[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4807 Reported in House (RH)]






                                                       Calendar No. 455
106th CONGRESS
  2d Session
                                H. R. 4807

                          [Report No. 106-788]

 To amend the Public Health Service Act to revise and extend programs 
established under the Ryan White Comprehensive AIDS Resources Emergency 
                  Act of 1990, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 29, 2000

Mr. Coburn (for himself, Mr. Waxman, Mr. Bilirakis, Mr. Greenwood, Mr. 
  Brown of Ohio, Mr. Stupak, Mr. Armey, Mr. Bilbray, Mr. Norwood, Mr. 
  Cox, Mr. Rogan, Mr. Barrett of Wisconsin, Mrs. Bono, Mr. Foley, Mr. 
    Shays, Mr. Hinchey, Mr. Weygand, Mr. Deutsch, Mr. Burr of North 
  Carolina, Mrs. Morella, Mr. Weldon of Florida, Mr. Shadegg, and Mr. 
   Stearns) introduced the following bill; which was referred to the 
                         Committee on Commerce

                             July 25, 2000

    Additional sponsors: Mr. Serrano, Mr. Delahunt, Mr. Berman, Mr. 
  Shimkus, Mrs. Mink of Hawaii, Mr. Pallone, Mr. McNulty, Mr. Hall of 
     Texas, Mr. Abercrombie, Ms. Brown of Florida, Mrs. Capps, Mr. 
   Strickland, Mr. Baldacci, Mr. Martinez, Mr. McHugh, Mr. Horn, Mr. 
 Frost, Ms. Roybal-Allard, Mr. Thompson of California, Mr. Baird, Mr. 
 Bentsen, Mr. Evans, Mr. Upton, Mr. Dixon, Mr. Jefferson, Mr. Rangel, 
 Mrs. Napolitano, Ms. Berkley, Mr. Wynn, Mr. Rodriguez, Mr. Baca, Ms. 
   Sanchez, Ms. McCarthy of Missouri, Mr. Boucher, Mr. Gonzalez, Mr. 
   Ackerman, Mr. Hobson, Mr. Whitfield, Mr. Fossella, Ms. Millender-
McDonald, Ms. Pryce of Ohio, Mr. Larson, Ms. Baldwin, Ms. DeGette, Mrs. 
Kelly, Ms. Kilpatrick, Mr. Tiahrt, Ms. Rivers, Mr. Matsui, Mr. Green of 
  Wisconsin, Mr. Kuykendall, Mrs. Fowler, Mr. Kolbe, Mr. Wexler, Mr. 
 Green of Texas, Mrs. Maloney of New York, Mr. Inslee, Mr. Maloney of 
 Connecticut, Mr. Gutierrez, Mr. Becerra, Mr. Filner, Mr. DeFazio, Ms. 
 Ros-Lehtinen, Mr. Leach, Mr. Dingell, Mr. McGovern, Mr. Largent, Mr. 
   Cooksey, Mr. Sawyer, Ms. Schakowsky, Mr. Rush, Mrs. Biggert, Mr. 
 Calvert, Mr. Canady of Florida, Mr. Lampson, Mr. Ganske, Mr. Sanders, 
Mr. Costello, Mr. Davis of Illinois, Mr. Blagojevich, Mr. Schaffer, Mr. 
McIntosh, Mr. Borski, Mr. Gallegly, Mr. Lazio, Mr. Nadler, Mr. Ramstad, 
     Mr. Meehan, Mr. Dicks, Mrs. Lowey, Mr. Sherman, Mr. Sabo, Ms. 
    Slaughter, Mr. Brady of Pennsylvania, Mr. Rahall, Mr. Frank of 
Massachusetts, Ms. Lee, Mr. LaTourette, Mr. LoBiondo, Mr. Gillmor, Mr. 
  Gilman, Mr. Neal of Massachusetts, Mr. Gilchrest, Mrs. Wilson, Mrs. 
 Myrick, Mr. Smith of New Jersey, Mr. Tancredo, Mrs. Christensen, Mr. 
  Farr of California, Mr. Towns, Mr. Smith of Washington, Mr. LaHood, 
 Mrs. Johnson of Connecticut, Mr. Castle, Mr. Cunningham, Mr. Packard, 
  Ms. Waters, Mr. Engel, Mr. Cardin, Mrs. Thurman, Mr. Gejdenson, Mr. 
 Reynolds, Mr. Lewis of California, Mr. Conyers, Mr. Ford, Mr. Forbes, 
 Mr. Blumenauer, Mr. Udall of New Mexico, Mr. Kleczka, Mr. Bishop, Mr. 
Roemer, Ms. Kaptur, Mr. Turner, Mr. Lipinski, Mr. Hastings of Florida, 
Ms. Jackson-Lee of Texas, Mr. Fattah, Mr. Kucinich, Mr. McDermott, Ms. 
     Hooley of Oregon, Mr. Pascrell, Mr. Andrews, Mr. Thompson of 
Mississippi, Mr. Romero-Barcelo, Mr. Holden, Mr. Kind, Ms. DeLauro, Mr. 
Holt, Mr. Reyes, Mr. Brady of Texas, Mr. Kildee, Mr. Payne, Mr. Allen, 
Mr. Sweeney, Mrs. Jones of Ohio, Mr. Bass, Mr. Cummings, Mr. Ortiz, Mr. 
Watkins, Ms. Eddie Bernice Johnson of Texas, Mrs. McCarthy of New York, 
Mr. Owens, Mr. Phelps, Mr. Sandlin, Mr. Udall of Colorado, Ms. Norton, 
Mr. Crowley, Ms. Dunn, Mr. Moran of Virginia, Mr. Gibbons, Ms. Carson, 
  Mr. Bliley, Mr. Hoeffel, Mr. Ose, Mr. Moore, Mr. Hall of Ohio, Mrs. 
    Emerson, Mr. LaFalce, Mr. Rothman, Mr. Menendez, Mr. Shaw, Mr. 
   Hilliard, Mr. Peterson of Minnesota, Mr. Quinn, Ms. McKinney, Mr. 
 Underwood, Mr. Davis of Virginia, Mr. Lewis of Georgia, Mrs. Meek of 
 Florida, Mr. Smith of Texas, Mr. Olver, Mr. Hoyer, Mr. Franks of New 
Jersey, Mr. Weiner, Mr. Murtha, Mr. Klink, Mr. Pomeroy, Mr. Saxton, Mr. 
     Boehlert, Mr. Clyburn, Mr. Clement, Mr. Davis of Florida, Mr. 
 Frelinghuysen, Mr. Weldon of Pennsylvania, Mr. Tauzin, Mr. Skeen, Mr. 
    Capuano, Mr. Dooley of California, Mr. Jackson of Illinois, Mr. 
 Moakley, Mr. Meeks of New York, Mrs. Clayton, Mr. Wu, Ms. Danner, Mr. 
Coyne, Mr. Levin, Mr. Stenholm, Mr. Pastor, Mr. Markey, Mr. Doyle, Mr. 
  Traficant, Mr. Pickering, Mr. Tierney, Mr. Scott, Mr. Sessions, Mr. 
    Boyd, Mr. Kennedy of Rhode Island, Mr. Hinojosa, Mr. Wamp, Mr. 
                         McCollum, and Mr. Clay

