[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2823 Reported in Senate (RS)]







                                                       Calendar No. 580
109th CONGRESS
  2d Session
                                S. 2823

          To provide life-saving care for those with HIV/AIDS.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 17, 2006

 Mr. Enzi (for himself, Mr. Kennedy, Mr. Hatch, Mr. DeWine, Mr. Burr, 
and Mr. Frist) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

                             August 3, 2006

                Reported by Mr. Enzi, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
          To provide 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,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Ryan White HIV/AIDS 
Treatment Modernization Act''.</DELETED>

    <DELETED>TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS</DELETED>

<DELETED>SEC. 101. ESTABLISHMENT AND GENERAL ELIGIBILITY.</DELETED>

<DELETED>    (a) In General.--Section 2601 of the Public Health Service 
Act (42 U.S.C. 300ff-11) is amended by striking subsections (b) through 
(d) and inserting the following:</DELETED>
<DELETED>    ``(b) Continued Status as Eligible Area.--Notwithstanding 
any other provision of this section, a metropolitan area shall continue 
to be eligible to receive a grant under this part until such area, for 
three consecutive grant years, fails to meet the requirements of 
subsection (a).''.</DELETED>
<DELETED>    (b) Definition.--Section 2607(2) of the Public Health 
Service Act (42 U.S.C. 300ff-17(2)) is amended by adding at the end the 
following: ``For purposes of determining eligibility under this part, 
the boundaries of each metropolitan area shall be the boundaries that 
were in effect for each such area for fiscal year 1994.''.</DELETED>

<DELETED>SEC. 102. LIVING CASES OF HIV/AIDS.</DELETED>

<DELETED>    (a) In General.--Section 2601(a) of the Public Health 
Service Act (42 U.S.C. 300ff-11(a)) is amended by striking ``for which 
there'' and all that follows through ``available'' and inserting ``for 
which there is reported to and confirmed by the Director of the Centers 
for Disease Control and Prevention a cumulative total of more than 
2,000 cases of AIDS for the most recent period of 5 calendar years for 
which such data are available''.</DELETED>
<DELETED>    (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--</DELETED>
        <DELETED>    (1) in subparagraph (B), by striking ``cases of 
        acquired immune deficiency syndrome'' and inserting ``cases of 
        HIV/AIDS (reported to and confirmed by the Director of the 
        Centers for Disease Control and Prevention)'';</DELETED>
        <DELETED>    (2) by striking subparagraphs (C) and (D) and 
        inserting the following:</DELETED>
                <DELETED>    ``(C) Living cases of hiv/aids.--
                </DELETED>
                        <DELETED>    ``(i) In general.--Except as 
                        provided for in clauses (ii) and (iii), the 
                        amount determined in this subparagraph is the 
                        number of living cases of HIV/AIDS (reported to 
                        and confirmed by the Director of the Centers 
                        for Disease Control and Prevention) through 
                        December 31 of the most recent calendar 
                        year.</DELETED>
                        <DELETED>    ``(ii) Fiscal years 2007 through 
                        2010.--For each of fiscal years 2007 through 
                        2010, the Secretary may use the proxy number 
                        for the number of HIV cases described in clause 
                        (iii) if--</DELETED>
                                <DELETED>    ``(I) the State involved--
                                </DELETED>
                                        <DELETED>    ``(aa) is 
                                        reporting, or the State will by 
                                        October 1, 2006 have submitted 
                                        a transition plan for 
                                        reporting, accurate and 
                                        reliable HIV cases to the 
                                        Director of the Centers for 
                                        Disease Control and Prevention; 
                                        or</DELETED>
                                        <DELETED>    ``(bb) not later 
                                        than October 1, 2006, make all 
                                        necessary statutory changes to 
                                        allow for the collection of HIV 
                                        data certified by the Director 
                                        of the Centers for Disease 
                                        Control and 
                                        Prevention;</DELETED>
                                <DELETED>    ``(II) the State involved 
                                will by April 1, 2008, begin reporting 
                                accurate and reliable HIV cases, as 
                                determined by the Director of the 
                                Centers for Disease Control and 
                                Prevention; and</DELETED>
                                <DELETED>    ``(III) the Director of 
                                the Centers for Disease Control and 
                                Prevention has determined that such 
                                State does not have an established HIV 
                                surveillance system.</DELETED>
                        <DELETED>    ``(iii) Amount determined.--With 
                        respect to each of fiscal years 2007 through 
                        2010, the amount determined under this 
                        subparagraph shall be the lesser of--</DELETED>
                                <DELETED>    ``(I) the product of 0.9 
                                and the number of living AIDS cases in 
                                the area involved; or</DELETED>
                                <DELETED>    ``(II) an amount equal to 
                                110 percent of the funding level for 
                                the previous fiscal year, taking into 
                                account the shift of the formula pool 
                                from 0.5 to 0.67 in fiscal year 
                                2006.''; and</DELETED>
        <DELETED>    (3) by redesignating subparagraph (E) as 
        subparagraph (D).</DELETED>
<DELETED>    (c) Application.--Section 2604(b)(4)(A) of the Public 
Health Service Act (42 U.S.C. 300ff-14(b)(4)(A)) is amended--</DELETED>
        <DELETED>    (1) by striking ``acquired immune deficiency 
        syndrome'' and inserting ``HIV/AIDS''; and</DELETED>
        <DELETED>    (2) by striking ``such syndrome'' and inserting 
        ``HIV/AIDS''.</DELETED>
<DELETED>    (d) Coordination.--Section 2605(b) of the Public Health 
Service Act (42 U.S.C. 300ff-15(b)) is amended--</DELETED>
        <DELETED>    (1) in paragraph (3), by striking ``and'' at the 
        end;</DELETED>
        <DELETED>    (2) in paragraph (4), by striking the period and 
        inserting a semicolon; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
        <DELETED>    ``(5) the manner in which the expected 
        expenditures under the grant are related to the planning 
        process for States that receive funding under part B (including 
        the planning process described in section 2617(b)); 
        and</DELETED>
        <DELETED>    ``(6) the expected expenditures under the grant 
        and how those expenditures will improve overall client 
        outcomes, as described under the State plan under section 
        2617(b), or through additional outcomes measures.''.</DELETED>

<DELETED>SEC. 103. TYPE AND DISTRIBUTION OF GRANTS.</DELETED>

<DELETED>    (a) Distribution of Funds.--Section 2603(a)(2) of the 
Public Health Service Act (42 U.S.C. 300ff-13(a)(2)) is amended by 
striking ``50 percent'' and inserting ``66</DELETED>\<DELETED>2/
3</DELETED>\ <DELETED>percent''.</DELETED>
<DELETED>    (b) Emergency Grants.--Section 2603(a)(3)(E) of the Public 
Health Service Act (42 U.S.C. 300ff-13(a)(3)(E)) is amended to read as 
follows:</DELETED>
                <DELETED>    ``(E) Unexpended funds.--</DELETED>
                        <DELETED>    ``(i) In general.--An eligible 
                        area that has unobligated funds for a fiscal 
                        year under a grant under this part shall--
                        </DELETED>
                                <DELETED>    ``(I) return such funds to 
                                the Secretary to be applied as provided 
                                for in subsection (b); or</DELETED>
                                <DELETED>    ``(II) submit an 
                                application to the Secretary for the 
                                use of such funds in the succeeding 
                                fiscal year that includes a description 
                                of the manner in which the area intends 
                                to use such funds.</DELETED>
                        <DELETED>    ``(ii) Carryover.--With respect to 
                        an application received under clause (i)(II), 
                        the Secretary shall determine whether the area 
                        involved may carryover any unobligated funds 
                        for use under this part in the succeeding 
                        fiscal year or whether such amounts shall be 
                        returned to the Secretary for use under 
                        subsection (b). Notice shall be provided to the 
                        area of such determination.</DELETED>
                        <DELETED>    ``(iii) Failure to expend funds.--
                        Amounts carried over by an eligible area under 
                        this subparagraph that are not expended in the 
                        succeeding fiscal year shall be returned to the 
                        Secretary for use under subsection 
                        (b).</DELETED>
                        <DELETED>    ``(iv) Consideration in making 
                        grants.--The Secretary may, in determining the 
                        amount of a grant for a fiscal year under this 
                        paragraph, adjust the grant amount to reflect 
                        the amount of unexpended and uncanceled grant 
                        funds remaining at the end of the fiscal year 
                        preceding the year for which the grant 
                        determination is to be made. The amount of any 
                        such unexpended funds shall be determined using 
                        the financial status report of the 
                        grantee.''.</DELETED>
<DELETED>    (c) Hold Harmless.--Section 2603(a)(4) of the Public 
Health Service Act (42 U.S.C. 300ff-13(a)(4)) is amended to read as 
follows:</DELETED>
        <DELETED>    ``(4) Increases in grant.--</DELETED>
                <DELETED>    ``(A) In general.--For eligible areas 
                receiving grants under this section in fiscal year 
                2007, the Secretary shall increase the amount of the 
                grant made pursuant to paragraph (2) for the area to 
                ensure that--</DELETED>
                        <DELETED>    ``(i) for fiscal year 2007, the 
                        grant is not less than 90 percent of the amount 
                        of the grant made for the eligible area 
                        pursuant to such paragraph for the base 
                        year;</DELETED>
                        <DELETED>    ``(ii) for fiscal year 2008, the 
                        grant is not less than 85 percent of the amount 
                        of such base year grant; and</DELETED>
                        <DELETED>    ``(iii) for fiscal year 2009, the 
                        grant is not less than 80 percent of the amount 
                        of the base year grant.</DELETED>
                <DELETED>    ``(B) Base year.--With respect to grants 
                made pursuant to paragraph (2) for an eligible area, 
                the base year shall be fiscal year 2006.''.</DELETED>

<DELETED>SEC. 104. CORE MEDICAL SERVICES.</DELETED>

<DELETED>    Section 2604 of the Public Health Service Act (42 U.S.C. 
300ff-14) is amended by adding at the end the following:</DELETED>
<DELETED>    ``(h) Required Funding for Core Medical Services.--
</DELETED>
        <DELETED>    ``(1) In general.--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 
        core medical services, except that the Secretary shall waive 
        the application of this subsection with respect to a grantee if 
        the Secretary determines that, within the service area of the 
        grantee--</DELETED>
                <DELETED>    ``(A) there is no waiting lists for AIDS 
                Drug Assistance Program services; and</DELETED>
                <DELETED>    ``(B) core medical services are available 
                to all individuals infected with HIV/AIDS.</DELETED>
        <DELETED>    ``(2) 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 
        diseases of the individual) means the following 
        services:</DELETED>
                <DELETED>    ``(A) Outpatient and ambulatory health 
                services.</DELETED>
                <DELETED>    ``(B) AIDS Drug Assistance Program 
                treatments.</DELETED>
                <DELETED>    ``(C) AIDS pharmaceutical 
                assistance.</DELETED>
                <DELETED>    ``(D) Oral health care.</DELETED>
                <DELETED>    ``(E) Early intervention 
                services.</DELETED>
                <DELETED>    ``(F) Health insurance premium and cost 
                sharing assistance for low-income 
                individuals.</DELETED>
                <DELETED>    ``(G) Home health care.</DELETED>
                <DELETED>    ``(H) Hospice services.</DELETED>
                <DELETED>    ``(I) Home and community-based health 
                services as defined under section 2614(c), except 
                homemaker services.</DELETED>
                <DELETED>    ``(J) Mental health services.</DELETED>
                <DELETED>    ``(K) Substance abuse outpatient 
                care.</DELETED>
                <DELETED>    ``(L) Medical case management, including 
                treatment adherence services.</DELETED>
        <DELETED>    ``(3) Support services.--Notwithstanding any other 
        provision of law, and subject to paragraph (1), a grantee under 
        this part, subject to the approval of the Secretary, may 
        provide support services (such as respite care for individuals 
        with HIV/AIDS, outreach services, medical transportation, 
        nutritional counseling, linguistic services, and referral for 
        health care and support services for individuals with HIV/AIDS) 
        needed to achieve medical outcomes which are related to the 
        medical outcomes for an individual infected with HIV and 
        approved by the Secretary.</DELETED>
        <DELETED>    ``(4) 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.</DELETED>
        <DELETED>    ``(5) Unexpended funds.--Any amounts required to 
        be expended for core medical services or support services under 
        this subsection that remain unobligated at the end of the 
        fiscal year in which the funds were awarded shall be remitted 
        to the Secretary for reallocation under section 
        2603(b).''.</DELETED>

<DELETED>SEC. 105. SUPPLEMENTAL GRANTS.</DELETED>

<DELETED>    Section 2603(b) of the Public Health Service Act (42 
U.S.C. 300ff-13(b)) is amended--</DELETED>
        <DELETED>    (1) by striking ``severe need'' each place that 
        such appears and inserting ``demonstrated need'';</DELETED>
        <DELETED>    (2) in paragraph (1)--</DELETED>
                <DELETED>    (A) in the matter preceding subparagraph 
                (A), by striking ``Not later than'' and all that 
                follows through ``the Secretary shall'' and insert 
                ``The Secretary shall'';</DELETED>
                <DELETED>    (B) by striking subparagraph (F) and 
                inserting the following:</DELETED>
                <DELETED>    ``(F) demonstrate the inclusiveness of 
                affected communities and individuals with HIV/
                AIDS;'';</DELETED>
                <DELETED>    (C) in subparagraph (G), by striking the 
                period and inserting ``; and''; and</DELETED>
                <DELETED>    (D) by adding at the end the 
                following:</DELETED>
                <DELETED>    ``(H) demonstrate the ability of the 
                applicant to expend funds efficiently by not having any 
                unexpended funds reallocated under section 
                2603(a)(3)(E).'';</DELETED>
        <DELETED>    (3) in paragraph (2)--</DELETED>
                <DELETED>    (A) by striking subparagraph (B) and 
                inserting the following:</DELETED>
                <DELETED>    ``(B) Demonstrated need.--In determining 
                demonstrated need for purposes of subparagraph (A), the 
                Secretary shall consider relevant factors that impact 
                the need for supplemental financial assistance, 
                including--</DELETED>
                        <DELETED>    ``(i) the unmet need for such 
                        services, as determined under section 
                        2602(b)(4) or other community input process as 
                        defined under section 2609A(a);</DELETED>
                        <DELETED>    ``(ii) an increasing need for HIV/
                        AIDS-related services, including relative rates 
                        of increase in the number of cases of HIV/
                        AIDS;</DELETED>
                        <DELETED>    ``(iii) the relative rates of 
                        increase in the number of cases of HIV/AIDS 
                        within new or emerging 
                        subpopulations;</DELETED>
                        <DELETED>    ``(iv) the current prevalence of 
                        HIV/AIDS;</DELETED>
                        <DELETED>    ``(v) relevant factors related to 
                        the cost and complexity of delivering health 
                        care to individuals with HIV/AIDS in the 
                        eligible area;</DELETED>
                        <DELETED>    ``(vi) the impact of co-morbid 
                        factors, including co-occurring infections, 
                        determined relevant by the Secretary;</DELETED>
                        <DELETED>    ``(vii) the prevalence of 
                        homelessness;</DELETED>
                        <DELETED>    ``(viii) the prevalence of 
                        individuals described under section 
                        2602(b)(2)(M);</DELETED>
                        <DELETED>    ``(ix) the relevant factors that 
                        limit access to health care, including 
                        geographic variation, adequacy of health 
                        insurance coverage, and language barriers; 
                        or</DELETED>
                        <DELETED>    ``(x) the impact of a precipitous 
                        decline in the amount received under this 
                        subpart to an increase in unmet need for such 
                        services.''; and</DELETED>
                <DELETED>    (B) by striking subparagraphs (C) and 
                (D).</DELETED>

