[Congressional Record Volume 146, Number 98 (Tuesday, July 25, 2000)]
[House]
[Pages H6962-H6980]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 RYAN WHITE CARE ACT AMENDMENTS OF 2000

  Mr. COBURN. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 4807) to amend the Public Health Service Act to revise and 
extend programs established under the Ryan White Comprehensive AIDS 
Resources Emergency Act of 1990, and for other purposes, as amended.
  The Clerk read as follows:

                               H.R. 4807

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Ryan White CARE Act 
     Amendments of 2000''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents for this Act is as follows:

 TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

           Subtitle A--HIV Health Services Planning Councils

Sec. 101. Membership of councils.
Sec. 102. Duties of councils.
Sec. 103. Open meetings; other additional provisions.

              Subtitle B--Type and Distribution of Grants

Sec. 111. Formula grants.
Sec. 112. Supplemental grants.

                      Subtitle C--Other Provisions

Sec. 121. Use of amounts.
Sec. 122. Application.
Sec. 123. Review of administrative costs and compensation.

                      TITLE II--CARE GRANT PROGRAM

                  Subtitle A--General Grant Provisions

Sec. 201. Priority for women, infants, and children.
Sec. 202. Use of grants.
Sec. 203. Grants to establish HIV care consortia.
Sec. 204. Provision of treatments.
Sec. 205. State application.
Sec. 206. Distribution of funds.
Sec. 207. Supplemental grants for certain States.

Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission 
                                 of HIV

Sec. 211. Repeals.
Sec. 212. Grants.
Sec. 213. Study by Institute of Medicine.

           Subtitle C--Certain Partner Notification Programs

Sec. 221. Grants for compliant partner notification programs.

                 TITLE III--EARLY INTERVENTION SERVICES

                 Subtitle A--Formula Grants for States

Sec. 301. Repeal of program.

                     Subtitle B--Categorical Grants

Sec. 311. Preferences in making grants.
Sec. 312. Planning and development grants.
Sec. 313. Authorization of appropriations.

                     Subtitle C--General Provisions

Sec. 321. Provision of certain counseling services.
Sec. 322. Additional required agreements.

                TITLE IV--OTHER PROGRAMS AND ACTIVITIES

 Subtitle A--Certain Programs for Research, Demonstrations, or Training

Sec. 401. Grants for coordinated services and access to research for 
              women, infants, children, and youth.
Sec. 402. AIDS education and training centers.

              Subtitle B--General Provisions in Title XXVI

Sec. 411. Evaluations and reports.
Sec. 412. Data collection through Centers for Disease Control and 
              Prevention.
Sec. 413. Coordination.
Sec. 414. Plan regarding release of prisoners with HIV disease.
Sec. 415. Audits.
Sec. 416. Administrative simplification.
Sec. 417. Authorization of appropriations for parts A and B.

                      TITLE V--GENERAL PROVISIONS

Sec. 501. Studies by Institute of Medicine.
Sec. 502. Development of rapid HIV test.

[[Page H6963]]

                        TITLE VI--EFFECTIVE DATE

Sec. 601. Effective date.

 TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

           Subtitle A--HIV Health Services Planning Councils

     SEC. 101. MEMBERSHIP OF COUNCILS.

       (a) In General.--Section 2602(b) of the Public Health 
     Service Act (42 U.S.C. 300ff-12(b)) is amended--
       (1) in paragraph (1), by striking ``demographics of the 
     epidemic in the eligible area involved,'' and inserting 
     ``demographics of the population of individuals with HIV 
     disease in the eligible area involved,''; and
       (2) in paragraph (2)--
       (A) in subparagraph (G), by striking ``or AIDS'';
       (B) in subparagraph (K), by striking ``and'' at the end;
       (C) in subparagraph (L), by striking the period and 
     inserting the following: ``, including but not limited to 
     providers of HIV prevention services; and''; and
       (D) by adding at the end the following subparagraph:
       ``(M) representatives of individuals who formerly were 
     Federal, State, or local prisoners, were released from the 
     custody of the penal system during the preceding three years, 
     and had HIV disease as of the date on which the individuals 
     were so released.''.
       (b) Conflicts of Interests.--Section 2602(b)(5) of the 
     Public Health Service Act (42 U.S.C. 300ff-12(b)(5)) is 
     amended by adding at the end the following subparagraph:
       ``(C) Composition of council.--The following applies 
     regarding the membership of a planning council under 
     paragraph (1):
       ``(i) Not less than 33 percent of the council shall be 
     individuals who are receiving HIV-related services pursuant 
     to a grant under section 2601(a), are not officers, 
     employees, or consultants to any entity that receives amounts 
     from such a grant, and do not represent any such entity, and 
     reflect the demographics of the population of individuals 
     with HIV disease as determined under paragraph (4)(A). For 
     purposes of the preceding sentence, an individual shall be 
     considered to be receiving such services if the individual is 
     a parent of, or a caregiver for, a minor child who is 
     receiving such services.
       ``(ii) With respect to membership on the planning council, 
     clause (i) may not be construed as having any effect on 
     entities that receive funds from grants under any of parts B 
     through F but do not receive funds from grants under section 
     2601(a), on officers or employees of such entities, or on 
     individuals who represent such entities.''.

     SEC. 102. DUTIES OF COUNCILS.

       (a) In General.--Section 2602(b)(4) of the Public Health 
     Service Act (42 U.S.C. 300ff-12(b)(4)) is amended--
       (1) by redesignating subparagraphs (A) through (E) as 
     subparagraphs (C) through (G), respectively;
       (2) by inserting before subparagraph (C) (as so 
     redesignated) the following subparagraphs:
       ``(A) determine the size and demographics of the population 
     of individuals with HIV disease;
       ``(B) determine the needs of such population, with 
     particular attention to--
       ``(i) individuals with HIV disease who are not receiving 
     HIV-related services; and
       ``(ii) disparities in access and services among affected 
     subpopulations and historically underserved communities;'';
       (3) in subparagraph (C) (as so redesignated), by striking 
     clauses (i) through (iv) and inserting the following:
       ``(i) size and demographics of the population of 
     individuals with HIV disease (as determined under 
     subparagraph (A)) and the needs of such population (as 
     determined under subparagraph (B));
       ``(ii) demonstrated (or probable) cost effectiveness and 
     outcome effectiveness of proposed strategies and 
     interventions, to the extent that data are reasonably 
     available;
       ``(iii) priorities of the communities with HIV disease for 
     whom the services are intended;
       ``(iv) availability of other governmental and 
     nongovernmental resources to provide HIV-related services to 
     individuals and families with HIV disease, including the 
     State plan under title XIX of the Social Security Act 
     (relating to the Medicaid program) and the program under 
     title XXI of such Act (relating to the program for State 
     children's health insurance); and
       ``(v) capacity development needs resulting from disparities 
     in the availability of HIV-related services in historically 
     underserved communities;'';
       (4) in subparagraph (D) (as so redesignated), by amending 
     the subparagraph to read as follows:
       ``(D) develop a comprehensive plan for the organization and 
     delivery of health and support services described in section 
     2604 that--
       ``(i) includes a strategy for identifying individuals with 
     HIV disease who are not receiving such services and for 
     informing the individuals of and enabling the individuals to 
     utilize the services, giving particular attention to 
     eliminating disparities in access and services among affected 
     subpopulations and historically underserved communities, and 
     including discrete goals, a timetable, and an appropriate 
     allocation of funds;
       ``(ii) includes a strategy to coordinate the provision of 
     such services with programs for HIV prevention and for the 
     prevention and treatment of substance abuse, including 
     programs that provide comprehensive treatment services for 
     such abuse; and
       ``(iii) is compatible with any State or local plan for the 
     provision of services to individuals with HIV disease;'';
       (5) in subparagraph (F) (as so redesignated), by striking 
     ``and'' at the end;
       (6) in subparagraph (G) (as so redesignated)--
       (A) by striking ``public meetings,'' and inserting ``public 
     meetings (in accordance with paragraph (7)),''; and
       (B) by striking the period and inserting ``; and''; and
       (7) by adding at the end the following subparagraph:
       ``(H) coordinate with Federal grantees that provide HIV-
     related services within the eligible area.''.
       (b) Process for Establishing Allocation Priorities.--
     Section 2602 of the Public Health Service Act (42 U.S.C. 
     300ff-12) is amended by adding at the end the following 
     subsection:
       ``(d) Process for Establishing Allocation Priorities.--
     Promptly after the date of the submission of the report 
     required in section 501(b) of the Ryan White CARE Act 
     Amendments of 2000 (relating to the relationship between 
     epidemiological measures and health care for certain 
     individuals with HIV disease), the Secretary, in consultation 
     with entities that receive amounts from grants under section 
     2601(a) or 2611, shall develop epidemiologic measures--
       ``(1) for establishing the number of individuals living 
     with HIV disease who are not receiving HIV-related health 
     services; and
       ``(2) for carrying out the duties under subsection (b)(4) 
     and section 2617(b).''.
       (c) Training.--Section 2602 of the Public Health Service 
     Act (42 U.S.C. 300ff-12), as amended by subsection (b) of 
     this section, is amended by adding at the end the following 
     subsection:
       ``(e) Training Guidance and Materials.--The Secretary shall 
     provide to each chief elected official receiving a grant 
     under 2601(a) guidelines and materials for training members 
     of the planning council under paragraph (1) regarding the 
     duties of the council.''.

     SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVISIONS.

       Section 2602(b) of the Public Health Service Act (42 U.S.C. 
     300ff-12(b)) is amended--
       (1) in paragraph (3), by striking subparagraph (C); and
       (2) by adding at the end the following paragraph:
       ``(7) Public deliberations.--With respect to a planning 
     council under paragraph (1), the following applies:
       ``(A) The council may not be chaired solely by an employee 
     of the grantee under section 2601(a).
       ``(B) In accordance with criteria established by the 
     Secretary:
       ``(i) The meetings of the council shall be open to the 
     public and shall be held only after adequate notice to the 
     public.
       ``(ii) The records, reports, transcripts, minutes, agenda, 
     or other documents which were made available to or prepared 
     for or by the council shall be available for public 
     inspection and copying at a single location.
       ``(iii) Detailed minutes of each meeting of the council 
     shall be kept. The accuracy of all minutes shall be certified 
     to by the chair of the council.
       ``(iv) This subparagraph does not apply to any disclosure 
     of information of a personal nature that would constitute a 
     clearly unwarranted invasion of personal privacy, including 
     any disclosure of medical information or personnel 
     matters.''.

              Subtitle B--Type and Distribution of Grants

     SEC. 111. FORMULA GRANTS.

       (a) Expedited Distribution.--Section 2603(a)(2) of the 
     Public Health Service Act (42 U.S.C. 300ff-13(a)(2)) is 
     amended in the first sentence by striking ``for each of the 
     fiscal years 1996 through 2000'' and inserting ``for a fiscal 
     year''.
       (b) Amount of Grant; Estimate of Living Cases.--
       (1) In general.--Section 2603(a)(3)) of the Public Health 
     Service Act (42 U.S.C. 300ff-13(a)(3)) is amended--
       (A) in subparagraph (C)(i), by inserting before the 
     semicolon the following: ``, except that (subject to 
     subparagraph (D)), for grants made pursuant to this paragraph 
     for fiscal year 2005 and subsequent fiscal years, the cases 
     counted for each 12-month period beginning on or after July 
     1, 2004, shall be cases of HIV disease (as reported to and 
     confirmed by such Director) rather than cases of acquired 
     immune deficiency syndrome''; and
       (B) in subparagraph (C), in the matter after and below 
     clause (ii)(X)--
       (i) in the first sentence, by inserting before the period 
     the following: ``, and shall be reported to the congressional 
     committees of jurisdiction''; and
       (ii) by adding at the end the following sentence: ``Updates 
     shall as applicable take into account the counting of cases 
     of HIV disease pursuant to clause (i).''
       (2) Determination of secretary regarding data on hiv 
     cases.--Section 2603(a)(3)) of the Public Health Service Act 
     (42 U.S.C. 300ff-13(a)(3)) is amended--
       (A) by redesignating subparagraph (D) as subparagraph (E); 
     and
       (B) by inserting after subparagraph (C) the following 
     subparagraph:
       ``(D) Determination of secretary regarding data on hiv 
     cases.--
       ``(i) In general.--Not later than July 1, 2004, the 
     Secretary shall determine whether there is data on cases of 
     HIV disease from all eligible areas (reported to and 
     confirmed by the Director of the Centers for Disease Control 
     and Prevention) sufficiently accurate and reliable for use 
     for purposes of subparagraph (C)(i). In making such a 
     determination, the Secretary shall take into consideration 
     the findings of the study under section 501(b) of the Ryan 
     White CARE Act Amendments of 2000 (relating to the 
     relationship between epidemiological measures and health care 
     for certain individuals with HIV disease), the fiscal impact 
     of the use of such data,

[[Page H6964]]

     the impact of the use of such data on the organization and 
     delivery of HIV-related services in eligible areas, and the 
     fiscal impact of not using such data.
       ``(ii) Effect of adverse determination.--If under clause 
     (i) the Secretary determines that data on cases of HIV 
     disease is not sufficiently accurate and reliable for use for 
     purposes of subparagraph (C)(i), then notwithstanding such 
     subparagraph, for any fiscal year prior to fiscal year 2007 
     the references in such subparagraph to cases of HIV disease 
     do not have any legal effect.
       ``(iii) Grants and technical assistance regarding counting 
     of hiv cases.--Of the amounts appropriated under section 2675 
     for a fiscal year, the Secretary shall reserve amounts to 
     make grants and provide technical assistance to States and 
     eligible areas with respect to obtaining data on cases of HIV 
     disease to ensure that data on such cases is available from 
     all States and eligible areas as soon as is practicable but 
     not later than the beginning of fiscal year 2007.''.
       (c) Increases in Grant.--Section 2603(a)(4)) of the Public 
     Health Service Act (42 U.S.C. 300ff-13(a)(4)) is amended to 
     read as follows:
       ``(4) Increases in grant.--
       ``(A) In general.--For each fiscal year in a protection 
     period for an eligible area, the Secretary shall increase the 
     amount of the grant made pursuant to paragraph (2) for the 
     area to ensure that--
       ``(i) for the first fiscal year in the protection period, 
     the grant is not less than 98 percent of the amount of the 
     grant made for the eligible area pursuant to such paragraph 
     for the base year for the protection period;
       ``(ii) for any second fiscal year in such period, the grant 
     is not less than 95.7 percent of the amount of such base year 
     grant;
       ``(iii) for any third fiscal year in such period, the grant 
     is not less than 91.1 percent of the amount of the base year 
     grant;
       ``(iv) for any fourth fiscal year in such period, the grant 
     is not less than 84.2 percent of the amount of the base year 
     grant; and
       ``(v) for any fifth or subsequent fiscal year in such 
     period, the grant is not less than 75 percent of the amount 
     of the base year grant.
       ``(B) Base year; protection period.--With respect to grants 
     made pursuant to paragraph (2) for an eligible area:
       ``(i) The base year for a protection period is the fiscal 
     year preceding the trigger grant-reduction year.
       ``(ii) The first trigger grant-reduction year is the first 
     fiscal year (after fiscal year 2000) for which the grant for 
     the area is less than the grant for the area for the 
     preceding fiscal year.
       ``(iii) A protection period begins with the trigger grant-
     reduction year and continues until the beginning of the first 
     fiscal year for which the amount of the grant for the area 
     equals or exceeds the amount of the grant for the base year 
     for the period.
       ``(iv) Any subsequent trigger grant-reduction year is the 
     first fiscal year, after the end of the preceding protection 
     period, for which the amount of the grant is less than the 
     amount of the grant for the preceding fiscal year.''.

     SEC. 112. SUPPLEMENTAL GRANTS.

       (a) In General.--Section 2603(b)(2) of the Public Health 
     Service Act (42 U.S.C. 300ff-13(b)(2)) is amended--
       (1) in the heading for the paragraph, by striking 
     ``Definition'' and inserting ``Amount of grant'';
       (2) by redesignating subparagraphs (A) through (C) as 
     subparagraphs (B) through (D), respectively;
       (3) by inserting before subparagraph (B) (as so 
     redesignated) the following subparagraph:
       ``(A) In general.--The amount of each grant made for 
     purposes of this subsection shall be determined by the 
     Secretary based on a weighting of factors under paragraph 
     (1), with severe need under subparagraph (B) of such 
     paragraph counting one-third.'';
       (4) in subparagraph (B) (as so redesignated)--
       (A) in clause (ii), by striking ``and'' at the end;
       (B) in clause (iii), by striking the period and inserting a 
     semicolon; and
       (C) by adding at the end the following clauses:
       ``(iv) the current prevalence of HIV disease;
       ``(v) an increasing need for HIV-related services, 
     including relative rates of increase in the number of cases 
     of HIV disease; and
       ``(vi) unmet need for such services, as determined under 
     section 2602(b)(4).'';
       (5) in subparagraph (C) (as so redesignated)--
       (A) by striking ``subparagraph (A)'' each place such term 
     appears and inserting ``subparagraph (B)''';
       (B) in the second sentence, by striking ``2 years after the 
     date of enactment of this paragraph'' and inserting ``18 
     months after the date of the enactment of the Ryan White CARE 
     Act Amendments of 2000''; and
       (C) by inserting after the second sentence the following 
     sentence: ``Such a mechanism shall be modified to reflect the 
     findings of the study under section 501(b) of the Ryan White 
     CARE Act Amendments of 2000 (relating to the relationship 
     between epidemiological measures and health care for certain 
     individuals with HIV disease).''; and
       (6) in subparagraph (D) (as so redesignated), by striking 
     ``subparagraph (B)'' and inserting ``subparagraph (C)'''.
       (b) Requirements for Application.--Section 2603(b)(1)(E) of 
     the Public Health Service Act (42 U.S.C. 300ff-13(b)(1)(E)) 
     is amended by inserting ``youth,'' after ``children,''.
       (c) Conforming Amendment.--Section 2603(b) of the Public 
     Health Service Act (42 U.S.C. 300ff-13(b)) is amended--
       (1) by striking paragraph (4); and
       (2) by redesignating paragraph (5) as paragraph (4).

                      Subtitle C--Other Provisions

     SEC. 121. USE OF AMOUNTS.