                             July 25, 2000

  Reported with an amendment, committed to the Committee of the Whole 
       House on the State of the Union and ordered to be printed
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]
 [For text of introduced bill, see copy of bill as introduced on June 
                               29, 2000]

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to revise and extend programs 
established under the Ryan White Comprehensive AIDS Resources Emergency 
                  Act of 1990, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ryan White CARE Act Amendments of 
2000''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

 TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

           Subtitle A--HIV Health Services Planning Councils

Sec. 101. Membership of councils.
Sec. 102. Duties of councils.
Sec. 103. Open meetings; other additional provisions.

              Subtitle B--Type and Distribution of Grants

Sec. 111. Formula grants.
Sec. 112. Supplemental grants.

                      Subtitle C--Other Provisions

Sec. 121. Use of amounts.
Sec. 122. Application.
Sec. 123. Review of administrative costs and compensation.

                      TITLE II--CARE GRANT PROGRAM

                  Subtitle A--General Grant Provisions

Sec. 201. Priority for women, infants, and children.
Sec. 202. Use of grants.
Sec. 203. Grants to establish HIV care consortia.
Sec. 204. Provision of treatments.
Sec. 205. State application.
Sec. 206. Distribution of funds.
Sec. 207. Supplemental grants for certain States.

Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission 
                                 of HIV

Sec. 211. Repeals.
Sec. 212. Grants.
Sec. 213. Study by Institute of Medicine.

           Subtitle C--Certain Partner Notification Programs

Sec. 221. Grants for compliant partner notification programs.

                 TITLE III--EARLY INTERVENTION SERVICES

                 Subtitle A--Formula Grants for States

Sec. 301. Repeal of program.

                     Subtitle B--Categorical Grants

Sec. 311. Preferences in making grants.
Sec. 312. Planning and development grants.
Sec. 313. Authorization of appropriations.

                     Subtitle C--General Provisions

Sec. 321. Provision of certain counseling services.
Sec. 322. Additional required agreements.

                TITLE IV--OTHER PROGRAMS AND ACTIVITIES

 Subtitle A--Certain Programs for Research, Demonstrations, or Training

Sec. 401. Grants for coordinated services and access to research for 
                            women, 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 HIV disease.
Sec. 415. Audits.
Sec. 416. Administrative simplification.
Sec. 417. Authorization of appropriations for parts A and B.

                      TITLE V--GENERAL PROVISIONS

Sec. 501. Studies by Institute of Medicine.
Sec. 502. Development of rapid HIV test.

