[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2311 Engrossed Amendment House (EAH)]
2d Session
S. 2311
_______________________________________________________________________
AMENDMENTS
In the House of Representatives, U. S.,
October 5, 2000.
Resolved, That the bill from the Senate (S. 2311) entitled ``An Act to
revise and extend the Ryan White CARE Act programs under title XXVI of the
Public Health Service Act, to improve access to health care and the quality of
care under such programs, and to provide for the development of increased
capacity to provide health care and related support services to individuals and
families with HIV disease, and for other purposes'', do pass with the following
AMENDMENTS:
Strike out all after the enacting clause and insert:
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.
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.
Sec. 503. Technical corrections.
TITLE VI--EFFECTIVE DATE
Sec. 601. Effective date.
TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES
Subtitle A--HIV Health Services Planning Councils
SEC. 101. MEMBERSHIP OF COUNCILS.
(a) In General.--Section 2602(b) of the Public Health Service Act
(42 U.S.C. 300ff-12(b)) is amended--
(1) in paragraph (1), by striking ``demographics of the
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 (C), by inserting before the
semicolon the following: ``, including providers of
housing and homeless services'';
(B) in subparagraph (G), by striking ``or AIDS'';
(C) in subparagraph (K), by striking ``and'' at the
end;
(D) in subparagraph (L), by striking the period and
inserting the following: ``, including but not limited
to providers of HIV prevention services; and''; and
(E) by adding at the end the following
subparagraph:
``(M) representatives of individuals who formerly
were Federal, State, or local prisoners, were released
from the custody of the penal system during the
preceding 3 years, and had HIV disease as of the date
on which the individuals were so released.''.
(b) Conflicts of Interests.--Section 2602(b)(5) of the Public
Health Service Act (42 U.S.C. 300ff-12(b)(5)) is amended by adding at
the end the following subparagraph:
``(C) Composition of council.--The following
applies regarding the membership of a planning council
under paragraph (1):
``(i) Not less than 33 percent of the
council shall be individuals who are receiving
HIV-related services pursuant to a grant under
section 2601(a), are not officers, employees,
or consultants to any entity that receives
amounts from such a grant, and do not 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 know
their HIV status and are not receiving HIV-
related services; and
``(ii) disparities in access and services
among affected subpopulations and historically
underserved communities;'';
(3) in subparagraph (C) (as so redesignated), by striking
clauses (i) through (iv) and inserting the following:
``(i) size and demographics of the
population of individuals with HIV disease (as
determined under subparagraph (A)) and the
needs of such population (as determined under
subparagraph (B));
``(ii) demonstrated (or probable) cost
effectiveness and outcome effectiveness of
proposed strategies and interventions, to the
extent that data are reasonably available;
``(iii) priorities of the communities with
HIV disease for whom the services are intended;
``(iv) coordination in the provision of
services to such individuals with programs for
HIV prevention and for the prevention and
treatment of substance abuse, including
programs that provide comprehensive treatment
for such abuse;
``(v) availability of other governmental
and non-governmental resources, including the
State medicaid plan under title XIX of the
Social Security Act and the State Children's
Health Insurance Program under title XXI of
such Act to cover health care costs of eligible
individuals and families with HIV disease; and
``(vi) capacity development needs resulting
from disparities in the availability of HIV-
related services in historically underserved
communities;'';
(4) in subparagraph (D) (as so redesignated), by amending
the subparagraph to read as follows:
``(D) develop a comprehensive plan for the
organization and delivery of health and support
services described in section 2604 that--
``(i) includes a strategy for identifying
individuals who know their HIV status and are
not receiving such services and for informing
the individuals of and enabling the individuals
to utilize the services, giving particular
attention to eliminating disparities in access
and services among affected subpopulations and
historically underserved communities, and
including discrete goals, a timetable, and an
appropriate allocation of funds;
``(ii) includes a strategy to coordinate
the provision of such services with programs
for HIV prevention (including outreach and
early intervention) and for the prevention and
treatment of substance abuse (including
programs that provide comprehensive 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 planning councils and entities that receive amounts from grants
under section 2601(a) or 2611, shall develop epidemiologic measures--
``(1) for establishing the number of individuals living
with HIV disease who are not receiving HIV-related health
services; and
``(2) for carrying out the duties under subsection (b)(4)
and section 2617(b).''.
(c) Training.--Section 2602 of the Public Health Service Act (42
U.S.C. 300ff-12), as amended by subsection (b) of this section, is
amended by adding at the end the following subsection:
``(e) Training Guidance and Materials.--The Secretary shall provide
to each chief elected official receiving a grant under 2601(a)
guidelines and materials for training members of the planning council
under paragraph (1) regarding the duties of the council.''.
(d) Conforming Amendment.--Section 2603(c) of the Public Health
Service Act (42 U.S.C. 300ff-12(b)) is amended by striking ``section
2602(b)(3)(A)'' and inserting ``section 2602(b)(4)(C)''.
SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVISIONS.
Section 2602(b) of the 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).
``(ii) Effect of adverse determination.--If
under clause (i) the Secretary determines that
data on cases of HIV disease is not
sufficiently accurate and reliable for use for
purposes of subparagraph (C)(i), then
notwithstanding such subparagraph, for any
fiscal year prior to fiscal year 2007 the
references in such subparagraph to cases of HIV
disease do not have any legal effect.
``(iii) Grants and technical assistance
regarding counting of hiv cases.--Of the
amounts appropriated under section 318B for a
fiscal year, the Secretary shall reserve
amounts to make grants and provide technical
assistance to States and eligible areas with
respect to obtaining data on cases of HIV
disease to ensure that data on such cases is
available from all States and eligible areas as
soon as is practicable but not later than the
beginning of fiscal year 2007.''.