       (a) Primary Purposes.--Section 2604(b)(1) of the Public 
     Health Service Act (42 U.S.C. 300ff-14(b)(1)) is amended--
       (1) in the matter preceding subparagraph (A), by striking 
     ``HIV-related--'' and inserting ``HIV-related services, as 
     follows:'';
       (2) in subparagraph (A)--
       (A) by striking ``outpatient'' and all that follows through 
     ``substance abuse treatment and'' and inserting the 
     following: ``Outpatient and ambulatory health services, 
     including substance abuse treatment,''; and
       (B) by striking ``; and'' and inserting a period;
       (3) in subparagraph (B), by striking ``(B) inpatient case 
     management'' and inserting ``(C) Inpatient case management'';
       (4) by inserting after subparagraph (A) the following 
     subparagraph:
       ``(B) Outpatient and ambulatory support services (including 
     case management), to the extent that such services 
     facilitate, support, or sustain the delivery, or benefits of 
     health services for individuals and families with HIV 
     disease.''; and
       (5) by adding at the end the following:
       ``(D) Outreach activities that are intended to identify 
     individuals with HIV disease who are not receiving HIV-
     related services, and that are--
       ``(i) necessary to implement the strategy under section 
     2602(b)(4)(D), including activities facilitating the access 
     of such individuals to HIV-related primary care services at 
     entities described in paragraph (3);
       ``(ii) conducted in a manner consistent with the 
     requirements under sections 2605(a)(3) and 2651(b)(2); and
       ``(iii) supplement, and do not supplant, such activities 
     that are carried out with amounts appropriated under section 
     317.''.
       (b) Additional Purposes.--Section 2604(b) (42 U.S.C. 300ff-
     14(b)) of the Public Health Service Act is amended--
       (1) by redesignating paragraph (3) as paragraph (4);
       (2) by inserting after paragraph (2) the following:
       ``(3) Early intervention services.--
       ``(A) In general.--The purposes for which a grant under 
     section 2601 may be used include providing to individuals 
     with HIV disease early intervention services described in 
     section 2651(b)(2) (including referrals under subparagraph 
     (C) of such section), subject to subparagraph (B). The 
     entities through which such services may be provided under 
     the grant include public health departments, emergency rooms, 
     substance abuse and mental health treatment programs, 
     detoxification centers, detention facilities, clinics 
     regarding sexually transmitted diseases, homeless shelters, 
     HIV disease counseling and testing sites, health care points 
     of entry specified by States or eligible areas, federally 
     qualified health centers, and entities described in section 
     2652(a).
       ``(B) Conditions.--With respect to an entity that proposes 
     to provide early intervention services under subparagraph 
     (A), such subparagraph applies only if the entity 
     demonstrates to the satisfaction of the chief elected 
     official for the eligible area involved that--
       ``(i) Federal, State, or local funds are otherwise 
     inadequate for the early intervention services the entity 
     proposes to provide; and
       ``(ii) the entity will expend funds pursuant to such 
     subparagraph to supplement and not supplant other funds 
     available to the entity for the provision of early 
     intervention services for the fiscal year involved.''; and
       (3) in paragraph (4) (as so redesignated), by inserting 
     ``youth,'' after ``children,'' each place such term appears;
       (c) Quality Management.--Section 2604 of the Public Health 
     Service Act (42 U.S.C. 300ff-14) is amended--
       (1) by redesignating subsections (c) through (f) as 
     subsections (d) through (g), respectively; and
       (2) by inserting after subsection (b) the following:
       ``(c) Quality Management.--
       ``(1) Requirement.--The chief elected official of an 
     eligible area that receives a grant under this part shall 
     provide for the establishment of a quality management program 
     to assess the extent to which HIV health services provided to 
     patients under the grant are consistent with the most recent 
     Public Health Service guidelines for the treatment of HIV 
     disease and related opportunistic infection, and as 
     applicable, to develop strategies for ensuring that such 
     services are consistent with the guidelines.
       ``(2) Use of funds.--From amounts received under a grant 
     awarded under this part for a fiscal year, the chief elected 
     official of an eligible area may (in addition to amounts to 
     which subsection (f)(1) applies) use for activities 
     associated with the quality management program required in 
     paragraph (1) not more than the lesser of--
       ``(A) 5 percent of amounts received under the grant; or
       ``(B) $3,000,000.''.

     SEC. 122. APPLICATION.

       Section 2605(a) of the Public Health Service Act (42 U.S.C. 
     300ff-15(a)) is amended--
       (1) by redesignating paragraphs (3) through (6) as 
     paragraphs (4) through (7), respectively; and
       (2) by inserting after paragraph (2) the following 
     paragraph:
       ``(3) that entities within the eligible area that receive 
     funds under a grant under section 2601(a) will maintain 
     relationships with appropriate entities in the area, 
     including entities described in section 2604(b)(3);''.

     SEC. 123. REVIEW OF ADMINISTRATIVE COSTS AND COMPENSATION.

       Each chief elected official of an eligible area (as defined 
     in section 2607 of the Public Health

[[Page H6965]]

     Service Act) shall ensure that, not later than one year after 
     the date of the enactment of this Act, the planning council 
     for the eligible area--
       (1) conducts a review of the existing, available data on 
     the extent to which entities in the area that receive amounts 
     from a grant under section 2601(a) of the Public Health 
     Service Act have from their overall budget expended amounts 
     for administrative costs (including financial compensation 
     and benefits), expressed as a proportion and indicating the 
     growth in such expenditures, including a statement of the 
     average amount expended for such costs per client served and 
     the average amount expended for such costs per client served 
     in providing HIV-related services; and
       (2) makes a determination of whether the financial 
     compensation of any officers or employees of such entities 
     exceeds that of the chief elected official of the eligible 
     area.

                      TITLE II--CARE GRANT PROGRAM

                  Subtitle A--General Grant Provisions

     SEC. 201. PRIORITY FOR WOMEN, INFANTS, AND CHILDREN.

       Section 2611(b) of the Public Health Service Act (42 U.S.C. 
     300ff-21(b)) is amended by inserting ``youth,'' after 
     ``children,'' each place such term appears.

     SEC. 202. USE OF GRANTS.

       Section 2612 of the Public Health Service Act (42 U.S.C. 
     300ff-22) is amended--
       (1) by striking ``A State may use'' and inserting ``(a) In 
     General.--A State may use''; and
       (2) by adding at the end the following subsections:
       ``(b) Support Services; Outreach.--The purposes for which a 
     grant under this part may be used include delivering or 
     enhancing the following:
       ``(1) Support services under section 2611(a) (including 
     case management) to the extent that such services facilitate, 
     support, or sustain the delivery, or benefits of health 
     services for individuals and families with HIV disease.
       ``(2) Outreach activities that are intended to identify 
     individuals with HIV disease who are not receiving HIV-
     related services, and that are--
       ``(A) necessary to implement the strategy under section 
     2617(b)(4)(B);
       ``(B) conducted in a manner consistent with the requirement 
     under section 2617(b)(6)(G); and
       ``(C) supplement, and do not supplant, such activities that 
     are carried out with amounts appropriated under section 317.
       ``(c) Early Intervention Services.--
       ``(1) In general.--The purposes for which a grant under 
     this part may be used include providing to individuals with 
     HIV disease early intervention services described in section 
     2651(b)(2) (including referrals under subparagraph (C) of 
     such section), subject to paragraph (2). The entities through 
     which such services may be provided under the grant include 
     public health departments, emergency rooms, substance abuse 
     and mental health treatment programs, detoxification centers, 
     detention facilities, clinics regarding sexually transmitted 
     diseases, homeless shelters, HIV disease counseling and 
     testing sites, health care points of entry specified by 
     States or eligible areas, federally qualified health centers, 
     and entities described in section 2652(a).
       ``(2) Conditions.--With respect to an entity that proposes 
     to provide early intervention services under paragraph (1), 
     such paragraph applies only if the entity demonstrates to the 
     satisfaction of the State involved that--
       ``(A) Federal, State, or local funds are otherwise 
     inadequate for the early intervention services the entity 
     proposes to provide; and
       ``(B) the entity will expend funds pursuant to such 
     paragraph to supplement and not supplant other funds 
     available to the entity for the provision of early 
     intervention services for the fiscal year involved.
       ``(d) Quality Management.--
       ``(1) Requirement.--Each State that receives a grant under 
     this part shall provide for the establishment of a quality 
     management program to assess the extent to which HIV health 
     services provided to patients under the grant are consistent 
     with the most recent Public Health Service guidelines for the 
     treatment of HIV disease and related opportunistic infection, 
     and as applicable, to develop strategies for ensuring that 
     such services are consistent with the guidelines.
       ``(2) Use of funds.--From amounts received under a grant 
     awarded under this part for a fiscal year, the State may (in 
     addition to amounts to which section 2618(c)(5) applies) use 
     for activities associated with the quality management program 
     required in paragraph (1) not more than the lesser of--
       ``(A) 5 percent of amounts received under the grant; or
       ``(B) $3,000,000.''.

     SEC. 203. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

       Section 2613 of the Public Health Service Act (42 U.S.C. 
     300ff-23) is amended--
       (1) in subsection (b)(1)--
       (A) in subparagraph (A), by inserting before the semicolon 
     the following: ``, particularly those experiencing 
     disparities in access and services and those who reside in 
     historically underserved communities''; and
       (B) in subparagraph (B), by inserting after ``by such 
     consortium'' the following: ``is consistent with the 
     comprehensive plan under 2617(b)(4) and'';
       (2) in subsection (c)(1)--
       (A) in subparagraph (D), by striking ``and'' after the 
     semicolon at the end;
       (B) in subparagraph (E), by striking the period and 
     inserting ``; and'';
       (C) by adding at the end the following subparagraph:
       ``(F) demonstrates that adequate planning occurred to 
     address disparities in access and services and historically 
     underserved communities.''; and
       (3) in subsection (c)(2)--
       (A) in subparagraph (B), by striking ``and'' after the 
     semicolon;
       (B) in subparagraph (C), by striking the period and 
     inserting ``; and''; and
       (C) by inserting after subparagraph (C) the following 
     subparagraph:
       ``(D) entities described in section 2602(b)(2).''.

     SEC. 204. PROVISION OF TREATMENTS.

       Section 2616 of the Public Health Service Act (42 U.S.C. 
     300ff-26) is amended by adding at the end the following 
     subsection:
       ``(e) Use of Health Insurance and Plans.--In carrying out 
     subsection (a), a State may expend a grant under this part to 
     provide the therapeutics described in such subsection by 
     paying on behalf of individuals with HIV disease the costs of 
     purchasing or maintaining health insurance or plans whose 
     coverage includes a full range of such therapeutics and 
     appropriate primary care services.''.

     SEC. 205. STATE APPLICATION.

       (a) Determination of Size and Needs of Population; 
     Comprehensive Plan.--Section 2617(b) of the Public Health 
     Service Act (42 U.S.C. 300ff-27(b)) is amended--
       (1) by redesignating paragraphs (2) through (4) as 
     paragraphs (4) through (6), respectively;
       (2) by inserting after paragraph (1) the following 
     paragraphs:
       ``(2) a determination of the size and demographics of the 
     population of individuals with HIV disease in the State;
       ``(3) a determination of the needs of such population, with 
     particular attention to--
       ``(A) individuals with HIV disease who are not receiving 
     HIV-related services; and
       ``(B) disparities in access and services among affected 
     subpopulations and historically underserved communities;''; 
     and
       (3) in paragraph (4) (as so redesignated)--
       (A) by striking ``comprehensive plan for the organization'' 
     and inserting ``comprehensive plan that describes the 
     organization'';
       (B) by striking ``, including--'' and inserting ``, and 
     that--'';
       (C) by redesignating subparagraphs (A) through (C) as 
     subparagraphs (D) through (F), respectively;
       (D) by inserting before subparagraph (C) the following 
     subparagraphs:
       ``(A) establishes priorities for the allocation of funds 
     within the State based on--
       ``(i) size and demographics of the population of 
     individuals with HIV disease (as determined under paragraph 
     (2)) and the needs of such population (as determined under 
     paragraph (3));
       ``(ii) availability of other governmental and 
     nongovernmental resources to provide HIV-related services to 
     individuals and families with HIV disease;
       ``(iii) capacity development needs resulting from 
     disparities in the availability of HIV-related services in 
     historically underserved communities and rural communities; 
     and
       ``(iv) the efficiency of the administrative mechanism of 
     the State for rapidly allocating funds to the areas of 
     greatest need within the State;
       ``(B) includes a strategy for identifying individuals with 
     HIV disease who are not receiving such services and for 
     informing the individuals of and enabling the individuals to 
     utilize the services, giving particular attention to 
     eliminating disparities in access and services among affected 
     subpopulations and historically underserved communities, and 
     including discrete goals, a timetable, and an appropriate 
     allocation of funds;
       ``(C) includes a strategy to coordinate the provision of 
     such services with programs for HIV prevention and for the 
     prevention and treatment of substance abuse, including 
     programs that provide comprehensive treatment services for 
     such abuse;'';
       (E) in subparagraph (D) (as redesignated by subparagraph 
     (C) of this paragraph), by inserting ``describes'' before 
     ``the services and activities'';
       (F) in subparagraph (E) (as so redesignated), by inserting 
     ``provides'' before ``a description''; and
       (G) in subparagraph (F) (as so redesignated), by inserting 
     ``provides'' before ``a description''.
       (b) Public Participation.--Section 2617(b) of the Public 
     Health Service Act, as amended by subsection (a) of this 
     section, is amended--
       (1) in paragraph (5), by striking ``HIV'' and inserting 
     ``HIV disease''; and
       (2) in paragraph (6), by amending subparagraph (A) to read 
     as follows:
       ``(A) the public health agency that is administering the 
     grant for the State engages in a public advisory planning 
     process, including public hearings, that includes the 
     participants under paragraph (5), and entities described in 
     section 2602(b)(2), in developing the comprehensive plan 
     under paragraph (4) and commenting on the implementation of 
     such plan;''.
       (c) Health Care Relationships.--Section 2617(b) of the 
     Public Health Service Act, as amended by subsection (a) of 
     this section, is amended in paragraph (6)--
       (1) in subparagraph (E), by striking ``and'' at the end;
       (2) in subparagraph (F), by striking the period and 
     inserting ``; and''; and
       (3) by adding at the end the following subparagraph:
       ``(G) entities within areas in which activities under the 
     grant are carried out will maintain relationships with 
     appropriate entities in the area, including entities 
     described in section 2612(c);''.

     SEC. 206. DISTRIBUTION OF FUNDS.

       (a) Minimum Allotment.-- Section 2618(b)(1)(A)(i) of the 
     Public Health Service Act (42 U.S.C. 300ff-28(b)(1)(A)(i)) is 
     amended--

[[Page H6966]]

       (1) in subclause (I), by striking ``$100,000'' and 
     inserting ``$200,000''; and
       (2) in subclause (II), by striking ``$250,000'' and 
     inserting ``$500,000''.
       (b) Amount of Grant; Estimate of Living Cases.--Section 
     2618(b)(2) of the Public Health Service Act (42 U.S.C. 300ff-
     28(b)(2)) is amended--
       (1) in subparagraph (D)(i), by inserting before the 
     semicolon the following: ``, except that (subject to 
     subparagraph (E)), for grants made pursuant to this paragraph 
     for fiscal year 2005 and subsequent fiscal years, the cases 
     counted for each 12-month period beginning on or after July 
     1, 2004, shall be cases of HIV disease (as reported to and 
     confirmed by such Director) rather than cases of acquired 
     immune deficiency syndrome'';
       (2) by redesignating subparagraphs (E) through (H) as 
     subparagraphs (F) through (I), respectively; and
       (3) by inserting after subparagraph (D) the following 
     subparagraph:
       ``(E) Determination of secretary regarding data on hiv 
     cases.--If under 2603(a)(3)(D)(i) the Secretary determines 
     that data on cases of HIV disease is not sufficiently 
     accurate and reliable, then notwithstanding subparagraph (D) 
     of this paragraph, for any fiscal year prior to fiscal year 
     2007 the references in such subparagraph to cases of HIV 
     disease do not have any legal effect.''.
       (c) Increases in Formula Amount.--Section 2618(b) of the 
     Public Health Service Act (42 U.S.C. 300ff-28(b)) is 
     amended--
       (1) in paragraph (1)(A)(ii), by inserting before the 
     semicolon the following: ``and then, as applicable, increased 
     under paragraph (2)(H)''; and
       (2) in paragraph (2)--
       (A) in subparagraph (A)(i), by striking ``subparagraph 
     (H)'' and inserting ``subparagraphs (H) and (I)''; and
       (B) in subparagraph (H) (as redesignated by subsection 
     (b)(2) of this section), by amending the subparagraph to read 
     as follows:
       ``(H) Limitation.--
       ``(i) In general.--The Secretary shall ensure that the 
     amount of a grant awarded to a State or territory under 
     section 2611 for a fiscal year is not less than--

       ``(I) with respect to fiscal year 2001, 99 percent;
       ``(II) with respect to fiscal year 2002, 98 percent;
       ``(III) with respect to fiscal year 2003, 97 percent;
       ``(IV) with respect to fiscal year 2004, 96 percent; and
       ``(V) with respect to fiscal year 2005, 95 percent;

     of the amount such State or territory received for fiscal 
     year 2000 under such section. In administering this 
     subparagraph, the Secretary shall, with respect to States or 
     territories that will under such section receive grants in 
     amounts that exceed the amounts that such States received 
     under such section for fiscal year 2000, proportionally 
     reduce such amounts to ensure compliance with this 
     subparagraph. In making such reductions, the Secretary shall 
     ensure that no such State receives less than that State 
     received for fiscal year 2000.
       ``(ii) Ratable reduction.--If the amount appropriated under 
     section 2677 for a fiscal year and available for grants under 
     section 2611 is less than the amount appropriated and 
     available under such section for fiscal year 2000, the 
     limitation contained in clause (i) shall be reduced by a 
     percentage equal to the percentage of the reduction in such 
     amounts appropriated and available.''.
       (d) Territories.--Section 2618(b)(1)(B) of the Public 
     Health Service Act (42 U.S.C. 300ff-28(b)(1)(B)) is amended 
     by inserting ``the greater of $50,000 or'' after ``shall 
     be''.
       (e) Separate Treatment Drug Grants.--Section 2618(b)(2) of 
     the Public Health Service Act, as amended by subsection 
     (b)(3) of this section, is amended in subparagraph (I)--
       (1) by redesignating clauses (i) and (ii) as subclauses (I) 
     and (II), respectively;
       (2) by striking ``(I) Appropriations'' and all that follows 
     through ``With respect to'' and inserting the following:
       ``(I) Appropriations for treatment drug program.--
       ``(i) Formula grants.--With respect to'';
       (3) in subclause (I) of clause (i) (as designated by 
     paragraphs (1) and (2)), by striking ``100 percent'' and 
     inserting ``98 percent''; and
       (4) by adding at the end the following clause:
       ``(ii) Supplemental treatment drug grants.--

       ``(I) In general.--With respect to the fiscal year 
     involved, if under section 2677 an appropriations Act 
     provides an amount exclusively for carrying out section 2616, 
     and such amount is not less than the amount so provided for 
     the preceding fiscal year, the Secretary shall reserve 2 
     percent of such amount for making grants to States whose 
     population of individuals with HIV disease has, as determined 
     by the Secretary, a need for quantities of therapeutics 
     described in section 2616(a) greater than the quantities 
     available pursuant to clause (i). Such a grant is available 
     for purposes of obtaining such therapeutics. The Secretary 
     shall carry out this clause as a program of discretionary 
     grants, and not as a program of formula grants.
       ``(II) Distribution of grants.--The Secretary shall 
     disburse all amounts under grants under subclause (I) for a 
     fiscal year not later than 240 days after the date on which 
     the amount referred to in such subclause with respect to 
     section 2616 becomes available.
       ``(III) Requirement of matching funds.--A condition for 
     receiving a grant under subclause (I) is that the State agree 
     to make available (directly or through donations from public 
     or private entities) non-Federal contributions toward the 
     costs of obtaining the therapeutics involved in an amount 
     that is not less than 25 percent of such costs (determined in 
     the same manner as under 2617(d)(2)(A)).''.

