[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6143 Reported in House (RH)]







                                                 Union Calendar No. 420
109th CONGRESS
  2d Session
                                H. R. 6143

                          [Report No. 109-695]

  To amend title XXVI of the Public Health Service Act to revise and 
 extend the program for providing life-saving care for those with HIV/
                                 AIDS.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 21, 2006

  Mrs. Bono (for herself, Mr. Pitts, Mr. Barton of Texas, Mr. Deal of 
   Georgia, Mr. Radanovich, Mr. Norwood, Mr. Upton, Mr. Buyer, Mrs. 
  Myrick, Mr. Gillmor, and Mr. Terry) introduced the following bill; 
       which was referred to the Committee on Energy and Commerce

                           September 28, 2006

Committed to the Committee of the Whole House on the State of the Union 
                       and ordered to be printed

_______________________________________________________________________

                                 A BILL


 
  To amend title XXVI of the Public Health Service Act to revise and 
 extend the program for providing life-saving care for those with HIV/
                                 AIDS.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Ryan White HIV/
AIDS Treatment Modernization Act of 2006''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
              TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS

Sec. 101. Establishment of program; general eligibility for grants.
Sec. 102. Type and distribution of grants; formula grants.
Sec. 103. Type and distribution of grants; supplemental grants.
Sec. 104. Timeframe for obligation and expenditure of grant funds.
Sec. 105. Use of amounts.
Sec. 106. Additional amendments to part A.
Sec. 107. New program in part A; transitional grants for certain areas 
                            ineligible under section 2601.
Sec. 108. Authorization of appropriations for part A.
                         TITLE II--CARE GRANTS

Sec. 201. General use of grants.
Sec. 202. AIDS Drug Assistance Program.
Sec. 203. Distribution of funds.
Sec. 204. Additional amendments to subpart I of part B.
Sec. 205. Supplemental grants on basis of demonstrated need.
Sec. 206. Emerging communities.
Sec. 207. Timeframe for obligation and expenditure of grant funds.
Sec. 208. Authorization of appropriations for subpart I of part B.
Sec. 209. Early diagnosis grant program.
Sec. 210. Certain partner notification programs; authorization of 
                            appropriations.
                 TITLE III--EARLY INTERVENTION SERVICES

Sec. 301. Establishment of program; core medical services.
Sec. 302. Eligible entities; preferences; planning and development 
                            grants.
Sec. 303. Authorization of appropriations.
Sec. 304. Confidentiality and informed consent.
Sec. 305. Provision of certain counseling services.
Sec. 306. General provisions.
             TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH

Sec. 401. Women, infants, children, and youth.
Sec. 402. GAO Report.
                      TITLE V--GENERAL PROVISIONS

Sec. 501. General provisions.
                  TITLE VI--DEMONSTRATION AND TRAINING

Sec. 601. Demonstration and training.
Sec. 602. AIDS education and training centers.
Sec. 603. Codification of minority AIDS initiative.
                  TITLE VII--MISCELLANEOUS PROVISIONS

Sec. 701. Hepatitis; use of funds.
Sec. 702. Certain references.

              TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS

SEC. 101. ESTABLISHMENT OF PROGRAM; GENERAL ELIGIBILITY FOR GRANTS.

    (a) In General.--Section 2601 of the Public Health Service Act (42 
U.S.C. 300ff-11) is amended by strikingstriking subsections (b) through 
(d) and inserting the following:
    ``(b) Continued Status as Eligible Area.--Notwithstanding any other 
provision of this section, a metropolitan area that is an eligible area 
for a fiscal year continues to be an eligible area until the 
metropolitan area fails, for three consecutive fiscal years--
            ``(1) to meet the requirements of subsection (a); and
            ``(2) to have a cumulative total of 3,000 or more living 
        cases of AIDS (reported to and confirmed by the Director of the 
        Centers for Disease Control and Prevention) as of December 31 
        of the most recent calendar year for which such data is 
        available.
    ``(c) Boundaries.--For purposes of determining eligibility under 
this part--
            ``(1) with respect to a metropolitan area that received 
        funding under this part in fiscal year 2006, the boundaries of 
        such metropolitan area shall be the boundaries that were in 
        effect for such area for fiscal year 1994; or
            ``(2) with respect to a metropolitan area that becomes 
        eligible to receive funding under this part in any fiscal year 
        after fiscal year 2006, the boundaries of such metropolitan 
        area shall be the boundaries that are in effect for such area 
        when such area initially receives funding under this part.''.
    (b) Technical and Conforming Amendments.--Section 2601(a) of the 
Public Health Service Act (42 U.S.C. 300ff-11(a)) is amended--
            (1) by striking ``through (d)'' and inserting ``through 
        (c)''; and
            (2) by inserting ``and confirmed by'' after ``reported 
        to''.
    (c) Definition of Metropolitan Area.--Section 2607(2) of the Public 
Health Service Act (42 U.S.C. 300ff-17(2)) is amended--
            (1) by striking ``area referred'' and inserting ``area that 
        is referred''; and
            (2) by inserting before the period the following: ``, and 
        that has a population of 50,000 or more individuals''.

SEC. 102. TYPE AND DISTRIBUTION OF GRANTS; FORMULA GRANTS.

    (a) Distribution Percentages.--Section 2603(a)(2) of the Public 
Health Service Act (42 U.S.C. 300ff-13(a)(2)) is amended--
            (1) in the first sentence--
                    (A) by striking ``50 percent of the amount 
                appropriated under section 2677'' and inserting ``66\2/
                3\ percent of the amount made available under section 
                2610(b) for carrying out this subpart''; and
                    (B) by striking ``paragraph (3)'' and inserting 
                ``paragraphs (3) and (4)''.
            (2) by striking the last sentence.
    (b) Distribution Based on Living Cases of HIV/AIDS.--Section 
2603(a)(3) of the Public Health Service Act (42 U.S.C. 300ff-13(a)(3)) 
is amended--
            (1) in subparagraph (B), by striking ``estimated living 
        cases of acquired immune deficiency syndrome'' and inserting 
        ``living cases of HIV/AIDS (reported to and confirmed by the 
        Director of the Centers for Disease Control and Prevention)''; 
        and
            (2) by striking subparagraphs (C) through (E) and inserting 
        the following:
                    ``(C) Living cases of hiv/aids.--
                            ``(i) Requirement of names-based 
                        reporting.--Except as provided in clause (ii), 
                        the number determined under this subparagraph 
                        for an eligible area for a fiscal year for 
                        purposes of subparagraph (B) is the number of 
                        living names-based cases of HIV/AIDS that, as 
                        of December 31 of the most recent calendar year 
                        for which such data is available, have been 
                        reported to and confirmed by the Director of 
                        the Centers for Disease Control and Prevention.
                            ``(ii) Transition period; exemption 
                        regarding non-aids cases.--For each of the 
                        fiscal years 2007 through 2010, an eligible 
                        area is, subject to clauses (iii) through (v), 
                        exempt from the requirement under clause (i) 
                        that living names-based non-AIDS cases of HIV 
                        be reported unless--
                                    ``(I) a system was in operation as 
                                of December 31, 2005, that provides 
                                sufficiently accurate and reliable 
                                names-based reporting of such cases 
                                throughout the State in which the area 
                                is located, subject to clause (viii); 
                                or
                                    ``(II) no later than the beginning 
                                of fiscal year 2008, 2009, or 2010, the 
                                Secretary, in consultation with the 
                                chief executive of the State in which 
                                the area is located, determines that a 
                                system has become operational in the 
                                State that provides sufficiently 
                                accurate and reliable names-based 
                                reporting of such cases throughout the 
                                State.
                            ``(iii) Requirements for exemption for 
                        fiscal year 2007.--For fiscal year 2007, an 
                        exemption under clause (ii) for an eligible 
                        area applies only if, by October 1, 2006--
                                    ``(I)(aa) the State in which the 
                                area is located had submitted to the 
                                Secretary a plan for making the 
                                transition to sufficiently accurate and 
                                reliable names-based reporting of 
                                living non-AIDS cases of HIV; or
                                    ``(bb) all statutory changes 
                                necessary to provide for sufficiently 
                                accurate and reliable reporting of such 
                                cases had been made; and
                                    ``(II) the State had agreed that, 
                                by April 1, 2008, the State will begin 
                                accurate and reliable names-based 
                                reporting of such cases, except that 
                                such agreement is not required to 
                                provide that, as of such date, the 
                                system for such reporting be fully 
                                sufficient with respect to accuracy and 
                                reliability throughout the area.
                            ``(iv) Requirement for exemption as of 
                        fiscal year 2008.--For each of the fiscal years 
                        2008 through 2010, an exemption under clause 
                        (ii) for an eligible area applies only if, as 
                        of April 1, 2008, the State in which the area 
                        is located is substantially in compliance with 
                        the agreement under clause (iii)(II).
                            ``(v) Progress toward names-based 
                        reporting.--For fiscal year 2009 or 2010, the 
                        Secretary may terminate an exemption under 
                        clause (ii) for an eligible area if the State 
                        in which the area is located submitted a plan 
                        under clause (iii)(I)(aa) and the Secretary 
                        determines that the State is not substantially 
                        following the plan.
                            ``(vi) Counting of cases in areas with 
                        exemptions.--
                                    ``(I) In general.--With respect to 
                                an eligible area that is under a 
                                reporting system for living non-AIDS 
                                cases of HIV that is not names-based 
                                (referred to in this subparagraph as 
                                `code-based reporting'), the Secretary 
                                shall, for purposes of this 
                                subparagraph, modify the number of such 
                                cases reported for the eligible area in 
                                order to adjust for duplicative 
                                reporting in and among systems that use 
                                code-based reporting.
                                    ``(II) Adjustment rate.--The 
                                adjustment rate under subclause (I) for 
                                an eligible area shall be a reduction 
                                of 5 percent in the number of living 
                                non-AIDS cases of HIV reported for the 
                                area.
                            ``(vii) Multiple political jurisdictions.--
                        With respect to living non-AIDS cases of HIV, 
                        if an eligible area is not entirely within one 
                        political jurisdiction and as a result is 
                        subject to more than one reporting system for 
                        purposes of this subparagraph:
                                    ``(I) Names-based reporting under 
                                clause (i) applies in a jurisdictional 
                                portion of the area, or an exemption 
                                under clause (ii) applies in such 
                                portion (subject to applicable 
                                provisions of this subparagraph), 
                                according to whether names-based 
                                reporting or code-based reporting is 
                                used in such portion.
                                    ``(II) If under subclause (I) both 
                                names-based reporting and code-based 
                                reporting apply in the area, the number 
                                of code-based cases shall be reduced 
                                under clause (vi).
                            ``(viii) List of eligible areas meeting 
                        standard regarding december 31, 2005.--
                                    ``(I) In general.--If an eligible 
                                area or portion thereof is in a State 
                                specified in subclause (II), the 
                                eligible area or portion shall be 
                                considered to meet the standard 
                                described in clause (ii)(I). No other 
                                eligible area or portion thereof may be 
                                considered to meet such standard.
                                    ``(II) Relevant states.--For 
                                purposes of subclause (I), the States 
                                specified in this subclause are the 
                                following: Alaska, Alabama, Arkansas, 
                                Arizona, Colorado, Florida, Indiana, 
                                Iowa, Idaho, Kansas, Louisiana, 
                                Michigan, Minnesota, Missouri, 
                                Mississippi, North Carolina, North 
                                Dakota, Nebraska, New Jersey, New 
                                Mexico, New York, Nevada, Ohio, 
                                Oklahoma, South Carolina, South Dakota, 
                                Tennessee, Texas, Utah, Virginia, 
                                Wisconsin, West Virginia, Wyoming, 
                                Guam, and the Virgin Islands.
                            ``(ix) Rules of construction regarding 
                        acceptance of reports.--
                                    ``(I) Cases of aids.--With respect 
                                to an eligible area that is subject to 
                                the requirement under clause (i) and is 
                                not in compliance with the requirement 
                                for names-based reporting of living 
                                non-AIDS cases of HIV, the Secretary 
                                shall, notwithstanding such 
                                noncompliance, accept reports of living 
                                cases of AIDS that are in accordance 
                                with such clause.
                                    ``(II) Applicability of exemption 
                                requirements.--The provisions of 
                                clauses (ii) through (viii) may not be 
                                construed as having any legal effect 
                                for fiscal year 2011 or any subsequent 
                                fiscal year, and accordingly, the 
                                status of a State for purposes of such 
                                clauses may not be considered after 
                                fiscal year 2010.
                            ``(x) Program for detecting inaccurate or 
                        fraudulent counting.--The Secretary shall carry 
                        out a program to monitor the reporting of 
                        names-based cases for purposes of this 
                        subparagraph and to detect instances of 
                        inaccurate reporting, including fraudulent 
                        reporting.''.
    (c) Code-Based Areas; Limitation on Increase in Grant.--Section 
2603(a)(3) of the Public Health Service Act (42 U.S.C. 300ff-13(a)), as 
amended by subsection (b)(2) of this section, is amended by adding at 
the end the following subparagraph:
                    ``(D) Code-based areas; limitation on increase in 
                grant.--
                            ``(i) In general.--For each of the fiscal 
                        years 2007 through 2010, if code-based 
                        reporting (within the meaning of subparagraph 
                        (C)(vi)) applies in an eligible area or any 
                        portion thereof as of the beginning of the 
                        fiscal year involved, then notwithstanding any 
                        other provision of this paragraph, the amount 
                        of the grant pursuant to this paragraph for 
                        such area for such fiscal year may not--
                                    ``(I) for fiscal year 2007, exceed 
                                by more than 5 percent the amount of 
                                the grant for the area that would have 
                                been made pursuant to this paragraph 
                                and paragraph (4) for fiscal year 2006 
                                (as such paragraphs were in effect for 
                                such fiscal year) if paragraph (2) (as 
                                so in effect) had been applied by 
                                substituting `66\2/3\ percent' for `50 
                                percent'; and
                                    ``(II) for each of the fiscal years 
                                2008 and 2009, exceed by more than 5 
                                percent the amount of the grant 
                                pursuant to this paragraph and 
                                paragraph (4) for the area for the 
                                preceding fiscal year.
                            ``(ii) Use of amounts involved.--For each 
                        of the fiscal years 2007 through 2010, amounts 
                        available as a result of the limitation under 
                        clause (i) shall be made available by the 
                        Secretary as additional amounts for grants 
                        pursuant to subsection (b) for the fiscal year 
                        involved, subject to paragraph (4) and section 
                        2610(d)(2).''.
    (d) Hold Harmless.--Section 2603(a) of the Public Health Service 
Act (42 U.S.C. 300ff-13(a)) is amended--
            (1) in paragraph (3)(A)--
                    (A) in clause (ii), by striking the period at the 
                end and inserting a semicolon; and
                    (B) by inserting after and below clause (ii) the 
                following:
                ``which product shall then, as applicable, be increased 
                under paragraph (4).''.
            (2) by amending paragraph (4) to read as follows:
            ``(4) Increases in grant.--
                    ``(A) In general.--For each eligible area that 
                received a grant pursuant to this subsection for fiscal 
                year 2006, the Secretary shall, for each of the fiscal 
                years 2007 through 2009, increase the amount of the 
                grant made pursuant to paragraph (3) for the area to 
                ensure that the amount of the grant for the fiscal year 
                involved is not less than the following amount, as 
                applicable to such fiscal year:
                            ``(i) For fiscal year 2007, an amount equal 
                        to 95 percent of the amount of the grant that 
                        would have been made pursuant to paragraph (3) 
                        and this paragraph for fiscal year 2006 (as 
                        such paragraphs were in effect for such fiscal 
                        year) if paragraph (2) (as so in effect) had 
                        been applied by substituting `66\2/3\ percent' 
                        for `50 percent'.
                            ``(ii) For each of the fiscal years 2008 
                        and 2009, an amount equal to 95 percent of the 
                        amount of the grant made pursuant to paragraph 
                        (3) and this paragraph for the preceding fiscal 
                        year.
                    ``(B) Source of funds for increase.--
                            ``(i) In general.--From the amounts 
                        available for carrying out the single program 
                        referred to in section 2609(d)(2)(C) for a 
                        fiscal year (relating to supplemental grants), 
                        the Secretary shall make available such amounts 
                        as may be necessary to comply with subparagraph 
                        (A), subject to section 2610(d)(2).
                            ``(ii) Pro rata reduction.--If the amounts 
                        referred to in clause (i) for a fiscal year are 
                        insufficient to fully comply with subparagraph 
                        (A) for the year, the Secretary, in order to 
                        provide the additional funds necessary for such 
                        compliance, shall reduce on a pro rata basis 
                        the amount of each grant pursuant to this 
                        subsection for the fiscal year, other than 
                        grants for eligible areas for which increases 
                        under subparagraph (A) apply. A reduction under 
                        the preceding sentence may not be made in an 
                        amount that would result in the eligible area 
                        involved becoming eligible for such an 
                        increase.
                    ``(C) Limitation.--This paragraph may not be 
                construed as having any applicability after fiscal year 
                2009.''.

SEC. 103. TYPE AND DISTRIBUTION OF GRANTS; SUPPLEMENTAL GRANTS.

