Congressional Record, Volume 146 Issue 123 (Thursday, October 5, 2000)

[Congressional Record Volume 146, Number 123 (Thursday, October 5, 2000)]
[House]
[Pages H8817-H8847]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

RYAN WHITE CARE ACT AMENDMENTS OF 2000

Mr. GOSS. Mr. Speaker, by direction of the Committee on Rules, I call
up House Resolution 611 and ask for its immediate consideration.
The Clerk read the resolution, as follows:

H. Res. 611

Resolved, That upon the adoption of this resolution it
shall be in order without intervention of any point of order
to consider in the House the bill (S. 2311) to revise and
extend the Ryan White CARE Act programs under title XXVI of
the Public Health Service Act, to improve access to health
care and the quality of care under such programs, and to
provide for the development of increased capacity to provide
health care and related support services to individuals and
families with HIV disease, and for other purposes. The bill
shall be considered as read for amendment. The amendment in
the nature of a substitute printed in the Congressional
Record and numbered 1 pursuant to clause 8 of rule XVIII
shall be considered as adopted. The previous question shall
be considered as ordered on the bill, as amended, to final
passage without intervening motion except: (1) one hour of
debate on the bill, as amended, equally divided and
controlled by the chairman and ranking minority member of the
Committee on Commerce; and (2) one motion to recommit with or
without instructions.

The SPEAKER pro tempore. The gentleman from Florida (Mr. Goss) is
recognized for 1 hour.
Mr. GOSS. Mr. Speaker, for purposes of debate only, I am pleased to
yield the customary 30 minutes to my friend, the distinguished
gentleman from Ohio (Mr. Hall), pending which I yield myself such time
as I may consume. During consideration of this resolution, all time
yielded is for purposes of debate only.
Mr. Speaker, this is a fair and straightforward closed rule for a
very important piece of legislation. The rule waives all points of
order against consideration of the bill and provides that the amendment
in the nature of a substitute printed in the Congressional Record shall
be considered as adopted.

{time} 1030

This is largely a noncontroversial bill. As no members of the
minority testified differently last night at the Committee on Rules,
this rule should receive unanimous support, and I urge support.
This reauthorization of the Ryan White CARE Act recognizes the
changing demographics of the AIDS epidemic in our country in a way that
truly honors the memory of the courageous young boy for which the bill
was originally named. Today, there are between 800,000 and 900,000
persons living with HIV in the United States of America with some
40,000 new infections annually. This conference report seeks to shift
resources to the most needy areas while preserving the best features of
the current programs.
The gentleman from Virginia (Chairman Bliley) should be commended for
his leadership and attention to this critical public health issue which
is of concern to every Member of this body. I am hopeful that the
progress made on this authorization will spur funding for another
essential program for individuals afflicted with the HIV virus.
As my colleagues remember and well know, this House led the way and
adopted the Ricky Ray Authorization Act in the last Congress. It
authorized $750 million for compassion assistance and recognition to
hemophiliacs who contracted AIDS through no fault of their own because
of contaminated blood products in the 1980s.
Now, the first installment was provided last year, and this year the
gentleman from Florida (Chairman Young) of the Committee on
Appropriations should be commended for exceeding the President's
request in the House version of the Fiscal Year 2001 Labor-HHS
appropriation bill for the next installment.
As negotiations continue and we near the end of this Congress, I am
hopeful that the White House will become fully engaged on the Ricky Ray
funding problem and work with leadership and Congress to provide full
funding for these victims as soon as humanly possible. The need is
great and the time is now.
I am confident that, if the White House shows true leadership and
demonstrates that this problem is really a top priority for them, we
will be able to move further toward full funding this year. Obviously
we cannot undo the tragic events of the 1980s, but we can work to
provide assistance to these individuals before it is any later.
Mr. Speaker, this rule should engender little debate. It is a fair
rule for a good bill. I urge its adoption.
Mr. Speaker, I reserve the balance of my time.
Mr. HALL of Ohio. Mr. Speaker, I want to thank the gentleman from

[[Page H8818]]

Florida (Mr. Goss) for yielding me the time.
Mr. Speaker, this is a closed rule. It will allow for the
consideration of S. 2311, which is called the Ryan White CARE Act
Amendments of 2000. As the gentleman from Florida has described, this
rule provides for 1 hour of general debate to be equally divided and
controlled by the chairman and ranking minority member of the Committee
on Commerce. Under this closed rule, no amendments can be offered on
the House floor.
In 1990, Congress passed the Ryan White Comprehensive AIDS Resources
Emergency Act. It was known as the Ryan White CARE Act. This law
created programs to help Americans with AIDS and HIV, the virus that
causes AIDS, and to slow the spread of HIV.
These programs expired October 1. The bill we are considering will
reauthorize and strengthen the Ryan White CARE Act programs by
expanding access, improving quality, and providing additional services.
Some of the changes will help target health care services to the people
who need it the most but who can least afford it.
Women, children, infants and youth with HIV will especially benefit
from this bill as will low-income individuals and families. AIDS
possesses one of the greatest health challenges of our generation, and
there is no way to avoid its tragic grip. However, an active role by
the Federal government can, in my opinion, ease the tragedy by reducing
the number of new HIV cases and by supporting victims and their
families.
The Ryan White CARE Act has worked. The Federal funds spent under
this law have saved lives and reduced suffering. These are dollars that
could not have been better spent. For example, between 1994 and 1999,
pediatric AIDS cases declined by nearly 80 percent largely because of
these programs funded by the Federal Government under this Act.
I would like to point out to my colleague that this act offers a
framework that we should apply to tackling other tragic diseases, such
as childhood cancer. I hope that Congress will learn from the success
of this act.
This legislation extending the Ryan White CARE Act represents our
best response to dealing with AIDS and its consequences. The bill we
are considering is a compromise between the previously passed House and
Senate versions. The Senate version passed by unanimous consent. The
House version passed by a voice vote under suspension of the rules. I
am proud to be a cosponsor of this House version.
Because there is general agreement between the House and Senate,
there is no need for a formal conference committee.
I urge my colleagues to vote for the rule and for the bill.
Mr. Speaker, I reserve the balance of my time.
Mr. GOSS. Mr. Speaker, I advise that we have no speakers lined up,
and I would be prepared to yield back if the gentleman from Ohio (Mr.
Hall) has no speakers.
Mr. HALL of Ohio. Mr. Speaker, I yield back the balance of my time.
Mr. GOSS. Mr. Speaker, I yield back the balance of my time, and I
move the previous question on the resolution.
The previous question was ordered.
The resolution was agreed to.
A motion to reconsider was laid on the table.
Mr. COBURN. Mr. Speaker, pursuant to House Resolution 611, I call up
the Senate bill (S. 2311) to revise and extend the Ryan White CARE Act
programs under title XXVI of the Public Health Service Act, to improve
access to health care and the quality of care under such programs, and
to provide for the development of increased capacity to provide health
care and related support services to individuals and families with HIV
disease, and for other purposes, and ask for its immediate
consideration.
The Clerk read the title of the Senate bill.
The SPEAKER pro tempore (Mr. Simpson). Pursuant to House Resolution
611, the Senate bill is considered read for amendment.
The text of S. 2311 is as follows:

S. 2311

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. REFERENCES; TABLE OF CONTENTS.

(a) References.--Except as otherwise expressly provided,
whenever in this Act an amendment or repeal is expressed in
terms of an amendment to, or repeal of, a section or other
provision, the reference shall be considered to be made to a
section or other provision of the Public Health Service Act
(42 U.S.C. 201 et seq.).
(b) Table of Contents.--The table of contents of this Act
is as follows:

Sec. 1. Short title.
Sec. 2. References; table of contents.

TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM

Subtitle A--Purpose; Amendments to Part A (Emergency Relief Grants)

Sec. 101. Duties of planning council, funding priorities, quality
assessment.
Sec. 102. Quality management.
Sec. 103. Funded entities required to have health care relationships.
Sec. 104. Support services required to be health care-related.
Sec. 105. Use of grant funds for early intervention services.
Sec. 106. Replacement of specified fiscal years regarding the sunset on
expedited distribution requirement.
Sec. 107. Hold harmless provision.
Sec. 108. Set-aside for infants, children, and women.

Subtitle B--Amendments to Part B (Care Grant Program)

Sec. 121. State requirements concerning identification of need and
allocation of resources.
Sec. 122. Quality management.
Sec. 123. Funded entities required to have health care referral
relationships.
Sec. 124. Support services required to be health care-related.
Sec. 125. Use of grant funds for early intervention services.
Sec. 126. Authorization of appropriations for HIV-related services for
women and children.
Sec. 127. Repeal of requirement for completed Institute of Medicine
report.
Sec. 130. Supplement grants for certain States.
Sec. 131. Use of treatment funds.
Sec. 132. Increase in minimum allotment.
Sec. 133. Set-aside for infants, children, and women.

Subtitle C--Amendments to Part C (Early Intervention Services)

Sec. 141. Amendment of heading; repeal of formula grant program.
Sec. 142. Planning and development grants.
Sec. 143. Authorization of appropriations for categorical grants.
Sec. 144. Administrative expenses ceiling; quality management program.
Sec. 145. Preference for certain areas.

Subtitle D--Amendments to Part D (General Provisions)

Sec. 151. Research involving women, infants, children, and youth.
Sec. 152. Limitation on administrative expenses.
Sec. 153. Evaluations and reports.
Sec. 154. Authorization of appropriations for grants under parts A and
B.

Subtitle E--Amendments to Part F (Demonstration and Training)

Sec. 161. Authorization of appropriations.

TITLE II--MISCELLANEOUS PROVISIONS

Sec. 201. Institute of Medicine study.

TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM

Subtitle A--Purpose; Amendments to Part A (Emergency Relief Grants)

SEC. 101. DUTIES OF PLANNING COUNCIL, FUNDING PRIORITIES,
QUALITY ASSESSMENT.

Section 2602 (42 U.S.C. 300ff-12) is amended--
(1) in subsection (b)--
(A) in paragraph (2)(C), by inserting before the semicolon
the following: ``, including providers of housing and
homeless services''; and
(B) in paragraph (4), by striking ``shall--'' and all that
follows and inserting ``shall have the responsibilities
specified in subsection (d).''; and
(2) by adding at the end the following:
``(d) Duties of Planning Council.--The planning council
established under subsection (b) shall have the following
duties:
``(1) Priorities for allocation of funds.--The council
shall establish priorities for the allocation of funds within
the eligible area, including how best to meet each such
priority and additional factors that a grantee should
consider in allocating funds under a grant, based on the
following factors:
``(A) The size and demographic characteristics of the
population with HIV disease to be served, including, subject
to subsection (e), the needs of individuals living with HIV
infection who are not receiving HIV-related health services.
``(B) The documented needs of the population with HIV
disease with particular attention being given to disparities
in health services among affected subgroups within the
eligible area.
``(C) The demonstrated or probable cost and outcome
effectiveness of proposed strategies and interventions, to
the extent that data are reasonably available.

[[Page H8819]]

``(D) Priorities of the communities with HIV disease for
whom the services are intended.
``(E) The availability of other governmental and non-
governmental resources, including the State medicaid plan
under title XIX of the Social Security Act and the State
Children's Health Insurance Program under title XXI of such
Act to cover health care costs of eligible individuals and
families with HIV disease.
``(F) Capacity development needs resulting from gaps in the
availability of HIV services in historically underserved low-
income communities.
``(2) Comprehensive service delivery plan.--The council
shall develop a comprehensive plan for the organization and
delivery of health and support services described in section
2604. Such plan shall be compatible with any existing State
or local plans regarding the provision of such services to
individuals with HIV disease.
``(3) Assessment of fund allocation efficiency.--The
council shall assess the efficiency of the administrative
mechanism in rapidly allocating funds to the areas of
greatest need within the eligible area.
``(4) Statewide statement of need.--The council shall
participate in the development of the Statewide coordinated
statement of need as initiated by the State public health
agency responsible for administering grants under part B.
``(5) Coordination with other federal grantees.--The
council shall coordinate with Federal grantees providing HIV-
related services within the eligible area.
``(6) Community participation.--The council shall establish
methods for obtaining input on community needs and priorities
which may include public meetings, conducting focus groups,
and convening ad-hoc panels.
``(e) Process for Establishing Allocation Priorities.--
``(1) In general.--Not later than 24 months after the date
of enactment of the Ryan White CARE Act Amendments of 2000,
the Secretary shall--
``(A) consult with eligible metropolitan areas, affected
communities, experts, and other appropriate individuals and
entities, to develop epidemiologic measures for establishing
the number of individuals living with HIV disease who are not
receiving HIV-related health services; and
``(B) provide advice and technical assistance to planning
councils with respect to the process for establishing
priorities for the allocation of funds under subsection
(d)(1).
``(2) Exception.--Grantees under subsection (d)(1)(A) shall
not be required to establish priorities for individuals not
in care until epidemiologic measures are developed under
paragraph (1).''.

SEC. 102. QUALITY MANAGEMENT.

(a) Funds Available for Quality Management.--Section 2604
(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 medical 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 to develop
strategies for improvements in the access to and quality of
medical services.
``(2) Use of funds.--From amounts received under a grant
awarded under this part, the chief elected official of an
eligible area may use, for activities associated with its
quality management program, not more than the lesser of--
``(A) 5 percent of amounts received under the grant; or
``(B) $3,000,000.''.
(b) Quality Management Required for Eligibility for
Grants.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended--
(1) by redesignating paragraphs (3) through (6) as
paragraphs (5) through (8), respectively; and
(2) by inserting after paragraph (2) the following:
``(3) that the chief elected official of the eligible area
will satisfy all requirements under section 2604(c);''.

SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE
RELATIONSHIPS.

(a) Use of Amounts.--Section 2604(e)(1) (42 U.S.C. 300ff-
14(d)(1)) (as so redesignated by section 102(a)) is amended
by inserting ``and the State Children's Health Insurance
Program under title XXI of such Act'' after ``Social Security
Act''.
(b) Applications.--Section 2605(a) (42 U.S.C. 300ff-15(a))
is amended by inserting after paragraph (3), as added by
section 102(b), the following:
``(4) that funded entities within the eligible area that
receive funds under a grant under section 2601(a) shall
maintain appropriate relationships with entities in the area
served that constitute key points of access to the health
care system for individuals with HIV disease (including
emergency rooms, substance abuse treatment programs,
detoxification centers, adult and juvenile detention
facilities, sexually transmitted disease clinics, HIV
counseling and testing sites, and homeless shelters) and
other entities under section 2652(a) for the purpose of
facilitating early intervention for individuals newly
diagnosed with HIV disease and individuals knowledgeable of
their status but not in care;''.

SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
RELATED.

(a) In General.--Section 2604(b)(1) (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 health services.--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
services.--Inpatient case management''; and
(4) by inserting after subparagraph (A) the following:
``(B) Outpatient support services.--Outpatient and
ambulatory support services (including case management), to
the extent that such services facilitate, enhance, support,
or sustain the delivery, continuity, or benefits of health
services for individuals and families with HIV disease.''.
(b) Conforming Amendment to Application Requirements.--
Section 2605(a) (42 U.S.C. 300ff-15(a)), as amended by
section 102(b), is further amended--
(1) in paragraph (6) (as so redesignated), by striking
``and'' at the end thereof;
(2) in paragraph (7) (as so redesignated), by striking the
period and inserting ``; and''; and
(3) by adding at the end the following:
``(8) that the eligible area has procedures in place to
ensure that services provided with funds received under this
part meet the criteria specified in section 2604(b)(1).''.

SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.

(a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-
14(b)(1)), as amended by section 104(a), is further amended
by adding at the end the following:
``(D) Early intervention services.--Early intervention
services as described in section 2651(b)(2), with follow-
through referral, provided for the purpose of facilitating
the access of individuals receiving the services to HIV-
related health services, but only if the entity providing
such services--
``(i)(I) is receiving funds under subparagraph (A) or (C);
or
``(II) is an entity constituting a point of access to
services, as described in paragraph (2)(C), that maintains a
relationship with an entity described in subclause (I) and
that is serving individuals at elevated risk of HIV disease;
and
``(ii) demonstrates to the satisfaction of the chief
elected official that no other Federal, State, or local funds
are available for the early intervention services the entity
will provide with funds received under this paragraph.''.
(b) Conforming Amendments to Application Requirements.--
Section 2605(a)(1) (42 U.S.C. 300ff-15(a)(1)) is amended--
(1) in subparagraph (A), by striking ``services to
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''; and
(2) in subparagraph (B), by striking ``services for
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''.

SEC. 106. REPLACEMENT OF SPECIFIED FISCAL YEARS REGARDING THE
SUNSET ON EXPEDITED DISTRIBUTION REQUIREMENTS.

Section 2603(a)(2) (42 U.S.C. 300ff-13(a)(2)) is amended by
striking ``for each of the fiscal years 1996 through 2000''
and inserting ``for a fiscal year''.

SEC. 107. HOLD HARMLESS PROVISION.

Section 2603(a)(4) (42 U.S.C. 300ff-13(a)(4)) is amended to
read as follows:
``(4) Limitations.--
``(A) In general.--With respect to each of fiscal years
2001 through 2005, the Secretary shall ensure that the amount
of a grant made to an eligible area under paragraph (2) for
such a fiscal year is not less than an amount equal to 98
percent of the amount the eligible area received for the
fiscal year preceding the year for which the determination is
being made.
``(B) Application of provision.--Subparagraph (A) shall
only apply with respect to those eligible areas receiving a
grant under paragraph (2) for fiscal year 2000 in an amount
that has been adjusted in accordance with paragraph (4) of
this subsection (as in effect on the day before the date of
enactment of the Ryan White CARE Act Amendments of 2000).''.

SEC. 108. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.

Section 2604(b)(3) (42 U.S.C. 300ff-14(b)(3)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``established priorities''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.

[[Page H8820]]

Subtitle B--Amendments to Part B (Care Grant Program)

SEC. 121. STATE REQUIREMENTS CONCERNING IDENTIFICATION OF
NEED AND ALLOCATION OF RESOURCES.

(a) General Use of Grants.--Section 2612 (42 U.S.C. 300ff-
22) is amended--
(1) by striking ``A State'' and inserting ``(a) In
General.--A State''; and
(2) in the matter following paragraph (5)--
(A) by striking ``paragraph (2)'' and inserting
``subsection (a)(2) and section 2613'';
(b) Application.--Section 2617(b) (42 U.S.C. 300ff-27(b))
is amended--
(1) in paragraph (1)(C)--
(A) by striking clause (i) and inserting the following:
``(i) the size and demographic characteristics of the
population with HIV disease to be served, except that by not
later than October 1, 2002, the State shall take into account
the needs of individuals not in care, based on epidemiologic
measures developed by the Secretary in consultation with the
State, affected communities, experts, and other appropriate
individuals (such State shall not be required to establish
priorities for individuals not in care until such
epidemiologic measures are developed);'';
(B) in clause (iii), by striking ``and'' at the end; and
(C) by adding at the end the following:
``(v) the availability of other governmental and non-
governmental resources;
``(vi) the capacity development needs resulting in gaps in
the provision of HIV services in historically underserved
low-income and rural low-income communities; and
``(vii) the efficiency of the administrative mechanism in
rapidly allocating funds to the areas of greatest need within
the State;''; and
(2) in paragraph (2)--
(A) in subparagraph (B), by striking ``and'' at the end;
(B) by redesignating subparagraph (C) as subparagraph (F);
and
(C) by inserting after subparagraph (B), the following:
``(C) an assurance that capacity development needs
resulting from gaps in the provision of services in
underserved low-income and rural low-income communities will
be addressed; and
``(D) with respect to fiscal year 2003 and subsequent
fiscal years, assurances that, in the planning and allocation
of resources, the State, through systems of HIV-related
health services provided under paragraphs (1), (2), and (3)
of section 2612(a), will make appropriate provision for the
HIV-related health and support service needs of individuals
who have been diagnosed with HIV disease but who are not
currently receiving such services, based on the epidemiologic
measures developed under paragraph (1)(C)(i);''.

SEC. 122. QUALITY MANAGEMENT.

(a) State Requirement for Quality Management.--Section
2617(b)(4) (42 U.S.C. 300ff-27(b)(4)) is amended--
(1) by striking subparagraph (C) and inserting the
following:
``(C) the State will provide for--
``(i) the establishment of a quality management program to
assess the extent to which medical 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 infections and to develop
strategies for improvements in the access to and quality of
medical services; and
``(ii) a periodic review (such as through an independent
peer review) to assess the quality and appropriateness of
HIV-related health and support services provided by entities
that receive funds from the State under this part;'';
(2) by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively;
(3) by inserting after subparagraph (D), the following:
``(E) an assurance that the State, through systems of HIV-
related health services provided under paragraphs (1), (2),
and (3) of section 2612(a), has considered strategies for
working with providers to make optimal use of financial
assistance under the State medicaid plan under title XIX of
the Social Security Act, the State Children's Health
Insurance Program under title XXI of such Act, and other
Federal grantees that provide HIV-related services, to
maximize access to quality HIV-related health and support
services;
(4) in subparagraph (F), as so redesignated, by striking
``and'' at the end; and
(5) in subparagraph (G), as so redesignated, by striking
the period and inserting ``; and''.
(b) Availability of Funds for Quality Management.--
(1) Availability of grant funds for planning and
evaluation.--Section 2618(c)(3) (42 U.S.C. 300ff-28(c)(3)) is
amended by inserting before the period ``, including not more
than $3,000,000 for all activities associated with its
quality management program''.
(2) Exception to combined ceiling on planning and
administration funds for states with small grants.--Paragraph
(6) of section 2618(c) (42 U.S.C. 300ff-28(c)(6)) is amended
to read as follows:
``(6) Exception for quality management.--Notwithstanding
paragraph (5), a State whose grant under this part for a
fiscal year does not exceed $1,500,000 may use not to exceed
20 percent of the amount of the grant for the purposes
described in paragraphs (3) and (4) if--
``(A) that portion of such amount in excess of 15 percent
of the grant is used for its quality management program; and
``(B) the State submits and the Secretary approves a plan
(in such form and containing such information as the
Secretary may prescribe) for use of funds for its quality
management program.''.

SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE
RELATIONSHIPS.

Section 2617(b)(4) (42 U.S.C. 300ff-27(b)(4)), as amended
by section 122(a), is further amended by adding at the end
the following:
``(H) that funded entities maintain appropriate
relationships with entities in the area served that
constitute key points of access to the health care system for
individuals with HIV disease (including emergency rooms,
substance abuse treatment programs, detoxification centers,
adult and juvenile detention facilities, sexually transmitted
disease clinics, HIV counseling and testing sites, and
homeless shelters), and other entities under section 2652(a),
for the purpose of facilitating early intervention for
individuals newly diagnosed with HIV disease and individuals
knowledgeable of their status but not in care.''.

SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
RELATED.

(a) Technical Amendment.--Section 3(c)(2)(A)(iii) of the
Ryan White CARE Act Amendments of 1996 (Public Law 104-146)
is amended by inserting ``before paragraph (2) as so
redesignated'' after ``inserting''.
(b) Services.--Section 2612(a)(1) (42 U.S.C. 300ff-
22(a)(1)), as so designated by section 121(a), is amended by
striking ``for individuals with HIV disease'' and inserting
``, subject to the conditions and limitations that apply
under such section''.
(c) Conforming Amendment to State Application
Requirement.--Section 2617(b)(2) (42 U.S.C. 300ff-27(b)(2)),
as amended by section 121(b), is further amended by adding at
the end the following:
``(F) an assurance that the State has procedures in place
to ensure that services provided with funds received under
this section meet the criteria specified in section
2604(b)(1)(B); and''.

SEC. 125. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.

Section 2612(a) (42 U.S.C. 300ff-22(a)), as amended by
section 121, is further amended by adding at the end the
following:
``(6) Early intervention services.--The State, through
systems of HIV-related health services provided under
paragraphs (1), (2), and (3) of section 2612(a), may provide
early intervention services, as described in section
2651(b)(2), with follow-up referral, provided for the purpose
of facilitating the access of individuals receiving the
services to HIV-related health services, but only if the
entity providing such services--
``(A)(i) is receiving funds under section 2612(a)(1); or
``(ii) is an entity constituting a point of access to
services, as described in section 2617(b)(4), that maintains
a referral relationship with an entity described in clause
(i) and that is serving individuals at elevated risk of HIV
disease; and
``(B) demonstrates to the State's satisfaction that no
other Federal, State, or local funds are available for the
early intervention services the entity will provide with
funds received under this paragraph.''.

SEC. 126. AUTHORIZATION OF APPROPRIATIONS FOR HIV-RELATED
SERVICES FOR WOMEN AND CHILDREN.

Section 2625(c)(2) (42 U.S.C. 300ff-33(c)(2)) is amended by
striking ``fiscal years 1996 through 2000'' and inserting
``fiscal years 2001 through 2005''.

SEC. 127. REPEAL OF REQUIREMENT FOR COMPLETED INSTITUTE OF
MEDICINE REPORT.

Section 2628 (42 U.S.C. 300ff-36) is repealed.

SEC. 128. SUPPLEMENT 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 by adding
at the end the following:

``SEC. 2622. SUPPLEMENTAL GRANTS.

[[Page H8821]]

that is equal to not less than the level of such activities
in the State for the 1-year period preceding the fiscal year
for which the State is applying to receive a grant under this
part;
``(4) a demonstration of the ability of the State to
utilize such supplemental financial resources in a manner
that is immediately responsive and cost effective;
``(5) a demonstration that the resources will be allocated
in accordance with the local demographic incidence of AIDS
including appropriate allocations for services for infants,
children, women, and families with HIV disease;
``(6) a demonstration of the inclusiveness of the planning
process, with particular emphasis on affected communities and
individuals with HIV disease; and
``(7) a demonstration of the manner in which the proposed
services are consistent with local needs assessments and the
statewide coordinated statement of need.
``(d) Amount Reserved for Emerging Communities.--
``(1) In general.--For awarding grants under this section
for each fiscal year, the Secretary shall reserve the greater
of 50 percent of the amount to be utilized under subsection
(e) for such fiscal year or $5,000,000, to be provided to
States that contain emerging communities for use in such
communities.
``(2) Definition.--In paragraph (1), the term `emerging
community' means a metropolitan area--
``(A) that is not eligible for a grant under part A; and
``(B) for which there has been reported to the Director of
the Centers for Disease Control and Prevention a cumulative
total of between 1000 and 1999 cases of acquired immune
deficiency syndrome for the most recent period of 5 calendar
years for which such data are available.
``(e) Appropriations.--With respect to each fiscal year
beginning with fiscal year 2001, the Secretary, to carry out
this section, shall utilize 50 percent of the amount
appropriated under section 2677 to carry out part B for such
fiscal year that is in excess of the amount appropriated to
carry out such part in fiscal year preceding the fiscal year
involved.

SEC. 129. USE OF TREATMENT FUNDS.

(a) State Duties.--Section 2616(c) (42 U.S.C. 300ff-26(c))
is amended--
(1) in the matter preceding paragraph (1), by striking
``shall--'' and inserting ``shall use funds made available
under this section to--'';
(2) by redesignating paragraphs (1) through (5) as
subparagraphs (A) through (E), respectively and realigning
the margins of such subparagraphs appropriately;
(3) in subparagraph (D) (as so redesignated), by striking
``and'' at the end;
(4) in subparagraph (E) (as so redesignated), by striking
the period and ``; and''; and
(5) by adding at the end the following:
``(F) encourage, support, and enhance adherence to and
compliance with treatment regimens, including related medical
monitoring.'';
(6) by striking ``In carrying'' and inserting the
following:
``(1) In general.--In carrying''; and
(7) by adding at the end the following:
``(2) Limitations.--
``(A) In general.--No State shall use funds under paragraph
(1)(F) unless the limitations on access to HIV/AIDS
therapeutic regimens as defined in subsection (e)(2) are
eliminated.
``(B) Amount of funding.--No State shall use in excess of
10 percent of the amount set-aside for use under this section
in any fiscal year to carry out activities under paragraph
(1)(F) unless the State demonstrates to the Secretary that
such additional services are essential and in no way diminish
access to therapeutics.''.
(b) Supplement Grants.--Section 2616 (42 U.S.C. 300ff-
26(c)) is amended by adding at the end the following:
``(e) Supplemental Grants for the Provision of
Treatments.--
``(1) In general.--From amounts made available under
paragraph (5), the Secretary shall award supplemental grants
to States determined to be eligible under paragraph (2) to
enable such States to provide access to therapeutics to treat
HIV disease as provided by the State under subsection
(c)(1)(B) for individuals at or below 200 percent of the
Federal poverty line.
``(2) Criteria.--The Secretary shall develop criteria for
the awarding of grants under paragraph (1) to States that
demonstrate a severe need. In determining the criteria for
demonstrating State severity of need (as defined for purposes
of section 2603(b)(2)(A)), the Secretary shall consider
whether limitation to access exist such that--
``(A) the State programs under this section are unable to
provide HIV/AIDS therapeutic regimens to all eligible
individuals living at or below 200 percent of the Federal
poverty line; and
``(B) the State programs under this section are unable to
provide to all eligible individuals appropriate HIV/AIDS
therapeutic regimens as recommended in the most recent
Federal treatment guidelines.
``(3) State requirement.--The Secretary may not make a
grant to a State under this subsection unless the State
agrees that--
``(A) the State will make available (directly or through
donations from public or private entities) non-Federal
contributions toward the activities to be carried out under
the grant in an amount equal to $1 for each $4 of Federal
funds provided in the grant; and
``(B) the State will not impose eligibility requirements
for services or scope of benefits limitations under
subsection (a) that are more restrictive than such
requirements in effect as of January 1, 2000.
``(4) Use and coordination.--Amounts made available under a
grant under this subsection shall only be used by the State
to provide AIDS/HIV-related medications. The State shall
coordinate the use of such amounts with the amounts otherwise
provided under this section in order to maximize drug
coverage.
``(5) Funding.--
``(A) Reservation of amount.--The Secretary may reserve not
to exceed 4 percent, but not less than 2 percent, of any
amount referred to in section 2618(b)(2)(H) that is
appropriated for a fiscal year, to carry out this subsection.
``(B) Minimum amount.--In providing grants under this
subsection, the Secretary shall ensure that the amount of a
grant to a State under this part is not less than the amount
the State received under this part in the previous fiscal
year, as a result of grants provided under this
subsection.''.
(c) Supplement and not Supplant.--Section 2616 (42 U.S.C.
300ff-26(c)), as amended by subsection (b), is further
amended by adding at the end the following:
``(f) Supplement not Supplant.--Notwithstanding any other
provision of law, amounts made available under this section
shall be used to supplement and not supplant other funding
available to provide treatments of the type that may be
provided under this section.''.

SEC. 130. INCREASE IN MINIMUM ALLOTMENT.

(a) In General.--Section 2618(b)(1)(A)(i) (42 U.S.C. 300ff-
28(b)(1)(A)(i)) is amended--
(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) Technical Amendment.--Section 2618(b)(3)(B) (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''.

SEC. 131. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.

Section 2611(b) (42 U.S.C. 300ff-21(b)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``State shall use''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.

Subtitle C--Amendments to Part C (Early Intervention Services)

SEC. 141. AMENDMENT OF HEADING; REPEAL OF FORMULA GRANT
PROGRAM.

(a) Amendment of Heading.--The heading of part C of title
XXVI is amended to read as follows:

``Part C--Early Intervention and Primary Care Services''.

(b) Repeal.--Part C of title XXVI (42 U.S.C. 300ff-41 et
seq.) is amended--
(1) by repealing subpart I; and
(2) by redesignating subparts II and III as subparts I and
II.
(c) Conforming Amendments.--
(1) Information regarding receipt of services.--Section
2661(a) (42 U.S.C. 300ff-61(a)) is amended by striking
``unless--'' and all that follows through ``(2) in the case
of'' and inserting ``unless, in the case of''.
(2) Additional agreements.--Section 2664 (42 U.S.C. 300ff-
64) is amended--
(A) in subsection (e)(5), by striking ``2642(b) or'';
(B) in subsection (f)(2), by striking ``2642(b) or''; and
(C) by striking subsection (h).

SEC. 142. PLANNING AND DEVELOPMENT GRANTS.

(a) Allowing Planning and Development Grant To Expand
Ability To Provide Primary Care Services.--Section 2654(c)
(42 U.S.C. 300ff-54(c)) is amended--
(1) in paragraph (1), to read as follows:
``(1) In general.--The Secretary may provide planning and
development grants to public and nonprofit private entities
for the purpose of--
``(A) enabling such entities to provide HIV early
intervention services; or
``(B) assisting such entities to expand the capacity,
preparedness, and expertise to deliver primary care services
to individuals with HIV disease in underserved low-income
communities on the condition that the funds are not used to
purchase or improve land or to purchase, construct, or
permanently improve (other than minor remodeling) any
building or other facility.''; and
(2) in paragraphs (2) and (3) by striking ``paragraph (1)''
each place that such appears and inserting ``paragraph
(1)(A)''.
(b) Amount; Duration.--Section 2654(c) (42 U.S.C. 300ff-
54(c)), as amended by subsection (a), 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.

[[Page H8822]]

``(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) (42 U.S.C.
300ff-54(c)(5)), as so redesignated by subsection (b), is
amended by striking ``1 percent'' and inserting ``5
percent''.

SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CATEGORICAL
GRANTS.

Section 2655 (42 U.S.C. 300ff-55) is amended by striking
``1996'' and all that follows through ``2000'' and inserting
``2001 through 2005''.

SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY MANAGEMENT
PROGRAM.

Section 2664(g) (42 U.S.C. 300ff-64(g)) is amended--
(1) in paragraph (3), to read as follows:
``(3) the applicant will not expend more than 10 percent of
the grant for costs of administrative activities with respect
to the grant;'';
(2) in paragraph (4), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(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.''.

SEC. 145. PREFERENCE FOR CERTAIN AREAS.

Section 2651 (42 U.S.C. 300ff-51) is amended by adding at
the end the following:
``(d) Preference in Awarding Grants.--Beginning in fiscal
year 2001, in awarding new grants under this section, the
Secretary shall give preference to applicants that will use
amounts received under the grant to serve areas that are
otherwise not eligible to receive assistance under part A.''.

Subtitle D--Amendments to Part D (General Provisions)

SEC. 151. RESEARCH INVOLVING WOMEN, INFANTS, CHILDREN, AND
YOUTH.

(a) Elimination of Requirement To Enroll Significant
Numbers of Women and Children.--Section 2671(b) (42 U.S.C.
300ff-71(b)) is amended--
(1) in paragraph (1), by striking subparagraphs (C) and
(D); and
(2) by striking paragraphs (3) and (4).
(b) Information and Education.--Section 2671(d) (42 U.S.C.
300ff-71(d)) is amended by adding at the end the following:
``(4) The applicant will provide individuals with
information and education on opportunities to participate in
HIV/AIDS-related clinical research.''.
(c) Quality Management; Administrative Expenses Ceiling.--
Section 2671(f) (42 U.S.C. 300ff-71(f)) is amended--
(1) by striking the subsection heading and designation and
inserting the following:
``(f) Administration.--
``(1) Application.--''; and
(2) by adding at the end the following:
``(2) Quality management program.--A grantee under this
section shall implement a quality management program.''.
(d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g))
is amended by adding at the end the following: ``The
Secretary acting through the Director of NIH, shall examine
the distribution and availability of ongoing and appropriate
HIV/AIDS-related research projects to existing sites under
this section for purposes of enhancing and expanding
voluntary access to HIV-related research, especially within
communities that are not reasonably served by such
projects.''.
(e) Authorization of Appropriations.--Section 2671(j) (42
U.S.C. 300ff-71(j)) is amended by striking ``fiscal years
1996 through 2000'' and inserting ``fiscal years 2001 through
2005''.

SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.

Section 2671 (42 U.S.C. 300ff-71) is amended--
(1) by redesignating subsections (i) and (j), as
subsections (j) and (k), respectively; and
(2) by inserting after subsection (h), the following:
``(i) Limitation on Administrative Expenses.--
``(1) Determination by secretary.--Not later than 12 months
after the date of enactment of the Ryan White Care Act
Amendments of 2000, the Secretary, in consultation with
grantees under this part, shall conduct a review of the
administrative, program support, and direct service-related
activities that are carried out under this part to ensure
that eligible individuals have access to quality, HIV-related
health and support services and research opportunities under
this part, and to support the provision of such services.
``(2) Requirements.--
``(A) In general.--Not later than 180 days after the
expiration of the 12-month period referred to in paragraph
(1) the Secretary, in consultation with grantees under this
part, shall determine the relationship between the costs of
the activities referred to in paragraph (1) and the access of
eligible individuals to the services and research
opportunities described in such paragraph.
``(B) Limitation.--After a final determination under
subparagraph (A), the Secretary may not make a grant under
this part unless the grantee complies with such requirements
as may be included in such determination.''.

SEC. 153. EVALUATIONS AND REPORTS.

Section 2674(c) (42 U.S.C. 399ff-74(c)) is amended by
striking ``1991 through 1995'' and inserting ``2001 through
2005''.

SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR GRANTS UNDER
PARTS A AND B.

Section 2677 (42 U.S.C. 300ff-77) is amended to read as
follows:

``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

``There are authorized to be appropriated--
``(1) such sums as may be necessary to carry out part A for
each of the fiscal years 2001 through 2005; and
``(2) such sums as may be necessary to carry out part B for
each of the fiscal years 2001 through 2005.''.

Subtitle E--Amendments to Part F (Demonstration and Training)

SEC. 161. AUTHORIZATION OF APPROPRIATIONS.

(a) Schools; Centers.--Section 2692(c)(1) (42 U.S.C. 300ff-
111(c)(1)) is amended by striking ``fiscal years 1996 through
2000'' and inserting ``fiscal years 2001 through 2005''.
(b) Dental Schools.--Section 2692(c)(2) (42 U.S.C. 300ff-
111(c)(2)) is amended by striking ``fiscal years 1996 through
2000'' and inserting ``fiscal years 2001 through 2005''.

TITLE II--MISCELLANEOUS PROVISIONS

SEC. 201. INSTITUTE OF MEDICINE STUDY.

(a) In General.--Not later than 120 days after the date of
enactment of this Act, the Secretary of Health and Human
Services shall enter into a contract with the Institute of
Medicine for the conduct of 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.
(b) Requirements.--
(1) Completion.--The study under subsection (a) shall be
completed not later than 21 months after the date on which
the contract referred to in such subsection is entered into.
(2) Issues to be considered.--The study conducted under
subsection (a) shall consider--
(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;
(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;
and
(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) Report.--Not later than 90 days after the date on which
the study is completed under subsection (a), the Secretary of
Health and Human Services shall prepare and submit to the
appropriate committees of Congress a report describing the
manner in which the conclusions and recommendations of the
Institute of Medicine can be addressed and implemented.

The SPEAKER pro tempore. Pursuant to House Resolution 611, the
amendment in the nature of a substitute printed in the Congressional
Record and numbered 1 is considered adopted.
The text of S. 2311, as amended pursuant to House Resolution 611, is
as follows:
Strike all after the enacting clause and insert the
following:

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.

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.

[[Page H8823]]

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.
Sec. 503. Technical corrections.

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 (C), by inserting before the semicolon
the following: ``, including providers of housing and
homeless services'';
(B) in subparagraph (G), by striking ``or AIDS'';
(C) in subparagraph (K), by striking ``and'' at the end;
(D) in subparagraph (L), by striking the period and
inserting the following: ``, including but not limited to
providers of HIV prevention services; and''; and
(E) 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 3 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 know their HIV
status and 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) coordination in the provision of services to such
individuals with programs for HIV prevention and for the
prevention and treatment of substance abuse, including
programs that provide comprehensive treatment for such abuse;
``(v) availability of other governmental and non-
governmental resources, including the State medicaid plan
under title XIX of the Social Security Act and the State
Children's Health Insurance Program under title XXI of such
Act to cover health care costs of eligible individuals and
families with HIV disease; and
``(vi) 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 who
know their HIV status and 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 (including
outreach and early intervention) 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 planning councils and 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.''.
(d) Conforming Amendment.--Section 2603(c) of the Public
Health Service Act (42 U.S.C. 300ff-12(b)) is amended by
striking ``section 2602(b)(3)(A)'' and inserting ``section
2602(b)(4)(C)''.

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

[[Page H8824]]

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).
``(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 318B
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 percent of the amount of such base year
grant;
``(iii) for any third fiscal year in such period, the grant
is not less than 92 percent of the amount of the base year
grant;
``(iv) for any fourth fiscal year in such period, the grant
is not less than 89 percent of the amount of the base year
grant; and
``(v) for any fifth or subsequent fiscal year in such
period, if, pursuant to paragraph (3)(D)(ii)), the references
in paragraph (3)(C)(i) to HIV disease do not have any legal
effect, the grant is not less than 85 percent of the amount
of the base year grant.
``(B) Special Rule.--If for fiscal year 2005, pursuant to
paragraph (3)(D)(ii), data on cases of HIV disease are used
for purposes of paragraph (3)(C)(i), the Secretary shall
increase the amount of a grant made pursuant to paragraph (2)
for an eligible area to ensure that the grant is not less
than 98 percent of the amount of the grant made for the area
in fiscal year 2004.
``(C) 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 determined
pursuant to paragraph (2) for the area equals or exceeds the
amount of the grant determined under subparagraph (A).
``(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) Technical and 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);
(2) by redesignating paragraph (5) as paragraph (4); and
(3) in paragraph (4) (as so redesignated), in subparagraph
(B), by striking ``grants'' and inserting ``grant''.

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, enhance, support, or sustain the delivery,
continuity, 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 know their HIV status and
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)(A);
``(ii) conducted in a manner consistent with the
requirements under sections 2605(a)(3) and 2651(b)(2); and

[[Page H8825]]

``(iii) supplement, and do not supplant, such activities
that are carried out with amounts appropriated under section
317.''.
(b) Early Intervention Services.--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); and
(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), with follow-up referral provided for the
purpose of facilitating the access of individuals receiving
the services to HIV-related health services. The entities
through which such services may be provided under the grant
include public health departments, emergency rooms, substance
abuse and mental health treatment programs, detoxification
centers, detention facilities, clinics regarding sexually
transmitted diseases, homeless shelters, HIV disease
counseling and testing sites, health care points of entry
specified by eligible areas, federally qualified health
centers, and entities described in section 2652(a) that
constitute a point of access to services by maintaining
referral relationships.
``(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.''.
(c) Priority for Women, Infants, and Children.--Section
2604(b) (42 U.S.C. 300ff-14(b)) of the Public Health Service
Act is amended in paragraph (4) (as redesignated by
subsection (b)(1) of this section) by amending the paragraph
to read as follows:
``(4) Priority for women, infants and children.--
``(A) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with
HIV disease, including treatment measures to prevent the
perinatal transmission of HIV, the chief elected official of
an eligible area, in accordance with the established
priorities of the planning council, shall for each of such
populations in the eligible area use, from the grants made
for the area under section 2601(a) for a fiscal year, not
less than the percentage constituted by the ratio of the
population involved (infants, children, youth, or women in
such area) with acquired immune deficiency syndrome to the
general population in such area of individuals with such
syndrome.
``(B) Waiver.--With respect the population involved, the
Secretary may provide to the chief elected official of an
eligible area a waiver of the requirement of subparagraph (A)
if such official demonstrates to the satisfaction of the
Secretary that the population is receiving HIV-related health
services through the State medicaid program under title XIX
of the Social Security Act, the State children's health
insurance program under title XXI of such Act, or other
Federal or State programs.''.
(d) 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 for improvement
in the access to and quality of HIV health services.
``(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.