<DELETED>SEC. 106. ADMINISTRATIVE COSTS.</DELETED>

<DELETED>    Section 2604(f) of the Public Health Service Act (42 
U.S.C. 300ff-14(f)) is amended--</DELETED>
        <DELETED>    (1) in paragraph (1), by striking ``5 percent'' 
        and inserting ``10 percent''; and</DELETED>
        <DELETED>    (2) in paragraph (2)(B), by inserting ``the 
        activities carried out by HIV health services planning council 
        as established under section 2602(b),'' after 
        ``including''.</DELETED>

<DELETED>SEC. 107. AUDITS.</DELETED>

<DELETED>    Section 2605(a) of the Public Health Service Act (42 
U.S.C. 300ff-15(a)) is amended--</DELETED>
        <DELETED>    (1) in paragraph (8), by striking ``and'' at the 
        end;</DELETED>
        <DELETED>    (2) in paragraph (9), by striking the period and 
        inserting ``; and''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
        <DELETED>    ``(10) that the chief elected official will submit 
        to the lead State agency under section 2617(b)(4), audits 
        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.''.</DELETED>

<DELETED>SEC. 108. PLANNING COUNCIL REPRESENTATION.</DELETED>

<DELETED>    Section 2602(b)(2)(G) of the Public Health Service Act (42 
U.S.C. 300ff-12(b)(2)(G)) is amended by inserting ``, Native Americans, 
individuals co-infected with hepatitis B or C'' after 
``disease''.</DELETED>

<DELETED>SEC. 109. PAYER OF LAST RESORT.</DELETED>

<DELETED>    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.</DELETED>

<DELETED>SEC. 110. TRANSITIONAL GRANTS FOR OTHER AREAS.</DELETED>

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

      <DELETED>``Subpart I--General Grant Provisions'';</DELETED>

        <DELETED>    (2) by redesignating sections 2606 and 2607 as 
        sections 2610 and 2610A, respectively; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>

          <DELETED>``Subpart II--Transitional Grants</DELETED>

<DELETED>``SEC. 2609. ESTABLISHMENT.</DELETED>

<DELETED>    ``(a) Eligible Areas.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary, acting through 
        the Administrator of the Health Resources and Services 
        Administration, shall, subject to subsection (b), make grants 
        in accordance with this subpart for the purpose of assisting in 
        the provision of the services specified in section 2604 in any 
        metropolitan area--</DELETED>
                <DELETED>    ``(A) 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 less than 2,000, cases of acquired 
                immune deficiency syndrome for the most recent period 
                of 5 calendar years for which such data are available; 
                and</DELETED>
                <DELETED>    ``(B) 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 less than 1,000, cases of acquired 
                immune deficiency syndrome for the most recent period 
                of 5 calendar years for which such data are 
                available.</DELETED>
        <DELETED>    ``(2) Additional eligible areas.--With respect to 
        fiscal year 2007, a metropolitan area that received funding 
        under this part for fiscal year 2006 but which does not meet 
        the eligibility threshold described in paragraph (1)(A) for 
        fiscal year 2007 shall be deemed to be eligible under such 
        paragraph (1)(A).</DELETED>
<DELETED>    ``(b) Continued Status as Eligible Area.--Notwithstanding 
any other provision of this section, a metropolitan area shall continue 
to be eligible to receive a grant under this section until such area, 
for three consecutive grant years, fails to meet the applicable 
requirement of subparagraph (A) or (B) of subsection (a)(1) concerning 
the number of living cases of AIDS over the most recent 5-year 
period.</DELETED>

<DELETED>``SEC. 2609A. APPLICATION OF OTHER PROVISIONS.</DELETED>

<DELETED>    ``(a) Administration.--</DELETED>
        <DELETED>    ``(1) In general.--The provisions of section 2602 
        shall apply to areas that receive a grant under this subpart, 
        except that the chief elected official may elect not to comply 
        with the provisions of subsection (b), so long as the official 
        provides documentation to the Secretary that details the 
        process used to obtain community input (particularly from those 
        inflected with HIV) for the design and implementation of 
        activities related to such grant.</DELETED>
        <DELETED>    ``(2) Exception.--The exception provided for in 
        paragraph (1) shall not apply in fiscal years 2007 through 2009 
        to areas that receive funding under this part.</DELETED>
<DELETED>    ``(b) Distribution.--The provisions of section 2603 shall 
apply for purposes of awarding grants under this subpart, except that--
</DELETED>
        <DELETED>    ``(1) with respect to areas described in section 
        2609(a)(1)(A)--</DELETED>
                <DELETED>    ``(A) 66</DELETED>\<DELETED>2/3</DELETED>\ 
                <DELETED>percent of the amounts appropriated under 
                section 2609B(1) for each fiscal year shall be 
                allocated to such areas as provided for in section 
                2603(a); and</DELETED>
                <DELETED>    ``(B) 33</DELETED>\<DELETED>1/3</DELETED>\ 
                <DELETED>percent of the amounts appropriated under 
                section 2609B(1) for each fiscal year shall be 
                allocated to such areas as provided for in section 
                2603(b); and</DELETED>
        <DELETED>    ``(2) with respect to areas described in section 
        2609(a)(1)(B), 100 percent of the amounts appropriated under 
        section 2609B(2) for each fiscal year shall be allocated to 
        such areas as provided for in section 2603(a).</DELETED>
<DELETED>    ``(c) Hold Harmless.--Paragraph (4) of section 2603(a) 
shall not apply to an area for purposes of this subpart.</DELETED>
<DELETED>    ``(d) Use of Amounts.--Amounts provided to an area under a 
grant under this part shall be used by such entity as provided for in 
section 2604.</DELETED>
<DELETED>    ``(e) Application.--To be eligible to receive a grant 
under this subpart, an area shall submit to the Secretary an 
application that meets the requirements of section 2605.</DELETED>
<DELETED>    ``(f) Technical Assistance and Definitions.--The 
provisions of sections 2606 and 2707 shall apply for purposes of this 
subpart, except that with respect to the definition of metropolitan 
area in section 2607(2), such term shall be applied so that for 
purposes of determining eligible areas, the Secretary shall use the 
boundaries of a respective area that were used when the area involved 
initially receive funding under this part.</DELETED>

<DELETED>``SEC. 2609B. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    ``There are authorized to be appropriated to carry out 
this subpart--</DELETED>
        <DELETED>    ``(1) with respect to areas described in section 
        2609(a)(1)(A), $123,300,000 for fiscal year 2007, $127,900,000 
        for fiscal year 2008, $132,600,000 for fiscal year 2009, 
        $137,500,000 for fiscal year 2010, and $142,600,000 for fiscal 
        year 2011; and</DELETED>
        <DELETED>    ``(2) with respect to areas described in section 
        2609(a)(1)(B), $5,000,000 for each of the fiscal years 2007 
        through 2011.</DELETED>

        <DELETED>``Subpart III--General Provisions''.</DELETED>

<DELETED>    (b) Repeal.--Section 2620 of the Public Health Service Act 
(42 U.S.C. 300ff-30) is repealed.</DELETED>

<DELETED>SEC. 111. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    Subpart I of part A of title XXVI of the Public Health 
Service Act (42 U.S.C. 300ff-11) is amended by adding at the end the 
following:</DELETED>

<DELETED>``SEC. 2606. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    ``For the purpose of carrying put this subpart, there are 
authorized to be appropriated $418,600,000 for fiscal year 2007, 
$434,100,000 for fiscal year 2008, $450,100,000 for fiscal year 2009, 
$466,800,000 for fiscal year 2010, and $484,100,000 for fiscal year 
2011.''.</DELETED>

                <DELETED>TITLE II--CARE GRANTS</DELETED>

<DELETED>SEC. 201. LIVING CASES OF HIV/AIDS.</DELETED>

<DELETED>    (a) Priority.--Section 2611(b)(1) of the Public Health 
Service Act (42 U.S.C. 300ff-21(b)(1)) is amended--</DELETED>
        <DELETED>    (1) by striking ``acquired immune deficiency 
        syndrome'' and inserting ``HIV/AIDS''; and</DELETED>
        <DELETED>    (2) by striking ``such syndrome'' and inserting 
        ``HIV/AIDS''.</DELETED>
<DELETED>    (b) Application.--Section 2617(d)(3) of the Public Health 
Service Act (42 U.S.C. 300ff-27(d)(3)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (A), by striking ``acquired 
        immune deficiency syndrome'' and inserting ``HIV/AIDS''; 
        and</DELETED>
        <DELETED>    (2) in subparagraph (C), by striking ``acquired 
        immune deficiency syndrome'' and inserting ``HIV/
        AIDS''.</DELETED>
<DELETED>    (c) Distribution of Funds.--Section 2618(a) of the Public 
Health Service Act (42 U.S.C. 300ff-28(a)) is amended--</DELETED>
        <DELETED>    (1) in paragraph (1)(A)(i)--</DELETED>
                <DELETED>    (A) in subclause (I), by striking ``cases 
                of acquired immune deficiency syndrome, as determined 
                under paragraph (2)(D)'' and inserting ``living cases 
                of AIDS (reported to and confirmed by the Director of 
                the Centers for Disease Control and Prevention)''; 
                and</DELETED>
                <DELETED>    (B) in subclause (II)--</DELETED>
                        <DELETED>    (i) by striking ``cases of 
                        acquired immune deficiency syndrome, as 
                        determined under paragraph (2)(D)'' and 
                        inserting ``living cases of AIDS (reported to 
                        and confirmed by the Director of the Centers 
                        for Disease Control and Prevention)''; 
                        and</DELETED>
                        <DELETED>    (ii) by inserting ``and'' after 
                        the semicolon; and</DELETED>
        <DELETED>    (2) in paragraph (2)--</DELETED>
                <DELETED>    (A) in subparagraph (B), by striking 
                ``estimated number of living cases of acquired immune 
                deficiency syndrome'' and inserting ``number of living 
                cases of HIV/AIDS'';</DELETED>
                <DELETED>    (B) in subparagraph (C)--</DELETED>
                        <DELETED>    (i) by striking ``estimated'' each 
                        place that such term appears; and</DELETED>
                        <DELETED>    (ii) by striking ``acquired immune 
                        deficiency syndrome'' each place that such 
                        appears and inserting ``HIV/AIDS''; 
                        and</DELETED>
                <DELETED>    (C) by striking subparagraph (D) and 
                inserting the following:</DELETED>
                <DELETED>    ``(F) Living cases of hiv/aids.--
                </DELETED>
                        <DELETED>    ``(i) In general.--Except as 
                        provided for in clause (ii) and (iii), the 
                        amount determined in this subparagraph is the 
                        number of living cases of HIV/AIDS (reported to 
                        and confirmed by the Director of the Centers 
                        for Disease Control and Prevention) through 
                        December 31 of the most recent calendar year 
                        involved.</DELETED>
                        <DELETED>    ``(ii) Fiscal years 2007 through 
                        2010.--For each of fiscal years 2007 through 
                        2010, the Secretary may use the proxy number 
                        for the number of HIV cases described in clause 
                        (iii) if--</DELETED>
                                <DELETED>    ``(I) the State involved--
                                </DELETED>
                                        <DELETED>    ``(aa) is 
                                        reporting, or the State will by 
                                        October 1, 2006 have submitted 
                                        a transition plan for 
                                        reporting, accurate and 
                                        reliable HIV cases to the 
                                        Director of the Centers for 
                                        Disease Control and Prevention; 
                                        or</DELETED>
                                        <DELETED>    ``(bb) not later 
                                        than October 1, 2006, make all 
                                        necessary statutory changes to 
                                        allow for the collection of HIV 
                                        data certified by the Director 
                                        of the Centers for Disease 
                                        Control and 
                                        Prevention;</DELETED>
                                <DELETED>    ``(II) the State involved 
                                will by April 1, 2008, begin reporting 
                                accurate and reliable HIV cases, as 
                                determined by the Director of the 
                                Centers for Disease Control and 
                                Prevention; and</DELETED>
                                <DELETED>    ``(III) the Director of 
                                the Centers for Disease Control and 
                                Prevention has determined that such 
                                State does not have an established HIV 
                                surveillance system.</DELETED>
                        <DELETED>    ``(iii) Amount determined.--With 
                        respect to each of fiscal years 2007 through 
                        2010, the amount determined under this 
                        subparagraph shall be the lesser of--</DELETED>
                                <DELETED>    ``(I) the product of 0.9 
                                and the number of living AIDS cases in 
                                the area involved; or</DELETED>
                                <DELETED>    ``(II) an amount equal to 
                                110 percent of the funding level for 
                                the previous fiscal year.''.</DELETED>

<DELETED>SEC. 202. AIDS DRUG ASSISTANCE PROGRAM.</DELETED>

<DELETED>    (a) Requirement of Minimum Drug List.--Section 2616 of the 
Public Health Service Act (42 U.S.C. 300ff-26) is amended--</DELETED>
        <DELETED>    (1) in subsection (c), by striking paragraph (1) 
        and inserting the following:</DELETED>
        <DELETED>    ``(1) ensure that those treatments contained on 
        the list of core AIDS Drug Assistance Program antiretroviral 
        medications developed by the Secretary based on Public Health 
        Service guidelines, are the minimum required treatments to be 
        included under the program established under this section;''; 
        and</DELETED>
        <DELETED>    (2) in subsection (d), by adding at the end the 
        following: ``The Secretary, in consultation with the Public 
        Health Service, shall develop and maintain a list of classes of 
        core AIDS Drug Assistance Program antiretroviral medications 
        that shall be based upon those medications included in the 
        Department of Health and Human Service's Public Health Service 
        HIV/AIDS Clinical Practice Guidelines for use of HIV/AIDS 
        Drugs, drugs needed to manage symptoms associated with HIV 
        infection.''.</DELETED>
<DELETED>    (b) State Requirements.--Subclauses (I) through (III) of 
section 2618(a)(2)(I)(ii) of the Public Health Service Act (42 U.S.C. 
300ff-28(a)(2)(I)(ii)(I)-(III)) are amended to read as 
follows:</DELETED>
                                        <DELETED>    ``(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 (as described in 
                                        section 2616(b)), 
                                        pharmaceutical therapeutics 
                                        described under sections 
                                        2616(a) and 2616(c).</DELETED>
                                        <DELETED>    ``(II) Eligible 
                                        states.--For purposes of 
                                        subclause (I), a State shall be 
                                        an eligible State if the State 
                                        did not have unexpended funds 
                                        subject to reallocation under 
                                        section 2618(d) and, in 
                                        accordance with criteria 
                                        established by the Secretary, 
                                        demonstrates a severe need for 
                                        a grant under this clause. In 
                                        developing such criteria, 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.</DELETED>
                                <DELETED>    ``(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.''.</DELETED>
<DELETED>    (c) Increase in ADAP Set-Aside.--Section 
2618(a)(2)(I)(ii)(V) of the Public Health Service Act (42 U.S.C. 300ff-
28(a)(2)(I)(ii)(V)) is amended by striking ``3'' and inserting 
``5''.</DELETED>
<DELETED>    (d) Drug Rebate Program.--Section 2616 of the Public 
Health Service Act (42 U.S.C. 300ff-26) is amended by adding at the end 
the following:</DELETED>
<DELETED>    ``(f) Drug Rebate Program.--A State shall ensure that any 
drug rebates received on drugs purchased from funds provided under this 
section are applied to activities supported under this title, with a 
preference for activities described under this section.''.</DELETED>