    Section 2603(b) of the Public Health Service Act (42 U.S.C. 300ff-
13(b)) is amended--
            (1) in paragraph (1)--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``Not later than'' and all that follows 
                through ``the Secretary shall'' and inserting the 
                following: ``Subject to subsection (a)(4)(B)(i) and 
                section 2610(d), the Secretary shall'';
                    (B) in subparagraph (B), by striking ``demonstrates 
                the severe need in such area'' and inserting 
                ``demonstrates the need in such area, on an objective 
                and quantified basis,'';
                    (C) by striking subparagraph (F) and inserting the 
                following:
                    ``(F) demonstrates the inclusiveness of affected 
                communities and individuals with HIV/AIDS;'';
                    (D) in subparagraph (G), by striking the period and 
                inserting ``; and''; and
                    (E) by adding at the end the following:
                    ``(H) demonstrates the ability of the applicant to 
                expend funds efficiently by not having had, for the 
                most recent grant year under subsection (a) for which 
                data is available, more than 2 percent of grant funds 
                under such subsection canceled or covered by any 
                waivers under subsection (c)(3).''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (A), by striking ``severe 
                need'' and inserting ``demonstrated need'';
                    (B) by striking subparagraph (B) and inserting the 
                following:
                    ``(B) Demonstrated need.--The factors considered by 
                the Secretary in determining whether an eligible area 
                has a demonstrated need for purposes of paragraph 
                (1)(B) may include any or all of the following:
                            ``(i) The unmet need for such services, as 
                        determined under section 2602(b)(4) or other 
                        community input process as defined under 
                        section 2609(d)(1)(A).
                            ``(ii) An increasing need for HIV/AIDS-
                        related services, including relative rates of 
                        increase in the number of cases of HIV/AIDS.
                            ``(iii) The relative rates of increase in 
                        the number of cases of HIV/AIDS within new or 
                        emerging subpopulations.
                            ``(iv) The current prevalence of HIV/AIDS.
                            ``(v) Relevant factors related to the cost 
                        and complexity of delivering health care to 
                        individuals with HIV/AIDS in the eligible area.
                            ``(vi) The impact of co-morbid factors, 
                        including co-occurring conditions, determined 
                        relevant by the Secretary.
                            ``(vii) The prevalence of homelessness.
                            ``(viii) The prevalence of individuals 
                        described under section 2602(b)(2)(M).
                            ``(ix) The relevant factors that limit 
                        access to health care, including geographic 
                        variation, adequacy of health insurance 
                        coverage, and language barriers.
                            ``(x) The impact of a decline in the amount 
                        received pursuant to subsection (a) on services 
                        available to all individuals with HIV/AIDS 
                        identified and eligible under this title.''; 
                        and
                    (C) by striking subparagraphs (C) and (D) and 
                inserting the following:
                    ``(C) Priority in making grants.--The Secretary 
                shall provide funds under this subsection to an 
                eligible area to address the decline in services 
                related to the decline in the amounts received pursuant 
                to subsection (a) consistent with the grant award for 
                the eligible area for fiscal year 2006, to the extent 
                that the factor under subparagraph (B)(x) (relating to 
                a decline in funding) applies to the eligible area.''.

SEC. 104. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT FUNDS.

    Section 2603 of the Public Health Service Act (42 U.S.C. 300ff-13) 
is amended--
            (1) by redesignating subsection (c) as subsection (d); and
            (2) by inserting after subsection (b) the following:
    ``(c) Timeframe for Obligation and Expenditure of Grant Funds.--
            ``(1) Obligation by end of grant year.--Effective for 
        fiscal year 2007 and subsequent fiscal years, funds from a 
        grant award made pursuant to subsection (a) or (b) for a fiscal 
        year are available for obligation by the eligible area involved 
        through the end of the one-year period beginning on the date in 
        such fiscal year on which funds from the award first become 
        available to the area (referred to in this subsection as the 
        `grant year for the award'), except as provided in paragraph 
        (3)(A).
            ``(2) Supplemental grants; cancellation of unobligated 
        balance of grant award.--Effective for fiscal year 2007 and 
        subsequent fiscal years, if a grant award made pursuant to 
        subsection (b) for an eligible area for a fiscal year has an 
        unobligated balance as of the end of the grant year for the 
        award--
                    ``(A) the Secretary shall cancel that unobligated 
                balance of the award, and shall require the eligible 
                area to return any amounts from such balance that have 
                been disbursed to the area; and
                    ``(B) the funds involved shall be made available by 
                the Secretary as additional amounts for grants pursuant 
                to subsection (b) for the first fiscal year beginning 
                after the fiscal year in which the Secretary obtains 
                the information necessary for determining that the 
                balance is required under subparagraph (A) to be 
                canceled, except that the availability of the funds for 
                such grants is subject to subsection (a)(4) and section 
                2610(d)(2) as applied for such year.
            ``(3) Formula grants; cancellation of unobligated balance 
        of grant award; waiver permitting carryover.--
                    ``(A) In general.--Effective for fiscal year 2007 
                and subsequent fiscal years, if a grant award made 
                pursuant to subsection (a) for an eligible area for a 
                fiscal year has an unobligated balance as of the end of 
                the grant year for the award, the Secretary shall 
                cancel that unobligated balance of the award, and shall 
                require the eligible area to return any amounts from 
                such balance that have been disbursed to the area, 
                unless--
                            ``(i) before the end of the grant year, the 
                        chief executive officer of the area submits to 
                        the Secretary a written application for a 
                        waiver of the cancellation, which application 
                        includes a description of the purposes for 
                        which the area intends to expend the funds 
                        involved; and
                            ``(ii) the Secretary approves the waiver.
                    ``(B) Expenditure by end of carryover year.--With 
                respect to a waiver under subparagraph (A) that is 
                approved for a balance that is unobligated as of the 
                end of a grant year for an award:
                            ``(i) The unobligated funds are available 
                        for expenditure by the eligible area involved 
                        for the one-year period beginning upon the 
                        expiration of the grant year (referred to in 
                        this subsection as the `carryover year').
                            ``(ii) If the funds are not expended by the 
                        end of the carryover year, the Secretary shall 
                        cancel that unexpended balance of the award, 
                        and shall require the eligible area to return 
                        any amounts from such balance that have been 
                        disbursed to the area.
                    ``(C) Use of cancelled balances.--In the case of 
                any balance of a grant award that is cancelled under 
                subparagraph (A) or (B)(ii), the grant funds involved 
                shall be made available by the Secretary as additional 
                amounts for grants pursuant to subsection (b) for the 
                first fiscal year beginning after the fiscal year in 
                which the Secretary obtains the information necessary 
                for determining that the balance is required under such 
                subparagraph to be canceled, except that the 
                availability of the funds for such grants is subject to 
                subsection (a)(4) and section 2610(d)(2) as applied for 
                such year.
                    ``(D) Corresponding reduction in future grant.--
                            ``(i) In general.--In the case of an 
                        eligible area for which a balance from a grant 
                        award under subsection (a) is unobligated as of 
                        the end of the grant year for the award--
                                    ``(I) the Secretary shall reduce, 
                                by the same amount as such unobligated 
                                balance, the amount of the grant under 
                                such subsection for the first fiscal 
                                year beginning after the fiscal year in 
                                which the Secretary obtains the 
                                information necessary for determining 
                                that such balance was unobligated as of 
                                the end of the grant year (which 
                                requirement for a reduction applies 
                                without regard to whether a waiver 
                                under subparagraph (A) has been 
                                approved with respect to such balance); 
                                and
                                    ``(II) the grant funds involved in 
                                such reduction shall be made available 
                                by the Secretary as additional funds 
                                for grants pursuant to subsection (b) 
                                for such first fiscal year, subject to 
                                subsection (a)(4) and section 
                                2610(d)(2);
                        except that this clause does not apply to the 
                        eligible area if the amount of the unobligated 
                        balance was 2 percent or less.
                            ``(ii) Relation to increases in grant.--A 
                        reduction under clause (i) for an eligible area 
                        for a fiscal year may not be taken into account 
                        in applying subsection (a)(4) with respect to 
                        the area for the subsequent fiscal year.''.

SEC. 105. USE OF AMOUNTS.

    Section 2604 of the Public Health Service Act (42 U.S.C. 300ff-14) 
is amended to read as follows:

``SEC. 2604. USE OF AMOUNTS.

    ``(a) Requirements.--The Secretary may not make a grant under 
section 2601(a) to the chief elected official of an eligible area 
unless such political subdivision agrees that--
            ``(1) subject to paragraph (2), the allocation of funds and 
        services within the eligible area will be made in accordance 
        with the priorities established, pursuant to section 
        2602(b)(4)(C), by the HIV health services planning council that 
        serves such eligible area;
            ``(2) funds provided under section 2601 will be expended 
        only for--
                    ``(A) core medical services described in subsection 
                (c);
                    ``(B) support services described in subsection (d); 
                and
                    ``(C) administrative expenses described in 
                subsection (h); and
            ``(3) the use of such funds will comply with the 
        requirements of this section.
    ``(b) Direct Financial Assistance to Appropriate Entities.--
            ``(1) In general.--The chief elected official of an 
        eligible area shall use amounts from a grant under section 2601 
        to provide direct financial assistance to entities described in 
        paragraph (2) for the purpose of providing core medical 
        services and support services.
            ``(2) Appropriate entities.--Direct financial assistance 
        may be provided under paragraph (1) to public or nonprofit 
        private entities, or private for-profit entities if such 
        entities are the only available provider of quality HIV care in 
        the area.
    ``(c) Required Funding for Core Medical Services.--
            ``(1) In general.--With respect to a grant under section 
        2601 for an eligible area for a grant year, the chief elected 
        official of the area shall, of the portion of the grant 
        remaining after reserving amounts for purposes of paragraphs 
        (1) and (5)(B)(i) of subsection (h), use not less than 75 
        percent to provide core medical services that are needed in the 
        eligible area for individuals with HIV/AIDS who are identified 
        and eligible under this title (including services regarding the 
        co-occurring conditions of the individuals).
            ``(2) Waiver.--
                    ``(A) In general.--The Secretary shall waive the 
                application of paragraph (1) with respect to a chief 
                elected official for a grant year if the Secretary 
                determines that, within the eligible area involved--
                            ``(i) there are no waiting lists for AIDS 
                        Drug Assistance Program services under section 
                        2616; and
                            ``(ii) core medical services are available 
                        to all individuals with HIV/AIDS identified and 
                        eligible under this title.
                    ``(B) Notification of waiver status.--When 
                informing the chief elected official of an eligible 
                area that a grant under section 2601 is being made for 
                the area for a grant year, the Secretary shall inform 
                the official whether a waiver under subparagraph (A) is 
                in effect for such year.
            ``(3) Core medical services.--For purposes of this 
        subsection, the term `core medical services', with respect to 
        an individual with HIV/AIDS (including the co-occurring 
        conditions of the individual), means the following services:
                    ``(A) Outpatient and ambulatory health services.
                    ``(B) AIDS Drug Assistance Program treatments in 
                accordance with section 2616.
                    ``(C) AIDS pharmaceutical assistance.
                    ``(D) Oral health care.
                    ``(E) Early intervention services described in 
                subsection (e).
                    ``(F) Health insurance premium and cost sharing 
                assistance for low-income individuals in accordance 
                with section 2615.
                    ``(G) Home health care.
                    ``(H) Medical nutrition therapy.
                    ``(I) Hospice services.
                    ``(J) Home and community-based health services as 
                defined under section 2614(c).
                    ``(K) Mental health services.
                    ``(L) Substance abuse outpatient care.
                    ``(M) Medical case management, including treatment 
                adherence services.
    ``(d) Support Services.--
            ``(1) In general.--For purposes of this section, the term 
        `support services' means services, subject to the approval of 
        the Secretary, that are needed for individuals with HIV/AIDS to 
        achieve their medical outcomes (such as respite care for 
        persons caring for individuals with HIV/AIDS, outreach 
        services, medical transportation, linguistic services, and 
        referrals for health care and support services).
            ``(2) Medical outcomes.--In this subsection, the term 
        `medical outcomes' means those outcomes affecting the HIV-
        related clinical status of an individual with HIV/AIDS.
    ``(e) Early Intervention Services.--
            ``(1) In general.--For purposes of this section, the term 
        `early intervention services' means HIV/AIDS early intervention 
        services described in section 2651(e), with follow-up referral 
        provided for the purpose of facilitating the access of 
        individuals receiving the services to HIV-related health 
        services. The 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/AIDS counseling and testing sites, health care points of 
        entry specified by eligible areas, federally qualified health 
        centers, and entities described in section 2652(a) that 
        constitute a point of access to services by maintaining 
        referral relationships.
            ``(2) Conditions.--With respect to an entity that proposes 
        to provide early intervention services under paragraph (1), 
        such paragraph shall apply only if the entity demonstrates to 
        the satisfaction of the chief elected official for the eligible 
        area involved that--
                    ``(A) Federal, State, or local funds are otherwise 
                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.
    ``(f) Priority for Women, Infants, Children, and Youth.--
            ``(1) In general.--For the purpose of providing health and 
        support services to infants, children, youth, and women with 
        HIV/AIDS, including treatment measures to prevent the perinatal 
        transmission of HIV, the chief elected official of an eligible 
        area, in accordance with the established priorities of the 
        planning council, shall for each of such populations in the 
        eligible area use, from the grants made for the area under 
        section 2601(a) for a fiscal year, not less than the percentage 
        constituted by the ratio of the population involved (infants, 
        children, youth, or women in such area) with HIV/AIDS to the 
        general population in such area of individuals with HIV/AIDS.
            ``(2) Waiver.--With respect to the population involved, the 
        Secretary may provide to the chief elected official of an 
        eligible area a waiver of the requirement of paragraph (1) if 
        such official demonstrates to the satisfaction of the Secretary 
        that the population is receiving HIV-related health services 
        through the State medicaid program under title XIX of the 
        Social Security Act, the State children's health insurance 
        program under title XXI of such Act, or other Federal or State 
        programs.
    ``(g) Requirement of Status as Medicaid Provider.--
            ``(1) Provision of service.--Subject to paragraph (2), the 
        Secretary may not make a grant under section 2601(a) for the 
        provision of services under this section in a State unless, in 
        the case of any such service that is available pursuant to the 
        State plan approved under title XIX of the Social Security Act 
        for the State--
                    ``(A) the political subdivision involved will 
                provide the service directly, and the political 
                subdivision has entered into a participation agreement 
                under the State plan and is qualified to receive 
                payments under such plan; or
                    ``(B) the political subdivision will enter into an 
                agreement with a public or nonprofit private entity 
                under which the entity will provide the service, and 
                the entity has entered into such a participation 
                agreement and is qualified to receive such payments.
            ``(2) Waiver.--
                    ``(A) In general.--In the case of an entity making 
                an agreement pursuant to paragraph (1)(B) regarding the 
                provision of services, the requirement established in 
                such paragraph shall be waived by the HIV health 
                services planning council for the eligible area if the 
                entity does not, in providing health care services, 
                impose a charge or accept reimbursement available from 
                any third-party payor, including reimbursement under 
                any insurance policy or under any Federal or State 
                health benefits program.
                    ``(B) Determination.--A determination by the HIV 
                health services planning council of whether an entity 
                referred to in subparagraph (A) meets the criteria for 
                a waiver under such subparagraph shall be made without 
                regard to whether the entity accepts voluntary 
                donations for the purpose of providing services to the 
                public.
    ``(h) Administration.--
            ``(1) Limitation.--The chief executive officer of an 
        eligible area shall not use in excess of 10 percent of amounts 
        received under a grant under this part for administrative 
        expenses.
            ``(2) Allocations by chief executive officer.--In the case 
        of entities and subcontractors to which the chief executive 
        officer of an eligible area allocates amounts received by the 
        officer under a grant under this part, the officer shall ensure 
        that, of the aggregate amount so allocated, the total of the 
        expenditures by such entities for administrative expenses does 
        not exceed 10 percent (without regard to whether particular 
        entities expend more than 10 percent for such expenses).
            ``(3) Administrative activities.--For purposes of paragraph 
        (1), amounts may be used for administrative activities that 
        include--
                    ``(A) routine grant administration and monitoring 
                activities, including the development of applications 
                for part A funds, the receipt and disbursal of program 
                funds, the development and establishment of 
                reimbursement and accounting systems, the development 
                of a clinical quality management program as described 
                in paragraph (5), the preparation of routine 
                programmatic and financial reports, and compliance with 
                grant conditions and audit requirements; and
                    ``(B) all activities associated with the grantee's 
                contract award procedures, including the activities 
                carried out by the HIV health services planning council 
                as established under section 2602(b), the development 
                of requests for proposals, contract proposal review 
                activities, negotiation and awarding of contracts, 
                monitoring of contracts through telephone consultation, 
                written documentation or onsite visits, reporting on 
                contracts, and funding reallocation activities.
            ``(4) Subcontractor administrative activities.--For the 
        purposes of this subsection, subcontractor administrative 
        activities include--
                    ``(A) usual and recognized overhead activities, 
                including established indirect rates for agencies;
                    ``(B) management oversight of specific programs 
                funded under this title; and
                    ``(C) other types of program support such as 
                quality assurance, quality control, and related 
                activities.
            ``(5) Clinical quality management.--
                    ``(A) Requirement.--The chief elected official of 
                an eligible area that receives a grant under this part 
                shall provide for the establishment of a clinical 
                quality 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/AIDS 
                and related opportunistic infection, and as applicable, 
                to develop strategies for ensuring that such services 
                are consistent with the guidelines for improvement in 
                the access to and quality of HIV health services.
                    ``(B) Use of funds.--
                            ``(i) In general.--From amounts received 
                        under a grant awarded under this subpart for a 
                        fiscal year, the chief elected official of an 
                        eligible area may use for activities associated 
                        with the clinical quality management program 
                        required in subparagraph (A) not to exceed the 
                        lesser of--
                                    ``(I) 5 percent of amounts received 
                                under the grant; or
                                    ``(II) $3,000,000.
                            ``(ii) Relation to limitation on 
                        administrative expenses.--The costs of a 
                        clinical quality management program under 
                        subparagraph (A) may not be considered 
                        administrative expenses for purposes of the 
                        limitation established in paragraph (1).
    ``(i) Construction.--A chief elected official may not use amounts 
received under a grant awarded under this part to purchase or improve 
land, or to purchase, construct, or permanently improve (other than 
minor remodeling) any building or other facility, or to make cash 
payments to intended recipients of services.''.