(a) In General.--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 (5) through (8), respectively; and
(2) by inserting after paragraph (2) the following
paragraphs:
``(3) that entities within the eligible area that receive
funds under a grant under this part will maintain appropriate
relationships with entities in the eligible area served that
constitute key points of access to the health care system for
individuals with HIV disease (including emergency rooms,
substance abuse treatment programs, detoxification centers,
adult and juvenile detention facilities, sexually transmitted
disease clinics, HIV counseling and testing sites, mental
health programs, and homeless shelters), and other entities
under section 2604(b)(3) and 2652(a), for the purpose of
facilitating early intervention for individuals newly
diagnosed with HIV disease and individuals knowledgeable of
their HIV status but not in care;
``(4) that the chief elected official of the eligible area
will satisfy all requirements under section 2604(c);''.
(b) Conforming Amendments.--Section 2605(a) (42 U.S.C.
300ff-15(a)(1)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by striking ``services to
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''; and
(B) in subparagraph (B), by striking ``services for
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)'';
(2) in paragraph (7) (as redesignated by subsection (a)(1)
of this section), by striking ``and'' at the end;
(3) in paragraph (8) (as so redesignated), by striking the
period and inserting ``; and''; and
(4) by adding at the end the following paragraph:
``(9) that the eligible area has procedures in place to
ensure that services provided with funds received under this
part meet the criteria specified in section 2604(b)(1).''.

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 to read as follows:
``(b) Priority for Women, Infants and Children.--
``(1) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with
HIV disease, including treatment measures to prevent the
perinatal transmission of HIV, a State shall for each of such
populations use, of the funds allocated under this part to
the State for a fiscal year, not less than the percentage
constituted by the ratio of the population involved (infants,
children, youth, or women in the State) with acquired immune
deficiency syndrome to the general population in the State of
individuals with such syndrome.
``(2) Waiver.--With respect the population involved, the
Secretary may provide to a State a waiver of the requirement
of paragraph (1) if the State demonstrates to the
satisfaction of the Secretary that the population is
receiving HIV-related health services through the State
medicaid program under title XIX of the Social Security Act,
the State children's health insurance program under title XXI
of such Act, or other Federal or State programs.''.

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) Outpatient and ambulatory support services under
section 2611(a) (including case management) to the extent
that such services facilitate, enhance, support, or sustain
the delivery, continuity, 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 know their HIV status and
are not receiving HIV-related services, and that are--
``(A) necessary to implement the strategy under section
2617(b)(4)(B), including activities facilitating the access
of such individuals to HIV-related primary care services at
entities described in subsection (c)(1);
``(B) conducted in a manner consistent with the requirement
under section 2617(b)(6)(G) and 2651(b)(2); 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), with follow-up referral provided for the purpose
of facilitating the access of individuals receiving the
services to HIV-related health services. The entities through
which such services may be provided under the grant include
public health departments, emergency rooms, substance abuse
and mental health treatment programs, detoxification centers,
detention facilities, clinics regarding sexually transmitted
diseases, homeless shelters, HIV disease counseling and
testing sites, health care points of entry specified by
States or eligible areas,

[[Page H8826]]

federally qualified health centers, and entities described in
section 2652(a) that constitute a point of access to services
by maintaining referral relationships.
``(2) Conditions.--With respect to an entity that proposes
to provide early intervention services under paragraph (1),
such paragraph 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 for
improvement in the access to and quality of HIV health
services.
``(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(b)(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''; 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) the types of entities described in section
2602(b)(2).''.

SEC. 204. PROVISION OF TREATMENTS.

(a) In General.--Section 2616(c) of the Public Health
Service Act (42 U.S.C. 300ff-26(c)) is amended--
(1) in paragraph (4), by striking ``and'' after the
semicolon at the end;
(2) in paragraph (5), by striking the period and inserting
``; and''; and
(3) by inserting after paragraph (5) the following:
``(6) encourage, support, and enhance adherence to and
compliance with treatment regimens, including related medical
monitoring.
``Of the amount reserved by a State for a fiscal year for use
under this section, the State may not use more than 5 percent
to carry out services under paragraph (6), except that the
percentage applicable with respect to such paragraph is 10
percent if the State demonstrates to the Secretary that such
additional services are essential and in no way diminish
access to the therapeutics described in subsection (a).''.
(b) Health Insurance and Plans.--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.--
``(1) In general.--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.
``(2) Limitation.--The authority established in paragraph
(1) applies only to the extent that, for the fiscal year
involved, the costs of the health insurance or plans to be
purchased or maintained under such paragraph do not exceed
the costs of otherwise providing therapeutics described in
subsection (a).''.

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 know their HIV
status and 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 non-
governmental resources, including the State medicaid plan
under title XIX of the Social Security Act and the State
Children's Health Insurance Program under title XXI of such
Act to cover health care costs of eligible 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 who
know their HIV status and 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 (including
outreach and early intervention) 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 the types of 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 appropriate relationships
with entities in the area served that constitute key points
of access to the health care system for individuals with HIV
disease (including emergency rooms, substance abuse treatment
programs, detoxification centers, adult and juvenile
detention facilities, sexually transmitted disease clinics,
HIV counseling and testing sites, mental health programs, and
homeless shelters), and other entities under section 2612(c)
and 2652(a), for the purpose of facilitating early
intervention for individuals newly diagnosed with HIV disease
and individuals knowledgeable of their HIV status but not in
care.''.

SEC. 206. DISTRIBUTION OF FUNDS.

(a) Minimum Allotment.--Section 2618 of the Public Health
Service Act (42 U.S.C. 300ff-28) is amended--
(1) by redesignating subsections (b) through (e) as
subsections (a) through (d), respectively; and
(2) in subsection (a) (as so redesignated), in paragraph
(1)(A)(i)--
(A) in subclause (I), by striking ``$100,000'' and
inserting ``$200,000''; and
(B) in subclause (II), by striking ``$250,000'' and
inserting ``$500,000''.
(b) Amount of Grant; Estimate of Living Cases.--Section
2618(a) of the Public Health

[[Page H8827]]

Service Act (as redesignated by subsection (a)(1) of this
section) is amended in paragraph (2)--
(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
or section 2620 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 are 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(a) of the
Public Health Service Act (as redesignated by subsection
(a)(1) of this section) 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 or subparagraph (I)(i) 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 section 2611 or subparagraph (I)(i),
respectively (notwithstanding such subparagraph). 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 or subparagraph 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 or subparagraph (I)(i) is less than the amount
appropriated and available for fiscal year 2000 under section
2611 or subparagraph (I)(i), respectively, the limitation
contained in clause (i) for the grants involved shall be
reduced by a percentage equal to the percentage of the
reduction in such amounts appropriated and available.''.
(d) Territories.--Section 2618(a) of the Public Health
Service Act (as redesignated by subsection (a)(1) of this
section) is amended in paragraph (1)(B) by inserting ``the
greater of $50,000 or'' after ``shall be''.
(e) Separate Treatment Drug Grants.--Section 2618(a) of the
Public Health Service Act (as redesignated by subsection
(a)(1) of this section and amended by subsection (b)(2) of
this section) is amended in paragraph (2)(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 inserting before the semicolon
the following: ``, less the percentage reserved under clause
(ii)(V)''; and
(4) by adding at the end the following clause:
``(ii) Supplemental treatment drug grants.--

``(I) In general.--From amounts made available under
subclause (V), the Secretary shall make supplemental grants
to States described in subclause (II) to enable such States
to increase access to therapeutics described in section
2616(a), as provided by the State under section 2616(c)(2).
``(II) Eligible states.--For purposes of subclause (I), a
State described in this subclause is a State that, in
accordance with criteria established by the Secretary,
demonstrates a severe need for a grant under such subclause.
In developing such criteria, the Secretary shall consider
eligibility standards, formulary composition, and the number
of eligible individuals at or below 200 percent of the
official poverty line to whom the State is unable to provide
therapeutics described in section 2616(a).

``(III) State requirements.--The Secretary may not make a
grant to a State under this clause unless the State agrees
that--

``(aa) the State will make available (directly or through
donations from public or private entities) non-Federal
contributions toward the activities to carried out under the
grant in an amount equal to $1 for each $4 of Federal funds
provided in the grant; and
``(bb) the State will not impose eligibility requirements
for services or scope of benefits limitations under section
2616(a) that are more restrictive than such requirements in
effect as of January 1, 2000.
``(IV) Use and coordination.--Amounts made available under
a grant under this clause shall only be used by the State to
provide HIV/AIDS-related medications. The State shall
coordinate the use of such amounts with the amounts otherwise
provided under section 2616(a) in order to maximize drug
coverage.

``(V) Funding.--For the purpose of making grants under this
clause, the Secretary shall each fiscal year reserve 3
percent of the amount referred to in clause (i) with respect
to section 2616, subject to subclause (VI).
``(VI) Limitation.--In reserving amounts under subclause
(V) and making grants under this clause for a fiscal year,
the Secretary shall ensure for each State that the total of
the grant under section 2611 for the State for the fiscal
year and the grant under clause (i) for the State for the
fiscal year is not less than such total for the State for the
preceding fiscal year.''.

(f) Technical Amendment.--Section 2618(a) of the Public
Health Service Act (as redesignated by subsection (a)(1) of
this section) is amended in paragraph (3)(B) 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 2619 the following section:

``SEC. 2620. SUPPLEMENTAL GRANTS.

``(a) In General.--The Secretary shall award supplemental
grants to States determined to be eligible under subsection
(b) to enable such States to provide comprehensive services
of the type described in section 2612(a) to supplement the
services otherwise provided by the State under a grant under
this subpart in emerging communities within the State that
are not eligible to receive grants under part A.
``(b) Eligibility.--To be eligible to receive a
supplemental grant under subsection (a), a State shall--
``(1) be eligible to receive a grant under this subpart;
``(2) demonstrate the existence in the State of an emerging
community as defined in subsection (d)(1); and
``(3) submit the information described in subsection (c).
``(c) Reporting Requirements.--A State that desires a grant
under this section shall, as part of the State application
submitted under section 2617, submit a detailed description
of the manner in which the State will use amounts received
under the grant and of the severity of need. Such description
shall include--
``(1) a report concerning the dissemination of supplemental
funds under this section and the plan for the utilization of
such funds in the emerging community;
``(2) a demonstration of the existing commitment of local
resources, both financial and in-kind;
``(3) a demonstration that the State will maintain HIV-
related activities at a level that is equal to not less than
the level of such activities in the State for the 1-year
period preceding the fiscal year for which the State is
applying to receive a grant under this part;
``(4) a demonstration of the ability of the State to
utilize such supplemental financial resources in a manner
that is immediately responsive and cost effective;
``(5) a demonstration that the resources will be allocated
in accordance with the local demographic incidence of AIDS
including appropriate allocations for services for infants,
children, women, and families with HIV disease;
``(6) a demonstration of the inclusiveness of the planning
process, with particular emphasis on affected communities and
individuals with HIV disease; and
``(7) a demonstration of the manner in which the proposed
services are consistent with local needs assessments and the
statewide coordinated statement of need.
``(d) Definition of Emerging Community.--In this section,
the term `emerging community' means a metropolitan area--
``(1) that is not eligible for a grant under part A; and
``(2) for which there has been reported to the Director of
the Centers for Disease Control and Prevention a cumulative
total of between 500 and 1999 cases of acquired immune
deficiency syndrome for the most recent period of 5 calendar
years for which such data are available (except that, for
fiscal year 2005 and subsequent fiscal years, cases of HIV
disease shall be counted rather than cases of acquired immune
deficiency syndrome if cases

[[Page H8828]]

of HIV disease are being counted for purposes of section
2618(a)(2)(D)(i)).
``(e) Funding.--
``(1) In general.--Subject to paragraph (2), with respect
to each fiscal year beginning with fiscal year 2001, the
Secretary, to carry out this section, shall utilize--
``(A) the greater of--
``(i) 25 percent of the amount appropriated under 2677 to
carry out part B, excluding the amount appropriated under
section 2618(a)(2)(I), for such fiscal year that is in excess
of the amount appropriated to carry out such part in fiscal
year preceding the fiscal year involved; or
``(ii) $5,000,000;
to provide funds to States for use in emerging communities
with at least 1000, but less than 2000, cases of AIDS as
reported to and confirmed by the Director of the Centers for
Disease Control and Prevention for the five year period
preceding the year for which the grant is being awarded; and
``(B) the greater of--
``(i) 25 percent of the amount appropriated under 2677 to
carry out part B, excluding the amount appropriated under
section 2618(a)(2)(I), for such fiscal year that is in excess
of the amount appropriated to carry out such part in fiscal
year preceding the fiscal year involved; or
``(ii) $5,000,000;

to provide funds to States for use in emerging communities
with at least 500, but less than 1000, cases of AIDS reported
to and confirmed by the Director of the Centers for Disease
Control and Prevention for the five year period preceding the
year for which the grant is being awarded.
``(2) Trigger of funding.--This section shall be effective
only for fiscal years beginning in the first fiscal year in
which the amount appropriated under 2677 to carry out part B,
excluding the amount appropriated under section
2618(a)(2)(I), exceeds by at least $20,000,000 the amount
appropriated under 2677 to carry out part B in fiscal year
2000, excluding the amount appropriated under section
2618(a)(2)(I).
``(3) Minimum amount in future years.--Beginning with the
first fiscal year in which amounts provided for emerging
communities under paragraph (1)(A) equals $5,000,000 and
under paragraph (1)(B) equals $5,000,000, the Secretary shall
ensure that amounts made available under this section for the
types of emerging communities described in each such
paragraph in subsequent fiscal years is at least $5,000,000.
``(4) Distribution.--Grants under this section for emerging
communities shall be formula grants. There shall be two
categories of such formula grants, as follows:
``(A) One category of such grants shall be for emerging
communities for which the cumulative total of cases for
purposes of subsection (d)(2) is 999 or fewer cases. The
grant made to such an emerging community for a fiscal year
shall be the product of--
``(i) an amount equal to 50 percent of the amount available
pursuant to this subsection for the fiscal year involved; and
``(ii) a percentage equal to the ratio constituted by the
number of cases for such emerging community for the fiscal
year over the aggregate number of such cases for such year
for all emerging communities to which this subparagraph
applies.
``(B) The other category of formula grants shall be for
emerging communities for which the cumulative total of cases
for purposes of subsection (d)(2) is 1000 or more cases. The
grant made to such an emerging community for a fiscal year
shall be the product of--
``(i) an amount equal to 50 percent of the amount available
pursuant to this subsection for the fiscal year involved; and
``(ii) a percentage equal to the ratio constituted by the
number of cases for such community for the fiscal year over
the aggregate number of such cases for the fiscal year for
all emerging communities to which this subparagraph
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);
(2) by striking sections 2627 and 2628; and
(3) by redesignating section 2629 as 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--

``(I) the Secretary shall reserve the applicable percentage
under clause (iv) for making grants under paragraph (1) both
to States described in clause (ii) and States described in
clause (iii); and
``(II) the Secretary shall reserve the remaining amounts
for other States, taking into consideration the factors
described in subparagraph (C)(iii), except that this
subclause does not apply to any State that for the fiscal
year involved is receiving amounts pursuant to subclause (I).

``(ii) Required testing of newborns.--For purposes of
clause (i)(I), the States described in this clause are 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 and that the biological
mother of each such infant, and the legal guardian of the
infant (if other than the biological mother), be informed of
the results of the testing; 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, and that the biological
mother of each such infant, and the legal guardian of the
infant (if other than the biological mother), be informed of
the results of the testing.

``(iii) Most significant reduction in cases of perinatal
transmission.--For purposes of clause (i)(I), the States
described in this clause are the following (exclusive of
States described in clause (ii)), as applicable:

``(I) For fiscal years 2001 and 2002, the two States that,
relative to other States, have the most significant reduction
in the rate of new cases of the perinatal transmission of HIV
(as indicated by the number of such cases reported to the
Director of the Centers for Disease Control and Prevention
for the most recent periods for which the data are
available).
``(II) For fiscal years 2003 and 2004, the three States
that have the most significant such reduction.
``(III) For fiscal year 2005, the four States that have the
most significant such reduction.

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

``(I) For fiscal year 2001, 33 percent.
``(II) For fiscal year 2002, 50 percent.
``(III) For fiscal year 2003, 67 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.
``(iii) In the case of a State that meets the conditions to
receive amounts reserved under subparagraph (B)(i)(II), the
Secretary shall in making grants consider the following
factors:

``(I) The extent of the reduction in the rate of new cases
of the perinatal transmission of HIV.
``(II) The extent of the reduction in the rate of new cases
of perinatal cases of acquired immune deficiency syndrome.
``(III) The overall incidence of cases of infection with
HIV among women of childbearing age.
``(IV) The overall incidence of cases of acquired immune
deficiency syndrome among women of childbearing age.
``(V) The higher acceptance rate of HIV testing of pregnant
women.
``(VI) The extent to which women and children with HIV
disease are receiving HIV-related health services.
``(VII) The extent to which HIV-exposed children are
receiving health services appropriate to such exposure.'';
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 (notwithstanding
any other provision of this Act or the amendments made by
this Act);
(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)(iv)(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

[[Page H8829]]

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, as amended by section 211(3), is amended by
adding at the end the following section:

``SEC. 2628. 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.--In fiscal year
2004, the Secretary shall collect information from the States
describing the actions taken by the States toward meeting the
recommendations specified for the States under subsection
(a)(1)(C).
``(c) Submission of Reports to Congress.--The Secretary
shall submit to the appropriate committees of the Congress
reports describing the information collected under subsection
(b).''.

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; Preference
in Making Grants.--In making grants under subsection (a), 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(a)(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.''.

TITLE III--EARLY INTERVENTION SERVICES

Subtitle A--Formula Grants for States

SEC. 301. REPEAL OF PROGRAM.

(a) Repeal.--Subpart I of part C of title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-41 et seq.) is
repealed.
(b) Conforming Amendments.--Part C of title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-41 et seq.), as
amended by subsection (a) of this section, is amended--
(1) by redesignating subparts II and III as subparts I and
II, respectively;
(2) in section 2661(a), by striking ``unless--'' and all
that follows through ``(2) in the case of'' and inserting
``unless, in the case of''; and
(3) in section 2664--
(A) in subsection (e)(5), by striking ``2642(b) or'';
(B) in subsection (f)(2), by striking ``2642(b) or''; and
(C) by striking subsection (h).

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) Certain Areas.--Of the applicants who qualify for
preference under this section--
``(1) 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; and
``(2) the Secretary shall give special consideration to
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:

[[Page H8830]]

``(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--
``(A) 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 as applicable, to develop strategies for
ensuring that such services are consistent with the
guidelines; and
``(B) to ensure that improvements in the access to and
quality of HIV health 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.

(a) Elimination of Requirement To Enroll Significant
Numbers of Women and Children.--Section 2671(b) (42 U.S.C.
300ff-71(b)) is amended--
(1) 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
(2) by striking paragraphs (3) and (4).
(b) Information and Education.--Section 2671(d) (42 U.S.C.
300ff-71(d)) is amended by adding at the end the following:
``(4) The applicant will provide individuals with
information and education on opportunities to participate in
HIV/AIDS-related clinical research.''.
(c) Quality Management; Administrative Expenses Ceiling.--
Section 2671(f) (42 U.S.C. 300ff-71(f)) is amended--
(1) by striking the subsection heading and designation and
inserting the following:
``(f) Administration.--
``(1) Application.--''; and
(2) by adding at the end the following:
``(2) Quality management program.--A grantee under this
section shall implement a quality management program to
assess the extent to which HIV health services provided to
patients under the grant are consistent with the most recent
Public Health Service guidelines for the treatment of HIV
disease and related opportunistic infection, and as
applicable, to develop strategies for ensuring that such
services are consistent with the guidelines for improvement
in the access to and quality of HIV health services.''.
(d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g))
is amended by adding at the end the following: ``The
Secretary acting through the Director of NIH, shall examine
the distribution and availability of ongoing and appropriate
HIV/AIDS-related research projects to existing sites under
this section for purposes of enhancing and expanding
voluntary access to HIV-related research, especially within
communities that are not reasonably served by such projects.
Not later than 12 months after the date of enactment of the
Ryan White CARE Act Amendments of 2000, the Secretary shall
prepare and submit to the appropriate committees of Congress
a report that describes the findings made by the Director and
the manner in which the conclusions based on those findings
can be addressed.''.
(e) Administrative Expenses.--Section 2671 of the Public
Health Service Act (42 U.S.C. 300ff-71) is amended--
(1) by redesignating subsections (i) and (j) as subsections
(j) and (k), respectively; and
(2) by inserting after subsection (h) the following
subsection:
``(i) Limitation on Administrative Expenses.--
``(1) Determination by secretary.--Not later than 12 months
after the date of enactment of the Ryan White Care Act
Amendments of 2000, the Secretary, in consultation with
grantees under this part, shall conduct a review of the
administrative, program support, and direct service-related
activities that are carried out under this part to ensure
that eligible individuals have access to quality, HIV-related
health and support services and research opportunities under
this part, and to support the provision of such services.
``(2) Requirements.--
``(A) In general.--Not later than 180 days after the
expiration of the 12-month period referred to in paragraph
(1) the Secretary, in consultation with grantees under this
part, shall determine the relationship between the costs of
the activities referred to in paragraph (1) and the access of
eligible individuals to the services and research
opportunities described in such paragraph.
``(B) Limitation.--After a final determination under
subparagraph (A), the Secretary may not make a grant under
this part unless the grantee complies with such requirements
as may be included in such determination.''.
(f) Authorization of Appropriations.--Section 2671 of the
Public Health Service Act (42 U.S.C. 300ff-71) is amended in
subsection (j) (as redesignated by subsection (e)(1) of this
section) by striking ``fiscal years 1996 through 2000'' and
inserting ``fiscal years 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 the 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:

[[Page H8831]]

``(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 B of title III of the Public Health Service Act (42
U.S.C. 243 et seq.) is amended by inserting after section
318A the following section:

``data collection regarding programs under title xxvi

``Sec. 318B. For the purpose of collecting and providing
data for program planning and evaluation activities under
title XXVI, there are authorized to 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 2675 of the Public Health Service Act (42 U.S.C.
300ff-75) 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 2675 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 2 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 (42
U.S.C. 300ff-71 et seq.) is amended by inserting after
section 2675 the following section:

``SEC. 2675A. 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 2675A the following section:

``SEC. 2675B. 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 2 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 2 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 2 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

[[Page H8832]]

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 3 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 2 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 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.