                        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 
        epidemic in the eligible area involved,'' and inserting 
        ``demographics of the population of individuals with HIV 
        disease in the eligible area involved,''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (G), by striking ``or AIDS'';
                    (B) in subparagraph (K), by striking ``and'' at the 
                end;
                    (C) in subparagraph (L), by striking the period and 
                inserting the following: ``, including but not limited 
                to providers of HIV prevention services; and''; and
                    (D) by adding at the end the following 
                subparagraph:
                    ``(M) representatives of individuals who formerly 
                were Federal, State, or local prisoners, were released 
                from the custody of the penal system during the 
                preceding three 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 represent 
                        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 considered 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 
        subparagraphs (C) through (G), respectively;
            (2) by inserting before subparagraph (C) (as so 
        redesignated) the following subparagraphs:
                    ``(A) determine the size and demographics of the 
                population of individuals with HIV disease;
                    ``(B) determine the needs of such population, with 
                particular attention to--
                            ``(i) individuals with HIV disease who are 
                        not receiving HIV-related services; and
                            ``(ii) disparities in access and services 
                        among affected subpopulations and 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 interventions, to the 
                        extent that data are reasonably available;
                            ``(iii) priorities of the communities with 
                        HIV disease for whom the services are intended;
                            ``(iv) availability of other governmental 
                        and nongovernmental resources to provide HIV-
                        related services to individuals and families 
                        with HIV disease, including the State plan 
                        under title XIX of the Social Security Act 
                        (relating to the Medicaid program) and the 
                        program under title XXI of such Act (relating 
                        to the program for State children's health 
                        insurance); and
                            ``(v) capacity development needs 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 with HIV disease who 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 allocation of funds;
                            ``(ii) includes a strategy to coordinate 
                        the provision of such services with programs 
                        for HIV prevention and for the prevention and 
                        treatment of substance abuse, including 
                        programs that provide comprehensive treatment 
                        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.--Section 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 and health care for 
certain individuals with HIV disease), the Secretary, in consultation 
with 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 2601(a) 
guidelines and materials for training members of the planning council 
under paragraph (1) regarding the duties of the council.''.

SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVISIONS.

    Section 2602(b) of the Public Health Service Act (42 U.S.C. 300ff-
12(b)) is amended--
            (1) in paragraph (3), by striking subparagraph (C); and
            (2) by adding at the end the following 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 the public and shall be held only after 
                        adequate notice to the public.
                            ``(ii) The records, reports, transcripts, 
                        minutes, agenda, or other documents which were 
                        made available to or prepared for or by the 
                        council shall be available for public 
                        inspection and copying at a single location.
                            ``(iii) Detailed minutes of each 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''.
    (b) Amount of Grant; Estimate of Living Cases.--
            (1) In general.--Section 2603(a)(3)) of the Public Health 
        Service Act (42 U.S.C. 300ff-13(a)(3)) is amended--
                    (A) in subparagraph (C)(i), by inserting before the 
                semicolon the following: ``, except that (subject to 
                subparagraph (D)), for grants made pursuant to this 
                paragraph for fiscal year 2005 and subsequent fiscal 
                years, the cases counted for each 12-month period 
                beginning on or after July 1, 2004, shall be cases of 
                HIV disease (as reported to and confirmed by such 
                Director) rather than cases of acquired immune 
                deficiency syndrome''; and
                    (B) in subparagraph (C), in the matter after and 
                below clause (ii)(X)--
                            (i) in the first sentence, by inserting 
                        before the period the following: ``, and shall 
                        be reported to the congressional 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 
                subparagraph (E); and
                    (B) by inserting after subparagraph (C) the 
                following subparagraph:
                    ``(D) Determination of secretary regarding data on 
                hiv cases.--
                            ``(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 Amendments of 2000 
                        (relating to the relationship between 
                        epidemiological measures and health care for 
                        certain individuals with HIV disease), the 
                        fiscal impact of the use of such data, the 
                        impact of the use of such data on the 
                        organization and delivery of HIV-related 
                        services in eligible areas, and the fiscal 
                        impact of not using such data.
                            ``(ii) Effect of adverse 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 2675 for a 
                        fiscal year, the Secretary shall reserve 
                        amounts to make grants and provide technical 
                        assistance to States and eligible areas with 
                        respect to obtaining data on cases of HIV 
                        disease to ensure that data on such cases is 
                        available from all States and eligible areas as 
                        soon as is practicable but not later than the 
                        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 95.7 percent 
                        of the amount of such base year grant;
                            ``(iii) for any third fiscal year in such 
                        period, the grant is not less than 91.1 percent 
                        of the amount of the base year grant;
                            ``(iv) for any fourth fiscal year in such 
                        period, the grant is not less than 84.2 percent 
                        of the amount of the base year grant; and
                            ``(v) for any fifth or subsequent fiscal 
                        year in such period, the grant is not less than 
                        75 percent of the amount of the base year 
                        grant.
                    ``(B) Base year; protection period.--With respect 
                to grants made pursuant to 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 for the area 
                        equals or exceeds the amount of the grant for 
                        the base year for the period.
                            ``(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.''.

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 
        ``Definition'' and inserting ``Amount of grant'';
            (2) by redesignating subparagraphs (A) through (C) as 
        subparagraphs (B) through (D), respectively;
            (3) by inserting before subparagraph (B) (as so 
        redesignated) the following subparagraph:
                    ``(A) In general.--The amount of each grant made 
                for purposes of this subsection shall be determined by 
                the Secretary based on a weighting of factors under 
                paragraph (1), with severe need under subparagraph (B) 
                of such paragraph counting one-third.'';
            (4) in subparagraph (B) (as so redesignated)--
                    (A) in clause (ii), by striking ``and'' at the end;
                    (B) in clause (iii), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following clauses:
                            ``(iv) the current prevalence of HIV 
                        disease;
                            ``(v) an increasing need for HIV-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) Conforming Amendment.--Section 2603(b) of the Public Health 
Service Act (42 U.S.C. 300ff-13(b)) is amended--
            (1) by striking paragraph (4); and
            (2) by redesignating paragraph (5) as paragraph (4).