(c) Increases in Grant.--Section 2603(a)(4)) of the Public Health
Service Act (42 U.S.C. 300ff-13(a)(4)) is amended to read as follows:
``(4) Increases in grant.--
``(A) In general.--For each fiscal year in a
protection period for an eligible area, the Secretary
shall increase the amount of the grant made pursuant to
paragraph (2) for the area to ensure that--
``(i) for the first fiscal year in the
protection period, the grant is not less than
98 percent of the amount of the grant made for
the eligible area pursuant to such paragraph
for the base year for the protection period;
``(ii) for any second fiscal year in such
period, the grant is not less than 95 percent
of the amount of such base year grant;
``(iii) for any third fiscal year in such
period, the grant is not less than 92 percent
of the amount of the base year grant;
``(iv) for any fourth fiscal year in such
period, the grant is not less than 89 percent
of the amount of the base year grant; and
``(v) for any fifth or subsequent fiscal
year in such period, if, pursuant to paragraph
(3)(D)(ii)), the references in paragraph
(3)(C)(i) to HIV disease do not have any legal
effect, the grant is not less than 85 percent
of the amount of the base year grant.
``(B) Special Rule.--If for fiscal year 2005,
pursuant to paragraph (3)(D)(ii), data on cases of HIV
disease are used for purposes of paragraph (3)(C)(i),
the Secretary shall increase the amount of a grant made
pursuant to paragraph (2) for an eligible area to
ensure that the grant is not less than 98 percent of
the amount of the grant made for the area in fiscal
year 2004.
``(C) Base year; protection period.--With respect
to grants made pursuant to paragraph (2) for an
eligible area:
``(i) The base year for a protection period
is the fiscal year preceding the trigger grant-
reduction year.
``(ii) The first trigger grant-reduction
year is the first fiscal year (after fiscal
year 2000) for which the grant for the area is
less than the grant for the area for the
preceding fiscal year.
``(iii) A protection period begins with the
trigger grant-reduction year and continues
until the beginning of the first fiscal year
for which the amount of the grant determined
pursuant to paragraph (2) for the area equals
or exceeds the amount of the grant determined
under subparagraph (A).
``(iv) Any subsequent trigger grant-
reduction year is the first fiscal year, after
the end of the preceding protection period, for
which the amount of the grant is less than the
amount of the grant for the preceding fiscal
year.''.
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) Technical and Conforming Amendment.--Section 2603(b) of the
Public Health Service Act (42 U.S.C. 300ff-13(b)) is amended--
(1) by striking paragraph (4);
(2) by redesignating paragraph (5) as paragraph (4); and
(3) in paragraph (4) (as so redesignated), in subparagraph
(B), by striking ``grants'' and inserting ``grant''.
Subtitle C--Other Provisions
SEC. 121. USE OF AMOUNTS.
(a) Primary Purposes.--Section 2604(b)(1) of the Public Health
Service Act (42 U.S.C. 300ff-14(b)(1)) is amended--
(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, enhance, support, or sustain the
delivery, continuity, or benefits of health services
for individuals and families with HIV disease.''; and
(5) by adding at the end the following:
``(D) Outreach activities that are intended to
identify individuals with HIV disease who know their
HIV status and are not receiving HIV-related services,
and that are--
``(i) necessary to implement the strategy
under 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)(A);
``(ii) conducted in a manner consistent
with the requirements under sections 2605(a)(3)
and 2651(b)(2); and
``(iii) supplement, and do not supplant,
such activities that are carried out with
amounts appropriated under section 317.''.
(b) Early Intervention Services.--Section 2604(b) (42 U.S.C. 300ff-
14(b)) of the Public Health Service Act is amended--
(1) by redesignating paragraph (3) as paragraph (4); and
(2) by inserting after paragraph (2) the following:
``(3) Early intervention services.--
``(A) In general.--The purposes for which a grant
under section 2601 may be used include providing to
individuals with HIV disease early intervention
services described in section 2651(b)(2), with follow-
up referral provided for the purpose of facilitating
the access of individuals receiving the services to
HIV-related health services. The entities through which
such services may be provided under the grant include
public health departments, emergency rooms, substance
abuse and mental health treatment programs,
detoxification centers, detention facilities, clinics
regarding sexually transmitted diseases, homeless
shelters, HIV disease counseling and testing sites,
health care points of entry specified by eligible
areas, federally qualified health centers, and entities
described in section 2652(a) that constitute a point of
access to services by maintaining referral
relationships.
``(B) Conditions.--With respect to an entity that
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.''.
(c) Priority for Women, Infants, and Children.--Section 2604(b) (42
U.S.C. 300ff-14(b)) of the Public Health Service Act is amended in
paragraph (4) (as redesignated by subsection (b)(1) of this section) by
amending the paragraph to read as follows:
``(4) Priority for women, infants and children.--
``(A) In general.--For the purpose of providing
health and support services to infants, children,
youth, and women with HIV disease, including treatment
measures to prevent the perinatal transmission of HIV,
the chief elected official of an eligible area, in
accordance with the established priorities of the
planning council, shall for each of such populations in
the eligible area use, from the grants made for the
area under section 2601(a) for a fiscal year, not less
than the percentage constituted by the ratio of the
population involved (infants, children, youth, or women
in such area) with acquired immune deficiency syndrome
to the general population in such area of individuals
with such syndrome.
``(B) Waiver.--With respect the population
involved, the Secretary may provide to the chief
elected official of an eligible area a waiver of the
requirement of subparagraph (A) if such official
demonstrates to the satisfaction of the Secretary that
the population is receiving HIV-related health services
through the State medicaid program under title XIX of
the Social Security Act, the State children's health
insurance program under title XXI of such Act, or other
Federal or State programs.''.