SEC. 503. TECHNICAL CORRECTIONS.

(a) Public Health Service Act.--Title XXVI of the Public
Health Service Act (42 U.S.C. 300ff-11 et seq.) is amended--
(1) in section 2605(d)--
(A) in paragraph (1), by striking ``section 2608'' and
inserting ``section 2677''; and
(B) in paragraph (4), by inserting ``section'' before
2601(a)''; and
(2) in section 2673(a), in the matter preceding paragraph
(1), by striking ``the Agency for Health Care Policy and
Research'' and inserting ``the Director of the Agency for
Healthcare Research and Quality''.
(b) Related Act.--The first paragraph (2) of section 3(c)
of the Ryan White Care Act Amendments of 1996 (Public Law
104-146; 110 Stat. 1354) is amended in subparagraph (A)(iii)
by striking ``by inserting the following new paragraph:'' and
inserting ``by inserting before paragraph (2) (as so
redesignated) the following new paragraph''.

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 House Resolution 611, the
gentleman from Oklahoma (Mr. Coburn) and the gentleman from Ohio (Mr.
Brown) each will control 30 minutes.
The Chair recognizes the gentleman from Oklahoma (Mr. Coburn).
Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, this is a bill that is long overdue. Before we get into
the topic of discussions on this bill, I think it is important that the
American public know that this reauthorization is going to allow at
least $1 billion per year to be spent in Ryan White CARE Act policies
and procedures. Also, the American public should know that we are going
to spend about $10 billion a year on this epidemic, both in terms of
research, drug treatments, and all associated factors with it.
As we think about that, if we were to apply the same efforts to many
other diseases in our country, we would be achieving far more than we
are today.
This bill is long overdue. It is long overdue in a lot of ways. It is
long overdue because the government has failed through the CDC and the
FDA and the NIH to appropriately handle this epidemic.
Two decades ago, the HIV/AIDS epidemic was recognized. Our Federal
response to HIV/AIDS epidemic at that time was to ignore proven public
health policies. This bill institutes for the first time in the Ryan
White CARE Act proven public health policies that will, in fact, make a
difference in the number of people who are infected.
These include ensuring medical access to all who are infected, not a
special select few; early intervention in people who are infected;
reliable disease surveillance and partner notification, including a
responsibility to not infect anyone else with this disease. We will
also, for the first time, recognize all of those living with HIV rather
than focusing exclusively on those with AIDS.
There are many other noteworthy changes made by this bill. Waiting
lists to access life-saving HIV medications under the AIDS Drug
Assistance program will be eliminated. Prevention will be incorporated
as part of the comprehensive care program. Planning councils will be
more representative of the infected population. Patients who rely on
the CARE Act for their well-being will be given a greater voice in
priority setting, and accountability safeguards will ensure that
Federal AIDS funds will be spent on needed patient care. This bill will
also provide Federal assistance to States to ensure that all pregnant
women with HIV and their children are identified and provided care.
One of the most promising victories in the battle against AIDS was a
1994 finding that the administration of a drug could significantly
reduce the chance that a child born to an HIV positive mother would
become infected. Yet, despite these miracles, a significant number of
women still are not tested for HIV during their pregnancy, and hundreds
of children are needlessly infected each year with an incurable disease
that will prematurely claim their lives.
This bill will provide up to $400 million annually to any State that
makes identifying and ensuring proper care for HIV and infected women
and their HIV-exposed newborns a priority.
The two States with such baby AIDS laws, New York and Connecticut,
have experienced great success. Universal newborn HIV testing has
resulted in the identification of all HIV-exposed births and 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
newborns referred for early diagnosis and care of HIV infection. That
is according to Dr. Guthrie Birkhead, the director of the New York AIDS
Institute.
Dr. Birkhead noted that the rates of prenatal care have been
increasing, not decreasing as we were told would happen. There has been
no detectable change in prenatal participation trends that might be
related to the newborn testing program.
The Connecticut baby AIDS law, which requires every newborn to be
screened for HIV if the mother's status is unknown, was enacted almost
a year ago. In the first 10 months, 26 newborns who were perinatally
exposed to HIV

[[Page H8833]]

have been identified. This is more than four times as many as were
diagnosed with HIV in the previous 3 years combined.
This substantial financial incentive amounts to a Federal endorsement
of universal HIV newborn testing as a routine medical practice. I must
regrettably note that the organization in my profession that purports
to represent physicians who care for mothers and women has yet to
endorse this. The question we ought to ask ourselves is why the
American College of Obstetricians and Gynecologists, knowing that we
can save children's lives and we can treat women, has failed to yet
endorse this.
This bill will also provide additional resources to support partner
notification programs so that everyone who has been exposed to HIV is
given the right to know that exposure. In addition, it will empower
those who are infected to protect others from infection by providing
prevention counseling as a part of a comprehensive care program. This
includes providing advice on how to disclose one's HIV status to a
potential partner and emphasizing to those living with HIV that they
have a responsibility not to give this disease to anyone else.
Finally, the bill recognizes everyone living with HIV and guarantees
access to life-saving treatment to all who are infected. Current
funding formulas are based on AIDS infection, the end stage of HIV
infection. The CDC only recently recommended that States begin tracking
the full scope of the epidemic, not just AIDS. The American public
ought to be asking why has it waited so long.
Over 12 years ago, the Presidential Commission on HIV warned the
continual focus on AIDS rather than the full spectrum of HIV disease
has left our Nation unable to deal adequately with the epidemic. Well,
this bill changes that. This observation was absolutely correct. Yet,
it was ignored by the CDC and Federal policy makers. The results have
been devastating.
While our attention was placed on AIDS, the virus silently spread
through communities of color, and more and more women became
unknowingly infected. Only now are AIDS statistics revealing the paths
that the virus took 10 years ago. Unfortunately, the casualties are
increasingly rising for women and women of color.
While women and African-Americans comprise the majority of new HIV
infections, they also receive less appropriate care according to the
General Accounting Office. This is a direct result of the CARE Act's
misplaced emphasis on AIDS data and determining funding and priority
setting. That has changed with this bill.
All of these changes, while long overdue, will do much to improve our
Nation's responsibilities to HIV and AIDS by ensuring medical access to
all of those who are infected and by providing the proper care for all.
Mr. Speaker, I include the following letter for the Record, as
follows:

General Accounting Office,

Washington, DC, August 24, 2000.
Hon. Tom A. Coburn,
Vice Chair, Subcommittee on Health and Environment, Committee
on Commerce, House of Representatives.
Subject: Ryan White CARE Act: Title I Funding for San
Francisco
Dear Mr. Coburn: This letter responds to your request for
additional information regarding funding for San Francisco
under the Ryan White CARE Act. Specifically, you asked that
we compare San Francisco's fiscal year 2000 title I grant
award, which was determined using the act's hold-harmless
provision, with what the award would have been had deceased
AIDS cases been included in the calculation. You also asked
how funding for San Francisco that was based on the inclusion
of deceased AIDS cases would have compared with the amount
San Francisco would have received if the fiscal year 2000
hold-harmless level had been reduced by 25 percent.
In brief, San Francisco's fiscal year 2000 title I grant
award would have been 26 percent less had both living and
deceased AIDS cases been used to calculate the award instead
of the current hold-harmless provision. The reason for this
result is the substantial decline in newly reported AIDS
cases in San Francisco compared with other eligible
metropolitan areas (EMA). Therefore, a 25-percent reduction
in the current hold-harmless level would have provided San
Francisco with funding comparable to what it would have
received if title I grants had been calculated on the basis
of both deceased and living cases.
This analysis is based on data obtained from the Centers
for Disease Control and Prevention and computer models we
developed to calculate how funding would change under various
formula scenarios. We performed our work in August 2000
according to generally accepted government auditing
standards.

Background

The Ryan White CARE Act of 1990 provides health care and
preventive services to people infected with the human
immunodeficiency virus. Prior to the 1996 reauthorization of
the act, the number of both living and deceased AIDS cases
was used to distribute title I funds among EMAs. Under this
practice, areas of the country with the longest experience
with the disease had the most deceased cases and therefore
received funding disproportionate to their share of living
cases in need of care. The 1996 reauthorization eliminated
this practice by counting only live AIDS cases. The effect of
the change was to shift funding away from EMAs with higher
proportions of deceased cases and toward those with newly
diagnosed cases. As geographic trends in the disease change,
the revised formula automatically realigns funding with the
current distribution of the disease.
A hold-harmless provision was also included in the 1996
reauthorization to provide for a gradual transition to new
funding levels for those EMAs that would otherwise have
experienced substantial funding decreases. This provision
allowed grant awards for affected EMAs to decline by no more
than 5 percent by fiscal year 2000. In fiscal year 1996, four
EMAs benefited from the hold-harmless provision: San
Francisco, New York, Houston, and Jersey City. By fiscal year
1999, all but San Francisco had made the transition to the
new formula.
Under the current title I formula, EMAs receive grant
awards that are proportional to the number of living AIDS
cases. In fiscal year 2000, Los Angeles had 6.9 percent of
all AIDS cases nationally and received 6.7 percent of title I
funding. Similarly, Miami had 4.4 percent of all AIDS cases
and received 4.3 percent of title I funding. EMAs received
$1,290 in title I funds per AIDS case in fiscal year 2000.
However, because of the hold-harmless provision, San
Francisco's grant award was substantially higher: it received
$2,360 per AIDS case, or 80 percent more than other EMAs. As
a consequence, San Francisco received 6.7 percent of title I
formula funding even though it had just 3.8 percent of all
living AIDS cases.

RESULTS OF DIFFERENT FUNDING APPROACHES

If both deceased and living AIDS cases had been used to
calculate fiscal year 2000 title I formula grants instead of
the hold-harmless provision, San Francisco's grant would have
been about 4.9 percent of all title I formula funding, or 26
percent less than it actually was (see fig. 1). Thus, a 25-
percent reduction in the current hold-harmless level, as
provided for in H.R. 4807, would have an effect on San
Francisco's funding similar to that of calculating grant
awards on the basis of both deceased and living cases.
An important reason that San Francisco's share of living
AIDS cases is so much lower than its share of title I formula
funding is that the rate of new cases has declined to a much
greater extent in San Francisco than in almost any other area
of the country. As figure 2 shows, San Francisco's newly
reported AIDS cases dropped by over 50 percent between 1990
and 1999, while other EMAs have shown either smaller declines
(Los Angeles) or increases (Miami).
At the start of the decade, Los Angeles and San Francisco
were reporting nearly the same number of new AIDS cases
(2,130 in Los Angeles and 1,923 in San Francisco). By the end
of the decade, San Francisco was reporting half as many new
cases as Los Angeles (904 compared with 2,027). Similarly, at
the start of the decade, Miami was reporting about half as
many new AIDS cases as San Francisco (1,076 in Miami compared
with 1,923 in San Francisco). By the end of the decade, Miami
was reporting about 70 percent more new cases than San
Francisco.
We did not obtain comments from other parties because your
request pertains to the formula provisions in the law and not
to the activities of any agency or organization.
If you have any questions regarding this letter, please
contact me at (202) 512-7118 or Jerry Fastrup at (202) 512-
7211. Greg Dybalski and Michael Williams made major
contributions to this work.
Sincerely yours,
Janet Heinrich,
Associate Director, Health Financing

and Public Health Issues.

Mr. Speaker, I reserve the balance of my time.

{time} 1045

Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may
consume.
I first want to commend the gentleman from Oklahoma (Mr. Coburn) and
the gentleman from California (Mr. Waxman) for their outstanding work
on the Ryan White CARE Act Amendments of 2000.
I also want to acknowledge the gentlewoman from California (Ms.
Eshoo). Her constituents should know she worked exceptionally hard on
this bill, particularly on those provisions with particular
significance to San Francisco. The same can be said of the gentlewoman
from California (Ms. Pelosi).

[[Page H8834]]

She deserves a great deal of credit and praise for her ongoing
involvement and input on these provisions.
This bill required a tremendous amount of work and negotiation. Staff
members Paul Kim and Roland Foster put in a staggering number of hours,
and it shows in the quality of the final product. John Ford, Marc
Wheat, Karen Nelson, Eleanor Dehoney also deserves our thanks, as well
as Stacey Rampey and Scott Boule.
Over the last several years, much has been written about ``The
changing face of AIDS.'' This is not a wholly accurate
characterization. HIV/AIDS is not a moving target. It does not leave
one population when it moves to another population. Instead, HIV/AIDS
expands to absorb new populations while continuing its progression in
groups already affected by the virus.
When the AIDS epidemic surfaced in this country 19 years ago, white
gay males were the at-risk population. That has not changed. The
population still is at an elevated risk. But the epidemic has expanded
its reach dramatically in these 2 decades. The latest HIV/AIDS
statistics show that African American and Latino communities are
significantly over-represented in the number of new HIV infections.
African Americans comprise 12 percent of the population but accounted
for more than 50 percent of the estimated 40,000 new HIV infections in
1999.
The aggressive nature of this virus calls for an equally aggressive
response, and it speaks to the importance of updating and reauthorizing
the Ryan White Act. Ryan White programs get information and services to
the people who need them. They combat the illness as well as the
alienation and isolation that can be one of its most disabling effects.
If HIV/AIDS is a war, and it is set to kill more people worldwide
than World War I, World War II, Korea, and Vietnam combined, then the
Ryan White programs are this Nation's front line defenses. The act was
created in memory of Ryan White, a young teenager who became a national
hero in the fight against HIV/AIDS. Ryan wanted to attend school. He
wanted to be treated like other young people. Those seem like modest
goals, but he had to overcome tremendous obstacles to achieve them.
Ryan was a hemophiliac and contracted HIV through a bad blood
transfusion. But he fought against ignorance, he fought against fear,
he fought against prejudice on behalf of all individuals with HIV/AIDS.
Ryan died on April 8, 1990, at the age of 18. Ten years after his
death, 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, so-called EMA, Ryan
White programs provide primary care and support services and the kinds
of medications that can tame HIV/AIDS into a chronic, rather than an
acute, illness. There is more to do, and the Ryan White Act 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 of
HIV/AIDS among young gay males is again 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; Ryan White programs are vital.
During the 13th International AIDS Conference held in Durbin, South
Africa, scientists shared some amazing research findings. These
findings provide sorely needed hope for developing nations ravaged by
HIV/AIDS. The research indicates that the so-called AIDS cocktails,
which have revolutionized HIV/AIDS treatment in the U.S. and other
industrialized nations, can be successfully used even in countries
lacking a sophisticated health care infrastructure.
That does not mean it will be easy. There must have been times when
Ryan White himself felt overwhelmed by the intransigence, the
callousness, and the hatred that he encountered. This Nation should
fight AIDS here and abroad with that sense of commitment that he had.
Reauthorizing Ryan White is part of that commitment, and I urge its
passage.
Mr. Speaker, I reserve the balance of my time.
Mr. COBURN. Mr. Speaker, I yield such time as he may consume to the
gentleman from Florida (Mr. Bilirakis), the chairman of the
Subcommittee on Health of the Committee on Commerce.
Mr. BILIRAKIS. Mr. Speaker, I thank the gentleman for yielding me
this time and for being here to lead our side on this very, very
significant bill.
I too arise in support of this amendment to S. 2311, the Ryan White
CARE Act Amendments of 2000. This final legislation is the result of
negotiations between the Senate and the House, and the resulting bill
is designed to bring the CARE Act into the 21st century.
I salute my committee colleagues, the gentleman from Oklahoma (Mr.
Coburn) and the gentleman from California (Mr. Waxman), for their
excellent work on this legislation; and I urge Members to support its
passage.
My Subcommittee on Health and Environment held a hearing on the bill,
and the full Committee on Commerce approved it by voice vote after
adopting several bipartisan amendments to further refine and strengthen
this very important measure.
Before the August recess, the House approved legislation to
reauthorize the Ryan White CARE Act with strong bipartisan support. The
act provides critical funding to address the needs of patients living
with HIV and AIDS. S. 2311 reflects the agreements reached between the
House and the Senate, and I expect this bill to be signed into law in
the near future.
The Ryan White Comprehensive AIDS Resources Emergency, or ``CARE''
Act as we call it, 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 1 million Americans living with HIV and AIDS. The bill before
us will ensure that these patients continue to receive the care and
medications they need to enhance and prolong their lives.
The bill 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 proactive instead
of reactive in the fight against HIV and AIDS. It should be noted,
however, Mr. Speaker, 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.
The bill which originally passed the House would have hurt certain
cities such as San Francisco. In this regard, Mr. Speaker, I will
submit for the Record a letter that GAO sent to the gentleman from
Oklahoma (Mr. Coburn). After lengthy negotiations, it has been agreed
the hold harmless reduction will be a compromised 15 percent over the
next 5 years.
The Ryan White CARE Act must be reauthorized to improve our public
health strategies. The bill before us will ensure that the HIV/AIDS
epidemic can be tracked more accurately and that appropriate funding
and information about this disease can be directed effectively. I have
been very encouraged to hear from patient advocates in support of this
measure. For example, AIDS Action stated that it is ``very pleased with
the compromise bill that has been negotiated between the House and the
Senate. It represents a modernization of the CARE Act and will allow us
to provide quality care for people with HIV and AIDS.''
In closing, Mr. Speaker, I want to again recognize the hard work of
all the Members and their staffs, whose bipartisan efforts advanced
this reauthorization bill. The gentleman from Oklahoma (Mr. Coburn) and
the gentleman from California (Mr. Waxman), who I mentioned previously,
and staff members Roland Foster and Paul Kim worked very hard to
advance this measure in the House, working with Senators Jeffords,
Frist, and Kennedy. And obviously, working with my counterpart on the
other side in the

[[Page H8835]]

subcommittee, the gentleman from Ohio (Mr. Brown), the gentleman from
Michigan (Mr. Dingell), et cetera, we were able to craft this
compromise legislation.
It 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.
Mr. BROWN of Ohio. Mr. Speaker, I yield 5 minutes to the gentlewoman
from California (Ms. Pelosi), who has been one of the real leaders in
this whole process in pulling this bill together.
Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding me this
time, and I want to compliment him on his great leadership on this
legislation; he and the gentleman from Florida (Mr. Bilirakis) for
their leadership, and I associate myself with the comments that the
gentleman from Florida made in recognition of those who worked so hard
to make it a success; and, if it is allowed, to especially recognize
the work of Senator Kennedy for bringing about the compromises that
exist in this bill.
The gentleman from California (Mr. Waxman) has been a champion in
Congress since the onset of the AIDS epidemic, and his leadership is
very much in evidence in this bill; and the ranking member, the
gentleman from Ohio (Mr. Brown), helped us through some difficult times
here, but I think the product is one that this whole body can
wholeheartedly support. That is why, Mr. Speaker, I rise in strong
support of the reauthorization of the Ryan White CARE Act.
Passage of this vital legislation is the most important action this
Congress can take on the issue of AIDS this year. And I would like to
thank again the Committee on Commerce, the gentleman from Michigan (Mr.
Dingell), the gentleman from Virginia (Mr. Bliley), the gentleman from
Florida (Mr. Bilirakis), the gentleman from California (Mr. Waxman),
the gentleman from Ohio (Mr. Brown), and also point out the
distinguished work of the gentlewoman from California (Ms. Eshoo).
The gentlewoman from California (Ms. Eshoo) lives in the same
metropolitan area that I do. We are in the same area for care and
treatment and prevention for people with HIV/AIDS. This is about care
today, but her leadership on the committee has been indispensable to
the success that we see here today with this legislation.
Since the beginning of the AIDS epidemic, my district in San
Francisco has been one of the most severely impacted in the country.
When I came to the Congress 13 years ago, we had already lost over
13,000 of our friends and loved ones to the AIDS epidemic. That is
13,000, 13 years ago. We have suffered greatly, but we have learned a
lot we would like the rest of the country to benefit from as we have
responded to this challenge.
The Ryan White CARE Act was modeled on a system of community-based
care that we developed to face the crisis in the 1980s. As a result of
this work early in the epidemic, San Francisco produced data that
showed the country that comprehensive HIV/AIDS care and services not
only saved lives but also saved money and valuable health care
resources. Today, the CARE Act programs provide foundation for care and
treatment for low-income individuals with HIV and AIDS.
The recent declines we have seen in AIDS deaths are a direct result
of the therapies and services that have been made more widely available
through the CARE Act to large numbers of uninsured and underinsured
people with HIV and AIDS. Each year, the CARE Act ensures that
approximately half a million people, 500,000 people, living with HIV
and AIDS have access to the medical services, including pharmaceuticals
that are needed to sustain and prolong life. This represents
approximately two-thirds of the individuals living with HIV/AIDS in
this country.
Although great strides have been made, there is much more to be done.
The combination therapies that have brought us so much hope are still
not reaching all those in need. The changing nature of the HIV/AIDS
epidemic, along with the continuing impact of it in traditionally
affected communities, has created new challenges for the CARE Act.
People of color now represent the majority of new AIDS cases, and the
proportion of new AIDS cases among women has grown from 11 percent in
1990 to 23 percent in most recent statistics.
In addition, new HIV infections have remained constant at 40,000
cases per year. These new infections, combined with the decline in AIDS
deaths, means more individuals than ever before are living with HIV and
in need of treatment regimens that are costly, complicated and
lifelong. As a result, the demand on HIV care providers has grown.
The Ryan White CARE Act's remarkable ability to adapt to the changing
nature of the AIDS epidemic was confirmed earlier this year when a GAO
report concluded that the CARE Act is helping our public health
infrastructure adjust to these new challenges by directing services to
African Americans, Hispanics, and women in higher proportions than
their representation in the AIDS population.
Again, I thank our colleagues, including the gentleman from Oklahoma
(Mr. Coburn) and the Committee on Commerce for their great work. This
program is an important example of the way that effective leadership at
the Federal, State, and local levels can translate into improved health
outcomes for the people of this country. I think it also is a wonderful
example of bipartisanship, where we can all come together and give what
I hope will be unanimous support for this act. I urge my colleagues to
vote ``yes'' on the reauthorization.
Mr. Speaker, I serve on the Subcommittee on Labor, Health and Human
Services, and Education of the Committee on Appropriations, and one of
the priorities we have there is research, prevention, and care for
people with HIV/AIDS.