       (f) Technical Amendment.--Section 2618(b)(3)(B) of the 
     Public Health Service Act (42 U.S.C. 300ff-28(b)(3)(B)) is 
     amended by striking ``and the Republic of the Marshall 
     Islands'' and inserting ``the Republic of the Marshall 
     Islands, the Federated States of Micronesia, and the Republic 
     of Palau, and only for purposes of paragraph (1) the 
     Commonwealth of Puerto Rico''.

     SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

       Subpart I of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-11 et seq.) is amended--
       (1) by striking section 2621; and
       (2) by inserting after section 2620 the following section:

     ``SEC. 2621. SUPPLEMENTAL GRANTS.

       ``(a) In General.--From amounts available pursuant to 
     subsection (d) for a fiscal year, the Secretary shall make 
     grants to States that meet the conditions to receive grants 
     under section 2611, and that have one or more eligible 
     communities, for the purpose of providing in such communities 
     comprehensive services of the type described in section 
     2612(a) to supplement the development and care activities, 
     primary care, and support services otherwise provided in such 
     communities by the State under a grant under section 2611.
       ``(b) Eligible Community.--For purposes of this section, 
     the term `eligible community' means a geographic area that--
       ``(1) is not within any eligible area as defined in section 
     2607; and
       ``(2) has a severe need for supplemental financial 
     assistance to combat the HIV epidemic, according to criteria 
     developed by the Secretary in consultation with the States, 
     including evidence of underserved or rural areas or both.
       ``(c) Application.--A grant under subsection (a) may be 
     made to a State if the State submits to the Secretary, as 
     part of the State application submitted under section 2617, 
     such information as required to apply for funds under this 
     section as determined by the Secretary in consultation with 
     the States.
       ``(d) Funding.--
       ``(1) In general.--For the purpose of making grants under 
     subsection (a) for a fiscal year, the Secretary shall reserve 
     50 percent of the amount specified in paragraph (2).
       ``(2) Increases in part b funding.--
       ``(A) In general.--For purposes of paragraph (1), the 
     amount specified in this paragraph is the amount by which the 
     amount appropriated under section 2677 for the fiscal year 
     involved and available for carrying out part B is an increase 
     over the amount so appropriated and available for the 
     preceding fiscal year, subject to subparagraphs (B) and (C).
       ``(B) Initial allocation year.--The allocation under 
     paragraph (1) shall not be made until the first fiscal year 
     for which the amount appropriated under section 2677 for the 
     fiscal year involved and available for carrying out part B is 
     an increase of not less than $20,000,000 over the amount so 
     appropriated and available for fiscal year 2000, subject to 
     subparagraph (C).
       ``(C) Exclusion regarding separate treatment drug grants.--
     Each determination under subparagraph (A) or (B) of the 
     amount appropriated under section 2677 for a fiscal year and 
     available for carrying out part B shall be made without 
     regard to any amount to which section 2618(b)(2)(I)(i) 
     applies.''.

Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission 
                                 of HIV

     SEC. 211. REPEALS.

       Subpart II of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-33 et seq.) is amended--
       (1) in section 2626, by striking each of subsections (d) 
     through (f); and
       (2) by striking section 2627.

     SEC. 212. GRANTS.

       (a) In General.--Section 2625(c) of the Public Health 
     Service Act (42 U.S.C. 300ff-33) is amended--
       (1) in paragraph (1), by inserting at the end the following 
     subparagraph:
       ``(F) Making available to pregnant women with HIV disease, 
     and to the infants of women with such disease, treatment 
     services for such disease in accordance with applicable 
     recommendations of the Secretary.'';
       (2) by amending paragraph (2) to read as follows:
       ``(2) Funding.--
       ``(A) Authorization of appropriations.--For the purpose of 
     carrying out this subsection, there are authorized to be 
     appropriated $30,000,000 for each of the fiscal years 2001 
     through 2005. Amounts made available under section 2677 for 
     carrying out this part are not available for carrying out 
     this section unless otherwise authorized.
       ``(B) Allocations for certain states.--
       ``(i) In general.--Of the amounts appropriated under 
     subparagraph (A) for a fiscal year in excess of $10,000,000, 
     the Secretary shall reserve the applicable percentage under 
     clause (ii) for making grants under paragraph (1) to States 
     that under law (including under regulations or the discretion 
     of State officials) have--

       ``(I) a requirement that all newborn infants born in the 
     State be tested for HIV disease; or
       ``(II) a requirement that newborn infants born in the State 
     be tested for HIV disease in circumstances in which the 
     attending obstetrician for the birth does not know the HIV 
     status of the mother of the infant.

       ``(ii) Applicable percentage.--For purposes of clause (i), 
     the applicable amount for a fiscal year is as follows:

       ``(I) For fiscal year 2001, 25 percent.
       ``(II) For fiscal year 2002, 50 percent.

[[Page H6967]]

       ``(III) For fiscal year 2003, 50 percent.
       ``(IV) For fiscal year 2004, 75 percent.
       ``(V) For fiscal year 2005, 75 percent.

       ``(C) Certain provisions.--With respect to grants under 
     paragraph (1) that are made with amounts reserved under 
     subparagraph (B) of this paragraph:
       ``(i) Such a grant may not be made in an amount exceeding 
     $4,000,000.
       ``(ii) If pursuant to clause (i) or pursuant to an 
     insufficient number of qualifying applications for such 
     grants (or both), the full amount reserved under subparagraph 
     (B) for a fiscal year is not obligated, the requirement under 
     such subparagraph to reserve amounts ceases to apply.''; and
       (3) by adding at the end the following paragraph:
       ``(4) Maintenance of effort.--A condition for the receipt 
     of a grant under paragraph (1) is that the State involved 
     agree that the grant will be used to supplement and not 
     supplant other funds available to the State to carry out the 
     purposes of the grant.''.
       (b) Special Funding Rule for Fiscal Year 2001.--
       (1) In general.--If for fiscal year 2001 the amount 
     appropriated under paragraph (2)(A) of section 2625(c) of the 
     Public Health Service Act is less than $14,000,000--
       (A) the Secretary of Health and Human Services shall, for 
     the purpose of making grants under paragraph (1) of such 
     section, reserve from the amount specified in paragraph (2) 
     of this subsection an amount equal to the difference between 
     $14,000,000 and the amount appropriated under paragraph 
     (2)(A) of such section for such fiscal year;
       (B) the amount so reserved shall, for purposes of paragraph 
     (2)(B)(i) of such section, be considered to have been 
     appropriated under paragraph (2)(A) of such section; and
       (C) the percentage specified in paragraph (2)(B)(ii)(I) of 
     such section is deemed to be 50 percent.
       (2) Allocation from increases in funding for part b.--For 
     purposes of paragraph (1), the amount specified in this 
     paragraph is the amount by which the amount appropriated 
     under section 2677 of the Public Health Service Act for 
     fiscal year 2001 and available for grants under section 2611 
     of such Act is an increase over the amount so appropriated 
     and available for fiscal year 2000.

     SEC. 213. STUDY BY INSTITUTE OF MEDICINE.

       Subpart II of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-33 et seq.) is amended by adding 
     at the end the following section:

     ``SEC. 2630. RECOMMENDATIONS FOR REDUCING INCIDENCE OF 
                   PERINATAL TRANSMISSION.

       ``(a) Study by Institute of Medicine.--
       ``(1) In general.--The Secretary shall request the 
     Institute of Medicine to enter into an agreement with the 
     Secretary under which such Institute conducts a study to 
     provide the following:
       ``(A) For the most recent fiscal year for which the 
     information is available, a determination of the number of 
     newborn infants with HIV born in the United States with 
     respect to whom the attending obstetrician for the birth did 
     not know the HIV status of the mother.
       ``(B) A determination for each State of any barriers, 
     including legal barriers, that prevent or discourage an 
     obstetrician from making it a routine practice to offer 
     pregnant women an HIV test and a routine practice to test 
     newborn infants for HIV disease in circumstances in which the 
     obstetrician does not know the HIV status of the mother of 
     the infant.
       ``(C) Recommendations for each State for reducing the 
     incidence of cases of the perinatal transmission of HIV, 
     including recommendations on removing the barriers identified 
     under subparagraph (B).
     If such Institute declines to conduct the study, the 
     Secretary shall enter into an agreement with another 
     appropriate public or nonprofit private entity to conduct the 
     study.
       ``(2) Report.--The Secretary shall ensure that, not later 
     than 18 months after the effective date of this section, the 
     study required in paragraph (1) is completed and a report 
     describing the findings made in the study is submitted to the 
     appropriate committees of the Congress, the Secretary, and 
     the chief public health official of each of the States.
       ``(b) Progress Toward Recommendations.--Each State shall 
     comply with the following (as applicable to the fiscal year 
     involved):
       ``(1) For fiscal year 2004, the State shall submit to the 
     Secretary a report describing the actions taken by the State 
     toward meeting the recommendations specified for the State 
     under subsection (a)(1)(C).
       ``(2) For fiscal year 2005 and each subsequent fiscal 
     year--
       ``(A) the State shall make reasonable progress toward 
     meeting such recommendations; or
       ``(B) if the State has not made such progress--
       ``(i) the State shall cooperate with the Director of the 
     Centers for Disease Control and Prevention in carrying out 
     activities toward meeting the recommendations; and
       ``(ii) the State shall submit to the Secretary a report 
     containing a description of any barriers identified under 
     subsection (a)(1)(B) that continue to exist in the State; as 
     applicable, the factors underlying the continued existence of 
     such barriers; and a description of how the State intends to 
     reduce the incidence of cases of the perinatal transmission 
     of HIV.
       ``(c) Submission of Reports to Congress.--The Secretary 
     shall submit to the appropriate committees of the Congress 
     each report received by the Secretary under subsection 
     (b)(2)(B)(ii).''.

           Subtitle C--Certain Partner Notification Programs

     SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICATION PROGRAMS.

       Part B of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-21 et seq.) is amended by adding at the end the 
     following subpart:

          ``Subpart III--Certain Partner Notification Programs

     ``SEC. 2631. GRANTS FOR PARTNER NOTIFICATION PROGRAMS.

       ``(a) In General.--In the case of States whose laws or 
     regulations are in accordance with subsection (b), the 
     Secretary, subject to subsection (c)(2), may make grants to 
     the States for carrying out programs to provide partner 
     counseling and referral services.
       ``(b) Description of Compliant State Programs.--For 
     purposes of subsection (a), the laws or regulations of a 
     State are in accordance with this subsection if under such 
     laws or regulations (including programs carried out pursuant 
     to the discretion of State officials) the following policies 
     are in effect:
       ``(1) The State requires that the public health officer of 
     the State carry out a program of partner notification to 
     inform partners of individuals with HIV disease that the 
     partners may have been exposed to the disease.
       ``(2)(A) In the case of a health entity that provides for 
     the performance on an individual of a test for HIV disease, 
     or that treats the individual for the disease, the State 
     requires, subject to subparagraph (B), that the entity 
     confidentially report the positive test results to the State 
     public health officer in a manner recommended and approved by 
     the Director of the Centers for Disease Control and 
     Prevention, together with such additional information as may 
     be necessary for carrying out such program.
       ``(B) The State may provide that the requirement of 
     subparagraph (A) does not apply to the testing of an 
     individual for HIV disease if the individual underwent the 
     testing through a program designed to perform the test and 
     provide the results to the individual without the individual 
     disclosing his or her identity to the program. This 
     subparagraph may not be construed as affecting the 
     requirement of subparagraph (A) with respect to a health 
     entity that treats an individual for HIV disease.
       ``(3) The program under paragraph (1) is carried out in 
     accordance with the following:
       ``(A) Partners are provided with an appropriate opportunity 
     to learn that the partners have been exposed to HIV disease, 
     subject to subparagraph (B).
       ``(B) The State does not inform partners of the identity of 
     the infected individuals involved.
       ``(C) Counseling and testing for HIV disease are made 
     available to the partners and to infected individuals, and 
     such counseling includes information on modes of transmission 
     for the disease, including information on prenatal and 
     perinatal transmission and preventing transmission.
       ``(D) Counseling of infected individuals and their partners 
     includes the provision of information regarding therapeutic 
     measures for preventing and treating the deterioration of the 
     immune system and conditions arising from the disease, and 
     the provision of other prevention-related information.
       ``(E) Referrals for appropriate services are provided to 
     partners and infected individuals, including referrals for 
     support services and legal aid.
       ``(F) Notifications under subparagraph (A) are provided in 
     person, unless doing so is an unreasonable burden on the 
     State.
       ``(G) There is no criminal or civil penalty on, or civil 
     liability for, an infected individual if the individual 
     chooses not to identify the partners of the individual, or 
     the individual does not otherwise cooperate with such 
     program.
       ``(H) The failure of the State to notify partners is not a 
     basis for the civil liability of any health entity who under 
     the program reported to the State the identity of the 
     infected individual involved.
       ``(I) The State provides that the provisions of the program 
     may not be construed as prohibiting the State from providing 
     a notification under subparagraph (A) without the consent of 
     the infected individual involved.
       ``(4) The State annually reports to the Director of the 
     Centers for Disease Control and Prevention the number of 
     individuals from whom the names of partners have been sought 
     under the program under paragraph (1), the number of such 
     individuals who provided the names of partners, and the 
     number of partners so named who were notified under the 
     program.
       ``(5) The State cooperates with such Director in carrying 
     out a national program of partner notification, including the 
     sharing of information between the public health officers of 
     the States.
       ``(c) Reporting System for Cases of HIV Disease.--
       ``(1) Preference in making grants through fiscal year 
     2003.--In making grants under subsection (a) for each of the 
     fiscal years 2001 through 2003, the Secretary shall give 
     preference to States whose reporting systems for cases of HIV 
     disease produce data on such cases that is sufficiently 
     accurate and reliable for use for purposes of section 
     2618(b)(2)(D)(i).
       ``(2) Eligibility condition after fiscal year 2003.--For 
     fiscal year 2004 and subsequent fiscal years, a State may not 
     receive a grant under subsection (a) unless the reporting 
     system of the State for cases of HIV disease produces data on 
     such cases that is sufficiently accurate and reliable for 
     purposes of section 2618(b)(2)(D)(i).
       ``(d) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $30,000,000 for fiscal year 2001, and such sums 
     as may be necessary for each of the fiscal years 2002 through 
     2005.''.

[[Page H6968]]

                 TITLE III--EARLY INTERVENTION SERVICES

                 Subtitle A--Formula Grants for States

     SEC. 301. REPEAL OF PROGRAM.

       Subpart I of part C of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-41 et seq.) is repealed.

                     Subtitle B--Categorical Grants

     SEC. 311. PREFERENCES IN MAKING GRANTS.

       Section 2653 of the Public Health Service Act (42 U.S.C. 
     300ff-53) is amended by adding at the end the following 
     subsection:
       ``(d) Underserved and Rural Areas.--Of the applicants who 
     qualify for preference under this section, the Secretary 
     shall give preference to applicants that will expend the 
     grant under section 2651 to provide early intervention under 
     such section in rural areas or in areas that are underserved 
     with respect to such services.''.

     SEC. 312. PLANNING AND DEVELOPMENT GRANTS.

       (a) In General.--Section 2654(c)(1) of the Public Health 
     Service Act (42 U.S.C. 300ff-54(c)(1)) is amended by striking 
     ``planning grants'' and all that follows and inserting the 
     following: ``planning grants to public and nonprofit private 
     entities for purposes of--
       ``(A) enabling such entities to provide HIV early 
     intervention services; and
       ``(B) assisting the entities in expanding their capacity to 
     provide HIV-related health services, including early 
     intervention services, in low-income communities and affected 
     subpopulations that are underserved with respect to such 
     services (subject to the condition that a grant pursuant to 
     this subparagraph may not be expended to purchase or improve 
     land, or to purchase, construct, or permanently improve, 
     other than minor remodeling, any building or other 
     facility).''.
       (b) Amount; Duration.--Section 2654(c) of the Public Health 
     Service Act (42 U.S.C. 300ff-54(c)) is further amended--
       (1) by redesignating paragraph (4) as paragraph (5); and
       (2) by inserting after paragraph (3) the following:
       ``(4) Amount and duration of grants.--
       ``(A) Early intervention services.--A grant under paragraph 
     (1)(A) may be made in an amount not to exceed $50,000.
       ``(B) Capacity development.--
       ``(i) Amount.--A grant under paragraph (1)(B) may be made 
     in an amount not to exceed $150,000.
       ``(ii) Duration.--The total duration of a grant under 
     paragraph (1)(B), including any renewal, may not exceed 3 
     years.''.
       (c) Increase in Limitation.--Section 2654(c)(5) of the 
     Public Health Service Act (42 U.S.C. 300ff-54(c)(5)), as 
     redesignated by subsection (b), is amended by striking ``1 
     percent'' and inserting ``5 percent''.

     SEC. 313. AUTHORIZATION OF APPROPRIATIONS.

       Section 2655 of the Public Health Service Act (42 U.S.C. 
     300ff-55) is amended by striking ``in each of'' and all that 
     follows and inserting ``for each of the fiscal years 2001 
     through 2005.''.

                     Subtitle C--General Provisions

     SEC. 321. PROVISION OF CERTAIN COUNSELING SERVICES.

       Section 2662(c)(3) of the Public Health Service Act (42 
     U.S.C. 300ff-62(c)(3)) is amended--
       (1) in the matter preceding subparagraph (A), by striking 
     ``counseling on--'' and inserting ``counseling--'';
       (2) in each of subparagraphs (A), (B), and (D), by 
     inserting ``on'' after the subparagraph designation; and
       (3) in subparagraph (C)--
       (A) by striking ``(C) the benefits'' and inserting ``(C)(i) 
     that explains the benefits''; and
       (B) by inserting after clause (i) (as designated by 
     subparagraph (A) of this paragraph) the following clause:
       ``(ii) that emphasizes it is the duty of infected 
     individuals to disclose their infected status to their sexual 
     partners and their partners in the sharing of hypodermic 
     needles; that provides advice to infected individuals on the 
     manner in which such disclosures can be made; and that 
     emphasizes that it is the continuing duty of the individuals 
     to avoid any behaviors that will expose others to HIV;

     SEC. 322. ADDITIONAL REQUIRED AGREEMENTS.

       Section 2664(g) of the Public Health Service Act (42 U.S.C. 
     300ff-64(g)) is amended--
       (1) in paragraph (3)--
       (A) by striking ``7.5 percent'' and inserting ``10 
     percent''; and
       (B) by striking ``and'' after the semicolon at the end;
       (2) in paragraph (4), by striking the period and inserting 
     ``; and''; and
       (3) by adding at the end the following paragraph:
       ``(5) the applicant will provide for the establishment of a 
     quality management program to assess the extent to which 
     medical services funded under this title that are provided to 
     patients are consistent with the most recent Public Health 
     Service guidelines for the treatment of HIV disease and 
     related opportunistic infections and that improvements in the 
     access to and quality of medical services are addressed.''.