(d) Quality Management.--Section 2604 of the Public Health Service
Act (42 U.S.C. 300ff-14) is amended--
(1) by redesignating subsections (c) through (f) as
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 for improvement in the access to
and quality of HIV health services.
``(2) Use of funds.--From amounts received under a grant
awarded under this part for a fiscal year, the chief elected
official of an eligible area may (in addition to amounts to
which subsection (f)(1) applies) use for activities associated
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.
(a) In General.--Section 2605(a) of the Public Health Service Act
(42 U.S.C. 300ff-15(a)) is amended--
(1) by redesignating paragraphs (3) through (6) as
paragraphs (5) through (8), respectively; and
(2) by inserting after paragraph (2) the following
paragraphs:
``(3) that entities within the eligible area that receive
funds under a grant under this part will maintain appropriate
relationships with entities in the eligible area served that
constitute key points of access to the health care system for
individuals with HIV disease (including emergency rooms,
substance abuse treatment programs, detoxification centers,
adult and juvenile detention facilities, sexually transmitted
disease clinics, HIV counseling and testing sites, mental
health programs, and homeless shelters), and other entities
under section 2604(b)(3) and 2652(a), for the purpose of
facilitating early intervention for individuals newly diagnosed
with HIV disease and individuals knowledgeable of their HIV
status but not in care;
``(4) that the chief elected official of the eligible area
will satisfy all requirements under section 2604(c);''.
(b) Conforming Amendments.--Section 2605(a) (42 U.S.C. 300ff-
15(a)(1)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by striking ``services to
individuals with HIV disease'' and inserting ``services
as described in section 2604(b)(1)''; and
(B) in subparagraph (B), by striking ``services for
individuals with HIV disease'' and inserting ``services
as described in section 2604(b)(1)'';
(2) in paragraph (7) (as redesignated by subsection (a)(1)
of this section), by striking ``and'' at the end;
(3) in paragraph (8) (as so redesignated), by striking the
period and inserting ``; and''; and
(4) by adding at the end the following paragraph:
``(9) that the eligible area has procedures in place to
ensure that services provided with funds received under this
part meet the criteria specified in section 2604(b)(1).''.
TITLE II--CARE GRANT PROGRAM
Subtitle A--General Grant Provisions
SEC. 201. PRIORITY FOR WOMEN, INFANTS, AND CHILDREN.
Section 2611(b) of the Public Health Service Act (42 U.S.C. 300ff-
21(b)) is amended to read as follows:
``(b) Priority for Women, Infants and Children.--
``(1) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with
HIV disease, including treatment measures to prevent the
perinatal transmission of HIV, a State shall for each of such
populations use, of the funds allocated under this part to the
State for a fiscal year, not less than the percentage
constituted by the ratio of the population involved (infants,
children, youth, or women in the State) with acquired immune
deficiency syndrome to the general population in the State of
individuals with such syndrome.
``(2) Waiver.--With respect the population involved, the
Secretary may provide to a State a waiver of the requirement of
paragraph (1) if the State demonstrates to the satisfaction of
the Secretary that the population is receiving HIV-related
health services through the State medicaid program under title
XIX of the Social Security Act, the State children's health
insurance program under title XXI of such Act, or other Federal
or State programs.''.
SEC. 202. USE OF GRANTS.
Section 2612 of the Public Health Service Act (42 U.S.C. 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) Outpatient and ambulatory support services under
section 2611(a) (including case management) to the extent that
such services facilitate, enhance, support, or sustain the
delivery, continuity, or benefits of health services for
individuals and families with HIV disease.
``(2) Outreach activities that are intended to identify
individuals with HIV disease who know their HIV status and are
not receiving HIV-related services, and that are--
``(A) necessary to implement the strategy under
section 2617(b)(4)(B), including activities
facilitating the access of such individuals to HIV-
related primary care services at entities described in
subsection (c)(1);
``(B) conducted in a manner consistent with the
requirement under section 2617(b)(6)(G) and 2651(b)(2);
and
``(C) supplement, and do not supplant, such
activities that are carried out with amounts
appropriated under 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), with follow-up referral provided for the purpose of
facilitating the access of individuals receiving the services
to HIV-related health services. The entities through which such
services may be provided under the grant include public health
departments, emergency rooms, substance abuse and mental health
treatment programs, detoxification centers, detention
facilities, clinics regarding sexually transmitted diseases,
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) that constitute a point of access
to services by maintaining referral relationships.
``(2) Conditions.--With respect to an entity that proposes
to provide early intervention services under paragraph (1),
such paragraph applies only if the entity demonstrates to the
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 for improvement in
the access to and quality of HIV health services.
``(2) Use of funds.--From amounts received under a grant
awarded under this part for a fiscal year, the State may (in
addition to amounts to which section 2618(b)(5) applies) use
for activities associated with the quality management program
required in paragraph (1) not more than the lesser of--
``(A) 5 percent of amounts received under the
grant; or
``(B) $3,000,000.''.
SEC. 203. GRANTS TO ESTABLISH HIV CARE CONSORTIA.
Section 2613 of the Public Health Service Act (42 U.S.C. 300ff-23)
is amended--
(1) in subsection (b)(1)--
(A) in subparagraph (A), by inserting before the
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''; 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) the types of entities described in section
2602(b)(2).''.
SEC. 204. PROVISION OF TREATMENTS.
(a) In General.--Section 2616(c) of the Public Health Service Act
(42 U.S.C. 300ff-26(c)) is amended--
(1) in paragraph (4), by striking ``and'' after the
semicolon at the end;
(2) in paragraph (5), by striking the period and inserting
``; and''; and
(3) by inserting after paragraph (5) the following:
``(6) encourage, support, and enhance adherence to and
compliance with treatment regimens, including related medical
monitoring.
