[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2339 Introduced in Senate (IS)]








109th CONGRESS
  2d Session
                                S. 2339

 To reauthorize the HIV Health Care Services Program under title 26 of 
                     the Public Health Service Act.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 28, 2006

  Mr. Coburn introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To reauthorize the HIV Health Care Services Program under title 26 of 
                     the Public Health Service Act.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ryan White CARE Act Amendments of 
2006''.

SEC. 2. REAUTHORIZATION OF APPROPRIATIONS.

    Title XXVI of the Public Health Service Act (42 U.S.C. 300ff-11 et 
seq.) is amended--
            (1) in section 2677--
                    (A) in subsection (a), by striking ``2001 through 
                2005'' and inserting ``2006 through 2010''; and
                    (B) in subsection (b), by striking ``2001 through 
                2005'' and inserting ``2006 through 2010'';
            (2) in section 2625(c)(2)(A), by striking ``2001 through 
        2005'' and inserting ``2006 through 2010'';
            (3) in section 2631(d), by striking ``2005'' and inserting 
        ``2010'';
            (4) in section 2655, by striking ``2001 through 2005'' and 
        inserting ``2006 through 2010'';
            (5) in section 2671(l), as redesignated by section 4(d)(1) 
        of this Act, by striking ``for each of'' and all that follows 
        through the period and inserting ``for each of the fiscal years 
        2006 through 2010.''; and
            (6) in section 2692(c)--
                    (A) in paragraph (1), by striking ``2001 through 
                2005'' and inserting ``2006 through 2010''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A), by striking ``2001 
                        through 2005'' and inserting ``2006 through 
                        2010''; and
                            (ii) in subparagraph (B), by striking 
                        ``2001 through 2005'' and inserting ``2006 
                        through 2010''.

SEC. 3. DEFINITIONS.

    Section 2676 of the Public Health Service Act (42 U.S.C. 300ff-76) 
is amended--
            (1) by redesignating paragraphs (11) and (12), as 
        paragraphs (12) and (15), respectively;
            (2) by inserting after paragraph (10) the following:
            ``(11) Partner notification.--The term `partner 
        notification' means the process by which--
                    ``(A) an HIV-positive individual provides the names 
                of such individual's sex and needle-sharing partners to 
                health care providers or other health workers, who then 
                confidentially notify the partners directly of the 
                partners' exposure to HIV; and
                    ``(B) current and past partners of an HIV-positive 
                individual (index person) are confidentially notified 
                of the partners' exposure to HIV, counseled about the 
                partners' exposure, and offered services, including 
                testing, referrals for treatment, and notification of 
                the partners' sex and needle-sharing partners.''; and
            (3) by inserting after paragraph (12) (as redesignated by 
        paragraph (1)) the following:
            ``(13) Primary medical care.--The term `primary medical 
        care' means medical care that consists of medication, 
        prescription drugs, diagnostic tests, visits with physicians 
        and medically credentialed health care providers, treatment for 
        oral health, treatment for psychiatric conditions, and 
        treatment for other health care conditions directly related to 
        HIV/AIDS infection, as well as the cost of health insurance 
        premiums, co-payments, and deductibles. Such term does not 
        include case management for non-medical services or short-term 
        transitional housing.
            ``(14) Routine testing.--The term `routine testing' means 
        HIV testing--
                    ``(A) that is administered automatically to those 
                accessing health care services for any reason; and
                    ``(B) in which--
                            ``(i) pre-test counseling is not required 
                        but the subject is notified that the subject 
                        will receive an HIV test and the subject may 
                        opt out of such testing; and
                            ``(ii) for those individuals with a 
                        positive test result, post-test counseling, 
                        including referrals to care, is provided and 
                        confidentiality is protected.''.

SEC. 4. FUNDING FOR PRIMARY MEDICAL CARE.

    (a) Part A.--Section 2604 of the Public Health Service Act (42 
U.S.C. 300ff-14) is amended by adding at the end the following:
    ``(h) Required Funding for Primary Medical Care.--Notwithstanding 
any other provision of law, a grantee under this part shall expend not 
less than 75 percent of the funds received under the grant on primary 
medical care.''.
    (b) Part B.--Section 2612 of the Public Health Service Act (42 
U.S.C. 300ff-22) is amended by adding at the end the following:
    ``(e) Required Funding for Primary Medical Care.--Notwithstanding 
any other provision of law, a grantee under this part shall expend not 
less than 75 percent of the funds received under the grant on primary 
medical care.''.
    (c) Part C.--Subpart II of part C of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff-61 et seq.) is amended by adding at 
the end the following:

``SEC. 2668. REQUIRED FUNDING FOR PRIMARY MEDICAL CARE.

    ``Notwithstanding any other provision of law, a grantee under this 
part shall expend not less than 75 percent of the funds received under 
the grant on primary medical care. Grant funds expended for the 
services described in subparagraphs (B) through (E) of section 
2651(b)(2) shall count as expenditures on primary medical care.''.
    (d) Grants for Coordinated Services and Access to Research for 
Women, Infants, Children, and Youth.--Section 2671 of the Public Health 
Service Act (42 U.S.C. 300ff-71) is amended--
            (1) by redesignating subsection (k) as subsection (l); and
            (2) by inserting after subsection (j) the following:
    ``(k) Required Funding for Primary Medical Care.--Notwithstanding 
any other provision of law, a grantee under this section shall expend 
not less than 75 percent of the funds received under the grant on 
primary medical care.''.

