[Congressional Record Volume 152, Number 135 (Friday, December 8, 2006)]
[House]
[Pages H9282-H9296]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
RYAN WHITE HIV/AIDS TREATMENT MODERNIZATION ACT OF 2006
Mr. BARTON of Texas. Mr. Speaker, I ask unanimous consent to take
from the Speaker's table the bill (H.R. 6143) to amend title XXVI of
the Public Health Service Act to revise and extend the program for
providing life-saving care for those with HIV/AIDS, with a Senate
amendment thereto, and concur in the Senate amendment.
The Clerk read the title of the bill.
The Clerk read the Senate amendment, as follows:
Senate amendment:
Strike out all after the enacting clause and insert:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Ryan White
HIV/AIDS Treatment Modernization Act of 2006''.
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS
Sec. 101. Establishment of program; general eligibility for grants.
Sec. 102. Type and distribution of grants; formula grants.
Sec. 103. Type and distribution of grants; supplemental grants.
Sec. 104. Timeframe for obligation and expenditure of grant funds.
Sec. 105. Use of amounts.
Sec. 106. Additional amendments to part A.
Sec. 107. New program in part A; transitional grants for certain areas
ineligible under section 2601.
Sec. 108. Authorization of appropriations for part A.
TITLE II--CARE GRANTS
Sec. 201. General use of grants.
Sec. 202. AIDS Drug Assistance Program.
Sec. 203. Distribution of funds.
Sec. 204. Additional amendments to subpart I of part B.
Sec. 205. Supplemental grants on basis of demonstrated need.
Sec. 206. Emerging communities.
Sec. 207. Timeframe for obligation and expenditure of grant funds.
Sec. 208. Authorization of appropriations for subpart I of part B.
Sec. 209. Early diagnosis grant program.
Sec. 210. Certain partner notification programs; authorization of
appropriations.
TITLE III--EARLY INTERVENTION SERVICES
Sec. 301. Establishment of program; core medical services.
Sec. 302. Eligible entities; preferences; planning and development
grants.
Sec. 303. Authorization of appropriations.
Sec. 304. Confidentiality and informed consent.
Sec. 305. Provision of certain counseling services.
Sec. 306. General provisions.
TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH
Sec. 401. Women, infants, children, and youth.
Sec. 402. GAO Report.
TITLE V--GENERAL PROVISIONS
Sec. 501. General provisions.
TITLE VI--DEMONSTRATION AND TRAINING
Sec. 601. Demonstration and training.
Sec. 602. AIDS education and training centers.
Sec. 603. Codification of minority AIDS initiative.
TITLE VII--MISCELLANEOUS PROVISIONS
Sec. 701. Hepatitis; use of funds.
Sec. 702. Certain references.
Sec. 703. Repeal.
TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS
SEC. 101. ESTABLISHMENT OF PROGRAM; GENERAL ELIGIBILITY FOR
GRANTS.
(a) In General.--Section 2601 of the Public Health Service
Act (42 U.S.C. 300ff-11) is amended by striking subsections
(b) through (d) and inserting the following:
``(b) Continued Status as Eligible Area.--Notwithstanding
any other provision of this section, a metropolitan area that
is an eligible area for a fiscal year continues to be an
eligible area until the metropolitan area fails, for three
consecutive fiscal years--
``(1) to meet the requirements of subsection (a); and
``(2) to have a cumulative total of 3,000 or more living
cases of AIDS (reported to and confirmed by the Director of
the Centers for Disease Control and Prevention) as of
December 31 of the most recent calendar year for which such
data is available.
``(c) Boundaries.--For purposes of determining eligibility
under this part--
``(1) with respect to a metropolitan area that received
funding under this part in fiscal year 2006, the boundaries
of such metropolitan area shall be the boundaries that were
in effect for such area for fiscal year 1994; or
``(2) with respect to a metropolitan area that becomes
eligible to receive funding under this part in any fiscal
year after fiscal year 2006, the boundaries of such
metropolitan area shall be the boundaries that are in effect
for such area when such area initially receives funding under
this part.''.
(b) Technical and Conforming Amendments.--Section 2601(a)
of the Public Health Service Act (42 U.S.C. 300ff-11(a)) is
amended--
(1) by striking ``through (d)'' and inserting ``through
(c)''; and
(2) by inserting ``and confirmed by'' after ``reported
to''.
(c) Definition of Metropolitan Area.--Section 2607(2) of
the Public Health Service Act (42 U.S.C. 300ff-17(2)) is
amended--
(1) by striking ``area referred'' and inserting ``area that
is referred''; and
(2) by inserting before the period the following: ``, and
that has a population of 50,000 or more individuals''.
SEC. 102. TYPE AND DISTRIBUTION OF GRANTS; FORMULA GRANTS.
(a) Distribution Percentages.--Section 2603(a)(2) of the
Public Health Service Act (42 U.S.C. 300ff-13(a)(2)) is
amended--
(1) in the first sentence--
(A) by striking ``50 percent of the amount appropriated
under section 2677'' and inserting ``66\2/3\ percent of the
amount made available under section 2610(b) for carrying out
this subpart''; and
(B) by striking ``paragraph (3)'' and inserting
``paragraphs (3) and (4)''.
(2) by striking the last sentence.
(b) Distribution Based on Living Cases of HIV/AIDS.--
Section 2603(a)(3) of the Public Health Service Act (42
U.S.C. 300ff-13(a)(3)) is amended--
(1) in subparagraph (B), by striking ``estimated living
cases of acquired immune deficiency syndrome'' and inserting
``living cases of HIV/AIDS (reported to and confirmed by the
Director of the Centers for Disease Control and
Prevention)''; and
(2) by striking subparagraphs (C) through (E) and inserting
the following:
``(C) Living cases of hiv/aids.--
``(i) Requirement of names-based reporting.--Except as
provided in clause (ii), the number determined under this
subparagraph for an eligible area for a fiscal year for
purposes of subparagraph (B) is the number of living names-
based cases of HIV/AIDS that, as of December 31 of the most
recent calendar year for which such data is available, have
been reported to and confirmed by the Director of the Centers
for Disease Control and Prevention.
``(ii) Transition period; exemption regarding non-aids
cases.--For each of the fiscal years 2007 through 2009, an
eligible area is, subject to clauses (iii) through (v),
exempt from the requirement under clause (i) that living
names-based non-AIDS cases of HIV be reported unless--
``(I) a system was in operation as of December 31, 2005,
that provides sufficiently accurate and reliable names-based
reporting of such cases throughout the State in which the
area is located, subject to clause (viii); or
``(II) no later than the beginning of fiscal year 2008 or
2009, the Secretary, in consultation with the chief executive
of the State in which the area is located, determines that a
system has become operational in the State that provides
sufficiently accurate and reliable names-based reporting of
such cases throughout the State.
``(iii) Requirements for exemption for fiscal year 2007.--
For fiscal year 2007, an exemption under clause (ii) for an
eligible area applies only if, by October 1, 2006--
``(I)(aa) the State in which the area is located had
submitted to the Secretary a plan for making the transition
to sufficiently accurate and reliable names-based reporting
of living non-AIDS cases of HIV; or
``(bb) all statutory changes necessary to provide for
sufficiently accurate and reliable reporting of such cases
had been made; and
``(II) the State had agreed that, by April 1, 2008, the
State will begin accurate and reliable names-based reporting
of such cases, except that such agreement is not required to
provide that, as of such date, the system for such reporting
be fully sufficient with respect to accuracy and reliability
throughout the area.
``(iv) Requirement for exemption as of fiscal year 2008.--
For each of the fiscal years 2008 through 2010, an exemption
under clause (ii) for an eligible area applies only if, as of
April 1, 2008, the State in which the area is located is
substantially in compliance with the agreement under clause
(iii)(II).
``(v) Progress toward names-based reporting.--For fiscal
year 2009, the Secretary may
[[Page H9283]]
terminate an exemption under clause (ii) for an eligible area
if the State in which the area is located submitted a plan
under clause (iii)(I)(aa) and the Secretary determines that
the State is not substantially following the plan.
``(vi) Counting of cases in areas with exemptions.--
``(I) In general.--With respect to an eligible area that is
under a reporting system for living non-AIDS cases of HIV
that is not names-based (referred to in this subparagraph as
`code-based reporting'), the Secretary shall, for purposes of
this subparagraph, modify the number of such cases reported
for the eligible area in order to adjust for duplicative
reporting in and among systems that use code-based reporting.
