW OF RAPID HIV TESTS.— 
Deadline. 
(1) IN GENERAL.—Not later than 90 days after the date 
of the enactment of this Act, the Secretary, in consultation 
with the Director of the Centers for Disease Control and Preven-
tion and the Commissioner of Food and Drugs, shall submit 
to the appropriate committees of the Congress a report 
describing the progress made towards, and barriers to, the 
premarket review and commercial distribution of rapid HIV 
tests. The report shall— 
(A) assess the public health need for and public health 
benefits of rapid HIV tests, including the minimization 
of false positive results through the availability of multiple 
rapid HIV tests; 
(B) make recommendations regarding the need for the 
expedited review of rapid HIV test applications submitted 
to the Center for Biologies Evaluation and Research and, 
if such recommendations are favorable, specify criteria and 
procedures for such expedited review; and 
(C) specify whether the barriers to the premarket 
review of rapid HFV tests include the unnecessary applica-
tion of requirements— 
(i) necessary to ensure the efficacy of devices for 
donor screening to rapid HIV tests intended for use 
in other screening situations; or 
(ii) for identifying antibodies to HIV subtypes of 
rare incidence in the United States to rapid HIV tests 
intended for use in screening situations other than 
donor screening. 
(c) 
GUIDELINES 
OF CENTERS 
FOR DISEASE 
CONTROL AND 
PREVENTION.—Promptly after commercial distribution of a rapid 
HIV test begins, the Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall establish 
or update guidelines that include recommendations for States, hos-
pitals, and other appropriate entities regarding the ready avail-
ability of such tests for administration to pregnant women who 
are in labor or in the late stage of pregnancy and whose HIV 
status is not known to the attending obstetrician. 
SEC. 503. TECHNICAL CORRECTIONS. 
(a) PUBLIC HEALTH SERVICE ACT.—^Title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff-ll et seq.) is amended— 
42 use 300ff-l5. 
(1) in section 2605(d)— 
(A) in paragraph (1), by striking "section 2608" and 
inserting "section 2677"; and 
(B) in paragraph (4), by inserting "section" before 
"2601(a)"; and 
42 use 300ff-73. 
(2) in section 2673(a), in the matter preceding paragraph 
(1), by striking "the Agency for Health Care Policy and 
PUBLIC LAW 106-345—OCT. 20, 2000 
114 STAT. 1355 
Research" and inserting "the Director of the Agency for 
Healthcare Research and Quality". 
(b) RELATED ACT.—The first paragraph (2) of section 3(c) of 
the Ryan White CARE Act Amendments of 1996 (Public Law 104-
146; 110 Stat. 1354) is amended in subparagraph (A)(iii) by striking 42 USC 300ff-22. 
"by inserting the following new paragraph:" and inserting "by 
inserting before paragraph (2) (as so redesignated) the following 
new paragraph". 
TITLE VI—EFFECTIVE DATE 
SEC. 601. EFFECTIVE DATE. 
42 USC 300{f-12 
This Act and the amendments made by this Act take effect 
October 1, 2000, or upon the date of the enactment of this Act, 
whichever occurs later. 
Approved October 20, 2000. 
LEGISLATIVE HISTORY—S. 2311 (H.R. 4807): 
HOUSE REPORTS: No. 106-788 accompanying H.R. 4807 (Comm. on Commerce). 
SENATE REPORTS: No. 106-294 (Comm. on Health, Education, Labor, and Pen-
sions). 
CONGRESSIONAL RECORD, Vol. 146 (2000): 
June 6, considered and passed Senate. 
Oct. 5, considered and passed House, amended. Senate concurred in House 
amendments. 
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 36 (2000): 
Oct. 20, Presidential statement.