                      Subtitle C--Other Provisions

SEC. 121. USE OF AMOUNTS.

    (a) Primary Purposes.--Section 2604(b)(1) of the Public Health 
Service Act (42 U.S.C. 300ff-14(b)(1)) is amended--
            (1) in the matter preceding subparagraph (A), by striking 
        ``HIV-related--'' and inserting ``HIV-related services, as 
        follows:'';
            (2) in subparagraph (A)--
                    (A) by striking ``outpatient'' and all that follows 
                through ``substance abuse treatment and'' and inserting 
                the following: ``Outpatient and ambulatory health 
                services, including 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 
                services facilitate, support, or sustain the delivery, 
                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 are not 
                receiving HIV-related services, and that are--
                            ``(i) necessary to implement the strategy 
                        under section 2602(b)(4)(D), including 
                        activities facilitating the access of such 
                        individuals to HIV-related primary care 
                        services at entities described in paragraph 
                        (3);
                            ``(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 activities that are carried out with 
                        amounts appropriated under section 317.''.
    (b) Additional Purposes.--Section 2604(b) (42 U.S.C. 300ff-14(b)) 
of the Public Health Service Act is amended--
            (1) by redesignating paragraph (3) as paragraph (4);
            (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) (including 
                referrals under subparagraph (C) of such section), 
                subject to subparagraph (B). 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, homeless 
                shelters, HIV disease counseling and testing sites, 
                health care points of entry specified by States or 
                eligible areas, federally qualified health centers, and 
                entities described in section 2652(a).
                    ``(B) Conditions.--With respect to an entity that 
                proposes to provide early intervention services under 
                subparagraph (A), such subparagraph applies only if the 
                entity demonstrates to the satisfaction of the chief 
                elected official for the eligible area involved that--
                            ``(i) Federal, State, or local funds are 
                        otherwise inadequate for the early intervention 
                        services the entity proposes to provide; and
                            ``(ii) the entity will expend funds 
                        pursuant to such subparagraph to supplement and 
                        not supplant other funds available to the 
                        entity for the provision of early intervention 
                        services for the fiscal year involved.''; and
            (3) in paragraph (4) (as so redesignated), by inserting 
        ``youth,'' after ``children,'' each place such term appears;
    (c) Quality Management.--Section 2604 of the Public Health Service 
Act (42 U.S.C. 300ff-14) is amended--
            (1) by redesignating subsections (c) through (f) as 
        subsections (d) through (g), respectively; and
            (2) by inserting after subsection (b) the 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.
            ``(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 
        with the quality management program required in paragraph (1) 
        not more than the lesser of--
                    ``(A) 5 percent of amounts received under the 
                grant; or
                    ``(B) $3,000,000.''.

SEC. 122. APPLICATION.

    Section 2605(a) of the Public Health Service Act (42 U.S.C. 300ff-
15(a)) is amended--
            (1) by redesignating paragraphs (3) through (6) as 
        paragraphs (4) through (7), respectively; and
            (2) by inserting after paragraph (2) the following 
        paragraph:
            ``(3) that entities within the eligible area that receive 
        funds under a grant under section 2601(a) will maintain 
        relationships with appropriate entities in the area, including 
        entities described in section 2604(b)(3);''.

SEC. 123. REVIEW OF ADMINISTRATIVE COSTS AND COMPENSATION.

    Each chief elected official of an eligible area (as defined in 
section 2607 of the Public Health Service Act) shall ensure that, not 
later than one year after the date of the enactment of this Act, the 
planning council for the eligible area--
            (1) conducts a review of the existing, available data on 
        the extent to which entities in the area that receive amounts 
        from a grant under section 2601(a) of the Public Health Service 
        Act have from their overall budget expended amounts for 
        administrative costs (including financial compensation and 
        benefits), expressed as a proportion and indicating the growth 
        in such expenditures, including a statement of the average 
        amount expended for such costs per client served and the 
        average amount expended for such costs per client served in 
        providing HIV-related services; and
            (2) makes a determination of whether the financial 
        compensation of any officers or employees of such entities 
        exceeds that of the chief elected official of the eligible 
        area.

                      TITLE II--CARE GRANT PROGRAM

                  Subtitle A--General Grant Provisions

SEC. 201. PRIORITY FOR WOMEN, INFANTS, AND CHILDREN.

    Section 2611(b) of the Public Health Service Act (42 U.S.C. 300ff-
21(b)) is amended by inserting ``youth,'' after ``children,'' each 
place such term appears.

SEC. 202. USE OF GRANTS.