``Of the amount reserved by a State for a fiscal year for use under
this section, the State may not use more than 5 percent to carry out
services under paragraph (6), except that the percentage applicable
with respect to such paragraph is 10 percent if the State demonstrates
to the Secretary that such additional services are essential and in no
way diminish access to the therapeutics described in subsection (a).''.
(b) Health Insurance and Plans.--Section 2616 of the Public Health
Service Act (42 U.S.C. 300ff-26) is amended by adding at the end the
following subsection:
``(e) Use of Health Insurance and Plans.--
``(1) In general.--In carrying out subsection (a), a State
may expend a grant under this part to provide the therapeutics
described in such subsection by paying on behalf of individuals
with HIV disease the costs of purchasing or maintaining health
insurance or plans whose coverage includes a full range of such
therapeutics and appropriate primary care services.
``(2) Limitation.--The authority established in paragraph
(1) applies only to the extent that, for the fiscal year
involved, the costs of the health insurance or plans to be
purchased or maintained under such paragraph do not exceed the
costs of otherwise providing therapeutics described in
subsection (a).''.
SEC. 205. STATE APPLICATION.
(a) Determination of Size and Needs of Population; 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 know their
HIV status and are not receiving HIV-related services;
and
``(B) disparities in access and services among
affected subpopulations and historically underserved
communities;''; and
(3) in paragraph (4) (as so redesignated)--
(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 non-governmental resources, including the
State medicaid plan under title XIX of the
Social Security Act and the State Children's
Health Insurance Program under title XXI of
such Act to cover health care costs of eligible
individuals and families with HIV disease;
``(iii) capacity development needs
resulting from disparities in the availability
of HIV-related services in historically
underserved communities and rural communities;
and
``(iv) the efficiency of the administrative
mechanism of the State for rapidly allocating
funds to the areas of greatest need within the
State;
``(B) includes a strategy for identifying
individuals who know their HIV status and are not
receiving such services and for informing the
individuals of and enabling the individuals to utilize
the services, giving particular attention to
eliminating disparities in access and services among
affected subpopulations and historically underserved
communities, and including discrete goals, a timetable,
and an appropriate allocation of funds;
``(C) includes a strategy to coordinate the
provision of such services with programs for HIV
prevention (including outreach and early intervention)
and for the prevention and treatment of substance abuse
(including programs that provide comprehensive
treatment services for such abuse);'';
(E) in subparagraph (D) (as redesignated by
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 the types of 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
appropriate relationships with entities in the area
served that constitute key points of access to the
health care system for individuals with HIV disease
(including emergency rooms, substance abuse treatment
programs, detoxification centers, adult and juvenile
detention facilities, sexually transmitted disease
clinics, HIV counseling and testing sites, mental
health programs, and homeless shelters), and other
entities under section 2612(c) and 2652(a), for the
purpose of facilitating early intervention for
individuals newly diagnosed with HIV disease and
individuals knowledgeable of their HIV status but not
in care.''.
SEC. 206. DISTRIBUTION OF FUNDS.
(a) Minimum Allotment.--Section 2618 of the Public Health Service
Act (42 U.S.C. 300ff-28) is amended--
(1) by redesignating subsections (b) through (e) as
subsections (a) through (d), respectively; and
(2) in subsection (a) (as so redesignated), in paragraph
(1)(A)(i)--
(A) in subclause (I), by striking ``$100,000'' and
inserting ``$200,000''; and
(B) in subclause (II), by striking ``$250,000'' and
inserting ``$500,000''.
(b) Amount of Grant; Estimate of Living Cases.--Section 2618(a) of
the Public Health Service Act (as redesignated by subsection (a)(1) of
this section) is amended in paragraph (2)--
(1) in subparagraph (D)(i), by inserting before the
semicolon the following: ``, except that (subject to
subparagraph (E)), for grants made pursuant to this paragraph
or section 2620 for fiscal year 2005 and subsequent fiscal
years, the cases counted for each 12-month period beginning on
or after July 1, 2004, shall be cases of HIV disease (as
reported to and confirmed by such Director) rather than cases
of acquired immune 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 are 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(a) of the Public
Health Service Act (as redesignated by subsection (a)(1) of this
section) 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 or
subparagraph (I)(i) for a fiscal year is not
less than--
``(I) with respect to fiscal year
2001, 99 percent;
``(II) with respect to fiscal year
2002, 98 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 section 2611 or
subparagraph (I)(i), respectively
(notwithstanding such subparagraph). In
administering this subparagraph, the Secretary
shall, with respect to States or territories
that will under such section receive grants in
amounts that exceed the amounts that such
States received under such section or
subparagraph for fiscal year 2000,
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 or subparagraph (I)(i) is less than the
amount appropriated and available for fiscal
year 2000 under section 2611 or subparagraph
(I)(i), respectively, the limitation contained
in clause (i) for the grants involved shall be
reduced by a percentage equal to the percentage
of the reduction in such amounts appropriated
and available.''.
(d) Territories.--Section 2618(a) of the Public Health Service Act
(as redesignated by subsection (a)(1) of this section) is amended in
paragraph (1)(B) by inserting ``the greater of $50,000 or'' after
``shall be''.