``(II) Adjustment rate.--The adjustment rate under
subclause (I) for an eligible area shall be a reduction of 5
percent in the number of living non-AIDS cases of HIV
reported for the area.
``(vii) Multiple political jurisdictions.--With respect to
living non-AIDS cases of HIV, if an eligible area is not
entirely within one political jurisdiction and as a result is
subject to more than one reporting system for purposes of
this subparagraph:
``(I) Names-based reporting under clause (i) applies in a
jurisdictional portion of the area, or an exemption under
clause (ii) applies in such portion (subject to applicable
provisions of this subparagraph), according to whether names-
based reporting or code-based reporting is used in such
portion.
``(II) If under subclause (I) both names-based reporting
and code-based reporting apply in the area, the number of
code-based cases shall be reduced under clause (vi).
``(viii) List of eligible areas meeting standard regarding
December 31, 2005.--
``(I) In general.--If an eligible area or portion thereof
is in a State specified in subclause (II), the eligible area
or portion shall be considered to meet the standard described
in clause (ii)(I). No other eligible area or portion thereof
may be considered to meet such standard.
``(II) Relevant states.--For purposes of subclause (I), the
States specified in this subclause are the following: Alaska,
Alabama, Arkansas, Arizona, Colorado, Florida, Indiana, Iowa,
Idaho, Kansas, Louisiana, Michigan, Minnesota, Missouri,
Mississippi, North Carolina, North Dakota, Nebraska, New
Jersey, New Mexico, New York, Nevada, Ohio, Oklahoma, South
Carolina, South Dakota, Tennessee, Texas, Utah, Virginia,
Wisconsin, West Virginia, Wyoming, Guam, and the Virgin
Islands.
``(ix) Rules of construction regarding acceptance of
reports.--
``(I) Cases of aids.--With respect to an eligible area that
is subject to the requirement under clause (i) and is not in
compliance with the requirement for names-based reporting of
living non-AIDS cases of HIV, the Secretary shall,
notwithstanding such noncompliance, accept reports of living
cases of AIDS that are in accordance with such clause.
``(II) Applicability of exemption requirements.--The
provisions of clauses (ii) through (viii) may not be
construed as having any legal effect for fiscal year 2010 or
any subsequent fiscal year, and accordingly, the status of a
State for purposes of such clauses may not be considered
after fiscal year 2009.
``(x) Program for detecting inaccurate or fraudulent
counting.--The Secretary shall carry out a program to monitor
the reporting of names-based cases for purposes of this
subparagraph and to detect instances of inaccurate reporting,
including fraudulent reporting.''.
(c) Code-Based Areas; Limitation on Increase in Grant.--
Section 2603(a)(3) of the Public Health Service Act (42
U.S.C. 300ff-13(a)), as amended by subsection (b)(2) of this
section, is amended by adding at the end the following
subparagraph:
``(D) Code-based areas; limitation on increase in grant .--
``(i) In general.--For each of the fiscal years 2007
through 2009, if code-based reporting (within the meaning of
subparagraph (C)(vi)) applies in an eligible area or any
portion thereof as of the beginning of the fiscal year
involved, then notwithstanding any other provision of this
paragraph, the amount of the grant pursuant to this paragraph
for such area for such fiscal year may not--
``(I) for fiscal year 2007, exceed by more than 5 percent
the amount of the grant for the area that would have been
made pursuant to this paragraph and paragraph (4) for fiscal
year 2006 (as such paragraphs were in effect for such fiscal
year) if paragraph (2) (as so in effect) had been applied by
substituting `66\2/3\ percent' for `50 percent'; and
``(II) for each of the fiscal years 2008 and 2009, exceed
by more than 5 percent the amount of the grant pursuant to
this paragraph and paragraph (4) for the area for the
preceding fiscal year.
``(ii) Use of amounts involved.--For each of the fiscal
years 2007 through 2009, amounts available as a result of the
limitation under clause (i) shall be made available by the
Secretary as additional amounts for grants pursuant to
subsection (b) for the fiscal year involved, subject to
paragraph (4) and section 2610(d)(2).''.
(d) Hold Harmless.--Section 2603(a) of the Public Health
Service Act (42 U.S.C. 300ff-13(a)) is amended--
(1) in paragraph (3)(A)--
(A) in clause (ii), by striking the period at the end and
inserting a semicolon; and
(B) by inserting after and below clause (ii) the following:
``which product shall then, as applicable, be increased under
paragraph (4).''.
(2) by amending paragraph (4) to read as follows:
``(4) Increases in grant.--
``(A) In general.--For each eligible area that received a
grant pursuant to this subsection for fiscal year 2006, the
Secretary shall, for each of the fiscal years 2007 through
2009, increase the amount of the grant made pursuant to
paragraph (3) for the area to ensure that the amount of the
grant for the fiscal year involved is not less than the
following amount, as applicable to such fiscal year:
``(i) For fiscal year 2007, an amount equal to 95 percent
of the amount of the grant that would have been made pursuant
to paragraph (3) and this paragraph for fiscal year 2006 (as
such paragraphs were in effect for such fiscal year) if
paragraph (2) (as so in effect) had been applied by
substituting `66\2/3\ percent' for `50 percent'.
``(ii) For each of the fiscal years 2008 and 2009, an
amount equal to 100 percent of the amount of the grant made
pursuant to paragraph (3) and this paragraph for fiscal year
2007.
``(B) Source of funds for increase.--
``(i) In general.--From the amounts available for carrying
out the single program referred to in section 2609(d)(2)(C)
for a fiscal year (relating to supplemental grants), the
Secretary shall make available such amounts as may be
necessary to comply with subparagraph (A), subject to section
2610(d)(2).
``(ii) Pro rata reduction.--If the amounts referred to in
clause (i) for a fiscal year are insufficient to fully comply
with subparagraph (A) for the year, the Secretary, in order
to provide the additional funds necessary for such
compliance, shall reduce on a pro rata basis the amount of
each grant pursuant to this subsection for the fiscal year,
other than grants for eligible areas for which increases
under subparagraph (A) apply. A reduction under the preceding
sentence may not be made in an amount that would result in
the eligible area involved becoming eligible for such an
increase.
``(C) Limitation.--This paragraph may not be construed as
having any applicability after fiscal year 2009.''.
SEC. 103. TYPE AND DISTRIBUTION OF GRANTS; SUPPLEMENTAL
GRANTS.
Section 2603(b) of the Public Health Service Act (42 U.S.C.
300ff-13(b)) is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by striking
``Not later than'' and all that follows through ``the
Secretary shall'' and inserting the following: ``Subject to
subsection (a)(4)(B)(i) and section 2610(d), the Secretary
shall'';
(B) in subparagraph (B), by striking ``demonstrates the
severe need in such area'' and inserting ``demonstrates the
need in such area, on an objective and quantified basis,'';
(C) by striking subparagraph (F) and inserting the
following:
``(F) demonstrates the inclusiveness of affected
communities and individuals with HIV/AIDS;'';
(D) in subparagraph (G), by striking the period and
inserting ``; and''; and
(E) by adding at the end the following:
``(H) demonstrates the ability of the applicant to expend
funds efficiently by not having had, for the most recent
grant year under subsection (a) for which data is available,
more than 2 percent of grant funds under such subsection
canceled or covered by any waivers under subsection
(c)(3).''; and
(2) in paragraph (2)--
(A) in subparagraph (A), by striking ``severe need'' and
inserting ``demonstrated need'';
(B) by striking subparagraph (B) and inserting the
following:
``(B) Demonstrated need.--The factors considered by the
Secretary in determining whether an eligible area has a
demonstrated need for purposes of paragraph (1)(B) may
include any or all of the following:
``(i) The unmet need for such services, as determined under
section 2602(b)(4) or other community input process as
defined under section 2609(d)(1)(A).
``(ii) An increasing need for HIV/AIDS-related services,
including relative rates of increase in the number of cases
of HIV/AIDS.
``(iii) The relative rates of increase in the number of
cases of HIV/AIDS within new or emerging subpopulations.
``(iv) The current prevalence of HIV/AIDS.
