[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2311 Engrossed in Senate (ES)]
106th CONGRESS
2d Session
S. 2311
_______________________________________________________________________
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ryan White CARE Act Amendments of
2000''.
SEC. 2. REFERENCES; TABLE OF CONTENTS.
(a) References.--Except as otherwise expressly provided, whenever
in this Act an amendment or repeal is expressed in terms of an
amendment to, or repeal of, a section or other provision, the reference
shall be considered to be made to a section or other provision of the
Public Health Service Act (42 U.S.C. 201 et seq.).
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title.
Sec. 2. References; table of contents.
TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM
Subtitle A--Amendments to Part A (Emergency Relief Grants)
Sec. 101. Duties of planning council, funding priorities, quality
assessment.
Sec. 102. Quality management.
Sec. 103. Funded entities required to have health care relationships.
Sec. 104. Support services required to be health care-related.
Sec. 105. Use of grant funds for early intervention services.
Sec. 106. Replacement of specified fiscal years regarding the sunset on
expedited distribution requirements.
Sec. 107. Hold harmless provision.
Sec. 108. Set-aside for infants, children, and women.
Subtitle B--Amendments to Part B (Care Grant Program)
Sec. 121. State requirements concerning identification of need and
allocation of resources.
Sec. 122. Quality management.
Sec. 123. Funded entities required to have health care relationships.
Sec. 124. Support services required to be health care-related.
Sec. 125. Use of grant funds for early intervention services.
Sec. 126. Authorization of appropriations for HIV-related services for
women and children.
Sec. 127. Repeal of requirement for completed Institute of Medicine
report.
Sec. 128. Supplement grants for certain States.
Sec. 129. Use of treatment funds.
Sec. 130. Increase in minimum allotment.
Sec. 131. Set-aside for infants, children, and women.
Subtitle C--Amendments to Part C (Early Intervention Services)
Sec. 141. Amendment of heading; repeal of formula grant program.
Sec. 142. Planning and development grants.
Sec. 143. Authorization of appropriations for categorical grants.
Sec. 144. Administrative expenses ceiling; quality management program.
Sec. 145. Preference for certain areas.
Sec. 146. Technical amendment.
Subtitle D--Amendments to Part D (General Provisions)
Sec. 151. Research involving women, infants, children, and youth.
Sec. 152. Limitation on administrative expenses.
Sec. 153. Evaluations and reports.
Sec. 154. Authorization of appropriations for grants under parts A and
B.
Subtitle E--Amendments to Part F (Demonstration and Training)
Sec. 161. Authorization of appropriations.
TITLE II--MISCELLANEOUS PROVISIONS
Sec. 201. Institute of Medicine study.
TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM
Subtitle A--Amendments to Part A (Emergency Relief Grants)
SEC. 101. DUTIES OF PLANNING COUNCIL, FUNDING PRIORITIES, QUALITY
ASSESSMENT.
Section 2602 (42 U.S.C. 300ff-12) is amended--
(1) in subsection (b)--
(A) in paragraph (2)(C), by inserting before the
semicolon the following: ``, including providers of
housing and homeless services''; and
(B) in paragraph (4), by striking ``shall--'' and
all that follows and inserting ``shall have the
responsibilities specified in subsection (d).''; and
(2) by adding at the end the following:
``(d) Duties of Planning Council.--The planning council established
under subsection (b) shall have the following duties:
``(1) Priorities for allocation of funds.--The council
shall establish priorities for the allocation of funds within
the eligible area, including how best to meet each such
priority and additional factors that a grantee should consider
in allocating funds under a grant, based on the following
factors:
``(A) The size and demographic characteristics of
the population with HIV disease to be served,
including, subject to subsection (e), the needs of
individuals living with HIV infection who are not
receiving HIV-related health services.
``(B) The documented needs of the population with
HIV disease with particular attention being given to
disparities in health services among affected subgroups
within the eligible area.
``(C) The demonstrated or probable cost and outcome
effectiveness of proposed strategies and interventions,
to the extent that data are reasonably available.
``(D) Priorities of the communities with HIV
disease for whom the services are intended.
``(E) The 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.
``(F) Capacity development needs resulting from
gaps in the availability of HIV services in
historically underserved low-income communities.