<DELETED>SEC. 203. COORDINATION.</DELETED>

<DELETED>    Section 2617(b) of the Public Health Service Act (42 
U.S.C. 300ff-27(b)) is amended--</DELETED>
        <DELETED>    (1) by redesignating paragraphs (4) through (6) as 
        paragraphs (5) through (7), respectively;</DELETED>
        <DELETED>    (2) by inserting after paragraph (3), the 
        following:</DELETED>
        <DELETED>    ``(4) the designation of a lead State agency that 
        shall--</DELETED>
                <DELETED>    ``(A) administer all assistance received 
                under this part;</DELETED>
                <DELETED>    ``(B) conduct the needs assessment and 
                prepare the State plan under paragraph (3);</DELETED>
                <DELETED>    ``(C) prepare all applications for 
                assistance under this part;</DELETED>
                <DELETED>    ``(D) receive notices with respect to 
                programs under this title;</DELETED>
                <DELETED>    ``(E) every 2 years, collect and submit to 
                the Secretary all audits from grantees within the 
                State, including audits regarding funds expended in 
                accordance with this part; and</DELETED>
                <DELETED>    ``(F) carry out any other duties 
                determined appropriate by the Secretary to facilitate 
                the coordination of programs under this 
                title.'';</DELETED>
        <DELETED>    (3) in paragraph (5) (as so redesignated)--
        </DELETED>
                <DELETED>    (A) in the matter preceding subparagraph 
                (A), by striking ``under this part'' and inserting 
                ``under any provision of this title'';</DELETED>
                <DELETED>    (B) in subparagraph (E), by striking 
                ``and'' at the end; and</DELETED>
                <DELETED>    (C) by inserting after subparagraph (F), 
                the following:</DELETED>
                <DELETED>    ``(G) includes key outcomes to be measured 
                by all entities in the State receiving assistance under 
                this title; and''.</DELETED>

<DELETED>SEC. 204. DISTRIBUTION OF FUNDS.</DELETED>

<DELETED>    (a) In General.--Section 2618(a)(2) of the Public Health 
Service Act (42 U.S.C. 300ff-28(a)(2)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (A)--</DELETED>
                <DELETED>    (A) in clause (i), by striking ``and (I)'' 
                and inserting ``, (I), and (J)''; and</DELETED>
                <DELETED>    (B) in clause (ii)--</DELETED>
                        <DELETED>    (i) in subclause (I)--</DELETED>
                                <DELETED>    (I) by striking ``0.8'' 
                                and inserting ``0.75''; and</DELETED>
                                <DELETED>    (II) by striking ``and'' 
                                at the end;</DELETED>
                        <DELETED>    (ii) in subclause (II), by 
                        striking the period and inserting ``; and''; 
                        and</DELETED>
                        <DELETED>    (iii) by adding at the end the 
                        following:</DELETED>
                                <DELETED>    ``(III) the product of 
                                0.05 and the ratio of the locality 
                                distribution factor (as determined 
                                under subparagraph (D)) to the sum of 
                                the respective State distribution 
                                factors for all States and 
                                territories.'';</DELETED>
        <DELETED>    (2) in subparagraph (C)(ii), by striking ``(as 
        determined under part A)'' and inserting ``under subpart I of 
        part A and an eligible area under section 
        2609(a)(1)(A)'';</DELETED>
        <DELETED>    (3) by inserting after subparagraph (C), the 
        following:</DELETED>
                <DELETED>    ``(D) Locality distribution factor.--For 
                purposes of subparagraph (A)(ii)(III), the term 
                `locality distribution factor' means an amount equal to 
                the sum of--</DELETED>
                        <DELETED>    ``(i) the number of living cases 
                        of HIV/AIDS in the State or territory involved, 
                        as determined under subparagraph (F); 
                        less</DELETED>
                        <DELETED>    ``(ii) the number of living cases 
                        of HIV/AIDS in such State or territory that are 
                        within an eligible area (as determined under 
                        subpart I of part A and section 
                        2609(a)(1)(A)).'';</DELETED>
        <DELETED>    (4) by striking subparagraph (E) and inserting the 
        following:</DELETED>
                <DELETED>    ``(E) Severity of need.--</DELETED>
                        <DELETED>    ``(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 (D) 
                        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.</DELETED>
                        <DELETED>    ``(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, 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.</DELETED>
                        <DELETED>    ``(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, and the provisions of subparagraphs 
                        (A) through (D) shall not apply, and the 
                        Secretary shall use the severity of need index 
                        (as defined in clause (iv)) for the formula 
                        allocations for fiscal year 2013, subject to 
                        the Congressional Review Act.</DELETED>
                        <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(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:</DELETED>
                                <DELETED>    ``(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.</DELETED>
                                <DELETED>    ``(II) 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).</DELETED>
                                <DELETED>    ``(III) Information 
                                regarding the process by which the 
                                Secretary received community input 
                                regarding the application of the 
                                severity of need index.</DELETED>
                                <DELETED>    ``(IV) Timeline and 
                                process for the implementation of the 
                                severity of need index to ensure that 
                                it is applied in the following fiscal 
                                year.</DELETED>
                        <DELETED>    ``(vi) Annual reports.--Not later 
                        than 1 year after the date of enactment of the 
                        Ryan White HIV/AIDS Treatment Modernization 
                        Act, 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--
                        </DELETED>
                                <DELETED>    ``(I) that updates 
                                progress toward having client level 
                                data;</DELETED>
                                <DELETED>    ``(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</DELETED>
                                <DELETED>    ``(III) that, as 
                                applicable, states whether the 
                                Secretary could develop a severity of 
                                need index before fiscal year 
                                2010.''.</DELETED>
        <DELETED>    (5) by striking subparagraph (G), and inserting 
        the following:</DELETED>
                <DELETED>    ``(G) Unexpended funds.--</DELETED>
                        <DELETED>    ``(i) In general.--A State that 
                        has unobligated funds for a fiscal year under a 
                        grant under this part shall--</DELETED>
                                <DELETED>    ``(I) return such funds to 
                                the Secretary to be applied as provided 
                                for in section 2620; or</DELETED>
                                <DELETED>    ``(II) submit an 
                                application to the Secretary for the 
                                use of such funds in the succeeding 
                                fiscal year that includes a description 
                                of the manner in which the State 
                                intends to use such funds.</DELETED>
                        <DELETED>    ``(ii) Carryover.--With respect to 
                        an application received under clause (i)(II), 
                        the Secretary shall determine whether the State 
                        involved may carryover any unobligated funds 
                        for use under this part in the succeeding 
                        fiscal year or whether such amounts shall be 
                        returned to the Secretary for use under section 
                        2620. Notice shall be provided to the area of 
                        such determination.</DELETED>
                        <DELETED>    ``(iii) Failure to expend funds.--
                        Amounts carried over by a State under this 
                        subparagraph that are not expended in the 
                        succeeding fiscal year shall be returned to the 
                        Secretary for use under section 2610.</DELETED>
                        <DELETED>    ``(iv) Consideration in making 
                        grants.--The Secretary may, in determining the 
                        amount of a grant for a fiscal year under this 
                        paragraph, adjust the grant amount to reflect 
                        the amount of unexpended and uncanceled grant 
                        funds remaining at the end of the fiscal year 
                        preceding the year for which the grant 
                        determination is to be made. The amount of any 
                        such unexpended funds shall be determined using 
                        the financial status report of the 
                        grantee.'';</DELETED>
        <DELETED>    (6) by striking subparagraph (H); and</DELETED>
        <DELETED>    (7) in subparagraph (I)(ii), by striking subclause 
        (VI) and inserting the following:</DELETED>
                                <DELETED>    ``(VI) Increases in 
                                grant.--</DELETED>
                                        <DELETED>    ``(aa) In 
                                        general.--For eligible areas 
                                        receiving grants under this 
                                        section in fiscal year 2007, 
                                        the Secretary shall increase 
                                        the amount of the grant made 
                                        pursuant to paragraph (2) for 
                                        the State to ensure that--
                                        </DELETED>

                                                <DELETED>    ``(AA) for 
                                                fiscal year 2007, the 
                                                grant is not less than 
                                                90 percent of the 
                                                amount of the grant 
                                                made for the State 
                                                under section 2620 and 
                                                section 2618(a) for the 
                                                base year;</DELETED>

                                                <DELETED>    ``(BB) for 
                                                fiscal year 2008, the 
                                                grant is not less than 
                                                85 percent of the 
                                                amount of such base 
                                                year grant; 
                                                and</DELETED>

                                                <DELETED>    ``(CC) for 
                                                fiscal year 2009, the 
                                                grant is not less than 
                                                80 percent of the 
                                                amount of the base year 
                                                grant.</DELETED>

                                        <DELETED>    ``(bb) Base 
                                        year.--With respect to grants 
                                        made pursuant to paragraph (2) 
                                        for an State, the base year 
                                        shall be fiscal year 
                                        2006.''.</DELETED>
<DELETED>    (b) Reallocation.--Section 2618(d) of the Public Health 
Service Act (42 U.S.C. 300ff-28(d)) is amended by striking ``in 
proportion to the original grants made to such States'' and insert 
``reallocated pursuant to section 2620''.</DELETED>

<DELETED>SEC. 205. CORE MEDICAL SERVICES.</DELETED>

<DELETED>    Section 2612 of the Public Health Service Act (42 U.S.C. 
300ff-22) is amended by adding at the end the following:</DELETED>
<DELETED>    ``(e) Required Funding for Core Medical Services.--
</DELETED>
        <DELETED>    ``(1) In general.--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 
        core medical services, except that the Secretary shall waive 
        the application of this subsection with respect to a grantee if 
        the Secretary determines that, within the service area of the 
        grantee--</DELETED>
                <DELETED>    ``(A) there is no waiting lists for AIDS 
                Drug Assistance Program services; and</DELETED>
                <DELETED>    ``(B) core medical services are available 
                to all individuals infected with HIV/AIDS.</DELETED>
        <DELETED>    ``(2) 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 
        diseases of the individual) means the following 
        services:</DELETED>
                <DELETED>    ``(A) Outpatient and ambulatory health 
                services.</DELETED>
                <DELETED>    ``(B) AIDS Drug Assistance Program 
                treatments.</DELETED>
                <DELETED>    ``(C) AIDS pharmaceutical 
                assistance.</DELETED>
                <DELETED>    ``(D) Oral health care.</DELETED>
                <DELETED>    ``(E) Early intervention 
                services.</DELETED>
                <DELETED>    ``(F) Health insurance premium and cost 
                sharing assistance for low-income 
                individuals.</DELETED>
                <DELETED>    ``(G) Home health care.</DELETED>
                <DELETED>    ``(H) Hospice services.</DELETED>
                <DELETED>    ``(I) Home and community-based health 
                services as defined under section 2614(c), except 
                homemaker services.</DELETED>
                <DELETED>    ``(J) Mental health services.</DELETED>
                <DELETED>    ``(K) Substance abuse outpatient 
                care.</DELETED>
                <DELETED>    ``(L) Medical case management, including 
                treatment adherence services.</DELETED>
        <DELETED>    ``(3) Support services.--Notwithstanding any other 
        provision of law, and subject to paragraph (1), a grantee under 
        this part, subject to the approval of the Secretary, may 
        provide support services (such as respite care for individuals 
        with HIV/AIDS, outreach services, medical transportation, 
        nutritional counseling, linguistic services, and referral for 
        health care and support services for individuals with HIV/AIDS) 
        needed to achieve medical outcomes which are related to the 
        medical outcomes for an individual infected with HIV and 
        approved by the Secretary.</DELETED>
        <DELETED>    ``(4) 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.</DELETED>
        <DELETED>    ``(5) Unexpended funds.--Any amounts required to 
        be expended for core medical services or support services under 
        this subsection that remain unobligated at the end of the 
        fiscal year in which the funds were awarded shall be remitted 
        to the Secretary for reallocation under section 
        2620.''.</DELETED>

<DELETED>SEC. 206. SUPPLEMENTAL GRANTS.</DELETED>

<DELETED>    (a) In General.--Section 2620 of the Public Health Service 
Act (42 U.S.C. 300ff-30) is amended to read as follows:</DELETED>

<DELETED>``SEC. 2620. SUPPLEMENTAL GRANTS.</DELETED>

<DELETED>    ``(a) In General.--The Secretary shall utilize amounts 
appropriated under section 2622 for a fiscal year and made available in 
accordance with subsection (c) to award grants to States whose 
applications under section 2617 demonstrate a need in the State for 
supplemental financial assistance to combat the HIV epidemic and that 
have not had unexpended funds subject to the reallocation under section 
2618(a)(2)(G).</DELETED>
<DELETED>    ``(b) Demonstrated Need.--In determining demonstrated need 
for purposes of subsection (a), the Secretary shall consider relevant 
factors that impact the need for supplemental financial assistance, 
including--</DELETED>
        <DELETED>    ``(1) the unmet need for such services, as 
        determined under section 2602(b)(4) or other community input 
        process as defined under section 2609A(a);</DELETED>
        <DELETED>    ``(2) an increasing need for HIV/AIDS-related 
        services, including relative rates of increase in the number of 
        cases of HIV/AIDS;</DELETED>
        <DELETED>    ``(3) the relative rates of increase in the number 
        of cases of HIV/AIDS within new or emerging 
        subpopulations;</DELETED>
        <DELETED>    ``(4) the current prevalence of HIV/
        AIDS;</DELETED>
        <DELETED>    ``(5) relevant factors related to the cost and 
        complexity of delivering health care to individuals with HIV/
        AIDS in the eligible area;</DELETED>
        <DELETED>    ``(6) the impact of co-morbid factors, including 
        co-occurring infections, determined relevant by the 
        Secretary;</DELETED>
        <DELETED>    ``(7) the prevalence of homelessness;</DELETED>
        <DELETED>    ``(8) the prevalence of individuals described 
        under section 2602(b)(2)(M);</DELETED>
        <DELETED>    ``(9) the relevant factors that limit access to 
        health care, including geographic variation, adequacy of health 
        insurance coverage, and language barriers; or</DELETED>
        <DELETED>    ``(10) the impact of a precipitous decline in the 
        amount received under this subpart to an increase in unmet need 
        for such services.</DELETED>
<DELETED>    ``(c) Amount and Trigger of Funding.--</DELETED>
        <DELETED>    ``(1) Amount.--For each fiscal year beginning with 
        the trigger year described in paragraph (2), the Secretary 
        shall make available for purposes of awarding grants under this 
        section, </DELETED>\<DELETED>1/3</DELETED>\ <DELETED>of the sum 
        of--</DELETED>
                <DELETED>    ``(A) the amount appropriated under 
                section 2622 for such fiscal year; less</DELETED>
                <DELETED>    ``(B) the amount made available to carry 
                out section 2618(a)(2)(I) and section 2621 for such 
                fiscal year.</DELETED>
        <DELETED>    ``(2) Trigger year.--This section shall be 
        effective only for fiscal years beginning in the first fiscal 
        year in which the amount appropriated under section 2621, 
        excluding any amounts made available to carry out section 
        2618(a)(2)(I) and section 2621 for such fiscal year, exceeds 
        the amount appropriated under section 2677(b) (as such section 
        existed on the day before the date of enactment of the Ryan 
        White HIV/AIDS Treatment Modernization Act) for fiscal year 
        2006, excluding any amount made available to carry out section 
        2618(a)(2)(I) for fiscal year 2006.''.</DELETED>
<DELETED>    (b) Conforming Amendments.--Section 2618 of the Public 
Health Service Act (42 U.S.C. 300ff-28) is amended--</DELETED>
        <DELETED>    (1) in subsection (a)(1), by striking ``section 
        2677'' and inserting ``section 2622 and to the provisions of 
        section 2620''; and</DELETED>
        <DELETED>    (2) in subsection (c)(1), by inserting ``, except 
        for grants awarded under section 2620,'' after ``under this 
        part''.</DELETED>