``(v) Relevant factors related to the cost and complexity
of delivering health care to individuals with HIV/AIDS in the
eligible area.
``(vi) The impact of co-morbid factors, including co-
occurring conditions, determined relevant by the Secretary.
``(vii) The prevalence of homelessness.
``(viii) The prevalence of individuals described under
section 2602(b)(2)(M).
``(ix) The relevant factors that limit access to health
care, including geographic variation, adequacy of health
insurance coverage, and language barriers.
``(x) The impact of a decline in the amount received
pursuant to subsection (a) on services available to all
individuals with HIV/AIDS identified and eligible under this
title.''; and
(C) by striking subparagraphs (C) and (D) and inserting the
following:
``(C) Priority in making grants.--The Secretary shall
provide funds under this subsection to an eligible area to
address the decline or disruption of all EMA-provided
services related to the decline in the amounts received
pursuant to subsection (a) consistent with the grant award
for the eligible area for fiscal year 2006, to the extent
that the factor under subparagraph (B)(x) (relating to a
decline in funding) applies to the eligible area.''.
SEC. 104. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT
FUNDS.
Section 2603 of the Public Health Service Act (42 U.S.C.
300ff-13) is amended--
(1) by redesignating subsection (c) as subsection (d);
(2) by inserting after subsection (b) the following:
[[Page H9284]]
``(c) Timeframe for Obligation and Expenditure of Grant
Funds.--
``(1) Obligation by end of grant year.--Effective for
fiscal year 2007 and subsequent fiscal years, funds from a
grant award made pursuant to subsection (a) or (b) for a
fiscal year are available for obligation by the eligible area
involved through the end of the one-year period beginning on
the date in such fiscal year on which funds from the award
first become available to the area (referred to in this
subsection as the `grant year for the award'), except as
provided in paragraph (3)(A).
``(2) Supplemental grants; cancellation of unobligated
balance of grant award.--Effective for fiscal year 2007 and
subsequent fiscal years, if a grant award made pursuant to
subsection (b) for an eligible area for a fiscal year has an
unobligated balance as of the end of the grant year for the
award--
``(A) the Secretary shall cancel that unobligated balance
of the award, and shall require the eligible area to return
any amounts from such balance that have been disbursed to the
area; and
``(B) the funds involved shall be made available by the
Secretary as additional amounts for grants pursuant to
subsection (b) for the first fiscal year beginning after the
fiscal year in which the Secretary obtains the information
necessary for determining that the balance is required under
subparagraph (A) to be canceled, except that the availability
of the funds for such grants is subject to subsection (a)(4)
and section 2610(d)(2) as applied for such year.
``(3) Formula grants; cancellation of unobligated balance
of grant award; waiver permitting carryover.--
``(A) In general.--Effective for fiscal year 2007 and
subsequent fiscal years, if a grant award made pursuant to
subsection (a) for an eligible area for a fiscal year has an
unobligated balance as of the end of the grant year for the
award, the Secretary shall cancel that unobligated balance of
the award, and shall require the eligible area to return any
amounts from such balance that have been disbursed to the
area, unless--
``(i) before the end of the grant year, the chief elected
official of the area submits to the Secretary a written
application for a waiver of the cancellation, which
application includes a description of the purposes for which
the area intends to expend the funds involved; and
``(ii) the Secretary approves the waiver.
``(B) Expenditure by end of carryover year.--With respect
to a waiver under subparagraph (A) that is approved for a
balance that is unobligated as of the end of a grant year for
an award:
``(i) The unobligated funds are available for expenditure
by the eligible area involved for the one-year period
beginning upon the expiration of the grant year (referred to
in this subsection as the `carryover year').
``(ii) If the funds are not expended by the end of the
carryover year, the Secretary shall cancel that unexpended
balance of the award, and shall require the eligible area to
return any amounts from such balance that have been disbursed
to the area.
``(C) Use of cancelled balances.--In the case of any
balance of a grant award that is cancelled under subparagraph
(A) or (B)(ii), the grant funds involved shall be made
available by the Secretary as additional amounts for grants
pursuant to subsection (b) for the first fiscal year
beginning after the fiscal year in which the Secretary
obtains the information necessary for determining that the
balance is required under such subparagraph to be canceled,
except that the availability of the funds for such grants is
subject to subsection (a)(4) and section 2610(d)(2) as
applied for such year.
``(D) Corresponding reduction in future grant.--
``(i) In general.--In the case of an eligible area for
which a balance from a grant award under subsection (a) is
unobligated as of the end of the grant year for the award--
``(I) the Secretary shall reduce, by the same amount as
such unobligated balance, the amount of the grant under such
subsection for the first fiscal year beginning after the
fiscal year in which the Secretary obtains the information
necessary for determining that such balance was unobligated
as of the end of the grant year (which requirement for a
reduction applies without regard to whether a waiver under
subparagraph (A) has been approved with respect to such
balance); and
``(II) the grant funds involved in such reduction shall be
made available by the Secretary as additional funds for
grants pursuant to subsection (b) for such first fiscal year,
subject to subsection (a)(4) and section 2610(d)(2);
except that this clause does not apply to the eligible area
if the amount of the unobligated balance was 2 percent or
less.
``(ii) Relation to increases in grant.--A reduction under
clause (i) for an eligible area for a fiscal year may not be
taken into account in applying subsection (a)(4) with respect
to the area for the subsequent fiscal year.''; and
(3) by adding at the end the following:
``(e) Report on the Awarding of Supplemental Funds.--Not
later than 45 days after the awarding of supplemental funds
under this section, the Secretary shall submit to Congress a
report concerning such funds. Such report shall include
information detailing--
``(1) the total amount of supplemental funds available
under this section for the year involved;
``(2) the amount of supplemental funds used in accordance
with the hold harmless provisions of subsection (a)(4);
``(3) the amount of supplemental funds disbursed pursuant
to subsection (b)(2)(C);
``(4) the disbursement of the remainder of the supplemental
funds after taking into account the uses described in
paragraphs (2) and (3); and
``(5) the rationale used for the amount of funds disbursed
as described under paragraphs (2), (3), and (4).''.
SEC. 105. USE OF AMOUNTS.
Section 2604 of the Public Health Service Act (42 U.S.C.
300ff-14) is amended to read as follows:
``SEC. 2604. USE OF AMOUNTS.
``(a) Requirements.--The Secretary may not make a grant
under section 2601(a) to the chief elected official of an
eligible area unless such political subdivision agrees that--
``(1) subject to paragraph (2), the allocation of funds and
services within the eligible area will be made in accordance
with the priorities established, pursuant to section
2602(b)(4)(C), by the HIV health services planning council
that serves such eligible area;
``(2) funds provided under section 2601 will be expended
only for--
``(A) core medical services described in subsection (c);
``(B) support services described in subsection (d); and
``(C) administrative expenses described in subsection (h);
and
``(3) the use of such funds will comply with the
requirements of this section.
``(b) Direct Financial Assistance to Appropriate
Entities.--
``(1) In general.--The chief elected official of an
eligible area shall use amounts from a grant under section
2601 to provide direct financial assistance to entities
described in paragraph (2) for the purpose of providing core
medical services and support services.
``(2) Appropriate entities.--Direct financial assistance
may be provided under paragraph (1) to public or nonprofit
private entities, or private for-profit entities if such
entities are the only available provider of quality HIV care
in the area.
``(c) Required Funding for Core Medical Services.--
``(1) In general.--With respect to a grant under section
2601 for an eligible area for a grant year, the chief elected
official of the area shall, of the portion of the grant
remaining after reserving amounts for purposes of paragraphs
(1) and (5)(B)(i) of subsection (h), use not less than 75
percent to provide core medical services that are needed in
the eligible area for individuals with HIV/AIDS who are
identified and eligible under this title (including services
regarding the co-occurring conditions of the individuals).
``(2) Waiver.--
``(A) In general.--The Secretary shall waive the
application of paragraph (1) with respect to a chief elected
official for a grant year if the Secretary determines that,
within the eligible area involved--
``(i) there are no waiting lists for AIDS Drug Assistance
Program services under section 2616; and
``(ii) core medical services are available to all
individuals with HIV/AIDS identified and eligible under this
title.
``(B) Notification of waiver status.--When informing the
chief elected official of an eligible area that a grant under
section 2601 is being made for the area for a grant year, the
Secretary shall inform the official whether a waiver under
subparagraph (A) is in effect for such year.