``(2) Comprehensive service delivery plan.--The council
shall develop a comprehensive plan for the organization and
delivery of health and support services described in section
2604. Such plan shall be compatible with any existing State or
local plans regarding the provision of such services to
individuals with HIV disease.
``(3) Assessment of fund allocation efficiency.--The
council shall assess the efficiency of the administrative
mechanism in rapidly allocating funds to the areas of greatest
need within the eligible area.
``(4) Statewide statement of need.--The council shall
participate in the development of the Statewide coordinated
statement of need as initiated by the State public health
agency responsible for administering grants under part B.
``(5) Coordination with other federal grantees.--The
council shall coordinate with Federal grantees providing HIV-
related services within the eligible area.
``(6) Community participation.--The council shall establish
methods for obtaining input on community needs and priorities
which may include public meetings, conducting focus groups, and
convening ad-hoc panels.
``(e) Process for Establishing Allocation Priorities.--
``(1) In general.--Not later than 24 months after the date
of enactment of the Ryan White CARE Act Amendments of 2000, the
Secretary shall--
``(A) consult with eligible metropolitan areas,
affected communities, experts, and other appropriate
individuals and entities, to develop epidemiologic
measures for establishing the number of individuals
living with HIV disease who are not receiving HIV-
related health services; and
``(B) provide advice and technical assistance to
planning councils with respect to the process for
establishing priorities for the allocation of funds
under subsection (d)(1).
``(2) Exception.--Grantees under this part shall not be
required to establish priorities for individuals not in care
until epidemiologic measures are developed under paragraph
(1).''.
SEC. 102. QUALITY MANAGEMENT.
(a) Funds Available for Quality Management.--Section 2604 (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 medical 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 to develop
strategies for improvements in the access to and quality of
medical services.
``(2) Use of funds.--From amounts received under a grant
awarded under this part, the chief elected official of an
eligible area may use, for activities associated with its
quality management program, not more than the lesser of--
``(A) 5 percent of amounts received under the
grant; or
``(B) $3,000,000.''.
(b) Quality Management Required for Eligibility for Grants.--
Section 2605(a) (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:
``(3) that the chief elected official of the eligible area
will satisfy all requirements under section 2604(c);''.
SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE RELATIONSHIPS.
(a) Use of Amounts.--Section 2604(e)(1) (42 U.S.C. 300ff-14(d)(1))
(as so redesignated by section 102(a)) is amended by inserting ``and
the State Children's Health Insurance Program under title XXI of such
Act'' after ``Social Security Act''.
(b) Applications.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is
amended by inserting after paragraph (3), as added by section 102(b),
the following:
``(4) that funded entities within the eligible area that
receive funds under a grant under section 2601(a) shall
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 2652(a) for the purpose of facilitating
early intervention for individuals newly diagnosed with HIV
disease and individuals knowledgeable of their status but not
in care;''.
SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-RELATED.
(a) In General.--Section 2604(b)(1) (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 health services.--
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
services.--Inpatient case management''; and
(4) by inserting after subparagraph (A) the following:
``(B) Outpatient support services.--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.''.
(b) Conforming Amendment to Application Requirements.--Section
2605(a) (42 U.S.C. 300ff-15(a)), as amended by section 102(b), is
further amended--
(1) in paragraph (7) (as so redesignated), by striking
``and'' at the end thereof;
(2) in paragraph (8) (as so redesignated), by striking the
period and inserting ``; and''; and
(3) by adding at the end the following:
``(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).''.
SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.
(a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-14(b)(1)), as
amended by section 104(a), is further amended by adding at the end the
following:
``(D) Early intervention services.--Early
intervention services as described in section
2651(b)(2), with follow-through referral, provided for
the purpose of facilitating the access of individuals
receiving the services to HIV-related health services,
but only if the entity providing such services--
``(i)(I) is receiving funds under
subparagraph (A) or (C); or
``(II) is an entity constituting a point of
access to services, as described in section
2605(a)(4), that maintains a relationship with
an entity described in subclause (I) and that
is serving individuals at elevated risk of HIV
disease;
``(ii) demonstrates to the satisfaction of
the chief elected official that Federal, State,
or local funds are inadequate for the early
intervention services the entity will provide
with funds received under this subparagraph;
and
``(iii) demonstrates to the satisfaction of
the chief elected official that funds will be
utilized under this subparagraph to supplement
not supplant other funds available for such
services in the year for which such funds are
being utilized.