<DELETED>SEC. 207. REDUCTION OF THE ADAP WAITING LIST.</DELETED>

<DELETED>    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 adding at the 
end the following:</DELETED>

<DELETED>``SEC. 2621. REDUCTION OF THE ADAP WAITING LIST.</DELETED>

<DELETED>    ``(a) In General.--If the Secretary determines that there 
is additional need for States to have funds to provide eligible 
individuals (as described in section 2616(b)) appropriate access to 
pharmaceutical therapies, the Secretary may make supplemental grants to 
States described in subsection (b) to enable such States to purchase 
and distribute to eligible individuals pharmaceutical therapies as 
described in sections 2616(a) and 2616(e).</DELETED>
<DELETED>    ``(b) Eligible States.--For purposes of subsection (a), a 
State is an eligible State if the State did not have unexpended funds 
subject to reallocation under section 2618(d), and, in accordance with 
criteria established by the Secretary, demonstrates a need for a grant 
under such subsection. In developing such criteria, the Secretary shall 
consider eligibility standards, formulary composition, the number of 
eligible individuals to whom the State is unable to provide 
therapeutics described in section 2616(a), and unanticipated increases 
in the number of eligible individuals.</DELETED>
<DELETED>    ``(c) State Requirements.--The Secretary may not make a 
grant to a State under this section unless the State involved agrees 
that the State will make available (directly or through donations from 
public or private entities) non-Federal contributions toward the 
activities to be carried out under the grant in an amount equal to $1 
for each $4 of Federal funds provided under the grant, except that the 
Secretary may waive this subsection if the State has otherwise fully 
complied with section 2617(d) with respect to the grant year 
involved.</DELETED>
<DELETED>    ``(d) Authorization of Appropriations.--There is 
authorized to be appropriated to carry out this section, $40,000,000 
for fiscal year 2007.''.</DELETED>

<DELETED>SEC. 208. NATIVE AMERICAN REPRESENTATION.</DELETED>

<DELETED>    Section 2617(b)(6) of the Public Health Service Act (42 
U.S.C. 300ff-27(b)(5)), as so redesignated, is amended by inserting 
``Native Americans within the State,'' before ``representatives of 
grantees''.</DELETED>

<DELETED>SEC. 209. PAYER OF LAST RESORT.</DELETED>

<DELETED>    Section 2617(b)(7)(F)(ii) of the Public Health Service Act 
(42 U.S.C. 300ff-27(b)(6))is amended by inserting ``(except for a 
program administered by or providing the services of the Indian Health 
Services)'' before the semicolon.</DELETED>

<DELETED>SEC. 210. HEPATITIS.</DELETED>

<DELETED>    Section 2614(a)(3) of the Public Health Service Act (42 
U.S.C. 300ff-24(a)(3)) is amended by inserting ``, including speciality 
care (including vaccinations) for hepatitis coinfection,'' after 
``health services''.</DELETED>

<DELETED>SEC. 211. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    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:</DELETED>

<DELETED>``SEC. 2622. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    ``For the purpose of carrying put this subpart, there are 
authorized to be appropriated $1,190,400,000 for fiscal year 2007, 
$1,193,000,000 for fiscal year 2008, $1,237,100,000 for fiscal year 
2009, $1,282,900,000 for fiscal year 2010, and $1,330,300,000 for 
fiscal year 2011.''.</DELETED>

       <DELETED>TITLE III--EARLY INTERVENTION SERVICES</DELETED>

<DELETED>SEC. 301. CATEGORICAL GRANTS.</DELETED>

<DELETED>    (a) Establishment of Program.--Section 2651(b) of the 
Public Health Service Act (42 U.S.C. 300ff-51(b)) is amended--
</DELETED>
        <DELETED>    (1) in paragraph (2)(D), by striking ``the 
        disease'' and inserting ``HIV/AIDS'';</DELETED>
        <DELETED>    (2) in paragraph (4)(B)--</DELETED>
                <DELETED>    (A) in clause (i), by striking 
                ``paragraphs (1)'' and all that follows through 
                ``2652(a)'' and inserting ``subparagraphs (A), (D), 
                (E), and (F) of section 12652(a)(1)''; and</DELETED>
                <DELETED>    (B) in clause (ii), by striking 
                ``paragraphs (3) and (4) of section 2652(a)'' and 
                inserting ``subparagraphs (B) and (C) of section 
                2652(a)(1)''; and</DELETED>
        <DELETED>    (3) in paragraph (5)(A), by striking ``the 
        disease'' each place that such appears and inserting ``HIV/
        AIDS''.</DELETED>
<DELETED>    (b) 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:</DELETED>
<DELETED>    ``(a) Eligible Entities.--</DELETED>
        <DELETED>    ``(1) In general.--The entities referred to in 
        section 2651(a) are public entities and nonprofit private 
        entities that are--</DELETED>
                <DELETED>    ``(A) federally-qualified health centers 
                under section 1905(l)(2)(B) of the Social Security 
                Act;</DELETED>
                <DELETED>    ``(B) grantees under section 1001 
                (regarding family planning) other than 
                States;</DELETED>
                <DELETED>    ``(C) comprehensive hemophilia diagnostic 
                and treatment centers;</DELETED>
                <DELETED>    ``(D) rural health clinics;</DELETED>
                <DELETED>    ``(E) health facilities operated by or 
                pursuant to a contract with the Indian Health 
                Service;</DELETED>
                <DELETED>    ``(F) nonprofit private entities that 
                provide comprehensive primary care services to 
                populations at risk of HIV/AIDS.</DELETED>
        <DELETED>    ``(2) Underserved populations.--Entities described 
        in paragraph (1) shall serve underserved populations which may 
        include minority populations and Native American populations, 
        ex-offenders, individuals co-infected with HIV and hepatitis B 
        or C, low-income populations, inner city populations, and rural 
        populations.''.</DELETED>
<DELETED>    (c) Preferences in Making Grants.--Section 2653 of the 
Public Health Service Act (42 U.S.C. 300ff-53) is amended--</DELETED>
        <DELETED>    (1) in subsection (b)(1)--</DELETED>
                <DELETED>    (A) in subparagraph (A), by striking 
                ``acquired immune deficiency syndrome'' and inserting 
                ``HIV/AIDS''; and</DELETED>
                <DELETED>    (B) in subparagraph (D), by inserting 
                before the semicolon the following: ``and the number of 
                cases of individuals coinfected with HIV/AIDS and 
                hepatitis B or C''; and</DELETED>
        <DELETED>    (2) in subsection (d)(2), by striking ``special 
        consideration'' and inserting ``preference''.</DELETED>
<DELETED>    (d) Planning and Development Grants.--Section 2654(c) of 
the Public Health Service Act (42 U.S.C. 300ff-54(c)) is amended--
</DELETED>
        <DELETED>    (1) in paragraph (1)--</DELETED>
                <DELETED>    (A) in subparagraph (A), by striking 
                ``HIV''; and</DELETED>
                <DELETED>    (B) in subparagraph (B), by striking 
                ``HIV'' and inserting ``HIV/AIDS''; and</DELETED>
        <DELETED>    (2) in paragraph (3), by striking ``or underserved 
        communities'' and inserting ``areas or to underserved 
        populations''.</DELETED>
<DELETED>    (e) 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, $234,800,000 for fiscal year 2010, 
and $252,800,000 for fiscal year 2011''.</DELETED>

<DELETED>SEC. 302. GENERAL PROVISIONS.</DELETED>

<DELETED>    (a) Counseling Services.--Section 2662(a) of the Public 
Health Service Act (42 U.S.C. 300ff-62(a)) is amended by striking ``the 
disease'' and inserting ``HIV/AIDS''.</DELETED>
<DELETED>    (b) 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''.</DELETED>
<DELETED>    (c) Additional Required Agreements.--Section 2664(a) of 
the Public Health Service Act (42 U.S.C. 300ff-64(a)) is amended--
</DELETED>
        <DELETED>    (1) in paragraph (1)--</DELETED>
                <DELETED>    (A) in subparagraph (A), by striking 
                ``and'' at the end;</DELETED>
                <DELETED>    (B) in subparagraph (B), by striking 
                ``and'' at the end; and</DELETED>
                <DELETED>    (C) by adding at the end the 
                following:</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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) or through additional outcome 
                measures;'';</DELETED>
        <DELETED>    (2) in paragraph (2), by striking the period and 
        inserting a semicolon; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(4) the applicant agrees to 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.''.</DELETED>

<DELETED>SEC. 303. CORE MEDICAL SERVICES.</DELETED>

<DELETED>    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:</DELETED>

<DELETED>``SEC. 2688. REQUIRED FUNDING FOR CORE MEDICAL 
              SERVICES.</DELETED>

<DELETED>    ``(a) In General.--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 core medical services, except 
that the Secretary shall waive the application of this section with 
respect to a grantee if the Secretary determines that, within the 
service area of the grantee--</DELETED>
        <DELETED>    ``(1) there is no waiting lists for AIDS Drug 
        Assistance Program services; and</DELETED>
        <DELETED>    ``(2) core medical services are available to all 
        individuals infected with HIV/AIDS.</DELETED>
<DELETED>    ``(b) Core Medical Services.--For purposes of this 
section, the term `core medical services' with respect to an individual 
infected with HIV/AIDS (including the co-occurring diseases of the 
individual) means the following services:</DELETED>
        <DELETED>    ``(1) Outpatient and ambulatory health 
        services.</DELETED>
        <DELETED>    ``(2) AIDS Drug Assistance Program 
        treatments.</DELETED>
        <DELETED>    ``(3) AIDS pharmaceutical assistance.</DELETED>
        <DELETED>    ``(4) Oral health care.</DELETED>
        <DELETED>    ``(5) Early intervention services.</DELETED>
        <DELETED>    ``(6) Health insurance premium and cost sharing 
        assistance for low-income individuals.</DELETED>
        <DELETED>    ``(7) Home health care.</DELETED>
        <DELETED>    ``(8) Hospice services.</DELETED>
        <DELETED>    ``(9) Home and community-based health services as 
        defined under section 2614(c), except homemaker 
        services.</DELETED>
        <DELETED>    ``(10) Mental health services.</DELETED>
        <DELETED>    ``(11) Substance abuse outpatient care.</DELETED>
        <DELETED>    ``(12) Medical case management, including 
        treatment adherence services.</DELETED>
<DELETED>    ``(c) Support Services.--Notwithstanding any other 
provision of law, and subject to subsection (a), a grantee under this 
part, subject to the approval of the Secretary, may provide support 
services (such as respite care for individuals with HIV/AIDS, outreach 
services, medical transportation, nutritional counseling, linguistic 
services, and referral for health care and support services for 
individuals with HIV/AIDS) needed to achieve medical outcomes which are 
related to the medical outcomes for an individual infected with HIV and 
approved by the Secretary.</DELETED>
<DELETED>    ``(d) 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.</DELETED>
<DELETED>    ``(e) Unexpended Funds.--Any amounts required to be 
expended for core medical services or support services under this 
section that remain unobligated at the end of the fiscal year in which 
the funds were awarded shall be remitted to the Secretary for 
reallocation under this section.''.</DELETED>

<DELETED>SEC. 304. PAYER OF LAST RESORT.</DELETED>

<DELETED>    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.</DELETED>

    <DELETED>TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH</DELETED>

<DELETED>SEC. 401. WOMEN, INFANTS, CHILDREN, AND YOUTH.</DELETED>

<DELETED>    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:</DELETED>

    <DELETED>``PART D--WOMEN, INFANTS, CHILDREN, AND YOUTH</DELETED>

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

<DELETED>    ``(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) that provide family-centered care involving outpatient 
or ambulatory care (directly or through contracts) for women, infants, 
children, and youth with HIV/AIDS.</DELETED>
<DELETED>    ``(b) Additional Services for Patients and Families.--
Funds provided under grants awarded under subsection (a) may be also be 
used for the following support services:</DELETED>
        <DELETED>    ``(1) Family-centered care including case 
        management.</DELETED>
        <DELETED>    ``(2) Referrals for additional services 
        including--</DELETED>
                <DELETED>    ``(A) referrals for inpatient hospital 
                services, treatment for substance abuse, and mental 
                health services; and</DELETED>
                <DELETED>    ``(B) referrals for other social and 
                support services, as appropriate.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) The provision of information and education 
        on opportunities to participate in HIV/AIDS-related clinical 
        research.</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Administration.--</DELETED>
        <DELETED>    ``(1) 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:</DELETED>
                <DELETED>    ``(A) 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).</DELETED>
                <DELETED>    ``(B) 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.</DELETED>
        <DELETED>    ``(2) Quality management program.--A grantee under 
        this section shall implement a quality management program to 
        assess the extent to which HIV health services provided to 
        patients under the grant are consistent with the most recent 
        Public Health Service guidelines for the treatment of HIV/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.</DELETED>
<DELETED>    ``(e) Annual Review of Programs; Evaluations.--</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Other procedures or policies of the 
                entity regarding the participation of such individuals 
                in such program.</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(f) Cap on Administrative Expenses.--A grantee may not 
use more than 10 percent of amounts received under a grant awarded 
under this section for administrative expenses.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(h) Definitions.--In this section:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Indirect costs.--The term `indirect costs' 
        means costs included in a Federally negotiated indirect 
        rate.</DELETED>
        <DELETED>    ``(3) Services.--The term `services' means--
        </DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) services that sustain program 
                activity and contribute to or help improve services 
                under subparagraph (A).</DELETED>
<DELETED>    ``(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.''.</DELETED>