SEC. 106. ADDITIONAL AMENDMENTS TO PART A.

    (a) Reporting of Cases.--Section 2601(a) of the Public Health 
Service Act (42 U.S.C. 300ff-11(a)) is amended by striking ``for the 
most recent period'' and inserting ``during the most recent period''.
    (b) Planning Council Representation.--Section 2602(b)(2)(G) of the 
Public Health Service Act (42 U.S.C. 300ff-12(b)(2)(G)) is amended by 
inserting ``, members of a Federally recognized Indian tribe as 
represented in the population, individuals co-infected with hepatitis B 
or C'' after ``disease''.
    (c) Application for Grant.--
            (1) Payer of last resort.--Section 2605(a)(6)(A) of the 
        Public Health Service Act (42 U.S.C. 300ff-15(a)(6)(A)) is 
        amended by inserting ``(except for a program administered by or 
        providing the services of the Indian Health Service)'' before 
        the semicolon.
            (2) Audits.--Section 2605(a) of the Public Health Service 
        Act (42 U.S.C. 300ff-15(a)) is amended--
                    (A) in paragraph (8), by striking ``and'' at the 
                end;
                    (B) in paragraph (9), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(10) that the chief elected official will submit to the 
        lead State agency under section 2617(b)(4), audits, consistent 
        with Office of Management and Budget circular A133, regarding 
        funds expended in accordance with this part every 2 years and 
        shall include necessary client-based data to compile unmet need 
        calculations and Statewide coordinated statements of need 
        process.''.
            (3) Coordination.--Section 2605(b) of the Public Health 
        Service Act (42 U.S.C. 300ff-15(b)) is amended--
                    (A) in paragraph (3), by striking ``and'' at the 
                end;
                    (B) in paragraph (4), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following:
            ``(5) the manner in which the expected expenditures are 
        related to the planning process for States that receive funding 
        under part B (including the planning process described in 
        section 2617(b)); and
            ``(6) the expected expenditures and how those expenditures 
        will improve overall client outcomes, as described under the 
        State plan under section 2617(b), and through additional 
        outcomes measures as identified by the HIV health services 
        planning council under section 2602(b).''.

SEC. 107. NEW PROGRAM IN PART A; TRANSITIONAL GRANTS FOR CERTAIN AREAS 
              INELIGIBLE UNDER SECTION 2601.

    (a) In General.--Part A of title XXVI of the Public Health Service 
Act (42 U.S.C. 300ff-11) is amended--
            (1) by inserting after the part heading the following:

                ``Subpart I--General Grant Provisions'';

    and
            (2) by adding at the end the following:

                   ``Subpart II--Transitional Grants

``SEC. 2609. ESTABLISHMENT OF PROGRAM.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall make grants 
for the purpose of providing services described in section 2604 in 
transitional areas, subject to the same provisions regarding the 
allocation of grant funds as apply under subsection (c) of such 
section.
    ``(b) Transitional Areas.--For purposes of this section, the term 
`transitional area' means, subject to subsection (c), a metropolitan 
area for which there has been reported to and confirmed by the Director 
of the Centers for Disease Control and Prevention a cumulative total of 
at least 1,000, but fewer than 2,000, cases of AIDS during the most 
recent period of 5 calendar years for which such data are available.
    ``(c) Certain Eligibility Rules.--
            ``(1) Fiscal year 2007.--With respect to grants under 
        subsection (a) for fiscal year 2007, a metropolitan area that 
        received funding under subpart I for fiscal year 2006 but does 
        not for fiscal year 2007 qualify under such subpart as an 
        eligible area and does not qualify under subsection (b) as a 
        transitional area shall, notwithstanding subsection (b), be 
        considered a transitional area.
            ``(2) Continued status as transitional area.--
                    ``(A) In general.--Notwithstanding subsection (b), 
                a metropolitan area that is a transitional area for a 
                fiscal year continues, except as provided in 
                subparagraph (B), to be a transitional area until the 
                metropolitan area fails, for three consecutive fiscal 
                years--
                            ``(i) to qualify under such subsection as a 
                        transitional area; and
                            ``(ii) to have a cumulative total of 1,500 
                        or more living cases of AIDS (reported to and 
                        confirmed by the Director of the Centers for 
                        Disease Control and Prevention) as of December 
                        31 of the most recent calendar year for which 
                        such data is available.
                    ``(B) Exception regarding status as eligible 
                area.--Subparagraph (A) does not apply for a fiscal 
                year if the metropolitan area involved qualifies under 
                subpart I as an eligible area.
    ``(d) Application of Certain Provisions of Subpart I.--
            ``(1) Administration; planning council.--
                    ``(A) In general.--The provisions of section 2602 
                apply with respect to a grant under subsection (a) for 
                a transitional area to the same extent and in the same 
                manner as such provisions apply with respect to a grant 
                under subpart I for an eligible area, except that, 
                subject to subparagraph (B), the chief elected official 
                of the transitional area may elect not to comply with 
                the provisions of section 2602(b) if the official 
                provides documentation to the Secretary that details 
                the process used to obtain community input 
                (particularly from those with HIV) in the transitional 
                area for formulating the overall plan for priority 
                setting and allocating funds from the grant under 
                subsection (a).
                    ``(B) Exception.--For each of the fiscal years 2007 
                through 2009, the exception described in subparagraph 
                (A) does not apply if the transitional area involved 
                received funding under subpart I for fiscal year 2006.
            ``(2) Type and distribution of grants; timeframe for 
        obligation and expenditure of grant funds.--
                    ``(A) Formula grants; supplemental grants.--The 
                provisions of section 2603 apply with respect to grants 
                under subsection (a) to the same extent and in the same 
                manner as such provisions apply with respect to grants 
                under subpart I, subject to subparagraphs (B) and (C).
                    ``(B) Formula grants; increase in grant.--For 
                purposes of subparagraph (A), section 2603(a)(4) does 
                not apply.
                    ``(C) Supplemental grants; single program with 
                subpart i program.--With respect to section 2603(b) as 
                applied for purposes of subparagraph (A):
                            ``(i) The Secretary shall combine amounts 
                        available pursuant to such subparagraph with 
                        amounts available for carrying out section 
                        2603(b) and shall administer the two programs 
                        as a single program.
                            ``(ii) In the single program, the Secretary 
                        has discretion in allocating amounts between 
                        eligible areas under subpart I and transitional 
                        areas under this section, subject to the 
                        eligibility criteria that apply under such 
                        section, and subject to section 2603(b)(2)(C) 
                        (relating to priority in making grants).
                            ``(iii) Pursuant to section 2603(b)(1), 
                        amounts for the single program are subject to 
                        use under sections 2603(a)(4) and 2610(d)(1).
            ``(3) Application; technical assistance; definitions.--The 
        provisions of sections 2605, 2606, and 2607 apply with respect 
        to grants under subsection (a) to the same extent and in the 
        same manner as such provisions apply with respect to grants 
        under subpart I.''.
    (b) Conforming Amendments.--Subpart I of part A of title XXVI of 
the Public Health Service Act, as designated by subsection (a)(1) of 
this section, is amended by striking ``this part'' each place such term 
appears and inserting ``this subpart''.

SEC. 108. AUTHORIZATION OF APPROPRIATIONS FOR PART A.

    Part A of title XXVI of the Public Health Service Act, as amended 
by section 106(a), is amended by adding at the end the following:

                   ``Subpart III--General Provisions

``SEC. 2610. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) In General.--For the purpose of carrying out this part, there 
are authorized to be appropriated $604,000,000 for fiscal year 2007, 
$626,300,000 for fiscal year 2008, $649,500,000 for fiscal year 2009, 
$673,600,000 for fiscal year 2010, and $698,500,000 for fiscal year 
2011. Amounts appropriated under the preceding sentence for a fiscal 
year are available for obligation by the Secretary until the end of the 
second succeeding fiscal year.
    ``(b) Reservation of Amounts.--
            ``(1) Fiscal year 2007.--Of the amount appropriated under 
        subsection (a) for fiscal year 2007, the Secretary shall 
        reserve--
                    ``(A) $458,310,000 for grants under subpart I; and
                    ``(B) $145,690,000 for grants under section 2609.
            ``(2) Subsequent fiscal years.--Of the amount appropriated 
        under subsection (a) for fiscal year 2008 and each subsequent 
        fiscal year--
                    ``(A) the Secretary shall reserve an amount for 
                grants under subpart I; and
                    ``(B) the Secretary shall reserve an amount for 
                grants under section 2609.
    ``(c) Transfer of Certain Amounts; Change in Status as Eligible 
Area or Transitional Area.--Notwithstanding subsection (b):
            ``(1) If a metropolitan area is an eligible area under 
        subpart I for a fiscal year, but for a subsequent fiscal year 
        ceases to be an eligible area by reason of section 2601(b)--
                    ``(A)(i) the amount reserved under paragraph (1)(A) 
                or (2)(A) of subsection (b) of this section for the 
                first such subsequent year of not being an eligible 
                area is deemed to be reduced by an amount equal to the 
                amount of the grant made pursuant to section 2603(a) 
                for the metropolitan area for the preceding fiscal 
                year; and
                    ``(ii)(I) if the metropolitan area qualifies for 
                such first subsequent fiscal year as a transitional 
                area under 2609, the amount reserved under paragraph 
                (1)(B) or (2)(B) of subsection (b) for such fiscal year 
                is deemed to be increased by an amount equal to the 
                amount of the reduction under subparagraph (A) for such 
                year; or
                    ``(II) if the metropolitan area does not qualify 
                for such first subsequent fiscal year as a transitional 
                area under 2609, an amount equal to the amount of such 
                reduction is, notwithstanding subsection (a), 
                transferred and made available for grants pursuant to 
                section 2618(a)(1), in addition to amounts available 
                for such grants under section 2623; and
                    ``(B) if a transfer under subparagraph (A)(ii)(II) 
                is made with respect to the metropolitan area for such 
                first subsequent fiscal year, then--
                            ``(i) the amount reserved under paragraph 
                        (1)(A) or (2)(A) of subsection (b) of this 
                        section for such year is deemed to be reduced 
                        by an additional $500,000; and
                            ``(ii) an amount equal to the amount of 
                        such additional reduction is, notwithstanding 
                        subsection (a), transferred and made available 
                        for grants pursuant to section 2618(a)(1), in 
                        addition to amounts available for such grants 
                        under section 2623.
            ``(2) If a metropolitan area is a transitional area under 
        section 2609 for a fiscal year, but for a subsequent fiscal 
        year ceases to be a transitional area by reason of section 
        2609(c)(2) (and does not qualify for such subsequent fiscal 
        year as an eligible area under subpart I)--
                    ``(A) the amount reserved under subsection 
                (b)(2)(B) of this section for the first such subsequent 
                fiscal year of not being a transitional area is deemed 
                to be reduced by an amount equal to the total of--
                            ``(i) the amount of the grant that, 
                        pursuant to section 2603(a), was made under 
                        section 2609(d)(2)(A) for the metropolitan area 
                        for the preceding fiscal year; and
                            ``(ii) $500,000; and
                    ``(B) an amount equal to the amount of the 
                reduction under subparagraph (A) for such year is, 
                notwithstanding subsection (a), transferred and made 
                available for grants pursuant to section 2618(a)(1), in 
                addition to amounts available for such grants under 
                section 2623.
            ``(3) If a metropolitan area is a transitional area under 
        section 2609 for a fiscal year, but for a subsequent fiscal 
        year qualifies as an eligible area under subpart I--
                    ``(A) the amount reserved under subsection 
                (b)(2)(B) of this section for the first such subsequent 
                fiscal year of becoming an eligible area is deemed to 
                be reduced by an amount equal to the amount of the 
                grant that, pursuant to section 2603(a), was made under 
                section 2609(d)(2)(A) for the metropolitan area for the 
                preceding fiscal year; and
                    ``(B) the amount reserved under subsection 
                (b)(2)(A) for such fiscal year is deemed to be 
                increased by an amount equal to the amount of the 
                reduction under subparagraph (A) for such year.
    ``(d) Certain Transfers; Allocations Between Programs Under Subpart 
I.--With respect to paragraphs (1)(B)(i) and (2)(A)(ii) of subsection 
(c), the Secretary shall administer any reductions under such 
paragraphs for a fiscal year in accordance with the following:
            ``(1) The reductions shall be made from amounts available 
        for the single program referred to in section 2609(d)(2)(C) 
        (relating to supplemental grants).
            ``(2) The reductions shall be made before the amounts 
        referred to in paragraph (1) are used for purposes of section 
        2603(a)(4).
            ``(3) If the amounts referred to in paragraph (1) are not 
        sufficient for making all the reductions, the reductions shall 
        be reduced until the total amount of the reductions equals the 
        total of the amounts referred to in such paragraph.
    ``(e) Rules of Construction Regarding First Subsequent Fiscal 
Year.--Paragraphs (1) and (2) of subsection (c) apply with respect to 
each series of fiscal years during which a metropolitan area is an 
eligible area under subpart I or a transitional area under section 2609 
for a fiscal year and then for a subsequent fiscal year ceases to be 
such an area by reason of section 2601(b) or 2609(c)(2), respectively, 
rather than applying to a single such series. Paragraph (3) of 
subsection (c) applies with respect to each series of fiscal years 
during which a metropolitan area is a transitional area under section 
2609 for a fiscal year and then for a subsequent fiscal year becomes an 
eligible area under subpart I, rather than applying to a single such 
series.''.

                         TITLE II--CARE GRANTS

SEC. 201. GENERAL USE OF GRANTS.

    (a) In General.--Section 2612 of the Public Health Service Act (42 
U.S.C. 300ff-22) is amended to read as follows:

``SEC. 2612. GENERAL USE OF GRANTS.

    ``(a) In General.--A State may use amounts provided under grants 
made under section 2611 for--
            ``(1) core medical services described in subsection (b);
            ``(2) support services described in subsection (c); and
            ``(3) administrative expenses described in section 
        2618(b)(3).
    ``(b) Required Funding for Core Medical Services.--
            ``(1) In general.--With respect to a grant under section 
        2611 for a State for a grant year, the State shall, of the 
        portion of the grant remaining after reserving amounts for 
        purposes of subparagraphs (A) and (E)(ii)(I) of section 
        2618(b)(3), use not less than 75 percent to provide core 
        medical services that are needed in the State for individuals 
        with HIV/AIDS who are identified and eligible under this title 
        (including services regarding the co-occurring conditions of 
        the individuals).
            ``(2) Waiver.--
                    ``(A) In general.--The Secretary shall waive the 
                application of paragraph (1) with respect to a State 
                for a grant year if the Secretary determines that, 
                within the State--
                            ``(i) there are no waiting lists for AIDS 
                        Drug Assistance Program services under section 
                        2616; and
                            ``(ii) core medical services are available 
                        to all individuals with HIV/AIDS identified and 
                        eligible under this title.
                    ``(B) Notification of waiver status.--When 
                informing a State that a grant under section 2611 is 
                being made to the State for a fiscal year, the 
                Secretary shall inform the State whether a waiver under 
                subparagraph (A) is in effect for the fiscal year.
            ``(3) Core medical services.--For purposes of this 
        subsection, the term `core medical services', with respect to 
        an individual infected with HIV/AIDS (including the co-
        occurring conditions of the individual) means the following 
        services:
                    ``(A) Outpatient and ambulatory health services.
                    ``(B) AIDS Drug Assistance Program treatments in 
                accordance with section 2616.
                    ``(C) AIDS pharmaceutical assistance.
                    ``(D) Oral health care.
                    ``(E) Early intervention services described in 
                subsection (d).
                    ``(F) Health insurance premium and cost sharing 
                assistance for low-income individuals in accordance 
                with section 2615.
                    ``(G) Home health care.
                    ``(H) Medical nutrition therapy.
                    ``(I) Hospice services.
                    ``(J) Home and community-based health services as 
                defined under section 2614(c).
                    ``(K) Mental health services.
                    ``(L) Substance abuse outpatient care.
                    ``(M) Medical case management, including treatment 
                adherence services.
    ``(c) Support Services.--
            ``(1) In general.--For purposes of this subsection, the 
        term `support services' means services, subject to the approval 
        of the Secretary, that are needed for individuals with HIV/AIDS 
        to achieve their medical outcomes (such as respite care for 
        persons caring for individuals with HIV/AIDS, outreach 
        services, medical transportation, linguistic services, and 
        referrals for health care and support services).
            ``(2) Definition of medical outcomes.--In this subsection, 
        the term `medical outcomes' means those outcomes affecting the 
        HIV-related clinical status of an individual with HIV/AIDS.
    ``(d) Early Intervention Services.--
            ``(1) In general.--For purposes of this section, the term 
        `early intervention services' means HIV/AIDS early intervention 
        services described in section 2651(e), with follow-up referral 
        provided for the purpose of facilitating the access of 
        individuals receiving the services to HIV-related health 
        services. The 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/AIDS counseling and testing sites, health care points of 
        entry specified by States, federally qualified health centers, 
        and entities described in section 2652(a) that constitute a 
        point of access to services by maintaining referral 
        relationships.
            ``(2) Conditions.--With respect to an entity that proposes 
        to provide early intervention services under paragraph (1), 
        such paragraph shall apply only if the entity demonstrates to 
        the satisfaction of the chief elected official for the State 
        involved that--
                    ``(A) Federal, State, or local funds are otherwise 
                inadequate for the early intervention services the 
                entity proposes to provide; and
                    ``(B) the entity will expend funds pursuant to such 
                subparagraph to supplement and not supplant other funds 
                available to the entity for the provision of early 
                intervention services for the fiscal year involved.
    ``(e) Priority for Women, Infants, Children, and Youth.--
            ``(1) In general.--For the purpose of providing health and 
        support services to infants, children, youth, and women with 
        HIV/AIDS, including treatment measures to prevent the perinatal 
        transmission of HIV, a State shall for each of such populations 
        in the eligible area use, from the grants made for the area 
        under section 2601(a) for a fiscal year, not less than the 
        percentage constituted by the ratio of the population involved 
        (infants, children, youth, or women in such area) with HIV/AIDS 
        to the general population in such area of individuals with HIV/
        AIDS.
            ``(2) Waiver.--With respect to the population involved, the 
        Secretary may provide to a State a waiver of the requirement of 
        paragraph (1) if such State demonstrates to the satisfaction of 
        the Secretary that the population is receiving HIV-related 
        health services through the State medicaid program under title 
        XIX of the Social Security Act, the State children's health 
        insurance program under title XXI of such Act, or other Federal 
        or State programs.
    ``(f) Construction.--A State may not use amounts received under a 
grant awarded under section 2611 to purchase or improve land, or to 
purchase, construct, or permanently improve (other than minor 
remodeling) any building or other facility, or to make cash payments to 
intended recipients of services.''.
    (b) HIV Care Consortia.--Section 2613 of the Public Health Service 
Act (42 U.S.C. 300ff-23) is amended--
            (1) in subsection (a), in the matter preceding paragraph 
        (1)--
                    (A) by striking ``may use'' and inserting ``may, 
                subject to subsection (f), use''; and
                    (B) by striking ``section 2612(a)(1)'' and 
                inserting ``section 2612(a)''; and
            (2) by adding at the end the following subsection:
    ``(f) Allocation of Funds; Treatment as Support Services.--For 
purposes of the requirement of section 2612(b)(1), expenditures of 
grants under section 2611 for or through consortia under this section 
are deemed to be support services, not core medical services. The 
preceding sentence may not be construed as having any legal effect on 
the provisions of subsection (a) that relate to authorized expenditures 
of the grant.''.
    (c) Technical Amendments.--Part B of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff-21 et seq.) is amended--
            (1) in section 2611--
                    (A) in subsection (a), by striking the subsection 
                designation and heading; and
                    (B) by striking subsection (b);
            (2) in section 2614--
                    (A) in subsection (a), in the matter preceding 
                paragraph (1), by striking ``section 2612(a)(2)'' and 
                inserting ``section 2612(b)(3)(J)''; and
                    (B) in subsection (c)(2)(B), by striking 
                ``homemaker or'';
            (3) in section 2615(a) by striking ``section 2612(a)(3)'' 
        and inserting ``2612(b)(3)(F)''; and
            (4) in section 2616(a) by striking ``section 2612(a)(5)'' 
        and inserting ``2612(b)(3)(B)''.