{time} 1100

We want to focus heavily on prevention. We must continue our research
for a cure. We are trying to find a vaccine and, hopefully, that will
happen before not too long. But we must never forget the people out
there who are diagnosed with HIV and AIDS now.
I am pleased that the bill eventually will recognize and count those
infected with HIV but not full-blown cases of AIDS in the numbers and
in the formula. I wish that would have been sooner. But, nonetheless,
there is the recognition. I commend the legislators on the committee,
members of the committee, for making that distinction and having it be
a part of our formula down the road.
Once again, Mr. Speaker, I want to commend the gentleman from
California (Mr. Waxman) who I see now on the floor. As I said earlier,
he has been a champion since day one on this issue. We have all been
very well-served by his leadership, that of the gentleman from Ohio
(Mr. Brown) and others.
I urge my colleagues to vote aye.
Mr. COBURN. Mr. Speaker, I ask unanimous consent that the remainder
of the time on our side be controlled by the gentleman from Florida
(Mr. Bilirakis).
The SPEAKER pro tempore (Mr. Simpson). Is there objection to the
request of the gentleman from Oklahoma?
There was no objection.
Mr. BILIRAKIS. Mr. Speaker, I yield 3\1/2\ minutes to the gentlewoman
from Maryland (Mrs. Morella).
Mrs. MORELLA. Mr. Speaker, I thank the gentleman for yielding me the
time.
Mr. Speaker, I rise in strong support of the Ryan White CARE Act
Amendments of 2000. I want to thank the gentleman from Florida
(Chairman Bilirakis) for his leadership in bringing this bill to the
floor and the gentleman from Ohio (Mr. Brown), the ranking member, for
his role in so doing.
And also, there are other colleagues of ours who deserve particular
attention. The gentleman from Oklahoma (Mr. Coburn), the gentleman from
California (Mr. Waxman) and the gentleman from Ohio (Mr. Brown) worked
very hard. They were dedicated in their commitment and their hard work
has paid off for these critical programs.
The CARE Act represents the largest authorization of Federal funds
specifically designated to provide health and social services to people
infected with HIV. Declaring an AIDS emergency, Congress passed the
Ryan White Comprehensive AIDS Resources Emergency Act in August of
1990. Six years later, we voted to reauthorize the CARE Act

[[Page H8836]]

by a unanimous vote in the House of Representatives and a 97-3 vote in
the Senate.
Over the last 9 years, the CARE Act has helped increase the
availability of primary care health and support services especially for
the uninsured and underinsured persons with HIV disease. The multi-
title structure of the CARE Act has worked effectively to dramatically
improve the quality of life for people living with HIV and their
families. It has helped to reduce cost of inpatient care and increase
access to care for underserved populations, including people of color.
The legislation we are considering today revises the grant formulas
to shift the emphasis of the programs away from treating people with
full-blown AIDS to people with the viral precursor, HIV, of AIDS. This
legislation includes a new formula beginning in 2005 for distributing
funds to States and cities based on the number of both AIDS and HIV
cases compared to the current formula, which allocates funds based
solely on AIDS cases.
Also included in this measure is $20 million to reduce HIV mother-to-
child transmission. The bill also addresses prevention of the disease
by including $30 million for tracking the disease and encouraging
people to notify their partners.
Additionally, those receiving care through Ryan White programs are
required to enroll in counseling programs.
Today, promising new drug therapies have brought new hope and new
challenges to the battle against the epidemic, but these new drugs do
not constitute a cure and an effective vaccine is still years away.
Moreover, the treatments do not work for everyone, they are difficult
to access especially for communities of color, and their long-term
efficacy remains unknown. Nonetheless, AIDS deaths have declined
dramatically in the last 3 years and more people are living longer with
HIV.
The HIV/AIDS epidemic thus remains an enormous health emergency in
the United States, and it will remain so into this century. The state
of the epidemic points to an increase rather than a decrease in the
overall need for health care, drug treatment, social services. As a
Nation, we must continue our effort to expand access to these services
for people living with HIV/AIDS, particularly in communities of color
and women.
This Ryan White CARE Act has proven to be an essential and effective
part of the Federal response to the HIV/AIDS crisis. This legislation
will ensure we continue this response.
I certainly ask this body to support this comprehensive, meaningful
and truly successful legislation.
Mr. BROWN of Ohio. Mr. Speaker, I yield 4\1/2\ minutes to the
gentleman from California (Mr. Waxman) who played a very central role
in the negotiations on this bill.
Mr. WAXMAN. Mr. Speaker, I thank the gentleman for yielding me the
time.
Mr. Speaker, I rise in strong support of S. 2311, the Ryan White CARE
Act Amendments of 2000.
As the original author of the Ryan White CARE Act and the coauthor of
the House reauthorization bill, H.R. 4807, I want to applaud the
Members and the staffs on both sides of the aisle for moving this
crucial legislation with such speed and bipartisan cooperation.
I want to recognize the gentleman from Oklahoma (Mr. Coburn) for his
commitment to reauthorizing this Act and his leadership in fashioning
the compromises that allowed us to move the bill I think virtually
unanimously through the House and to get an agreement with the Senate.
He made this consensus legislation a reality.
The gentleman from Florida (Chairman Bilirakis), the gentleman from
Ohio (Mr. Brown), the gentleman from Virginia (Chairman Bliley), and
the gentleman from Michigan (Mr. Dingell) have lent their unqualified
support. And numerous Members, including the gentlewoman from
California (Ms. Pelosi), the gentleman from New York (Mr. Towns), the
gentlewoman from California (Ms. Eshoo), the gentleman from Texas (Mr.
Rodriguez) and the gentlewoman from the Virgin Islands (Mrs.
Christensen) have helped ensure its passage.
Mr. Speaker, the original CARE Act was enacted in the wake of a
decade of lost opportunities. I told this House in 1990 that, ``Having
missed our opportunity to provide an ounce of prevention, we must now
prepare to pay for pounds and pounds of cure.''
Today, the AIDS epidemic is everywhere. It threatens everyone. But
there is still no vaccine and there is still no cure. Nevertheless, the
Ryan White CARE Act has made an enormous difference. It provides care
to tens of thousands of Americans living with HIV/AIDS. It helps their
families cope with the burdens of AIDS and HIV infection, and it
provides urgently needed funding to community providers and hospitals
to combat the epidemic.
Today's overwhelming bipartisan support for the CARE Act demonstrates
that Congress understands how crucial it is to the health and welfare
of our country.
Mr. Speaker, this legislation preserves the best features of the CARE
Act while making reforms to better respond to a changing epidemic.
First and foremost, this legislation better addresses the needs of
individuals with HIV who have not developed AIDS. In 2004, we will
determine whether to use nationwide data on HIV infection in the CARE
Act. I believe this will happen, and I have been told by the State of
California that they will have such data by 2004.
We also call on States and cities to do more to reach those who are
not receiving care and to serve the needs of our historically
underserved communities. We call for ending lingering disparities in
care and for better coordination of HIV/AIDS treatment with prevention.
We have also focused CARE Act programs on the needs of vulnerable
populations. Funds will be allocated to better reflect the proportions
of women, children, infants and youth with HIV. I expect this will
increase such funding for those populations in the future.
This legislation also greatly expands our national effort to
eliminate the perinatal transmission of HIV/AIDS. These new funds will
help bring the number of babies born with HIV in our country down to
zero.
We also redirect funding to cities and States in the greatest need of
assistance. The title I and title II ``hold harmless'' provisions have
been revised to ensure a manageable transition to funding allocations
which better reflect the epidemic. At the same time, potential
disruptions in patient care are minimized. And the title I, title II,
and AIDS Drug Assistance Program (ADAP) supplemental grants will assist
cities and States with the greatest need of funds.
These are the principal reforms to the CARE Act. They will expand
access, improve quality, and enhance services for individuals with HIV
and AIDS.
Regrettably, Mr. Speaker, much more could be done and much more needs
to be done. We must expand Medicaid to provide care to individuals with
HIV who have not developed AIDS. We must lead the global search for an
effective HIV vaccine and a cure for AIDS. And we must provide
resources and our hard-earned expertise to help other countries combat
the epidemic.
For today, though, I am pleased that we will fulfill the expectations
of Jeanne White, the mother of Ryan White, and of so many Americans
living with HIV and AIDS by reauthorizing the Ryan White CARE Act.
Mr. Speaker, I rise in strong support of the Ryan White CARE Act
Amendments.
As the original author of the Ryan White CARE Act and the co-author
of the House reauthorization bill, H.R. 4807, I want to applaud the
Members and the staff on both sides of the aisle for moving this
crucial legislation with such speed and bipartisan cooperation.
I want to recognize Dr. Coburn for his commitment to reauthorizing
the CARE Act. He has made this consensus legislation a reality.
Chairman Bilirakis and Mr. Brown, Chairman Bliley and Mr. Dingell have
lent their unqualified support. And numerous Members, including Ms.
Pelosi, Mr. Towns, Mr. Eshoo, Mr. Rodriguez and Dr. Christensen, have
helped ensure its passage.
Mr. Speaker, the original CARE Act was enacted in the wake of a
decade of lost opportunities. I told this House in 1990 that, ``Having
missed our opportunity to provide an ounce of prevention, we must now
prepare to pay for pounds and pounds of cure.''
Ten years ago, there were those who spoke of the AIDS epidemic as a
thing of the past. There were those who dismissed the disease

[[Page H8837]]

as a danger to others, and not themselves. And there were those who
opposed the Ryan White CARE Act.
Mr. Speaker, they were wrong then, and they are wrong today. The AIDS
epidemic is everywhere. It threatens everyone. It is devastating the
globe from Russia to subSaharan Africa. And there is still no vaccine.
There is still no cure.
But in the face of these challenges, the CARE Act has made a
difference. The CARE Act provides care to tens of thousands of
Americans living with HIV/AIDS. If helps their families cope with the
burdens of AIDS and HIV infection. And it provides urgently needed
funding to community providers and hospitals to combat the epidemic.
Today's overwhelming bipartisan support for the CARE Act demonstrates
that Congress understands how crucial it is to the health and welfare
of our country.
Let me highlight the important ways this legislation preserves the
best and proven features of the CARE Act, while making important and
substantial reforms to better respond to a changing epidemic. I am
particularly pleased that this consensus House and Senate legislation
reflects virtually all of the provisions and agreements reached by this
House in H.R. 4807.
Most important of all, this legislation better addresses the needs of
individuals with HIV who have not developed AIDS. With 40,000 new
infections every year and improved prospects for delaying the onset of
AIDS, the number of new deaths from AIDS has declined but the number of
individuals with HIV is rising inexorably. In response, this
legislation calls on the Secretary of Health and Human Services to
determine in 2004 whether we have nationwide data on accurate and
reliable cases of HIV infection which can be used in allocating CARE
Act funds. I believe this will happen, and I have been told by the
State of California that they are confident they will have such data by
2004.
We also call on States and cities to better determine the number and
demographics of individuals with HIV. We require special efforts to
reach those who are not receiving care and serve the needs of our
historically underserved communities. We call for ending lingering
disparities in care. And we require States, cities and the Federal
government to develop new strategies to better coordinate HIV/AIDS
treatment with prevention.
The need for better coordination cuts across systems of care, Federal
agencies, States, cities, providers and community organizations. Ten
years ago, I described the CARE Act as providing ``a continuum of
prevention services--counseling and testing, diagnostics for those who
test positive, and therapeutics for those whose diagnostics indicate a
medical intervention.'' Patients receiving care under the CARE Act
today deserve seamless continuity between testing, counseling,
treatments, support and prevention services.
Just last week, the Institute of Medicine released a comprehensive
report on our nation's HIV prevention efforts. They concluded that
``prevention services for HIV-infected people should be integrated into
the standard of care at all primary care centers, sexually-transmitted
disease clinics, drug treatment facilities, and mental health
centers.'' This is precisely what we set out to accomplish in H.R.
4807, and this policy is reflected fully in this final consensus
legislation.
This legislation also strengthens the responsiveness of CARE Act
programs to the public. Title I Planning Councils will include a
greater number of independent individuals with HIV/AIDS. Planning
Council meetings and records will be exposed to greater public
``sunshine.'' All Planning Council members will receive improved
training. And States will make their planning more accessible to a
broader range of public stakeholders.
We have also focused CARE Act programs on the needs of vulnerable
populations. Just yesterday, the Office of National AIDS Policy
announced that half of the 40,000 new HIV infections every year occur
among our teens and young adults. In this legislation, funds will be
allocated to better reflect the proportions of women, children, infants
and youth with HIV. I expect this will increase such funding for these
populations in the future.
We have also strengthened the Title IV program for medical care,
social services, and access to research for low-income children, youth,
women and families. States and cities must develop novel strategies to
coordinate their HIV/AIDS services and substance abuse services. And
the Secretary of Health and Human Services must develop a plan in
consultation with the Attorney General for the treatment of prisoners
with HIV/AIDS.

This legislation greatly expands our national effort to eliminate the
perinatal transmission of HIV/AIDS. The last ten years have seen a
dramatic decline in such cases, due largely to the treatment of
pregnant mothers with zidovudine. In an important compromise, we have
increased an existing $10 million CARE Act grant program by $20
million, with a proportion of new funds set aside for States with
either mandatory newborn testing or significant declines in perinatal
transmission. I am confident these funds will be well spent on offering
counseling and testing to all pregnant women, outreach to high-risk
women and other innovative prevention efforts.
Funding has also been redirected to cities and States with the
greatest need of additional assistance. The Title I and Title II ``hold
harmless'' provisions have been revised to ensure a manageable
transition to funding allocations which better reflect the current
distribution and epidemiology of the epidemic. This will be
accomplished while minimizing potential disruptions in care for
individuals with HIV/AIDS. Under Title II, States' base funds as well
as their total funding will be held harmless to a small percentage of
loss.
Under Title I, a city's potential loss in its formula allocation is
limited to a percentage of the amount allocated to the city in the base
year preceding its need for the hold harmless. In its fifth,
consecutive year of need for the hold harmless, a city would lose no
more than 15 percent of its base year allocation. Such losses would not
be compounded, as was contemplated in the original Senate bill. But if
the Secretary determines that data on HIV prevalence will be used in
Title I formula grants in 2005, no city may lose more than 2 percent of
its 2004 formula allocation in 2005.
Additionally, Title I supplemental grants and new AIDS Drug
Assistance Program (ADAP) supplemental grants will be directed to
cities and States with ``severe need'' for such funding, based on more
objective and quantitative criteria. And new Title II supplemental
formula grants will be given to ``emerging communities'' with AIDS case
counts which fall below the threshold for Title I eligibility.
These are the principal reforms to the CARE Act. They will expand
access, improve quality and enhance services for individuals with HIV/
AIDS. And I want to recognize the hard work of House staff, including
Roland Foster, Paul Kim, Karen Nelson, Marc Wheat, John Ford, Eleanor
Dehoney, Brent Delmonte, Katie Porter, Anne Esposito and House
Legislative Counsel Pete Goodloe, in making this possible.
Mr. Speaker, much more could be done and much more needs to be done.
We must expand Medicaid to provide care to individuals with HIV who
have not developed AIDS. We must lead the global search for an
effective HIV vaccine and a cure to AIDS. And we must provide resources
and our hard-earned expertise to help other countries combat the
epidemic.
For today, though, I am pleased we will fulfill the expectations of
Jeanne White, the mother of Ryan White, and of so many Americans living
with HIV and AIDS by reauthorizing the Ryan White CARE Act.
Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from
New York (Mr. Gilman) the chairman of the Committee on International
Relations.
Mr. GILMAN. Mr. Speaker, I thank the gentleman for yielding me the
time.
Mr. Speaker, I rise today in support of S. 2311, the Ryan White CARE
Act Amendments as adopted by the Senate. It is a primary source of
Federal AIDS prevention and treatment funding. I commend the gentleman
from Florida (Mr. Bilirakis), the subcommittee chairman on health and
environment; the gentleman from Oklahoma (Mr. Coburn); the gentleman
from Ohio (Mr. Brown); and the gentleman from California (Mr. Waxman)
for their full support of this important measure.
This legislation accomplishes many of our most important HIV goals:
modifying the eligibility requirements and allocation formulas for
grants to State and local governments; giving States increased
flexibility to provide a wider range of treatments and support
services; emphasizing the provision of services for women, infants, and
children by substituting special grant set-asides; capping
administrative and evaluation expenses for the grant programs; and
requiring States to implement the Center for Disease Control guidelines
regarding HIV testing and counseling for pregnant women.
Also included in this measure is an important fund, $20 million, to
reduce HIV transmission from mothers to their babies and $30 million
for tracking the disease and encouraging people to notify their
partners, and provisions to require people receiving care through Ryan
White programs to enroll in counseling programs.
In short, Mr. Speaker, this legislation not only demonstrates the
bipartisan humanitarian spirit of this Congress, but also in working
together in areas of mutual concern that we can accomplish worthy
goals.
Accordingly, I am in strong support of the Ryan White CARE Amendments
and I urge our colleagues to adopt it at the earliest possible date.

[[Page H8838]]

Mr. BROWN of Ohio. Mr. Speaker, I yield 2\1/2\ minutes to the
gentlewoman from California (Mrs. Capps) who is a registered nurse and
has been a real leader on all kinds of public health issues.
Mrs. CAPPS. Mr. Speaker, I thank my colleague for yielding me the
time.
Mr. Speaker, I rise in strong support of the Ryan White CARE Act
Amendments of 2000. I commend my colleagues on the Committee on
Commerce and others for all of their hard work.
Today's medical advances allow many individuals with AIDS to lead
longer and more productive lives. However, as patients live longer, the
cost of their care and treatment has placed an ever-greater demand on
community-based organizations and State and local governments.
In the face of these challenges, the Ryan White CARE Act has made a
great difference. This CARE Act provides care to tens of thousands of
Americans living with HIV/AIDS.
Recently I spoke with the Health Educator, Jayne Brechwald, with the
Santa Barbara County Health Care Services in my district. She works on
a daily basis with members of the community who benefit greatly from
Ryan White funding. She spoke in strong support of funding for crucial
services such as Meals on Wheels, food banks, housing counseling. She
also praised programs which help those diagnosed navigate the options
available for them. These include the medical care, education, and
dental care that are so important during this terrifying time in a
person's life.
In Jayne's words, ``Ryan White funding is really about local control.
The program requires that we do a needs assessment every year so that
we have a very targeted, specific idea of how the population we serve
is changing and how the funding is being utilized.''
I believe that the Ryan White Act represents the Federal Government
at its best. This program defers to local expertise, while providing
the needed helping hand of targeted Federal funding.
Mr. Speaker, I applaud this legislation and urge its passage.
Mr. BILIRAKIS. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman
from Pennsylvania (Mr. Greenwood).
Mr. GREENWOOD. Mr. Speaker, I thank the gentleman for yielding me the
time. I also thank the gentleman from Florida (Mr. Bilirakis) for his
leadership on this issue; as well as the minority chair of the
Subcommittee on Health, the gentleman from Ohio (Mr. Brown); and the
gentleman from Oklahoma (Mr. Coburn) and the gentleman from California
(Mr. Waxman) for their collaboration. Anytime the gentleman from
Oklahoma (Mr. Coburn) and the gentleman from California (Mr. Waxman)
agree on something, it has got to be pretty close to right on.
Mr. Speaker, I also want to thank Dorothy Mann from the Philadelphia
area, a friend of mine, who helped negotiate one of the toughest
aspects of this bill; and that has to do with the testing of newborns.