<DELETED>SEC. 402. GAO REPORT.</DELETED>

<DELETED>    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--</DELETED>
        <DELETED>    (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;</DELETED>
        <DELETED>    (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;</DELETED>
        <DELETED>    (3) how funds are used to provide family-centered 
        care involving outpatient or ambulatory care authorized under 
        section 2671(a) of such title;</DELETED>
        <DELETED>    (4) how funds are used to provide additional 
        services authorized under section 2671(b) of such title; 
        and</DELETED>
        <DELETED>    (5) how funds are used to help identify HIV-
        positive pregnant women and connect them with care that can 
        improve their health and prevent perinatal 
        transmission.</DELETED>

             <DELETED>TITLE V--GENERAL PROVISIONS</DELETED>

<DELETED>SEC. 501. GENERAL PROVISIONS.</DELETED>

<DELETED>    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:</DELETED>

            <DELETED>``PART E--GENERAL PROVISIONS</DELETED>

<DELETED>``SEC. 2681. COORDINATION.</DELETED>

<DELETED>    ``(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 the Minority AIDS Initiative 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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 2682. AUDITS.</DELETED>

<DELETED>    ``(a) In General.--For fiscal year 2007, 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.</DELETED>
<DELETED>    ``(b) Posting on the Internet.--All audits that the 
Secretary receives from the State lead agency under section 2617(b)(4) 
shall be posted on the Internet website of the Health Resources and 
Services Administration.</DELETED>

<DELETED>``SEC. 2683. PUBLIC HEALTH EMERGENCY.</DELETED>

<DELETED>    ``(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).</DELETED>
<DELETED>    ``(b) Emergency Area and Emergency Period.--In this 
section:</DELETED>
        <DELETED>    ``(1) Emergency area.--The term `emergency area' 
        means a geographic area in which there exists--</DELETED>
                <DELETED>    ``(A) an emergency or disaster declared by 
                the President pursuant to the National Emergencies Act 
                of the Robert T. Stafford Disaster Relief and Emergency 
                Assistance Act; and</DELETED>
                <DELETED>    ``(B) a public health emergency declared 
                by the Secretary pursuant to section 319.</DELETED>
        <DELETED>    ``(2) Emergency period.--The term `emergency 
        period' means the period in which there exists--</DELETED>
                <DELETED>    ``(A) an emergency or disaster declared by 
                the President pursuant to the National Emergencies Act 
                of the Robert T. Stafford Disaster Relief and Emergency 
                Assistance Act; and</DELETED>
                <DELETED>    ``(B) a public health emergency declared 
                by the Secretary pursuant to section 319.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN 
              ACTIVITIES.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 2685. PRIVACY PROTECTIONS.</DELETED>

<DELETED>    ``The Secretary shall collect client-level data under this 
title in a manner that is consistent with the unique identifier as 
reported to the Director of the Centers for Disease Control and 
Prevention as of the date of enactment of this section.</DELETED>

<DELETED>``SEC. 2686. GAO REPORT.</DELETED>

<DELETED>    ``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, 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.</DELETED>

<DELETED>``SEC. 2687. DEFINITIONS.</DELETED>

<DELETED>    ``For purposes of this title:</DELETED>
        <DELETED>    ``(1) Counseling.--The term `counseling' means 
        such counseling provided by an individual trained to provide 
        such counseling.</DELETED>
        <DELETED>    ``(2) Family-centered care.--The term `family-
        centered care' means the system of services described in this 
        section 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.</DELETED>
        <DELETED>    ``(3) Families with hiv/aids.--The term `families 
        with HIV/AIDS' means families in which one or more members have 
        HIV/AIDS.</DELETED>
        <DELETED>    ``(4)  HIV.--The term `HIV' means infection with 
        the etiologic agent for acquired immune deficiency 
        syndrome.</DELETED>
        <DELETED>    ``(5) HIV/AIDS.--The term `HIV/AIDS' means 
        infection with the etiologic agent for acquired immune 
        deficiency syndrome, and includes any condition arising from 
        such syndrome.</DELETED>
        <DELETED>    ``(6) 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.</DELETED>
        <DELETED>    ``(7) 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.</DELETED>
        <DELETED>    ``(8) State.--The term `State', except as 
        otherwise specifically provided, means each of the 50 States, 
        the District of Columbia, the Virgin Islands, Guam, American 
        Samoa, the Commonwealth of the Northern Mariana Islands, Puerto 
        Rico, and the Republic of the Marshall Islands.</DELETED>
        <DELETED>    ``(9) Youth with hiv.--The term `youth with HIV' 
        means individuals who are 13 through 24 years old and who have 
        HIV/AIDS.''.</DELETED>

        <DELETED>TITLE VI--DEMONSTRATION AND TRAINING</DELETED>

<DELETED>SEC. 601. DEMONSTRATION AND TRAINING.</DELETED>

<DELETED>    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:</DELETED>

        <DELETED>``PART F--DEMONSTRATION AND TRAINING</DELETED>

          <DELETED>``Subpart I--Special Projects of National 
                         Significance</DELETED>

<DELETED>``SEC. 2691. SPECIAL PROJECTS OF NATIONAL 
              SIGNIFICANCE.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) quickly respond to emerging needs of 
        individuals receiving assistance under this title; 
        and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Grants.--The Secretary shall award grants under 
subsection (a) to entities eligible for funding under parts A, B, C, 
and D based on--</DELETED>
        <DELETED>    ``(1)(A) 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)(iii), 
        including funds to facilitate the purchase and enhance the 
        utilization of qualified health information technology 
        systems;</DELETED>
        <DELETED>    ``(B) demonstrated ability to create and maintain 
        a qualified health information technology system;</DELETED>
        <DELETED>    ``(C) the potential replicability of the proposed 
        activity in other similar localities or nationally;</DELETED>
        <DELETED>    ``(D) the demonstrated reliability of the proposed 
        qualified health information technology system across a variety 
        of providers, geographic regions, and clients; and</DELETED>
        <DELETED>    ``(E) the demonstrated ability to maintain a safe 
        and secure qualified health information system; or</DELETED>
        <DELETED>    ``(2) newly emerging needs of individuals 
        receiving assistance under this title.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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 comply with the privacy 
regulations promulgated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996.</DELETED>
<DELETED>    ``(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 from grantees funded under this part.''.</DELETED>

<DELETED>SEC. 602. AIDS EDUCATION AND TRAINING CENTERS.</DELETED>

<DELETED>    Section 2692(a)(2) of the Public Health Service Act (42 
U.S.C. 300ff-92(a)(2)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (A)--</DELETED>
                <DELETED>    (A) by inserting ``and Native Americans'' 
                after ``minority individuals''; and</DELETED>
                <DELETED>    (B) by striking ``and'' at the 
                end;</DELETED>
        <DELETED>    (2) in subparagraph (B), by striking the period 
        and inserting ``; and''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
                <DELETED>    ``(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.''.</DELETED>

<DELETED>SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE UNDER RYAN 
              WHITE COMPREHENSIVE AIDS RESOURCES EMERGENCY ACT OF 
              1990.</DELETED>

<DELETED>    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:</DELETED>

       <DELETED>``Subpart II--Minority AIDS Initiative</DELETED>

<DELETED>``SEC. 2693. MINORITY AIDS INITIATIVE.</DELETED>

<DELETED>    ``(a) In General.--There is authorized to be appropriated 
for the purpose of carrying out activities under this section to 
evaluate and address the disproportionate impact of HIV disease and 
disparities in access, treatment, care, and outcome on racial and 
ethnic minorities, including African Americans, Alaska Natives, 
Latinos, American Indians, Asian Americans, Native Hawaiians, and 
Pacific Islanders, $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 2010.</DELETED>
<DELETED>    ``(b) Certain Activities.--</DELETED>
        <DELETED>    ``(1) In general.--In carrying out the purpose 
        described in subsection (a), the Secretary shall provide for--
        </DELETED>
                <DELETED>    ``(A) emergency assistance under part 
                A;</DELETED>
                <DELETED>    ``(B) comprehensive care under part 
                B;</DELETED>
                <DELETED>    ``(C) early intervention services under 
                part C;</DELETED>
                <DELETED>    ``(D) services through demonstration 
                projects for HIV-related care; and</DELETED>
                <DELETED>    ``(E) activities through education and 
                training centers under section 2692.</DELETED>
        <DELETED>    ``(2) Allocations among activities.--Activities 
        under paragraph (1) shall be carried out by the Secretary in 
        accordance with the following:</DELETED>
                <DELETED>    ``(A) Of the amount appropriated for each 
                fiscal year under subsection (a), $43,800,000 for 
                fiscal year 2007, $45,400,000 for fiscal year 2008, 
                $47,100,000 for fiscal year 2009, $48,800,000 for 
                fiscal year 2010, and $50,700,000 for fiscal year 2010, 
                shall be used for competitive, supplemental grants to 
                improve HIV-related health outcomes to reduce existing 
                racial and ethnic health disparities.</DELETED>
                <DELETED>    ``(B) Of the amount appropriated for each 
                fiscal year under subsection (a), $7,000,000 for fiscal 
                year 2007, $7,300,000 for fiscal year 2008, $7,500,000 
                for fiscal year 2009, $7,800,000 for fiscal year 2010, 
                and $8,100,000 for fiscal year 2010, shall be used for 
                competitive, supplemental support educational 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.</DELETED>
                <DELETED>    ``(C) Of the amount appropriated for each 
                fiscal year under subsection (a), $53,400,000 for 
                fiscal year 2007, $55,400,000 for fiscal year 2008, 
                $57,400,000 for fiscal year 2009, $59,500,000 for 
                fiscal year 2010, and $61,800,000 for fiscal year 2010, 
                shall be used 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.</DELETED>
                <DELETED>    ``(D) Of the amount appropriated for each 
                fiscal year under subsection (a), $18,500,000 for each 
                of fiscal years 2007 through 2011 shall be used for 
                sustaining and expanding efforts to deliver 
                comprehensive, culturally and linguistically 
                appropriate research-based intervention and care 
                services for HIV disease to racial and ethnic minority 
                women, infants, children, and youth.</DELETED>
                <DELETED>    ``(E) Of the amount appropriated for each 
                fiscal year under subsection (a), $8,500,000 for each 
                of fiscal years 2007 through 2011 shall be used for 
                increasing the training capacity of centers to expand 
                the number of community-based racial and ethnic 
                minority health care professionals with treatment 
                expertise and knowledge about the most appropriate 
                standards of HIV disease-related treatments and medical 
                care for adults, adolescents, and children with HIV 
                disease.</DELETED>
<DELETED>    ``(e) 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).''.</DELETED>

<DELETED>SEC. 604. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    Section 2692(c) of the Public Health Service Act (42 
U.S.C. 300ff-92(c)) is amended to read as follows:</DELETED>
<DELETED>    ``(c) Authorization of Appropriations.--</DELETED>
        <DELETED>    ``(1) Schools; centers.--For the purpose of 
        awarding grants under subsection (a), there and authorized to 
        be appropriated $34,700,000 for each of fiscal years 2007 
        through 2011.</DELETED>
        <DELETED>    ``(2) Dental schools.--For the purpose of awarding 
        grants under paragraphs (2) and (3) of subsection (b), there 
        are authorized to be appropriated $13,000,000 for each of 
        fiscal years 2007 through 2011.''.</DELETED>

         <DELETED>TITLE VII--MISCELLANEOUS PROVISIONS</DELETED>

<DELETED>SEC. 701. HEPATITIS.</DELETED>

<DELETED>    (a) Provision of Certain Counseling Services.--Section 
2662 of the Public Health Service Act (42 U.S.C. 300ff-62) is amended--
</DELETED>
        <DELETED>    (1) in subsection (a)--</DELETED>
                <DELETED>    (A) in paragraph (1), by inserting ``, 
                hepatitis B, and hepatitis C'' before the 
                semicolon;</DELETED>
                <DELETED>    (B) in paragraph (2), by inserting ``and 
                testing for hepatitis B and hepatitis C'' before the 
                semicolon;</DELETED>
                <DELETED>    (C) in paragraph (6), by striking ``and'' 
                at the end;</DELETED>
                <DELETED>    (D) in paragraph (7), by striking the 
                period and inserting ``; and''; and</DELETED>
                <DELETED>    (E) by adding at the end the 
                following:</DELETED>
        <DELETED>    ``(8) 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</DELETED>
        <DELETED>    (2) in subsection (c)(3)(C)(i), by inserting ``, 
        hepatitis B, or hepatitis B'' after ``exposed to HIV'' each 
        place that such appears.</DELETED>
<DELETED>    (b) Use of Amounts.--Section 2667 of the Public Health 
Service Act (42 U.S.C. 300ff-67) is amended--</DELETED>
        <DELETED>    (1) in paragraph (2), by striking ``and'' at the 
        end;</DELETED>
        <DELETED>    (2) in paragraph (3), by striking the period and 
        inserting ``; and''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
        <DELETED>    ``(4) shall provide information on the 
        transmission and prevention of hepatitis A, B, and C and the 
        location of entities that provide hepatitis A and B 
        vaccinations to individuals with HIV.''.</DELETED>

<DELETED>SEC. 702. TECHNICAL PROVISIONS.</DELETED>

<DELETED>    Title XXVI of the Public Health Service Act (42 U.S.C. 
300ff et seq.) is amended by striking ``HIV disease'' each place that 
such appears and inserting ``HIV/AIDS''.</DELETED>

<DELETED>SEC. 703. REPEAL.</DELETED>

<DELETED>    Section 2677 of the Public Health Service Act (42 U.S.C. 
300ff-77) is repealed.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ryan White HIV/AIDS Treatment 
Modernization Act of 2006''.

              TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS

SEC. 101. ESTABLISHMENT AND GENERAL ELIGIBILITY.

    (a) In General.--Section 2601 of the Public Health Service Act (42 
U.S.C. 300ff-11) is amended by striking subsections (b) through (d) and 
inserting the following:
    ``(b) Continued Status as Eligible Area.--Notwithstanding any other 
provision of this section, a metropolitan area shall continue to be 
eligible to receive a grant under this part until such area, for three 
consecutive grant years, fails to meet the requirements of subsection 
(a).''.
    (b) Definition.--Section 2607(2) of the Public Health Service Act 
(42 U.S.C. 300ff-17(2)) is amended by adding at the end the following: 
``For purposes of determining eligibility under this part, the 
boundaries of each metropolitan area shall be the boundaries that were 
in effect for each such area for fiscal year 1994.''.

SEC. 102. LIVING CASES OF HIV/AIDS.