SEC. 202. AIDS DRUG ASSISTANCE PROGRAM.

    (a) Requirement of Minimum Drug List.--Section 2616 of the Public 
Health Service Act (42 U.S.C. 300ff-26) is amended--
            (1) in subsection (c), by striking paragraph (1) and 
        inserting the following:
            ``(1) ensure that the therapeutics included on the list of 
        classes of core antiretroviral therapeutics established by the 
        Secretary under subsection (e) are, at a minimum, the 
        treatments provided by the State pursuant to this section;'';
            (2) by redesignating subsection (e) as subsection (f); and
            (3) by inserting after subsection (d) the following:
    ``(e) List of Classes of Core Antiretroviral Therapeutics.--For 
purposes of subsection (c)(1), the Secretary shall develop and maintain 
a list of classes of core antiretroviral therapeutics, which list shall 
be based on the therapeutics included in the guidelines of the 
Secretary known as the Clinical Practice Guidelines for Use of HIV/AIDS 
Drugs, relating to drugs needed to manage symptoms associated with HIV. 
The preceding sentence does not affect the authority of the Secretary 
to modify such Guidelines.''.
    (b) Drug Rebate Program.--Section 2616 of the Public Health Service 
Act, as amended by subsection (a)(2) of this section, is amended by 
adding at the end the following:
    ``(g) Drug Rebate Program.--A State shall ensure that any drug 
rebates received on drugs purchased from funds provided pursuant to 
this section are applied to activities supported under this subpart, 
with priority given to activities described under this section.''.

SEC. 203. DISTRIBUTION OF FUNDS.

    (a) Distribution Based on Living Cases of HIV/AIDS.--
            (1) State distribution factor.--Section 2618(a)(2) of the 
        Public Health Service Act (42 U.S.C. 300ff-28(a)(2)) is 
        amended--
                    (A) in subparagraph (B), by striking ``estimated 
                number of living cases of acquired immune deficiency 
                syndrome in the eligible area involved'' and inserting 
                ``number of living cases of HIV/AIDS in the State 
                involved''; and
                    (B) by amending subparagraph (D) to read as 
                follows:
                    ``(D) Living cases of hiv/aids.--
                            ``(i) Requirement of names-based 
                        reporting.--Except as provided in clause (ii), 
                        the number determined under this subparagraph 
                        for a State for a fiscal year for purposes of 
                        subparagraph (B) is the number of living names-
                        based cases of HIV/AIDS in the State that, as 
                        of December 31 of the most recent calendar year 
                        for which such data is available, have been 
                        reported to and confirmed by the Director of 
                        the Centers for Disease Control and Prevention.
                            ``(ii) Transition period; exemption 
                        regarding non-aids cases.--For each of the 
                        fiscal years 2007 through 2010, a State is, 
                        subject to clauses (iii) through (v), exempt 
                        from the requirement under clause (i) that 
                        living non-AIDS names-based cases of HIV be 
                        reported unless--
                                    ``(I) a system was in operation as 
                                of December 31, 2005, that provides 
                                sufficiently accurate and reliable 
                                names-based reporting of such cases 
                                throughout the State, subject to clause 
                                (vii); or
                                    ``(II) no later than the beginning 
                                of fiscal year 2008, 2009, or 2010, the 
                                Secretary, after consultation with the 
                                chief executive of the State, 
                                determines that a system has become 
                                operational in the State that provides 
                                sufficiently accurate and reliable 
                                names-based reporting of such cases 
                                throughout the State.
                            ``(iii) Requirements for exemption for 
                        fiscal year 2007.--For fiscal year 2007, an 
                        exemption under clause (ii) for a State applies 
                        only if, by October 1, 2006--
                                    ``(I)(aa) the State had submitted 
                                to the Secretary a plan for making the 
                                transition to sufficiently accurate and 
                                reliable names-based reporting of 
                                living non-AIDS cases of HIV; or
                                    ``(bb) all statutory changes 
                                necessary to provide for sufficiently 
                                accurate and reliable reporting of such 
                                cases had been made; and
                                    ``(II) the State had agreed that, 
                                by April 1, 2008, the State will begin 
                                accurate and reliable names-based 
                                reporting of such cases, except that 
                                such agreement is not required to 
                                provide that, as of such date, the 
                                system for such reporting be fully 
                                sufficient with respect to accuracy and 
                                reliability throughout the area.
                            ``(iv) Requirement for exemption as of 
                        fiscal year 2008.--For each of the fiscal years 
                        2008 through 2010, an exemption under clause 
                        (ii) for a State applies only if, as of April 
                        1, 2008, the State is substantially in 
                        compliance with the agreement under clause 
                        (iii)(II).
                            ``(v) Progress toward names-based 
                        reporting.--For fiscal year 2009 or 2010, the 
                        Secretary may terminate an exemption under 
                        clause (ii) for a State if the State submitted 
                        a plan under clause (iii)(I)(aa) and the 
                        Secretary determines that the State is not 
                        substantially following the plan.
                            ``(vi) Counting of cases in areas with 
                        exemptions.--
                                    ``(I) In general.--With respect to 
                                a State that is under a reporting 
                                system for living non-AIDS cases of HIV 
                                that is not names-based (referred to in 
                                this subparagraph as `code-based 
                                reporting'), the Secretary shall, for 
                                purposes of this subparagraph, modify 
                                the number of such cases reported for 
                                the State in order to adjust for 
                                duplicative reporting in and among 
                                systems that use code-based reporting.
                                    ``(II) Adjustment rate.--The 
                                adjustment rate under subclause (I) for 
                                a State shall be a reduction of 5 
                                percent in the number of living non-
                                AIDS cases of HIV reported for the 
                                State.
                            ``(vii) List of states meeting standard 
                        regarding december 31, 2005.--
                                    ``(I) In general.--If a State is 
                                specified in subclause (II), the State 
                                shall be considered to meet the 
                                standard described in clause (ii)(I). 
                                No other State may be considered to 
                                meet such standard.
                                    ``(II) Relevant states.--For 
                                purposes of subclause (I), the States 
                                specified in this subclause are the 
                                following: Alaska, Alabama, Arkansas, 
                                Arizona, Colorado, Florida, Indiana, 
                                Iowa, Idaho, Kansas, Louisiana, 
                                Michigan, Minnesota, Missouri, 
                                Mississippi, North Carolina, North 
                                Dakota, Nebraska, New Jersey, New 
                                Mexico, New York, Nevada, Ohio, 
                                Oklahoma, South Carolina, South Dakota, 
                                Tennessee, Texas, Utah, Virginia, 
                                Wisconsin, West Virginia, Wyoming, 
                                Guam, and the Virgin Islands.
                            ``(viii) Rules of construction regarding 
                        acceptance of reports.--
                                    ``(I) Cases of aids.--With respect 
                                to a State that is subject to the 
                                requirement under clause (i) and is not 
                                in compliance with the requirement for 
                                names-based reporting of living non-
                                AIDS cases of HIV, the Secretary shall, 
                                notwithstanding such noncompliance, 
                                accept reports of living cases of AIDS 
                                that are in accordance with such 
                                clause.
                                    ``(II) Applicability of exemption 
                                requirements.--The provisions of 
                                clauses (ii) through (vii) may not be 
                                construed as having any legal effect 
                                for fiscal year 2011 or any subsequent 
                                fiscal year, and accordingly, the 
                                status of a State for purposes of such 
                                clauses may not be considered after 
                                fiscal year 2010.
                            ``(ix) Program for detecting inaccurate or 
                        fraudulent counting.--The Secretary shall carry 
                        out a program to monitor the reporting of 
                        names-based cases for purposes of this 
                        subparagraph and to detect instances of 
                        inaccurate reporting, including fraudulent 
                        reporting.''.
            (2) Non-ema distribution factor.--Section 2618(a)(2)(C) of 
        the Public Health Service Act (42 U.S.C. 300ff-28(a)(2)(C)) is 
        amended--
                    (A) in clause (i), by striking ``estimated number 
                of living cases of acquired immune deficiency 
                syndrome'' each place such term appears and inserting 
                ``number of living cases of HIV/AIDS''; and
                    (B) in clause (ii), by amending such clause to read 
                as follows:
                            ``(ii) a number equal to the sum of--
                                    ``(I) the total number of living 
                                cases of HIV/AIDS that are within areas 
                                in such State that are eligible areas 
                                under subpart I of part A for the 
                                fiscal year involved, which individual 
                                number for an area is the number that 
                                applies under section 2601 for the area 
                                for such fiscal year; and
                                    ``(II) the total number of such 
                                cases that are within areas in such 
                                State that are transitional areas under 
                                section 2609 for such fiscal year, 
                                which individual number for an area is 
                                the number that applies under such 
                                section for the fiscal year.''.
    (b) Formula Amendments Generally.--Section 2618(a)(2) of the Public 
Health Service Act (42 U.S.C. 300ff-28(a)(2)) is amended--
            (1) in subparagraph (A)--
                    (A) by striking ``The amount referred to'' in the 
                matter preceding clause (i) and all that follows 
                through the end of clause (i) and inserting the 
                following: ``For purposes of paragraph (1), the amount 
                referred to in this paragraph for a State (including a 
                territory) for a fiscal year is, subject to 
                subparagraphs (E) and (F)--
                            ``(i) an amount equal to the amount made 
                        available under section 2623 for the fiscal 
                        year involved for grants pursuant to paragraph 
                        (1), subject to subparagraph (G); and''; and
                    (B) in clause (ii)--
                            (i) in subclause (I)--
                                    (I) by striking ``0.80'' and 
                                inserting ``0.75''; and
                                    (II) by striking ``and'' at the 
                                end;
                            (ii) in subclause (II)--
                                    (I) by inserting ``non-EMA'' after 
                                ``respective''; and
                                    (II) by striking the period and 
                                inserting ``; and''; and
                            (iii) by adding at the end the following:
                                    ``(III) if the State does not for 
                                such fiscal year contain any area that 
                                is an eligible area under subpart I of 
                                part A or any area that is a 
                                transitional area under section 2609 
                                (referred to in this subclause as a 
                                `no-EMA State'), the product of 0.05 
                                and the ratio of the number of cases 
                                that applies for the State under 
                                subparagraph (D) to the sum of the 
                                respective numbers of cases that so 
                                apply for all no-EMA States.'';
            (2) by striking subparagraphs (E) through (H);
            (3) by inserting after subparagraph (D) the following 
        subparagraphs:
                    ``(E) Code-based states; limitation on increase in 
                grant.--
                            ``(i) In general.--For each of the fiscal 
                        years 2007 through 2010, if code-based 
                        reporting (within the meaning of subparagraph 
                        (D)(vi)) applies in a State as of the beginning 
                        of the fiscal year involved, then 
                        notwithstanding any other provision of this 
                        paragraph, the amount of the grant pursuant to 
                        paragraph (1) for the State may not for the 
                        fiscal year involved exceed by more than 5 
                        percent the amount of the grant pursuant to 
                        this paragraph for the State for the preceding 
                        fiscal year, except that the limitation under 
                        this clause may not result in a grant pursuant 
                        to paragraph (1) for a fiscal year that is less 
                        than the minimum amount that applies to the 
                        State under such paragraph for such fiscal 
                        year.
                            ``(ii) Use of amounts involved.--For each 
                        of the fiscal years 2007 through 2010, amounts 
                        available as a result of the limitation under 
                        clause (i) shall be made available by the 
                        Secretary as additional amounts for grants 
                        pursuant to section 2620, subject to 
                        subparagraph (H).
                    ``(F) Severity of need.--
                            ``(i) Fiscal years beginning with 2011.--
                        If, by January 1, 2010, the Secretary notifies 
                        the appropriate committees of Congress that the 
                        Secretary has developed a severity of need 
                        index in accordance with clause (v), the 
                        provisions of subparagraphs (A) through (E) 
                        shall not apply for fiscal year 2011 or any 
                        fiscal year thereafter, and the Secretary shall 
                        use the severity of need index (as defined in 
                        clause (iv)) for the determination of the 
                        formula allocations, subject to the 
                        Congressional Review Act.
                            ``(ii) Subsequent fiscal years.--If, on or 
                        before any January 1 that is subsequent to the 
                        date referred to in clause (i), the Secretary 
                        notifies the appropriate committees of Congress 
                        that the Secretary has developed a severity of 
                        need index, in accordance with clause (v), for 
                        each succeeding fiscal year, the provisions of 
                        subparagraphs (A) through (D) shall not apply 
                        for the subsequent fiscal year or any fiscal 
                        year thereafter, and the Secretary shall use 
                        the severity of need index (as defined in 
                        clause (iv)) for the determination of the 
                        formula allocations, subject to the 
                        Congressional Review Act.
                            ``(iii) Fiscal year 2013.--The Secretary 
                        shall notify the appropriate committees of 
                        Congress that the Secretary has developed a 
                        severity of need index by January 1, 2012, in 
                        accordance with clause (v), and the provisions 
                        of subparagraphs (A) through (D) shall not 
                        apply for fiscal year 2013 or any fiscal year 
                        thereafter, and the Secretary shall use the 
                        severity of need index (as defined in clause 
                        (iv)) for the determination of the formula 
                        allocations, subject to the Congressional 
                        Review Act.
                            ``(iv) Definition of severity of need 
                        index.--In this subparagraph, the term 
                        `severity of need index' means the index of the 
                        relative needs of individuals within the State, 
                        as identified by a variety of different 
                        factors, and is a factor that is multiplied by 
                        the number of living HIV/AIDS cases in the 
                        State, providing different weights to those 
                        cases based on their needs.
                            ``(v) Requirements for secretarial 
                        notification.--When the Secretary notifies the 
                        appropriate committees of Congress that the 
                        Secretary has developed a severity of need 
                        index, the Secretary shall provide the 
                        following:
                                    ``(I) Methodology for and rationale 
                                behind developing the severity of need 
                                index, including information related to 
                                the field testing of the severity of 
                                need index.
                                    ``(II) An independent contractor 
                                analysis of activities carried out 
                                under subclause (I).
                                    ``(III) Expected changes in funding 
                                allocations, given the application of 
                                the severity of need index and the 
                                elimination of the provisions of 
                                subparagraphs (A) through (D).
                                    ``(IV) Information regarding the 
                                process by which the Secretary received 
                                community input regarding the 
                                application and development of the 
                                severity of need index.
                                    ``(V) Timeline and process for the 
                                implementation of the severity of need 
                                index to ensure that it is applied in 
                                the following fiscal year.
                            ``(vi) Annual reports.--Not later than 1 
                        year after the date of enactment of the Ryan 
                        White HIV/AIDS Treatment Modernization Act of 
                        2006, and annually thereafter until the 
                        Secretary notifies Congress that the Secretary 
                        has developed a severity of need index in 
                        accordance with this subparagraph, the 
                        Secretary shall prepare and submit to the 
                        appropriate committees of Congress a report--
                                    ``(I) that updates progress toward 
                                having client level data;
                                    ``(II) that updates the progress 
                                toward having a severity of need index, 
                                including information related to the 
                                methodology and process for obtaining 
                                community input; and
                                    ``(III) that, as applicable, states 
                                whether the Secretary could develop a 
                                severity of need index before fiscal 
                                year 2010.''; and
            (4) by redesignating subparagraph (I) as subparagraph (G).
    (c) Separate ADAP Grants.--Section 2618(a)(2)(G) of the Public 
Health Service Act (42 U.S.C. 300ff-28(a)(2)(G)), as redesignated by 
subsection (b)(4) of this section, is amended--
            (1) in clause (i)--
                    (A) in the matter preceding subclause (I), by 
                striking ``section 2677'' and inserting ``section 
                2623'';
                    (B) in subclause (II), by striking the period at 
                the end and inserting a semicolon; and
                    (C) by adding after and below subclause (II) the 
                following:
                        ``which product shall then, as applicable, be 
                        increased under subparagraph (H).'';
            (2) in clause (ii)--
                    (A) by striking subclauses (I) through (III) and 
                inserting the following:
                                    ``(I) In general.--From amounts 
                                made available under subclause (V), the 
                                Secretary shall award supplemental 
                                grants to States described in subclause 
                                (II) to enable such States to purchase 
                                and distribute to eligible individuals 
                                under section 2616(b) pharmaceutical 
                                therapeutics described under 
                                subsections (c)(2) and (e) of such 
                                section.
                                    ``(II) Eligible states.--For 
                                purposes of subclause (I), a State 
                                shall be an eligible State if the State 
                                did not have unobligated funds subject 
                                to reallocation under section 2618(d) 
                                in the previous fiscal year and, in 
                                accordance with criteria established by 
                                the Secretary, demonstrates a severe 
                                need for a grant under this clause. For 
                                purposes of determining severe need, 
                                the Secretary shall consider 
                                eligibility standards, formulary 
                                composition, the number of eligible 
                                individuals to whom a State is unable 
                                to provide therapeutics described in 
                                section 2616(a), and an unanticipated 
                                increase of eligible individuals with 
                                HIV/AIDS.
                                    ``(III) State requirements.--The 
                                Secretary may not make a grant to a 
                                State under this clause unless the 
                                State agrees that the State will make 
                                available (directly or through 
                                donations of public or private 
                                entities) non-Federal contributions 
                                toward the activities to be carried out 
                                under the grant in an amount equal to 
                                $1 for each $4 of Federal funds 
                                provided in the grant, except that the 
                                Secretary may waive this subclause if 
                                the State has otherwise fully complied 
                                with section 2617(d) with respect to 
                                the grant year involved. The provisions 
                                of this subclause shall apply to States 
                                that are not required to comply with 
                                such section 2617(d).''.
                    (B) in subclause (IV), by moving the subclause two 
                ems to the left;
                    (C) in subclause (V), by striking ``3 percent'' and 
                inserting ``5 percent''; and
                    (D) by striking subclause (VI); and
            (3) by adding at the end the following clause:
                            ``(iii) Code-based states; limitation on 
                        increase in formula grant.--The limitation 
                        under subparagraph (E)(i) applies to grants 
                        pursuant to clause (i) of this subparagraph to 
                        the same extent and in the same manner as such 
                        limitation applies to grants pursuant to 
                        paragraph (1), except that the reference to 
                        minimum grants does not apply for purposes of 
                        this clause. Amounts available as a result of 
                        the limitation under the preceding sentence 
                        shall be made available by the Secretary as 
                        additional amounts for grants under clause (ii) 
                        of this subparagraph.''.
    (d) Hold Harmless.--Section 2618(a)(2) of the Public Health Service 
Act (42 U.S.C. 300ff-28(a)(2)), as amended by subsection (b)(4) of this 
section, is amended by adding at the end the following subparagraph:
                    ``(H) Increase in formula grants.--
                            ``(i) In general.--For each of the fiscal 
                        years 2007 through 2009, the Secretary shall 
                        ensure, subject to clauses (ii) through (iv), 
                        that the total for a State of the grant 
                        pursuant to paragraph (1) and the grant 
                        pursuant to subparagraph (G) is not less than 
                        95 percent of such total for the State for the 
                        preceding fiscal year, except that any increase 
                        under this clause--
                                    ``(I) may not result in a grant 
                                pursuant to paragraph (1) that is more 
                                than 95 percent of the amount of such 
                                grant for the preceding fiscal year; 
                                and
                                    ``(II) may not result in a grant 
                                pursuant to subparagraph (G) that is 
                                more than 95 percent of the amount of 
                                such grant for such preceding fiscal 
                                year.
                            ``(ii) Fiscal year 2007.--For purposes of 
                        clause (i) as applied for fiscal year 2007, the 
                        references in such clause to subparagraph (G) 
                        are deemed to be references to subparagraph (I) 
                        as such subparagraph was in effect for fiscal 
                        year 2006.
                            ``(iii) Source of funds for increase.--
                                    ``(I) In general.--From the amount 
                                reserved under section 2623(b)(2) for a 
                                fiscal year, and from amounts available 
                                for such section pursuant to subsection 
                                (d) of this section, the Secretary 
                                shall make available such amounts as 
                                may be necessary to comply with clause 
                                (i).
                                    ``(II) Pro rata reduction.--If the 
                                amounts referred to in subclause (I) 
                                for a fiscal year are insufficient to 
                                fully comply with clause (i) for the 
                                year, the Secretary, in order to 
                                provide the additional funds necessary 
                                for such compliance, shall reduce on a 
                                pro rata basis the amount of each grant 
                                pursuant to paragraph (1) for the 
                                fiscal year, other than grants for 
                                States for which increases under clause 
                                (i) apply and other than States 
                                described in paragraph (1)(A)(i)(I). A 
                                reduction under the preceding sentence 
                                may not be made in an amount that would 
                                result in the State involved becoming 
                                eligible for such an increase.
                            ``(iv) Applicability.--This paragraph may 
                        not be construed as having any applicability 
                        after fiscal year 2009.''.
    (e) Administrative Expenses; Clinical Quality Management.--Section 
2618(b) of the Public Health Service Act (42 U.S.C. 300ff-28(b)) is 
amended--
            (1) by redesignating paragraphs (2) through (7) as 
        paragraphs (1) through (6);
            (2) in paragraph (2) (as so redesignated)--
                    (A) by striking ``paragraph (5)'' and inserting 
                ``paragraph (4)''; and
                    (B) by striking ``paragraph (6)'' and inserting 
                ``paragraph (5)'';
            (3) in paragraph (3) (as so redesignated)--
                    (A) by amending subparagraph (A) to read as 
                follows:
                    ``(A) In general.--Subject to paragraph (4,) and 
                except as provided in paragraph (5), a State may not 
                use more than 10 percent of amounts received under a 
                grant awarded under section 2611 for administration.'';
                    (B) by redesignating subparagraphs (B) and (C) as 
                subparagraphs (C) and (D), respectively;
                    (C) by inserting after subparagraph (A) the 
                following:
                    ``(B) Allocations.--In the case of entities and 
                subcontractors to which a State allocates amounts 
                received by the State under a grant under section 2611, 
                the State shall ensure that, of the aggregate amount so 
                allocated, the total of the expenditures by such 
                entities for administrative expenses does not exceed 10 
                percent (without regard to whether particular entities 
                expend more than 10 percent for such expenses).'';
                    (D) in subparagraph (C) (as so redesignated), by 
                inserting before the period the following: ``, 
                including a clinical quality management program under 
                subparagraph (E)''; and
                    (E) by adding at the end the following:
                    ``(E) Clinical quality management.--
                            ``(i) Requirement.--Each State that 
                        receives a grant under section 2611 shall 
                        provide for the establishment of a clinical 
                        quality management program to assess the extent 
                        to which HIV health services provided to 
                        patients under the grant are consistent with 
                        the most recent Public Health Service 
                        guidelines for the treatment of HIV/AIDS and 
                        related opportunistic infection, and as 
                        applicable, to develop strategies for ensuring 
                        that such services are consistent with the 
                        guidelines for improvement in the access to and 
                        quality of HIV health services.
                            ``(ii) Use of funds.--
                                    ``(I) In general.--From amounts 
                                received under a grant awarded under 
                                section 2611 for a fiscal year, a State 
                                may use for activities associated with 
                                the clinical quality management program 
                                required in clause (i) not to exceed 
                                the lesser of--
                                            ``(aa) 5 percent of amounts 
                                        received under the grant; or
                                            ``(bb) $3,000,000.
                                    ``(II) Relation to limitation on 
                                administrative expenses.--The costs of 
                                a clinical quality management program 
                                under clause (i) may not be considered 
                                administrative expenses for purposes of 
                                the limitation established in 
                                subparagraph (A).'';
            (4) in paragraph (4) (as so redesignated)--
                    (A) by striking ``paragraph (6)'' and inserting 
                ``paragraph (5)''; and
                    (B) by striking ``paragraphs (3) and (4)'' and 
                inserting ``paragraphs (2) and (3)''; and
            (5) in paragraph (5) (as so redesignated), by striking 
        ``paragraph (3)'' and all that follows through ``(5),'' and 
        inserting the following: ``paragraphs (2) and (3), may, 
        notwithstanding paragraphs (2) through (4),''.
    (f) Reallocation for Supplemental Grants.--Section 2618(d) of the 
Public Health Service Act (42 U.S.C. 300ff-28(d)) is amended to read as 
follows:
    ``(d) Reallocation.--Any portion of a grant made to a State under 
section 2611 for a fiscal year that has not been obligated as described 
in subsection (c) ceases to be available to the State and shall be made 
available by the Secretary for grants under section 2620, in addition 
to amounts made available for such grants under section 2623(b)(2).''.
    (g) Definitions; Other Technical Amendments.--Section 2618(a) of 
the Public Health Service Act (42 U.S.C. 300ff-28(a)) is amended--
            (1) in paragraph (1), in the matter preceding subparagraph 
        (A), by striking ``section 2677'' and inserting ``section 
        2623'';
            (2) in paragraph (1)(A)--
                    (A) in the matter preceding clause (i), by striking 
                ``each of the several States and the District of 
                Columbia'' and inserting ``each of the 50 States, the 
                District of Columbia, Guam, and the Virgin Islands 
                (referred to in this paragraph as a `covered State')''; 
                and
                    (B) in clause (i)--
                            (i) in subclause (I), by striking ``State 
                        or District'' and inserting ``covered State''; 
                        and
                            (ii) in subclause (II)--
                                    (I) by striking ``State or 
                                District'' and inserting ``covered 
                                State''; and
                                    (II) by inserting ``and'' after the 
                                semicolon; and
            (3) in paragraph (1)(B), by striking ``each territory of 
        the United States, as defined in paragraph (3),'' and inserting 
        ``each territory other than Guam and the Virgin Islands'';
            (4) in paragraph (2)(C)(i), by striking ``or territory''; 
        and
            (5) by striking paragraph (3).