SEC. 5. SUPPLEMENTAL TREATMENT DRUG GRANTS SAFETY NET.

    (a) In General.--Section 2618(a)(2)(I)(ii) of the Public Health 
Service Act (42 U.S.C. 300ff-28(a)(2)(I)(ii)) is amended by striking 
subclauses (V) and (VI) and inserting the following:
                                    ``(V) Funding.--
                                            ``(aa) Authorization of 
                                        appropriations.--There is 
                                        authorized to be appropriated 
                                        to carry out this clause for a 
                                        fiscal year an amount that is 
                                        not more than 8 percent of the 
                                        amount appropriated to carry 
                                        out section 2616 for such 
                                        fiscal year.
                                            ``(bb) Transfer of funds 
                                        when appropriations are 
                                        insufficient.--

                                                    ``(AA) In 
                                                general.--For any 
                                                fiscal year for which 
                                                the amount appropriated 
                                                to carry out this 
                                                clause and the amount 
                                                redistributed to carry 
                                                out this clause 
                                                pursuant to section 
                                                2679 total less than 5 
                                                percent of the amount 
                                                appropriated to carry 
                                                out section 2616 for 
                                                such fiscal year, the 
                                                Secretary shall 
                                                transfer from funds 
                                                appropriated to carry 
                                                out this part (except 
                                                this section) and parts 
                                                A, C, D, E, and F, for 
                                                the fiscal year and in 
                                                accordance with subitem 
                                                (BB), such amounts as 
                                                are necessary to make 
                                                the lesser of 
                                                $35,000,000 or 5 
                                                percent of the amount 
                                                appropriated to carry 
                                                out section 2616 for 
                                                such fiscal year, 
                                                available to carry out 
                                                this clause for such 
                                                fiscal year.

                                                    ``(BB) Formula for 
                                                the transfer of 
                                                funds.--In carrying out 
                                                subitem (AA) for a 
                                                fiscal year, the 
                                                Secretary shall 
                                                transfer from each part 
                                                under this title an 
                                                amount, from the amount 
                                                of funds appropriated 
                                                for such part for the 
                                                fiscal year, that bears 
                                                the same relation to 
                                                the total amount 
                                                required to be 
                                                transferred under 
                                                subitem (AA) for the 
                                                fiscal year, as the 
                                                amount of funds 
                                                appropriated to carry 
                                                out such part for the 
                                                fiscal year bears to 
                                                the total amount of 
                                                funds appropriated to 
                                                carry out this title 
                                                for such fiscal year.

                                                    ``(CC) Additional 
                                                amounts from hrsa.--In 
                                                addition to 
                                                transferring funds 
                                                under subitem (AA), the 
                                                Secretary may transfer, 
                                                for any fiscal year for 
                                                which the amount 
                                                appropriated to carry 
                                                out this clause is less 
                                                than $35,000,000, not 
                                                more than $5,000,000 
                                                from administrative 
                                                funds of the Health 
                                                Resources and Services 
                                                Administration of the 
                                                Department of Health 
                                                and Human Services to 
                                                carry out this 
                                                clause.''.

    (b) Return of Unobligated Funds.--
            (1) In general.--Part D of title XXVI of the Public Health 
        Service Act (42 U.S.C. 300ff-71 et seq.) is amended by adding 
        at the end the following:

``SEC. 2679. UNOBLIGATED FUNDS USED FOR SUPPLEMENTAL TREATMENT DRUG 
              GRANTS.

    ``Notwithstanding any other provision of this title, any funds 
received under this title during a fiscal year that remain unobligated 
at the end of the second fiscal year succeeding the fiscal year during 
which the funds were received shall be returned to the Administrator of 
the Health Resources and Services Administration who shall redistribute 
such funds to carry out section 2618(a)(2)(C)(ii).''.
            (2) Conforming amendments.--Section 2618 of the Public 
        Health Service Act (42 U.S.C. 300ff-28) is amended--
                    (A) in subsection (a)(2)(I)(ii)(I) by striking 
                ``subclause (V)'' and inserting ``subclause (V) and 
                section 2679''; and
                    (B) by striking subsection (d).

SEC. 6. ENSURING EQUITABLE PER CASE FUNDING.