                TITLE IV--OTHER PROGRAMS AND ACTIVITIES

 Subtitle A--Certain Programs for Research, Demonstrations, or Training

     SEC. 401. GRANTS FOR COORDINATED SERVICES AND ACCESS TO 
                   RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND 
                   YOUTH.

       Section 2671 of the Public Health Service Act (42 U.S.C. 
     300ff-71) is amended--
       (1) in subsection (b)--
       (A) in paragraph (1), by striking subparagraphs (C) and (D) 
     and inserting the following:
       ``(C) The applicant will demonstrate linkages to research 
     and how access to such research is being offered to 
     patients.''; and
       (B) by striking paragraphs (3) and (4);
       (2) in subsection (g), by adding at the end the following: 
     ``In addition, the Secretary, in coordination with the 
     Director of such Institutes, shall examine the distribution 
     and availability of appropriate HIV-related research projects 
     with respect to grantees under subsection (a) for purposes of 
     enhancing and expanding HIV-related research, especially 
     within communities that are underrepresented with respect to 
     such projects.'';
       (3) in subsection (f)--
       (A) by striking the subsection heading and designation and 
     inserting the following:
       ``(f) Administration.--
       ``(1) Application.--''; and
       (B) by adding at the end the following paragraph:
       ``(2) Quality management program.--A grantee under this 
     section shall implement a quality management program.''; and
       (4) in subsection (j), by striking ``1996 through 2000'' 
     and inserting ``2001 through 2005''.

     SEC. 402. AIDS EDUCATION AND TRAINING CENTERS.

       (a) Schools; Centers.--
       (1) In general.--Section 2692(a)(1) of the Public Health 
     Service Act (42 U.S.C. 300ff-111(a)(1)) is amended--
       (A) in subparagraph (A)--
       (i) by striking ``training'' and inserting ``to train'';
       (ii) by striking ``and including'' and inserting ``, 
     including''; and
       (iii) by inserting before the semicolon the following: ``, 
     and including (as applicable to the type of health 
     professional involved), prenatal and other gynecological care 
     for women with HIV disease'';
       (B) in subparagraph (B), by striking ``and'' after the 
     semicolon at the end;
       (C) in subparagraph (C), by striking the period and 
     inserting ``; and''; and
       (D) by adding at the end the following:
       ``(D) to develop protocols for the medical care of women 
     with HIV disease, including prenatal and other gynecological 
     care for such women.''.
       (2) Dissemination of treatment guidelines; medical 
     consultation activities.--Not later than 90 days after the 
     date of the enactment of this Act, the Secretary of Health 
     and Human Services shall issue and begin implementation of a 
     strategy for the dissemination of HIV treatment information 
     to health care providers and patients.
       (b) Dental Schools.--Section 2692(b) of the Public Health 
     Service Act (42 U.S.C. 300ff-111(b)) is amended--
       (1) by amending paragraph (1) to read as follows:
       ``(1) In general.--
       ``(A) Grants.--The Secretary may make grants to dental 
     schools and programs described in subparagraph (B) to assist 
     such schools and programs with respect to oral health care to 
     patients with HIV disease.
       ``(B) Eligible applicants.--For purposes of this 
     subsection, the dental schools and programs referred to in 
     this subparagraph are dental schools and programs that were 
     described in section 777(b)(4)(B) as such section was in 
     effect on the day before the date of enactment of the Health 
     Professions Education Partnerships Act of 1998 (Public Law 
     105-392) and in addition dental hygiene programs that are 
     accredited by the Commission on Dental Accreditation.'';
       (2) in paragraph (2), by striking ``777(b)(4)(B)'' and 
     inserting ``the section referred to in paragraph (1)(B)''; 
     and
       (3) by inserting after paragraph (4) the following 
     paragraph:
       ``(5) Community-based care.--The Secretary may make grants 
     to dental schools and programs described in paragraph (1)(B) 
     that partner with community-based dentists to provide oral 
     health care to patients with HIV disease in unserved areas. 
     Such partnerships shall permit the training of dental 
     students and residents and the participation of community 
     dentists as adjunct faculty.''.
       (c) Authorization of Appropriations.--
       (1) Schools; centers.--Section 2692(c)(1) of the Public 
     Health Service Act (42 U.S.C. 300ff-111(c)(1)) is amended by 
     striking ``fiscal years 1996 through 2000'' and inserting 
     ``fiscal years 2001 through 2005''.
       (2) Dental schools.--Section 2692(c)(2) of the Public 
     Health Service Act (42 U.S.C. 300ff-111(c)(2)) is amended to 
     read as follows:
       ``(2) Dental schools.--
       ``(A) In general.--For the purpose of grants under 
     paragraphs (1) through (4) of subsection (b), there are 
     authorized to be appropriated such sums as may be necessary 
     for each of the fiscal years 2001 through 2005.
       ``(B) Community-based care.--For the purpose of grants 
     under subsection (b)(5), there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2001 through 2005.''.

              Subtitle B--General Provisions in Title XXVI

     SEC. 411. EVALUATIONS AND REPORTS.

       Section 2674(c) of the Public Health Service Act (42 U.S.C. 
     300ff-74(c)) is amended by striking ``1991 through 1995'' and 
     inserting ``2001 through 2005''.

     SEC. 412. DATA COLLECTION THROUGH CENTERS FOR DISEASE CONTROL 
                   AND PREVENTION.

       Part D of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-71 et seq.) is amended--
       (1) by redesignating section 2675 as section 2675A; and
       (2) by inserting after section 2674 the following section:

     ``SEC. 2675. DATA COLLECTION.

       ``For the purpose of collecting and providing data for 
     program planning and evaluation activities under this title, 
     there are authorized to

[[Page H6969]]

     be appropriated to the Secretary (acting through the Director 
     of the Centers for Disease Control and Prevention) such sums 
     as may be necessary for each of the fiscal years 2001 through 
     2005. Such authorization of appropriations is in addition to 
     other authorizations of appropriations that are available for 
     such purpose.''.

     SEC. 413. COORDINATION.

       Section 2675A of the Public Health Service Act, as 
     redesignated by section 412 of this Act, is amended--
       (1) by amending subsection (a) to read as follows:
       ``(a) Requirement.--The Secretary shall ensure that the 
     Health Resources and Services Administration, the Centers for 
     Disease Control and Prevention, the Substance Abuse and 
     Mental Health Services Administration, and the Health Care 
     Financing Administration coordinate the planning, funding, 
     and implementation of Federal HIV programs to enhance the 
     continuity of care and prevention services for individuals 
     with HIV disease or those at risk of such disease. The 
     Secretary shall consult with other Federal agencies, 
     including the Department of Veterans Affairs, as needed and 
     utilize planning information submitted to such agencies by 
     the States and entities eligible for support.'';
       (2) by redesignating subsections (b) and (c) as subsections 
     (c) and (d), respectively;
       (3) by inserting after subsection (b) the following 
     subsection:
       ``(b) Report.--The Secretary shall biennially prepare and 
     submit to the appropriate committees of the Congress a report 
     concerning the coordination efforts at the Federal, State, 
     and local levels described in this section, including a 
     description of Federal barriers to HIV program integration 
     and a strategy for eliminating such barriers and enhancing 
     the continuity of care and prevention services for 
     individuals with HIV disease or those at risk of such 
     disease.''; and
       (4) in each of subsections (c) and (d) (as redesignated by 
     paragraph (2) of this section), by inserting ``and prevention 
     services'' after ``continuity of care'' each place such term 
     appears.

     SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH HIV 
                   DISEASE.

       Section 2675A of the Public Health Service Act, as amended 
     by section 413(2) of this Act, is amended by adding at the 
     end the following subsection:
       ``(e) Recommendations Regarding Release of Prisoners.--
     After consultation with the Attorney General and the Director 
     of the Bureau of Prisons, with States, with eligible areas 
     under part A, and with entities that receive amounts from 
     grants under part A or B, the Secretary, consistent with the 
     coordination required in subsection (a), shall develop a plan 
     for the medical case management of and the provision of 
     support services to individuals who were Federal or State 
     prisoners and had HIV disease as of the date on which the 
     individuals were released from the custody of the penal 
     system. The Secretary shall submit the plan to the Congress 
     not later than two years after the date of the enactment of 
     the Ryan White CARE Act Amendments of 2000.''.

     SEC. 415. AUDITS.

       Part D of title XXVI of the Public Health Service Act, as 
     amended by section 412 of this Act, is amended by inserting 
     after section 2675A the following section:

     ``SEC. 2675B. AUDITS.

       ``For fiscal year 2002 and subsequent fiscal years, the 
     Secretary may reduce the amounts of grants under this title 
     to a State or political subdivision of a State for a fiscal 
     year if, with respect to such grants for the second preceding 
     fiscal year, the State or subdivision fails to prepare audits 
     in accordance with the procedures of section 7502 of title 
     31, United States Code. The Secretary shall annually select 
     representative samples of such audits, prepare summaries of 
     the selected audits, and submit the summaries to the 
     Congress.''.

     SEC. 416. ADMINISTRATIVE SIMPLIFICATION.

       Part D of title XXVI of the Public Health Service Act, as 
     amended by section 415 of this Act, is amended by inserting 
     after section 2675B the following section:

     ``SEC. 2675C. ADMINISTRATIVE SIMPLIFICATION REGARDING PARTS A 
                   AND B.

       ``(a) Coordinated Disbursement.--After consultation with 
     the States, with eligible areas under part A, and with 
     entities that receive amounts from grants under part A or B, 
     the Secretary shall develop a plan for coordinating the 
     disbursement of appropriations for grants under part A with 
     the disbursement of appropriations for grants under part B in 
     order to assist grantees and other recipients of amounts from 
     such grants in complying with the requirements of such parts. 
     The Secretary shall submit the plan to the Congress not later 
     than 18 months after the date of the enactment of the Ryan 
     White CARE Act Amendments of 2000. Not later than two years 
     after the date on which the plan is so submitted, the 
     Secretary shall complete the implementation of the plan, 
     notwithstanding any provision of this title that is 
     inconsistent with the plan.
       ``(b) Biennial Applications.--After consultation with the 
     States, with eligible areas under part A, and with entities 
     that receive amounts from grants under part A or B, the 
     Secretary shall make a determination of whether the 
     administration of parts A and B by the Secretary, and the 
     efficiency of grantees under such parts in complying with the 
     requirements of such parts, would be improved by requiring 
     that applications for grants under such parts be submitted 
     biennially rather than annually. The Secretary shall submit 
     such determination to the Congress not later than two years 
     after the date of the enactment of the Ryan White CARE Act 
     Amendments of 2000.
       ``(c) Application Simplification.--After consultation with 
     the States, with eligible areas under part A, and with 
     entities that receive amounts from grants under part A or B, 
     the Secretary shall develop a plan for simplifying the 
     process for applications under parts A and B. The Secretary 
     shall submit the plan to the Congress not later than 18 
     months after the date of the enactment of the Ryan White CARE 
     Act Amendments of 2000. Not later than two years after the 
     date on which the plan is so submitted, the Secretary shall 
     complete the implementation of the plan, notwithstanding any 
     provision of this title that is inconsistent with the 
     plan.''.

     SEC. 417. AUTHORIZATION OF APPROPRIATIONS FOR PARTS A AND B.

       Section 2677 of the Public Health Service Act (42 U.S.C. 
     300ff-77) is amended to read as follows:

     ``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) Part A.--For the purpose of carrying out part A, 
     there are authorized to be appropriated such sums as may be 
     necessary for each of the fiscal years 2001 through 2005.
       ``(b) Part B.--For the purpose of carrying out part B, 
     there are authorized to be appropriated such sums as may be 
     necessary for each of the fiscal years 2001 through 2005.''.

                      TITLE V--GENERAL PROVISIONS

     SEC. 501. STUDIES BY INSTITUTE OF MEDICINE.

       (a) State Surveillance Systems on Prevalence of HIV.--The 
     Secretary of Health and Human Services (referred to in this 
     section as the ``Secretary'') shall request the Institute of 
     Medicine to enter into an agreement with the Secretary under 
     which such Institute conducts a study to provide the 
     following:
       (1) A determination of whether the surveillance system of 
     each of the States regarding the human immunodeficiency virus 
     provides for the reporting of cases of infection with the 
     virus in a manner that is sufficient to provide adequate and 
     reliable information on the number of such cases and the 
     demographic characteristics of such cases, both for the State 
     in general and for specific geographic areas in the State.
       (2) A determination of whether such information is 
     sufficiently accurate for purposes of formula grants under 
     parts A and B of title XXVI of the Public Health Service Act.
       (3) With respect to any State whose surveillance system 
     does not provide adequate and reliable information on cases 
     of infection with the virus, recommendations regarding the 
     manner in which the State can improve the system.
       (b) Relationship Between Epidemiological Measures and 
     Health Care for Certain Individuals With HIV Disease.--
       (1) In general.--The Secretary shall request the Institute 
     of Medicine to enter into an agreement with the Secretary 
     under which such Institute conducts a study concerning the 
     appropriate epidemiological measures and their relationship 
     to the financing and delivery of primary care and health-
     related support services for low-income, uninsured, and 
     under-insured individuals with HIV disease.
       (2) Issues to be considered.--The Secretary shall ensure 
     that the study under paragraph (1) considers the following:
       (A) The availability and utility of health outcomes 
     measures and data for HIV primary care and support services 
     and the extent to which those measures and data could be used 
     to measure the quality of such funded services.
       (B) The effectiveness and efficiency of service delivery 
     (including the quality of services, health outcomes, and 
     resource use) within the context of a changing health care 
     and therapeutic environment, as well as the changing 
     epidemiology of the epidemic, including determining the 
     actual costs, potential savings, and overall financial impact 
     of modifying the program under title XIX of the Social 
     Security Act to establish eligibility for medical assistance 
     under such title on the basis of infection with the human 
     immunodeficiency virus rather than providing such assistance 
     only if the infection has progressed to acquired immune 
     deficiency syndrome.
       (C) Existing and needed epidemiological data and other 
     analytic tools for resource planning and allocation 
     decisions, specifically for estimating severity of need of a 
     community and the relationship to the allocations process.
       (D) Other factors determined to be relevant to assessing an 
     individual's or community's ability to gain and sustain 
     access to quality HIV services.
       (c) Other Entities.--If the Institute of Medicine declines 
     to conduct a study under this section, the Secretary shall 
     enter into an agreement with another appropriate public or 
     nonprofit private entity to conduct the study.
       (d) Report.--The Secretary shall ensure that--
       (1) not later than three years after the date of the 
     enactment of this Act, the study required in subsection (a) 
     is completed and a report describing the findings made in the 
     study is submitted to the appropriate committees of the 
     Congress; and
       (2) not later than two years after the date of the 
     enactment of this Act, the study required in subsection (b) 
     is completed and a report describing the findings made in the 
     study is submitted to such committees.

     SEC. 502. DEVELOPMENT OF RAPID HIV TEST.

       (a) Expansion, Intensification, and Coordination of 
     Research and Other Activities.--
       (1) In general.--The Director of NIH shall expand, 
     intensify, and coordinate research and other activities of 
     the National Institutes of Health with respect to the 
     development of reliable and affordable tests for HIV disease 
     that can rapidly be administered and whose results can 
     rapidly be obtained (in this section referred to a ``rapid 
     HIV test'').
       (2) Report to congress.--The Director of NIH shall 
     periodically submit to the appropriate

[[Page H6970]]

     committees of Congress a report describing the research and 
     other activities conducted or supported under paragraph (1).
       (3) Authorization of appropriations.--For the purpose of 
     carrying out this subsection, there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2001 through 2005.
       (b) Premarket Review of Rapid HIV Tests.--
       (1) In general.--Not later than 90 days after the date of 
     the enactment of this Act, the Secretary, in consultation 
     with the Director of the Centers for Disease Control and 
     Prevention and the Commissioner of Food and Drugs, shall 
     submit to the appropriate committees of the Congress a report 
     describing the progress made towards, and barriers to, the 
     premarket review and commercial distribution of rapid HIV 
     tests. The report shall--
       (A) assess the public health need for and public health 
     benefits of rapid HIV tests, including the minimization of 
     false positive results through the availability of multiple 
     rapid HIV tests;
       (B) make recommendations regarding the need for the 
     expedited review of rapid HIV test applications submitted to 
     the Center for Biologics Evaluation and Research and, if such 
     recommendations are favorable, specify criteria and 
     procedures for such expedited review; and
       (C) specify whether the barriers to the premarket review of 
     rapid HIV tests include the unnecessary application of 
     requirements--
       (i) necessary to ensure the efficacy of devices for donor 
     screening to rapid HIV tests intended for use in other 
     screening situations; or
       (ii) for identifying antibodies to HIV subtypes of rare 
     incidence in the United States to rapid HIV tests intended 
     for use in screening situations other than donor screening.
       (c) Guidelines of Centers for Disease Control and 
     Prevention.--Promptly after commercial distribution of a 
     rapid HIV test begins, the Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall establish or update guidelines that include 
     recommendations for States, hospitals, and other appropriate 
     entities regarding the ready availability of such tests for 
     administration to pregnant women who are in labor or in the 
     late stage of pregnancy and whose HIV status is not known to 
     the attending obstetrician.

                        TITLE VI--EFFECTIVE DATE

     SEC. 601. EFFECTIVE DATE.

       This Act and the amendments made by this Act take effect 
     October 1, 2000, or upon the date of the enactment of this 
     Act, whichever occurs later.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Oklahoma (Mr. Coburn) and the gentleman from New York (Mr. Rangel) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Oklahoma (Mr. Coburn).


                             General Leave

  Mr. COBURN. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days within which to revise and extend their remarks 
and insert extraneous material on H.R. 4807, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Oklahoma?
  There was no objection.
  Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I want to make a statement. We are getting ready to talk 
a bill that will spend $7.1 billion over the next 5 years. We have 32 
minutes to do it in; that is about $215 million a minute as we talk. I 
think it is unconscionable that we are doing this at this time at 
night, where the American public cannot see the extent of this epidemic 
and the problems we have facing it, the way the epidemic has moved into 
our minority communities, unfortunately, and in a greater rate than in 
any other communities, and that we are not going to put the resources 
that are necessarily needed to address that.
  Mr. Speaker, I would just make that point; that this is the wrong 
time of the evening for us to be doing this. I stand here embarrassed 
that we are not going to be able to have an opportunity to educate the 
American public about the needs that are addressed in this bill.
  Mr. Speaker, first of all, we need to recognize Jeanne White and the 
loss that she had and her vigor and desire to bring forward a bill to 
care for people with HIV. We have spent a lot of money in this country 
already, some of it very successfully, some of it not very 
successfully; but we have with this bill made some very significant 
major changes in this legislation.
  In 1988, a Presidential commission made recommendations to the 
Congress and to the Government on what we should do. One of the things 
that they described in that report is the importance that should be 
placed on prevention. We have heard our grandmoms tell us for years 
that an ounce of prevention is worth a pound of cure.