{time} 1115

AIDS is clearly the worst epidemic in modern history. It is a
tragedy, and it has struck down so many millions of people around the
world. But of all of its victims, certainly the children, the newborns,
are the most innocent and the ones who tug most heavily on our hearts.
Four million women become pregnant in this country every year and
7,000 of those 4 million women are HIV positive. Several hundred of the
babies that they bear will be born HIV positive. Of those little
children, fully half of them will die before they reach the age of 3;
and by the age of 5, 90 percent of them have perished. So obviously
anything that can be done to rescue these children from that horrible
fate needs to be done. When a woman's HIV status is known during her
pregnancy, in two-thirds of the cases the child can be prevented from
becoming HIV positive with AZT treatments that are given during
pregnancy, during labor and several weeks afterwards, and Cesarian
deliveries seem to very dramatically reduce the likelihood that the
child will become HIV positive.
What we have done in this bill to try to solve the logjam between
those who do and those who do not believe in mandatory testing is we
have put $30 million in here to go to those States that either have
mandatory testing laws or do the most through a variety of programs to
reduce the incidence of HIV being passed on to newborns. In New York,
they have had a law on the books for 3 years; and they have been able
to identify every child who could potentially become exposed to HIV
through delivery. They have been able to prevent all of that. In 98
percent of the cases, the mother has been able to get treatment. It has
been wildly successful.
This bill goes a long way to making sure that that track record will
apply to every State in the Union.
Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the
distinguished gentlewoman from the District of Columbia (Ms. Norton).
Ms. NORTON. Mr. Speaker, I thank the gentleman for yielding time, and
I thank him and his partners on the other side for their hard work in
bringing this most important legislation to the floor.
This week, the surgeon general was quoted as saying the epidemic has
evolved to become increasingly an epidemic of people of color, of women
and of the young. We have got to get rid of this epidemic, not let it
evolve; and what we are doing here this morning will have a great deal
to do with getting rid of it.
The disease has moved to a devastating place, Mr. Speaker, to the
poorest communities of color. Blacks are only 12 percent of the
population. They are 50 percent of the new cases. Almost 80 percent of
the new cases among women are black and Latino women. Half of the new
cases occur in youth. We are now finding that we have to educate each
new cohort perhaps every 4 or 5 years of gay men because the newest
cohort needs to learn what those that have passed on in their 20s
perhaps had to learn. We are dealing with a preventable disease. But
when people get this disease, they need our care and they need our
love.
I am grateful to the gay and lesbian community of this country for
the way in which they brought this issue to the forefront and now have
helped us gather a bipartisan majority for the Ryan White bill. If we
continue to do what we are doing today, we will show what we all know,
that this is a disease, unlike heart disease and unlike cancer, that we
can prevent. This is a disease that we can eliminate. I thank all of
those who contributed to this moment on the House floor.
Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman
from California (Ms. Woolsey).
(Ms. WOOLSEY asked and was given permission to revise and extend her
remarks.)
Ms. WOOLSEY. Mr. Speaker, I rise in support of H.R. 4807, to
reauthorize the Ryan White CARE Act. This reauthorization is very
important to our Nation. It is particularly important to my
constituents in the North Bay across the Golden Gate Bridge from San
Francisco, and for all of the people in the entire San Francisco Bay
region. This act provides crucial services for care and treatment for
individuals with HIV and AIDS. To date, the CARE act has worked to
dramatically improve the quality of life for people living with HIV and
for their families. It has reduced the use of costly inpatient care as
well as increased the access to high-quality care for underserved
populations.
By supporting this important legislation, Mr. Speaker, we are
ensuring that the thousands of Americans living with HIV/AIDS can
continue to receive the care and the treatment that is absolutely
necessary for their comfort and for their survival.
Mr. Speaker, we must spare no effort to fight the HIV/AIDS epidemic.
By reauthorizing the Ryan White CARE Act, we are taking a positive step
to successfully dealing with this very deadly disease. We must adopt
the reauthorization.
Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman
from Illinois (Mr. Davis).
(Mr. DAVIS of Illinois asked and was given permission to revise and
extend his remarks.)
Mr. DAVIS of Illinois. Mr. Speaker, I rise today in strong support of
the Ryan White CARE Act. And I rise because this legislation has meant
so much to so many people throughout the country. The Ryan White CARE

[[Page H8839]]

Act has meant so much that there are many people who feel as they tell
their stories that without it they simply would not be alive.
Mr. John Davis, the newly elected cochair of the city of Chicago's
HIV services planning council, says if it was not for the Ryan White
CARE Act, he would probably be dead. Mr. Davis, a former heroin addict,
says that his road to recovery began with him seeking help at a Ryan
White-funded housing program.
Like Mr. Davis, thousands of others throughout the country have had
the same experiences. Mr. Derrick Hicks from Chicago is able to live
longer and get access to medications he may not otherwise be able to
afford. And so, as we continue to see the impact and the effects of
this program throughout the country, I simply rise to support it and
say that without it many people would not have had the quality of life.
I urge continued support.
Mr. BROWN of Ohio. Mr. Speaker, I yield myself the balance of my
time.
I again ask for this House's support for the Ryan White CARE Act. It
is a tremendous testament to bipartisanship support and the negotiating
skills of the gentleman from Oklahoma (Mr. Coburn) and the gentleman
from California (Mr. Waxman) and their staffs. I ask for unanimous
support from this House for this very good legislation that will make a
big difference in dealing with this dreadful disease.
Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I would like to echo the remarks that the gentleman from
Ohio (Mr. Brown) just made. I had planned to do so, also. It is just
amazing what can be done from a bipartisan standpoint if people really
are sincere and really care about solving an issue rather than being
concerned about demagoguery, if you will, or with some of the things
that take place. The fact that the gentleman from Oklahoma (Mr. Coburn)
and the gentleman from California (Mr. Waxman) worked so well on this
and were able to get it done speaks well for both of them and for the
Congress when it works in that way.
Mr. Speaker, I yield the balance of my time to the gentleman from
Oklahoma (Mr. Coburn).
(Mr. COBURN asked and was given permission to revise and extend his
remarks.)
Mr. COBURN. Mr. Speaker, I want to first recognize Paul Kim for his
great help on the gentleman from California's (Mr. Waxman) staff; Marc
Wheat, the majority counsel on our side; and Roland Foster, a staff
member of mine who has been with me for 6 years since I have been in
Congress.
This is a good bill. There is no question about it. But this bill is
not enough. Forty thousand people this year are going to become
infected with HIV. It does not have to happen. We should be asking the
CDC, we should be asking the FDA, we should be asking the NIH why they
would not use proven public health policy to stop this epidemic.
The best way to treat people with HIV today is to make sure no one
else ever encounters this disease. This is a preventable disease.
Although we have gone a long way from where we were in putting in the
public health policies that should be there, they are still not there.
The reason they are not there is not a good enough reason. We have
proven in the medical community that we can secure and hold
confidentially anybody's HIV status. We have been perfect on that
score. And to use that as a reason now not to move to the next step, I
challenge my friend, the gentleman from Ohio (Mr. Brown), and I
challenge the gentleman from Florida (Mr. Bilirakis) that in the next
Congress and the Congress that follows that you will look very closely
at what public health policies could do to prevent that 40,000 people
from never getting the disease.
We know. We handled the tuberculosis epidemic in this country. We
stopped it dead with a whole lot less effort. This is something we can
accomplish. We have proven with this bill that if we will work and talk
together and understand each other's motivations, problems and
concerns, that through discussion and bipartisan approach that we can
solve those problems. The 40,000 people out there this year that are
going to get infected deserve for us to do that. As I leave this body,
what I would ask is the Members of this body, look at real problems,
not the political things that surround it; and if we will do that,
40,000 people will not be infected.
I thank the gentleman from Ohio (Mr. Brown) for his work. The
gentleman from California (Mr. Waxman) has been great to work with. I
appreciate the ability that we can express ourselves through true
concern and solve a problem. I would hope that every Member of this
body will support this bill.
I also would leave one message with my colleagues. There are diseases
much greater than this disease that face our country today. Diabetes
will take tons more people than HIV. Breast cancer will take tons more
people than HIV. And yet we are not anywhere close to the same dollar
commitment in those diseases as we are HIV. Because we have had a
misguided policy on treatment of HIV, we are spending dollars that
could be spent in other areas. I would beg the body to look at that.
Mr. BLILEY. Mr. Speaker, I rise in support of this amendment to S.
2311, the Ryan White CARE Act Amendments of 2000. I congratulate Dr.
Coburn and Mr. Waxman for their excellent work on this legislation, and
salute my colleagues on the Commerce Committee who, through workmanlike
diligence and thoughtfulness, have dramatically improved the way the
Ryan White CARE Act will work now and into the future.
Before the August recess, the House acted on a bi-partisan basis to
authorize the Ryan White CARE Act. This very important Act provides
funding to address the needs of those living with HIV and AIDS. Because
of the importance of this legislation, I made it a priority to resolve
the differences between the House-passed bill and the bill passed in
the other body. As the newsletter AIDS Policy and Law reported, ``The
negotiators decided to use the House bill, sponsored by Representatives
Tom Coburn, and Henry Waxman, as the vehicle for renewing the statute
through fiscal year 2005. The Senate bill was scrapped, with only a few
of its provisions being folded into the Coburn-Waxman H.R. 4807.'' The
negotiating team, which included my staff and those from the offices of
Representatives Bilirakis, Waxman, Dingell, Brown, Senators Jeffords,
Frist, and Kennedy, achieved a good compromise. I have an additional
statement that explains our work in greater detail that I will enter
into the record for myself and the negotiators just mentioned. I
commend the passage of this important legislation to my colleagues.
As many of my colleagues may recall, President Reagan's HIV
Commission concluded that ``early diagnosis of HIV infection is
essential'' because HIV infection ``can be treated more effectively
when detected early.'' The medical breakthroughs which have been
developed in the twelve years since the inception of this report make
early intervention even more important than ever, and I am pleased that
this legislation recognizes that partner counseling and referral
activities are the most effective early intervention to identify those
who do not know their status in the early stages of the disease.
Very importantly, this bill begins the process of basing Ryan White
CARE Act funding on HIV cases, not AIDS cases. Such a change will
ensure that Ryan White CARE Act dollars go where the disease is growing
quickly, not to the areas with the highest historical incidences of
AIDS. It also provides incentives for States to implement re
commendations belatedly issued by the Centers for Disease Control and
Prevention to move to HIV reporting systems, one of the most important
public health initiatives in America at the close of the 20th Century.

It is a national tragedy that public health officials in the States
were unable or unwilling to move to HIV reporting years ago. The
identification of HIV reporting as a serious public health concern was
identified by the first Presidential Commission on HIV, appointed by
President Ronald Reagan, which stated that ``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 . . . 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.''
It is imperative that the Ryan White CARE Act be reauthorized to
provide

[[Page H8840]]

the incentives to move public health in the right direction so that the
HIV/AIDS epidemic can be tracked more accurately, and appropriate
funding and information about this disease be better directed.
As many of my colleagues will recall, when we last brought the Ryan
White bill to the floor in July, the most contentious issue was the
bill's ``hold harmless'' provision. The bill which originally passed
the House would have trimmed the substantial overpayments received by
San Francisco so that it would eventually receive no more per capita
than any other metropolitan area.
After lengthy negotiations, it has been agreed that the hold harmless
reduction will be a compromise between the original House and Senate
provisions, which will now be a reduction of 15% over the next five
years to slow the transition to equitable funding.
I ask my colleagues to join with me in support of this important
legislation that moves us in the right direction as we enter the 21st
Century.

Ryan White CARE Act Amendments of 2000

Managers' Statement of Explanation

The Ryan White CARE Act Amendments of 2000 reauthorize
Title XXVI of the Public Health Service Act to ensure that
individuals living with HIV and AIDS receive health care and
related support services. The legislation contains
authorization for appropriations and programmatic changes to
ensure the CARE Act programs respond to evolving demographic
trends in the HIV/AIDS epidemic and advances in treatment and
care.

I. Background

In March, 1990, Congress enacted the Ryan White CARE Act,
honoring Ryan White, a young man who taught the Nation to
respond to the HIV/AIDS epidemic with hope and action rather
than fear. By the spring of 1990, over 128,000 people had
been diagnosed with AIDS in the United States and 78,000 had
died of the disease. The CARE Act was reauthorized in 1996,
as the epidemic spread to more than 600,000 Americans
diagnosed with AIDS and amidst the nationwide recognition
that CARE Act programs were indispensable to the care and
treatment of Americans with HIV/AIDS.
The CARE Act Amendments of 2000 marks the second
reauthorization of the CARE Act. In the last twenty years,
the HIV/AIDS epidemic has claimed over 420,000 American men,
women, and children. Today, the Centers for Disease Control
and Prevention estimates that there are currently between
800,000 and 900,000 persons living with HIV in the United
States, with 40,000 new infections annually.
While there is still no cure, the CARE Act has been
instrumental in responding to the public health, social and
economic burdens of the HIV/AIDS epidemic. However, the
steady expansion and changed demographics of the epidemic, as
well as the improved survival time for people living with
AIDS, are placing increasing stress on State and local health
care systems, community based organizations and families
providing care. Most importantly, the epidemic is expanding
beyond major cities to smaller cities and rural regions, and
disproportionately affecting women, communities of color,
children and youth.
The Ryan White CARE Act Amendments of 2000 preserves the
best and proven features of existing CARE Act programs. But
the CARE Act Amendments of 2000 also makes important and
substantial reforms to respond to the significant changes in
the HIV/AIDS epidemic of the last 5 years.

II. Organization of Services Under the CARE Act Amendments of 2000

Title I. Emergency Relief for Areas with Substantial Need
for Services: Provides emergency relief grants to 51 eligible
metropolitan areas (EMAs) disproportionately affected by the
HIV epidemic to provide primary care and HIV-related support
services to people with HIV and AIDS. Half of the Title I
funding is distributed by formula; the remaining half is
distributed competitively, based on the demonstration of
severity of need and other criteria.
Planning Council membership has been revised to include HIV
prevention providers, homeless and housing service providers,
and representatives of prisoners. A third of Planning Council
members must be individuals with HIV/AIDS receiving care who
are not officers, employees or consultants to Title I
grantees.
Title II. CARE Grant Program: Provides formula grants to
States, District of Columbia, Puerto Rico and U.S.
territories to improve the quality of health care and support
services for individuals with HIV disease and their families.
The funds are used: to provide medical support services, to
continue health insurance payments, to provide home care
services, and, through the AIDS Drug Assistance Programs
(ADAP), to provide medications necessary for the care of
these individuals. Supplemental formula grants are awarded to
States with ``emerging communities'' which are ineligible for
grants under Title I.
Subtitle B provides discretionary grants to States for the
reduction of perinatal transmission of HIV, and for HIV
counseling, testing, and outreach to pregnant women. Subtitle
C provides discretionary grants to States for partner
notification, counseling and referral services.
Title III. Early Intervention Services: Funds nonprofit
entities providing primary care and outpatient early
intervention services, including case management, counseling,
testing, referrals, and clinical and diagnostic services to
individuals diagnosed with HIV. The unfunded program of State
formula grants in current law is repeated.
Title IV. Other Programs and Activities: Provides grants
for comprehensive services to children, youth, and women
living with HIV and their families. Such services include
primary, specialty and psychosocial care, as well as HIV
outreach and prevention activities. Grantees must demonstrate
linkages to, and provide clients with access and education
on, HIV/AIDS clinical research.
Title IV newly authorizes the AIDS Education and Training
Centers (AETC), a network of 14 regional centers conducting
clinical HIV education and training of health providers, to
provide prenatal and gynecological care. The HIV/AIDS Dental
Reimbursement program, covering uncompensated oral health
care for patients with HIV/AIDS, is expanded to provide
community-based care in underserved areas.
Under Subtitle B, general provisions authorize CDC data
collection for CARE Act planning and evaluation, enhanced
interagency coordination of HIV services and prevention,
development of a plan for the case management of prisoners
with HIV, and administrative provisions related to audits,
and a plan for simplification of CARE Act grant
disbursements.
Title V. General Provisions: Authorizes Institute of
Medicine (IOM) studies and expansion of Federal support for
the development of rapid HIV tests. Makes necessary and
technical corrections in Title XXVI of the Public Health
Service Act.

III. Summary of Selected Provisions

Use of HIV Case Data in Formula Grants
In order to target funding more accurately to reflect the
HIV/AIDS epidemic, the Managers have revised and updated the
Title I and Title II formulas to make use of data on cases of
HIV infection as well as of AIDS. In Fiscal Year (FY) 2005,
HIV and AIDS case data is intended to be used in the Title I
and Title II formulas.
However, no later than July 1, 2004, the Secretary shall
determine whether HIV case data, as reported to and confirmed
by the Director of CDC, is sufficiently accurate and reliable
from all eligible areas and States for such use in the
formula. The Secretary shall also consider the findings of
the Institute of Medicine (IOM) study undertaken under
section 501(b).
If the Secretary makes an adverse determination regarding
HIV case data, the Managers intend that only AIDS case data
will be used in FY2005 formula allocations. The Secretary
shall also provide grants and technical assistance to States
and eligible areas to ensure that accurate and reliable HIV
case data is available no later than FY2007.
Planning and priority setting
The Managers have strengthened the capacity of EMAs and
States to plan, prioritize, and allocate funds, based on the
size and demographic characteristics of the populations with
HIV disease in the eligible area. Planning, priority setting,
and funding allocation processes must take into account the
demographics of the local HIV/AIDS epidemic, existing
disparities in access HIV-related health care, and resulting
adverse health outcomes. It is the intent of the Managers
that CARE Act dollars more closely follow the shifting trends
in the local epidemic and address disparities in health care
access and health outcomes as well as the need for capacity
development within the local and State HIV health care
infrastructures.
The Managers intend both EMAs and States to develop
strategies to bring into and retain in care those individuals
who are aware of their HIV status but are not receiving
services. As part of this process, the Managers place the
highest priority on EMAs and States focusing on eliminating
disparities in access and services among affected
subpopulations and historically underserved communities. The
Managers recognize, however, that the relative availability
or lack of HIV prevalence data will be reflected in the
scope, goals, timetable and allocation of funds for
implementation of the strategy.
The Managers also expect the Secretary to collaborate with
Title I and II grant recipients and providers to develop
epidemiologic measures and tools for use in identifying
persons with HIV infection who know their HIV status but are
not in care. The Managers recognize the difficulty the EMAs
and States may experience in identifying persons with HIV
infection who are not in care and who may be unknown to any
health or social support system. The efforts on the part of
EMAs and States to accomplish these important tasks, however,
should not be delayed until this process is complete.
Instead, the Managers expect Title I and II grant recipients
to establish and implement strategies responsive to these
urgent needs before the development of nationally uniform
measures, to the extent that is practicable and to which
necessary prevalence data is reasonably available.
The Managers have also authorized outreach activities in
Title I and II intended to

[[Page H8841]]

identify individuals with HIV disease know their HIV status
but are not receiving services. The intent is to ensure that
EMAs and States understand that outreach activities which are
consistent with early intervention services and necessary to
implement the aforementioned strategies, are appropriate uses
of Title I and II funds. It is not the Managers' intent that
such activities supplant or otherwise duplicate activities
such as case finding, surveillance and social marketing
campaigns currently funded and administered by the Centers
for Disease Control and Prevention (CDC). Instead, this
authorization reflects the urgency of increasing the
coordination between HIV prevention and HIV care and
treatment services in all CARE Act programs.
Hold harmless provisions
The hold-harmless provisions are intended to minimize loss
and stabilize systems of care in EMAs and States, while
assuring that funds are allocated in Title I and II to
reflect the current distribution and epidemiology of the
epidemic.
The Managers have revised the Title I hold harmless to
limit a potential loss in an EMA's formula allocation to a
small percentage of the amount allocated to the eligible are
in the previous (or base) year. An EMA may lose no more than
15 percent of its base formula allocation over five years,
beginning with 2 percent in the first year and increasing in
subsequent years. If the Secretary determines that data on
HIV prevalence are accurate and reliable for use in
determining Title I formula grants for Fiscal Year 2005, all
EMAs may lose no more than 2 percent of their Fiscal Year
2004 formula allocation in that year.
Should an EMA experience a decline in its Title I formula
allocation followed by an intervening year in which there is
not decline, its losses in any subsequent, nonconsecutive
year of decline would once again be limited to 2 percent
(ie., the intervening year `resets the clock').
The Managers intend to ensure that essential primary care
and support services are not compromised by short-term
fluctuations in AIDS case counts. Because no new EMA is
expected by HRSA's Bureau of HIV/AIDS to require that hold
harmless in the first three or four years of this
reauthorization period, the Managers expect this policy will
shield all eligible areas, save those currently requiring the
hold harmless, from any meaningful loss in Title I formula
funding.
Under the Title II hold harmless, a State or territory may
lose no more than 1 percent from the previous fiscal year
amounts, or 5 percent over the 5-year reauthorization period.
This protection extends to base Title II funding (which
excludes funds for AIDS Drug Assistance Programs (ADAP)), as
well as to overall Title II funding.
Women, child, infants, and youth set-aside
The Managers are aware of the rising incidence of HIV among
youth and women, particularly women of color, and recognize
the challenges in assuring them access to primary care and
support services for HIV and AIDS. The Managers intend to
increase the availability of primary care and health-related
supportive services under Title I and Title II for each of
the four groups described in the set-aside. Youth are added
as a new category within this set-aside. The Managers intend
the term ``youth'' to include persons between the ages of 13
and 24, and ``children'' to include those under the age of
13, including infants.
The Managers clarify that the set-asides for women,
infants, children, and youth with HIV disease be allocated
proportionally, based on the percentage of the local HIV-
infected population that each group represents. The Managers
intend that the States and EMAs continue to make every effort
to reach and serve women, infants, children, and youth living
with HIV/AIDS by allocating sufficient resources under Titles
I and II to serve each of these populations. The Managers
also recognize that these priority populations often comprise
a greater proportion of HIV cases rather than AIDS cases in a
local area. This distinction should be taken into account
where necessary prevalence data is reasonably available.
The Mangers are aware that these populations may also have
access to HIV care through other parts of Title XXVI,
Medicaid, State Children's Health Insurance Program (SCHIP),
and other Federal and State programs. Therefore, the
requirements to proportionally allocate funds provided under
Title II to each of these populations may be waived for
States which reasonably demonstrate that these populations
are receiving adequate care.
Capacity development
Titles I, II and III of this legislation provide a new
focus on strengthening the capacity of minority communities
and underserved areas where HIV/AIDS is having a
disproportionate impact. Currently, many underserved urban
and rural areas are not able to compete successfully for
planning grants and early intervention service grants due to
the lack of infrastructure and experience with the Ryan White
Care Act programs. This gap in services available is
increasingly important, as the HIV and AIDS epidemic extends
into rural communities. In addition to authorizing capacity
development under Titles I and II, the Managers establish a
preference for rural areas under Title III that will allow
program administrators to target capacity development grants,
planning grants, and the delivery of primary care services to
rural communities with a growing need for HIV services.
However, urban areas are not excluded from consideration for
future grants nor is funding reduced to current grants in
urban areas.
Quality management
The Managers recognize the importance of having CARE Act
grantees ensure that quality services are provide to people
with HIV and that quality management activities are conducted
on an ongoing basis. Quality management programs are intended
to serve grantees in evaluating and improving the quality of
primary care and health-related supportive services provided
under this act. The quality management program should
accomplish a threefold purpose: (1) assist direct service
medical providers funded through the CARE Act in assuring
that funded services adhere to established HIV clinical
practices and Public Health Service (PHS) guidelines to the
extent possible; (2) ensure that strategies for improvements
to quality medical care include vital health-related
supportive service in achieving appropriate access and
adherence with HIV medical care; and (3) ensure that
available demographic, clinical, and health are utilization
information is used to monitor the spectrum of HIV-related
illnesses and trends in the local epidemic.
The Managers expect the Secretary to provide States with
guidance and technical assistance for establishing quality
management programs, including disseminating such models as
have been developed by States and are already being utilized
by Title II programs and in clinical practice environments.
Furthermore, the Managers intend that the Secretary provide
clarification and guidance regarding the distinction between
use of CARE Act funds for such program expenditures that are
covered as their planning and evaluation and funds for
program support costs. It is not the Managers' intent to
divert current program resources or to reassign current
program support costs or clinical quality programs to new
cost areas, if they are an integral part of a State's current
quality management efforts.
Program support costs are described as any expenditure
related to the provision of delivering or receiving health
services supported by CARE Act funds. As applied to the
clinical quality programs, these costs include, but are not
limited to, activities such as chart review, peer-to-peer
review activities, data collection to measure health
indicators or outcomes, or other types of activities related
to the development or implementation of a clinical quality
improvement program. Planning and evaluation costs are
related to the collection and analysis of system and process
indicators for purposes of determining the impact and
effectiveness of funded health-related support services in
providing access to and support of individuals and
communities within the health delivery system.
Early intervention services
The Managers authorize early intervention services as
eligible services under Titles I and II under certain
circumstances. The Managers intend to allow grantees to
provide certain early intervention services, such as HIV
counseling, testing, and referral services, to individuals at
high risk for HIV infection, in accordance with State or EMA
planning activities. The Managers recognize the range of
organizations that may be eligible to provide early
intervention services, including other grantees under Titles
I, II and III such as community based organizations (CBOs)
that act as points of entry into the health care system for
traditionally underserved and minority populations.
The Managers believe that referral relationships maintained
by providers of early intervention services are essential to
increasing the number of people with HIV/AIDS who are
identified and to bringing them into care earlier in the
progression of their disease.
Health-care related support services
The Managers wish to stress the importance of CARE Act
funds in meeting the health care needs of persons and
families with HIV disease. The Act requires support services
provided through CARE Act funds to be health care related.
States and EMAs should ensure that support services meet the
objective of increasing access to health care and ongoing
adherence with primary care needs. The Managers reaffirm the
critical relationship between support service provision and
positive health outcomes.
Title I planning council duties and membership
The Managers have amended numerous aspects of CARE Act
programs to enhance the coordination between HIV prevention
and HIV/AIDS care and treatment services. In this case,
Planning Council membership of the providers of HIV
prevention services will help assure this coordination. To
improve representation of underserved communities, providers
of services to homeless populations and representatives of
formerly incarcerated individuals with HIV disease are
included in planning council membership. It is the intent of
the Managers that the needs of all communities affected by
HIV/AIDS and all providers working with the service areas be
represented. The Managers also intend the Planning Councils
more adequately reflect the gender and racial demographics of
the HIV/AIDS population within their respective EMAs.
The Managers also intend that patients and consumers of
Title I services constitute a substantial proportion of
Planning Council memberships. The prohibition of officers,