SEC. 204. ADDITIONAL AMENDMENTS TO SUBPART I OF PART B.

    (a) References to Part B.--Subpart I of part B of title XXVI of the 
Public Health Service Act (42 U.S.C. 300ff-21 et seq.) is amended by 
striking ``this part'' each place such term appears and inserting 
``section 2611''.
    (b) Hepatitis.--Section 2614(a)(3) of the Public Health Service Act 
(42 U.S.C. 300ff-24(a)(3)) is amended by inserting ``, including 
specialty care and vaccinations for hepatitis co-infection,'' after 
``health services''.
    (c) Application for Grant.--
            (1) Coordination.--Section 2617(b) of the Public Health 
        Service Act (42 U.S.C. 300ff-27(b)) is amended--
                    (A) by redesignating paragraphs (4) through (6) as 
                paragraphs (5) through (7), respectively;
                    (B) by inserting after paragraph (3), the 
                following:
            ``(4) the designation of a lead State agency that shall--
                    ``(A) administer all assistance received under this 
                part;
                    ``(B) conduct the needs assessment and prepare the 
                State plan under paragraph (3);
                    ``(C) prepare all applications for assistance under 
                this part;
                    ``(D) receive notices with respect to programs 
                under this title;
                    ``(E) every 2 years, collect and submit to the 
                Secretary all audits, consistent with Office of 
                Management and Budget circular A133, from grantees 
                within the State, including audits regarding funds 
                expended in accordance with this part; and
                    ``(F) carry out any other duties determined 
                appropriate by the Secretary to facilitate the 
                coordination of programs under this title.'';
                    (C) in paragraph (5) (as so redesignated)--
                            (i) in subparagraph (E), by striking 
                        ``and'' at the end; and
                            (ii) by inserting after subparagraph (F) 
                        the following:
                    ``(G) includes key outcomes to be measured by all 
                entities in the State receiving assistance under this 
                title; and''; and
                    (D) in paragraph (7) (as so redesignated), in 
                subparagraph (A)--
                            (i) by striking ``paragraph (5)'' and 
                        inserting ``paragraph (6)''; and
                            (ii) by striking ``paragraph (4)'' and 
                        inserting ``paragraph (5)''.
            (2) Native american representation.--Section 2617(b)(6) of 
        the Public Health Service Act, as redesignated by paragraph 
        (1)(A) of this subsection, is amended by inserting before 
        ``representatives of grantees'' the following: ``members of a 
        Federally recognized Indian tribe as represented in the 
        State,''.
            (3) Payer of last resort.--Section 2617(b)(7)(F)(ii) of the 
        Public Health Service Act, as redesignated by paragraph (1)(A) 
        of this subsection, is amended by inserting before the 
        semicolon the following: ``(except for a program administered 
        by or providing the services of the Indian Health Service)''.
    (d) Matching Funds; Applicability of Requirement.--Section 
2617(d)(3) of the Public Health Service Act (42 U.S.C. 300ff-27(d)(3)) 
is amended--
            (1) in subparagraph (A), by striking ``acquired immune 
        deficiency syndrome'' and inserting ``HIV/AIDS''; and
            (2) in subparagraph (C), by striking ``acquired immune 
        deficiency syndrome'' and inserting ``HIV/AIDS''.

SEC. 205. SUPPLEMENTAL GRANTS ON BASIS OF DEMONSTRATED NEED.

    Subpart I of part B of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-21 et seq.) is amended--
            (1) by redesignating section 2620 as section 2621; and
            (2) by inserting after section 2619 the following:

``SEC. 2620. SUPPLEMENTAL GRANTS.

    ``(a) In General.--For the purpose of providing services described 
in section 2612(a), the Secretary shall make grants to States--
            ``(1) whose applications under section 2617 have 
        demonstrated the need in the State, on an objective and 
        quantified basis, for supplemental financial assistance to 
        provide such services; and
            ``(2) that did not, for the most recent grant year pursuant 
        to section 2618(a)(1) or 2618(a)(2)(G)(i) for which data is 
        available, have more than 2 percent of grant funds under such 
        sections canceled or covered by any waivers under section 
        2622(c).
    ``(b) Demonstrated Need.--The factors considered by the Secretary 
in determining whether an eligible area has a demonstrated need for 
purposes of subsection (a)(1) may include any or all of the following:
            ``(1) The unmet need for such services, as determined under 
        section 2617(b).
            ``(2) An increasing need for HIV/AIDS-related services, 
        including relative rates of increase in the number of cases of 
        HIV/AIDS.
            ``(3) The relative rates of increase in the number of cases 
        of HIV/AIDS within new or emerging subpopulations.
            ``(4) The current prevalence of HIV/AIDS.
            ``(5) Relevant factors related to the cost and complexity 
        of delivering health care to individuals with HIV/AIDS in the 
        eligible area.
            ``(6) The impact of co-morbid factors, including co-
        occurring conditions, determined relevant by the Secretary.
            ``(7) The prevalence of homelessness.
            ``(8) The prevalence of individuals described under section 
        2602(b)(2)(M).
            ``(9) The relevant factors that limit access to health 
        care, including geographic variation, adequacy of health 
        insurance coverage, and language barriers.
            ``(10) The impact of a decline in the amount received 
        pursuant to section 2618 on services available to all 
        individuals with HIV/AIDS identified and eligible under this 
        title.
    ``(c) Priority in Making Grants.--The Secretary shall provide funds 
under this section to a State to address the decline in services 
related to the decline in the amounts received pursuant to section 2618 
consistent with the grant award to the State for fiscal year 2006, to 
the extent that the factor under subsection (b)(10) (relating to a 
decline in funding) applies to the State.
    ``(d) Core Medical Services.--The provisions of section 2612(b) 
apply with respect to a grant under this section to the same extent and 
in the same manner as such provisions apply with respect to a grant 
made pursuant to section 2618(a)(1).
    ``(e) Applicability of Grant Authority.--The authority to make 
grants under this section applies beginning with the first fiscal year 
for which amounts are made available for such grants under section 
2623(b)(1).''.

SEC. 206. EMERGING COMMUNITIES.