                              {time}  2330

  We know that. And I am very thankful for the gentleman from 
California (Mr. Waxman) and his staff as we have been able to work 
together and with others on the other side of the aisle to bring to the 
body this bill. Again, I think it is very unfortunate that we, in fact, 
are doing this at this time.
  There are several other components to the bill that we will discuss 
as we proceed through it.
  Mr. Speaker, I include the report referred to earlier.

  Report of The Presidential Commission on the Human Immunodeficiency 
                             Virus Epidemic

     Submitted to The President of the United States, June 24, 1988

 Commissioners: Admiral James D. Watkins, Chairman, United States Navy 
  (Retired); Colleen Conway-Welch, Ph.D.; John J. Creedon; Theresa L. 
   Crenshaw, M.D.; Richard M. Devos; Kristine M. Gebbie, R.N., M.N.; 
   Burton James Lee III, M.D.; Frank Lilly, Ph.D.; His Eminence John 
 Cardinal O'Connor; Beny J. Primm, M.D.; Representative Penny Pullen; 
               Cory Servaas, M.D.; William B. Walsh, M.D.


                           executive summary

       The Human Immunodeficiency Virus (HIV) epidemic will be a 
     challenging factor in American life for years to come and 
     should be a concern to all Americans. Recent estimates 
     suggest that almost 500,000 Americans will have died or 
     progressed to later stages of the disease by 1992.
       Even this incredible number, however, does not reflect the 
     current gravity of the problem. One to 1.5 million Americans 
     are believed to be infected with the human immunodeficiency 
     virus but are not yet ill enough to realize it.
       The recommendations of the Commission seek to strike a 
     proper balance between our obligation as a society toward 
     those members of society who have HIV and those members of 
     society who do not have the virus. To slow or stop the spread 
     of the virus, to provide proper medical care for those who 
     have contracted the virus, and to protect the rights of both 
     infected and non-infected persons requires a careful 
     balancing of interests in a highly complex society.
       Knowledge is a critical weapon against HIV--knowledge about 
     the virus and how it is transmitted, knowledge of how to 
     maintain one's health, knowledge of one's own infection 
     status. It is critical too that knowledge lead to 
     responsibility toward oneself and others. It is the 
     responsibility of all Americans to become educated about HIV. 
     It is the responsibility of those infected not to infect 
     others. It is the responsibility of all citizens to treat 
     those infected with HIV with respect and compassion. All 
     individuals should be responsible for their actions and the 
     consequences of those actions.
       The urgency and breadth of the nation's HIV research effort 
     is without precedent in the history of the Federal 
     Government's response to an infectious disease crisis. 
     However, we are a long way from all the answers. The 
     directing of more resources toward managing this epidemic is 
     critical; equally important is the judicious use of those 
     resources.
       The term ``AIDS'' is obsolete. ``HIV infection'' more 
     correctly defines the problem. The medical, public health, 
     political, and community leadership must focus on the full 
     course of HIV infection rather than concentrating on later 
     stages of the disease (ARC and AIDS). Continual focus on AIDS 
     rather than the entire spectrum of HIV disease has left our 
     nation unable to deal adequately with the epidemic. Federal 
     and state data collection efforts must now be focused on 
     early HIV reports, while still collecting data on symptomatic 
     disease.
       Early diagnosis of HIV infection is essential, not only for 
     proper medical treatment and counseling of the infected 
     person but also for proper follow-up by the public health 
     authorities. HIV infection, like other chronic conditions--
     heart disease, high blood pressure, diabetes, cancer--can be 
     treated more effectively when detected early. Therefore, HIV 
     tests should be offered regularly by health care providers in 
     order to increase the currently small percentage of those 
     infected who are aware of the fact and under appropriate 
     care. Since many manifestations of HIV are treatable, those 
     infected should have ready access to treatment for the 
     opportunistic infections which often prove fatal for those 
     with HIV.
       Better understanding of the true incidence and prevalence 
     of HIV infection is critical and can be developed only 
     through careful accumulation of data from greatly increased 
     testing. Quality assured testing should be easily accessible, 
     confidential, voluntary, and associated with appropriate 
     counseling and care services. At the present time, a 
     relatively small percentage of those infected with HIV are 
     aware of their infected status.
       Some preventive measures must be undertaken immediately.
       Public health authorities across the United States must 
     begin immediately to institute confidential partner 
     notification, the system by which intimate contacts of 
     persons carrying sexually transmitted diseases, including 
     HIV, are warned of their exposure.
       The HIV epidemic has highlighted several ethical 
     considerations and responsibilities, including:
       the responsibility of those who are HIV-infected not to 
     infect others;

[[Page H6971]]

       the responsibility of the health care community to offer 
     comprehensive and compassionate care to all HIV-infected 
     persons; and
       the responsibility of all citizens to treat HIV infected 
     persons with respect and compassion.
       The Commission believes that if the recommendations in this 
     report are fully implemented, we will have achieved the 
     delicate balance between the complex needs and 
     responsibilities encountered throughout our society when 
     responding to the HIV epidemic.


                         Modeling HIV Infection

       Disease surveillance began early in the epidemic, before 
     the human immunodeficiency virus (HIV) had been identified or 
     isolated, and before it was known that there could be a 
     lengthy period of infection prior to illness. Because at that 
     time it was possible to identify only those individuals in 
     whom disease are far enough advanced to be symptomatic, 
     monitoring the epidemic meant monitoring disease, rather than 
     monitoring infection. The early concentration on the clinical 
     manifestation of AIDS has had the unintended effect of 
     misleading the public as to the extent of the infection in 
     the population, from initial infection to sero-conversion, to 
     an antibody positive asymptomatic stage to initial indicative 
     symptoms to full-blown AIDS. Continued emphasis on AIDS has 
     also impeded long-term planning efforts necessary to 
     effectively allocate resources for prevention and health 
     care. Decisions on who will receive care, and whose costs 
     will be covered, focused only on those most seriously ill. 
     Continuing to use only the term ``AIDS'' to make treatment, 
     reimbursement, or prevention program decisions is 
     anachronistic and a policy we can no longer afford.
       While it is of value to continue monitoring diagnosed AIDS 
     cases, public policy and prevention efforts should be based 
     on an understanding of the extent and distribution of HIV in 
     the population and on the rate at which new infections occur. 
     This is especially critical in dealing with HIV, for which 
     the average length of time between infection and diagnosis is 
     at least eight years, according to the Institute of Medicine.
       It is critical that CDC begin now to collect HIV infection 
     data from the states, not just case reports.
       The success of any disease or infection surveillance effort 
     is dependent upon coordination at the national, state, and 
     local levels and the sharing of resources and expenses.
       The public health profession has a long tradition of 
     respectful, confidential handling of sensitive data and of 
     affected persons; those currently holding public health posts 
     and should be striving to build public confidence by 
     stressing the profession's traditional adherence to this 
     standard.
       Until CDC changes the focus of data collection from 
     diagnosed AIDS cases to HIV infections, effectiveness of 
     planning and intervention will be limited.
       As of March 1988, CDC acknowledged that a precise statement 
     of the prevalence and rate of spread of HIV infection in the 
     general population is still not available. Most analysts 
     concur with CDC that, based on presently available data, the 
     best estimate of seroprevalence is one million, with a range 
     of up to 1.5 million. Repeatedly, witnesses before the 
     Commission agreed that every reasonable effort should be made 
     to increase the precision of this number, and of the rate of 
     infection within specific population groups.


                         obstacles to progress

       The Commission has identified the following obstacles to a 
     nationwide effort to improve the public's response to and 
     participation in programs designed to quantify the HIV 
     epidemic at the federal, state and local levels:
       Continued focus on the label ``AIDS,'' contributing to lack 
     of understanding of the importance of HIV infection as the 
     more significant element for taking control of the epidemic.
       Lack of strong CDD leadership in the public health 
     community for obtaining and coordinating HIV infection data.
       Inadequate counseling resources to assist those tested 
     makes many support and interest groups reluctant to recommend 
     widespread HIV testing.


                            recommendations

       To respond to these obstacles, the Commission recommends 
     the following:
       The Centers for Disease Control must provide clear 
     direction for expanded and improved surveillance, including 
     endorsement and support by national leaders, other federal 
     agencies, and state and local leaders.
       States should require reporting of HIV infections. This 
     information should be given to the Centers for Disease 
     Control in appropriate form for statistical analysis, without 
     identifiers.


                        women with HIV infection

       With little exception, HIV research and programs have 
     focused exclusively on homosexual men and intravenous drug 
     users. As a result, there is limited information about the 
     course of HIV infection in women. Diagnosis of AIDS in women 
     may be late or less accurate because the natural history of 
     infection in women is so poorly understood to date. There is 
     some evidence to suggest that it differs from men. The 
     problem of women with HIV infection is particularly important 
     because it is directly linked to the rapid growth of the 
     pediatric AIDS population.
       The greatest number of AIDS cases among women occur in the 
     black and Hispanic populations. Of all cases of AIDS in 
     women, 51 percent are black, and 20 percent are Hispanic. The 
     routes of viral transmission are the same for women as for 
     men, but in women, HIV infection occurring directly from 
     intravenous drug use, and through heterosexual contact with 
     an infected man rank first and second, respectively.
       One of the most serious problems facing the HIV-infected 
     mother is the guilt she may feel after giving birth to an 
     infected child, her despair as she watches that child die, or 
     her anguish, knowing that after her own imminent death, she 
     will leave children behind.


                               minorities

       The impact of HIV infection on black and Hispanic 
     communities has been felt very strongly; individuals from 
     these groups comprise about 40 percent of all persons with 
     symptomatic HIV infection.
       Leadership is critically needed from major national 
     minority organizations and from churches in minority 
     communities.


                          partner notification

       Both public health practice and case law makes clear that 
     persons put at risk of exposure to an infectious disease 
     should be alerted to their exposure. The Commission believes 
     that there should be a process in place in every state by 
     which the official state health agency is responsible for 
     assuring that those persons put unsuspectingly at risk for 
     HIV infection are notified of that exposure. Such a process 
     will enable that agency to work with the infected individual 
     and the patient's primary health care provider to assure that 
     contacts are notified of their exposure and urged to take 
     advantage of the opportunity for testing and counseling.
       When interviewed appropriately, any person infected should 
     be able to identify one or more persons from whom the 
     infection may have come or to whom it may have been given. 
     There are options for contacting those persons and ensuring 
     that they, too, are aware of their risks. Those options 
     include patient-managed referral and professional-assisted 
     referral (with notification by an individual's health care 
     provider or with notification by the health department).
       As an example, consider the women who has been married for 
     30 years to a man who, unknown to her, is a bisexual, or the 
     person who believes he or she is involved in a completely 
     monogamous marriage when, in fact, his or her spouse has been 
     having sex with others. These people are completely ignorant 
     of their exposure to the virus and would probably remain so 
     until either their spouse, their child, or they, themselves, 
     developed the clinical symptoms of AIDS. The Commission 
     firmly believes in these individuals' right to be notified of 
     their possible exposure so that they can seek prompt medical 
     attention and avoid potentially exposing others.


                            recommendations

       The public health department has an obligation to ensure 
     that any partners are aware of their exposure to the virus.
  Mr. Speaker, I reserve the balance of my time.


                         Parliamentary Inquiry

  Mr. BROWN of Ohio. Mr. Speaker, I have a parliamentary inquiry.
  The SPEAKER pro tempore (Mr. Tancredo). The gentleman will state it.
  Mr. BROWN of Ohio. Mr. Speaker, the gentleman from Oklahoma (Mr. 
Coburn) implied that we had less than 20 minutes per side. How much 
time do we have?
  The SPEAKER pro tempore. The gentleman from Oklahoma was recognized 
for 20 minutes.
  Without objection, the gentleman from Ohio (Mr. Brown) is recognized 
for 20 minutes.
  There was no objection.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, the gentleman from Oklahoma (Mr. Coburn) complained 
about the lateness of the hour, and all of us concur with that. An 
issue as important as this was scheduled literally last among 35 
suspensions. We are behind tonight naming post offices, regarding 
celebrating anniversaries; we are after our sense of Congress 
resolution regarding the importance of families eating together, 
something we all support, but a Congressional resolution for that; 
recognizing the importance of children in the U.S. We obviously 
recognize that. But to put all of that before this, it is again the 
sort of do-nothing Republican leadership in Congress that makes these 
decisions to schedule bills as important as this that we bipartisanly 
agree on finally after negotiations to put this bill last.
  It is clearly not the way this Congress should operate. We should be 
doing this during the day when Members of Congress are awake and in 
this Chamber and watching from their offices. Instead we are doing a 
very, very important bill, the Ryan White CARE Act, in literally the 
middle of the night. Mr. Speaker, I think none of us approve of that 
kind of lack of leadership by Republicans in this Chamber.

[[Page H6972]]

  I want to commend the gentleman from Oklahoma (Mr. Coburn) for his 
work; the gentleman from California (Mr. Waxman) for his work; Roland 
Foster, in the office of the gentleman from Oklahoma (Mr. Coburn); Paul 
Kim, in the office of the gentleman from California (Mr. Waxman); and 
Ellie Dehoney, in my office, for their exceptional work on this 
legislation.
  The battle against HIV/AIDS is more than a medical challenge, 
although that challenge alone is overwhelming. It is a battle against 
ignorance, against intolerance, against apathy. It is a battle against 
isolation, against alienation, against despair. It is a battle against 
time, it is international, and it is down the street. AIDS is set to 
kill more people worldwide than World War I, World War II, the Korean 
War, and the Vietnam War combined.
  The Ryan White CARE Act responds to HIV/AIDS, not just as a public 
health crisis, but as a threat to the stability and cohesiveness of 
communities and the rights of individuals. It fights the medical 
epidemic with prevention and with treatment. It fights ignorance, it 
fights intolerance, it fights apathy with awareness, commitment and 
compassion, and it fights alienation, isolation and despair by engaging 
communities in a focus that emphasizes living with HIV/AIDS, not dying 
with it.
  The act was created in the memory of Ryan White, a young teenager who 
became a national hero in this fight. He was a hemophiliac and 
contracted HIV through a bad blood transfusion, but Ryan White fought 
against ignorance, fear and prejudice on behalf of all individuals with 
HIV/AIDS.
  Ryan White died on April 8, 1990, at the age of 18. Ten years later 
the law named after him carries on his legacy. The Ryan White CARE Act 
has made a tremendous difference in the lives of people living with 
HIV/AIDS.
  In my district, which includes much of Ohio's only title I eligible 
metropolitan area, Ryan White programs provide primary care and support 
services and the kinds of medication that contain HIV/AIDS into a 
chronic, rather than an acute illness. There is more to do and Ryan 
White will continue to play a pivotal role.
  In Ohio, while AIDS deaths have declined, the incidence of HIV/AIDS 
has increased dramatically. After declining steadily, the incidence 
among young gay males is on the rise. HIV/AIDS is expanding into new 
populations, while continuing to spread in those populations originally 
at risk.
  Prevention is vital, treatment is vital, The Ryan White programs are 
vital.
  Mr. Speaker, I ask for passage of this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. COBURN. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from Maryland (Mrs. Morella).
  Mrs. MORELLA. Mr. Speaker, I thank the gentleman for yielding me 
time. I thank the gentleman particularly for his leadership on this 
issue. We have always been very fortunate in this House to have his 
expertise.
  I want to commend the gentleman from California (Mr. Waxman), the 
gentleman from Ohio (Mr. Brown), and others, including the staff who 
have worked very hard on this.
  I do agree, this is one of the most important measures that we will 
be voting on. It has made a difference, it will continue to make a 
tremendous difference, and the need is now greater than ever. I urge my 
colleagues obviously to support this bill, H.R. 4807, unanimously.
  What the bill does is it reauthorizes and enhances care and treatment 
programs vital to the health and survival of Americans with HIV and 
AIDS. HIV/AIDS is not a disease that discriminates. It touches all. In 
fact, my State of Maryland is now known as one of the top ten states 
and territories reporting the highest number of AIDS cases. This is in 
part due to the pandemic growth of HIV and AIDS in rural areas and how 
AIDS is disproportionately affecting women, youth and communities of 
color.
  This is a good bill. It has strong bipartisan support. Our States 
need this bill to be passed. Women need it, our youth need it; yes, all 
Americans need it. I urge strong support of this measure.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 4 minutes to the gentleman 
from California (Mr. Waxman), the author of the first Ryan White Act a 
decade or so ago.
  Mr. WAXMAN. Mr. Speaker, I thank the gentleman for yielding time to 
me.
  Mr. Speaker, I want to commend the leadership of the House, the 
Republican leaders of the House for scheduling this bill. While it is 
11:36 in Washington, it is only 8:36 in California.
  Mr. Speaker, I rise also to urge my colleagues to support H.R. 4807. 
As the original author of the Ryan White CARE Act and the coauthor of 
H.R. 4807, I am pleased that this consensus bill is before the House 
today. With more than 250 bipartisan cosponsors and being reported by 
voice vote from committee, H.R. 4807 should be acted on expeditiously 
by the House.
  Since we last authorized the CARE Act in 1996, there has been 
dramatic progress in treating AIDS, but there is still much more to be 
done. There are new treatments, but there still is no cure. There are 
fewer deaths, but no new HIV infections and dangerous complacency are 
on the rise, and the treatment gap grows wider every day for the poor 
and communities of color.
  This is why the CARE Act is so important. Its reauthorization is 
crucial to the lives and health of hundreds of thousands of Americans, 
and it is essential that we refine and expand the CARE Act to respond 
to the epidemic's growing impact on women and adolescents.
  H.R. 4807 preserves the structure of the original law and enhances 
its funding, but it also focuses on services for reaching individuals 
with HIV and AIDS who are not in care, eliminating disparities in 
services and access and helping historically underserved communities.
  The legislation also begins to shift Ryan White funding to the HIV 
infected population, not just individuals with AIDS. This is an 
important transition which will occur when reliable data on HIV 
prevalence is available, and it is an important transition because we 
need to find the people who are HIV infected, because with appropriate 
treatment perhaps many of them can be helped not to develop full-blown 
AIDS.
  The bill will also give priority to communities in severe need of 
supplemental funds. As HRSA Administrator Claude Fox testified, ``These 
efforts, building on the current CARE Act, will significantly improve 
access to important health services for low-income, underinsured, and 
uninsured persons with HIV.''
  The bill also expands the perinatal HIV grant program to $30 million, 
with an increasing set aside for States with mandatory newborn testing 
laws. While I do not share the belief that this set aside is necessary, 
I am pleased that Dr. Fox confirmed that the program will greatly 
increase the funds available to help end the transmission of HIV to 
newborns.
  The bill also enhances public participation in CARE Act programs and 
prevention efforts at the Federal, State and local levels, and adopts 
many important provisions in from the Senate bill.
  I want to applaud the gentleman from Oklahoma (Dr. Coburn) for his 
cooperation on authoring this consensus bill, and acknowledge the 
contributions of the many community organizations to the legislation.
  I want to thank the staff for their hard work, Roland Foster, Paul 
Kim, Karen Nelson, Marc Wheat, John Ford, Brent Delmonte, and Pete 
Goodloe.
  Mr. Speaker, our friends and colleagues are right, this is an 
important bill, and I urge full support for it.
  Mr. Speaker, I rise in support of H.R. 4807 and urge my colleagues to 
support the bill.
  As the original author of the Ryan White CARE Act and the co-author 
of H.R. 4807, I am pleased that this consensus legislation is before 
the House today.
  The bill has more than 250 bipartisan cosponsors and was reported by 
voice vote by the Commerce Committee. The Senate has already acted on 
its own bill, and H.R. 4807 should be acted on expeditiously by the 
House.


                       background on the care act

  Mr. Speaker, until 1990, it was volunteers, cities and States who 
carried the burden of care in the AIDS epidemic--not the Federal 
government. Enacting the Ryan White CARE Act into law was our 
government's overdue response to the AIDS crisis, providing urgently 
needed care to tens of thousands of Americans living with AIDS.
  Since we last reauthorized the CARE Act in 1996, there has been 
dramatic progress in

[[Page H6973]]

treating AIDS. Lives have been extended and hope has been renewed. 
Deaths from AIDS have declined in our country.
  But while progress has been made, progress must also be measured by 
the length of the road ahead. There are treatments, but there is still 
no cure. There are fewer deaths, but new HIV infections and a dangerous 
complacency are on the rise.
  The epidemic is reaching into every community and every State in 
America. The treatment gap is growing wider than ever for the poor and 
for communities of color. And worldwide, the epidemic has killed 18 
million people, orphaned millions of children and devastated entire 
countries.
  This is why the CARE Act is so important. The CARE Act is the 
foundation of our country's response to the AIDS epidemic. Its 
reauthorization is crucial to the lives and health of hundreds of 
thousands of Americans. And as AIDS increasingly threatens women, 
adolescents and our communities of color, it is essential that we 
refine and expand the CARE Act to respond to these changes in the 
epidemic.