    (a) Distribution of Funds.--Section 2618(a) of the Public Health 
Service Act (42 U.S.C. 300ff-28(a)) is amended--
            (1) in paragraph (1)(A)--
                    (A) in clause (i)--
                            (i) in subclause (I), by striking ``cases 
                        of acquired immune deficiency syndrome, as 
                        determined under paragraph (2)(D)'' and 
                        inserting ``cases of HIV disease (reported to 
                        and confirmed as accurate by the Director of 
                        the Centers for Disease Control and 
                        Prevention)''; and
                            (ii) in subclause (II)--
                                    (I) by striking ``cases of acquired 
                                immune deficiency syndrome, as 
                                determined under paragraph (2)(D)'' and 
                                inserting ``cases of HIV disease 
                                (reported to and confirmed as accurate 
                                by the Director of the Centers for 
                                Disease Control and Prevention)''; and
                                    (II) by inserting ``and'' after the 
                                semicolon; and
                    (B) in clause (ii), by striking ``paragraph 
                (2)(H)'' and inserting ``paragraph (2)(B)''; and
            (2) in paragraph (2)--
                    (A) by striking subparagraphs (A) through (G) and 
                inserting the following:
                    ``(A) Formula.--
                            ``(i) In general.--The amount referred to 
                        in paragraph (1)(A)(ii) for a State and 
                        paragraph (1)(B) for a territory of the United 
                        States shall be determined--
                                    ``(I) for fiscal year 2007, 
                                according to the formula under this 
                                paragraph as in effect on the day 
                                before the date of enactment of the 
                                Ryan White CARE Act Amendments of 2006; 
                                and
                                    ``(II) for fiscal year 2008 and 
                                each succeeding fiscal year, according 
                                to the formula described in clause 
                                (ii).
                            ``(ii) Amount based on cases not counted 
                        under part a.--A State or territory of the 
                        United States shall receive an amount under 
                        this part for a fiscal year that bears the same 
                        relation to the amount appropriated under 
                        section 2677(b) for grants under this part for 
                        the fiscal year as the number of cases 
                        determined under clause (iii) for the State or 
                        territory for such fiscal year bears to the 
                        total number of cases determined under clause 
                        (iii) for all States and territories for such 
                        fiscal year.
                            ``(iii) Number of cases.--
                                    ``(I) Reporting system in effect 
                                prior to october 2000.--In the case of 
                                a State or territory that has enacted 
                                an HIV reporting system that has been 
                                confirmed as accurate and reliable by 
                                the Director of the Centers for Disease 
                                Control and Prevention prior to October 
                                1, 2000, the number of cases under this 
                                clause for such State or territory for 
                                a fiscal year shall be equal to the 
                                total number of reported cases of HIV 
                                disease (reported to and confirmed as 
                                accurate by the Director of the Centers 
                                for Disease Control and Prevention) 
                                living in the State or territory during 
                                such year, minus the number of reported 
                                cases of HIV disease (reported to and 
                                confirmed as accurate by the Director 
                                of the Centers for Disease Control and 
                                Prevention) living in such State or 
                                territory that are within an eligible 
                                area (as determined under part A).
                                    ``(II) Reporting system in effect 
                                prior to october 2006 but after october 
                                2000.--In the case of a State or 
                                territory that has enacted an HIV 
                                reporting system that has been 
                                confirmed as accurate and reliable by 
                                the Director of the Centers for Disease 
                                Control and Prevention prior to October 
                                1, 2006, but on or after October 1, 
                                2000, the number of cases under this 
                                clause for such State or territory for 
                                a fiscal year shall be equal to the 
                                total number of cases of HIV disease 
                                (estimated by the Director of the 
                                Centers for Disease Control and 
                                Prevention) living in the State or 
                                territory during such year, minus the 
                                number of cases of HIV disease 
                                (estimated by the Director of the 
                                Centers for Disease Control and 
                                Prevention) living in such State or 
                                territory that are within an eligible 
                                area (as determined under part A).
                                    ``(III) Reporting system not in 
                                effect by october 2006.--In the case of 
                                a State or territory that has not 
                                enacted an HIV reporting system that 
                                has been confirmed as accurate and 
                                reliable by the Director of the Centers 
                                for Disease Control and Prevention 
                                prior to October 1, 2006, the number of 
                                cases under this clause for such State 
                                or territory for a fiscal year shall be 
                                equal to--
                                            ``(aa) until such time as 
                                        such State or territory has 
                                        enacted an HIV reporting system 
                                        that has been confirmed as 
                                        accurate and reliable by the 
                                        Director of the Centers for 
                                        Disease Control and Prevention, 
                                        the total number of reported 
                                        cases of acquired immune 
                                        deficiency syndrome (reported 
                                        to and confirmed as accurate by 
                                        the Director of the Centers for 
                                        Disease Control and Prevention) 
                                        living in the State or 
                                        territory during such year, 
                                        minus the number of reported 
                                        cases of acquired immune 
                                        deficiency syndrome (reported 
                                        to and confirmed as accurate by 
                                        the Director of the Centers for 
                                        Disease Control and Prevention) 
                                        living in such State or 
                                        territory that are within an 
                                        eligible area (as determined 
                                        under part A); and
                                            ``(bb) once such State or 
                                        territory has enacted an HIV 
                                        reporting system that has been 
                                        confirmed as accurate and 
                                        reliable by the Director of the 
                                        Centers for Disease Control and 
                                        Prevention, the total number of 
                                        cases of HIV disease (estimated 
                                        by the Director of the Centers 
                                        for Disease Control and 
                                        Prevention) living in the State 
                                        or territory during such year, 
                                        minus the number of cases of 
                                        HIV disease (estimated by the 
                                        Director of the Centers for 
                                        Disease Control and Prevention) 
                                        living in such State or 
                                        territory that are within an 
                                        eligible area (as determined 
                                        under part A).'';
                    (B) by redesignating subparagraphs (H) and (I) as 
                subparagraphs (B) and (C), respectively;
                    (C) in subparagraph (B) (as redesignated by 
                subparagraph (B))--
                            (i) by striking ``subparagraph (I)(i)'' 
                        each place the term appears and inserting 
                        ``subparagraph (C)(i)''; and
                            (ii) by adding at the end the following:
                            ``(iii) Effective date.--This subparagraph 
                        shall be effective through September 30, 
                        2008.''; and
                    (D) in subparagraph (C)(i) (as redesignated by 
                subparagraph (B)), by striking subclauses (I) and (II) 
                and inserting the following:
                                    ``(I) 100 percent of such amount; 
                                and
                                    ``(II) the percentage constituted 
                                by the ratio of the total number of 
                                reported cases of HIV disease (reported 
                                to an confirmed as accurate by the 
                                Director of the Centers for Disease 
                                Control and Prevention) living in the 
                                State to the total number of reported 
                                cases of HIV disease (reported to an 
                                confirmed as accurate by the Director 
                                of the Centers for Disease Control and 
                                Prevention) living in all States.''.
    (b) Conforming Amendments.--Section 2631(c) of the Public Health 
Service Act (42 U.S.C. 300ff-38(c)) is amended by striking ``for use 
for purposes of section 2618(a)(2)(D)(i)'' and inserting ``as reported 
to and confirmed as accurate and reliable by the Director of the 
Centers for Disease Control and Prevention''.
    (c) Striking of Supplemental Grants in Emerging Communities.--Title 
XXVI of the Public Health Service Act (42 U.S.C. 300ff-11 et seq.) is 
amended by striking section 2620.