    Section 2621 of the Public Health Service Act, as redesignated by 
section 205(1) of this Act, is amended--
            (1) in the heading for the section, by striking 
        ``supplemental grants'' and inserting ``emerging communities'';
            (2) in subsection (b)--
                    (A) in paragraph (2), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (3) as paragraph 
                (4); and
                    (C) by inserting after paragraph (2) the following:
            ``(3) agree that the grant will be used to provide funds 
        directly to emerging communities in the State, separately from 
        other funds under this title that are provided by the State to 
        such communities; and''; and
            (3) by striking subsections (d) and (e) and inserting the 
        following:
    ``(d) Definitions of Emerging Community.--For purposes of this 
section, the term `emerging community' means a metropolitan area (as 
defined in section 2607) for which there has been reported to and 
confirmed by the Director of the Centers for Disease Control and 
Prevention a cumulative total of at least 500, but fewer than 1,000, 
cases of AIDS during the most recent period of 5 calendar years for 
which such data are available.
    ``(e) Continued Status as Emerging Community.--Notwithstanding any 
other provision of this section, a metropolitan area that is an 
emerging community for a fiscal year continues to be an emerging 
community until the metropolitan area fails, for three consecutive 
fiscal years--
            ``(1) to meet the requirements of subsection (d); and
            ``(2) to have a cumulative total of 750 or more living 
        cases of AIDS (reported to and confirmed by the Director of the 
        Centers for Disease Control and Prevention) as of December 31 
        of the most recent calendar year for which such data is 
        available.
    ``(f) Distribution.--The amount of a grant under subsection (a) for 
a State for a fiscal year shall be an amount equal to the product of--
            ``(1) the amount available under section 2623(b)(1) for the 
        fiscal year; and
            ``(2) a percentage equal to the ratio constituted by the 
        number of living cases of HIV/AIDS in emerging communities in 
        the State to the sum of the respective numbers of such cases in 
        such communities for all States.''.

SEC. 207. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT FUNDS.

    Subpart I of part B of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-21 et seq.), as amended by section 205, is further 
amended by adding at the end the following:

``SEC. 2622. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT FUNDS.

    ``(a) Obligation by End of Grant Year.--Effective for fiscal year 
2007 and subsequent fiscal years, funds from a grant award made to a 
State for a fiscal year pursuant to section 2618(a)(1) or 
2618(a)(2)(G), or under section 2620 or 2621, are available for 
obligation by the State through the end of the one-year period 
beginning on the date in such fiscal year on which funds from the award 
first become available to the State (referred to in this section as the 
`grant year for the award'), except as provided in subsection (c)(1).
    ``(b) Supplemental Grants; Cancellation of Unobligated Balance of 
Grant Award.--Effective for fiscal year 2007 and subsequent fiscal 
years, if a grant award made to a State for a fiscal year pursuant to 
section 2618(a)(2)(G)(ii), or under section 2620 or 2621, has an 
unobligated balance as of the end of the grant year for the award--
            ``(1) the Secretary shall cancel that unobligated balance 
        of the award, and shall require the State to return any amounts 
        from such balance that have been disbursed to the State; and
            ``(2) the funds involved shall be made available by the 
        Secretary as additional amounts for grants pursuant to section 
        2620 for the first fiscal year beginning after the fiscal year 
        in which the Secretary obtains the information necessary for 
        determining that the balance is required under paragraph (1) to 
        be canceled, except that the availability of the funds for such 
        grants is subject to section 2618(a)(2)(H) as applied for such 
        year.
    ``(c) Formula Grants; Cancellation of Unobligated Balance of Grant 
Award; Waiver Permitting Carryover.--
            ``(1) In general.--Effective for fiscal year 2007 and 
        subsequent fiscal years, if a grant award made to a State for a 
        fiscal year pursuant to section 2618(a)(1) or 2618(a)(2)(G)(i) 
        has an unobligated balance as of the end of the grant year for 
        the award, the Secretary shall cancel that unobligated balance 
        of the award, and shall require the State to return any amounts 
        from such balance that have been disbursed to the State, 
        unless--
                    ``(A) before the end of the grant year, the State 
                submits to the Secretary a written application for a 
                waiver of the cancellation, which application includes 
                a description of the purposes for which the State 
                intends to expend the funds involved; and
                    ``(B) the Secretary approves the waiver.
            ``(2) Expenditure by end of carryover year.--With respect 
        to a waiver under paragraph (1) that is approved for a balance 
        that is unobligated as of the end of a grant year for an award:
                    ``(A) The unobligated funds are available for 
                expenditure by the State involved for the one-year 
                period beginning upon the expiration of the grant year 
                (referred to in this section as the `carryover year').
                    ``(B) If the funds are not expended by the end of 
                the carryover year, the Secretary shall cancel that 
                unexpended balance of the award, and shall require the 
                State to return any amounts from such balance that have 
                been disbursed to the State.
            ``(3) Use of cancelled balances.--In the case of any 
        balance of a grant award that is cancelled under paragraph (1) 
        or (2)(B), the grant funds involved shall be made available by 
        the Secretary as additional amounts for grants under section 
        2620 for the first fiscal year beginning after the fiscal year 
        in which the Secretary obtains the information necessary for 
        determining that the balance is required under such paragraph 
        to be canceled, except that the availability of the funds for 
        such grants is subject to section 2618(a)(2)(H) as applied for 
        such year.
            ``(4) Corresponding reduction in future grant.--
                    ``(A) In general.--In the case of a State for which 
                a balance from a grant award made pursuant to section 
                2618(a)(1) or 2618(a)(2)(G)(i) is unobligated as of the 
                end of the grant year for the award--
                            ``(i) the Secretary shall reduce, by the 
                        same amount as such unobligated balance, the 
                        amount of the grant under such section for the 
                        first fiscal year beginning after the fiscal 
                        year in which the Secretary obtains the 
                        information necessary for determining that such 
                        balance was unobligated as of the end of the 
                        grant year (which requirement for a reduction 
                        applies without regard to whether a waiver 
                        under paragraph (1) has been approved with 
                        respect to such balance); and
                            ``(ii) the grant funds involved in such 
                        reduction shall be made available by the 
                        Secretary as additional funds for grants under 
                        section 2620 for such first fiscal year, 
                        subject to section 2618(a)(2)(H);
                except that this subparagraph does not apply to the 
                State if the amount of the unobligated balance was 2 
                percent or less.
                    ``(B) Relation to increases in grant.--A reduction 
                under subparagraph (A) for a State for a fiscal year 
                may not be taken into account in applying section 
                2618(a)(2)(H) with respect to the State for the 
                subsequent fiscal year.
    ``(d) Treatment of Drug Rebates.--For purposes of this section, 
funds that are drug rebates referred to in section 2616(g) may not be 
considered part of any grant award referred to in subsection (a).''.

SEC. 208. AUTHORIZATION OF APPROPRIATIONS FOR SUBPART I OF PART B.

    Subpart I of part B of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-21 et seq.), as amended by section 207, is further 
amended by adding at the end the following:

``SEC. 2623. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) In General.--For the purpose of carrying out this subpart, 
there are authorized to be appropriated $1,195,500,000 for fiscal year 
2007, $1,239,500,000 for fiscal year 2008, $1,285,200,000 for fiscal 
year 2009, $1,332,600,000 for fiscal year 2010, and $1,381,700,000 for 
fiscal year 2011. Amounts appropriated under the preceding sentence for 
a fiscal year are available for obligation by the Secretary until the 
end of the second succeeding fiscal year.
    ``(b) Reservation of Amounts.--
            ``(1) Emerging communities.--Of the amount appropriated 
        under subsection (a) for a fiscal year, the Secretary shall 
        reserve $5,000,000 for grants under section 2621.
            ``(2) Supplemental grants.--
                    ``(A) In general.--Of the amount appropriated under 
                subsection (a) for a fiscal year in excess of the 2006 
                adjusted amount, the Secretary shall reserve \1/3\ for 
                grants under section 2620, except that the availability 
                of the reserved funds for such grants is subject to 
                section 2618(a)(2)(H) as applied for such year, and 
                except that any amount appropriated exclusively for 
                carrying out section 2616 (and, accordingly, 
                distributed under section 2618(a)(2)(G)) is not subject 
                to this subparagraph.
                    ``(B) 2006 adjusted amount.--For purposes of 
                subparagraph (A), the term `2006 adjusted amount' means 
                the amount appropriated for fiscal year 2006 under 
                section 2677(b) (as such section was in effect for such 
                fiscal year), excluding any amount appropriated for 
                such year exclusively for carrying out section 2616 
                (and, accordingly, distributed under section 
                2618(a)(2)(I), as so in effect).''.

SEC. 209. EARLY DIAGNOSIS GRANT PROGRAM.

    Section 2625 of the Public Health Service Act (42 U.S.C. 300ff-33) 
is amended to read as follows:

``SEC. 2625. EARLY DIAGNOSIS GRANT PROGRAM.

    ``(a) In General.--In the case of States whose laws or regulations 
are in accordance with subsection (b), the Secretary, acting through 
the Centers for Disease Control and Prevention, shall make grants to 
such States for the purposes described in subsection (c).
    ``(b) Description of Compliant States.--For purposes of 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), both of the 
policies described in paragraph (1) are in effect, or both of the 
policies described in paragraph (2) are in effect, as follows:
            ``(1)(A) Voluntary opt-out testing of pregnant women.
            ``(B) Universal testing of newborns.
            ``(2)(A) Voluntary opt-out testing of clients at sexually 
        transmitted disease clinics.
            ``(B) Voluntary opt-out testing of clients at substance 
        abuse treatment centers.
The Secretary shall periodically ensure that the applicable policies 
are being carried out and recertify compliance.
    ``(c) Use of Funds.--A State may use funds provided under 
subsection (a) for HIV/AIDS testing (including rapid testing), 
prevention counseling, treatment of newborns exposed to HIV/AIDS, 
treatment of mothers infected with HIV/AIDS, and costs associated with 
linking those diagnosed with HIV/AIDS to care and treatment for HIV/
AIDS.
    ``(d) Application.--A State that is eligible for the grant under 
subsection (a) shall submit an application to the Secretary, in such 
form, in such manner, and containing such information as the Secretary 
may require.
    ``(e) Limitation on Amount of Grant.--A grant under subsection (a) 
to a State for a fiscal year may not be made in an amount exceeding 
$10,000,000.
    ``(f) Rule of Construction.--Nothing in this section shall be 
construed to pre-empt State laws regarding HIV/AIDS counseling and 
testing.
    ``(g) Definitions.--In this section:
            ``(1) The term `voluntary opt-out testing' means HIV/AIDS 
        testing--
                    ``(A) that is administered to an individual seeking 
                other health care services; and
                    ``(B) in which--
                            ``(i) pre-test counseling is not required 
                        but the individual is informed that the 
                        individual will receive an HIV/AIDS test and 
                        the individual may opt out of such testing; and
                            ``(ii) for those individuals with a 
                        positive test result, post-test counseling 
                        (including referrals for care) is provided and 
                        confidentiality is protected.
            ``(2) The term `universal testing of newborns' means HIV/
        AIDS testing that is administered within 48 hours of delivery 
        to--
                    ``(A) all infants born in the State; or
                    ``(B) all infants born in the State whose mother's 
                HIV/AIDS status is unknown at the time of delivery.
    ``(h) Authorization of Appropriations.--Of the funds appropriated 
annually to the Centers for Disease Control and Prevention for HIV/AIDS 
prevention activities, $30,000,000 shall be made available for each of 
the fiscal years 2007 through 2011 for grants under subsection (a), of 
which $20,000,000 shall be made available for grants to States with the 
policies described in subsection (b)(1), and $10,000,000 shall be made 
available for grants to States with the policies described in 
subsection (b)(2). Funds provided under this section are available 
until expended.''.

SEC. 210. CERTAIN PARTNER NOTIFICATION PROGRAMS; AUTHORIZATION OF 
              APPROPRIATIONS.

    Section 2631(d) of the Public Health Service Act (42 U.S.C. 300ff-
38(d)) is amended by striking ``there are'' and all that follows and 
inserting the following: ``there is authorized to be appropriated 
$10,000,000 for each of the fiscal years 2007 through 2011.''.

                 TITLE III--EARLY INTERVENTION SERVICES

SEC. 301. ESTABLISHMENT OF PROGRAM; CORE MEDICAL SERVICES.

    (a) In General.--Section 2651 of the Public Health Service Act (42 
U.S.C. 300ff-51) is amended to read as follows:

``SEC. 2651. ESTABLISHMENT OF A PROGRAM.

    ``(a) In General.--For the purposes described in subsection (b), 
the Secretary, acting through the Administrator of the Health Resources 
and Services Administration, may make grants to public and nonprofit 
private entities specified in section 2652(a).
    ``(b) Requirements.--
            ``(1) In general.--The Secretary may not make a grant under 
        subsection (a) unless the applicant for the grant agrees to 
        expend the grant only for--
                    ``(A) core medical services described in subsection 
                (c);
                    ``(B) support services described in subsection (d); 
                and
                    ``(C) administrative expenses as described in 
                section 2664(g)(3).
            ``(2) Early intervention services.--An applicant for a 
        grant under subsection (a) shall expend not less than 50 
        percent of the amount received under the grant for the services 
        described in subparagraphs (B) through (E) of subsection (e)(1) 
        for individuals with HIV/AIDS.
    ``(c) Required Funding for Core Medical Services.--
            ``(1) In general.--With respect to a grant under subsection 
        (a) to an applicant for a fiscal year, the applicant shall, of 
        the portion of the grant remaining after reserving amounts for 
        purposes of paragraphs (3) and (5) of section 2664(g), use not 
        less than 75 percent to provide core medical services that are 
        needed in the area involved for individuals with HIV/AIDS who 
        are identified and eligible under this title (including 
        services regarding the co-occurring conditions of the 
        individuals).
            ``(2) Waiver.--
                    ``(A) The Secretary shall waive the application of 
                paragraph (1) with respect to an applicant for a grant 
                if the Secretary determines that, within the service 
                area of the applicant--
                            ``(i) there are no waiting lists for AIDS 
                        Drug Assistance Program services under section 
                        2616; and
                            ``(ii) core medical services are available 
                        to all individuals with HIV/AIDS identified and 
                        eligible under this title.
                    ``(B) Notification of waiver status.--When 
                informing an applicant that a grant under subsection 
                (a) is being made for a fiscal year, the Secretary 
                shall inform the applicant whether a waiver under 
                subparagraph (A) is in effect for the fiscal year.
            ``(3) Core medical services.--For purposes of this 
        subsection, the term `core medical services', with respect to 
        an individual with HIV/AIDS (including the co-occurring 
        conditions of the individual) means the following services:
                    ``(A) Outpatient and ambulatory health services.
                    ``(B) AIDS Drug Assistance Program treatments under 
                section 2616.
                    ``(C) AIDS pharmaceutical assistance.
                    ``(D) Oral health care.
                    ``(E) Early intervention services described in 
                subsection (e).
                    ``(F) Health insurance premium and cost sharing 
                assistance for low-income individuals in accordance 
                with section 2615.
                    ``(G) Home health care.
                    ``(H) Medical nutrition therapy.
                    ``(I) Hospice services.
                    ``(J) Home and community-based health services as 
                defined under section 2614(c).
                    ``(K) Mental health services.
                    ``(L) Substance abuse outpatient care.
                    ``(M) Medical case management, including treatment 
                adherence services.
    ``(d) Support Services.--
            ``(1) In general.--For purposes of this section, the term 
        `support services' means services, subject to the approval of 
        the Secretary, that are needed for individuals with HIV/AIDS to 
        achieve their medical outcomes (such as respite care for 
        persons caring for individuals with HIV/AIDS, outreach 
        services, medical transportation, linguistic services, and 
        referrals for health care and support services).
            ``(2) Definition of medical outcomes.--In this section, the 
        term `medical outcomes' means those outcomes affecting the HIV-
        related clinical status of an individual with HIV/AIDS.
    ``(e) Specification of Early Intervention Services.--
            ``(1) In general.--The early intervention services referred 
        to in this section are--
                    ``(A) counseling individuals with respect to HIV/
                AIDS in accordance with section 2662;
                    ``(B) testing individuals with respect to HIV/AIDS, 
                including tests to confirm the presence of the disease, 
                tests to diagnose the extent of the deficiency in the 
                immune system, and tests to provide information on 
                appropriate therapeutic measures for preventing and 
                treating the deterioration of the immune system and for 
                preventing and treating conditions arising from HIV/
                AIDS;
                    ``(C) referrals described in paragraph (2);
                    ``(D) other clinical and diagnostic services 
                regarding HIV/AIDS, and periodic medical evaluations of 
                individuals with HIV/AIDS; and
                    ``(E) providing the therapeutic measures described 
                in subparagraph (B).
            ``(2) Referrals.--The services referred to in paragraph 
        (1)(C) are referrals of individuals with HIV/AIDS to 
        appropriate providers of health and support services, 
        including, as appropriate--
                    ``(A) to entities receiving amounts under part A or 
                B for the provision of such services;
                    ``(B) to biomedical research facilities of 
                institutions of higher education that offer 
                experimental treatment for such disease, or to 
                community-based organizations or other entities that 
                provide such treatment; or
                    ``(C) to grantees under section 2671, in the case 
                of a pregnant woman.
            ``(3) Requirement of availability of all early intervention 
        services through each grantee.--
                    ``(A) In general.--The Secretary may not make a 
                grant under subsection (a) unless the applicant for the 
                grant agrees that each of the early intervention 
                services specified in paragraph (2) will be available 
                through the grantee. With respect to compliance with 
                such agreement, such a grantee may expend the grant to 
                provide the early intervention services directly, and 
                may expend the grant to enter into agreements with 
                public or nonprofit private entities, or private for-
                profit entities if such entities are the only available 
                provider of quality HIV care in the area, under which 
                the entities provide the services.
                    ``(B) Other requirements.--Grantees described in--
                            ``(i) subparagraphs (A), (D), (E), and (F) 
                        of section 2652(a)(1) shall use not less than 
                        50 percent of the amount of such a grant to 
                        provide the services described in subparagraphs 
                        (A), (B), (D), and (E) of paragraph (1) 
                        directly and on-site or at sites where other 
                        primary care services are rendered; and
                            ``(ii) subparagraphs (B) and (C) of section 
                        2652(a)(1) shall ensure the availability of 
                        early intervention services through a system of 
                        linkages to community-based primary care 
                        providers, and to establish mechanisms for the 
                        referrals described in paragraph (1)(C), and 
                        for follow-up concerning such referrals.''.
    (b) Administrative Expenses; Clinical Quality Management Program.--
Section 2664(g) of the Public Health Service Act (42 U.S.C. 300ff-
64(g)) is amended--
            (1) in paragraph (3), by amending the paragraph to read as 
        follows:
            ``(3) the applicant will not expend more than 10 percent of 
        the grant for administrative expenses with respect to the 
        grant, including planning and evaluation, except that the costs 
        of a clinical quality management program under paragraph (5) 
        may not be considered administrative expenses for purposes of 
        such limitation;''; and
            (2) in paragraph (5), by inserting ``clinical'' before 
        ``quality management''.