    Section 2612 of the Public Health Service Act (42 U.S.C. 300ff-22) 
is amended--
            (1) by striking ``A State may use'' and 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) Support services under section 2611(a) (including 
        case management) to the extent that such services facilitate, 
        support, or sustain the delivery, or benefits of health 
        services for individuals and families with HIV disease.
            ``(2) Outreach activities that are intended to identify 
        individuals with HIV disease who are not receiving HIV-related 
        services, and that are--
                    ``(A) necessary to implement the strategy under 
                section 2617(b)(4)(B);
                    ``(B) conducted in a manner consistent with the 
                requirement under section 2617(b)(6)(G); and
                    ``(C) supplement, and do not supplant, such 
                activities that are carried out with amounts 
                appropriated under section 317.
    ``(c) Early Intervention Services.--
            ``(1) In general.--The purposes for which a grant under 
        this part may be used include providing to individuals with HIV 
        disease early intervention services described in section 
        2651(b)(2) (including referrals under subparagraph (C) of such 
        section), subject to paragraph (2). The entities through which 
        such services may be provided under the grant include public 
        health departments, emergency rooms, substance abuse and mental 
        health treatment programs, detoxification centers, detention 
        facilities, clinics regarding sexually transmitted diseases, 
        homeless shelters, HIV disease counseling and testing sites, 
        health care points of entry specified by States or eligible 
        areas, federally qualified health centers, and entities 
        described in section 2652(a).
            ``(2) Conditions.--With respect to an entity that proposes 
        to provide early intervention services under paragraph (1), 
        such paragraph applies only if the entity demonstrates to the 
        satisfaction of the State involved that--
                    ``(A) Federal, State, or local funds are otherwise 
                inadequate for the early intervention services the 
                entity proposes to provide; and
                    ``(B) the entity will expend funds pursuant to such 
                paragraph to supplement and not 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.
            ``(2) Use of funds.--From amounts received under a grant 
        awarded under this part for a fiscal year, the State may (in 
        addition to amounts to which section 2618(c)(5) applies) use 
        for activities associated with the quality management program 
        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 
                semicolon 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 comprehensive plan under 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'';
                    (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
                    (C) by inserting after subparagraph (C) the 
                following subparagraph:
                    ``(D) entities described in section 2602(b)(2).''.

SEC. 204. PROVISION OF TREATMENTS.

    Section 2616 of the Public Health Service Act (42 U.S.C. 300ff-26) 
is amended by adding at the end the following subsection:
    ``(e) Use of Health Insurance and Plans.--In carrying out 
subsection (a), a State may expend a grant under this part to provide 
the therapeutics described in such subsection by paying on behalf of 
individuals with HIV disease the costs of purchasing or maintaining 
health insurance or plans whose coverage includes a full range of such 
therapeutics and appropriate primary care services.''.

SEC. 205. STATE APPLICATION.

    (a) Determination of Size and Needs of Population; Comprehensive 
Plan.--Section 2617(b) of the Public Health Service Act (42 U.S.C. 
300ff-27(b)) is amended--
            (1) by redesignating paragraphs (2) through (4) as 
        paragraphs (4) through (6), respectively;
            (2) by inserting after paragraph (1) the following 
        paragraphs:
            ``(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 are not 
                receiving HIV-related services; and
                    ``(B) disparities in access and services among 
                affected subpopulations and historically underserved 
                communities;''; and
            (3) in paragraph (4) (as so redesignated)--
                    (A) by striking ``comprehensive plan for the 
                organization'' and inserting ``comprehensive plan that 
                describes the organization'';
                    (B) by striking ``, including--'' and 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 nongovernmental resources to provide HIV-
                        related services to 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 
                        mechanism of the State for rapidly allocating 
                        funds to the areas of greatest need within the 
                        State;
                    ``(B) includes a strategy for identifying 
                individuals with HIV disease who 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 
                allocation of funds;
                    ``(C) includes a strategy to coordinate the 
                provision of such services with programs for HIV 
                prevention and for the prevention and treatment of 
                substance abuse, including programs that provide 
                comprehensive treatment services for such abuse;'';
                    (E) in subparagraph (D) (as redesignated by 
                subparagraph (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, 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:
                    ``(A) the public health agency that is 
                administering the grant for the State engages in a 
                public advisory planning process, including public 
                hearings, that includes the participants under 
                paragraph (5), and entities described in section 
                2602(b)(2), in developing the comprehensive plan under 
                paragraph (4) and commenting on the implementation of 
                such plan;''.
    (c) Health Care Relationships.--Section 2617(b) of the Public 
Health Service Act, as amended by subsection (a) of this section, is 
amended in paragraph (6)--
            (1) in subparagraph (E), by striking ``and'' at the end;
            (2) in subparagraph (F), by striking the period and 
        inserting ``; and''; and
            (3) by adding at the end the following subparagraph:
                    ``(G) entities within areas in which activities 
                under the grant are carried out will maintain 
                relationships with appropriate entities in the area, 
                including entities described in section 2612(c);''.

SEC. 206. DISTRIBUTION OF FUNDS.