    (a) In General.--Section 2601(a) of the Public Health Service Act 
(42 U.S.C. 300ff-11(a)) is amended by striking ``for which there'' and 
all that follows through ``available'' and inserting ``for which there 
is reported to and confirmed by the Director of the Centers for Disease 
Control and Prevention a cumulative total of more than 2,000 cases of 
AIDS for the most recent period of 5 calendar years for which such data 
are available''.
    (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 ``cases of acquired 
        immune deficiency syndrome'' and inserting ``cases of HIV/AIDS 
        (reported to and confirmed by the Director of the Centers for 
        Disease Control and Prevention)'';
            (2) by striking subparagraphs (C) and (D) and inserting the 
        following:
                    ``(C) Living cases of hiv/aids.--
                            ``(i) In general.--Except as provided for 
                        in clauses (ii) and (iii), the amount 
                        determined in this subparagraph is the number 
                        of living cases of HIV/AIDS (reported to and 
                        confirmed by the Director of the Centers for 
                        Disease Control and Prevention) through 
                        December 31 of the most recent calendar year.
                            ``(ii) Fiscal years 2007 through 2010.--For 
                        each of fiscal years 2007 through 2010, the 
                        Secretary may use the proxy number for the 
                        number of HIV cases described in clause (iii) 
                        if--
                                    ``(I) the State involved--
                                            ``(aa) is reporting, or the 
                                        State will by October 1, 2006 
                                        have submitted a transition 
                                        plan for reporting, accurate 
                                        and reliable HIV cases to the 
                                        Director of the Centers for 
                                        Disease Control and Prevention; 
                                        or
                                            ``(bb) not later than 
                                        October 1, 2006, make all 
                                        necessary statutory changes to 
                                        allow for the collection of HIV 
                                        data certified by the Director 
                                        of the Centers for Disease 
                                        Control and Prevention;
                                    ``(II) the State involved will by 
                                April 1, 2008, begin reporting accurate 
                                and reliable HIV cases, as determined 
                                by the Director of the Centers for 
                                Disease Control and Prevention; and
                                    ``(III) the Director of the Centers 
                                for Disease Control and Prevention has 
                                determined that such State does not 
                                have an established HIV surveillance 
                                system.
                            ``(iii) Amount determined.--With respect to 
                        each of fiscal years 2007 through 2010, the 
                        amount determined under this subparagraph shall 
                        be the lesser of--
                                    ``(I) the product of 0.9 and the 
                                number of living AIDS cases in the area 
                                involved; or
                                    ``(II) an amount equal to 110 
                                percent of the funding level for the 
                                previous fiscal year, taking into 
                                account the shift of the formula pool 
                                from 0.5 to 0.67 in fiscal year 
                                2006.''; and
            (3) by redesignating subparagraph (E) as subparagraph (D).
    (c) Application.--Section 2604(b)(4)(A) of the Public Health 
Service Act (42 U.S.C. 300ff-14(b)(4)(A)) is amended--
            (1) by striking ``acquired immune deficiency syndrome'' and 
        inserting ``HIV/AIDS''; and
            (2) by striking ``such syndrome'' and inserting ``HIV/
        AIDS''.
    (d) Coordination.--Section 2605(b) of the Public Health Service Act 
(42 U.S.C. 300ff-15(b)) is amended--
            (1) in paragraph (3), by striking ``and'' at the end;
            (2) in paragraph (4), by striking the period and inserting 
        a semicolon; and
            (3) by adding at the end the following:
            ``(5) the manner in which the expected expenditures under 
        the grant 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 under the grant and how 
        those expenditures will improve overall client outcomes, as 
        described under the State plan under section 2617(b), or 
        through additional outcomes measures.''.

SEC. 103. TYPE AND DISTRIBUTION OF GRANTS.

    (a) Distribution of Funds.--Section 2603(a)(2) of the Public Health 
Service Act (42 U.S.C. 300ff-13(a)(2)) is amended by striking ``50 
percent'' and inserting ``66\2/3\ percent''.
    (b) Emergency Grants.--Section 2603(a)(3)(E) of the Public Health 
Service Act (42 U.S.C. 300ff-13(a)(3)(E)) is amended to read as 
follows:
                    ``(E) Unexpended funds.--
                            ``(i) In general.--An eligible area that 
                        has unobligated funds for a fiscal year under a 
                        grant under this part shall--
                                    ``(I) return such funds to the 
                                Secretary to be applied as provided for 
                                in subsection (b); or
                                    ``(II) submit an application to the 
                                Secretary for the use of such funds in 
                                the succeeding fiscal year that 
                                includes a description of the manner in 
                                which the area intends to use such 
                                funds.
                            ``(ii) Carryover.--With respect to an 
                        application received under clause (i)(II), the 
                        Secretary shall determine whether the area 
                        involved may carryover any unobligated funds 
                        for use under this part in the succeeding 
                        fiscal year or whether such amounts shall be 
                        returned to the Secretary for use under 
                        subsection (b). Notice shall be provided to the 
                        area of such determination.
                            ``(iii) Failure to expend funds.--Amounts 
                        carried over by an eligible area under this 
                        subparagraph that are not expended in the 
                        succeeding fiscal year shall be returned to the 
                        Secretary for use under subsection (b).
                            ``(iv) Consideration in making grants.--The 
                        Secretary may, in determining the amount of a 
                        grant for a fiscal year under this paragraph, 
                        adjust the grant amount to reflect the amount 
                        of unexpended and uncanceled grant funds 
                        remaining at the end of the fiscal year 
                        preceding the year for which the grant 
                        determination is to be made. The amount of any 
                        such unexpended funds shall be determined using 
                        the financial status report of the grantee.''.
    (c) Hold Harmless.--Section 2603(a)(4) of the Public Health Service 
Act (42 U.S.C. 300ff-13(a)(4)) is amended to read as follows:
            ``(4) Increases in grant.--
                    ``(A) In general.--For eligible areas receiving 
                grants under this section in fiscal year 2007, the 
                Secretary shall increase the amount of the grant made 
                pursuant to paragraph (2) for the area to ensure that--
                            ``(i) for fiscal year 2007, the grant is 
                        not less than 90 percent of the amount of the 
                        grant made for the eligible area pursuant to 
                        such paragraph for the base year;
                            ``(ii) for fiscal year 2008, the grant is 
                        not less than 85 percent of the amount of such 
                        base year grant; and
                            ``(iii) for fiscal year 2009, the grant is 
                        not less than 80 percent of the amount of the 
                        base year grant.
                    ``(B) Base year.--With respect to grants made 
                pursuant to paragraph (2) for an eligible area, the 
                base year shall be fiscal year 2006.''.

SEC. 104. CORE MEDICAL SERVICES.

    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 Core Medical Services.--
            ``(1) In general.--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 core medical 
        services, except that the Secretary shall waive the application 
        of this subsection with respect to a grantee if the Secretary 
        determines that, within the service area of the grantee--
                    ``(A) there is no waiting lists for AIDS Drug 
                Assistance Program services; and
                    ``(B) core medical services are available to all 
                individuals infected with HIV/AIDS.
            ``(2) 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 
        diseases of the individual) means the following services:
                    ``(A) Outpatient and ambulatory health services.
                    ``(B) AIDS Drug Assistance Program treatments.
                    ``(C) AIDS pharmaceutical assistance.
                    ``(D) Oral health care.
                    ``(E) Early intervention services.
                    ``(F) Health insurance premium and cost sharing 
                assistance for low-income individuals.
                    ``(G) Home health care.
                    ``(H) Hospice services.
                    ``(I) Home and community-based health services as 
                defined under section 2614(c), except homemaker 
                services.
                    ``(J) Mental health services.
                    ``(K) Substance abuse outpatient care.
                    ``(L) Medical case management, including treatment 
                adherence services.
            ``(3) Support services.--Notwithstanding any other 
        provision of law, and subject to paragraph (1), a grantee under 
        this part, subject to the approval of the Secretary, may 
        provide support services (such as respite care for individuals 
        with HIV/AIDS, outreach services, medical transportation, 
        nutritional counseling, linguistic services, and referral for 
        health care and support services for individuals with HIV/AIDS) 
        needed to achieve medical outcomes which are related to the 
        medical outcomes for an individual infected with HIV and 
        approved by the Secretary.
            ``(4) 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.
            ``(5) Unexpended funds.--Any amounts required to be 
        expended for core medical services or support services under 
        this subsection that remain unobligated at the end of the 
        fiscal year in which the funds were awarded shall be remitted 
        to the Secretary for reallocation under section 2603(b).''.

SEC. 105. SUPPLEMENTAL GRANTS.

    Section 2603(b) of the Public Health Service Act (42 U.S.C. 300ff-
13(b)) is amended--
            (1) by striking ``severe need'' each place that such 
        appears and inserting ``demonstrated need'';
            (2) in paragraph (1)--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``Not later than'' and all that follows 
                through ``the Secretary shall'' and insert ``The 
                Secretary shall'';
                    (B) by striking subparagraph (F) and inserting the 
                following:
                    ``(F) demonstrate the inclusiveness of affected 
                communities and individuals with HIV/AIDS;'';
                    (C) in subparagraph (G), by striking the period and 
                inserting ``; and''; and
                    (D) by adding at the end the following:
                    ``(H) demonstrate the ability of the applicant to 
                expend funds efficiently by not having any unexpended 
                funds reallocated under section 2603(a)(3)(E).'';
            (3) in paragraph (2)--
                    (A) by striking subparagraph (B) and inserting the 
                following:
                    ``(B) Demonstrated need.--In determining 
                demonstrated need for purposes of subparagraph (A), the 
                Secretary shall consider relevant factors that impact 
                the need for supplemental financial assistance, 
                including--
                            ``(i) the unmet need for such services, as 
                        determined under section 2602(b)(4) or other 
                        community input process as defined under 
                        section 2609A(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 infections, 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; or
                            ``(x) the impact of a precipitous decline 
                        in the amount received under this subpart to an 
                        increase in unmet need for such services.''; 
                        and
                    (B) by striking subparagraphs (C) and (D).

SEC. 106. ADMINISTRATIVE COSTS.

    Section 2604(f) of the Public Health Service Act (42 U.S.C. 300ff-
14(f)) is amended--
            (1) in paragraph (1), by striking ``5 percent'' and 
        inserting ``10 percent''; and
            (2) in paragraph (2)(B), by inserting ``the activities 
        carried out by HIV health services planning council as 
        established under section 2602(b),'' after ``including''.

SEC. 107. AUDITS.

    Section 2605(a) of the Public Health Service Act (42 U.S.C. 300ff-
15(a)) is amended--
            (1) in paragraph (8), by striking ``and'' at the end;
            (2) in paragraph (9), by striking the period and inserting 
        ``; and''; and
            (3) 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 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.''.

SEC. 108. 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 ``, Native Americans, 
individuals co-infected with hepatitis B or C'' after ``disease''.

SEC. 109. 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.

SEC. 110. TRANSITIONAL GRANTS FOR OTHER AREAS.

    (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'';

            (2) by redesignating sections 2606 and 2607 as sections 
        2610 and 2610A, respectively; and
            (3) by adding at the end the following:

                   ``Subpart II--Transitional Grants

``SEC. 2609. ESTABLISHMENT.

    ``(a) Eligible Areas.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, shall, subject to subsection (b), make grants 
        in accordance with this subpart for the purpose of assisting in 
        the provision of the services specified in section 2604 in any 
        metropolitan area--
                    ``(A) 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 less than 2,000, cases of acquired immune 
                deficiency syndrome for the most recent period of 5 
                calendar years for which such data are available; and
                    ``(B) 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 less than 1,000, cases of acquired immune 
                deficiency syndrome for the most recent period of 5 
                calendar years for which such data are available.
            ``(2) Additional eligible areas.--With respect to fiscal 
        year 2007, a metropolitan area that received funding under this 
        part for fiscal year 2006 but which does not meet the 
        eligibility threshold described in paragraph (1)(A) for fiscal 
        year 2007 shall be deemed to be eligible under such paragraph 
        (1)(A).
    ``(b) Continued Status as Eligible Area.--Notwithstanding any other 
provision of this section, a metropolitan area shall continue to be 
eligible to receive a grant under this section until such area, for 
three consecutive grant years, fails to meet the applicable requirement 
of subparagraph (A) or (B) of subsection (a)(1) concerning the number 
of living cases of AIDS over the most recent 5-year period.

``SEC. 2609A. APPLICATION OF OTHER PROVISIONS.

    ``(a) Administration.--
            ``(1) In general.--The provisions of section 2602 shall 
        apply to areas that receive a grant under this subpart, except 
        that the chief elected official may elect not to comply with 
        the provisions of subsection (b), so long as the official 
        provides documentation to the Secretary that details the 
        process used to obtain community input (particularly from those 
        inflected with HIV) for the design and implementation of 
        activities related to such grant.
            ``(2) Exception.--The exception provided for in paragraph 
        (1) shall not apply in fiscal years 2007 through 2009 to areas 
        that receive funding under this part.
    ``(b) Distribution.--The provisions of section 2603 shall apply for 
purposes of awarding grants under this subpart, except that--
            ``(1) with respect to areas described in section 
        2609(a)(1)(A)--
                    ``(A) 66\2/3\ percent of the amounts appropriated 
                under section 2609B(1) for each fiscal year shall be 
                allocated to such areas as provided for in section 
                2603(a); and
                    ``(B) 33\1/3\ percent of the amounts appropriated 
                under section 2609B(1) for each fiscal year shall be 
                allocated to such areas as provided for in section 
                2603(b); and
            ``(2) with respect to areas described in section 
        2609(a)(1)(B), 100 percent of the amounts appropriated under 
        section 2609B(2) for each fiscal year shall be allocated to 
        such areas as provided for in section 2603(a).
    ``(c) Hold Harmless.--Paragraph (4) of section 2603(a) shall not 
apply to an area for purposes of this subpart.
    ``(d) Use of Amounts.--Amounts provided to an area under a grant 
under this part shall be used by such entity as provided for in section 
2604.
    ``(e) Application.--To be eligible to receive a grant under this 
subpart, an area shall submit to the Secretary an application that 
meets the requirements of section 2605.
    ``(f) Technical Assistance and Definitions.--The provisions of 
sections 2606 and 2707 shall apply for purposes of this subpart, except 
that with respect to the definition of metropolitan area in section 
2607(2), such term shall be applied so that for purposes of determining 
eligible areas, the Secretary shall use the boundaries of a respective 
area that were used when the area involved initially receive funding 
under this part.

``SEC. 2609B. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated to carry out this 
subpart--
            ``(1) with respect to areas described in section 
        2609(a)(1)(A), $123,300,000 for fiscal year 2007, $127,900,000 
        for fiscal year 2008, $132,600,000 for fiscal year 2009, 
        $137,500,000 for fiscal year 2010, and $142,600,000 for fiscal 
        year 2011; and
            ``(2) with respect to areas described in section 
        2609(a)(1)(B), $5,000,000 for each of the fiscal years 2007 
        through 2011.

                  ``Subpart III--General Provisions''.

    (b) Repeal.--Section 2620 of the Public Health Service Act (42 
U.S.C. 300ff-30) is repealed.

SEC. 111. AUTHORIZATION OF APPROPRIATIONS.

    Subpart I of part A of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-11) is amended by adding at the end the following:

``SEC. 2606. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purpose of carrying put this subpart, there are 
authorized to be appropriated $418,600,000 for fiscal year 2007, 
$434,100,000 for fiscal year 2008, $450,100,000 for fiscal year 2009, 
$466,800,000 for fiscal year 2010, and $484,100,000 for fiscal year 
2011.''.