SEC. 302. ELIGIBLE ENTITIES; PREFERENCES; PLANNING AND DEVELOPMENT 
              GRANTS.

    (a) Minimum Qualification of Grantees.--Section 2652(a) of the 
Public Health Service Act (42 U.S.C. 300ff-52(a)) is amended to read as 
follows:
    ``(a) Eligible Entities.--
            ``(1) In general.--The entities referred to in section 
        2651(a) are public entities and nonprofit private entities that 
        are--
                    ``(A) federally-qualified health centers under 
                section 1905(l)(2)(B) of the Social Security Act;
                    ``(B) grantees under section 1001 (regarding family 
                planning) other than States;
                    ``(C) comprehensive hemophilia diagnostic and 
                treatment centers;
                    ``(D) rural health clinics;
                    ``(E) health facilities operated by or pursuant to 
                a contract with the Indian Health Service;
                    ``(F) community-based organizations, clinics, 
                hospitals and other health facilities that provide 
                early intervention services to those persons infected 
                with HIV/AIDS through intravenous drug use; or
                    ``(G) nonprofit private entities that provide 
                comprehensive primary care services to populations at 
                risk of HIV/AIDS, including faith-based and community-
                based organizations.
            ``(2) Underserved populations.--Entities described in 
        paragraph (1) shall serve underserved populations which may 
        include minority populations and Native American populations, 
        ex-offenders, individuals with comorbidities including 
        hepatitis B or C, mental illness, or substance abuse, low-
        income populations, inner city populations, and rural 
        populations.''.
    (b) Preferences in Making Grants.--Section 2653 of the Public 
Health Service Act (42 U.S.C. 300ff-53) is amended--
            (1) in subsection (b)(1)--
                    (A) in subparagraph (A), by striking ``acquired 
                immune deficiency syndrome'' and inserting ``HIV/
                AIDS''; and
                    (B) in subparagraph (D), by inserting before the 
                semicolon the following: ``and the number of cases of 
                individuals co-infected with HIV/AIDS and hepatitis B 
                or C''; and
            (2) in subsection (d)(2), by striking ``special 
        consideration'' and inserting ``preference''.
    (c) Planning and Development Grants.--Section 2654(c) of the Public 
Health Service Act (42 U.S.C. 300ff-54(c)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A), by striking ``HIV''; and
                    (B) in subparagraph (B), by striking ``HIV'' and 
                inserting ``HIV/AIDS''; and
            (2) in paragraph (3), by striking ``or underserved 
        communities'' and inserting ``areas or to underserved 
        populations''.

SEC. 303. AUTHORIZATION OF APPROPRIATIONS.

    Section 2655 of the Public Health Service Act (42 U.S.C. 300ff-55) 
is amended by striking ``such sums'' and all that follows through 
``2005'' and inserting ``, $218,600,000 for fiscal year 2007, 
$226,700,000 for fiscal year 2008, $235,100,000 for fiscal year 2009, 
$243,800,000 for fiscal year 2010, and $252,800,000 for fiscal year 
2011''.

SEC. 304. CONFIDENTIALITY AND INFORMED CONSENT.

    Section 2661 of the Public Health Service Act (42 U.S.C. 300ff-61) 
is amended to read as follows:

``SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT.

    ``(a) Confidentiality.--The Secretary may not make a grant under 
this part unless, in the case of any entity applying for a grant under 
section 2651, the entity agrees to ensure that information regarding 
the receipt of early intervention services pursuant to the grant is 
maintained confidentially in a manner not inconsistent with applicable 
law.
    ``(b) Informed Consent.--The Secretary may not make a grant under 
this part unless the applicant for the grant agrees that, in testing an 
individual for HIV/AIDS, the applicant will test an individual only 
after the individual confirms that the decision of the individual with 
respect to undergoing such testing is voluntarily made.''.

SEC. 305. PROVISION OF CERTAIN COUNSELING SERVICES.

    Section 2662 of the Public Health Service Act (42 U.S.C. 300ff-62) 
is amended to read as follows:

``SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.

    ``(a) Counseling of Individuals With Negative Test Results.--The 
Secretary may not make a grant under this part unless the applicant for 
the grant agrees that, if the results of testing conducted for HIV/AIDS 
indicate that an individual does not have such condition, the applicant 
will provide the individual information, including--
            ``(1) measures for prevention of, exposure to, and 
        transmission of HIV/AIDS, hepatitis B, hepatitis C, and other 
        sexually transmitted diseases;
            ``(2) the accuracy and reliability of results of testing 
        for HIV/AIDS, hepatitis B, and hepatitis C;
            ``(3) the significance of the results of such testing, 
        including the potential for developing AIDS, hepatitis B, or 
        hepatitis C;
            ``(4) the appropriateness of further counseling, testing, 
        and education of the individual regarding HIV/AIDS and other 
        sexually transmitted diseases;
            ``(5) if diagnosed with chronic hepatitis B or hepatitis C 
        co-infection, the potential of developing hepatitis-related 
        liver disease and its impact on HIV/AIDS; and
            ``(6) information regarding the availability of hepatitis B 
        vaccine and information about hepatitis treatments.
    ``(b) Counseling of Individuals With Positive Test Results.--The 
Secretary may not make a grant under this part unless the applicant for 
the grant agrees that, if the results of testing for HIV/AIDS indicate 
that the individual has such condition, the applicant will provide to 
the individual appropriate counseling regarding the condition, 
including--
            ``(1) information regarding--
                    ``(A) measures for prevention of, exposure to, and 
                transmission of HIV/AIDS, hepatitis B, and hepatitis C;
                    ``(B) the accuracy and reliability of results of 
                testing for HIV/AIDS, hepatitis B, and hepatitis C; and
                    ``(C) the significance of the results of such 
                testing, including the potential for developing AIDS, 
                hepatitis B, or hepatitis C;
            ``(2) reviewing the appropriateness of further counseling, 
        testing, and education of the individual regarding HIV/AIDS and 
        other sexually transmitted diseases; and
            ``(3) providing counseling--
                    ``(A) on the availability, through the applicant, 
                of early intervention services;
                    ``(B) on the availability in the geographic area of 
                appropriate health care, mental health care, and social 
                and support services, including providing referrals for 
                such services, as appropriate;
                    ``(C)(i) that explains the benefits of locating and 
                counseling any individual by whom the infected 
                individual may have been exposed to HIV/AIDS, hepatitis 
                B, or hepatitis C and any individual whom the infected 
                individual may have exposed to HIV/AIDS, hepatitis B, 
                or hepatitis C; and
                    ``(ii) that emphasizes it is the duty of infected 
                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/AIDS, hepatitis B, or 
                hepatitis C; and
                    ``(D) on the availability of the services of public 
                health authorities with respect to locating and 
                counseling any individual described in subparagraph 
                (C);
            ``(4) if diagnosed with chronic hepatitis B or hepatitis C 
        co-infection, the potential of developing hepatitis-related 
        liver disease and its impact on HIV/AIDS; and
            ``(5) information regarding the availability of hepatitis B 
        vaccine.
    ``(c) Additional Requirements Regarding Appropriate Counseling.--
The Secretary may not make a grant under this part unless the applicant 
for the grant agrees that, in counseling individuals with respect to 
HIV/AIDS, the applicant will ensure that the counseling is provided 
under conditions appropriate to the needs of the individuals.
    ``(d) Counseling of Emergency Response Employees.--The Secretary 
may not make a grant under this part to a State unless the State agrees 
that, in counseling individuals with respect to HIV/AIDS, the State 
will ensure that, in the case of emergency response employees, the 
counseling is provided to such employees under conditions appropriate 
to the needs of the employees regarding the counseling.
    ``(e) Rule of Construction Regarding Counseling Without Testing.--
Agreements made pursuant to this section may not be construed to 
prohibit any grantee under this part from expending the grant for the 
purpose of providing counseling services described in this section to 
an individual who does not undergo testing for HIV/AIDS as a result of 
the grantee or the individual determining that such testing of the 
individual is not appropriate.''.

SEC. 306. GENERAL PROVISIONS.

    (a) Applicability of Certain Requirements.--Section 2663 of the 
Public Health Service Act (42 U.S.C. 300ff-63) is amended by striking 
``will, without'' and all that follows through ``be carried'' and 
inserting ``with funds appropriated through this Act will be carried''.
    (b) Additional Required Agreements.--Section 2664(a) of the Public 
Health Service Act (42 U.S.C. 300ff-64(a)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A), by striking ``and'' at the 
                end;
                    (B) in subparagraph (B), by striking ``and'' at the 
                end; and
                    (C) by adding at the end the following:
                    ``(C) information regarding how the expected 
                expenditures of the grant are related to the planning 
                process for localities funded under part A (including 
                the planning process described in section 2602) and for 
                States funded under part B (including the planning 
                process described in section 2617(b)); and
                    ``(D) a specification of the expected expenditures 
                and how those expenditures will improve overall client 
                outcomes, as described in the State plan under section 
                2617(b);'';
            (2) in paragraph (2), by striking the period and inserting 
        a semicolon; and
            (3) by adding at the end the following:
            ``(3) the applicant agrees to provide additional 
        documentation to the Secretary regarding the process used to 
        obtain community input into the design and implementation of 
        activities related to such grant; and
            ``(4) the applicant agrees to submit, every 2 years, to the 
        lead State agency under section 2617(b)(4) audits, consistent 
        with Office of Management and Budget circular A133, regarding 
        funds expended in accordance with this title and shall include 
        necessary client level data to complete unmet need calculations 
        and Statewide coordinated statements of need process.''.
    (c) Payer of Last Resort.--Section 2664(f)(1)(A) of the Public 
Health Service Act (42 U.S.C. 300ff-64(f)(1)(A)) is amended by 
inserting ``(except for a program administered by or providing the 
services of the Indian Health Service)'' before the semicolon.

             TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH

SEC. 401. WOMEN, INFANTS, CHILDREN, AND YOUTH.

    Part D of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff-71 et seq.) is amended to read as follows:

             ``PART D--WOMEN, INFANTS, CHILDREN, AND YOUTH

``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR 
              WOMEN, INFANTS, CHILDREN, AND YOUTH.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award grants 
to public and nonprofit private entities (including a health facility 
operated by or pursuant to a contract with the Indian Health Service) 
for the purpose of providing family-centered care involving outpatient 
or ambulatory care (directly or through contracts) for women, infants, 
children, and youth with HIV/AIDS.
    ``(b) Additional Services for Patients and Families.--Funds 
provided under grants awarded under subsection (a) may be used for the 
following support services:
            ``(1) Family-centered care including case management.
            ``(2) Referrals for additional services including--
                    ``(A) referrals for inpatient hospital services, 
                treatment for substance abuse, and mental health 
                services; and
                    ``(B) referrals for other social and support 
                services, as appropriate.
            ``(3) Additional services necessary to enable the patient 
        and the family to participate in the program established by the 
        applicant pursuant to such subsection including services 
        designed to recruit and retain youth with HIV.
            ``(4) The provision of information and education on 
        opportunities to participate in HIV/AIDS-related clinical 
        research.
    ``(c) Coordination With Other Entities.--A grant awarded under 
subsection (a) may be made only if the applicant provides an agreement 
that includes the following:
            ``(1) The applicant will coordinate activities under the 
        grant with other providers of health care services under this 
        Act, and under title V of the Social Security Act, including 
        programs promoting the reduction and elimination of risk of 
        HIV/AIDS for youth.
            ``(2) The applicant will participate in the statewide 
        coordinated statement of need under part B (where it has been 
        initiated by the public health agency responsible for 
        administering grants under part B) and in revisions of such 
        statement.
            ``(3) The applicant will every 2 years submit to the lead 
        State agency under section 2617(b)(4) audits regarding funds 
        expended in accordance with this title and shall include 
        necessary client-level data to complete unmet need calculations 
        and Statewide coordinated statements of need process.
    ``(d) Administration; Application.--A grant may only be awarded to 
an entity under subsection (a) if an application for the grant is 
submitted to the Secretary and the application is in such form, is made 
in such manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to carry out 
this section. Such application shall include the following:
            ``(1) Information regarding how the expected expenditures 
        of the grant are related to the planning process for localities 
        funded under part A (including the planning process outlined in 
        section 2602) and for States funded under part B (including the 
        planning process outlined in section 2617(b)).
            ``(2) A specification of the expected expenditures and how 
        those expenditures will improve overall patient outcomes, as 
        outlined as part of the State plan (under section 2617(b)) or 
        through additional outcome measures.
    ``(e) Annual Review of Programs; Evaluations.--
            ``(1) Review regarding access to and participation in 
        programs.--With respect to a grant under subsection (a) for an 
        entity for a fiscal year, the Secretary shall, not later than 
        180 days after the end of the fiscal year, provide for the 
        conduct and completion of a review of the operation during the 
        year of the program carried out under such subsection by the 
        entity. The purpose of such review shall be the development of 
        recommendations, as appropriate, for improvements in the 
        following:
                    ``(A) Procedures used by the entity to allocate 
                opportunities and services under subsection (a) among 
                patients of the entity who are women, infants, 
                children, or youth.
                    ``(B) Other procedures or policies of the entity 
                regarding the participation of such individuals in such 
                program.
            ``(2) Evaluations.----The Secretary shall, directly or 
        through contracts with public and private entities, provide for 
        evaluations of programs carried out pursuant to subsection (a).
    ``(f) Administrative Expenses.--
            ``(1) Limitation.--A grantee may not use more than 10 
        percent of amounts received under a grant awarded under this 
        section for administrative expenses.
            ``(2) Clinical quality management program.--A grantee under 
        this section shall implement a clinical quality 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/AIDS and related opportunistic infection, and as 
        applicable, to develop strategies for ensuring that such 
        services are consistent with the guidelines for improvement in 
        the access to and quality of HIV health services.
    ``(g) Training and Technical Assistance.--From the amounts 
appropriated under subsection (i) for a fiscal year, the Secretary may 
use not more than 5 percent to provide, directly or through contracts 
with public and private entities (which may include grantees under 
subsection (a)), training and technical assistance to assist applicants 
and grantees under subsection (a) in complying with the requirements of 
this section.
    ``(h) Definitions.--In this section:
            ``(1) Administrative expenses.--The term `administrative 
        expenses' means funds that are to be used by grantees for grant 
        management and monitoring activities, including costs related 
        to any staff or activity unrelated to services or indirect 
        costs.
            ``(2) Indirect costs.--The term `indirect costs' means 
        costs included in a Federally negotiated indirect rate.
            ``(3) Services.--The term `services' means--
                    ``(A) services that are provided to clients to meet 
                the goals and objectives of the program under this 
                section, including the provision of professional, 
                diagnostic, and therapeutic services by a primary care 
                provider or a referral to and provision of specialty 
                care; and
                    ``(B) services that sustain program activity and 
                contribute to or help improve services under 
                subparagraph (A).
    ``(i) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated, $71,800,000 
for each of the fiscal years 2007 through 2011.''.

SEC. 402. GAO REPORT.

    Not later than 24 months after the date of enactment of this Act, 
the Comptroller General of the Government Accountability Office shall 
conduct an evaluation, and submit to Congress a report, concerning the 
funding provided for under part D of title XXVI of the Public Health 
Service Act to determine--
            (1) how funds are used to provide the administrative 
        expenses, indirect costs, and services, as defined in section 
        2671(h) of such title, for individuals with HIV/AIDS;
            (2) how funds are used to provide the administrative 
        expenses, indirect costs, and services, as defined in section 
        2671(h) of such title, to family members of women, infants, 
        children, and youth infected with HIV/AIDS;
            (3) how funds are used to provide family-centered care 
        involving outpatient or ambulatory care authorized under 
        section 2671(a) of such title;
            (4) how funds are used to provide additional services 
        authorized under section 2671(b) of such title; and
            (5) how funds are used to help identify HIV-positive 
        pregnant women and their children who are exposed to HIV and 
        connect them with care that can improve their health and 
        prevent perinatal transmission.

                      TITLE V--GENERAL PROVISIONS

SEC. 501. GENERAL PROVISIONS.

    Part E of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff-80 et seq.) is amended to read as follows:

                      ``PART E--GENERAL PROVISIONS

``SEC. 2681. COORDINATION.