(e) Separate Treatment Drug Grants.--Section 2618(a) of the Public
Health Service Act (as redesignated by subsection (a)(1) of this
section and amended by subsection (b)(2) of this section) is amended in
paragraph (2)(I)--
(1) by redesignating clauses (i) and (ii) as subclauses (I)
and (II), respectively;
(2) by striking ``(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 inserting before the semicolon the
following: ``, less the percentage reserved under clause
(ii)(V)''; and
(4) by adding at the end the following clause:
``(ii) Supplemental treatment drug
grants.--
``(I) In general.--From amounts
made available under subclause (V), the
Secretary shall make supplemental
grants to States described in subclause
(II) to enable such States to increase
access to therapeutics described in
section 2616(a), as provided by the
State under section 2616(c)(2).
``(II) Eligible states.--For
purposes of subclause (I), a State
described in this subclause is a State
that, in accordance with criteria
established by the Secretary,
demonstrates a severe need for a grant
under such subclause. In developing
such criteria, the Secretary shall
consider eligibility standards,
formulary composition, and the number
of eligible individuals at or below 200
percent of the official poverty line to
whom the State is unable to provide
therapeutics described in section
2616(a).
``(III) State requirements.--The
Secretary may not make a grant to a
State under this clause unless the
State agrees that--
``(aa) the State will make
available (directly or through
donations from public or
private entities) non-Federal
contributions toward the
activities to carried out under
the grant in an amount equal to
$1 for each $4 of Federal funds
provided in the grant; and
``(bb) the State will not
impose eligibility requirements
for services or scope of
benefits limitations under
section 2616(a) that are more
restrictive than such
requirements in effect as of
January 1, 2000.
``(IV) Use and
coordination.--Amounts made
available under a grant under
this clause shall only be used
by the State to provide HIV/
AIDS-related medications. The
State shall coordinate the use
of such amounts with the
amounts otherwise provided
under section 2616(a) in order
to maximize drug coverage.
``(V) Funding.--For the purpose of
making grants under this clause, the
Secretary shall each fiscal year
reserve 3 percent of the amount
referred to in clause (i) with respect
to section 2616, subject to subclause
(VI).
``(VI) Limitation.--In reserving
amounts under subclause (V) and making
grants under this clause for a fiscal
year, the Secretary shall ensure for
each State that the total of the grant
under section 2611 for the State for
the fiscal year and the grant under
clause (i) for the State for the fiscal
year is not less than such total for
the State for the preceding fiscal
year.''.
(f) Technical Amendment.--Section 2618(a) of the Public Health
Service Act (as redesignated by subsection (a)(1) of this section) is
amended in paragraph (3)(B) by striking ``and the Republic of the
Marshall Islands'' and inserting ``the Republic of the Marshall
Islands, the Federated States of Micronesia, and the Republic of Palau,
and only for purposes of paragraph (1) the Commonwealth of Puerto
Rico''.
SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.
Subpart I of part B of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-11 et seq.) is amended--
(1) by striking section 2621; and
(2) by inserting after section 2619 the following section:
``SEC. 2620. SUPPLEMENTAL GRANTS.
``(a) In General.--The Secretary shall award supplemental grants to
States determined to be eligible under subsection (b) to enable such
States to provide comprehensive services of the type described in
section 2612(a) to supplement the services otherwise provided by the
State under a grant under this subpart in emerging communities within
the State that are not eligible to receive grants under part A.
``(b) Eligibility.--To be eligible to receive a supplemental grant
under subsection (a), a State shall--
``(1) be eligible to receive a grant under this subpart;
``(2) demonstrate the existence in the State of an emerging
community as defined in subsection (d)(1); and
``(3) submit the information described in subsection (c).
``(c) Reporting Requirements.--A State that desires a grant under
this section shall, as part of the State application submitted under
section 2617, submit a detailed description of the manner in which the
State will use amounts received under the grant and of the severity of
need. Such description shall include--
``(1) a report concerning the dissemination of supplemental
funds under this section and the plan for the utilization of
such funds in the emerging community;
``(2) a demonstration of the existing commitment of local
resources, both financial and in-kind;
``(3) a demonstration that the State will maintain HIV-
related activities at a level that is equal to not less than
the level of such activities in the State for the 1-year period
preceding the fiscal year for which the State is applying to
receive a grant under this part;
``(4) a demonstration of the ability of the State to
utilize such supplemental financial resources in a manner that
is immediately responsive and cost effective;
``(5) a demonstration that the resources will be allocated
in accordance with the local demographic incidence of AIDS
including appropriate allocations for services for infants,
children, women, and families with HIV disease;
``(6) a demonstration of the inclusiveness of the planning
process, with particular emphasis on affected communities and
individuals with HIV disease; and
``(7) a demonstration of the manner in which the proposed
services are consistent with local needs assessments and the
statewide coordinated statement of need.
``(d) Definition of Emerging Community.--In this section, the term
`emerging community' means a metropolitan area--
``(1) that is not eligible for a grant under part A; and
``(2) for which there has been reported to the Director of
the Centers for Disease Control and Prevention a cumulative
total of between 500 and 1999 cases of acquired immune
deficiency syndrome for the most recent period of 5 calendar
years for which such data are available (except that, for
fiscal year 2005 and subsequent fiscal years, cases of HIV
disease shall be counted rather than cases of acquired immune
deficiency syndrome if cases of HIV disease are being counted
for purposes of section 2618(a)(2)(D)(i)).