                         TITLE II--CARE GRANTS

SEC. 201. LIVING CASES OF HIV/AIDS.

    (a) Priority.--Section 2611(b)(1) of the Public Health Service Act 
(42 U.S.C. 300ff-21(b)(1)) is amended--
            (1) by striking ``acquired immune deficiency syndrome'' and 
        inserting ``HIV/AIDS''; and
            (2) by striking ``such syndrome'' and inserting ``HIV/
        AIDS''.
    (b) Application.--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''.
    (c) 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)(i)--
                    (A) in subclause (I), by striking ``cases of 
                acquired immune deficiency syndrome, as determined 
                under paragraph (2)(D)'' and inserting ``living cases 
                of AIDS (reported to and confirmed by the Director of 
                the Centers for Disease Control and Prevention)''; and
                    (B) in subclause (II)--
                            (i) by striking ``cases of acquired immune 
                        deficiency syndrome, as determined under 
                        paragraph (2)(D)'' and inserting ``living cases 
                        of AIDS (reported to and confirmed by the 
                        Director of the Centers for Disease Control and 
                        Prevention)''; and
                            (ii) by inserting ``and'' after the 
                        semicolon; and
            (2) in paragraph (2)--
                    (A) in subparagraph (B), by striking ``estimated 
                number of living cases of acquired immune deficiency 
                syndrome'' and inserting ``number of living cases of 
                HIV/AIDS'';
                    (B) in subparagraph (C)--
                            (i) by striking ``estimated'' each place 
                        that such term appears; and
                            (ii) by striking ``acquired immune 
                        deficiency syndrome'' each place that such 
                        appears and inserting ``HIV/AIDS''; and
                    (C) by striking subparagraph (D) and inserting the 
                following:
                    ``(F) Living cases of hiv/aids.--
                            ``(i) In general.--Except as provided for 
                        in clause (ii) and (iii), the amount determined 
                        in this subparagraph is the number of living 
                        cases of HIV/AIDS (reported to and confirmed by 
                        the Director of the Centers for Disease Control 
                        and Prevention) through December 31 of the most 
                        recent calendar year involved.
                            ``(ii) Fiscal years 2007 through 2010.--For 
                        each of fiscal years 2007 through 2010, the 
                        Secretary may use the proxy number for the 
                        number of HIV cases described in clause (iii) 
                        if--
                                    ``(I) the State involved--
                                            ``(aa) is reporting, or the 
                                        State will by October 1, 2006 
                                        have submitted a transition 
                                        plan for reporting, accurate 
                                        and reliable HIV cases to the 
                                        Director of the Centers for 
                                        Disease Control and Prevention; 
                                        or
                                            ``(bb) not later than 
                                        October 1, 2006, make all 
                                        necessary statutory changes to 
                                        allow for the collection of HIV 
                                        data certified by the Director 
                                        of the Centers for Disease 
                                        Control and Prevention;
                                    ``(II) the State involved will by 
                                April 1, 2008, begin reporting accurate 
                                and reliable HIV cases, as determined 
                                by the Director of the Centers for 
                                Disease Control and Prevention; and
                                    ``(III) the Director of the Centers 
                                for Disease Control and Prevention has 
                                determined that such State does not 
                                have an established HIV surveillance 
                                system.
                            ``(iii) Amount determined.--With respect to 
                        each of fiscal years 2007 through 2010, the 
                        amount determined under this subparagraph shall 
                        be the lesser of--
                                    ``(I) the product of 0.9 and the 
                                number of living AIDS cases in the area 
                                involved; or
                                    ``(II) an amount equal to 110 
                                percent of the funding level for the 
                                previous fiscal year.''.

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 those treatments contained on the list of 
        core AIDS Drug Assistance Program antiretroviral medications 
        developed by the Secretary based on Public Health Service 
        guidelines, are the minimum required treatments to be included 
        under the program established under this section;''; and
            (2) in subsection (d), by adding at the end the following: 
        ``The Secretary, in consultation with the Public Health 
        Service, shall develop and maintain a list of classes of core 
        AIDS Drug Assistance Program antiretroviral medications that 
        shall be based upon those medications included in the 
        Department of Health and Human Service's Public Health Service 
        HIV/AIDS Clinical Practice Guidelines for use of HIV/AIDS 
        Drugs, drugs needed to manage symptoms associated with HIV 
        infection.''.
    (b) State Requirements.--Subclauses (I) through (III) of section 
2618(a)(2)(I)(ii) of the Public Health Service Act (42 U.S.C. 300ff-
28(a)(2)(I)(ii) (I)-(III)) are amended to read as follows:
                                            ``(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 (as described in 
                                        section 2616(b)), 
                                        pharmaceutical therapeutics 
                                        described under sections 
                                        2616(a) and 2616(c).
                                            ``(II) Eligible states.--
                                        For purposes of subclause (I), 
                                        a State shall be an eligible 
                                        State if the State did not have 
                                        unexpended funds subject to 
                                        reallocation under section 
                                        2618(d) and, in accordance with 
                                        criteria established by the 
                                        Secretary, demonstrates a 
                                        severe need for a grant under 
                                        this clause. In developing such 
                                        criteria, 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.''.
    (c) Increase in ADAP Set-Aside.--Section 2618(a)(2)(I)(ii)(V) of 
the Public Health Service Act (42 U.S.C. 300ff-28(a)(2)(I)(ii)(V)) is 
amended by striking ``3'' and inserting ``5''.
    (d) Drug Rebate Program.--Section 2616 of the Public Health Service 
Act (42 U.S.C. 300ff-26) is amended by adding at the end the following:
    ``(f) Drug Rebate Program.--A State shall ensure that any drug 
rebates received on drugs purchased from funds provided under this 
section are applied to activities supported under this title, with a 
preference for activities described under this section.''.

SEC. 203. COORDINATION.

    Section 2617(b) of the Public Health Service Act (42 U.S.C. 300ff-
27(b)) is amended--
            (1) by redesignating paragraphs (4) through (6) as 
        paragraphs (5) through (7), respectively;
            (2) 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 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.'';
            (3) in paragraph (5) (as so redesignated)--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``under this part'' and inserting ``under any 
                provision of this title'';
                    (B) in subparagraph (E), by striking ``and'' at the 
                end; and
                    (C) 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''.

SEC. 204. DISTRIBUTION OF FUNDS.

    (a) In General.--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) in clause (i), by striking ``and (I)'' and 
                inserting ``, (I), and (J)''; and
                    (B) in clause (ii)--
                            (i) in subclause (I)--
                                    (I) by striking ``0.8'' and 
                                inserting ``0.75''; and
                                    (II) by striking ``and'' at the 
                                end;
                            (ii) in subclause (II), by striking the 
                        period and inserting ``; and''; and
                            (iii) by adding at the end the following:
                                    ``(III) the product of 0.05 and the 
                                ratio of the locality distribution 
                                factor (as determined under 
                                subparagraph (D)) to the sum of the 
                                respective State distribution factors 
                                for all States and territories.'';
            (2) in subparagraph (C)(ii), by striking ``(as determined 
        under part A)'' and inserting ``under subpart I of part A and 
        an eligible area under section 2609(a)(1)(A)'';
            (3) by inserting after subparagraph (C), the following:
                    ``(D) Locality distribution factor.--For purposes 
                of subparagraph (A)(ii)(III), the term `locality 
                distribution factor' means an amount equal to the sum 
                of--
                            ``(i) the number of living cases of HIV/
                        AIDS in the State or territory involved, as 
                        determined under subparagraph (F); less
                            ``(ii) the number of living cases of HIV/
                        AIDS in such State or territory that are within 
                        an eligible area (as determined under subpart I 
                        of part A and section 2609(a)(1)(A)).'';
            (4) by striking subparagraph (E) and inserting the 
        following:
                    ``(E) 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 (D) 
                        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, 
                        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, and 
                        the provisions of subparagraphs (A) through (D) 
                        shall not apply, and the Secretary shall use 
                        the severity of need index (as defined in 
                        clause (iv)) for the formula allocations for 
                        fiscal year 2013, 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) 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).
                                    ``(III) Information regarding the 
                                process by which the Secretary received 
                                community input regarding the 
                                application of the severity of need 
                                index.
                                    ``(IV) 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.''.
            (5) by striking subparagraph (G), and inserting the 
        following:
                    ``(G) Unexpended funds.--
                            ``(i) In general.--A State that has 
                        unobligated funds for a fiscal year under a 
                        grant under this part shall--
                                    ``(I) return such funds to the 
                                Secretary to be applied as provided for 
                                in section 2620; or
                                    ``(II) submit an application to the 
                                Secretary for the use of such funds in 
                                the succeeding fiscal year that 
                                includes a description of the manner in 
                                which the State intends to use such 
                                funds.
                            ``(ii) Carryover.--With respect to an 
                        application received under clause (i)(II), the 
                        Secretary shall determine whether the State 
                        involved may carryover any unobligated funds 
                        for use under this part in the succeeding 
                        fiscal year or whether such amounts shall be 
                        returned to the Secretary for use under section 
                        2620. Notice shall be provided to the area of 
                        such determination.
                            ``(iii) Failure to expend funds.--Amounts 
                        carried over by a State under this subparagraph 
                        that are not expended in the succeeding fiscal 
                        year shall be returned to the Secretary for use 
                        under section 2610.
                            ``(iv) Consideration in making grants.--The 
                        Secretary may, in determining the amount of a 
                        grant for a fiscal year under this paragraph, 
                        adjust the grant amount to reflect the amount 
                        of unexpended and uncanceled grant funds 
                        remaining at the end of the fiscal year 
                        preceding the year for which the grant 
                        determination is to be made. The amount of any 
                        such unexpended funds shall be determined using 
                        the financial status report of the grantee.'';
            (6) by striking subparagraph (H); and
            (7) in subparagraph (I)(ii), by striking subclause (VI) and 
        inserting the following:
                                    ``(VI) Increases in grant.--
                                            ``(aa) In general.--For 
                                        eligible areas receiving grants 
                                        under this section in fiscal 
                                        year 2007, the Secretary shall 
                                        increase the amount of the 
                                        grant made pursuant to 
                                        paragraph (2) for the State to 
                                        ensure that--

                                                    ``(AA) for fiscal 
                                                year 2007, the grant is 
                                                not less than 90 
                                                percent of the amount 
                                                of the grant made for 
                                                the State under section 
                                                2620 and section 
                                                2618(a) for the base 
                                                year;

                                                    ``(BB) for fiscal 
                                                year 2008, the grant is 
                                                not less than 85 
                                                percent of the amount 
                                                of such base year 
                                                grant; and

                                                    ``(CC) for fiscal 
                                                year 2009, the grant is 
                                                not less than 80 
                                                percent of the amount 
                                                of the base year grant.

                                            ``(bb) Base year.--With 
                                        respect to grants made pursuant 
                                        to paragraph (2) for an State, 
                                        the base year shall be fiscal 
                                        year 2006.''.
    (b) Reallocation.--Section 2618(d) of the Public Health Service Act 
(42 U.S.C. 300ff-28(d)) is amended by striking ``in proportion to the 
original grants made to such States'' and insert ``reallocated pursuant 
to section 2620''.

SEC. 205. CORE MEDICAL SERVICES.

    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 Core Medical Services.--
            ``(1) In general.--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 core medical 
        services, except that the Secretary shall waive the application 
        of this subsection with respect to a grantee if the Secretary 
        determines that, within the service area of the grantee--
                    ``(A) there is no waiting lists for AIDS Drug 
                Assistance Program services; and
                    ``(B) core medical services are available to all 
                individuals infected with HIV/AIDS.
            ``(2) 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 
        diseases of the individual) means the following services:
                    ``(A) Outpatient and ambulatory health services.
                    ``(B) AIDS Drug Assistance Program treatments.
                    ``(C) AIDS pharmaceutical assistance.
                    ``(D) Oral health care.
                    ``(E) Early intervention services.
                    ``(F) Health insurance premium and cost sharing 
                assistance for low-income individuals.
                    ``(G) Home health care.
                    ``(H) Hospice services.
                    ``(I) Home and community-based health services as 
                defined under section 2614(c), except homemaker 
                services.
                    ``(J) Mental health services.
                    ``(K) Substance abuse outpatient care.
                    ``(L) Medical case management, including treatment 
                adherence services.
            ``(3) Support services.--Notwithstanding any other 
        provision of law, and subject to paragraph (1), a grantee under 
        this part, subject to the approval of the Secretary, may 
        provide support services (such as respite care for individuals 
        with HIV/AIDS, outreach services, medical transportation, 
        nutritional counseling, linguistic services, and referral for 
        health care and support services for individuals with HIV/AIDS) 
        needed to achieve medical outcomes which are related to the 
        medical outcomes for an individual infected with HIV and 
        approved by the Secretary.
            ``(4) 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.
            ``(5) Unexpended funds.--Any amounts required to be 
        expended for core medical services or support services under 
        this subsection that remain unobligated at the end of the 
        fiscal year in which the funds were awarded shall be remitted 
        to the Secretary for reallocation under section 2620.''.

SEC. 206. SUPPLEMENTAL GRANTS.

    (a) In General.--Section 2620 of the Public Health Service Act (42 
U.S.C. 300ff-30) is amended to read as follows:

``SEC. 2620. SUPPLEMENTAL GRANTS.

    ``(a) In General.--The Secretary shall utilize amounts appropriated 
under section 2622 for a fiscal year and made available in accordance 
with subsection (c) to award grants to States whose applications under 
section 2617 demonstrate a need in the State for supplemental financial 
assistance to combat the HIV epidemic and that have not had unexpended 
funds subject to the reallocation under section 2618(a)(2)(G).
    ``(b) Demonstrated Need.--In determining demonstrated need for 
purposes of subsection (a), the Secretary shall consider relevant 
factors that impact the need for supplemental financial assistance, 
including--
            ``(1) the unmet need for such services, as determined under 
        section 2602(b)(4) or other community input process as defined 
        under section 2609A(a);
            ``(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 infections, 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; or
            ``(10) the impact of a precipitous decline in the amount 
        received under this subpart to an increase in unmet need for 
        such services.
    ``(c) Amount and Trigger of Funding.--
            ``(1) Amount.--For each fiscal year beginning with the 
        trigger year described in paragraph (2), the Secretary shall 
        make available for purposes of awarding grants under this 
        section, \1/3\ of the sum of--
                    ``(A) the amount appropriated under section 2622 
                for such fiscal year; less
                    ``(B) the amount made available to carry out 
                section 2618(a)(2)(I) and section 2621 for such fiscal 
                year.
            ``(2) Trigger year.--This section shall be effective only 
        for fiscal years beginning in the first fiscal year in which 
        the amount appropriated under section 2621, excluding any 
        amounts made available to carry out section 2618(a)(2)(I) and 
        section 2621 for such fiscal year, exceeds the amount 
        appropriated under section 2677(b) (as such section existed on 
        the day before the date of enactment of the Ryan White HIV/AIDS 
        Treatment Modernization Act of 2006) for fiscal year 2006, 
        excluding any amount made available to carry out section 
        2618(a)(2)(I) for fiscal year 2006.''.
    (b) Conforming Amendments.--Section 2618 of the Public Health 
Service Act (42 U.S.C. 300ff-28) is amended--
            (1) in subsection (a)(1), by striking ``section 2677'' and 
        inserting ``section 2622 and to the provisions of section 
        2620''; and
            (2) in subsection (c)(1), by inserting ``, except for 
        grants awarded under section 2620,'' after ``under this part''.