``(3) Core medical services.--For purposes of this
subsection, the term `core medical services', with respect to
an individual with HIV/AIDS (including the co-occurring
conditions of the individual), means the following services:
``(A) Outpatient and ambulatory health services.
``(B) AIDS Drug Assistance Program treatments in accordance
with section 2616.
``(C) AIDS pharmaceutical assistance.
``(D) Oral health care.
``(E) Early intervention services described in subsection
(e).
``(F) Health insurance premium and cost sharing assistance
for low-income individuals in accordance with section 2615.
``(G) Home health care.
``(H) Medical nutrition therapy.
``(I) Hospice services.
``(J) Home and community-based health services as defined
under section 2614(c).
``(K) Mental health services.
``(L) Substance abuse outpatient care.
``(M) Medical case management, including treatment
adherence services.
``(d) Support Services.--
``(1) In general.--For purposes of this section, the term
`support services' means services, subject to the approval of
the Secretary, that are needed for individuals with HIV/AIDS
to achieve their medical outcomes (such as respite care for
persons caring for individuals with HIV/AIDS, outreach
services, medical transportation, linguistic services, and
referrals for health care and support services).
``(2) Medical outcomes.--In this subsection, the term
`medical outcomes' means those outcomes affecting the HIV-
related clinical status of an individual with HIV/AIDS.
``(e) Early Intervention Services.--
``(1) In general.--For purposes of this section, the term
`early intervention services' means HIV/AIDS early
intervention services described in section 2651(e), 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/AIDS counseling and testing
sites, health care points of entry specified by eligible
[[Page H9285]]
areas, 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 shall apply only if the entity demonstrates to
the satisfaction of the chief elected official for the
eligible area 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.
``(f) Priority for Women, Infants, Children, and Youth.--
``(1) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with
HIV/AIDS, 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 HIV/AIDS to the general population in such
area of individuals with HIV/AIDS.
``(2) Waiver.--With respect to the population involved, the
Secretary may provide to the chief elected official of an
eligible area a waiver of the requirement of paragraph (1) 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.
``(g) Requirement of Status as Medicaid Provider.--
``(1) Provision of service.--Subject to paragraph (2), the
Secretary may not make a grant under section 2601(a) for the
provision of services under this section in a State unless,
in the case of any such service that is available pursuant to
the State plan approved under title XIX of the Social
Security Act for the State--
``(A) the political subdivision involved will provide the
service directly, and the political subdivision has entered
into a participation agreement under the State plan and is
qualified to receive payments under such plan; or
``(B) the political subdivision will enter into an
agreement with a public or nonprofit private entity under
which the entity will provide the service, and the entity has
entered into such a participation agreement and is qualified
to receive such payments.
``(2) Waiver.--
``(A) In general.--In the case of an entity making an
agreement pursuant to paragraph (1)(B) regarding the
provision of services, the requirement established in such
paragraph shall be waived by the HIV health services planning
council for the eligible area if the entity does not, in
providing health care services, impose a charge or accept
reimbursement available from any third-party payor, including
reimbursement under any insurance policy or under any Federal
or State health benefits program.
``(B) Determination.--A determination by the HIV health
services planning council of whether an entity referred to in
subparagraph (A) meets the criteria for a waiver under such
subparagraph shall be made without regard to whether the
entity accepts voluntary donations for the purpose of
providing services to the public.
``(h) Administration.--
``(1) Limitation.--The chief elected official of an
eligible area shall not use in excess of 10 percent of
amounts received under a grant under this part for
administrative expenses.
``(2) Allocations by chief elected official.--In the case
of entities and subcontractors to which the chief elected
official of an eligible area allocates amounts received by
the official under a grant under this part, the official
shall ensure that, of the aggregate amount so allocated, the
total of the expenditures by such entities for administrative
expenses does not exceed 10 percent (without regard to
whether particular entities expend more than 10 percent for
such expenses).
``(3) Administrative activities.--For purposes of paragraph
(1), amounts may be used for administrative activities that
include--
``(A) routine grant administration and monitoring
activities, including the development of applications for
part A funds, the receipt and disbursal of program funds, the
development and establishment of reimbursement and accounting
systems, the development of a clinical quality management
program as described in paragraph (5), the preparation of
routine programmatic and financial reports, and compliance
with grant conditions and audit requirements; and
``(B) all activities associated with the grantee's contract
award procedures, including the activities carried out by the
HIV health services planning council as established under
section 2602(b), the development of requests for proposals,
contract proposal review activities, negotiation and awarding
of contracts, monitoring of contracts through telephone
consultation, written documentation or onsite visits,
reporting on contracts, and funding reallocation activities.
``(4) Subcontractor administrative activities.--For the
purposes of this subsection, subcontractor administrative
activities include--
``(A) usual and recognized overhead activities, including
established indirect rates for agencies;
``(B) management oversight of specific programs funded
under this title; and
``(C) other types of program support such as quality
assurance, quality control, and related activities.
``(5) Clinical quality management.--
``(A) Requirement.--The chief elected official of an
eligible area that receives a grant under this part shall
provide for the establishment of a clinical quality
management program to assess the extent to which HIV health
services provided to patients under the grant are consistent
with the most recent Public Health Service guidelines for the
treatment of HIV/AIDS and related opportunistic infection,
and as applicable, to develop strategies for ensuring that
such services are consistent with the guidelines for
improvement in the access to and quality of HIV health
services.
``(B) Use of funds.--
``(i) In general.--From amounts received under a grant
awarded under this subpart for a fiscal year, the chief
elected official of an eligible area may use for activities
associated with the clinical quality management program
required in subparagraph (A) not to exceed the lesser of--
``(I) 5 percent of amounts received under the grant; or
``(II) $3,000,000.
``(ii) Relation to limitation on administrative expenses.--
The costs of a clinical quality management program under
subparagraph (A) may not be considered administrative
expenses for purposes of the limitation established in
paragraph (1).
``(i) Construction.--A chief elected official may not use
amounts received under a grant awarded under this part to
purchase or improve land, or to purchase, construct, or
permanently improve (other than minor remodeling) any
building or other facility, or to make cash payments to
intended recipients of services.''.
SEC. 106. ADDITIONAL AMENDMENTS TO PART A.
(a) Reporting of Cases.--Section 2601(a) of the Public
Health Service Act (42 U.S.C. 300ff-11(a)) is amended by
striking ``for the most recent period'' and inserting
``during the most recent period''.
(b) Planning Council Representation.--Section 2602(b)(2)(G)
of the Public Health Service Act (42 U.S.C. 300ff-
12(b)(2)(G)) is amended by inserting ``, members of a
Federally recognized Indian tribe as represented in the
population, individuals co-infected with hepatitis B or C''
after ``disease''.
(c) Application for Grant.--
(1) Payer of last resort.--Section 2605(a)(6)(A) of the
Public Health Service Act (42 U.S.C. 300ff-15(a)(6)(A)) is
amended by inserting ``(except for a program administered by
or providing the services of the Indian Health Service)''
before the semicolon.
(2) Audits.--Section 2605(a) of the Public Health Service
Act (42 U.S.C. 300ff-15(a)) is amended--
(A) in paragraph (8), by striking ``and'' at the end;
(B) in paragraph (9), by striking the period and inserting
``; and''; and
(C) by adding at the end the following:
``(10) that the chief elected official will submit to the
lead State agency under section 2617(b)(4), audits,
consistent with Office of Management and Budget circular
A133, regarding funds expended in accordance with this part
every 2 years and shall include necessary client-based data
to compile unmet need calculations and Statewide coordinated
statements of need process.''.
(3) Coordination.--Section 2605(b) of the Public Health
Service Act (42 U.S.C. 300ff-15(b)) is amended--
(A) in paragraph (3), by striking ``and'' at the end;
(B) in paragraph (4), by striking the period and inserting
a semicolon; and
(C) by adding at the end the following:
``(5) the manner in which the expected expenditures are
related to the planning process for States that receive
funding under part B (including the planning process
described in section 2617(b)); and
``(6) the expected expenditures and how those expenditures
will improve overall client outcomes, as described under the
State plan under section 2617(b), and through additional
outcomes measures as identified by the HIV health services
planning council under section 2602(b).''.