``(e) Funding.--
``(1) In general.--Subject to paragraph (2), with respect
to each fiscal year beginning with fiscal year 2001, the
Secretary, to carry out this section, shall utilize--
``(A) the greater of--
``(i) 25 percent of the amount appropriated
under 2677 to carry out part B, excluding the
amount appropriated under section
2618(a)(2)(I), for such fiscal year that is in
excess of the amount appropriated to carry out
such part in fiscal year preceding the fiscal
year involved; or
``(ii) $5,000,000,
to provide funds to States for use in emerging
communities with at least 1000, but less than 2000,
cases of AIDS as reported to and confirmed by the
Director of the Centers for Disease Control and
Prevention for the five year period preceding the year
for which the grant is being awarded; and
``(B) the greater of--
``(i) 25 percent of the amount appropriated
under 2677 to carry out part B, excluding the
amount appropriated under section
2618(a)(2)(I), for such fiscal year that is in
excess of the amount appropriated to carry out
such part in fiscal year preceding the fiscal
year involved; or
``(ii) $5,000,000,
to provide funds to States for use in emerging
communities with at least 500, but less than 1000,
cases of AIDS reported to and confirmed by the Director
of the Centers for Disease Control and Prevention for
the five year period preceding the year for which the
grant is being awarded.
``(2) Trigger of funding.--This section shall be effective
only for fiscal years beginning in the first fiscal year in
which the amount appropriated under 2677 to carry out part B,
excluding the amount appropriated under section 2618(a)(2)(I),
exceeds by at least $20,000,000 the amount appropriated under
2677 to carry out part B in fiscal year 2000, excluding the
amount appropriated under section 2618(a)(2)(I).
``(3) Minimum amount in future years.--Beginning with the
first fiscal year in which amounts provided for emerging
communities under paragraph (1)(A) equals $5,000,000 and under
paragraph (1)(B) equals $5,000,000, the Secretary shall ensure
that amounts made available under this section for the types of
emerging communities described in each such paragraph in
subsequent fiscal years is at least $5,000,000.
``(4) Distribution.--Grants under this section for emerging
communities shall be formula grants. There shall be two
categories of such formula grants, as follows:
``(A) One category of such grants shall be for
emerging communities for which the cumulative total of
cases for purposes of subsection (d)(2) is 999 or fewer
cases. The grant made to such an emerging community for
a fiscal year shall be the product of--
``(i) an amount equal to 50 percent of the
amount available pursuant to this subsection
for the fiscal year involved; and
``(ii) a percentage equal to the ratio
constituted by the number of cases for such
emerging community for the fiscal year over the
aggregate number of such cases for such year
for all emerging communities to which this
subparagraph applies.
``(B) The other category of formula grants shall be
for emerging communities for which the cumulative total
of cases for purposes of subsection (d)(2) is 1000 or
more cases. The grant made to such an emerging
community for a fiscal year shall be the product of--
``(i) an amount equal to 50 percent of the
amount available pursuant to this subsection
for the fiscal year involved; and
``(ii) a percentage equal to the ratio
constituted by the number of cases for such
community for the fiscal year over the
aggregate number of such cases for the fiscal
year for all emerging communities to which this
subparagraph applies.''.
Subtitle B--Provisions Concerning 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);
(2) by striking sections 2627 and 2628; and
(3) by redesignating section 2629 as section 2627.
SEC. 212. GRANTS.
(a) In General.--Section 2625(c) of the Public Health Service Act
(42 U.S.C. 300ff-33) is amended--
(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--
``(I) the Secretary shall reserve
the applicable percentage under clause
(iv) for making grants under paragraph
(1) both to States described in clause
(ii) and States described in clause
(iii); and
``(II) the Secretary shall reserve
the remaining amounts for other States,
taking into consideration the factors
described in subparagraph (C)(iii),
except that this subclause does not
apply to any State that for the fiscal
year involved is receiving amounts
pursuant to subclause (I).
``(ii) Required testing of newborns.--For
purposes of clause (i)(I), the States described
in this clause are States that under law
(including under regulations or the discretion
of State officials) have--
``(I) a requirement that all
newborn infants born in the State be
tested for HIV disease and that the
biological mother of each such infant,
and the legal guardian of the infant
(if other than the biological mother),
be informed of the results of the
testing; or
``(II) a requirement that newborn
infants 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, and that the
biological mother of each such infant,
and the legal guardian of the infant
(if other than the biological mother),
be informed of the results of the
testing.
``(iii) Most significant reduction in cases
of perinatal transmission.--For purposes of
clause (i)(I), the States described in this
clause are the following (exclusive of States
described in clause (ii)), as applicable:
``(I) For fiscal years 2001 and
2002, the two States that, relative to
other States, have the most significant
reduction in the rate of new cases of
the perinatal transmission of HIV (as
indicated by the number of such cases
reported to the Director of the Centers
for Disease Control and Prevention for
the most recent periods for which the
data are available).
``(II) For fiscal years 2003 and
2004, the three States that have the
most significant such reduction.
``(III) For fiscal year 2005, the
four States that have the most
significant such reduction.
``(iv) Applicable percentage.--For purposes
of clause (i), the applicable amount for a
fiscal year is as follows:
``(I) For fiscal year 2001, 33
percent.
``(II) For fiscal year 2002, 50
percent.
``(III) For fiscal year 2003, 67
percent.
``(IV) For fiscal year 2004, 75
percent.
``(V) For fiscal year 2005, 75
percent.
``(C) Certain provisions.--With respect to grants
under paragraph (1) that are made with amounts reserved
under subparagraph (B) of this paragraph:
``(i) Such a grant may not be made in an
amount exceeding $4,000,000.
``(ii) If pursuant to clause (i) or
pursuant to an insufficient number of
qualifying applications for such grants (or
both), the full amount reserved under
subparagraph (B) for a fiscal year is not
obligated, the requirement under such
subparagraph to reserve amounts ceases to
apply.
``(iii) In the case of a State that meets
the conditions to receive amounts reserved
under subparagraph (B)(i)(II), the Secretary
shall in making grants consider the following
factors:
``(I) The extent of the reduction
in the rate of new cases of the
perinatal transmission of HIV.