[[Page H8842]]

employees and consultants is not intended to impede the
participation qualified, motivated volunteers with Title I
grantees from serving on Planning Councils where they do not
maintain significant financial relationships, volunteers may
be reimbursed reasonable incidental costs, including for
training and transportation, which help to facilitate their
important contribution to the Planning Councils.
To ensure that new Planning Council members are adequately
prepared for full participation in meetings, the Managers
direct the Secretary to ensure that proper training and
guidance is provided to members of the Councils. The Managers
also expect Planning Councils to provide assistance, such as
transportation and childcare, to facilitate the participation
of consumers, particularly those from affected subpopulations
and historically underserved communities.
Consistent with the ``sunshine'' policies of the Federal
Advisory Committee Act (FACA), all meetings of the Planning
Councils shall be open to the public and be held after
adequate notice to the public. Detailed minutes, records,
reports, agenda, and other relevant documents should also be
available to the public. The Managers intend for such
documents to be available for inspection and copying at a
single location, including posting on the Internet.
Title I supplemental
In order to target funding to areas in greatest need of
assistance, severity of need is given a greater weight of 33
percent in the award of Title I supplemental grants. The
Managers intend that Title I supplemental awards are not
intended to be allocated on the basis of formula grant
allocations. Instead, such supplemental awards are to be
directed principally to those eligible areas with ``severe
need,'' or the greatest or expanding public health challenges
in confronting the epidemic. The Managers have included
additional factors to be considered in the assessment of
severe need, including the current prevalence of HIV/AIDS,
and the degree of increasing and unmet needs for services.
Additionally, the Managers believe that syphilis, hepatitis B
and hepatitis C should be regarded as important co-
morbidities to HIV/AIDS.
It is the Managers' strong view that HRSA's Bureau of HIV/
AIDS should employ standard, quantitative measures to the
maximum extent possible in lieu of narrative self-reporting
when awarding supplemental awards. The Managers therefore
renew the Bureau's obligation to develop in a timely manner a
mechanism for determining severe need upon the basis of
national, quantitative incidence data. In this regard, the
Managers recognize that adequate and reliable data on HIV
prevalence may not be uniformly available in all eligible
areas on the date of enactment. It is noted, however, that
``HIV disease'' under the CARE Act encompasses both persons
living with AIDS as well as persons diagnosed as HIV positive
who have not developed AIDS.
Title II base minimum funding
The minimum Title II base award is increased in order to
increase the funding available to States for the capacity
development of health system programs and infrastructure. The
Federated States of Micronesia and the Republic of Palau are
included as entities eligible to receive Title II funds, in
recognition of the need to establish a minimum level of
funding to assist in building HIV infrastructure.
Title II public participation
The Managers urge States to strengthen public participation
in the Ryan White Title II planning process. While the
Managers do not intend that States be mandated to consult
with all entities participating in the Title I planning
process, reference to such entities is intended to provide
guidance to the States that such entities are important
constituencies which the States should endeavor to include in
their planning processes. Moreover, States may demonstrate
compliance with the new requirement of an enhanced process of
public participation by providing evidence that existing
mechanisms for consumer and community input provide for the
participation of such entities. The intent is to allow States
to utilize the optimal public advisory planning process, such
as special planning bodies or standing advisory groups on
HIV/AIDS, for their particular population and circumstances.
The Managers are also aware of the difficulties that some
States with limited resources may encounter in convening
public hearings over large geographic or rural areas and
encourage the Secretary to work with these States to develop
appropriate processes for public input, and to consider such
limitations when enforcing these requirements.
Title II HIV care consortia
The Managers intend that the States continue to work with
local consortia to ensure that they identify potential
disparities in access to HIV care services at the local
level, with a special emphasis on those experiencing
disparities in access to care, historically underserved
populations, and HIV infected persons not in care. However,
the Managers do not intend that States and/or consortia be
mandated to consult with all entities participating in the
Title I planning process. Rather, reference to such entities
is intended to provide guidance to the States that such
entities are important constituencies which the States should
endeavor to include in their planning processes.
Title II ``emerging communities'' supplement
There continues to be a growing need to address the
geographic expansion of this epidemic, and this Act continues
the efforts made during the last reauthorization to direct
resources and services to areas that are particularly
underserved, including rural areas and metropolitan areas
with significant AIDS cases that are not eligible for Title I
funding. A supplemental formula grant program is created
within Title II to meet HIV care and support needs in non-EMA
areas. There are a large number of areas within States that
do not meet the definition of a Title I EMA but that,
nevertheless, experience significant numbers of people living
with AIDS. This provision stipulates that these ``emerging
communities,'' defined as cities with between 500 and 1,999
reported AIDS cases in the most recent 5-year period, be
allocated 50 percent of new appropriations to address the
growing need in these areas. Funding for this provision is
triggered when the allocations to carry out Part B, excluding
amounts allocated under section 2618(a)(2)(I), are
$20,000,000 in excess of funds available for this part in
fiscal year 2000, excluding amounts allocated under section
2618(a)(2)(I). States can apply for these supplemental awards
by describing the severity of need and the manner in which
funds are to be used.
The Managers intend to acknowledge the challenges faced by
many areas with a significant burden of HIV and AIDS and a
lack of health care infrastructure or resources to provide
HIV care services. This supplemental program allows the
Secretary to make grants to States to address HIV service
needs in these underserved areas. The Managers understand the
necessity to continue to support existing and expanding
critical Title II base services.
AIDS Drug Assistance Program supplemental grant and expanded
services
Under this Act, the AIDS Drug Assistance Program (ADAP) has
been strengthened to assist States in a number of areas. The
Secretary is authorized to reserve 3 percent of ADAP
appropriations for discretionary supplemental ADAP grants
which shall be awarded in accordance with severity of need
criteria established by the Secretary. Such criteria shall
account for existing eligibility standards, formulary
composition and the number of patients with incomes at or
below 200 percent of poverty. The Managers also encourage the
Secretary to consider such factors as the State's ability to
remove restrictions on eligibility based on current
medical conditions or income restrictions and to provide
HIV therapeutics consistent with PHS guidelines.
States are also required to match the Federal supplemental
at a rate of 1:4. The Managers expect the State to continue
to maintain current levels of effort in its ADAP funding. The
Managers intend that the 25 percent State match required to
receive funds under this section be implemented in a flexible
manner that recognizes the variations between Federal, State,
and programmatic fiscal years.
In addition, up to 5 percent of ADAP funds will be allowed
to support services that directly encourage, support, and
enhance adherence with treatment regimens, including medical
monitoring, as well as purchase health insurance plans where
those plans provided fuller and more cost-effective coverage
of AIDS therapies and other needed health care coverage.
However, up to 10 percent of ADAP funds may be expended for
such purposes if the State demonstrates that such services
are essential and do not diminish access to therapeutics.
Finally, the Managers recognize that existing Federal policy
provides adequate guidelines to states for carrying out
provisions under this section.
Partner notification, perinatal transmission, and counseling
services
Discretionary grants are authorized under this Act for
partner notification, counseling and referral services. The
Managers have also expanded the existing grant program to
States for the reduction of perinatal transmission of HIV,
and for HIV counseling, testing, and outreach to pregnant
women. Funding for perinatal HIV transmission reduction
activities is expanded, with additional grants available to
States with newborn testing laws or States with significant
reductions in perinatal HIV transmission. In addition, this
Act further specifies information to be conveyed to
individuals receiving HIV positive test results in order to
reduce risk of HIV transmission through sex or needle-sharing
practices.
Coordination of coverage and services
This Act also strengthens the requirements made on the
States and EMAs in a number of areas aimed at improving the
coordination of coverage and services. Grantees must assess
the availability of other funding sources, such as Medicaid
and the State Children's Health Insurance Program (SCHIP) and
improve efforts to ensure that CARE Act funds are coordinated
with other available payers.
Titles III and IV administrative expenses
The administrative cap for the directly funded Title III
programs is increased. The administrative cap for Title III
grants is raised from 7.5 percent to 10 percent to correspond
with the 10 percent cap on individual contractors in Title I.
The Secretary is directed to review administrative and
program support expenses for Title IV, in consultation with
grantees. In order to assure that

[[Page H8843]]

children, youth, women, and families have access to quality
HIV-related health and support services and research
opportunities, the Secretary is directed to work with Title
IV grantees to review expenses related to administrative,
program support, and direct service-related activities.
Title IV access to research
This Act removes the requirement that Title IV grantees
enroll a ``significant number'' of patients in research
projects. Title IV provides an important link between women,
children, and families affected by HIV/AIDS and HIV-related
clinical research programs. The ``significant number''
requirement is removed here to eliminate the incentive for
providers to inappropriately encourage or pressure patients
to enroll in research programs.
To maintain appropriate access to research opportunities,
providers are required to develop better documentation of the
linkages between care and research. The Secretary of Health
and Human Services (HHS), through the National Institutes of
Health (NIH), is also directed to examine the distribution
and availability of HIV-related clinical programs for
purposes of enhancing and expanding access to clinical
trials, including trials funded by NIH, CDC and private
sponsors. The Managers encourage the Secretary to assure that
NIH-sponsored HIV-related trials are responsive to the need
to coordinate the health services received by participants
with the achievement of research objectives. Nor do the
Managers intend this requirement to require the
redistribution of funds for such research projects.
Part F Dental Reimbursement Program
The Managers have established new grants for community-
based oral health care to support collaborative efforts
between dental education programs and community-based
providers directed at providing oral health care to patients
with HIV disease in currently unserved areas and communities
without dental education programs. Although the Dental
Program has been tremendously successful, there is still a
large HIV/AIDS population that has not benefitted because
there is not a dental education institution participating in
their area. These patients are also in need of dental
services that could be provided at community sites if more
community-based providers would partner with a dental school
or residency program. In these partnerships, dental students
or residents could provide treatment for HIV/AIDS patients in
underserved communities under the direction of a community-
based dentist who would serve as adjunct faculty. By
encouraging dental educational institutions to partner with
community-based providers, the Managers intend to address to
unmet need in these areas by ensuring that dental treatment
for the HIV/AIDS population is available in all areas of the
country, not just where dental schools are located.
Technical assistance and guidance
The Managers reaffirm the Secretary's responsibility in
providing needed guidance and tools to grantees in assisting
them in carrying out new requirements under this Act. The
Secretary is required to work with States and EMAs to
establish epidemiologic measures and tools for use in
identifying the number of individuals with HIV infection,
especially those who are not in care. The legislation
requests an IOM study to assist the Secretary in providing
this advice to grantees.
The Managers understand that the Secretary has convened a
Public Health Service Working Group on HIV Treatment
Information Dissemination, which has produced recommendations
and a strategy for the dissemination of HIV treatment
information to health care providers and patients.
Recognizing the importance of such a strategy, the Managers
intend that the Secretary issue and begin implementation of
the strategy to improve the quality of care received by
people living with HIV/AIDS.
Data collection through CDC
The Managers believe that an additional authorization for
HIV surveillance activities under the CDC will serve to
advance the purposes of the CARE Act. To better identify and
bring individuals with HIV/AIDS into care, States and cities
may use such funding to enhance their HIV/AIDS reporting
systems and expand case finding, surveillance, social
marketing campaigns, and other prevention service programs.
Notwithstanding its strong interest in improving the
coordination between HIV prevention and HIV care and
treatment services, the Managers intend that this enhanced
funding for CDC and its grantees ensure that CARE Act
programs and funds not duplicate or be diverted to activities
currently funded and administered by the CDC.
Coordination
This Act requires the Secretary to submit a plan to
Congress concerning the coordination of Health Resources and
Services Administration (HRSA), Centers for Disease Control
and Prevention (CDC), Substance Abuse and Mental Health
Services Administration (SAMHSA), and Health Care Financing
Administration (HCFA), to enhance the continuity of care and
prevention services for individuals with HIV disease or those
at risk of such disease. The Managers believe that much
greater effort is required to ensure that the provision of
HIV prevention and care services becomes as seamless as
possible, and that coordination be pursued at the Federal
level, in the States and local communities to eliminate any
administrative barriers to the efficient provision of high
quality services to individuals with HIV disease.
A second plan for submission to Congress focuses on the
medical case management and provision of support services to
persons with HIV released from Federal or State prisons.
Administrative simplification
The Managers intend for the Secretary of HHS to explore
opportunities to reduce the administrative requirements of
Ryan CARE Act grantees through simplifying and streamlining
the administrative processes required of grantees and
providers under Titles I and II. In consultation with
grantees and service providers of both parts, the Secretary
is directed to (1) develop a plan for coordinating the
disbursement of appropriations for grants under Title I with
the disbursement of appropriations for grants under Title II,
(2) explore the impact of biennial application for Titles I
and II on the efficiency of administration and the
administrative burden imposed on grantees and providers under
Titles I and II, and (3) develop a plan for simplifying the
application process for grants under Titles I and II. It is
the intent of the Managers to improve the ability of grantees
to comply with administrative requirements while decreasing
the amount of staff time and resources spent on
administrative requirements.
Program and service studies
The Managers request that the Secretary, through the IOM,
examine changing trends in the HIV/AIDS epidemic and the
financing and delivery of primary care and support services
for low-income, uninsured, and underinsured and individuals
with HIV disease. The Secretary is directed to make
recommendation regarding the most effective use of scarce
Federal resources. The purpose of the study is to examine key
factors associated with the effective and efficient financing
and delivery of HIV services (including the quality of
services, health outcomes, and cost-effectiveness). The
Managers expect that the study would include examination of
CARE Act financing of services in relation to existing public
sector financing and private health coverage; general
demographics and comorbidities of individuals with HIV
disease; regional variations in the financing and costs of
HIV service delivery; the availability and utility of health
outcomes measures and data for measuring quality of Ryan
White funded service; and available epidemiological tools and
data sets necessary for local and national resource planning
and allocation decisions, including an assessment of
implementation of HIV infection reporting, as it impacts
these factors.
The Managers also require an IOM study focuses on
determining the number of newborns with HIV, where the HIV
status of the mother is unknown; perinatal HIV transmission
reduction efforts in States; and barriers to routine HIV
testing of pregnant women and newborns when the mothers' HIV
status is unknown. The study is intended to provide States
with recommendations on improving perinatal prevention
services and reducing the number of pediatric HIV/AIDS cases
resulting from perinatal transmission.
Development of Rapid HIV Test
The Managers encourage the Secretary to expedite the
availability of rapid HIV tests which are safe, effective,
reliable and affordable. The Managers intend that the
National Institutes of Health expand research which may lead
to such tests. The Managers also intend that the Director of
CDC should take primary responsibility, in conjunction with
the Commissioner of Food and Drugs, for a report to Congress
on the public health need and recommendations for the
expedited review of rapid HIV tests. The Managers believe
that the Food and Drug Administration should account for the
particular applications and urgent need for rapid HIV tests,
as articulated by public health experts and the CDC, when
determining the specific requirements to which such tests
will be held prior to marketing.
Department of Veterans Affairs
The Managers note that the U.S. Department of Veterans
Affairs is the largest single direct provider of HIV care and
services in the country. Over 18,000 veterans received HIV
care at VA facilities in 1999. Veterans with HIV infection
are eligible to participate in Ryan White Title I and Title
II programs when they meet eligibility requirements set by
EMAs and States, whose plans for the delivery of services
must account for the availability of VA services. VA
facilities are eligible providers of HIV health and support
services where appropriate. The Managers expect that HRSA's
Bureau of HIV/AIDS shall encourage Ryan White grantees to
develop collaborations between providers and VA facilities to
optimize coordination and access to care to all persons with
HIV/AIDS.
International HIV/AIDS Initiatives
The Managers note that the CARE Act provides a model of
service delivery and Federal partnerships with States, cities
and community-based organizations which should prove valuable
in global efforts to combat the HIV/AIDS epidemic. The
Managers strongly encourage the Secretary, the Bureau of HIV/
AIDS at HRSA, and the CDC to provide technical assistance
available to other countries which has already proven
invaluable in helping to limit the suffering caused by HIV/
AIDS. It is the Managers' hope that the hard-earned knowledge
and experience gained in this country can benefit people with
HIV/AIDS overseas.

[[Page H8844]]

Ms. ESHOO. Mr. Speaker, I strongly support S. 2311, the Ryan White
Care Act Amendments of 2000. Enactment of this legislation will truly
make a difference in people's lives.
The Ryan White CARE Act, without question, was the most important
legislation Congress has ever enacted for people living with HIV and
AIDS. Every year, CARE Act funds provide lifesaving medical and social
services for tens of thousands of uninsured and underinsured Americans
battling these devastating diseases. AIDS medications, viral load
testing, treatment education, and case management are just a few of the
essential support services provided by federal CARE Act dollars.
Each of the programs created under the CARE Act services a specific
need yet, combined, they make up the health care and social service
safety net of last resort. Since it's creation in 1990, reliability and
stability have been the two cornerstones of the Ryan White law. When we
passed the House version of the reauthorization in July, I spoke out
against a provision that ran directly contrary to this safety net
principle. A 25 percent reduction in the ``hold harmless'' that was
part of the original House bill would have caused a rapid
destabilization of systems of care in the Bay Area and potentially
around the country. I fought that provision and I'm so pleased that the
bill before us today includes a more equitable formula that reflects
the changing face of the disease without gutting funding to any one
Eligible Metropolitan Area (EMA).
More people than ever are living with HIV/AIDS and the CARE Act must
keep pace with the increasing demands. When the CARE Act was passed in
1990, there were 155,619 AIDS cases. In 1996, there were 481,234 cases.
Today, America has 733,374 recorded cases of HIV/AIDS. AIDS is the
leading cause of death among African Americans between the ages of 25-
44 and the second leading cause of death among Latinos in the same age
group. HIV/AIDS are still very much with us and we must ensure that all
those infected get the medical and social services they need to live
longer, more productive lives.
And that's exactly what's been happening. Access to new medications
and treatments, such as combination antiretroviral therapies, has
significantly lengthened the life expectancy of people with HIV/AIDS.
People with AIDS are living longer and those with HIV aren't
progressing as quickly to full-blown AIDS. Thankfully, it's no longer
necessarily a death sentence. This, in turn, underscores the increasing
need for services. As people live longer, their dependence on CARE Act
programs greatly increases; hence, the importance of reauthorizing the
Ryan White Act.
So, I thank my colleagues, Senators Kennedy and Jeffords and
Representatives Brown, Waxman and Coburn, and their staffs, for their
work on S. 2311 and for their dedication to reauthorizing the CARE Act
this year. It's a good bill that will do wonderful things for people
across this country. I urge my colleagues' enthusiastic support.
Mrs. CHRISTENSEN. Mr. Speaker, I rise in support of S. 2311, Ryan
White Care Act. I am very thankful that were are acting on this very
important bill, before we run out of time, to ensure that individuals
living with HIV and AIDS will receive the health care and related
supported services that they need. While, S. 2311 is not perfect, it
does provide the necessary authorizations for appropriations and
programmatic changes to ensure that the CARE Act is responsive to the
evolving demographic trends in the HIV/AIDS epidemic and advances in
treatment care.
I am also pleased that one of my major concerns with the House bill
to reauthorize the CARE Act, HR 4807, involving incentives for HIV
testing of pregnant women and infants, is not in the bill before us
today. 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.
I am encouraged that S. 2311 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
change 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 that 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 the requirement in the
bill that planning, priority setting and funding allocation processes
must take into account the demographics of the local HIV/AIDs epidemic,
existing disparities in access to HIV--related care.
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 lifeline to countless Americans
infected with HIV and AIDS. It is our best ammunition in the war
against this devastating disease that 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 urge my colleagues to support this much needed and important bill.
Mr. HORN. Mr. Speaker, I rise to express my strong support for the
Ryan White Care Act Amendments of 2000. Over the past ten years, the
Ryan White Care Act has represented a unique partnership between
federal, state and local officials in delivering prevention and
treatment services to those affected by this disease.
The good news is the Care Act has expanded access to high quality
health care, which is more important than ever in accommodating the
growing numbers of people living with HIV and AIDS. As a result, it is
important that federal funds distributed to states and cities most
impacted by the disease, such as Long Beach, are needs-based. These
amendments are an important step towards the equitable distribution of
federal resources for people living with HIV and AIDS.
These amendments will also allow heavily impacted areas such as Long
Beach to use their funds now for early intervention services, so they
can locate people living with HIV and get them into care. With HIV
infecting more than 40,000 Americans each year--at an average treatment
cost of $200,000 per individual--prevention strategies remain the most
cost effective use of public health dollars.
Today, there are nearly 3800 AIDS cases in Long Beach alone. The Ryan
White Care Act Amendments will go a long way in improving access to
health care for these Americans, in addition to slowing the rate of new
infections, especially in communities of color. I am pleased to lend my
support to this important bill and encourage all my colleagues to do
the same.
Ms. SCHAKOWSKY. Mr. Speaker, I rise in strong support of S. 2311, the
Ryan White CARE Act Amendments of 2000. This bill will make a real and
profound difference in the lives of persons living with HIV/AIDS by
providing resources for essential primary care health and support
services.
The Ryan White CARE Act was first passed in 1990. Since that time,
the face of the HIV/AIDS epidemic has changed but the need for the Ryan
White CARE Act has not. Today, it is more important than ever that we
act to expand access to health and social services.
Since coming to Congress, I have had the opportunity to visit with
many of my constituents who have benefited from the Ryan White CARE
Act. Person after person has told me that, without this Act, they would
be unable to afford the treatments needed so that they can remain
healthy and productive members of their community. As members of
Congress, we have supported increased medical research efforts that
have led to promising treatment advances for people living with HIV/
AIDS. The Ryan White CARE Act helps to ensure that people can actually
obtain that treatment. It helps them find affordable housing and
employment opportunities. It is a program that works and deserves our
continued support.
In my district, as in other parts of the country, the HIV/AIDS
epidemic continues to threaten individuals, families and communities.