                          what h.r. 4807 does

  Today, the CARE Act provides early intervention services to prevent 
infection and to forestall illness in those who are infected. It 
furnishes medicines and outpatient and home health services to those 
who are ill. And the Act gives direct assistance to States and to the 
cities hardest hit by the epidemic.
  H.R. 4807 preserves the structure of the CARE Act and enhances its 
funding. But it focuses services for the first time on--reaching 
individuals with HIV and AIDS who are not in care; eliminating 
disparities in services and access; and helping historically 
underserved communities.
  The legislation also begins to shift Ryan White funding and services 
towards the HIV-infected population, not just individuals with AIDS. 
This is an important transition, and will mean a more equitable and 
accurate allocation of funds in relation to the demographics of the 
epidemic. But it will only occur when the Secretary determines that 
adequate and reliable data on HIV prevalence is available from all 
States and cities.
  The bill also addresses disparities in care through the Title I 
supplemental funds and a newly created Title II supplemental. 
Communities and cities in ``severe need'' of additional resources will 
be given increased priority for these funds, so that all underserved 
areas--rural or urban--may better serve their patients.
  These and other provisions enhance the responsiveness of the CARE Act 
to the needs of ethnic and racial minorities, consistent with the 
intent of the Congressional Black Caucus Minority AIDS Initiative. And 
as HRSA Administrator Claude Fox testified two weeks ago, ``These 
efforts, building on the current CARE Act, will significantly improve 
access to important health services for low-income, underinsured, and 
uninsured persons with HIV.''
  When the Title I formula was modified five years ago, a ``hold 
harmless'' was added to limit any Eligible Metropolitan Area's (EMA) 
losses over five years to 5 percent of its Title I formula allocation. 
Our intention was to provide some time to allow EMAs to prepare for 
changes in their services and reductions in their funding. While there 
is broad agreement that the best way to avoid the need for a hold 
harmless is to increase funding overall to Title I, the funding 
increases to date unfortunately have not been so great as to render the 
``hold harmless'' unnecessary. Now that five years have already passed 
since the formula was changed, the ``hold harmless'' has been adjusted 
to ensure greater funding equity in the Title I formula. I am 
particularly pleased that the Administration has made clear that it is 
unlikely that any new EMA will make use of such a hold harmless for the 
next three to four years.
  H.R. 4807 also expands an existing grant program to end perinatal HIV 
transmission to $30 million, with an increasing set-aside for States 
with mandatory newborn testing laws. While I do not share the belief 
that this set-aside is necessary, I am pleased that all of the funds 
will be available for voluntary counseling, testing, treatment and 
outreach to pregnant mothers, as well as for implementing newborn 
testing programs. Dr. Fox confirmed two weeks ago that this program 
will greatly increase the funds available to help end the transmission 
of HIV to newborns.
  This bill enhances public participation in both Title I and Title II, 
with greater representation of persons living with HIV and AIDS. Title 
I Planning Council meetings and records are opened to public 
``sunshine.'' And we call on States to engage in a more participatory 
public planning process.
  The legislation makes other important reforms. It calls for greater 
coordination of HIV care and prevention efforts at the Federal, State 
and local levels--something I have always strongly supported. Patients 
are entitled to a seamless continuum of HIV prevention and care 
services from outreach, counseling and testing through to diagnostics, 
treatment and care.
  Finally, H.R. 4807 also adopts many important provisions from the 
Senate's bill, particularly the authorization of early intervention 
services in Titles I and II, and the creation of new quality management 
programs for CARE Act services.


                               conclusion

  I want to applaud Dr. Coburn for his personal commitment to fighting 
AIDS and his cooperation on the bill. I also want to acknowledge the 
contributions of the many community organizations that participated in 
developing this legislation. And I want to thank the staff for their 
diligence and hard work--Roland Foster, Paul Kim, Karen Nelson, Marc 
Wheat, John Ford, Brent Delmonte and Pete Goodloe.
  Mr. Speaker, I want to conclude by citing my friend and colleague the 
Minority Leader. Two weeks ago, Mr. Gephardt spoke on this floor about 
AIDS in Africa. He said--

       There has never in the history of the world been a threat 
     to life like this . . . This is the moral issue of our time. 
     I pray that this House and all of our great Representatives 
     will stand and deliver on this, the most important moral 
     issue we will ever face.

  Mr. Speaker, our friend and colleague was right. His words hold true 
the world over.
  So I ask my colleagues to commit themselves anew to ending the 
epidemic. I ask them to support this legislation. And I ask them to 
dedicate this legislation to the memory of our friends, our family and 
our countrymen who have died of AIDS.

                              {time}  2340


Making in Order on Legislative Day of Today Consideration of H.R. 4920 
                     Under Suspension of the Rules

  Mr. LAZIO. Mr. Speaker, I ask unanimous consent that the Speaker be 
authorized to entertain a motion that the House suspend the rules and 
pass H.R. 4920, as amended, at any time on the present legislative day.
  The SPEAKER pro tempore (Mr. Tancredo). Is there objection to the 
request of the gentleman from New York?
  There was no objection.
  Mr. COBURN. Mr. Speaker, I continue to reserve my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentleman 
from New York (Mr. Towns), who has been a leader in fighting for health 
care for the disadvantaged.
  Mr. TOWNS. Mr. Speaker, let me begin by first thanking the gentleman 
from Oklahoma (Mr. Coburn) and, of course, the gentleman from 
California (Mr. Waxman) for bringing this bill forward. It is a very 
important bill, with the way things are going today in this Nation.
  I support the Ryan White CARE Act of 2000. We should pass this 
legislation, which is so vital to this Nation and its future.
  Approximately 19 percent of the AIDS cases are in New York State. 
That means one in five living with AIDS reside in New York State. There 
are 8,200 living AIDS cases in Brooklyn, the borough that I represent, 
alone. Seventy-five percent of the cases are minorities and 25 percent 
are women.
  This is just the beginning. I have yet to talk about the 100,000 
people estimated to be living with HIV disease who may or may not know 
their status.
  These numbers are truly staggering, and they show the importance and 
need of reauthorization of the Ryan White CARE Act.
  I will not stand here and say that this bill is perfect because it is 
not, but it does represent a balance and I congratulate my colleagues 
again for their creativity and strong leadership. However, I must admit 
there are some things that I would like to see modified, and let me 
name them; namely, the hold harmless provision in title I of the bill, 
which my colleague, the gentlewoman from California (Ms. Eshoo) framed 
so well during the markup in the full Committee on Commerce. I think 
the point that she made should have been accepted. All the EMAs should 
be held harmless and brought up to a higher funding level.
  There are many good provisions in this bill. It increases consumer 
participation on the planning council and ensures that the consumers 
are representative of the epidemic in that particular area. This change 
will enable the councils to be proactive when it comes to the disease, 
and the bill moves in the direction of counting HIV not AIDS cases.

[[Page H6974]]

  In addition, I would like to highlight the Congressional Black 
Caucus' AIDS initiative language within the Committee Report. The 
initiative is intended to be a critical component of the strategy of 
the Department of Health and Human Services to comprehensively address 
HIV/AIDS. It focuses on the communities hardest hit by the epidemic, 
and that is the most effective way to tackle the problem. Therefore, I 
urge my colleagues to support this act.
  Mr. COBURN. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, I also have a chart I want to show. Firstly, I thank the 
gentleman from New York (Mr. Towns) for his support of the bill and his 
fair criticism of what he sees as maybe a problem in funding 
disparities. However, I would tell him that the concerns of the State 
of New York were really of title II in this bill and not title I, and 
we changed that funding formula to meet the concerns of the State of 
New York.
  I also would point out, as he can see on a cost adjusted basis, that 
the State of New York on a basis of a per AIDS case gets approximately 
$1,900 less per individual in New York City than somebody in San 
Francisco, and the whole disparity that we are trying to address is not 
to harm San Francisco but is to make an equalization for those in New 
York City that they might have an increase in funds.
  The gentleman from New York (Mr. Towns) also made the statement that 
probably our problem is that there is just not enough money here, and I 
would probably tend to agree with him, that that is the base problem.
  The other thing that I want to correct in his statement is there are 
350,000, at least 350,000 in this country today that are infected with 
HIV that do not know it. It is not 100,000. It is 350,000. There are 
another 350,000 who have HIV and do know it, and there are another 
350,000 who have full-blown AIDS. The problem is, and the reason this 
bill has moved some direction towards prevention, is we have made no 
dent in the case of new HIV infections in 7 years in this country.
  The fact is that 40,000 this year, 40,000 next year and 40,000 last 
year and the 2 years before continue to get infected with this virus 
and that is why this bill is so important, because it redirects us to 
where the epidemic is, not to where it was.
  We still recognize where it was but we want to put the dollars where 
the epidemic is.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from California (Ms. Eshoo), who has been an outspoken and tireless 
advocate on behalf of AIDS patients.
  Ms. ESHOO. Mr. Speaker, I thank the ranking member, the gentleman 
from Ohio (Mr. Brown) for yielding me this time.
  Mr. Speaker, I rise this evening in support of the Ryan White CARE 
Act because without question it is the most important legislation 
Congress has ever enacted to provide life-saving and life-enhancing 
medical care and social services for people living with HIV and AIDS.
  It was intended as a safety net for people battling HIV and AIDS and 
these are really the two cornerstones of the CARE Act, reliability and 
stability. Yet contained in this bill that is on the floor this evening 
is a provision that I and others believe runs contradictory to that 
safety net principle. Under existing law, an eligible metropolitan 
area, we call them EMAs, that is our Federal shorthand, those areas 
receiving title I funds can lose no more than 5 percent of its funding 
over a 5-year period. This hold harmless provision was specifically 
designed to prevent the rapid destabilization of existing systems of 
care when changes in the title I formula were adopted by Congress in 
1996. H.R. 4807 changes this dramatically, allowing an EMA to lose 25 
percent of its funding over the same time period.
  The result will be a rapid decline in availability and quality of 
care, particularly in EMAs like San Francisco, where the epidemic has 
hit the hardest. AIDS advocates and EMAs across the country, not just 
the Bay Area, not just California but the entire country, including the 
State of New York, have expressed concern that a 25 percent hold 
harmless could destabilize the systems of care and undermine the very 
goals of the act. They fear what we already know in our area, that the 
25 percent hold harmless could ironically cause great harm.
  I support the Senate approach of 10 percent over 5 years and I urge 
my colleagues, that will eventually become conferees, to support the 
Senate language. We want to move ahead with this bill but we need to 
stay true of the hallmark of the act.

                              {time}  2350

  Mr. COBURN. Mr. Speaker, I yield myself 2\1/2\ minutes.
  Mr. Speaker, the AIDS Action Council, the largest AIDS organization 
in the United States, supports this funding formula. Let us be clear 
about that.
  Number two is Ryan White title I funds, San Francisco last year 
received over $35 million. At the end of the year, they had a $7 
million balance in their checking account. If we take the growth in 
title I funds that we have seen in this Congress and the two congresses 
previously, we are averaging 24 to 29 percent per year increase.
  Take a million dollars. Under this hold harmless, at the end of 5 
years that means they would have $750,000. But at a growth rate of 24 
to 29 percent, what they would actually have is well over a million 
dollars at the end of that 5 years. So we are into the specifics of 
talking about a cut when there is no cut.
  The fact is there is extreme imbalance in the amount of funding that 
is going to the EMA in San Francisco versus other areas and it is 
recognized. This legislation is not intended to hurt San Francisco. I 
will have a private wager with the gentleman and gentlewomen from 
California that in 5 years there will be more money under this formula 
for each of those EMAs than there is today, including San Francisco.
  Because, in fact, if we increase something 25 percent per year, at 
the end of 5 years we will not have 200 percent, we will have about 270 
percent. So even with the 25 percent cut, if that would happen, and 
that is just the potential. I understand my colleagues should be 
concerned to protect what is already coming in.
  The second point that I would make is that the testimony from the GAO 
clearly said that there is a disparity in the funding. And they clearly 
said that the foundational factor under which we made that funding was 
based on what the funding was in 1990, which was evidence of those who 
had HIV, had AIDS, and had died.
  So the base that is used for the San Francisco EMA continues to 
recognize in its base not people living with HIV, but people who have 
died from AIDS, people living with AIDS. What our formula will say is 
if HIV increases in San Francisco, they will get more money. As people 
live longer, they will get more money. And what we do is to make sure 
somebody who lives in South Carolina in the rural areas has the same 
opportunity for care and treatment as somebody in San Francisco.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentlewoman 
from the Virgin Islands (Mrs. Christensen).
  Mrs. CHRISTENSEN. Mr. Speaker, I too rise in support of H.R. 4807, 
the Ryan White CARE Act Amendments of 2000. I commend my colleagues, 
the gentleman from Oklahoma (Mr. Coburn) and the gentleman from 
California (Mr. Waxman) for their hard work and their leadership in 
crafting this legislation which is so important to people with HIV and 
AIDS and their families.
  While this bill is not perfect and needs to be fine-tuned, the 
product we have before us provides a good framework. One of my major 
concerns with this legislation remains the funding provided for States 
which have laws requiring mandatory testing of newborns. I oppose 
mandatory testing of any subpopulation and I strongly believe that this 
body must give full consideration to the Institute of Medicine study as 
it relates to this.
  I am encouraged, on the other hand, that H.R. 4807 changes funding 
formulas to encompass all who are infected with HIV and not just 
provide resources for individuals who have progressed to AIDS. This 
amendment responds to the changing nature of the

[[Page H6975]]

epidemic and the newer treatment protocols. It allows and enables 
treatment programs to begin and expand critical prevention efforts and 
encourages reporting of HIV infections by States which do not now 
report by infection.
  Another major area which is of critical concern to the Congressional 
Black Caucus Health Brain Trust is the community planning councils, 
their compensation, effectiveness, and operation.
  Mr. Speaker, we are encouraged by this bill's requiring that the 
local planning bodies and grantees reflect the demographics of the 
disease, that they conduct surveys to identify the epidemiology of the 
disease in their areas, and that they target funding to where the 
disease is most prevalent.
  Mr. Speaker, I would be remiss if I did not point out that based on 
current forecasts through fiscal year 2001, funding for the all-
important ADAP program falls more than $1 million short of what will be 
needed for the many low-income, uninsured, and underinsured Americans 
with HIV infection or AIDS, putting this country far from where we 
ought to be in fighting this epidemic.
  We in the Caucus, our partners in the Congress, and our communities 
will remain vigilant in the Nation's fight against the HIV/AIDS crisis. 
The Ryan White CARE Act is a lifeline to countless Americans infected 
with this virus and it is our best ammunition in the war against this 
devastating disease.
  Clearly, we in the U.S. Congress cannot wait until this disease 
mirrors the pandemic in Africa. An enhanced, strengthened, responsive 
and adequately funded Ryan White CARE Act is absolutely essential. I 
look forward to working closely with my colleagues in the House and the 
Senate and in the administration to craft and enact a measure that is 
responsive to the needs of all Americans, and I ask for my colleagues' 
support of this important legislation.
  Mr. Speaker, I rise in support of H.R. 4807, the Ryan White CARE Act 
Amendments of 2000, and I commend my colleagues Congressmen Tom Coburn 
and Henry Waxman for their hard work and leadership in crafting this 
legislation which is so important to persons with HIV and AIDS and 
their families.
  While, this bill is not perfect and needs to be strengthened and 
fine-tuned, the product we have before us, provides a framework which 
can be built upon to develop a more comprehensive and responsive 
reauthorization measure.
  One of my major concerns with this legislation, is the funding 
provided to states which have laws requiring the mandatory testing of 
newborns. I oppose mandatory testing of any sub-population, and I 
strongly believe, that this body must give full consideration to the 
IOM study as it relates to this issue. Let us seriously review those 
results and appropriately incorporate the findings in the ``mandatory 
testing'' provision of this reauthorization measure.
  I am encouraged that H.R. 4807 also changes city and state funding 
formulas to encompass all who are infected with HIV, and not just 
provide resources for individuals who have progressed to AIDS. This 
amendment responds to the changing nature of the epidemic and the newer 
treatment protocols which begin medication earlier. It allows for 
treatment programs to begin and expand critical prevention efforts. 
This bill also more effectively represents the burden of the disease 
and the need for care. In addition, this measure makes a concerted 
effort to support the fact, that the funding ``needs'' to follow the 
trends of the disease (which are disproportionately and increasingly 
affecting people of color).
  It also encourages reporting of HIV infections by states (many do not 
now report). Such adherence to reporting, will improve our ability to 
be more progressive and get in front of this epidemic by increasing 
prevention and outreach efforts.
  Another major area which is of critical concern to the Congressional 
Black Caucus and the communities we represent (which are primarily 
people of color), is the community planning councils, their 
composition, effectiveness and operations. This process has not worked 
well for many disenfranchised communities under existing authorization. 
Community input is essential to effective service provision at the 
local level. Therefore, we are encouraged by this bill requiring, that 
the local planning bodies and grantees reflect the demographics of the 
disease and secondly, that they conduct surveys to identify the 
epidemiology of the disease in their areas.
  Lastly, it directs that they target the funding where the disease is 
most prevalent. We, in the Caucus and our community partners, will be 
very vigilant on this issue.
  In this regard, I also encourage that African Americans and other 
people of color be appropriately represented in the clinical trials and 
investigator pools based on the trends of the disease.
  I would be remiss if, I did not say that based on the past 
epidemiology, and several studies and forecasts, FY 2001 funding for 
the all important ADAP program falls around $100 million dollars short 
of what will be needed to provide treatment to those infected.
  This dramatic shortfall represents the many low income, uninsured and 
under-insured Americans who will not receive appropriate care, and 
further puts this country far from where we need to be in fighting this 
epidemic and saving the lives of those infected and most at-risk.
  We in the Caucus and our partners in the Congress and the communities 
we serve, remain vigilant in the nation's fight against the HIV/AIDS 
crisis. The Ryan White Care Act is the life line to countless Americans 
infected with HIV and AIDS. It is our best ammunition in the war 
against this devastating disease which is plaguing our nation. Clearly, 
we in the U.S. Congress, must not wait until this disease begins to 
mirror the pandemic in Africa. An enhanced, strengthened, responsive 
and adequately funded Ryan White Care Act is absolutely essential to 
intensified care, treatment, prevention and outreach.
  I look forward to working closely with my colleagues in the House and 
Senate, and in the Administration to ensure the crafting and enactment 
of a measure that is responsive to the needs of all Americans. I 
therefore, ask you to respond positively, and vote for this important 
legislation.
  Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I submit for the Record a letter from the State of New 
York on the baby AIDS provision that they have in testing, and also the 
1990 Senate Ryan White CARE Act Debate Regarding the Need for HIV 
Partner Notification.