(b) Conforming Amendments to Application Requirements.--Section
2605(a)(1) (42 U.S.C. 300ff-15(a)(1)) is amended--
(1) in subparagraph (A), by striking ``services to
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''; and
(2) in subparagraph (B), by striking ``services for
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''.
SEC. 106. REPLACEMENT OF SPECIFIED FISCAL YEARS REGARDING THE SUNSET ON
EXPEDITED DISTRIBUTION REQUIREMENTS.
Section 2603(a)(2) (42 U.S.C. 300ff-13(a)(2)) is amended by
striking ``for each of the fiscal years 1996 through 2000'' and
inserting ``for a fiscal year''.
SEC. 107. HOLD HARMLESS PROVISION.
Section 2603(a)(4) (42 U.S.C. 300ff-13(a)(4)) is amended to read as
follows:
``(4) Limitation.--With respect to each of fiscal years
2001 through 2005, the Secretary shall ensure that the amount
of a grant made to an eligible area under paragraph (2) for
such a fiscal year is not less than an amount equal to 98
percent of the amount the eligible area received for the fiscal
year preceding the year for which the determination is being
made.''.
SEC. 108. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.
Section 2604(b)(3) (42 U.S.C. 300ff-14(b)(3)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``council''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.
Subtitle B--Amendments to Part B (Care Grant Program)
SEC. 121. STATE REQUIREMENTS CONCERNING IDENTIFICATION OF NEED AND
ALLOCATION OF RESOURCES.
(a) General Use of Grants.--Section 2612 (42 U.S.C. 300ff-22) is
amended--
(1) by striking ``A State'' and inserting ``(a) In
General.--A State''; and
(2) in the matter following paragraph (5)--
(A) by striking ``Services'' and inserting:
``(b) Delivery of Services.--Services'';
(B) by striking ``paragraph (1)'' and inserting
``subsection (a)(1)''; and
(C) by striking ``paragraph (2)'' and inserting
``subsection (a)(2) and section 2613'';
(b) Application.--Section 2617(b) (42 U.S.C. 300ff-27(b)) is
amended--
(1) in paragraph (1)(C)--
(A) by striking clause (i) and inserting the
following:
``(i) the size and demographic
characteristics of the population with HIV
disease to be served, except that by not later
than October 1, 2002, the State shall take into
account the needs of individuals not in care,
based on epidemiologic measures developed by
the Secretary in consultation with the State,
affected communities, experts, and other
appropriate individuals (such State shall not
be required to establish priorities for
individuals not in care until such
epidemiologic measures are developed);'';
(B) in clause (iii), by striking ``and'' at the
end; and
(C) by adding at the end the following:
``(v) the availability of other
governmental and non-governmental resources;
``(vi) the capacity development needs
resulting in gaps in the provision of HIV
services in historically underserved low-income
and rural low-income communities; and
``(vii) the efficiency of the
administrative mechanism in rapidly allocating
funds to the areas of greatest need within the
State;''; and
(2) in paragraph (2)--
(A) in subparagraph (B), by striking ``and'' at the
end;
(B) by redesignating subparagraph (C) as
subparagraph (F); and
(C) by inserting after subparagraph (B), the
following:
``(C) an assurance that capacity development needs
resulting from gaps in the provision of services in
underserved low-income and rural low-income communities
will be addressed; and
``(D) with respect to fiscal year 2003 and
subsequent fiscal years, assurances that, in the
planning and allocation of resources, the State,
through systems of HIV-related health services provided
under paragraphs (1), (2), and (3) of section 2612(a),
will make appropriate provision for the HIV-related
health and support service needs of individuals who
have been diagnosed with HIV disease but who are not
currently receiving such services, based on the
epidemiologic measures developed under paragraph
(1)(C)(i);''.
SEC. 122. QUALITY MANAGEMENT.