SEC. 107. NEW PROGRAM IN PART A; TRANSITIONAL GRANTS FOR
CERTAIN AREAS INELIGIBLE UNDER SECTION 2601.
(a) In General.--Part A of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-11) is amended--
(1) by inserting after the part heading the following:
``Subpart I--General Grant Provisions''; and
(2) by adding at the end the following:
``Subpart II--Transitional Grants
``SEC. 2609. ESTABLISHMENT OF PROGRAM.
``(a) In General.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall make grants for the purpose of
providing services described in section 2604 in transitional
areas, subject to the same provisions regarding the
allocation of grant funds as apply under subsection (c) of
such section.
``(b) Transitional Areas.--For purposes of this section,
the term `transitional area' means, subject to subsection
(c), a metropolitan area for which there has been reported to
and confirmed by the Director of the Centers for Disease
Control and Prevention a cumulative total of at least 1,000,
but fewer than 2,000, cases of AIDS during the most recent
period of 5 calendar years for which such data are available.
``(c) Certain Eligibility Rules.--
``(1) Fiscal year 2007.--With respect to grants under
subsection (a) for fiscal year 2007, a metropolitan area that
received funding under subpart I for fiscal year 2006 but
does not for fiscal
[[Page H9286]]
year 2007 qualify under such subpart as an eligible area and
does not qualify under subsection (b) as a transitional area
shall, notwithstanding subsection (b), be considered a
transitional area.
``(2) Continued status as transitional area.--
``(A) In general.--Notwithstanding subsection (b), a
metropolitan area that is a transitional area for a fiscal
year continues, except as provided in subparagraph (B), to be
a transitional area until the metropolitan area fails, for
three consecutive fiscal years--
``(i) to qualify under such subsection as a transitional
area; and
``(ii) to have a cumulative total of 1,500 or more living
cases of AIDS (reported to and confirmed by the Director of
the Centers for Disease Control and Prevention) as of
December 31 of the most recent calendar year for which such
data is available.
``(B) Exception regarding status as eligible area.--
Subparagraph (A) does not apply for a fiscal year if the
metropolitan area involved qualifies under subpart I as an
eligible area.
``(d) Application of Certain Provisions of Subpart I.--
``(1) Administration; planning council.--
``(A) In general.--The provisions of section 2602 apply
with respect to a grant under subsection (a) for a
transitional area to the same extent and in the same manner
as such provisions apply with respect to a grant under
subpart I for an eligible area, except that, subject to
subparagraph (B), the chief elected official of the
transitional area may elect not to comply with the provisions
of section 2602(b) if the official provides documentation to
the Secretary that details the process used to obtain
community input (particularly from those with HIV) in the
transitional area for formulating the overall plan for
priority setting and allocating funds from the grant under
subsection (a).
``(B) Exception.--For each of the fiscal years 2007 through
2009, the exception described in subparagraph (A) does not
apply if the transitional area involved received funding
under subpart I for fiscal year 2006.
``(2) Type and distribution of grants; timeframe for
obligation and expenditure of grant funds.--
``(A) Formula grants; supplemental grants.--The provisions
of section 2603 apply with respect to grants under subsection
(a) to the same extent and in the same manner as such
provisions apply with respect to grants under subpart I,
subject to subparagraphs (B) and (C).
``(B) Formula grants; increase in grant.--For purposes of
subparagraph (A), section 2603(a)(4) does not apply.
``(C) Supplemental grants; single program with subpart i
program.--With respect to section 2603(b) as applied for
purposes of subparagraph (A):
``(i) The Secretary shall combine amounts available
pursuant to such subparagraph with amounts available for
carrying out section 2603(b) and shall administer the two
programs as a single program.
``(ii) In the single program, the Secretary has discretion
in allocating amounts between eligible areas under subpart I
and transitional areas under this section, subject to the
eligibility criteria that apply under such section, and
subject to section 2603(b)(2)(C) (relating to priority in
making grants).
``(iii) Pursuant to section 2603(b)(1), amounts for the
single program are subject to use under sections 2603(a)(4)
and 2610(d)(1).
``(3) Application; technical assistance; definitions.--The
provisions of sections 2605, 2606, and 2607 apply with
respect to grants under subsection (a) to the same extent and
in the same manner as such provisions apply with respect to
grants under subpart I.''.
(b) Conforming Amendments.--Subpart I of part A of title
XXVI of the Public Health Service Act, as designated by
subsection (a)(1) of this section, is amended by striking
``this part'' each place such term appears and inserting
``this subpart''.
SEC. 108. AUTHORIZATION OF APPROPRIATIONS FOR PART A.
Part A of title XXVI of the Public Health Service Act, as
amended by section 106(a), is amended by adding at the end
the following:
``Subpart III--General Provisions
``SEC. 2610. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--For the purpose of carrying out this
part, there are authorized to be appropriated $604,000,000
for fiscal year 2007, $626,300,000 for fiscal year 2008, and
$649,500,000 for fiscal year 2009. Amounts appropriated under
the preceding sentence for a fiscal year are available for
obligation by the Secretary until the end of the second
succeeding fiscal year.
``(b) Reservation of Amounts.--
``(1) Fiscal year 2007.--Of the amount appropriated under
subsection (a) for fiscal year 2007, the Secretary shall
reserve--
``(A) $458,310,000 for grants under subpart I; and
``(B) $145,690,000 for grants under section 2609.
``(2) Subsequent fiscal years.--Of the amount appropriated
under subsection (a) for fiscal year 2008 and each subsequent
fiscal year--
``(A) the Secretary shall reserve an amount for grants
under subpart I; and
``(B) the Secretary shall reserve an amount for grants
under section 2609.
``(c) Transfer of Certain Amounts; Change in Status as
Eligible Area or Transitional Area.--Notwithstanding
subsection (b):
``(1) If a metropolitan area is an eligible area under
subpart I for a fiscal year, but for a subsequent fiscal year
ceases to be an eligible area by reason of section 2601(b)--
``(A)(i) the amount reserved under paragraph (1)(A) or
(2)(A) of subsection (b) of this section for the first such
subsequent year of not being an eligible area is deemed to be
reduced by an amount equal to the amount of the grant made
pursuant to section 2603(a) for the metropolitan area for the
preceding fiscal year; and
``(ii)(I) if the metropolitan area qualifies for such first
subsequent fiscal year as a transitional area under 2609, the
amount reserved under paragraph (1)(B) or (2)(B) of
subsection (b) for such fiscal year is deemed to be increased
by an amount equal to the amount of the reduction under
subparagraph (A) for such year; or
``(II) if the metropolitan area does not qualify for such
first subsequent fiscal year as a transitional area under
2609, an amount equal to the amount of such reduction is,
notwithstanding subsection (a), transferred and made
available for grants pursuant to section 2618(a)(1), in
addition to amounts available for such grants under section
2623; and
``(B) if a transfer under subparagraph (A)(ii)(II) is made
with respect to the metropolitan area for such first
subsequent fiscal year, then--
``(i) the amount reserved under paragraph (1)(A) or (2)(A)
of subsection (b) of this section for such year is deemed to
be reduced by an additional $500,000; and
``(ii) an amount equal to the amount of such additional
reduction is, notwithstanding subsection (a), transferred and
made available for grants pursuant to section 2618(a)(1), in
addition to amounts available for such grants under section
2623.
``(2) If a metropolitan area is a transitional area under
section 2609 for a fiscal year, but for a subsequent fiscal
year ceases to be a transitional area by reason of section
2609(c)(2) (and does not qualify for such subsequent fiscal
year as an eligible area under subpart I)--
``(A) the amount reserved under subsection (b)(2)(B) of
this section for the first such subsequent fiscal year of not
being a transitional area is deemed to be reduced by an
amount equal to the total of--
``(i) the amount of the grant that, pursuant to section
2603(a), was made under section 2609(d)(2)(A) for the
metropolitan area for the preceding fiscal year; and
``(ii) $500,000; and
``(B) an amount equal to the amount of the reduction under
subparagraph (A) for such year is, notwithstanding subsection
(a), transferred and made available for grants pursuant to
section 2618(a)(1), in addition to amounts available for such
grants under section 2623.