    (a) Minimum Allotment.-- Section 2618(b)(1)(A)(i) of the Public 
Health Service Act (42 U.S.C. 300ff-28(b)(1)(A)(i)) is amended--
            (1) in subclause (I), by striking ``$100,000'' and 
        inserting ``$200,000''; and
            (2) in subclause (II), by striking ``$250,000'' and 
        inserting ``$500,000''.
    (b) Amount of Grant; Estimate of Living Cases.--Section 2618(b)(2) 
of the Public Health Service Act (42 U.S.C. 300ff-28(b)(2)) is 
amended--
            (1) in subparagraph (D)(i), by inserting before the 
        semicolon the following: ``, except that (subject to 
        subparagraph (E)), for grants made pursuant to this paragraph 
        for fiscal year 2005 and subsequent fiscal years, the cases 
        counted for each 12-month 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'';
            (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 2603(a)(3)(D)(i) the Secretary 
                determines that data on cases of HIV disease is 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 subparagraph to cases of HIV disease 
                do not have any legal effect.''.
    (c) Increases in Formula Amount.--Section 2618(b) of the Public 
Health Service Act (42 U.S.C. 300ff-28(b)) is amended--
            (1) in paragraph (1)(A)(ii), by inserting before the 
        semicolon the following: ``and then, as applicable, increased 
        under paragraph (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 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 percent;
                                    ``(III) with respect to fiscal year 
                                2003, 97 percent;
                                    ``(IV) with respect to fiscal year 
                                2004, 96 percent; and
                                    ``(V) with respect to fiscal year 
                                2005, 95 percent;
                        of the amount such State or territory received 
                        for fiscal year 2000 under such section. 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 for fiscal 
                        year 2000, proportionally 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 
                        appropriated under section 2677 for a fiscal 
                        year and available for grants under section 
                        2611 is less than the amount appropriated and 
                        available under such section for fiscal year 
                        2000, the limitation contained in clause (i) 
                        shall be reduced by a percentage equal to the 
                        percentage of the reduction in such amounts 
                        appropriated and available.''.
    (d) Territories.--Section 2618(b)(1)(B) of the Public Health 
Service Act (42 U.S.C. 300ff-28(b)(1)(B)) is amended by inserting ``the 
greater of $50,000 or'' after ``shall be''.
    (e) Separate Treatment Drug Grants.--Section 2618(b)(2) of the 
Public Health Service Act, as amended by subsection (b)(3) of this 
section, is amended in subparagraph (I)--
            (1) by redesignating clauses (i) and (ii) as subclauses (I) 
        and (II), respectively;
            (2) by striking ``(I) 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 
        paragraphs (1) and (2)), by striking ``100 percent'' and 
        inserting ``98 percent''; and
            (4) by adding at the end the following clause:
                            ``(ii) Supplemental treatment drug 
                        grants.--
                                    ``(I) In general.--With respect to 
                                the fiscal year involved, if under 
                                section 2677 an appropriations Act 
                                provides an amount exclusively for 
                                carrying out section 2616, and such 
                                amount is not less than the amount so 
                                provided for the preceding fiscal year, 
                                the Secretary shall reserve 2 percent 
                                of such amount for making grants to 
                                States whose population of individuals 
                                with HIV disease has, as determined by 
                                the Secretary, a need for quantities of 
                                therapeutics described in section 
                                2616(a) greater than the quantities 
                                available pursuant to clause (i). Such 
                                a grant is available for purposes of 
                                obtaining such therapeutics. The 
                                Secretary shall carry out this clause 
                                as a program of discretionary grants, 
                                and not as a program of formula grants.
                                    ``(II) Distribution of grants.--The 
                                Secretary shall disburse all amounts 
                                under grants under subclause (I) for a 
                                fiscal year not later than 240 days 
                                after the date on which the amount 
                                referred to in such subclause with 
                                respect to section 2616 becomes 
                                available.
                                    ``(III) Requirement of matching 
                                funds.--A condition for receiving a 
                                grant under subclause (I) is that the 
                                State agree to make available (directly 
                                or through donations from public or 
                                private entities) non-Federal 
                                contributions toward the costs of 
                                obtaining the therapeutics involved in 
                                an amount that is not less than 25 
                                percent of such costs (determined in 
                                the same manner as under 
                                2617(d)(2)(A)).''.
    (f) Technical Amendment.--Section 2618(b)(3)(B) of the Public 
Health Service Act (42 U.S.C. 300ff-28(b)(3)(B)) is amended 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-11 et seq.) is amended--
            (1) by striking section 2621; and
            (2) by inserting after section 2620 the following section:

``SEC. 2621. SUPPLEMENTAL GRANTS.

    ``(a) In General.--From amounts available pursuant to subsection 
(d) for a fiscal year, the Secretary shall make grants to States that 
meet the conditions to receive grants under section 2611, and that have 
one or more eligible communities, for the purpose of providing in such 
communities comprehensive services of the type described in section 
2612(a) to supplement the development and care activities, primary 
care, and support services otherwise provided in such communities by 
the State under a grant under section 2611.
    ``(b) Eligible Community.--For purposes of this section, the term 
`eligible community' means a geographic area that--
            ``(1) is not within any eligible area as defined in section 
        2607; and
            ``(2) has a severe need for supplemental financial 
        assistance to combat the HIV epidemic, according to criteria 
        developed by the Secretary in consultation with the States, 
        including evidence of underserved or rural areas or both.
    ``(c) Application.--A grant under subsection (a) may be made to a 
State if the State submits to the Secretary, as part of the State 
application submitted under section 2617, such information as required 
to apply for funds under this section as determined by the Secretary in 
consultation with the States.
    ``(d) Funding.--
            ``(1) In general.--For the purpose of making grants under 
        subsection (a) for a fiscal year, the Secretary shall reserve 
        50 percent of the amount specified in paragraph (2).
            ``(2) Increases in part b funding.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the amount specified in this paragraph is the amount by 
                which the amount appropriated under section 2677 for 
                the fiscal year involved and available for carrying out 
                part B is an increase over the amount so appropriated 
                and available for the preceding fiscal year, subject to 
                subparagraphs (B) and (C).
                    ``(B) Initial allocation year.--The allocation 
                under paragraph (1) shall not be made until the first 
                fiscal year for which the amount appropriated under 
                section 2677 for the fiscal year involved and available 
                for carrying out part B is an increase of not less than 
                $20,000,000 over the amount so appropriated and 
                available for fiscal year 2000, subject to subparagraph 
                (C).
                    ``(C) Exclusion regarding separate treatment drug 
                grants.--Each determination under subparagraph (A) or 
                (B) of the amount appropriated under section 2677 for a 
                fiscal year and available for carrying out part B shall 
                be made without regard to any amount to which section 
                2618(b)(2)(I)(i) applies.''.