(a) State Requirement for Quality Management.--Section 2617(b)(4)
(42 U.S.C. 300ff-27(b)(4)) is amended--
(1) by striking subparagraph (C) and inserting the
following:
``(C) the State will provide for--
``(i) the establishment of a quality
management program to assess the extent to
which medical 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 infections and to develop
strategies for improvements in the access to
and quality of medical services; and
``(ii) a periodic review (such as through
an independent peer review) to assess the
quality and appropriateness of HIV-related
health and support services provided by
entities that receive funds from the State
under this part;'';
(2) by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively;
(3) by inserting after subparagraph (D), the following:
``(E) an assurance that the State, through systems
of HIV-related health services provided under
paragraphs (1), (2), and (3) of section 2612(a), has
considered strategies for working with providers to
make optimal use of financial assistance under the
State medicaid plan under title XIX of the Social
Security Act, the State Children's Health Insurance
Program under title XXI of such Act, and other Federal
grantees that provide HIV-related services, to maximize
access to quality HIV-related health and support
services;
(4) in subparagraph (F), as so redesignated, by striking
``and'' at the end; and
(5) in subparagraph (G), as so redesignated, by striking
the period and inserting ``; and''.
(b) Availability of Funds for Quality Management.--
(1) Availability of grant funds for planning and
evaluation.--Section 2618(c)(3) (42 U.S.C. 300ff-28(c)(3)) is
amended by inserting before the period ``, including not more
than $3,000,000 for all activities associated with its quality
management program''.
(2) Exception to combined ceiling on planning and
administration funds for states with small grants.--Paragraph
(6) of section 2618(c) (42 U.S.C. 300ff-28(c)(6)) is amended to
read as follows:
``(6) Exception for quality management.--Notwithstanding
paragraph (5), a State whose grant under this part for a fiscal
year does not exceed $1,500,000 may use not to exceed 20
percent of the amount of the grant for the purposes described
in paragraphs (3) and (4) if--
``(A) that portion of the amount that may be used
for such purposes in excess of 15 percent of the grant
is used for its quality management program; and
``(B) the State submits and the Secretary approves
a plan (in such form and containing such information as
the Secretary may prescribe) for use of funds for its
quality management program.''.
SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE RELATIONSHIPS.
Section 2617(b)(4) (42 U.S.C. 300ff-27(b)(4)), as amended by
section 122(a), is further amended by adding at the end the following:
``(H) that funded entities 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 2652(a), for the purpose of facilitating early
intervention for individuals newly diagnosed with HIV
disease and individuals knowledgeable of their status
but not in care.''.
SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-RELATED.
(a) Technical Amendment.--Section 3(c)(2)(A)(iii) of the Ryan White
CARE Act Amendments of 1996 (Public Law 104-146) is amended by
inserting ``before paragraph (2) as so redesignated'' after
``inserting''.
(b) Services.--Section 2612(a)(1) (42 U.S.C. 300ff-22(a)(1)), as so
designated by section 121(a), is amended by striking ``for individuals
with HIV disease'' and inserting ``, subject to the conditions and
limitations that apply under such section''.
(c) Conforming Amendment to State Application Requirement.--Section
2617(b)(2) (42 U.S.C. 300ff-27(b)(2)), as amended by section 121(b), is
further amended by inserting after subparagraph (D) the following:
``(E) an assurance that the State has procedures in
place to ensure that services provided with funds
received under this section meet the criteria specified
in section 2604(b)(1)(B); and''.
SEC. 125. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.
Section 2612(a) (42 U.S.C. 300ff-22(a)), as amended by section 121,
is further amended--
(1) in paragraph (4), by striking ``and'' at the end;
(2) in paragraph (5), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(6) to provide, through systems of HIV-related health
services provided under paragraphs (1), (2), and (3), early
intervention services, as 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, but only if the entity providing such
services--
``(A)(i) is receiving funds under section
2612(a)(1); or
``(ii) is an entity constituting a point of access
to services, as described in section 2617(b)(4), that
maintains a referral relationship with an entity
described in clause (i) and that is serving individuals
at elevated risk of HIV disease;
``(B) demonstrates to the State's satisfaction that
other Federal, State, or local funds are inadequate for
the early intervention services the entity will provide
with funds received under this paragraph; and
``(C) demonstrates to the satisfaction of the State
that funds will be utilized under this paragraph to
supplement not supplant other funds available for such
services in the year for which such funds are being
utilized.''.
SEC. 126. AUTHORIZATION OF APPROPRIATIONS FOR HIV-RELATED SERVICES FOR
WOMEN AND CHILDREN.