``(3) If a metropolitan area is a transitional area under
section 2609 for a fiscal year, but for a subsequent fiscal
year qualifies as an eligible area under subpart I--
``(A) the amount reserved under subsection (b)(2)(B) of
this section for the first such subsequent fiscal year of
becoming an eligible area is deemed to be reduced by an
amount equal to the amount of the grant that, pursuant to
section 2603(a), was made under section 2609(d)(2)(A) for the
metropolitan area for the preceding fiscal year; and
``(B) the amount reserved under subsection (b)(2)(A) for
such fiscal year is deemed to be increased by an amount equal
to the amount of the reduction under subparagraph (A) for
such year.
``(d) Certain Transfers; Allocations Between Programs Under
Subpart I.--With respect to paragraphs (1)(B)(i) and
(2)(A)(ii) of subsection (c), the Secretary shall administer
any reductions under such paragraphs for a fiscal year in
accordance with the following:
``(1) The reductions shall be made from amounts available
for the single program referred to in section 2609(d)(2)(C)
(relating to supplemental grants).
``(2) The reductions shall be made before the amounts
referred to in paragraph (1) are used for purposes of section
2603(a)(4).
``(3) If the amounts referred to in paragraph (1) are not
sufficient for making all the reductions, the reductions
shall be reduced until the total amount of the reductions
equals the total of the amounts referred to in such
paragraph.
``(e) Rules of Construction Regarding First Subsequent
Fiscal Year.--Paragraphs (1) and (2) of subsection (c) apply
with respect to each series of fiscal years during which a
metropolitan area is an eligible area under subpart I or a
transitional area under section 2609 for a fiscal year and
then for a subsequent fiscal year ceases to be such an area
by reason of section 2601(b) or 2609(c)(2), respectively,
rather than applying to a single such series. Paragraph (3)
of subsection (c) applies with respect to each series of
fiscal years during which a metropolitan area is a
transitional area under section 2609 for a fiscal year and
then for a subsequent fiscal year becomes an eligible area
under subpart I, rather than applying to a single such
series.''.
TITLE II--CARE GRANTS
SEC. 201. GENERAL USE OF GRANTS.
(a) In General.--Section 2612 of the Public Health Service
Act (42 U.S.C. 300ff-22) is amended to read as follows:
``SEC. 2612. GENERAL USE OF GRANTS.
``(a) In General.--A State may use amounts provided under
grants made under section 2611 for--
``(1) core medical services described in subsection (b);
``(2) support services described in subsection (c); and
``(3) administrative expenses described in section
2618(b)(3).
``(b) Required Funding for Core Medical Services.--
``(1) In general.--With respect to a grant under section
2611 for a State for a grant year, the State shall, of the
portion of the grant remaining after reserving amounts for
purposes of
[[Page H9287]]
subparagraphs (A) and (E)(ii)(I) of section 2618(b)(3), use
not less than 75 percent to provide core medical services
that are needed in the State for individuals with HIV/AIDS
who are identified and eligible under this title (including
services regarding the co-occurring conditions of the
individuals).
``(2) Waiver.--
``(A) In general.--The Secretary shall waive the
application of paragraph (1) with respect to a State for a
grant year if the Secretary determines that, within the
State--
``(i) there are no waiting lists for AIDS Drug Assistance
Program services under section 2616; and
``(ii) core medical services are available to all
individuals with HIV/AIDS identified and eligible under this
title.
``(B) Notification of waiver status.--When informing a
State that a grant under section 2611 is being made to the
State for a fiscal year, the Secretary shall inform the State
whether a waiver under subparagraph (A) is in effect for the
fiscal year.
``(3) Core medical services.--For purposes of this
subsection, the term `core medical services', with respect to
an individual infected with HIV/AIDS (including the co-
occurring conditions of the individual) means the following
services:
``(A) Outpatient and ambulatory health services.
``(B) AIDS Drug Assistance Program treatments in accordance
with section 2616.
``(C) AIDS pharmaceutical assistance.
``(D) Oral health care.
``(E) Early intervention services described in subsection
(d).
``(F) Health insurance premium and cost sharing assistance
for low-income individuals in accordance with section 2615.
``(G) Home health care.
``(H) Medical nutrition therapy.
``(I) Hospice services.
``(J) Home and community-based health services as defined
under section 2614(c).
``(K) Mental health services.
``(L) Substance abuse outpatient care.
``(M) Medical case management, including treatment
adherence services.
``(c) Support Services.--
``(1) In general.--For purposes of this subsection, the
term `support services' means services, subject to the
approval of the Secretary, that are needed for individuals
with HIV/AIDS to achieve their medical outcomes (such as
respite care for persons caring for individuals with HIV/
AIDS, outreach services, medical transportation, linguistic
services, and referrals for health care and support
services).
``(2) Definition of medical outcomes.--In this subsection,
the term `medical outcomes' means those outcomes affecting
the HIV-related clinical status of an individual with HIV/
AIDS.
``(d) Early Intervention Services.--
``(1) In general.--For purposes of this section, the term
`early intervention services' means HIV/AIDS early
intervention services described in section 2651(e), 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/AIDS counseling and testing
sites, health care points of entry specified by States,
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 shall apply only if the entity demonstrates to
the satisfaction of the chief elected official for 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
subparagraph to supplement and not supplant other funds
available to the entity for the provision of early
intervention services for the fiscal year involved.
``(e) Priority for Women, Infants, Children, and Youth.--
``(1) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with
HIV/AIDS, including treatment measures to prevent the
perinatal transmission of HIV, a State 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 HIV/AIDS to the general population in such
area of individuals with HIV/AIDS.
``(2) Waiver.--With respect to the population involved, the
Secretary may provide to a State a waiver of the requirement
of paragraph (1) if such 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.
``(f) Construction.--A State may not use amounts received
under a grant awarded under section 2611 to purchase or
improve land, or to purchase, construct, or permanently
improve (other than minor remodeling) any building or other
facility, or to make cash payments to intended recipients of
services.''.
(b) HIV Care Consortia.--Section 2613 of the Public Health
Service Act (42 U.S.C. 300ff-23) is amended--
(1) in subsection (a), in the matter preceding paragraph
(1)--
(A) by striking ``may use'' and inserting ``may, subject to
subsection (f), use''; and
(B) by striking ``section 2612(a)(1)'' and inserting
``section 2612(a)''; and
(2) by adding at the end the following subsection:
``(f) Allocation of Funds; Treatment as Support Services.--
For purposes of the requirement of section 2612(b)(1),
expenditures of grants under section 2611 for or through
consortia under this section are deemed to be support
services, not core medical services. The preceding sentence
may not be construed as having any legal effect on the
provisions of subsection (a) that relate to authorized
expenditures of the grant.''.
(c) Technical Amendments.--Part B of title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-21 et seq.) is
amended--
(1) in section 2611--
(A) in subsection (a), by striking the subsection
designation and heading; and
(B) by striking subsection (b);
(2) in section 2614--
(A) in subsection (a), in the matter preceding paragraph
(1), by striking ``section 2612(a)(2)'' and inserting
``section 2612(b)(3)(J)''; and
(B) in subsection (c)(2)(B), by striking ``homemaker or'';
(3) in section 2615(a) by striking ``section 2612(a)(3)''
and inserting ``section 2612(b)(3)(F)''; and
(4) in section 2616(a) by striking ``section 2612(a)(5)''
and inserting ``section 2612(b)(3)(B)''.
SEC. 202. AIDS DRUG ASSISTANCE PROGRAM.
(a) Requirement of Minimum Drug List.--Section 2616 of the
Public Health Service Act (42 U.S.C. 300ff-26) is amended--
(1) in subsection (c), by striking paragraph (1) and
inserting the following:
``(1) ensure that the therapeutics included on the list of
classes of core antiretroviral therapeutics established by
the Secretary under subsection (e) are, at a minimum, the
treatments provided by the State pursuant to this section;'';
(2) by redesignating subsection (e) as subsection (f); and
(3) by inserting after subsection (d) the following:
``(e) List of Classes of Core Antiretroviral
Therapeutics.--For purposes of subsection (c)(1), the
Secretary shall develop and maintain a list of classes of
core antiretroviral therapeutics, which list shall be based
on the therapeutics included in the guidelines of the
Secretary known as the Clinical Practice Guidelines for Use
of HIV/AIDS Drugs, relating to drugs needed to manage
symptoms associated with HIV. The preceding sentence does not
affect the authority of the Secretary to modify such
Guidelines.''.