SEC. 207. REDUCTION OF THE ADAP WAITING LIST.

    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 adding at the end the 
following:

``SEC. 2621. REDUCTION OF THE ADAP WAITING LIST.

    ``(a) In General.--If the Secretary determines that there is 
additional need for States to have funds to provide eligible 
individuals (as described in section 2616(b)) appropriate access to 
pharmaceutical therapies, the Secretary may make supplemental grants to 
States described in subsection (b) to enable such States to purchase 
and distribute to eligible individuals pharmaceutical therapies as 
described in sections 2616(a) and 2616(e).
    ``(b) Eligible States.--For purposes of subsection (a), a State is 
an eligible State if the State did not have unexpended funds subject to 
reallocation under section 2618(d), and, in accordance with criteria 
established by the Secretary, demonstrates a need for a grant under 
such subsection. In developing such criteria, the Secretary shall 
consider eligibility standards, formulary composition, the number of 
eligible individuals to whom the State is unable to provide 
therapeutics described in section 2616(a), and unanticipated increases 
in the number of eligible individuals.
    ``(c) State Requirements.--The Secretary may not make a grant to a 
State under this section unless the State involved agrees that the 
State will make available (directly or through donations from public or 
private entities) non-Federal contributions toward the activities to be 
carried out under the grant in an amount equal to $1 for each $4 of 
Federal funds provided under the grant, except that the Secretary may 
waive this subsection if the State has otherwise fully complied with 
section 2617(d) with respect to the grant year involved.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $40,000,000 for fiscal year 
2007.''.

SEC. 208. NATIVE AMERICAN REPRESENTATION.

    Section 2617(b)(6) of the Public Health Service Act (42 U.S.C. 
300ff-27(b)(5)), as so redesignated, is amended by inserting ``Native 
Americans within the State,'' before ``representatives of grantees''.

SEC. 209. PAYER OF LAST RESORT.

    Section 2617(b)(7)(F)(ii) of the Public Health Service Act (42 
U.S.C. 300ff-27(b)(6))is amended by inserting ``(except for a program 
administered by or providing the services of the Indian Health 
Services)'' before the semicolon.

SEC. 210. HEPATITIS.

    Section 2614(a)(3) of the Public Health Service Act (42 U.S.C. 
300ff-24(a)(3)) is amended by inserting ``, including speciality care 
(including vaccinations) for hepatitis coinfection,'' after ``health 
services''.

SEC. 211. AUTHORIZATION OF APPROPRIATIONS.

    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. 2622. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purpose of carrying put this subpart, there are 
authorized to be appropriated $1,190,400,000 for fiscal year 2007, 
$1,193,000,000 for fiscal year 2008, $1,237,100,000 for fiscal year 
2009, $1,282,900,000 for fiscal year 2010, and $1,330,300,000 for 
fiscal year 2011.''.

                 TITLE III--EARLY INTERVENTION SERVICES

SEC. 301. CATEGORICAL GRANTS.

    (a) Establishment of Program.--Section 2651(b) of the Public Health 
Service Act (42 U.S.C. 300ff-51(b)) is amended--
            (1) in paragraph (2)(D), by striking ``the disease'' and 
        inserting ``HIV/AIDS'';
            (2) in paragraph (4)(B)--
                    (A) in clause (i), by striking ``paragraphs (1)'' 
                and all that follows through ``2652(a)'' and inserting 
                ``subparagraphs (A), (D), (E), and (F) of section 
                12652(a)(1)''; and
                    (B) in clause (ii), by striking ``paragraphs (3) 
                and (4) of section 2652(a)'' and inserting 
                ``subparagraphs (B) and (C) of section 2652(a)(1)''; 
                and
            (3) in paragraph (5)(A), by striking ``the disease'' each 
        place that such appears and inserting ``HIV/AIDS''.
    (b) 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) nonprofit private entities that provide 
                comprehensive primary care services to populations at 
                risk of HIV/AIDS.
            ``(2) Underserved populations.--Entities described in 
        paragraph (1) shall serve underserved populations which may 
        include minority populations and Native American populations, 
        ex-offenders, individuals co-infected with HIV and hepatitis B 
        or C, low-income populations, inner city populations, and rural 
        populations.''.
    (c) 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 coinfected with HIV/AIDS and hepatitis B or 
                C''; and
            (2) in subsection (d)(2), by striking ``special 
        consideration'' and inserting ``preference''.
    (d) 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''.
    (e) 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, $234,800,000 for fiscal year 2010, 
and $252,800,000 for fiscal year 2011''.

SEC. 302. GENERAL PROVISIONS.

    (a) Counseling Services.--Section 2662(a) of the Public Health 
Service Act (42 U.S.C. 300ff-62(a)) is amended by striking ``the 
disease'' and inserting ``HIV/AIDS''.
    (b) 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''.
    (c) 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) or through additional outcome measures;'';
            (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 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.''.

SEC. 303. CORE MEDICAL SERVICES.

    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. 2688. REQUIRED FUNDING FOR CORE MEDICAL SERVICES.

    ``(a) In General.--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 core medical services, except that 
the Secretary shall waive the application of this section with respect 
to a grantee if the Secretary determines that, within the service area 
of the grantee--
            ``(1) there is no waiting lists for AIDS Drug Assistance 
        Program services; and
            ``(2) core medical services are available to all 
        individuals infected with HIV/AIDS.
    ``(b) Core Medical Services.--For purposes of this section, the 
term `core medical services' with respect to an individual infected 
with HIV/AIDS (including the co-occurring diseases of the individual) 
means the following services:
            ``(1) Outpatient and ambulatory health services.
            ``(2) AIDS Drug Assistance Program treatments.
            ``(3) AIDS pharmaceutical assistance.
            ``(4) Oral health care.
            ``(5) Early intervention services.
            ``(6) Health insurance premium and cost sharing assistance 
        for low-income individuals.
            ``(7) Home health care.
            ``(8) Hospice services.
            ``(9) Home and community-based health services as defined 
        under section 2614(c), except homemaker services.
            ``(10) Mental health services.
            ``(11) Substance abuse outpatient care.
            ``(12) Medical case management, including treatment 
        adherence services.
    ``(c) Support Services.--Notwithstanding any other provision of 
law, and subject to subsection (a), a grantee under this part, subject 
to the approval of the Secretary, may provide support services (such as 
respite care for individuals with HIV/AIDS, outreach services, medical 
transportation, nutritional counseling, linguistic services, and 
referral for health care and support services for individuals with HIV/
AIDS) needed to achieve medical outcomes which are related to the 
medical outcomes for an individual infected with HIV and approved by 
the Secretary.
    ``(d) 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) Unexpended Funds.--Any amounts required to be expended for 
core medical services or support services under this section that 
remain unobligated at the end of the fiscal year in which the funds 
were awarded shall be remitted to the Secretary for reallocation under 
this section.''.

SEC. 304. 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) 
that provide 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 also 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.
            ``(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.--
            ``(1) 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:
                    ``(A) 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).
                    ``(B) 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.
            ``(2) Quality management program.--A grantee under this 
        section shall implement a quality management program to assess 
        the extent to which HIV health services provided to patients 
        under the grant are consistent with the most recent Public 
        Health Service guidelines for the treatment of HIV/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.
    ``(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) Cap on Administrative Expenses.--A grantee may not use more 
than 10 percent of amounts received under a grant awarded under this 
section for administrative expenses.
    ``(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 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 the Minority AIDS Initiative 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 2007, 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 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 of 
                the Robert T. Stafford Disaster Relief and Emergency 
                Assistance Act; and
                    ``(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 of 
                the Robert T. Stafford Disaster Relief and Emergency 
                Assistance Act; and
                    ``(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.

    ``The Secretary shall collect client-level data under this title in 
a manner that is consistent with the unique identifier as reported to 
the Director of the Centers for Disease Control and Prevention as of 
the date of enactment of this section.

``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, 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) Counseling.--The term `counseling' means such 
        counseling provided by an individual trained to provide such 
        counseling.
            ``(2) Family-centered care.--The term `family-centered 
        care' means the system of services described in this section 
        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.
            ``(3) Families with hiv/aids.--The term `families with HIV/
        AIDS' means families in which one or more members have HIV/
        AIDS.
            ``(4)  HIV.--The term `HIV' means infection with the 
        etiologic agent for acquired immune deficiency syndrome.
            ``(5) HIV/AIDS.--The term `HIV/AIDS' means infection with 
        the etiologic agent for acquired immune deficiency syndrome, 
        and includes any condition arising from such syndrome.
            ``(6) 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.
            ``(7) 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.
            ``(8) State.--The term `State', except as otherwise 
        specifically provided, means each of the 50 States, the 
        District of Columbia, the Virgin Islands, Guam, American Samoa, 
        the Commonwealth of the Northern Mariana Islands, Puerto Rico, 
        and the Republic of the Marshall Islands.
            ``(9) 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:

                  ``PART F--DEMONSTRATION AND TRAINING

         ``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)(A) 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)(iii), including funds to 
        facilitate the purchase and enhance the utilization of 
        qualified health information technology systems;
            ``(B) demonstrated ability to create and maintain a 
        qualified health information technology system;
            ``(C) the potential replicability of the proposed activity 
        in other similar localities or nationally;
            ``(D) the demonstrated reliability of the proposed 
        qualified health information technology system across a variety 
        of providers, geographic regions, and clients; and
            ``(E) the demonstrated ability to maintain a safe and 
        secure qualified health information system; or
            ``(2) 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 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 from grantees 
funded under this part.''.

SEC. 602. AIDS EDUCATION AND TRAINING CENTERS.

    Section 2692(a)(2) of the Public Health Service Act (42 U.S.C. 
300ff-92(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.''.

SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE UNDER RYAN WHITE 
              COMPREHENSIVE AIDS RESOURCES EMERGENCY ACT OF 1990.

    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 II--Minority AIDS Initiative

``SEC. 2693. MINORITY AIDS INITIATIVE.

    ``(a) In General.--There is authorized to be appropriated for the 
purpose of carrying out activities under this section to evaluate and 
address the disproportionate impact of HIV disease and disparities in 
access, treatment, care, and outcome on racial and ethnic minorities, 
including African Americans, Alaska Natives, Latinos, American Indians, 
Asian Americans, Native Hawaiians, and Pacific Islanders, $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 2010.
    ``(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) comprehensive care under part B;
                    ``(C) early intervention services under part C;
                    ``(D) services through demonstration projects for 
                HIV-related care; 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) Of the amount appropriated for each fiscal 
                year under subsection (a), $43,800,000 for fiscal year 
                2007, $45,400,000 for fiscal year 2008, $47,100,000 for 
                fiscal year 2009, $48,800,000 for fiscal year 2010, and 
                $50,700,000 for fiscal year 2010, shall be used for 
                competitive, supplemental grants to improve HIV-related 
                health outcomes to reduce existing racial and ethnic 
                health disparities.
                    ``(B) Of the amount appropriated for each fiscal 
                year under subsection (a), $7,000,000 for fiscal year 
                2007, $7,300,000 for fiscal year 2008, $7,500,000 for 
                fiscal year 2009, $7,800,000 for fiscal year 2010, and 
                $8,100,000 for fiscal year 2010, shall be used for 
                competitive, supplemental support educational 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.
                    ``(C) Of the amount appropriated for each fiscal 
                year under subsection (a), $53,400,000 for fiscal year 
                2007, $55,400,000 for fiscal year 2008, $57,400,000 for 
                fiscal year 2009, $59,500,000 for fiscal year 2010, and 
                $61,800,000 for fiscal year 2010, shall be used 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.
                    ``(D) Of the amount appropriated for each fiscal 
                year under subsection (a), $18,500,000 for each of 
                fiscal years 2007 through 2011 shall be used for 
                sustaining and expanding efforts to deliver 
                comprehensive, culturally and linguistically 
                appropriate research-based intervention and care 
                services for HIV disease to racial and ethnic minority 
                women, infants, children, and youth.
                    ``(E) Of the amount appropriated for each fiscal 
                year under subsection (a), $8,500,000 for each of 
                fiscal years 2007 through 2011 shall be used for 
                increasing the training capacity of centers to expand 
                the number of community-based racial and ethnic 
                minority health care professionals with treatment 
                expertise and knowledge about the most appropriate 
                standards of HIV disease-related treatments and medical 
                care for adults, adolescents, and children with HIV 
                disease.
    ``(e) 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).''.

SEC. 604. AUTHORIZATION OF APPROPRIATIONS.

    Section 2692(c) of the Public Health Service Act (42 U.S.C. 300ff-
92(c)) is amended to read as follows:
    ``(c) Authorization of Appropriations.--
            ``(1) Schools; centers.--For the purpose of awarding grants 
        under subsection (a), there and authorized to be appropriated 
        $34,700,000 for each of fiscal years 2007 through 2011.
            ``(2) Dental schools.--For the purpose of awarding grants 
        under paragraphs (2) and (3) of subsection (b), there are 
        authorized to be appropriated $13,000,000 for each of fiscal 
        years 2007 through 2011.''.

                  TITLE VII--MISCELLANEOUS PROVISIONS

SEC. 701. HEPATITIS.

    (a) Provision of Certain Counseling Services.--Section 2662 of the 
Public Health Service Act (42 U.S.C. 300ff-62) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by inserting ``, hepatitis B, 
                and hepatitis C'' before the semicolon;
                    (B) in paragraph (2), by inserting ``and testing 
                for hepatitis B and hepatitis C'' before the semicolon;
                    (C) in paragraph (6), by striking ``and'' at the 
                end;
                    (D) in paragraph (7), by striking the period and 
                inserting ``; and''; and
                    (E) by adding at the end the following:
            ``(8) 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
            (2) in subsection (c)(3)(C)(i), by inserting ``, hepatitis 
        B, or hepatitis B'' after ``exposed to HIV'' each place that 
        such appears.
    (b) Use of Amounts.--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 and the location of 
        entities that provide hepatitis A and B vaccinations to 
        individuals with HIV.''.

SEC. 702. TECHNICAL PROVISIONS.

    Title XXVI of the Public Health Service Act (42 U.S.C. 300ff et 
seq.) is amended by striking ``HIV disease'' each place that such 
appears and inserting ``HIV/AIDS''.

SEC. 703. REPEAL.

    Section 2677 of the Public Health Service Act (42 U.S.C. 300ff-77) 
is repealed.
                                                       Calendar No. 580

109th CONGRESS

  2d Session

                                S. 2823

_______________________________________________________________________

                                 A BILL

          To provide life-saving care for those with HIV/AIDS.

_______________________________________________________________________

                             August 3, 2006

                       Reported with an amendment