Section 2625(c)(2) (42 U.S.C. 300ff-33(c)(2)) is amended by
striking ``fiscal years 1996 through 2000'' and inserting ``fiscal
years 2001 through 2005''.
SEC. 127. REPEAL OF REQUIREMENT FOR COMPLETED INSTITUTE OF MEDICINE
REPORT.
Section 2628 (42 U.S.C. 300ff-36) is repealed.
SEC. 128. 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 by adding at the end the
following:
``SEC. 2622. 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.
``(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(b)(2)(H), 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(b)(2)(H), 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(b)(2)(H),
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(b)(2)(H).
``(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.--The amount of a grant awarded to a
State under this section shall be determined by the Secretary
based on the formula described in section 2618(b)(2), except
that in applying such formula, the Secretary shall--
``(A) substitute `1.0' for `.80' in subparagraph
(A)(ii)(I) of such section; and
``(B) not consider the provisions of subparagraphs
(A)(ii)(II) and (C) of such section.''.
SEC. 129. USE OF TREATMENT FUNDS.
(a) State Duties.--Section 2616(c) (42 U.S.C. 300ff-26(c)) is
amended--
(1) in the matter preceding paragraph (1), by striking
``shall--'' and inserting ``shall use funds made available
under this section to--'';
(2) by redesignating paragraphs (1) through (5) as
subparagraphs (A) through (E), respectively and realigning the
margins of such subparagraphs appropriately;
(3) in subparagraph (D) (as so redesignated), by striking
``and'' at the end;
(4) in subparagraph (E) (as so redesignated), by striking
the period and inserting ``; and''; and
(5) by adding at the end the following:
``(F) encourage, support, and enhance adherence to and
compliance with treatment regimens, including related medical
monitoring.'';
(6) by striking ``In carrying'' and inserting the
following:
``(1) In general.--In carrying''; and
(7) by adding at the end the following:
``(2) Limitations.--
``(A) In general.--No State shall use funds under
paragraph (1)(F) unless the limitations on access to
HIV/AIDS therapeutic regimens as defined in subsection
(e)(2) are eliminated.
``(B) Amount of funding.--No State shall use in
excess of 10 percent of the amount set-aside for use
under this section in any fiscal year to carry out
activities under paragraph (1)(F) unless the State
demonstrates to the Secretary that such additional
services are essential and in no way diminish access to
therapeutics.''.
(b) Supplement Grants.--Section 2616 (42 U.S.C. 300ff-26) is
amended by adding at the end the following:
``(e) Supplemental Grants for the Provision of Treatments.--
``(1) In general.--From amounts made available under
paragraph (5), the Secretary shall award supplemental grants to
States determined to be eligible under paragraph (2) to enable
such States to increase access to therapeutics to treat HIV
disease as provided by the State under subsection (c)(1)(B) for
individuals at or below 200 percent of the Federal poverty
line.
``(2) Criteria.--The Secretary shall develop criteria for
the awarding of grants under paragraph (1) to States that
demonstrate a severe need. In determining the criteria for
demonstrating State severity of need, the Secretary shall
consider eligibility standards and formulary composition.
``(3) State requirement.--The Secretary may not make a
grant to a State under this subsection unless the State agrees
that--
``(A) the State will make available (directly or
through donations from public or private entities) non-
Federal contributions toward the activities to be
carried out under the grant in an amount equal to $1
for each $4 of Federal funds provided in the grant; and
``(B) the State will not impose eligibility
requirements for services or scope of benefits
limitations under subsection (a) that are more
restrictive than such requirements in effect as of
January 1, 2000.
``(4) Use and coordination.--Amounts made available under a
grant under this subsection 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 this section in order to maximize drug coverage.
``(5) Funding.--
``(A) Reservation of amount.--The Secretary shall
reserve 3 percent of any amount referred to in section
2618(b)(2)(H) that is appropriated for a fiscal year,
to carry out this subsection.
``(B) Minimum amount.--In providing grants under
this subsection, the Secretary shall ensure that the
amount of a grant to a State under this part is not
less than the amount the State received under this part
in the previous fiscal year, as a result of grants
provided under this subsection.''.