    ``(a) Requirement.--The Secretary shall ensure that the Health 
Resources and Services Administration, the Centers for Disease Control 
and Prevention, the Substance Abuse and Mental Health Services 
Administration, and the Centers for Medicare & Medicaid Services 
coordinate the planning, funding, and implementation of Federal HIV 
programs (including all minority AIDS initiatives of the Public Health 
Service, including under section 2693) to enhance the continuity of 
care and prevention services for individuals with HIV/AIDS or those at 
risk of such disease. The Secretary shall consult with other Federal 
agencies, including the Department of Veterans Affairs, as needed and 
utilize planning information submitted to such agencies by the States 
and entities eligible for assistance under this title.
    ``(b) Report.--The Secretary shall biennially prepare and submit to 
the appropriate committees of the Congress a report concerning the 
coordination efforts at the Federal, State, and local levels described 
in this section, including a description of Federal barriers to HIV 
program integration and a strategy for eliminating such barriers and 
enhancing the continuity of care and prevention services for 
individuals with HIV/AIDS or those at risk of such disease.
    ``(c) Integration by State.--As a condition of receipt of funds 
under this title, a State shall provide assurances to the Secretary 
that health support services funded under this title will be integrated 
with other such services, that programs will be coordinated with other 
available programs (including Medicaid), and that the continuity of 
care and prevention services of individuals with HIV/AIDS is enhanced.
    ``(d) Integration by Local or Private Entities.--As a condition of 
receipt of funds under this title, a local government or private 
nonprofit entity shall provide assurances to the Secretary that 
services funded under this title will be integrated with other such 
services, that programs will be coordinated with other available 
programs (including Medicaid), and that the continuity of care and 
prevention services of individuals with HIV is enhanced.

``SEC. 2682. AUDITS.

    ``(a) In General.--For fiscal year 2009, and each subsequent fiscal 
year, the Secretary may reduce the amounts of grants under this title 
to a State or political subdivision of a State for a fiscal year if, 
with respect to such grants for the second preceding fiscal year, the 
State or subdivision fails to prepare audits in accordance with the 
procedures of section 7502 of title 31, United States Code. The 
Secretary shall annually select representative samples of such audits, 
prepare summaries of the selected audits, and submit the summaries to 
the Congress.
    ``(b) Posting on the Internet.--All audits that the Secretary 
receives from the State lead agency under section 2617(b)(4) shall be 
posted, in their entirety, on the Internet website of the Health 
Resources and Services Administration.

``SEC. 2683. PUBLIC HEALTH EMERGENCY.

    ``(a) In General.--In an emergency area and during an emergency 
period, the Secretary shall have the authority to waive such 
requirements of this title to improve the health and safety of those 
receiving care under this title and the general public, except that the 
Secretary may not expend more than 5 percent of the funds allocated 
under this title for sections 2620 and section 2603(b).
    ``(b) Emergency Area and Emergency Period.--In this section:
            ``(1) Emergency area.--The term `emergency area' means a 
        geographic area in which there exists--
                    ``(A) an emergency or disaster declared by the 
                President pursuant to the National Emergencies Act or 
                the Robert T. Stafford Disaster Relief and Emergency 
                Assistance Act; or
                    ``(B) a public health emergency declared by the 
                Secretary pursuant to section 319.
            ``(2) Emergency period.--The term `emergency period' means 
        the period in which there exists--
                    ``(A) an emergency or disaster declared by the 
                President pursuant to the National Emergencies Act or 
                the Robert T. Stafford Disaster Relief and Emergency 
                Assistance Act; or
                    ``(B) a public health emergency declared by the 
                Secretary pursuant to section 319.
    ``(c) Unobligated Funds.--If funds under a grant under this section 
are not expended for an emergency in the fiscal year in which the 
emergency is declared, such funds shall be returned to the Secretary 
for reallocation under sections 2603(b) and 2620.

``SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

    ``None of the funds appropriated under this title shall be used to 
fund AIDS programs, or to develop materials, designed to promote or 
encourage, directly, intravenous drug use or sexual activity, whether 
homosexual or heterosexual. Funds authorized under this title may be 
used to provide medical treatment and support services for individuals 
with HIV.

``SEC. 2685. PRIVACY PROTECTIONS.

    ``(a) In General.--The Secretary shall ensure that any information 
submitted to, or collected by, the Secretary under this title excludes 
any personally identifiable information.
    ``(b) Definition.--In this section, the term `personally 
identifiable information' has the meaning given such term under the 
regulations promulgated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996.

``SEC. 2686. GAO REPORT.

    ``The Comptroller General of the Government Accountability Office 
shall biennially submit to the appropriate committees of Congress a 
report that includes a description of Federal, State, and local 
barriers to HIV program integration, particularly for racial and ethnic 
minorities, including activities carried out under subpart III of part 
F, and recommendations for enhancing the continuity of care and the 
provision of prevention services for individuals with HIV/AIDS or those 
at risk for such disease. Such report shall include a demonstration of 
the manner in which funds under this subpart are being expended and to 
what extent the services provided with such funds increase access to 
prevention and care services for individuals with HIV/AIDS and build 
stronger community linkages to address HIV prevention and care for 
racial and ethnic minority communities.

``SEC. 2687. DEFINITIONS.

    ``For purposes of this title:
            ``(1) AIDS.--The term `AIDS' means acquired immune 
        deficiency syndrome.
            ``(2) Co-occurring conditions.--The term `co-occurring 
        conditions' means one or more adverse health conditions in an 
        individual with HIV/AIDS, without regard to whether the 
        individual has AIDS and without regard to whether the 
        conditions arise from HIV.
            ``(3) Counseling.--The term `counseling' means such 
        counseling provided by an individual trained to provide such 
        counseling.
            ``(4) Family-centered care.--The term `family-centered 
        care' means the system of services described in this title that 
        is targeted specifically to the special needs of infants, 
        children, women and families. Family-centered care shall be 
        based on a partnership between parents, professionals, and the 
        community designed to ensure an integrated, coordinated, 
        culturally sensitive, and community-based continuum of care for 
        children, women, and families with HIV/AIDS.
            ``(5) Families with hiv/aids.--The term `families with HIV/
        AIDS' means families in which one or more members have HIV/
        AIDS.
            ``(6)  HIV.--The term `HIV' means infection with the human 
        immunodeficiency virus.
            ``(7) HIV/AIDS.--
                    ``(A) In general.--The term `HIV/AIDS' means HIV, 
                and includes AIDS and any condition arising from AIDS.
                    ``(B) Counting of cases.--The term `living cases of 
                HIV/AIDS', with respect to the counting of cases in a 
                geographic area during a period of time, means the sum 
                of--
                            ``(i) the number of living non-AIDS cases 
                        of HIV in the area; and
                            ``(ii) the number of living cases of AIDS 
                        in the area.
                    ``(C) Non-aids cases.--The term `non-AIDS', with 
                respect to a case of HIV, means that the individual 
                involved has HIV but does not have AIDS.
            ``(8) Human immunodeficiency virus.--The term `human 
        immunodeficiency virus' means the etiologic agent for AIDS.
            ``(9) Official poverty line.--The term `official poverty 
        line' means the poverty line established by the Director of the 
        Office of Management and Budget and revised by the Secretary in 
        accordance with section 673(2) of the Omnibus Budget 
        Reconciliation Act of 1981.
            ``(10) Person.--The term `person' includes one or more 
        individuals, governments (including the Federal Government and 
        the governments of the States), governmental agencies, 
        political subdivisions, labor unions, partnerships, 
        associations, corporations, legal representatives, mutual 
        companies, joint-stock companies, trusts, unincorporated 
        organizations, receivers, trustees, and trustees in cases under 
        title 11, United States Code.
            ``(11) State.--
                    ``(A) In general.--The term `State' means each of 
                the 50 States, the District of Columbia, and each of 
                the territories.
                    ``(B) Territories.--The term `territory' means each 
                of American Samoa, Guam, the Commonwealth of Puerto 
                Rico, the Commonwealth of the Northern Mariana Islands, 
                the Virgin Islands, the Republic of the Marshall 
                Islands, the Federated States of Micronesia, and Palau.
            ``(12) Youth with hiv.--The term `youth with HIV' means 
        individuals who are 13 through 24 years old and who have HIV/
        AIDS.''.

                  TITLE VI--DEMONSTRATION AND TRAINING

SEC. 601. DEMONSTRATION AND TRAINING.

    Subpart I of part F of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-101 et seq.) is amended to read as follows:

         ``Subpart I--Special Projects of National Significance

``SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

    ``(a) In General.--Of the amount appropriated under each of parts 
A, B, C, and D for each fiscal year, the Secretary shall use the 
greater of $20,000,000 or an amount equal to 3 percent of such amount 
appropriated under each such part, but not to exceed $25,000,000, to 
administer special projects of national significance to--
            ``(1) quickly respond to emerging needs of individuals 
        receiving assistance under this title; and
            ``(2) to fund special programs to develop a standard 
        electronic client information data system to improve the 
        ability of grantees under this title to report client-level 
        data to the Secretary.
    ``(b) Grants.--The Secretary shall award grants under subsection 
(a) to entities eligible for funding under parts A, B, C, and D based 
on--
    ``(1) whether the funding will promote obtaining client level data 
as it relates to the creation of a severity of need index under section 
2618(a)(2)(E), including funds to facilitate the purchase and enhance 
the utilization of qualified health information technology systems;
    ``(2) demonstrated ability to create and maintain a qualified 
health information technology system;
    ``(3) the potential replicability of the proposed activity in other 
similar localities or nationally;
    ``(4) the demonstrated reliability of the proposed qualified health 
information technology system across a variety of providers, geographic 
regions, and clients; and
    ``(5) the demonstrated ability to maintain a safe and secure 
qualified health information system; or
    ``(6) newly emerging needs of individuals receiving assistance 
under this title.
    ``(c) Coordination.--The Secretary may not make a grant under this 
section unless the applicant submits evidence that the proposed program 
is consistent with the statewide coordinated statement of need, and the 
applicant agrees to participate in the ongoing revision process of such 
statement of need.
    ``(d) Privacy Protection.--The Secretary may not make a grant under 
this section for the development of a qualified health information 
technology system unless the applicant provides assurances to the 
Secretary that the system will, at a minimum, comply with the privacy 
regulations promulgated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996.
    ``(e) Replication.--The Secretary shall make information concerning 
successful models or programs developed under this part available to 
grantees under this title for the purpose of coordination, replication, 
and integration. To facilitate efforts under this subsection, the 
Secretary may provide for peer-based technical assistance for grantees 
funded under this part.''.

SEC. 602. AIDS EDUCATION AND TRAINING CENTERS.

    (a) Amendments Regarding Schools and Centers.--Section 2692(a)(2) 
of the Public Health Service Act (42 U.S.C. 300ff-111(a)(2)) is 
amended--
            (1) in subparagraph (A)--
                    (A) by inserting ``and Native Americans'' after 
                ``minority individuals''; and
                    (B) by striking ``and'' at the end;
            (2) in subparagraph (B), by striking the period and 
        inserting ``; and''; and
            (3) by adding at the end the following:
                    ``(C) train or result in the training of health 
                professionals and allied health professionals to 
                provide treatment for hepatitis B or C co-infected 
                individuals.''.
    (b) Authorizations of Appropriations for Schools, Centers, and 
Dental Programs.--Section 2692(c) of the Public Health Service Act (42 
U.S.C. 300ff-111(c)) is amended to read as follows:
    ``(c) Authorization of Appropriations.--
            ``(1) Schools; centers.--For the purpose of awarding grants 
        under subsection (a), there is authorized to be appropriated 
        $34,700,000 for each of the fiscal years 2007 through 2011.
            ``(2) Dental schools.--For the purpose of awarding grants 
        under subsection (b), there is authorized to be appropriated 
        $13,000,000 for each of the fiscal years 2007 through 2011.''.

SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE.

    Part F of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff-101 et seq.) is amended by adding at the end the following:

                ``Subpart III--Minority AIDS Initiative

``SEC. 2693. MINORITY AIDS INITIATIVE.

    ``(a) In General.--For the purpose of carrying out activities under 
this section to evaluate and address the disproportionate impact of 
HIV/AIDS on, and the disparities in access, treatment, care, and 
outcomes for, racial and ethnic minorities (including African 
Americans, Alaska Natives, Latinos, American Indians, Asian Americans, 
Native Hawaiians, and Pacific Islanders), there are authorized to be 
appropriated $131,200,000 for fiscal year 2007, $135,100,000 for fiscal 
year 2008, $139,100,000 for fiscal year 2009, $143,200,000 for fiscal 
year 2010, and $147,500,000 for fiscal year 2011.
    ``(b) Certain Activities.--
            ``(1) In general.--In carrying out the purpose described in 
        subsection (a), the Secretary shall provide for--
                    ``(A) emergency assistance under part A;
                    ``(B) care grants under part B;
                    ``(C) early intervention services under part C;
                    ``(D) services through projects for HIV-related 
                care under part D; and
                    ``(E) activities through education and training 
                centers under section 2692.
            ``(2) Allocations among activities.--Activities under 
        paragraph (1) shall be carried out by the Secretary in 
        accordance with the following:
                    ``(A) For competitive, supplemental grants to 
                improve HIV-related health outcomes to reduce existing 
                racial and ethnic health disparities, the Secretary 
                shall, of the amount appropriated under subsection (a) 
                for a fiscal year, reserve the following, as 
                applicable:
                            ``(i) For fiscal year 2007, $43,800,000.
                            ``(ii) For fiscal year 2008, $45,400,000.
                            ``(iii) For fiscal year 2009, $47,100,000.
                            ``(iv) For fiscal year 2010, $48,800,000.
                            ``(v) For fiscal year 2011, $50,700,000.
                    ``(B) For competitive grants used for supplemental 
                support education and outreach services to increase the 
                number of eligible racial and ethnic minorities who 
                have access to treatment through the program under 
                section 2616 for therapeutics, the Secretary shall, of 
                the amount appropriated for a fiscal year under 
                subsection (a), reserve the following, as applicable:
                            ``(i) For fiscal year 2007, $7,000,000.
                            ``(ii) For fiscal year 2008, $7,300,000.
                            ``(iii) For fiscal year 2009, $7,500,000.
                            ``(iv) For fiscal year 2010, $7,800,000.
                            ``(v) For fiscal year 2011, $8,100,000.
                    ``(C) For planning grants, capacity-building 
                grants, and services grants to health care providers 
                who have a history of providing culturally and 
                linguistically appropriate care and services to racial 
                and ethnic minorities, the Secretary shall, of the 
                amount appropriated for a fiscal year under subsection 
                (a), reserve the following, as applicable:
                            ``(i) For fiscal year 2007, $53,400,000.
                            ``(ii) For fiscal year 2008, $55,400,000.
                            ``(iii) For fiscal year 2009, $57,400,000.
                            ``(iv) For fiscal year 2010, $59,500,000.
                            ``(v) For fiscal year 2011, $61,800,000.
                    ``(D) For eliminating racial and ethnic disparities 
                in the delivery of comprehensive, culturally and 
                linguistically appropriate care services for HIV 
                disease for women, infants, children, and youth, the 
                Secretary shall, of the amount appropriated under 
                subsection (a), reserve $18,500,000 for each of the 
                fiscal years 2007 through 2011.
                    ``(E) For increasing the training capacity of 
                centers to expand the number of health care 
                professionals with treatment expertise and knowledge 
                about the most appropriate standards of HIV disease-
                related treatments and medical care for racial and 
                ethnic minority adults, adolescents, and children with 
                HIV disease, the Secretary shall, of the amount 
                appropriated under subsection (a), reserve $8,500,000 
                for each of the fiscal years 2007 through 2011.
    ``(c) Consistency With Prior Program.--With respect to the purpose 
described in subsection (a), the Secretary shall carry out this section 
consistent with the activities carried out under this title by the 
Secretary pursuant to the Departments of Labor, Health and Human 
Services, and Education, and Related Agencies Appropriations Act, 2002 
(Public Law 107-116).''.

                  TITLE VII--MISCELLANEOUS PROVISIONS

SEC. 701. HEPATITIS; USE OF FUNDS.

    Section 2667 of the Public Health Service Act (42 U.S.C. 300ff-67) 
is amended--
            (1) in paragraph (2), by striking ``and'' at the end;
            (2) in paragraph (3), by striking the period and inserting 
        ``; and''; and
            (3) by adding at the end the following:
            ``(4) shall provide information on the transmission and 
        prevention of hepatitis A, B, and C, including education about 
        the availability of hepatitis A and B vaccines and assisting 
        patients in identifying vaccination sites.''.

SEC. 702. CERTAIN REFERENCES.

    Title XXVI of the Public Health Service Act (42 U.S.C. 300ff et 
seq.) is amended--
            (1) by striking ``acquired immune deficiency syndrome'' 
        each place such term appears, other than in section 2687(1) (as 
        added by section 501 of this Act), and inserting ``AIDS'';
            (2) by striking ``such syndrome'' and inserting ``AIDS''; 
        and
            (3) by striking ``HIV disease'' each place such term 
        appears and inserting ``HIV/AIDS''.
                                                 Union Calendar No. 420

109th CONGRESS

  2d Session

                               H. R. 6143

                          [Report No. 109-695]

_______________________________________________________________________

                                 A BILL

  To amend title XXVI of the Public Health Service Act to revise and 
 extend the program for providing life-saving care for those with HIV/
                                 AIDS.

_______________________________________________________________________

                           September 28, 2006

Committed to the Committee of the Whole House on the State of the Union 
                       and ordered to be printed