[[Page H8845]]

I want to recognize the outstanding efforts of many in combating this
crisis, both here and in the Chicagoland area. In particular, I want to
thank Representative Henry Waxman for his outstanding leadership. As
the original sponsor of the Ryan White CARE Act, he has worked to make
sure that it remains effective and is flexible enough to address the
changing nature of this epidemic.
I also want to point out the enormous efforts of the City of Chicago
and, specifically, the Department of Public Health. Mayor Richard Daley
has developed a strategic plan to provide a comprehensive response to
this epidemic, working with providers, prevention experts, community
representatives and, most importantly, people living with HIV/AIDS.
Recognizing that today there are more people living with an AIDS
diagnosis in Chicago than at any other time, the City is working to
prevent new infections, provide access to drug therapies and other
treatments, improve other services such as affordable housing, and
ensure that resources are used as effectively as possible to reflect
changing needs. Reauthorization of the Ryan White CARE Act with
adequate funding is essential to meeting those goals. I also want to
point out the important work of the AIDS Foundation of Chicago and
Chicago Health Outreach in this effort.
Finally, we must recognize that women and people of color represent a
disproportionate number of new AIDS cases. Many of those impacted are
uninsured, have no regular access to primary care services, and are
unable to afford anti-HIV therapies. I am working with the Evanston
Health Department and the faith community in my district to reach out
to these communities and provide information on prevention and
available services. Therefore, I am pleased that S. 2311 makes
improvements in the Ryan White CARE Act to help eliminate disparities
in access to services and outreach to underserved communities.
I urge my colleagues to support the Ryan White CARE Act
reauthorization and to follow up on this action by providing full
appropriation levels for its essential services.
Mr. TOWNS. Mr. Speaker, I rise in support of S. 2311, which
reauthorizes ``The Ryan White CARE Act''.
HIV infection and AIDS in Brooklyn remains a difficult battle. The
Centers for Disease Control found that minorities now account for more
than half of all new cases in the United States. AIDS now kills more
black men that gunshot wounds. And, it is also the leading cause of
death for Hispanic men ages 25 to 44. This disease has equally affected
women and children in minority communities. Eighty-four percent of the
AIDS cases involving children, age 12 and under, can be found in the
black community. And, AIDS has now become the second leading cause of
death for black women and the third leading cause for Hispanic women.
I have witnessed these statistics first hand. My congressional
district has the highest incidence of new AIDS cases of any area in New
York City. Brownsville has more people living with AIDS than 12 States.
It has the second highest number of blacks living with AIDS in all of
New York City. In addition, East New York and the Ft. Greene
neighborhoods have large populations of women living with AIDS.
Yet, we have not witnessed either the research or treatment and care
dollars following the change in disease patterns. While Brooklyn is the
epicenter of this disease in New York City, the majority of the Ryan
White and NIH funds are still going to organizations which do not serve
this constituency. In response to language which I worked to include in
this legislation, hopefully, this trend will be halted. And, minority
communities, like Brownsville, Ft. Greene and East New York, will
receive their fair share of treatment dollars.
I am very pleased that with today's floor consideration of the Ryan
White CARE Act we will be able to continue to bring resources to those
communities and people who are impacted by AIDS and HIV infection. And,
I would urge my colleagues to vote for its passage.
Mr. RUSH. Mr. Speaker, I would like to take this opportunity to
commend Mr. Waxman and Mr. Coburn for their hard work on the
reauthorization of the Ryan White CARE Act of 2000. The Ryan White CARE
Act provides grants to eligible metropolitan areas that are
disproportionately affected by the HIV epidemic; it provides grants to
the states and territories to provide health care support services to
people living with HIV/AIDS; it provides programs which support
outpatient HIV early intervention services for low-income, medically
underserved people in existing primary care systems; and it provides
services for children, youth, women and families in a comprehensive,
community-based, family-centered system of care.
I am glad to see that the Ryan White CARE Act Amendment of 2000 which
I am a cosponsor, addresses the needs of people living with HIV and
AIDS. As we witness the dramatic changes taking place in other world
nations now confronting exploding epidemics of HIV/AIDS, we recognize
that the course of the HIV epidemic is also changing.
Racial and ethnic minorities are increasingly becoming affected with
this dreadful disease at an alarming rate. With adequate funding, the
Ryan White CARE Act can continue providing medical services to people
living with HIV/AIDS, which can help to improve their quality of life.
Mr. Speaker, I would like to thank all of my colleagues who have come
to the floor today to speak on the importance of reauthorizing the Ryan
White CARE Act of 2000. I am pleased that this important piece of
legislation passed the House and Senate and that the leadership
considered this important reauthorization before the end of this
congressional session.
Mr. NADLER. Mr. Speaker, I rise in strong support of S. 2311, the
Ryan White CARE Act Amendments of 2000. This is important bipartisan
legislation and I am pleased to see it on the floor today on its way to
swift passage. I want to thank the authors for hearing the concerns
that were raised when the bill first came through the House, and I
believe we have reached a good compromise.
Mr. Speaker, the AIDS epidemic has ravaged our communities throughout
the country. The statistics are devastating. Through December 1998,
nearly 700,000 people had been diagnosed with AIDS. Over 400,000 of
these people have died. The Centers for Disease Control and Prevention
estimates that over 40,000 people become infected with HIV each year
with an estimated 600,000 to 900,000 people living with HIV today.
As a nation, we could have thrown up our hands and given up in the
face of this terrible tragedy. But in 1990, in one of the great
legislative achievements of the last decade, Congress took action to
address this emergency and passed the Ryan White CARE Act. The CARE Act
is a comprehensive program providing treatment and support services to
those living with HIV and AIDS. It has brought hope and a little
humanity to this terrifying crisis.
The CARE Act is a model of how we can accomplish great things in this
chamber. By working together, we have produced a program that provides
vital health services to people across the country while targeting
communities most in need. It is an efficient program that has been an
unqualified success.
We haven't found a cure for AIDS yet, but scientists are making
promising discoveries every day, bringing hope that we may one day rid
ourselves of this disease once and for all. Until then, there is the
CARE Act, reaching out to people who are suffering with HIV and AIDS
today and who need our help to lead healthy and productive lives. This
is a humane program that deserves our strong support.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise in strong support for a
cause that must be sustained and implemented in America today. S. 2311,
``Ryan White CARE Act of 2000'' will reauthorize the funds for programs
while also changing the formula for current distribution of Ryan White
programs. Mr. Speaker, I support this measure that builds on continuing
efforts to safeguard the lives of those suffering the most.
Accordingly, I applaud the efforts to bring this important legislation
to the floor today before the end of the 106th Congress.
Thanks to the persuasive skills by those working on behalf of those
afflicted with the HIV/AIDS epidemic, the funding formula within this
legislation will actually ensure that minorities are properly covered.
The legislation maintains the integrity of the multistructure of the
CARE Act, allowing funds to be targeted to the areas hardest hit by the
HIV and AIDS epidemic. In addition, I am pleased that the legislation
maintains and, in fact, strengthens the decision-making authority of
local planning councils and allows resources to be used to locate and
bring more individuals into the health care system. Further, I am also
delighted to learn that the bill will provide more individuals with
early intervention services, such as counseling and testing.
This bill will give states the option to readily extend Medicaid
coverage to people living with HIV. If adopted, states will have the
ability to add poor and low-income uninsured persons living with HIV to
the list of persons categorically eligible for Medicaid. This is very
important for people of the 18th Congressional District of Texas who
deserve every opportunity to getting the proper coverage it is so
critical that they receive quality care. There are HIV-infected persons
in my district and across America that need some relief immediately and
thus I am pleased by the Medicaid provision in the legislation.
Under current rules, most people living with HIV are ineligible for
Medicaid until they have progressed to AIDS and are disabled. Yet, new
treatment, such as highly active antiretrovial therapy (HAART), are
successfully delaying the progression from HIV infection to AIDS. That
is exciting, Mr. Speaker. We can turn this situation around. These
advances, along with access to comprehensive health care, have improved
the health and quality of

[[Page H8846]]

life for many people living with HIV. However, without access to
Medicaid these advances will remain out of reach for thousands of poor
and low-income uninsured people living with HIV.
Early access to HIV treatment through Medicaid, as provided by this
legislation, will result in a reduction of new AIDS cases, increase the
quality of life of thousands living with HIV, reduce high medical
interventions such as inpatient hospitalizations and terminal care,
increase tax revenues and reduce costs in the SSI and SSDI programs.
Another initiative, that effects personally my 18th district in
Texas, is the establishment of a new supplementary competitive grant
program for states in ``severe need''. HHS must consider the importance
of HIV and AIDS, the increased need for service along with the level of
unmet need. HHS also must look at disparities in the access to services
for historically underserved communities. Acknowledgment of loopholes
is being met and solutions being made to combat the destitute situation
many underserved communities find themselves in.
Finally, I believe it is significant that the reauthorization of the
Ryan White Act has the strong support of the Human Rights Campaign and
AIDS Action, two organizations that has done monumental work in the
promotion of better health care and other critical benefits for those
afflicted with HIV/AIDS. As a result of their hard work, we have a
bipartisan effort that finally begins to seek to reach out to
minorities in unprecedented fashion.
Congress has long recognized the broad scope of benefits of CARE Act
programs to those impacted by the HIV and AIDS. We need to continue
helping those in need and redouble our efforts to eliminate the
epidemic of HIV/AIDS. Mr. Speaker, I strongly urge my colleagues to
strongly support this legislation.
Mr. HOLT. Mr. Speaker, I rise today to express my strong support for
passing S. 2311 to reauthorize the Ryan White CARE Act.
I am proud to be a cosponsor of the House reauthorization (H.R. 4807)
that we passed by voice vote on July 27, 2000. I am equally proud to
stand in support of Senate bill 2311. I urge my colleagues to continue
their support for these amendments by voting for S. 2311, and help
ensure that those with AIDS will continue to receive the support and
resources they need.
Mr. Speaker, we all know the troubling statistics. Since its
inception, AIDS has claimed over 400,000 lives in the United States. An
estimated 900,000 Americans are living with HIV/AIDS today. Women
account for 30 percent of new infections. Over half of all new
infections occur in persons under 25. As the AIDS crisis has continued
year after year, it has become more and more difficult for anyone to
claim that AIDS is someone else's problem.
Since 1990, the CARE Act has helped establish a comprehensive,
community-based continuum of care for uninsured and under-insured
people living with HIV and AIDS, including access to primary medical
care, pharmaceuticals, and support services. The CARE Act provides
services to people who would not otherwise have access to care.
As a result of the CARE Act, many people with HIV and AIDS are
leading longer and healthier lives today.
Mr. Speaker, since my election to Congress, I have strongly supported
increases in funding for medical research. As the spouse of a
physician, I have a special affinity for those suffering from life-
threatening illnesses. I know some believe that government is the
problem and not the solution. But the truth is the opposite: in times
of great human suffering and injustice, our government has acted to
help our fellow citizens overcome life-threatening conditions and
situations. Federal aid for the Ryan White CARE Act is a prime example
of the good government can do in the face of tragedy and national
danger.
By passing S. 2311, we are making clear that the AIDS epidemic in the
United States will receive the attention and public health response it
deserves.
By passing S. 2311 today, Mr. Speaker, we will affirm our commitment
to people living with HIV/AIDS and their families. We will also be
affirming our dedication to sound public policy. By reauthorizing the
CARE Act, today, Mr. Speaker, we will give hope and a real chance for a
better life to thousands of HIV/AIDS victims.
Mr. DINGELL. Mr. Speaker, I rise today to express my strong support
for S. 2311, the Ryan White CARE Act Amendments of 2000. This is an
excellent bill and it deserves our immediate consideration and support.
I want to take particular note of the way in which this bill has been
developed. This bill comes to us by way of a remarkable bipartisan
effort led by my good friend and colleague Representative Waxman and
from the other side of the aisle, Representative Coburn. Given the
complexity of the Ryan White program and the potentially controversial
nature of the subject matter, the fact that we will pass a good bill at
this time of year with a strong bipartisan vote is a tribute to them.
Our colleagues in the other body have also worked hard on this bill
and are to be congratulated for their effort. Senators Jeffords,
Kennedy, and Frist have been solid partners in forging the legislation
before us today.
The CDC estimates that more than 900,000 persons in America are now
living with HIV. Approximately one-third of these persons know they are
infected and are receiving treatment. Another third know they are
infected, but are not receiving treatment. Another third does not know
they are infected. Another complication is that HIV infections are
occurring in every region of the country and in every kind of
situation. Underserved areas, such as rural areas, are having a
particularly difficult time because they lack the infrastructure of
proven prevention and treatment programs.
In brief, S. 2311 keeps those programs that have withstood the test
of time. Just as significantly, it makes changes where they were
needed. The four titles of the Ryan White CARE Act contain a variety of
grants and formulas that distribute funds at the state and local
levels. As we all know, changing programs of this kind is never easy.
In this case, we have successfully blended the need for change with the
need for continuity of care for those areas that have been especially
hard hit by the HIV/AIDS epidemic. On this point, let me note the great
work of our colleagues Representatives Eshoo, Towns and Pelosi. I note,
also, that a listing of all of the changes made to the Ryan White
program by this bill is set forth in the statement of managers that
will be included in the record of today's proceedings.
Finally, Mr. Speaker, I wish to acknowledge the work of ranking
member of the Health and Environment Subcommittee, Representative
Brown, and the Subcommittee Chairman, Representative Bilirakis. They
have forged a solid working relationship on a variety of bills that
have come before us this year and we are grateful for their hard work
and cooperation.
The SPEAKER pro tempore (Mr. Simpson). All time for debate has
expired.
Pursuant to House Resolution 611, the previous question is ordered on
the Senate bill, as amended.
The question is on the third reading of the Senate bill.
The Senate bill was ordered to be read a third time, and was read the
third time.
The SPEAKER pro tempore. The question is on the passage of the Senate
bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. BILIRAKIS. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The vote was taken by electronic device, and there were--yeas 411,
nays 0, not voting 22, as follows:

[Roll No. 512]

YEAS--411

Abercrombie
Ackerman
Aderholt
Allen
Andrews
Archer
Armey
Baca
Bachus
Baird
Baker
Baldacci
Baldwin
Ballenger
Barcia
Barr
Barrett (NE)
Barrett (WI)
Bartlett
Barton
Bass
Becerra
Bentsen
Bereuter
Berman
Berry
Biggert
Bilbray
Bilirakis
Bishop
Blagojevich
Bliley
Blumenauer
Blunt
Boehlert
Boehner
Bonilla
Bono
Borski
Boswell
Boucher
Boyd
Brady (PA)
Brady (TX)
Brown (FL)
Brown (OH)
Bryant
Burr
Burton
Buyer
Callahan
Calvert
Camp
Campbell
Canady
Cannon
Capps
Capuano
Cardin
Carson
Castle
Chabot
Chambliss
Chenoweth-Hage
Clayton
Clement
Clyburn
Coble
Coburn
Collins
Combest
Condit
Conyers
Cook
Cooksey
Costello
Cox
Coyne
Cramer
Crane
Crowley
Cubin
Cummings
Cunningham
Danner
Davis (FL)
Davis (IL)
Davis (VA)
Deal
DeFazio
DeGette
Delahunt
DeLauro
DeLay
DeMint
Deutsch
Diaz-Balart
Dickey
Dicks
Dingell
Dixon
Doggett
Dooley
Doolittle
Doyle
Dreier
Duncan
Dunn
Edwards
Ehlers
Ehrlich
Emerson
Engel
English
Etheridge
Evans
Everett
Ewing
Farr
Fattah
Filner
Fletcher
Foley
Forbes
Ford
Fossella
Fowler
Frank (MA)
Frelinghuysen
Frost
Gallegly
Ganske
Gejdenson
Gekas
Gibbons
Gilchrest
Gillmor
Gilman
Gonzalez
Goode
Goodlatte
Goodling
Gordon
Goss
Graham
Granger
Green (TX)
Green (WI)
Greenwood
Gutierrez
Gutknecht
Hall (OH)
Hall (TX)
Hansen
Hastings (FL)
Hastings (WA)
Hayes
Hayworth
Herger
Hill (IN)
Hill (MT)
Hilleary
Hilliard
Hinchey
Hinojosa

[[Page H8847]]

Hobson
Hoeffel
Hoekstra
Holden
Holt
Hooley
Horn
Hostettler
Houghton
Hoyer
Hulshof
Hunter
Hutchinson
Hyde
Inslee
Isakson
Istook
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Jenkins
John
Johnson (CT)
Johnson, E.B.
Johnson, Sam
Jones (NC)
Jones (OH)
Kanjorski
Kaptur
Kasich
Kelly
Kennedy
Kildee
Kilpatrick
Kind (WI)
Kingston
Kleczka
Knollenberg
Kolbe
Kucinich
Kuykendall
LaFalce
LaHood
Lampson
Lantos
Largent
Larson
Latham
LaTourette
Leach
Lee
Levin
Lewis (CA)
Lewis (GA)
Lewis (KY)
Linder
Lipinski
LoBiondo
Lofgren
Lowey
Lucas (KY)
Lucas (OK)
Luther
Maloney (NY)
Manzullo
Markey
Martinez
Mascara
Matsui
McCarthy (MO)
McCarthy (NY)
McCrery
McDermott
McGovern
McHugh
McInnis
McIntyre
McKeon
McKinney
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Metcalf
Mica
Millender-McDonald
Miller, Gary
Miller, George
Minge
Mink
Moakley
Mollohan
Moore
Moran (KS)
Moran (VA)
Morella
Myrick
Nadler
Napolitano
Neal
Nethercutt
Ney
Northup
Norwood
Nussle
Oberstar
Olver
Ortiz
Ose
Owens
Oxley
Packard
Pallone
Pascrell
Pastor
Payne
Pease
Pelosi
Peterson (MN)
Peterson (PA)
Petri
Phelps
Pickering
Pickett
Pitts
Pombo
Pomeroy
Porter
Portman
Price (NC)
Pryce (OH)
Quinn
Radanovich
Rahall
Ramstad
Regula
Reyes
Reynolds
Riley
Rivers
Rodriguez
Roemer
Rogan
Rogers
Rohrabacher
Ros-Lehtinen
Rothman
Roukema
Roybal-Allard
Royce
Rush
Ryan (WI)
Ryun (KS)
Sabo
Salmon
Sanchez
Sanders
Sandlin
Sanford
Sawyer
Saxton
Scarborough
Schaffer
Schakowsky
Scott
Sensenbrenner
Serrano
Sessions
Shadegg
Shaw
Shays
Sherman
Sherwood
Shimkus
Shows
Shuster
Simpson
Sisisky
Skeen
Skelton
Slaughter
Smith (MI)
Smith (NJ)
Smith (TX)
Smith (WA)
Snyder
Souder
Spence
Spratt
Stabenow
Stark
Stearns
Stenholm
Strickland
Stump
Stupak
Sununu
Talent
Tancredo
Tanner
Tauscher
Tauzin
Taylor (MS)
Taylor (NC)
Terry
Thomas
Thompson (CA)
Thompson (MS)
Thornberry
Thune
Thurman
Tiahrt
Tierney
Toomey
Towns
Traficant
Turner
Udall (CO)
Udall (NM)
Upton
Velazquez
Visclosky
Vitter
Walden
Walsh
Wamp
Waters
Watkins
Watt (NC)
Watts (OK)
Waxman
Weiner
Weldon (FL)
Weldon (PA)
Weller
Wexler
Weygand
Whitfield
Wicker
Wilson
Wolf
Woolsey
Wu
Wynn
Young (AK)

NOT VOTING--22

Berkley
Bonior
Clay
Eshoo
Franks (NJ)
Gephardt
Hefley
King (NY)
Klink
Lazio
Maloney (CT)
McCollum
McIntosh
Miller (FL)
Murtha
Obey
Paul
Rangel
Sweeney
Vento
Wise
Young (FL)

{time} 1151

So the Senate bill was passed.
The result of the vote was announced as above recorded.
The title of the Senate bill was amended so as to read: ``A bill 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.''.
A motion to reconsider was laid on the table.
Stated for:
Mr. MALONEY of Connecticut. Mr. Speaker, I was unavoidably detained
during rollcall vote No. 512. Had I been present I would have voted
``yes.''

____________________