(b) Drug Rebate Program.--Section 2616 of the Public Health
Service Act, as amended by subsection (a)(2) of this section,
is amended by adding at the end the following:
``(g) Drug Rebate Program.--A State shall ensure that any
drug rebates received on drugs purchased from funds provided
pursuant to this section are applied to activities supported
under this subpart, with priority given to activities
described under this section.''.
SEC. 203. DISTRIBUTION OF FUNDS.
(a) Distribution Based on Living Cases of HIV/AIDS.--
(1) State distribution factor.--Section 2618(a)(2) of the
Public Health Service Act (42 U.S.C. 300ff-28(a)(2)) is
amended--
(A) in subparagraph (B), by striking ``estimated number of
living cases of acquired immune deficiency syndrome in the
eligible area involved'' and inserting ``number of living
cases of HIV/AIDS in the State involved''; and
(B) by amending subparagraph (D) to read as follows:
``(D) Living cases of hiv/aids.--
``(i) Requirement of names-based reporting.--Except as
provided in clause (ii), the number determined under this
subparagraph for a State for a fiscal year for purposes of
subparagraph (B) is the number of living names-based cases of
HIV/AIDS in the State that, as of December 31 of the most
recent calendar year for which such data is available, have
been reported to and confirmed by the Director of the Centers
for Disease Control and Prevention.
``(ii) Transition period; exemption regarding non-aids
cases.--For each of the fiscal years 2007 through 2009, a
State is, subject to clauses (iii) through (v), exempt from
the requirement under clause (i) that living non-AIDS names-
based cases of HIV be reported unless--
``(I) a system was in operation as of December 31, 2005,
that provides sufficiently accurate and reliable names-based
reporting of such cases throughout the State, subject to
clause (vii); or
``(II) no later than the beginning of fiscal year 2008 or
2009, the Secretary, after consultation with the chief
executive of the State, determines that a system has become
operational in the State that provides sufficiently accurate
and reliable names-based reporting of such cases throughout
the State.
``(iii) Requirements for exemption for fiscal year 2007.--
For fiscal year 2007, an exemption under clause (ii) for a
State applies only if, by October 1, 2006--
``(I)(aa) the State had submitted to the Secretary a plan
for making the transition to sufficiently accurate and
reliable names-based reporting of living non-AIDS cases of
HIV; or
``(bb) all statutory changes necessary to provide for
sufficiently accurate and reliable reporting of such cases
had been made; and
``(II) the State had agreed that, by April 1, 2008, the
State will begin accurate and reliable names-based reporting
of such cases, except that such agreement is not required to
provide that,
[[Page H9288]]
as of such date, the system for such reporting be fully
sufficient with respect to accuracy and reliability
throughout the area.
``(iv) Requirement for exemption as of fiscal year 2008.--
For each of the fiscal years 2008 through 2010, an exemption
under clause (ii) for a State applies only if, as of April 1,
2008, the State is substantially in compliance with the
agreement under clause (iii)(II).
``(v) Progress toward names-based reporting.--For fiscal
year 2009, the Secretary may terminate an exemption under
clause (ii) for a State if the State submitted a plan under
clause (iii)(I)(aa) and the Secretary determines that the
State is not substantially following the plan.
``(vi) Counting of cases in areas with exemptions.--
``(I) In general.--With respect to a State that is under a
reporting system for living non-AIDS cases of HIV that is not
names-based (referred to in this subparagraph as `code-based
reporting'), the Secretary shall, for purposes of this
subparagraph, modify the number of such cases reported for
the State in order to adjust for duplicative reporting in and
among systems that use code-based reporting.
``(II) Adjustment rate.--The adjustment rate under
subclause (I) for a State shall be a reduction of 5 percent
in the number of living non-AIDS cases of HIV reported for
the State.
``(vii) List of states meeting standard regarding December
31, 2005.--
``(I) In general.--If a State is specified in subclause
(II), the State shall be considered to meet the standard
described in clause (ii)(I). No other State may be considered
to meet such standard.
``(II) Relevant states.--For purposes of subclause (I), the
States specified in this subclause are the following: Alaska,
Alabama, Arkansas, Arizona, Colorado, Florida, Indiana, Iowa,
Idaho, Kansas, Louisiana, Michigan, Minnesota, Missouri,
Mississippi, North Carolina, North Dakota, Nebraska, New
Jersey, New Mexico, New York, Nevada, Ohio, Oklahoma, South
Carolina, South Dakota, Tennessee, Texas, Utah, Virginia,
Wisconsin, West Virginia, Wyoming, Guam, and the Virgin
Islands.
``(viii) Rules of construction regarding acceptance of
reports.--
``(I) Cases of aids.--With respect to a State that is
subject to the requirement under clause (i) and is not in
compliance with the requirement for names-based reporting of
living non-AIDS cases of HIV, the Secretary shall,
notwithstanding such noncompliance, accept reports of living
cases of AIDS that are in accordance with such clause.
``(II) Applicability of exemption requirements.--The
provisions of clauses (ii) through (vii) may not be construed
as having any legal effect for fiscal year 2010 or any
subsequent fiscal year, and accordingly, the status of a
State for purposes of such clauses may not be considered
after fiscal year 2009.
``(ix) Program for detecting inaccurate or fraudulent
counting.--The Secretary shall carry out a program to monitor
the reporting of names-based cases for purposes of this
subparagraph and to detect instances of inaccurate reporting,
including fraudulent reporting.''.
(2) Non-ema distribution factor.--Section 2618(a)(2)(C) of
the Public Health Service Act (42 U.S.C. 300ff-28(a)(2)(C))
is amended--
(A) in clause (i), by striking ``estimated number of living
cases of acquired immune deficiency syndrome'' each place
such term appears and inserting ``number of living cases of
HIV/AIDS''; and
(B) in clause (ii), by amending such clause to read as
follows:
``(ii) a number equal to the sum of--
``(I) the total number of living cases of HIV/AIDS that are
within areas in such State that are eligible areas under
subpart I of part A for the fiscal year involved, which
individual number for an area is the number that applies
under section 2601 for the area for such fiscal year; and
``(II) the total number of such cases that are within areas
in such State that are transitional areas under section 2609
for such fiscal year, which individual number for an area is
the number that applies under such section for the fiscal
year.''.
(b) Formula Amendments Generally.--Section 2618(a)(2) of
the Public Health Service Act (42 U.S.C. 300ff-28(a)(2)) is
amended--
(1) in subparagraph (A)--
(A) by striking ``The amount referred to'' in the matter
preceding clause (i) and all that follows through the end of
clause (i) and inserting the following: ``For purposes of
paragraph (1), the amount referred to in this paragraph for a
State (including a territory) for a fiscal year is, subject
to subparagraphs (E) and (F)--
``(i) an amount equal to the amount made available under
section 2623 for the fiscal year involved for grants pursuant
to paragraph (1), subject to subparagraph (G); and''; and
(B) in clause (ii)--
(i) in subclause (I)--
(I) by striking ``.80'' and inserting ``0.75''; and
(II) by striking ``and'' at the end;
(ii) in subclause (II)--
(I) by inserting ``non-EMA'' after ``respective''; and
(II) by striking the period and inserting ``; and''; and
(iii) by adding at the end the following:
``(III) if the State does not for such fiscal year contain
any area that is an eligible area under subpart I of part A
or any area that is a transitional area under section 2609
(referred to in this subclause as a `no-EMA State'), the
product of 0.05 and the ratio of the number of cases that
applies for the State under subparagraph (D) to the sum of
the respective numbers of cases that so apply for all no-EMA
States.'';
(2) by striking subparagraphs (E) through (H);
(3) by inserting after subparagraph (D) the following
subparagraphs:
``(E) Code-based states; limitation on increase in grant.--
``(i) In general.--For each of the fiscal years 2007
through 2009, if code-based reporting (within the meaning of
subparagraph (D)(vi)) applies in a State as of the beginning
of the fiscal year involved, then notwithstanding any other
provision of this paragraph, the amount of the grant pursuant
to paragraph (1) for the State may not for the fiscal year
involved exceed by more than 5 percent the amount of the
grant pursuant to this paragraph for the State for the
preceding fiscal year, except that the limitation under this
clause may not result in a grant pursuant to paragraph (1)
for a fiscal year that is less than the minimum amount that
applies to the State under such paragraph for such fiscal
year.