Subtitle B--Provisions Concerning Pregnancy 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); and
            (2) by striking 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--
            (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 
                purpose 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, the 
                        Secretary shall reserve the applicable 
                        percentage under clause (ii) for making grants 
                        under paragraph (1) to States that under law 
                        (including under regulations or the discretion 
                        of State officials) have--
                                    ``(I) a requirement that all 
                                newborn infants born in the State be 
                                tested for HIV disease; or
                                    ``(II) a requirement that newborn 
                                infants born in the State be tested for 
                                HIV disease in circumstances in which 
                                the attending obstetrician for the 
                                birth does not know the HIV status of 
                                the mother of the infant.
                            ``(ii) Applicable percentage.--For purposes 
                        of clause (i), the applicable amount for a 
                        fiscal year is as follows:
                                    ``(I) For fiscal year 2001, 25 
                                percent.
                                    ``(II) For fiscal year 2002, 50 
                                percent.
                                    ``(III) For fiscal year 2003, 50 
                                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.''; 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 supplant 
        other funds available to the State to carry out the purposes of 
        the grant.''.
    (b) Special Funding Rule for Fiscal Year 2001.--
            (1) In general.--If for fiscal year 2001 the amount 
        appropriated under paragraph (2)(A) of section 2625(c) of the 
        Public 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 paragraph (2) of this subsection an amount equal to 
                the difference between $14,000,000 and the amount 
                appropriated under paragraph (2)(A) of such section for 
                such fiscal year;
                    (B) the amount so reserved shall, for purposes of 
                paragraph (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)(ii)(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 appropriated 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 
(42 U.S.C. 300ff-33 et seq.) is amended by adding at the end the 
following section:

``SEC. 2630. RECOMMENDATIONS FOR REDUCING INCIDENCE OF 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 born 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 pregnant women an HIV test and a 
                routine practice to test newborn infants 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 
                HIV, 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.
            ``(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 
        describing the findings made in the study is submitted to the 
        appropriate committees of the Congress, the Secretary, and the 
        chief public health official of each of the States.
    ``(b) Progress Toward Recommendations.--Each State shall comply 
with the following (as applicable to the fiscal year involved):
            ``(1) For fiscal year 2004, the State shall submit to the 
        Secretary a report describing the actions taken by the State 
        toward meeting the recommendations specified for the State 
        under subsection (a)(1)(C).
            ``(2) For fiscal year 2005 and each subsequent fiscal 
        year--
                    ``(A) the State shall make reasonable progress 
                toward meeting such recommendations; or
                    ``(B) if the State has not made such progress--
                            ``(i) the State shall cooperate with the 
                        Director of the Centers for Disease Control and 
                        Prevention in carrying out activities toward 
                        meeting the recommendations; and
                            ``(ii) the State shall submit to the 
                        Secretary a report containing a description of 
                        any barriers identified under subsection 
                        (a)(1)(B) that continue to exist in the State; 
                        as applicable, the factors underlying the 
                        continued existence of such barriers; and a 
                        description of how the State intends to reduce 
                        the incidence of cases of the perinatal 
                        transmission of HIV.
    ``(c) Submission of Reports to Congress.--The Secretary shall 
submit to the appropriate committees of the Congress each report 
received by the Secretary under subsection (b)(2)(B)(ii).''.

           Subtitle C--Certain Partner Notification Programs

SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICATION PROGRAMS.

    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.

    ``(a) In General.--In the case of States whose laws or regulations 
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 purposes 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 officer 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 construed 
        as affecting the requirement of subparagraph (A) with respect 
        to a health entity that treats an individual for HIV disease.
            ``(3) The program under paragraph (1) is carried out in 
        accordance with the following:
                    ``(A) Partners are provided with an appropriate 
                opportunity 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 transmission for the disease, including 
                information on prenatal and perinatal transmission and 
                preventing transmission.
                    ``(D) Counseling of infected individuals and their 
                partners includes the provision of information 
                regarding therapeutic measures for preventing and 
                treating the deterioration 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 
                individual chooses not to identify the partners of the 
                individual, or the individual 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 
                program 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 
        Centers for Disease Control and Prevention the number of 
        individuals from whom the names of partners have been sought 
        under the program under paragraph (1), the number of such 
        individuals 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.--
            ``(1) Preference in making grants through fiscal year 
        2003.--In making grants under subsection (a) for each of the 
        fiscal years 2001 through 2003, 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(b)(2)(D)(i).
            ``(2) Eligibility condition after fiscal year 2003.--For 
        fiscal year 2004 and subsequent fiscal years, a State may not 
        receive a grant under subsection (a) unless the reporting 
        system of the State for cases of HIV disease produces data on 
        such cases that is sufficiently accurate and reliable for 
        purposes of section 2618(b)(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.''.

                 TITLE III--EARLY INTERVENTION SERVICES

                 Subtitle A--Formula Grants for States

SEC. 301. REPEAL OF PROGRAM.