SEC. 7. ENSURING FUNDING CORRESPONDS WITH EPIDEMIOLOGICAL TRENDS.

    (a) Establishment of Programs of Grants.--
            (1) In general.--Section 2601 of the Public Health Service 
        Act (42 U.S.C. 300ff-11) is amended--
                    (A) in subsection (a), by striking ``for which 
                there'' and all that follows through the period and 
                inserting ``for which there is a cumulative total of 
                more than 2,500 living cases of HIV disease (reported 
                to and confirmed as accurate by the Director of the 
                Centers for Disease Control and Prevention). The 
                Secretary shall make grants in accordance with section 
                2603 to not more than 60 metropolitan areas that are 
                eligible for such grants pursuant to this 
                subsection.'';
                    (B) in subsection (b), by striking ``cases of 
                acquired immune deficiency syndrome'' and inserting 
                ``living cases of HIV disease'';
                    (C) by striking subsection (c) and inserting the 
                following:
    ``(c) Requirements Regarding Population.--
            ``(1) Number of individuals.--The Secretary may not make a 
        grant under this section for a metropolitan area unless the 
        area has a population of 500,000 or more individuals.
            ``(2) Geographic boundaries.--For purposes of eligibility 
        under this part, the boundaries of each metropolitan area are 
        the boundaries that correspond with the Office of Management 
        and Budget definition of metropolitan statistical area for the 
        year that is most recent to the year for which the 
        determination is made.''; and
                    (D) by striking subsection (d) and inserting the 
                following:
    ``(d) Continued Status as Eligible Area.--
            ``(1) Metropolitan areas that were eligible areas for 
        fiscal year 1996.--Notwithstanding any other provision of this 
        section, a metropolitan area that was an eligible area under 
        this part for fiscal year 1996 shall be an eligible area under 
        this part until such metropolitan area does not meet the 
        qualifications of an eligible area as described in this section 
        for 2 consecutive years.
            ``(2) Metropolitan areas to remain eligible areas until 2 
        consecutive years of not qualifying as an eligible area.--
        Notwithstanding any other provision of this section except as 
        provided in paragraph (1), a metropolitan area shall be deemed 
        an eligible area under this section until such time as such 
        metropolitan area does not meet the qualifications of an 
        eligible area as described in this section for 2 consecutive 
        years.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall take effect on October 1, 2007.
    (b) Type and Distribution of Grants.--Section 2603(a)(4) of the 
Public Health Service Act (42 U.S.C. 300ff-13(a)) is amended--
            (1) in subparagraph (A), by striking ``For each'' and 
        inserting ``Except as provided in subparagraph (D), for each''; 
        and
            (2) by adding at the end the following:
                    ``(D) Phase-out of increases in grants.--
                Notwithstanding any other provision of this paragraph--
                            ``(i) for fiscal year 2007, in the case of 
                        an eligible area in a protection period for 
                        such fiscal year, the Secretary shall increase 
                        the amount of the grant made pursuant to 
                        paragraph (2) for the area to ensure that the 
                        grant is not less than 50 percent of the amount 
                        of the grant made for the eligible area 
                        pursuant to such paragraph for the base year 
                        for the protection period;
                            ``(ii) for fiscal year 2008, in the case of 
                        an eligible area in a protection period for 
                        such fiscal year, the Secretary shall increase 
                        the amount of the grant made pursuant to 
                        paragraph (2) for the area to ensure that the 
                        grant is not less than 25 percent of the amount 
                        of the grant made for the eligible area 
                        pursuant to such paragraph for the base year 
                        for the protection period; and
                            ``(iii) for fiscal year 2009 and each 
                        succeeding fiscal year, in the case of an 
                        eligible area in a protection period for such 
                        fiscal year, the Secretary shall not increase 
                        the amount of the grant pursuant to this 
                        paragraph.''.

SEC. 8. PROHIBITION ON FUNDING FOR ENTITIES THAT PROHIBIT OR IMPOSE 
              BARRIERS ON PARTNER NOTIFICATION.