                                                State of New York,


                                         Department of Health,

                                     Albany, NY, February 3, 2000.
     Hon. Tom A. Coburn, M.D.,
     Member of the Congress, U.S. House of Representatives, Cannon 
         House Office Building, Washington, DC.
       Dear Dr. Coburn: I have been asked to reply to your letter 
     of December 20, 1999, to Commissioner Novello on prevention 
     of perinatal HIV transmission. The perinatal HIV prevention 
     program at the New York State Department of Health is a 
     comprehensive program that seeks to address many of the steps 
     in the chain of events leading to an HIV-infected child, as 
     identified by the Institute of Medicine in their 1998 report, 
     ``Reducing the Odds.''
       An important initial prevention step in this chain of 
     events is to ensure that all pregnant women are enrolled in 
     prenatal care in the first trimester and ideally, have 
     received preconception care. Significant program resources, 
     including new funding from the Centers for Disease Control 
     and Prevention (CDC) for outreach to high risk women, are 
     directed to this purpose in New York State. In 1997, 10.6 
     percent of all women (according to birth certificate data) 
     and about 10 percent of HIV positive women in New York State 
     (based on chart reviews) received no prenatal care.
       The second step in preventing perinatal transmission is to 
     ensure that all women in prenatal care receive HIV counseling 
     and testing according to the U.S. Public Health Service 
     guidelines. In New York State, regulations adopted in 1996 
     (10 NYCRR sections 98.2(c), 405.21(c), 751.5(a)) require all 
     regulated prenatal care providers (hospitals, clinics, HMO 
     providers) to provide HIV counseling with a clinical 
     recommendation to test, to all prenatal care patients. Such 
     counseling and recommended testing is the standard of medical 
     care in New York State, even for physicians not practicing in 
     regulated settings. The Commissioner has sent a letter to 
     this effect to all prenatal care physicians in the State. The 
     letter was co-signed by the State Medical Society and the 
     State chapters of professional organizations in pediatrics, 
     obstetrics and family practice. The Department also monitors 
     prenatal HIV counseling and testing rates at all regulated 
     health care providers through review of a sample of prenatal 
     care medical records. These data are fed back to providers 
     and technical assistance is provided to improve delivery of 
     these services.
       For women who test HIV positive or are known to be HIV 
     positive during pregnancy, the State has developed a network 
     of specialty providers for perinatal HIV medical care. These 
     providers ensure that each HIV positive pregnant woman has a 
     full evaluation for combination antiretroviral therapy 
     depending on her own health status, prescribe zidovudine 
     (ZDV) according to the PACTG 076 regimen for prevention of 
     perinatal transmission, and make referrals for housing, 
     adherence counseling and other supportive services that 
     these women may need to adhere to therapy. New York 
     Medicaid and the State's AIDS Drug Assistance Program 
     (ADAP) provide reimbursement for pharmaceuticals for women 
     in need so that all women have access to preventive 
     therapy.

[[Page H6976]]

     The Department, with the help of a panel of expert 
     clinicians, publishes detailed clinical treatment 
     guidelines for antiretroviral therapy and prevention of 
     perinatal transmission, and also funds a network of 
     clinical education providers across the state to train 
     clinicians carrying for HIV positive patients.
       In the area of newborn HIV testing, Public Health Law (PHL) 
     2500-f, signed into law by Governor Pataki in 1996, created 
     an exception for newborn HIV testing to the informed consent 
     requirements for HIV counseling and testing in the HIV 
     Confidentiality Law, PHL Article 27-F. It also directed the 
     Commissioner to develop a comprehensive program for the 
     testing of newborns for HIV. This program is further defined 
     in State regulations (10 NYCRR Subpart 69-1) and has gone 
     through two phases. During the first phase, beginning on 
     February 1, 1997, the Department's Newborn Screening 
     Laboratory began HIV testing of all newborn filter paper 
     specimens submitted for metabolic screening without removing 
     patient identifiers and returning those test results to the 
     birth hospital for transmittal to the pediatrician of record. 
     Prior to that time, blinded HIV newborn testing had been done 
     for epidemiological purposes since the late 1980's, and 
     mothers had been encouraged to receive a copy of their 
     newborn's HIV test result since May 1996 (over 90 percent of 
     mothers consented to receive their newborn's HIV test result 
     in that program).
       Universal newborn HIV testing has resulted in the 
     identification of all HIV-exposed births. HIV test results 
     from the newborn testing lab are often not available until 
     two weeks after birth. These results are not timely enough to 
     permit administration of ZDV therapy to prevent HIV 
     transmission, but can be used to counsel women to stop 
     breastfeeding which may prevent some cases of transmission. 
     Newborn testing has allowed hospital and health department 
     staff to ensure that over 98 percent of HIV positive mothers 
     are aware of their HIV status and have their newborns 
     referred for early diagnosis and care of HIV infection. In 
     less than 2 percent of cases have women not been located to 
     receive newborn HIV test results and have their HIV-exposed 
     newborns tested for HIV infection. The Department is in the 
     process of reviewing all pediatric medical records up to 6 
     months of age for HIV-exposed infants born starting in 1997 
     to determine the quality of HIV care they are receiving and 
     to document the perinatal HIV transmission rate.
       The second phase of the newborn HIV testing program began 
     on August 1, 1999. It added regulatory amendments to Subpart 
     69-1 to require expedited HIV testing in the hospital 
     delivery setting in cases where an HIV test result from 
     prenatal care is not available. This addition to the newborn 
     testing program was undertaken because of evidence that 
     perinatal HIV transmission may be reduced by initiating ZDV 
     therapy during labor or soon after delivery, even if ZDV was 
     not taken during prenatal care (NEJM 1998;339:1409-1414). 
     Hospitals now screen all women admitted for delivery for HIV 
     test results from prenatal care. If a prenatal HIV test 
     result is not available, the hospital must provide the woman 
     with HIV counseling and expedited testing if she consents. If 
     the mother does not consent to HIV testing of herself, the 
     hospital must perform expedited testing on her newborn 
     immediately after birth under the authority of the 
     comprehensive newborn HIV testing law. Expedited tests 
     must be available as soon as possible, but in no case 
     longer than 48 hours. Provisional data from the initial 
     months of the program show that 32 HIV positive women/
     newborns were identified for the first time by expedited 
     testing at delivery, permitting early initiation of ZDV in 
     most cases; 12 additional positive cases could have been 
     identified if all hospitals had fully implemented the 
     program, and 17 false positive HIV results occurred. False 
     positive preliminary HIV tests occur because Western blot 
     confirmation of preliminary positive results cannot always 
     be obtained in the 48 hour time period. The Department has 
     encouraged the Food and Drug Administration (FDA) to 
     approve additional rapid HIV tests in the near future to 
     alleviate this problem. A significant benefit of the 
     expedited testing program is that delivery hospitals are 
     now working more closely with their prenatal care 
     providers to ensure that HIV counseling and testing is 
     done at the appropriate time during prenatal care and that 
     the test results make it to the delivery hospital.
       Rates of participation in prenatal care in New York State 
     are monitored by review of birth certificate data. These 
     rates have been increasing gradually over recent years. 
     Currently about 80-85 percent of women delivering report 
     first or second trimester prenatal care and about 10.6 
     percent of women report no or unknown prenatal care. There 
     has been no detectable change in prenatal participation 
     trends through 1997 that might be related to the newborn 
     testing program. Anecdotally, we have not heard of problems 
     in this regard. The analysis is currently being updated 
     through 1998. Prenatal care for HIV positive women is also 
     being examined through review of prenatal charts. Limited 
     numbers of women whose HIV status was identified by newborn 
     testing are being interviewed to see what the impact of 
     newborn testing has been.
       Ultimately, the goals of the prenatal HIV prevention 
     program in New York are to reduce prenatal HIV transmission 
     to the lowest possible level through; ensuring access to 
     prenatal care for all pregnant women; ensuring counseling and 
     testing of all women in prenatal care; ensuring that all HIV 
     positive pregnant women are offered and adhere to ZDV therapy 
     and are evaluated themselves for combination therapy and 
     other care needs; ensuring that HIV test information is 
     transferred in a timely way to the anticipated birth 
     hospital; and, conducting expedited testing in the delivery 
     setting for all women/newborns for whom prenatal HIV test 
     results are not available.
       Newborn testing will continue to be conducted at the 
     Department's Newborn Screening Laboratory to ensure that all 
     HIV positive newborns are identified and referred to care. 
     The newborn testing data also provide valuable, timely 
     information to monitor the epidemiology of perinatal HIV and 
     prevention efforts.
       Thank you for your interest in our program. Please let me 
     know if I can provide any further information.
           Sincerely,
                                Guthrie S. Birkhead, M.D., M.P.H.,

     Director, AIDS Institute.
                                  ____


   1990 Senate Ryan White CARE Act Debate Regarding the Need for HIV 
                          Partner Notification

       In May 1990, Senators Barbara Mikulski (D-MD) and Ted 
     Kennedy (D-MA) offered an amendment to the original Ryan 
     White CARE Act which passed unanimously that would have 
     required all states to esstablish HIV reporting and partner 
     notification programs as a condition of receiving federal 
     funds under the CARE Act.
       Senator Mikulski stated that the addition of this 
     requirement was needed ``to improve this legislation.'' \1\
---------------------------------------------------------------------------
     \1\ Congressional Record--Senate, May 15, 1990, page 10356.
---------------------------------------------------------------------------
       Speaking in support of the amendment, Senator Kennedy 
     stated that, ``it is difficult to argue against doing the 
     utmost in terms of partner notifications.'' \2\ Senator 
     Kennedy compared failing to conduct partner notification to 
     having knowledge that someone's life is endangered and not 
     warning them. ``In a case in which there is a clear and 
     present danger, there is a duty to warn,'' Kennedy 
     asserted.\3\
---------------------------------------------------------------------------
     \2\ Congressional Record--Senate, May 15, 1990, page 10364.
     \3\ Congressional Record--Senate, May 15, 1990, page 10360.
---------------------------------------------------------------------------
       Senator Orrin Hatch (R-UT) advocated for the amendment 
     explaining that ``I do not see how in the world we are going 
     to solve this problem and how we are going to notify people 
     who are in jeopardy of getting AIDS unless we have required 
     contact tracing. . . . Contact tracing is absolutelyessential 
     for the ending of this epidemic.'' \4\
---------------------------------------------------------------------------
     \4\ Congressional Record--Senate, May 15, 1990, page 10358.
---------------------------------------------------------------------------
       Senator William Armstrong (R-CO) praised the inclusion of 
     the Kennedy/Mikulski amendment stating ``I think the Kennedy 
     amendment represents a strong step toward instituting 
     responsible public health measures to slow the spread of this 
     devastating epidemic. The Kennedy amendment, agreed to by 
     voice vote, will ensure that the collection of accurate 
     epidemiological information concerning the incidence of the 
     HIV epidemic, and more importantly will allow those innocent 
     individuals who are unknowingly placed a risk of infection to 
     be notified of their risk.'' \5\
---------------------------------------------------------------------------
     \5\ Congressional Record--Senate, May 16, 1990, page 10718.
---------------------------------------------------------------------------
       Responding to Senator Armstrong's statement, Senator 
     Kennedy conceded ``we agree with Senator Armstrong that 
     partner notification is an essential tool in the fight 
     against AIDS. . . . In unanimously approving the amendment 
     yesterday, I believe the Senate has done what is responsible 
     and necessary.'' \6\

     \6\ Congressional Record--Senate, May 16, 1990, page 10720.
---------------------------------------------------------------------------
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from California (Ms. Pelosi) who, with the gentleman from California 
(Mr. Waxman) has probably done more to fight HIV/AIDS in this 
institution.
  Ms. PELOSI. Mr. Speaker, I thank the gentleman from Ohio (Mr. Brown) 
for yielding me this time, and thank him for mentioning me in the same 
breath as the gentleman from California (Mr. Waxman) on the issue of 
HIV and AIDS.
  The gentleman from California (Mr. Waxman), in his remarks, pointed 
to the provisions of this Ryan White reauthorization bill. The 
distinguished gentleman from Ohio (Mr. Brown), the ranking member, 
talked about the need for it. I wish to associate myself with their 
remarks.
  Mr. Speaker, I also want to associate myself with the remarks of the 
gentleman from New York (Mr. Towns) and the gentlewoman from California 
(Ms. Eshoo) in their pointing out, regretfully, the hold harmless 
clause that will not be contained in this bill.
  I want to point out a few things, because my City of San Francisco, 
which I represent, has been mentioned here

[[Page H6977]]

this evening. Yes, we have suffered a great deal over the years from 
HIV/AIDS. When I came to Washington 13 years ago from California, 
13,000 people had died in my district at that point from HIV/AIDS. We 
have suffered over the years greatly. We do not want any other places 
to bear that pain.
  Working with the gentleman from California (Mr. Waxman) in a 
community-based way, the Ryan White authorization bill was developed 
with community-based input.
  Now, and at the time of the reauthorization a number of years ago, it 
was not taken into consideration that there would be protease 
inhibitors which would prolong life. What this bill does is penalizes 
San Francisco for two reasons. First of all, it does not give value to 
the work which we do with people who are HIV infected to prevent them 
from getting full-blown AIDS. Only at that time when they have full-
blown AIDS would they be counted in this formula.
  Secondly, it again does not take into consideration protease 
inhibitors, because if they would, then they would recognize that 
people do live longer and they are not predictably dead as they would 
have been if we looked back 10 years and project out with the life 
expectancy.
  So what I am saying to my colleagues is support the bill. We must 
move it along. Please agree with the Senate language. The health 
director of New York State has said that this bill, the Senate bill, is 
better for New York than that bill which will do harm to New York and 
to California.
  Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I would challenge what the gentlewoman from California 
(Ms. Pelosi) had to say. If my colleagues can see in this chart the 
nominal funding per AIDS case, and the arguments that she just made do 
not hold water.
  The fact is the 13,000 people she describes, California still is 
getting money for them. Their funding formula in San Francisco still 
considers those 13,000. There is nothing in this bill as people are 
identified with HIV, not AIDS, San Francisco will get more money, not 
less money.
  So the argument that there will be less money attributable to 
recognition of HIV and what is done in the EMA in San Francisco, it 
holds no water.

                              {time}  0000

  If one looks at this chart, what one sees is that San Francisco, in 
real dollars, based on 1999 EMA gets $5,958 per AIDS case. The next 
closest is $3,132 in Miami, Florida. My colleagues can see all the rest 
of the red there. The vast majority gets 60 percent or less than San 
Francisco.
  The goal of this bill is not to hurt San Francisco. The goal of the 
bill is to help those very people who do not have access at anywhere 
close to the level to the program, the medicines, or any other aspect 
of the Ryan White CARE funds. This is about fairness. This is not about 
fairness for a white male in Oklahoma. This is about fairness to an 
African American or Hispanic female in a rural area or in Baltimore who 
today does not get the same amount of resources directed to them that 
is available to somebody in San Francisco. It is not about penalizing. 
It is about fairness.
  Mr. Speaker, I gladly yield to the gentlewoman from California (Ms. 
Pelosi) for her question.
  Ms. PELOSI. Mr. Speaker, I thank the gentleman from Oklahoma for 
yielding to me.
  What I would say is what the gentleman is saying is not accurate. The 
fact is that we will see a decline. What is a mystery to me is that, 
while the gentleman is participating in this reauthorization of this 
very important legislation, maybe the top bill we will do this year, 
and I commend him all for the emphasis on prevention, because that is 
very, very important, but why we would not be wanting to help people 
throughout the country, without penalizing those who are fighting this, 
at the HIV level instead of waiting until people have a full-blown case 
of AIDS.
  Mr. COBURN. Mr. Speaker, reclaiming my time, we will have to 
disagree. The facts, they are very obvious. The facts are people with 
HIV today in this country are not and do not have the same reference to 
treatment and care based on the funding formula that we have. There is 
no recognition that we want to and there is no admission that we want 
anybody to get less treatment, nor will there be.
  The fact is that, as the gentlewoman from California very well knows, 
in the San Francisco EMA, they spent $55,000 of Ryan White CARE money 
to fund the advocacy of an election in California, an initiative 
balance that had nothing to do with Ryan White.
  So we also know many other things about EMA that I do not think we 
need to go into here. The facts are that, in San Jose, in the same area 
that the gentlewoman is, we are seeing $3,000 spent, whereas in the San 
Francisco EMA, it is $5,900.
  So I would respectfully disagree with the gentlewoman from California 
(Ms. Pelosi).
  The last point that I would make, if one has never told somebody they 
have HIV, if one has never been there to tell them that and then know 
they are not going to have access, regardless of whatever efforts one 
has, one cannot imagine the feeling knowing that one just put that 
person in a position of watching themselves die as we stand by.
  So I am not about to want anybody in the San Francisco EMA to have 
that experience because I have had to tell people that, and I doubt 
very few others in this body have.
  So I object to the fact that the gentlewoman would say that we are 
interested in withholding care for anybody with this disease. That is 
not what this debate is about. I understand that is where my colleagues 
want to take it. That is not what this debate is about.
  Mr. Speaker, I yield to the gentlewoman from California (Ms. Eshoo).
  Ms. ESHOO. Mr. Speaker, I appreciate the gentleman from Oklahoma 
yielding to me.
  Mr. Speaker, first of all to my colleague, we have had experience 
with the disease and in my own family. I have held someone in my arms 
and watched them die from it. So that is enough experience, I think, 
for anyone.
  But what this debate is about is not to say that the gentleman from 
Oklahoma is an unfair person. We are saying that this funding mechanism 
hurts an area that deserves the same kind of funding for the people 
that have HIV and AIDS.
  Mr. COBURN. Mr. Speaker, reclaiming my time on that statement to say 
that that area, that EMA gets twice as much money per person with that 
than anybody else in the country.
  If the gentlewoman can stand and defend that while people in Oklahoma 
are waiting in line and not getting drugs, while people cannot get any 
of the care in rural areas in this country because more money is 
consumed in one EMA relative to all the rest, and we can stand by and 
watch people have to wait for somebody to die before they can get on a 
drug list, I will not recognize that. I will not accept that. I believe 
that it is an unfounded statement.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 1\1/4\ minutes to the 
gentlewoman from California (Ms. Eshoo).
  Ms. ESHOO. Mr. Speaker, I thank the distinguished ranking member for 
yielding me this time.
  During the hearing that was before our Subcommittee on Health and 
Environment, which I am a member of, we had very clear testimony from 
individuals, one of them, the distinguished Health AIDS Director of the 
State of New York that said that this funding formula would hurt the 
State of New York and supported the Senate language and said that it 
would hurt California as well.
  Number two, the chart that was just up here and being used I 
questioned at the committee markup. It was removed because we are 
changing, shifting gears between title I and other titles, and that 
does not give a clear picture.
  Number three, the GAO admitted on the record, admitted on the record 
that people that live beyond 10 years did not fit within their fiscal 
year projections. The analysis that they had done, and they had not 
done an analysis of this impact.
  I think what has been acknowledged is the following: Is that the 
funding formula on hold harmless will do harm and that what we really 
need to have are additional resources in the bill so that we do not pit 
one American citizen that is HIV or with AIDS against one another. That 
is what is the ultimate fairness.