(c) Supplement and not Supplant.--Section 2616 (42 U.S.C. 300ff-
26(c)), as amended by subsection (b), is further amended by adding at
the end the following:
``(f) Supplement not Supplant.--Notwithstanding any other provision
of law, amounts made available under this section shall be used to
supplement and not supplant other funding available to provide
treatments of the type that may be provided under this section.''.
SEC. 130. INCREASE IN MINIMUM ALLOTMENT.
(a) In General.--Section 2618(b)(1)(A)(i) (42 U.S.C. 300ff-
28(b)(1)(A)(i)) is amended--
(1) in subclause (I), by striking ``$100,000'' and
inserting ``$200,000''; and
(2) in subclause (II), by striking ``$250,000'' and
inserting ``$500,000''.
(b) Territories.--Section 2618(b)(1)(B) (42 U.S.C. 300ff-
28(b)(1)(B)) is amended by inserting ``the greater of $50,000 or''
after ``shall be''.
(c) Technical Amendment.--Section 2618(b)(3)(B) (42 U.S.C. 300ff-
28(b)(3)(B)) is amended by striking ``and the Republic of the Marshall
Islands'' and inserting ``, the Republic of the Marshall Islands, the
Federated States of Micronesia, and the Republic of Palau, and only for
purposes of paragraph (1) the Commonwealth of Puerto Rico''.
SEC. 131. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.
Section 2611(b) (42 U.S.C. 300ff-21(b)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``State shall use''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.
Subtitle C--Amendments to Part C (Early Intervention Services)
SEC. 141. AMENDMENT OF HEADING; REPEAL OF FORMULA GRANT PROGRAM.
(a) Amendment of Heading.--The heading of part C of title XXVI is
amended to read as follows:
``Part C--Early Intervention and Primary Care Services''.
(b) Repeal.--Part C of title XXVI (42 U.S.C. 300ff-41 et seq.) is
amended--
(1) by repealing subpart I; and
(2) by redesignating subparts II and III as subparts I and
II.
(c) Conforming Amendments.--
(1) Information regarding receipt of services.--Section
2661(a) (42 U.S.C. 300ff-61(a)) is amended by striking
``unless--'' and all that follows through ``(2) in the case
of'' and inserting ``unless, in the case of''.
(2) Additional agreements.--Section 2664 (42 U.S.C. 300ff-
64) is amended--
(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).
SEC. 142. PLANNING AND DEVELOPMENT GRANTS.
(a) Allowing Planning and Development Grant To Expand Ability To
Provide Primary Care Services.--Section 2654(c) (42 U.S.C. 300ff-54(c))
is amended--
(1) in paragraph (1), to read as follows:
``(1) In general.--The Secretary may provide planning and
development grants to public and nonprofit private entities for
the purpose of--
``(A) enabling such entities to provide HIV early
intervention services; or
``(B) assisting such entities to expand the
capacity, preparedness, and expertise to deliver
primary care services to individuals with HIV disease
in underserved low-income communities on the condition
that the funds are not used to purchase or improve land
or to purchase, construct, or permanently improve
(other than minor remodeling) any building or other
facility.''; and
(2) in paragraphs (2) and (3) by striking ``paragraph (1)''
each place that such appears and inserting ``paragraph
(1)(A)''.
(b) Amount; Duration.--Section 2654(c) (42 U.S.C. 300ff-54(c)), as
amended by subsection (a), 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) (42 U.S.C. 300ff-
54(c)(5)), as so redesignated by subsection (b), is amended by striking
``1 percent'' and inserting ``5 percent''.
SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CATEGORICAL GRANTS.
Section 2655 (42 U.S.C. 300ff-55) is amended by striking ``1996''
and all that follows through ``2000'' and inserting ``2001 through
2005''.
SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY MANAGEMENT PROGRAM.
Section 2664(g) (42 U.S.C. 300ff-64(g)) is amended--
(1) in paragraph (3), to read as follows:
``(3) the applicant will not expend more than 10 percent of
the grant for costs of administrative activities with respect
to the grant;'';
(2) in paragraph (4), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(5) the applicant will provide for the establishment of a
quality management program to assess the extent to which
medical services funded under this title that are provided to
patients are consistent with the most recent Public Health
Service guidelines for the treatment of HIV disease and related
opportunistic infections and that improvements in the access to
and quality of medical services are addressed.''.