    Part D of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff-71 et seq.), as amended by section 5, is further amended by 
adding at the end the following:

``SEC. 2679A. PROHIBITION ON FUNDING FOR ENTITIES THAT PROHIBIT OR 
              IMPOSE BARRIERS ON PARTNER NOTIFICATION.

    ``Beginning 25 months after the date of enactment of this section, 
a State or locality that prohibits or imposes significant 
administrative, statutory, regulatory, or practical barriers to 
programs of partner notification shall not be eligible to receive funds 
under this title.''.

SEC. 9. COVERAGE FOR TREATMENT FOR HEPATITIS B AND HEPATITIS C CO-
              INFECTION.

    (a) Coverage Under Parts A and B.--Section 2604(b)(1) of the Public 
Health Service Act (42 U.S.C. 300ff-14(b)(1)) is amended by adding at 
the end the following:
                    ``(E) Treatment for hepatitis B or hepatitis C for 
                HIV-positive individuals who are co-infected with such 
                hepatitis.''.
    (b) Coverage Under Part C.--Section 2651(b)(2) of the Public Health 
Service Act (42 U.S.C. 300ff-51(b)(2)) is amended--
            (1) in subparagraph (E), by striking the period at the end 
        and inserting ``; and''; and
            (2) by adding at the end the following:
                    ``(F) providing treatment for hepatitis B or 
                hepatitis C for HIV-positive individuals who are co-
                infected with such hepatitis.''.
    (c) Special Projects of National Significance.--Section 2691(d) of 
the Public Health Service Act (42 U.S.C. 300ff-101(d)) is amended--
            (1) in paragraph (5), by striking ``and'' after the 
        semicolon;
            (2) in paragraph (6), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following:
            ``(7) HIV-positive individuals who are co-infected with 
        hepatitis B or hepatitis C.''.
    (d) HIV/AIDS Communities, Schools, and Centers.--Section 2692(a)(1) 
of the Public Health Service Act (42 U.S.C. 300ff-111(a)(1)) is 
amended--
            (1) in subparagraph (C), by striking ``and'' after the 
        semicolon;
            (2) in subparagraph (D), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
                    ``(E) to educate health care providers and service 
                providers regarding identification, treatment, and 
                treatment adherence and prevention education for 
                patients co-infected with HIV and hepatitis B or 
                hepatitis C.''.

SEC. 10. PLANNING COUNCILS.

    Section 2602(b) of the Public Health Service Act (42 U.S.C. 300ff-
12(b)) is amended--
            (1) in paragraph (2)--
                    (A) in subparagraph (L), by striking ``and'' after 
                the semicolon;
                    (B) in subparagraph (M), by striking the period at 
                the end and inserting a semicolon; and
                    (C) by adding at the end the following:
                    ``(N) faith-based organizations; and
                    ``(O) individuals who are co-infected with HIV and 
                hepatitis B or hepatitis C.'';
            (2) in paragraph (5)--
                    (A) in subparagraph (B), by adding at the end the 
                following: ``Any conflict of interest of an individual 
                on the planning council shall be reported to the 
                Administrator of the Health Resources and Services 
                Administration and shall be available to the public.''; 
                and
                    (B) in subparagraph (C)(i), by striking ``, are not 
                officers'' and all that follows through ``paragraph 
                (4)(A).'' and inserting ``and reflect the demographics 
                of the population of individuals with HIV disease as 
                determined under paragraph (4)(A), and not less than 51 
                percent of the council shall be individuals who are not 
                officers, employees, or consultants to any entity that 
                receives amounts from such a grant and do not represent 
                any such entity.''; and
            (3) by adding at the end the following:
            ``(8) Funding decisions.--Any funding decision of the 
        planning council shall require approval by the chief elected 
        official and chief executive officer of the eligible area 
        involved.''.

SEC. 11. REDUCTION OF ADMINISTRATIVE COSTS.

    (a) Part A.--Section 2604(f)(2) of the Public Health Service Act 
(42 U.S.C. 300ff-14(f)(2)) is amended--
            (1) in subparagraph (A), by striking ``and'' after the 
        semicolon;
            (2) in subparagraph (B), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
                    ``(C) costs associated with the activities of the 
                planning council and the planning for the allocation of 
                funds and services under this part.''.
    (b) Part B.--Section 2618(b) of the Public Health Service Act (42 
U.S.C. 300ff-28(b)) is amended--
            (1) by inserting before paragraph (2) the following:
            ``(1) [Reserved].''; and
            (2) in paragraph (4)--
                    (A) in subparagraph (B), by inserting ``, including 
                costs associated with the planning for the allocation 
                of funds and services under this part'' before the 
                period at the end; and
                    (B) in subparagraph (C)--
                            (i) in clause (ii), by striking ``and'' 
                        after the semicolon;
                            (ii) in clause (iii), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by adding at the end the following:
                            ``(iv) costs associated with the planning 
                        for the allocation of funds and services under 
                        this part.''.

SEC. 12. RAPID ROUTINE TESTING.

    (a) In General.--Part D of title XXVI of the Public Health Service 
Act (42 U.S.C. 300ff-71 et seq.), as amended by sections 5 and 8, is 
further amended by adding at the end the following:

``SEC. 2679B. RAPID ROUTINE TESTING.