``(II) The extent of the reduction
in the rate of new cases of perinatal
cases of acquired immune deficiency
syndrome.
``(III) The overall incidence of
cases of infection with HIV among women
of childbearing age.
``(IV) The overall incidence of
cases of acquired immune deficiency
syndrome among women of childbearing
age.
``(V) The higher acceptance rate of
HIV testing of pregnant women.
``(VI) The extent to which women
and children with HIV disease are
receiving HIV-related health services.
``(VII) The extent to which HIV-
exposed children are receiving health
services appropriate to such
exposure.''; and
(3) by adding at the end the following paragraph:
``(4) Maintenance of effort.--A condition for the receipt
of a grant under paragraph (1) is that the State involved agree
that the grant will be used to supplement and not 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 (notwithstanding any other provision
of this Act or the amendments made by this Act);
(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)(iv)(I) of such section is deemed to be 50
percent.
(2) Allocation from increases in funding for part b.--For
purposes of paragraph (1), the amount specified in this
paragraph is the amount by which the amount 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, as amended by section 211(3), is amended by adding at the end the
following section:
``SEC. 2628. 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.--In fiscal year 2004, the
Secretary shall collect information from the States describing the
actions taken by the States toward meeting the recommendations
specified for the States under subsection (a)(1)(C).
``(c) Submission of Reports to Congress.--The Secretary shall
submit to the appropriate committees of the Congress reports describing
the information collected under subsection (b).''.
Subtitle C--Certain Partner Notification Programs
SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICATION 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; Preference in
Making Grants.--In making grants under subsection (a), the Secretary
shall give preference to States whose reporting systems for cases of
HIV disease produce data on such cases that is sufficiently accurate
and reliable for use for purposes of section 2618(a)(2)(D)(i).
``(d) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $30,000,000
for fiscal year 2001, and such sums as may be necessary for each of the
fiscal years 2002 through 2005.''.
TITLE III--EARLY INTERVENTION SERVICES
Subtitle A--Formula Grants for States
SEC. 301. REPEAL OF PROGRAM.
(a) Repeal.--Subpart I of part C of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-41 et seq.) is repealed.
(b) Conforming Amendments.--Part C of title XXVI of the Public
Health Service Act (42 U.S.C. 300ff-41 et seq.), as amended by
subsection (a) of this section, is amended--
(1) by redesignating subparts II and III as subparts I and
II, respectively;
(2) in section 2661(a), by striking ``unless--'' and all
that follows through ``(2) in the case of'' and inserting
``unless, in the case of''; and
(3) in section 2664--
(A) in subsection (e)(5), by striking ``2642(b)
or'';
(B) in subsection (f)(2), by striking ``2642(b)
or''; and
(C) by striking subsection (h).
Subtitle B--Categorical Grants
SEC. 311. PREFERENCES IN MAKING GRANTS.
Section 2653 of the Public Health Service Act (42 U.S.C. 300ff-53)
is amended by adding at the end the following subsection:
``(d) Certain Areas.--Of the applicants who qualify for preference
under this section--
``(1) the Secretary shall give preference to applicants
that will expend the grant under section 2651 to provide early
intervention under such section in rural areas; and
``(2) the Secretary shall give special consideration to
areas that are underserved with respect to such services.''.
SEC. 312. PLANNING AND DEVELOPMENT GRANTS.
(a) In General.--Section 2654(c)(1) of the Public Health Service
Act (42 U.S.C. 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--
``(A) to assess the extent to which medical
services funded under this title that are provided to
patients are consistent with the most recent Public
Health Service guidelines for the treatment of HIV
disease and related opportunistic infections, and as
applicable, to develop strategies for ensuring that
such services are consistent with the guidelines; and
``(B) to ensure that improvements in the access to
and quality of HIV health services are addressed.''.
TITLE IV--OTHER PROGRAMS AND ACTIVITIES
Subtitle A--Certain Programs for Research, Demonstrations, or Training
SEC. 401. GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR
WOMEN, INFANTS, CHILDREN, AND YOUTH.
(a) Elimination of Requirement To Enroll Significant Numbers of
Women and Children.--Section 2671(b) (42 U.S.C. 300ff-71(b)) is
amended--
(1) in paragraph (1), by striking subparagraphs (C) and (D)
and inserting the following:
``(C) The applicant will demonstrate linkages to
research and how access to such research is being
offered to patients.''; and
(2) by striking paragraphs (3) and (4).
(b) Information and Education.--Section 2671(d) (42 U.S.C. 300ff-
71(d)) is amended by adding at the end the following:
``(4) The applicant will provide individuals with
information and education on opportunities to participate in
HIV/AIDS-related clinical research.''.
(c) Quality Management; Administrative Expenses Ceiling.--Section
2671(f) (42 U.S.C. 300ff-71(f)) is amended--
(1) by striking the subsection heading and designation and
inserting the following:
``(f) Administration.--
``(1) Application.--''; and
(2) by adding at the end the following:
``(2) Quality management program.--A grantee under this
section shall implement a quality management program to assess
the extent to which HIV health services provided to patients
under the grant are consistent with the most recent Public
Health Service guidelines for the treatment of HIV disease and
related opportunistic infection, and as applicable, to develop
strategies for ensuring that such services are consistent with
the guidelines for improvement in the access to and quality of
HIV health services.''.
(d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g)) is
amended by adding at the end the following: ``The Secretary acting
through the Director of NIH, shall examine the distribution and
availability of ongoing and appropriate HIV/AIDS-related research
projects to existing sites under this section for purposes of enhancing
and expanding voluntary access to HIV-related research, especially
within communities that are not reasonably served by such projects. Not
later than 12 months after the date of the enactment of the Ryan White
CARE Act Amendments of 2000, the Secretary shall prepare and submit to
the appropriate committees of Congress a report that describes the
findings made by the Director and the manner in which the conclusions
based on those findings can be addressed.''.