[[Page H6978]]

  Mr. COBURN. Mr. Speaker, may I inquire as to the balance of time.
  The SPEAKER pro tempore. The gentleman from Oklahoma (Mr. Coburn) has 
5 minutes remaining. The gentleman from Ohio (Mr. Brown) has 45 seconds 
remaining.
  Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, let me make a couple of points. The area which the 
gentlewoman spoke about was from the concerns of New York were with 
title II. We adjusted all of that funding, and she is aware that we 
adjusted that. The State of New York supports this bill.
  So let there be no question. We responded to what they recognize was 
a problem and fixed the title II funding distribution in the bill.
  The second thing, the reason we pulled the chart down was so we could 
put up the other one, which both show the same thing.
  The GAO testimony is clear. There is a disproportionate amount of 
money going for people in the EMA in San Francisco. I do not want to 
see that drop one penny. I do not believe it will. If I thought it 
would, I would not be sponsoring this bill.
  I believe the statement of the gentleman from New York (Mr. Towns) 
was probably the most profound of all, that we need more money. Dr. 
Green's testimony about more ADAP funds we authorized whatever may be 
consumed in this bill, and it is our job to make sure it is 
appropriated to make sure those people are there.
  So I think it is important for us to be clear. The fact is that GAO 
testimony says there is a marked disproportion. We are not going to fix 
that all. We are going to fix that a little bit, 2 percent this year, 
which, in direction, 2 percent this year with what has been 
appropriated will have no effect on the San Francisco EMA. I would hope 
that they would recognize that.
  Mr. Speaker, I reserve the balance of my time to close.
  Mr. BROWN of Ohio. Mr. Speaker, I yield the final 45 seconds to the 
gentlewoman from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE. Mr. Speaker, I thank the distinguished ranking 
member for his kindness in yielding me this time. I thank the gentleman 
from California (Mr. Waxman) for his leadership and the gentleman from 
Oklahoma (Mr. Coburn) for his leadership on H.R. 4807, the Ryan White 
CARE Act of 2000.
  Mr. Speaker, I have had the displeasure of speaking and recollecting 
with a friend who is laying comatose in a hospital room dying of AIDS. 
I had the unfortunate opportunity, I guess, and it is not an 
opportunity to get a call to say that a friend was dying, and rushing 
to their bedside and getting there just a little too late, and that 
friend died of AIDS.
  I have had coworkers who have lost their life as well. So this bill 
is extremely important.
  Mr. COBURN. Mr. Speaker, I yield 30 seconds to the gentlewoman from 
Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, this bill is extremely 
important because what it does is say that we want to save lives. I 
believe that we can do a lot with this bill, and I look forward to us 
doing such.
  But in my community they are asking for the Ryan White CARE Act to be 
reauthorized and to be funded. I want to see more dollars for research 
and treatment. I want to see more dollars to take care of those 
communities of which I represent, African American population, Hispanic 
population.
  I think we should recognize this is a worldwide crisis. Forty million 
children will be orphaned in Africa. We must fight it worldwide and 
fight it in the United States.
  Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. COBURN asked and was given permission to revise and extend his 
remarks.)
  Mr. COBURN. Mr. Speaker, we have just spent 15 minutes talking about 
a tug of war over money, and what we should be talking about is 
prevention and the great things this bill does to keep the next person 
from getting HIV infected.
  When I came to Congress in 1995, one of my goals was to try to raise 
the level of awareness of how we can prevent this disease. This is not 
hard. But we have let extraneous issues get before us.

                              {time}  0010

  There is no one on that side that I doubt their compassion for 
wanting to do the same thing I want to do, and that is to not ever see 
another person get this disease. The gentlewoman from California (Ms. 
Pelosi) and the gentlewoman from California (Ms. Eshoo) feel as 
strongly about that as I do, and I know the gentleman from California 
(Mr. Waxman) does.
  The gentleman from California has been a prince to work with. It has 
been one of the real pleasures of my time in Congress to have worked on 
this bill with him, and I will remember it and I thank him for his 
cooperation.
  But we cannot forget about what this epidemic is about. There should 
not be 40,000 new infections this year for this disease. Now, think 
about it. For every one person who gets this disease, it is a minimum 
of $10,000 in health care. If we prevent 1,000 from getting it, we save 
$10 million in health care that year, the next year, and every year. If 
we drop the infection rate in half in this country, we will save $5 
billion in 3 years, just by dropping the infection rate. We will have 
more money to take care of everybody that has it, plus we will be able 
to spend $5 billion on cancer research for breast cancer, just by 
prevention.
  We get lost in the wrong issues. The issue is prevention. This bill 
goes a long way in identifying that. I will work with anybody to make 
sure nobody gets shortchanged when it comes to this, but we have to 
work together to make sure that there is no waste; that there is not 
exorbitant payments to groups that are not doing things to help people 
with HIV; that we do everything that we can to make sure the next 
person does not get infected.
  I took a lot of heat in 1995 putting a baby AIDS bill into the Ryan 
White. It never got funded, and what was funded was not used for 
babies. The State of New York had the courage to put in a baby AIDS 
bill, where if we did not know the status of the mother they were 
tested. Today, all babies who are born are tested for HIV; 98.8 percent 
of them are in care. We have made a tremendous difference just in the 
discussion of it in the State of New York. I applaud the State of New 
York for what they have done.
  Mr. Speaker, I thank again the gentleman from California (Mr. Waxman) 
and his staff, Paul; my staff, Roland Foster, and I look forward to the 
conference as we go along, because the House, I am sure, will pass this 
bill.
  Mr. CROWLEY. Mr. Speaker, I rise in strong support of the Ryan White 
CARE Act Amendments of 2000.
  This legislation reflects a number of key priorities for my 
constituents in Queens and the Bronx, New York City by reauthorizing 
the most important and most widely encompassing set of programs for 
people with HIV and AIDS.
  On May 23, the AIDS Alliance for Children, Youth and Families held 
its annual ``Lobby Day'' in Washington to fight for increased resources 
for those people living with HIV and AIDS.
  At this meeting, I had the opportunity to speak with Ms. Martha Diaz 
of the Montifiore Medical Center in the Bronx, New York, in my 
Congressional District.
  Ms. Diaz deals with children and youths suffering from HIV and AIDS. 
Instead of actually lobbying me on the issue of reauthorizing Ryan 
White, she had her guests do the talking--over 100 mothers and 
children, many suffering from the affliction of AIDS.
  Their words were more touching than anything I can state on the floor 
today. But I am here to support this reauthorization for them and the 
thousands of Americans who battle this virus everyday of their lives.
  In New York, the AIDS crisis is particularly acute. New York City 
AIDS cases represent over 85 percent of the AIDS cases in New York 
State and 17 percent of the national total with 180,000 deaths from 
AIDS and AIDS related illnesses in 1998.
  Sadly, this horrible disease has disproportionately affected 
minorities. The majority of individuals living with AIDS in New York 
City are people of color.
  African Americans are more than eight times as likely as whites to 
have HIV and AIDS, and Hispanics more than four times as likely.
  The most stunning fact I have come across is from the U.S. Department 
of health and Human Services in October of 1998, when they reported 
that AIDS is the leading killer of black men age 25-44 and the second 
leading cause of death for black women aged 25-44.
  Together, Black and Hispanic women represent one fourth of all women 
in the United States but account for more than three quarters of the 
AIDS cases among women in the country.

[[Page H6979]]

  These are horrible statistics, but the Ryan White CARE Act is 
battling to change this story to bring down these horrendously high 
numbers.
  Specifically, this legislation also deals with one of my key 
projects, that of Babies born with AIDS.
  I have long worked in my community notably with Assemblywoman Nettie 
Mayersohn of Flushing, Queens, New York. Assembly-woman Mayersohn and I 
have been active, both in Albany and now in Washington, in working to 
address the issue of newborns with AIDS.
  This legislation will amend the current Baby AIDS grant program by 
adding treatment services for pregnant women with HIV to the list of 
authorized uses, which include counseling, voluntary testing and 
outreach for pregnant women with HIV and offset of State implementation 
of mandatory newborn testing programs.
  I ask my colleagues to support this legislation and send a signal to 
those living with HIV and AIDS that this Congress is not ignoring their 
needs.
  Mr. DREIER. Mr. Speaker, I am pleased to support H.R. 4807 which 
reauthorizes the Ryan White Comprehensive AIDS Resources Emergency 
(CARE) Act. I want to thank my colleagues on the Commerce Committee and 
particularly, Representatives Coburn and Waxman for their work in 
bringing forth a bipartisan bill.
  The CARE Act is critical to the lives and well-being of hundreds of 
thousands of individuals living with HIV and AIDS and those who are at 
risk of contracting HIV. Now in its tenth year, the CARE Act has been 
instrumental in creating and maintaining a system of care for those 
individuals without the ability to pay, including state-of-the-art 
medical services, cutting-edge diagnostic techniques, newly developed 
pharmaceutical therapies, and social support services.
  The CARE Act is significant to many individuals, and H.R. 4807 
directs federal funding to growing populations affected by the disease. 
Specifically, this bill addresses long-standing historical inequities 
in the distribution of funds across Ryan White Title I areas, the 
portion of the Act directed to the epicenters of the epidemic, which 
includes Los Angeles County. These inequities are driven primarily 
through the implementation of the ``holding harmless'' provision 
included in the previous reauthorization.
  The changing dynamic of the disease means that the CARE Act can no 
longer disregard the needs of all the other jurisdictions to protect 
just one jurisdiction. I believe that this bill ensures greater equity 
in the distribution of Ryan White funds across those jurisdictions most 
heavily impacted by the AIDS epidemic.
  Once again, I want to commend my colleagues on the Commerce Committee 
for bringing forward this bipartisan legislation, and I urge my 
colleagues to join me in voting for this measure.
  Mr. DAVIS of Virginia. Mr. Speaker, I rise today in strong support of 
H.R. 4807, the Ryan White CARE Act Amendments of 2000. Since its 
enactment in 1990, the Ryan White CARE program has provided 
comprehensive medical and social services to hundreds of thousands of 
individuals infected with the human immunodeficiency virus (HIV) and 
AIDS. And I am proud to be a cosponsor of this vitally needed 
legislation to reauthorize funding to continue the fight against this 
deadly virus.
  Ever 12 minutes another person in the United States is newly infected 
with HIV, the virus that causes AIDS. This equates to between 800,000 
and 900,000 individuals now living with HIV/AIDS. About a third of 
these individuals have been diagnosed and are in care; another third 
have been diagnosed, but may not be receiving ongoing care for their 
HIV disease; and the last third have not been diagnosed and, therefore 
are not in care.
  H.R. 4807 will take the Ryan White CARE program further than it ever 
has before to reach out and assist these infected individuals. This 
bill will refine the focus of the Ryan White CARE program, by not only 
continuing to fund programs to assist those individuals with AIDS, but 
by also creating programs to assist HIV-positive individuals. AIDS is 
the end stage of HIV disease and can occur up to 10 or 15 years after 
infection. By providing HIV-positive individuals with pro-active and 
aggressive treatment before it progresses into AIDS, we could enhance 
their quality of life and prevent further transmission of this deadly 
virus.
  H.R. 4807 also takes further measures focused on prevention. States 
with effective partner notification and HIV surveillance programs will 
be eligible for additional federal funds. Partner notification programs 
have been proven particularly effective in finding individuals from 
traditionally under-served communities and getting them into care. 
Federal resources will also be provided to assist states with efforts 
to reduce perinatal HIV transmission and to identify newborns at risk 
for infection, and individuals infected with HIV would be provided 
counseling to better empower them to disclose their status to potential 
partners.
  Mr. Speaker, with almost 1,000,000 people living with HIV and AIDS in 
America today, I am sure that many of us know someone who is suffering 
or has suffered from this virus. Unfortunately, my sister-in-law's life 
was tragically cut short by AIDS just four years ago. She had been 
infected by her ex-husband, and my brother and Kristin had no idea of 
her infection until she was near death. My entire family is committed 
to working towards preventing further innocent lives from being stolen 
away again. While I have consistently voted to support federal programs 
to treat and prevent AIDS, my wife, Peggy, has done her part as well. 
In 1997, she biked 300 long miles in the AIDS bike-a-thon to raise 
money for AIDS charities. My family's commitment to assisting 
individuals with HIV and AIDS is deep and personal. Mr. Speaker, I ask 
my fellow colleagues to do their part as well in the fight against AIDS 
by voting in support of the Ryan White CARE Act Amendments of 2000.
  Mr. LARSON. Mr. Speaker, I rise today in support of H.R. 4807, the 
Ryan White CARE Act Amendments of 2000. The programs that this will 
fund ensure that those living with HIV and AIDS in major metropolitan 
areas, as well as elsewhere, continue to get the federal support 
services they need.
  HIV and AIDS are problems that America cannot afford to turn her back 
on. According to the Centers for Disease Control and Prevention, the 
number of Americans living with AIDS has more than doubled over the 
last five years, and it is currently the 5th leading cause of death 
among people aged 25-44. Such unchecked and exponential growth 
represents a most extreme threat.
  Over the last few years we have seen a dramatic increase in spending 
for AIDS and HIV research, and accordingly, we have made some great 
progress regarding the treatment and understanding of this horrible 
disease. However, we must not forget about the 650,000-900,000 people 
who currently live with this disease and may have neither the means nor 
the opportunity to get the treatment they need and deserve. It is for 
these people, and for those who will be infected before such a time 
when a vaccine and other prevention methods are widely accessible and 
affordable, that we must pass the Ryan White CARE Act Amendments of 
2000.
  Under this act, funding to metropolitan areas will not only be based 
on the number of AIDS cases, but will also take into account the number 
of HIV infections. If we are to win this war we must do what we can to 
tackle AIDS in its early stages, and this means the treatment of people 
who suffer from HIV infection and not just the full-blown virus.
  Under the act, grants for dealing with perinatal transmission of HIV 
are increased from $10 to $30 million. This increased funding will add 
treatment services for pregnant women infected with HIV, and will 
increase the funding for service on the current list which includes 
counseling, voluntary testing, and outreach.
  Although we are extremely grateful for the recent advances in the 
treatment of HIV and AIDS, they still represent a very real threat to 
the well-being and security of our nation. By passing the Ryan White 
CARE Act Amendments of 2000 we will come one step closer to winning the 
war on HIV and AIDS, and we will come one step closer to helping those 
already infected with HIV and AIDS live more productive and healthier 
lives.
  Mr. Speaker, distinguished colleagues, we must pass H.R. 4807. It is 
imperative to the well being of our country, and it is imperative to me 
as a public servant, and it is imperative to anybody who has seen the 
devastating effects of HIV and AIDS. I urge all of my colleagues to 
support H.R. 4807 so that we can continue to provide these important 
programs to those living with this disease.
  Mr. BILIRAKIS. Mr. Speaker, I rise today in support of H.R. 4807, the 
Ryan White CARE Act Amendments of 2000. The Health and Environment 
Subcommittee held a hearing on the bill earlier this month. On July 
13th, the full Commerce Committee approved the bill by voice vote, 
after adopting several bipartisan amendments to further refine and 
strengthen this important legislation.
  The swift movement of this measure is a testament to its bipartisan 
nature, and I want to commend Congressmen Tom Coburn and Henry Waxman 
for their hard work. I was pleased to join many of my Committee 
colleagues as an original cosponsor of the bill.
  The Ryan White Comprehensive AIDS Resouces Emergency or ``CARE'' Act 
was enacted in 1990, and Congress approved bipartisan legislation to 
reauthorize the law in 1996. The Ryan White CARE Act provides critical 
funding for health and social services to the estimated one million 
Americans living with HIV and AIDS. The bill before us, H.R. 4807, will 
ensure that these patients continue to receive the care and medications 
they need to enhance and prolong their lives.

[[Page H6980]]

  H.R. 4807 makes an important change by relying on the number of HIV-
infected individuals--as opposed to only the number of persons living 
with AIDS--as the basis for allocating funding under Titles I and II of 
the Ryan White CARE Act. By targeting resources to the ``front line'' 
of the epidemic, we will be able to reduce transmission rates and 
ensure the necessary infrastructure is in place to provide care to HIV-
positive individuals as soon as possible. This change will allow the 
federal government to be pro-active, instead of reactive, in the fight 
against HIV and AIDS.
  It should be noted, however that this shift will only occur when 
reliable data on HIV prevalence is available. The bill also includes a 
``hold harmless'' provision to ensure that no metropolitan area will 
suffer a drastic reduction in CARE Act funds.
  H.R. 4807 also increases the focus on prevention. States with 
effective partner notification and HIV surveillance programs will be 
eligible for additional federal funds. Several witnesses at our 
Subcommittee hearing emphasized the importance of partner notification 
programs as an effective way to identify individuals from traditionally 
under-served communities and help them obtain care. This emphasis on 
prevention services is part of a comprehensive effort under the bill to 
eliminate barriers to access to care.
  In closing, Mr. Speaker, I want to again recognize the hard work of 
all the Members who worked together on a bipartisan basis to advance 
this reauthorization bill. H.R. 4807 is a critical piece of legislation 
that can literally save lives, and I urge all Members to join me today 
in supporting this important legislation.
  The SPEAKER pro tempore (Mr. Tancredo). The question is on the motion 
offered by the gentleman from Oklahoma (Mr. Coburn) that the House 
suspend the rules and pass the bill, H.R. 4807, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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