    ``(a) In General.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        Secretary shall require rapid routine testing of each client at 
        any health facility, provider, clinic, or entity (including an 
        HIV, STD, or substance abuse clinic) receiving funding from the 
        Centers for Disease Control and Prevention, the Substance Abuse 
        and Mental Health Services Administration, the Health Resources 
        and Services Administration, the Centers for Medicare & 
        Medicaid Services, or any reproductive health program 
        administered by the Secretary.
            ``(2) Exception.--Rapid routine testing shall not be 
        required in the case of an individual who has already been 
        diagnosed with HIV infection.
    ``(b) Pregnant Women and Newborns.--The Secretary shall require--
            ``(1) a health facility receiving Federal funds or a 
        Federal health program (including a program supported under 
        this title) that is treating a pregnant woman to offer to such 
        woman routine testing; and
            ``(2) a health facility receiving Federal funds or a 
        Federal health program (including a program supported under 
        this title) that is treating a newborn to offer to the parents 
        of such newborn rapid routine testing of such newborn if such 
        newborn's mother's HIV status is unknown.
    ``(c) Counseling and Treatment.--An entity or program that conducts 
routine testing pursuant to this section shall provide to each 
individual tested pursuant to this section who tests positive for HIV 
antibodies, appropriate counseling and referral into treatment in a 
timely manner.
    ``(d) Testing.--The Director of the Centers for Disease Control and 
Prevention shall annually purchase and distribute not less than 
1,500,000 rapid HIV tests, including tests that are oral based.
    ``(e) State or Local Prohibitions.--Beginning 25 months after the 
date of enactment of this section, a State or locality that prohibits 
or imposes significant administrative, statutory, regulatory, or 
practical barriers to routine testing as described in this section 
shall not be eligible to receive funds under this title.''.
    (b) CDC Guidelines for Pregnant Women.--Section 2625 of the Public 
Health Service Act (42 U.S.C. 300ff-33) is amended--
            (1) in subsection (a), by striking ``voluntary'' and 
        inserting ``routine''; and
            (2) in subsection (c)(1)(C), by striking ``voluntary HIV 
        testing for such disease'' and inserting ``routine testing''.

SEC. 13. ADAP RECOMMENDED FORMULARY AND REPORT CARD.

    Section 2616 of the Public Health Service Act (42 U.S.C. 300ff-26) 
is amended by adding at the end the following:
    ``(f) Recommendations for Minimum Standard Formulary and Annual 
Report.--
            ``(1) In general.--In carrying out this section, the 
        Secretary shall issue guidelines that provide recommendations 
        for therapeutics described in subsection (a) that shall, at a 
        minimum, be included in the formularies that are maintained by 
        the States for purposes of this section.
            ``(2) Annual reports.--Not later than May 31 of each year, 
        the Secretary shall submit to Congress a report that, with 
        respect to the program under this section, specifies the 
        following:
                    ``(A) For each State:
                            ``(i) The number of patients who have 
                        requested therapeutics described in subsection 
                        (a) from the program as carried out in the 
                        State, but are on a waiting list because such 
                        program does not have the capacity to serve the 
                        patients.
                            ``(ii) If patients on the waiting list are 
                        receiving such therapeutics, the sources from 
                        which the patients are obtaining the 
                        therapeutics.
                            ``(iii) The estimated cost to provide the 
                        amount of therapeutics that would be necessary 
                        to serve all patients on the waiting list and 
                        thereby eliminate the wait in the State.
                            ``(iv) Each source of funds that, in 
                        addition to funds appropriated to carry out 
                        this part, is used by the State to provide 
                        therapeutics under the program.
                    ``(B) Each State whose formulary maintained for 
                purposes of the program does not meet the 
                recommendations of the Secretary under paragraph (1).
                    ``(C) The actions being taken by States with such 
                waiting lists to reduce the number of patients on the 
                lists, including any restrictions imposed by the States 
                on the number or quantity of therapeutics made 
                available under the program.
                    ``(D) The amount of funds each State receives under 
                this title and how such funds have been allocated among 
                each of the following categories:
                            ``(i) Therapeutics.
                            ``(ii) Primary medical care, including 
                        medical evaluations and physician services.
                            ``(iii) Support services, administrative 
                        costs, and other expenses not included in 
                        clause (i) or (ii).''.

SEC. 14. STATE FLEXIBILITY IN PROVIDING HIV/AIDS CARE.

    (a) In General.--Section 2612 of the Public Health Service Act (42 
U.S.C. 300ff-22), as amended by section 4, is further amended by adding 
at the end the following:
    ``(f) State Flexibility in Providing HIV/AIDS Care.--Upon approval 
by the Secretary, a State may use amounts provided under a grant made 
under this part for providing medical assistance to individuals who are 
eligible for assistance under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) and are HIV-positive.''.
    (b) Supplement, Not Supplant.--Part D of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff-71 et seq.), as amended by sections 
5, 8, and 12, is further amended by adding at the end the following:

``SEC. 2679C. SUPPLEMENT, NOT SUPPLANT STATE MEDICAID FUNDING.

    ``Funds received by a State under this title shall be used to 
supplement, and not supplant, State funds that would otherwise be used 
for the State share of expenditures under a State plan under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) for providing 
medical assistance to individuals who are eligible for such assistance 
and are HIV-positive.''.

SEC. 15. PRICES PAID FOR THERAPEUTICS FOR ADAP.

