[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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