    Subpart I of part C of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-41 et seq.) is repealed.

                     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) Underserved and Rural Areas.--Of the applicants who qualify 
for preference under this section, 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 or in 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. 300ff-54(c)(1)) 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 
                intervention 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.--
                    ``(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 Public 
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 
                individuals 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 emphasizes 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 Public 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 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 
        opportunistic infections and that improvements in the access to 
        and quality of medical 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.

    Section 2671 of the Public Health Service Act (42 U.S.C. 300ff-71) 
is amended--
            (1) in subsection (b)--
                    (A) 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
                    (B) by striking paragraphs (3) and (4);
            (2) in subsection (g), by adding at the end the following: 
        ``In addition, the Secretary, in coordination with the Director 
        of such Institutes, shall examine the distribution and 
        availability of appropriate HIV-related research projects with 
        respect to grantees under subsection (a) for purposes of 
        enhancing and expanding HIV-related research, especially within 
        communities that are underrepresented with respect to such 
        projects.'';
            (3) in subsection (f)--
                    (A) by striking the subsection heading and 
                designation and inserting the following:
    ``(f) Administration.--
            ``(1) Application.--''; and
                    (B) by adding at the end the following paragraph:
            ``(2) Quality management program.--A grantee under this 
        section shall implement a quality management program.''; and
            (4) in subsection (j), by striking ``1996 through 2000'' 
        and inserting ``2001 through 2005''.

SEC. 402. AIDS 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-111(a)(1)) 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 type 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 
                gynecological care for such women.''.
            (2) Dissemination of treatment guidelines; medical 
        consultation activities.--Not later than 90 days after the date 
        of the enactment of this Act, the Secretary of Health and Human 
        Services shall issue and begin implementation of a strategy for 
        the dissemination of HIV treatment information to health care 
        providers and patients.
    (b) Dental Schools.--Section 2692(b) of the Public Health Service 
Act (42 U.S.C. 300ff-111(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 
                subsection, 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 
                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 
        paragraph:
            ``(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-111(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 
                necessary 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.''.

              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 CONTROL AND 
              PREVENTION.

    Part D of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff-71 et seq.) is amended--
            (1) by redesignating section 2675 as section 2675A; and
            (2) by inserting after section 2674 the following section:

``SEC. 2675. DATA COLLECTION.

    ``For the purpose of collecting and providing data for program 
planning and evaluation activities under this title, there are 
authorized to be appropriated to the Secretary (acting through the 
Director of the Centers for Disease Control and Prevention) such sums 
as may be necessary for each of the fiscal years 2001 through 2005. 
Such authorization of appropriations is in addition to other 
authorizations of appropriations that are available for such 
purpose.''.

SEC. 413. COORDINATION.

    Section 2675A of the Public Health Service Act, as redesignated by 
section 412 of this Act, 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 Administration coordinate 
the planning, funding, and implementation of Federal HIV programs to 
enhance the continuity of care and prevention 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 
        subsection:
    ``(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.

SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH HIV DISEASE.

    Section 2675A of the Public Health Service Act, as amended by 
section 413(2) of this Act, is amended by adding at the end 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 management 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 Congress not later than two 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, as amended 
by section 412 of this Act, is amended by inserting after section 2675A 
the following section:

``SEC. 2675B. 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 2675B 
the following section:

``SEC. 2675C. ADMINISTRATIVE SIMPLIFICATION REGARDING PARTS A AND B.

    ``(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 appropriations for 
grants under part A with the disbursement of appropriations for grants 
under part B in order to assist grantees and other recipients of 
amounts from such grants in complying with the requirements of such 
parts. The Secretary shall submit the 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 two 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 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 parts be submitted biennially 
rather than annually. The Secretary shall submit such determination to 
the Congress not later than two 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 under 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 under parts 
A and B. The Secretary shall submit the 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 two 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.''.

SEC. 417. AUTHORIZATION OF APPROPRIATIONS FOR PARTS A AND B.

    Section 2677 of the Public Health Service Act (42 U.S.C. 300ff-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

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 demographic 
        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 
        sufficiently 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.--
            (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 
                services and the extent to which those measures and 
                data could be used to measure the quality of such 
                funded services.
                    (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 
                assistance 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 three years after the date of the 
        enactment 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 two 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.

    (a) Expansion, Intensification, and Coordination of Research and 
Other Activities.--
            (1) In general.--The Director of NIH shall expand, 
        intensify, 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 a ``rapid HIV test'').
            (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.--
            (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 Prevention 
        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 Biologics 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 HIV tests include the unnecessary 
                application 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, hospitals, and other appropriate 
entities regarding the ready availability 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.

                        TITLE VI--EFFECTIVE DATE

SEC. 601. EFFECTIVE DATE.

    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.




                                                       Calendar No. 455

106th CONGRESS

  2d Session

                               H. R. 4807

                          [Report No. 106-788]

_______________________________________________________________________

                                 A BILL

 To amend the Public Health Service Act to revise and extend programs 
established under the Ryan White Comprehensive AIDS Resources Emergency 
                  Act of 1990, and for other purposes.

_______________________________________________________________________

                             July 25, 2000

  Reported with an amendment, committed to the Committee of the Whole 
       House on the State of the Union, and ordered to be printed