    (a) In General.--Section 2616 of the Public Health Service Act (42 
U.S.C. 300ff-26), as amended by section 13, is further amended by 
adding at the end the following:
    ``(g) Prices Paid for Therapeutics.--The Administrator of the 
Health Resources and Services Administration shall routinely analyze 
and report to Congress on the prices for therapeutics paid by programs 
established under this section.''.
    (b) Coordination of All Therapeutic Purchases Through ADAP.--Part D 
of title XXVI of the Public Health Service Act (42 U.S.C. 300ff-71 et 
seq.), as amended by sections 5, 8, 12, and 14, is further amended by 
adding at the end the following:

``SEC. 2679D. COORDINATION OF ALL THERAPEUTIC PURCHASES THROUGH ADAP.

    ``In any purchases of therapeutics to treat HIV disease pursuant to 
a program that receives Federal assistance under this title, an entity 
shall coordinate such purchases through the program described in 
section 2616 in order to ensure that the recipients of the therapeutics 
are receiving the best possible price for the therapeutics.''.

SEC. 16. AUTHORIZATION OF APPROPRIATIONS FOR ADAP.

    Section 2616 of the Public Health Service Act (42 U.S.C. 300ff-26), 
as amended by sections 13 and 15, is further amended by adding at the 
end the following:
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section--
            ``(1) $800,000,000 for fiscal year 2006;
            ``(2) $870,000,000 for fiscal year 2007;
            ``(3) $940,000,000 for fiscal year 2008;
            ``(4) $1,010,000,000 for fiscal year 2009; and
            ``(5) $1,080,000,000 for fiscal year 2010.''.

SEC. 17. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

    Section 2691 of the Public Health Service Act (42 U.S.C. 300ff-101) 
is amended--
            (1) in subsection (a), by striking ``the greater of 
        $20,000,000 or 3 percent of such amount appropriated under each 
        such part, but not to exceed $25,000,000,'' and inserting ``not 
        more than $15,000,000''; and
            (2) by adding at the end the following:
    ``(h) Pilot Programs.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, 
shall use funds available under this section to conduct not less than 5 
pilot programs to evaluate various forms of partner notification 
programs, including attitudes of source patients and those being 
notified towards such services and the cost effectiveness of such 
programs.
    ``(i) Standard Electronic Client Information Data System.--The 
Secretary, acting through the Administrator of the Health Resources and 
Services Administration, shall use funds available under this section 
to develop a standard electronic client information data system to 
improve coordination of coverage provided to patients under programs 
supported under this title, as well as programs under the medicare 
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.) and the medicaid program under title XIX of such Act (42 U.S.C. 
1396 et seq.).
    ``(j) Study.--The Secretary, acting through the Administrator of 
the Health Resources and Services Administration, shall use funds 
available under this section to conduct a study to develop 
recommendations for best primary medical care practices for disease 
management for those living with HIV disease or AIDS.''.

SEC. 18. HOUSING OPPORTUNITIES FOR PERSONS WITH HIV/AIDS.