(e) Administrative Expenses.--Section 2671 of the Public Health
Service Act (42 U.S.C. 300ff-71) is amended--
(1) by redesignating subsections (i) and (j) as subsections
(j) and (k), respectively; and
(2) by inserting after subsection (h) the following
subsection:
``(i) Limitation on Administrative Expenses.--
``(1) Determination by secretary.--Not later than 12 months
after the date of the enactment of the Ryan White Care Act
Amendments of 2000, the Secretary, in consultation with
grantees under this part, shall conduct a review of the
administrative, program support, and direct service-related
activities that are carried out under this part to ensure that
eligible individuals have access to quality, HIV-related health
and support services and research opportunities under this
part, and to support the provision of such services.
``(2) Requirements.--
``(A) In general.--Not later than 180 days after
the expiration of the 12-month period referred to in
paragraph (1) the Secretary, in consultation with
grantees under this part, shall determine the
relationship between the costs of the activities
referred to in paragraph (1) and the access of eligible
individuals to the services and research opportunities
described in such paragraph.
``(B) Limitation.--After a final determination
under subparagraph (A), the Secretary may not make a
grant under this part unless the grantee complies with
such requirements as may be included in such
determination.''.
(f) Authorization of Appropriations.--Section 2671 of the Public
Health Service Act (42 U.S.C. 300ff-71) is amended in subsection (j)
(as redesignated by subsection (e)(1) of this section) by striking
``fiscal years 1996 through 2000'' and inserting ``fiscal years 2001
through 2005''.
SEC. 402. 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 the
enactment of the Health Professions Education
Partnerships Act of 1998 (Public Law 105-392) and in
addition dental hygiene programs that are accredited by
the Commission on Dental Accreditation.'';
(2) in paragraph (2), by striking ``777(b)(4)(B)'' and
inserting ``the section referred to in paragraph (1)(B)''; and
(3) by inserting after paragraph (4) the following
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 B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 318A the following
section:
``data collection regarding programs under title xxvi
``Sec. 318B. For the purpose of collecting and providing data for
program planning and evaluation activities under title XXVI, there are
authorized to be appropriated to the Secretary (acting through the
Director of the Centers for Disease Control and 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 2675 of the Public Health Service Act (42 U.S.C. 300ff-75)
is amended--
(1) by amending subsection (a) to read as follows:
``(a) Requirement.--The Secretary shall ensure that the Health
Resources and Services Administration, the Centers for Disease Control
and Prevention, the Substance Abuse and Mental Health Services
Administration, and the Health Care Financing 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 2675 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 2 years after the date
of the enactment of the Ryan White CARE Act Amendments of 2000.''.
SEC. 415. AUDITS.
Part D of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-71 et seq.) is amended by inserting after section 2675 the
following section:
``SEC. 2675A. AUDITS.
``For fiscal year 2002 and subsequent fiscal years, the Secretary
may reduce the amounts of grants under this title to a State or
political subdivision of a State for a fiscal year if, with respect to
such grants for the second preceding fiscal year, the State or
subdivision fails to prepare audits in accordance with the procedures
of section 7502 of title 31, United States Code. The Secretary shall
annually select representative samples of such audits, prepare
summaries of the selected audits, and submit the summaries to the
Congress.''.
SEC. 416. ADMINISTRATIVE SIMPLIFICATION.
Part D of title XXVI of the Public Health Service Act, as amended
by section 415 of this Act, is amended by inserting after section 2675A
the following section:
``SEC. 2675B. ADMINISTRATIVE SIMPLIFICATION REGARDING PARTS A 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 2 years after the date on which
the plan is so submitted, the Secretary shall complete the
implementation of the plan, notwithstanding any provision of this title
that is inconsistent with the plan.
``(b) Biennial Applications.--After consultation with the States,
with eligible areas under part A, and with entities that receive
amounts from grants under part A or B, the Secretary 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 2 years after the date of the enactment of
the Ryan White CARE Act Amendments of 2000.
``(c) Application Simplification.--After consultation with the
States, with eligible areas 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 2 years after the date on which
the plan is so submitted, the Secretary shall complete the
implementation of the plan, notwithstanding any provision of this title
that is inconsistent with the plan.''.
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 3 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 2 years after the date of the enactment
of this Act, the study required in subsection (b) is completed
and a report describing the findings made in the study is
submitted to such committees.
SEC. 502. DEVELOPMENT OF RAPID HIV TEST.
(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.
SEC. 503. TECHNICAL CORRECTIONS.
(a) Public Health Service Act.--Title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-11 et seq.) is amended--
(1) in section 2605(d)--
(A) in paragraph (1), by striking ``section 2608''
and inserting ``section 2677''; and
(B) in paragraph (4), by inserting ``section''
before 2601(a)''; and
(2) in section 2673(a), in the matter preceding paragraph
(1), by striking ``the Agency for Health Care Policy and
Research'' and inserting ``the Director of the Agency for
Healthcare Research and Quality''.
(b) Related Act.--The first paragraph (2) of section 3(c) of the
Ryan White Care Act Amendments of 1996 (Public Law 104-146; 110 Stat.
1354) is amended in subparagraph (A)(iii) by striking ``by inserting
the following new paragraph:'' and inserting ``by inserting before
paragraph (2) (as so redesignated) the following new paragraph''.
TITLE VI--EFFECTIVE DATE
SEC. 601. EFFECTIVE DATE.
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.
Amend the title so as to read ``An Act 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.''.
Attest:
Clerk.