SEC. 145. PREFERENCE FOR CERTAIN AREAS.
Section 2651 (42 U.S.C. 300ff-51) is amended by adding at the end
the following:
``(d) Preference in Awarding Grants.--In awarding new grants under
this section, the Secretary shall give preference to applicants that
will use amounts received under the grant to serve areas that are
determined to be rural and underserved for the purposes of providing
health care to individuals infected with HIV or diagnosed with AIDS.''.
SEC. 146. TECHNICAL AMENDMENT.
Section 2652(a) (42 U.S.C. 300ff-52(a)) is amended--
(1) striking paragraphs (1) and (2) and inserting the
following:
``(1) health centers under section 330;''; and
(2) by redesignating paragraphs (3) through (6) as
paragraphs (2) through (5), respectively.
Subtitle D--Amendments to Part D (General Provisions)
SEC. 151. RESEARCH INVOLVING 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
(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.''.
(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 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) Authorization of Appropriations.--Section 2671(j) (42 U.S.C.
300ff-71(j)) is amended by striking ``fiscal years 1996 through 2000''
and inserting ``fiscal years 2001 through 2005''.
SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.
Section 2671 (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:
``(i) Limitation on Administrative Expenses.--
``(1) Determination by secretary.--Not later than 12 months
after the date of 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.''.
SEC. 153. EVALUATIONS AND REPORTS.
Section 2674(c) (42 U.S.C. 399ff-74(c)) is amended by striking
``1991 through 1995'' and inserting ``2001 through 2005''.
SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR GRANTS UNDER PARTS A AND
B.
Section 2677 (42 U.S.C. 300ff-77) is amended to read as follows:
``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated--
``(1) such sums as may be necessary to carry out part A for
each of the fiscal years 2001 through 2005; and
``(2) such sums as may be necessary to carry out part B for
each of the fiscal years 2001 through 2005.''.
Subtitle E--Amendments to Part F (Demonstration and Training)
SEC. 161. AUTHORIZATION OF APPROPRIATIONS.
(a) Schools; Centers.--Section 2692(c)(1) (42 U.S.C. 300ff-
111(c)(1)) is amended by striking ``fiscal years 1996 through 2000''
and inserting ``fiscal years 2001 through 2005''.
(b) Dental Schools.--Section 2692(c)(2) (42 U.S.C. 300ff-111(c)(2))
is amended by striking ``fiscal years 1996 through 2000'' and inserting
``fiscal years 2001 through 2005''.
(c) Dental Schools and Programs.--Section 2692(b) of the Public
Health Service Act (42 U.S.C. 300ff-111(b)) is amended--
(1) in paragraph (1), by striking ``777(b)(4)(B)'' and
inserting ``777(b)(4)(B) (as such section existed on the day
before the date of enactment of the Health Professions
Education Partnerships Act of 1998 (Public Law 105-392)) and
dental hygiene programs that are accredited by the Commission
on Dental Accreditation''; and
(2) in paragraph (2), by striking ``777(b)(4)(B)'' and
inserting ``777(b)(4)(B) (as such section existed on the day
before the date of enactment of the Health Professions
Education Partnerships Act of 1998 (Public Law 105-392))''.
TITLE II--MISCELLANEOUS PROVISIONS
SEC. 201. INSTITUTE OF MEDICINE STUDY.
(a) In General.--Not later than 120 days after the date of
enactment of this Act, the Secretary of Health and Human Services shall
enter into a contract with the Institute of Medicine for the conduct of
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.
(b) Requirements.--
(1) Completion.--The study under subsection (a) shall be
completed not later than 21 months after the date on which the
contract referred to in such subsection is entered into.
(2) Issues to be considered.--The study conducted under
subsection (a) shall consider--
(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;
(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; and
(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) Report.--Not later than 90 days after the date on which the
study is completed under subsection (a), the Secretary of Health and
Human Services shall prepare and submit to the appropriate committees
of Congress a report describing the manner in which the conclusions and
recommendations of the Institute of Medicine can be addressed and
implemented.
Passed the Senate June 6, 2000.
Attest:
Secretary.
106th CONGRESS
2d Session
S. 2311
_______________________________________________________________________
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.
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