    (a) HOPWA Formula Amendments.--Section 854(c) of the AIDS Housing 
Opportunity Act (42 U.S.C. 12903(c)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``The Secretary'' and inserting 
                ``Except as provided in subsection (h), the 
                Secretary'';
                    (B) by striking ``cases of acquired 
                immunodeficiency syndrome'' each place that terms 
                appears and inserting ``reported living cases of HIV 
                disease (as reported to, and confirmed as accurate, by 
                the Director of the Centers for Disease Control and 
                Prevention)'';
                    (C) in subparagraph (B), by striking ``acquired 
                immunodeficiency syndrome'' and inserting ``reported 
                living cases of HIV disease (as reported to, and 
                confirmed as accurate, by the Director of the Centers 
                for Disease Control and Prevention)''; and
                    (D) in the undesignated matter following 
                subparagraph (B), in the second sentence, by striking 
                ``reported to and confirmed by the Director of the 
                Centers for Disease Control of the Public Health 
                Service''; and
            (2) in paragraph (3), by striking ``acquired 
        immunodeficiency syndrome'' each place that term appears and 
        inserting ``HIV disease''.
    (b) Transition Formula and Exception to the Use of Reported HIV 
Data.--Section 854 of the AIDS Housing Opportunity Act (42 U.S.C. 
12903) is amended by adding at the end the following:
    ``(g) Transition Formula.--In applying the formula allocation under 
subsection (c)(1), the Secretary shall--
            ``(1) for fiscal year 2007, allocate--
                    ``(A) 75 percent of any amounts made available for 
                allocation, using the formula allocation described in 
                subsection (c), as in effect on the day before the date 
                of enactment of the Ryan White CARE Act Amendments of 
                2006; and
                    ``(B) 25 percent of such amounts made available for 
                allocation, using the formula allocation described in 
                subsection (c), as amended by the Ryan White CARE Act 
                Amendments of 2006;
            ``(2) for fiscal year 2008, allocate--
                    ``(A) 25 percent of any amounts made available for 
                allocation, using the formula allocation described in 
                subsection (c), as in effect on the day before the date 
                of enactment of the Ryan White CARE Act Amendments of 
                2006; and
                    ``(B) 75 percent of such amounts made available for 
                allocation, using the formula allocation described in 
                subsection (c), as amended by the Ryan White CARE Act 
                Amendments of 2006; and
            ``(3) for fiscal year 2009, and each fiscal year 
        thereafter, allocate any amounts made available for allocation 
        using the formula allocation described in subsection (c), as 
        amended by the Ryan White CARE Act Amendments of 2006.
    ``(h) Exception to the Use of Reported HIV Data.--Any State or 
city--
            ``(1) that has enacted an HIV reporting system that has 
        been confirmed as accurate and reliable by the Director of the 
        Centers for Disease Control and Prevention prior to October 1, 
        2000, shall for purposes of allocating any amounts under 
        subsection (c) to that State or city, have such allocation 
        determined by using the formula allocation described in such 
        subsection, as amended by the Ryan White CARE Act Amendments of 
        2006;
            ``(2) that has enacted an HIV reporting system that has 
        been confirmed as accurate and reliable by the Director of the 
        Centers for Disease Control and Prevention prior to October 1, 
        2006, but on or after October 1, 2000, shall for purposes of 
        allocating any amounts under subsection (c) to that State or 
        city, have such allocation determined by using the formula 
        allocation based on the number of cases of HIV disease 
        (estimated by the Director of the Centers for Disease Control 
        and Prevention) instead of reported living cases of HIV disease 
        (as reported to, and confirmed as accurate, by the Director of 
        the Centers for Disease Control and Prevention); and
            ``(3) that does not have an HIV reporting system that has 
        been confirmed as accurate and reliable by the Director of the 
        Centers for Disease Control and Prevention prior to October 1, 
        2006, shall for purposes of allocating any amounts under 
        subsection (c) to that State or city--
                    ``(A) until such time as such State or city has 
                enacted an HIV reporting system that has been confirmed 
                as accurate and reliable by the Director of the Centers 
                for Disease Control and Prevention, have such 
                allocation determined by using the formula allocation 
                described in such subsection as in effect on the day 
                before the date of enactment of the Ryan White CARE Act 
                Amendments of 2006; and
                    ``(B) once such State or city has enacted an HIV 
                reporting system that has been confirmed as accurate 
                and reliable by the Director of the Centers for Disease 
                Control and Prevention, have such allocation determined 
                by using the formula allocation based on the number of 
                cases of HIV disease (estimated by the Director of the 
                Centers for Disease Control and Prevention) instead of 
                reported living cases of HIV disease (as reported to, 
                and confirmed as accurate, by the Director of the 
                Centers for Disease Control and Prevention).''.
    (c) Allocation Requirement.--Section 854 of the AIDS Housing 
Opportunity Act (42 U.S.C. 12903) is amended by adding at the end the 
following:
    ``(h) Allocation Requirement.--The Secretary shall ensure that not 
less than 75 percent of all amounts allocated under this section are 
used for the provision, construction, maintenance, or development of 
housing assistance.''.

SEC. 19. ENSURING STABILITY IN INFRASTRUCTURE.

    Section 2618(a)(2)(B)(i) of the Public Health Service Act (42 
U.S.C. 300ff-28(a)(2)(B)(i)), as redesignated by section 6, is 
amended--
            (1) by striking ``2000'' each place the term appears and 
        inserting ``2005'';
            (2) in subclause (I), by striking ``2001, 99 percent'' and 
        inserting ``2006, 95 percent'';
            (3) in subclause (II), by striking ``2002, 98 percent'' and 
        inserting ``2007, 90 percent'';
            (4) in subclause (III), by striking ``2003, 97 percent'' 
        and inserting ``2008, 85 percent'';
            (5) in subclause (IV), by striking ``2004, 96 percent'' and 
        inserting ``2009, 80 percent''; and
            (6) in subclause (V), by striking ``2005, 95 percent'' and 
        inserting ``2010, 75 percent''.

SEC. 20. COORDINATION OF GRANTEES.

    Section 2675 of the Public Health Service Act (42 U.S.C. 300ff-75) 
is amended by adding at the end the following:
    ``(f) Coordination of Grantees Requirement.--
            ``(1) In general.--The Secretary shall provide State AIDS 
        officials with the authority to request and obtain all 
        information necessary for States to coordinate HIV care and 
        treatment pursuant to this title with other federally funded 
        projects to maximize efficiency and effectiveness of HIV/AIDS 
        services.
            ``(2) Coordination of services.--As a condition of receipt 
        of funds under this title, an entity shall participate in a 
        process established by the State in which the entity is located 
        to coordinate HIV/AIDS services across the State.''.

SEC. 21. TECHNICAL CORRECTIONS.

    Title XXVI of the Public Health Service Act (42 U.S.C. 300ff-11 et 
seq.) is amended--
            (1) in section 2604--
                    (A) in subsection (b)(2)(A), by striking 
                ``entities,,'' and inserting ``entities,''; and
                    (B) in subsection (f)--
                            (i) by striking the subsection heading and 
                        inserting the following: ``Administration''; 
                        and
                            (ii) in paragraph (1), by striking 
                        ``administration,.'' and inserting 
                        ``administration.'';
            (2) in section 2617(b)(6)(B)(iv), by inserting ``section'' 
        before ``2615'';
            (3) in section 2618(a)(3)(B), by striking ``means,'' and 
        inserting ``means'';
            (4) in section 2662(c)(3)(C)(ii), by striking ``HIV.'' and 
        inserting ``HIV; and''; and
            (5) in section 2692(b)(2), by striking ``in section the 
        section'' and inserting ``in the section''.
                                 <all>