``(ii) Use of amounts involved.--For each of the fiscal
years 2007 through 2009, amounts available as a result of the
limitation under clause (i) shall be made available by the
Secretary as additional amounts for grants pursuant to
section 2620, subject to subparagraph (H).''; and
(4) by redesignating subparagraph (I) as subparagraph (F).
(c) Separate ADAP Grants.--Section 2618(a)(2)(G) of the
Public Health Service Act (42 U.S.C. 300ff-28(a)(2)(G)), as
redesignated by subsection (b)(4) of this section, is
amended--
(1) in clause (i)--
(A) in the matter preceding subclause (I), by striking
``section 2677'' and inserting ``section 2623'';
(B) in subclause (II), by striking the period at the end
and inserting a semicolon; and
(C) by adding after and below subclause (II) the following:
``which product shall then, as applicable, be increased under
subparagraph (H).'';
(2) in clause (ii)--
(A) by striking subclauses (I) through (III) and inserting
the following:
``(I) In general.--From amounts made available under
subclause (V), the Secretary shall award supplemental grants
to States described in subclause (II) to enable such States
to purchase and distribute to eligible individuals under
section 2616(b) pharmaceutical therapeutics described under
subsections (c)(2) and (e) of such section.
``(II) Eligible states.--For purposes of subclause (I), a
State shall be an eligible State if the State did not have
unobligated funds subject to reallocation under section
2618(d) in the previous fiscal year and, in accordance with
criteria established by the Secretary, demonstrates a severe
need for a grant under this clause. For purposes of
determining severe need, the Secretary shall consider
eligibility standards, formulary composition, the number of
eligible individuals to whom a State is unable to provide
therapeutics described in section 2616(a), and an
unanticipated increase of eligible individuals with HIV/AIDS.
``(III) State requirements.--The Secretary may not make a
grant to a State under this clause unless the State agrees
that the State will make available (directly or through
donations of public or private entities) non-Federal
contributions toward the activities to be carried out under
the grant in an amount equal to $1 for each $4 of Federal
funds provided in the grant, except that the Secretary may
waive this subclause if the State has otherwise fully
complied with section 2617(d) with respect to the grant year
involved. The provisions of this subclause shall apply to
States that are not required to comply with such section
2617(d).''.
(B) in subclause (IV), by moving the subclause two ems to
the left;
(C) in subclause (V), by striking ``3 percent'' and
inserting ``5 percent''; and
(D) by striking subclause (VI); and
(3) by adding at the end the following clause:
``(iii) Code-based states; limitation on increase in
formula grant.--The limitation under subparagraph (E)(i)
applies to grants pursuant to clause (i) of this subparagraph
to the same extent and in the same manner as such limitation
applies to grants pursuant to paragraph (1), except that the
reference to minimum grants does not apply for purposes of
this clause. Amounts available as a result of the limitation
under the preceding sentence shall be made available by the
Secretary as additional amounts for grants under clause (ii)
of this subparagraph.''.
(d) Hold Harmless.--Section 2618(a)(2) of the Public Health
Service Act (42 U.S.C. 300ff-28(a)(2)), as amended by
subsection (b)(4) of this section, is amended by adding at
the end the following subparagraph:
``(H) Increase in formula grants.--
``(i) Assurance of amount.--
``(I) General rule.--For fiscal year 2007, the Secretary
shall ensure, subject to clauses (ii) through (iv), that the
total for a State of the grant pursuant to paragraph (1) and
the grant pursuant to subparagraph (G) is not less than 95
percent of such total for the State for fiscal year 2006.
``(II) Rule of construction.--With respect to the
application of subclause (I), the 95 percent requirement
under such subclause shall apply with respect to each grant
awarded under paragraph (1) and with respect to each grant
awarded under subparagraph (G).
``(ii) Fiscal year 2007.--For purposes of clause (i) as
applied for fiscal year 2007, the references in such clause
to subparagraph (G) are deemed to be references to
subparagraph (I) as such subparagraph was in effect for
fiscal year 2006.
``(iii) Fiscal years 2008 and 2009.--For each of the fiscal
years 2008 and 2009, the Secretary shall ensure that the
total for a State of the grant pursuant to paragraph (1) and
the grant pursuant to subparagraph (G) is not less than 100
percent of such total for the State for fiscal year 2007.
[[Page H9289]]
``(iv) Source of funds for increase.--
``(I) In general.--From the amount reserved under section
2623(b)(2) for a fiscal year, and from amounts available for
such section pursuant to subsection (d) of this section, the
Secretary shall make available such amounts as may be
necessary to comply with clause (i).
``(II) Pro rata reduction.--If the amounts referred to in
subclause (I) for a fiscal year are insufficient to fully
comply with clause (i) for the year, the Secretary, in order
to provide the additional funds necessary for such
compliance, shall reduce on a pro rata basis the amount of
each grant pursuant to paragraph (1) for the fiscal year,
other than grants for States for which increases under clause
(i) apply and other than States described in paragraph
(1)(A)(i)(I). A reduction under the preceding sentence may
not be made in an amount that would result in the State
involved becoming eligible for such an increase.
``(v) Applicability.--This paragraph may not be construed
as having any applicability after fiscal year 2009.''.
(e) Administrative Expenses; Clinical Quality Management.--
Section 2618(b) of the Public Health Service Act (42 U.S.C.
300ff-28(b)) is amended--
(1) by redesignating paragraphs (2) through (7) as
paragraphs (1) through (6);
(2) in paragraph (2) (as so redesignated)--
(A) by striking ``paragraph (5)'' and inserting ``paragraph
(4)''; and
(B) by striking ``paragraph (6)'' and inserting ``paragraph
(5)'';
(3) in paragraph (3) (as so redesignated)--
(A) by amending subparagraph (A) to read as follows:
``(A) In general.--Subject to paragraph (4,) and except as
provided in paragraph (5), a State may not use more than 10
percent of amounts received under a grant awarded under
section 2611 for administration.'';
(B) by redesignating subparagraphs (B) and (C) as
subparagraphs (C) and (D), respectively;
(C) by inserting after subparagraph (A) the following:
``(B) Allocations.--In the case of entities and
subcontractors to which a State allocates amounts received by
the State under a grant under section 2611, the State shall
ensure that, of the aggregate amount so allocated, the total
of the expenditures by such entities for administrative
expenses does not exceed 10 percent (without regard to
whether particular entities expend more than 10 percent for
such expenses).'';
(D) in subparagraph (C) (as so redesignated), by inserting
before the period the following: ``, including a clinical
quality management program under subparagraph (E)''; and
(E) by adding at the end the following:
``(E) Clinical quality management.--
``(i) Requirement.--Each State that receives a grant under
section 2611 shall provide for the establishment of a
clinical quality management program to assess the extent to
which HIV health services provided to patients under the
grant are consistent with the most recent Public Health
Service guidelines for the treatment of HIV/AIDS and related
opportunistic infection, and as applicable, to develop
strategies for ensuring that such services are consistent
with the guidelines for improvement in the access to and
quality of HIV health services.
``(ii) Use of funds.--
``(I) In general.--From amounts received under a grant
awarded under section 2611 for a fiscal year, a State may use
for activities associated with the clinical quality
management program required in clause (i) not to exceed the
lesser of--
``(aa) 5 percent of amounts received under the grant; or
``(bb) $3,000,000.
``(II) Relation to limitation on administrative expenses.--
The costs of a clinical quality management program under
clause (i) may not be considered administrative expenses for
purposes of the limitation established in subparagraph
(A).'';
(4) in paragraph (4) (as so redesignated)--
(A) by striking ``paragraph (6)'' and inserting ``paragraph
(5)''; and
(B) by striking ``paragraphs (3) and (4)'' and inserting
``paragraphs (2) and (3)''; and
(5) in paragraph (5) (as so redesignated), by striking
``paragraphs (3)'' and all that follows through ``(5),'' and
inserting the following: ``paragraphs (2) and (3), may,
notwithstanding paragraphs (2) through (4),''.
(f) Reallocation for Supplemental Grants.--Section 2618(d)
of the Public Health Service Act (42 U.S.C. 300ff-28(d)) is
amended to read as follows:
``(d) Reallocation.--Any portion of a grant made to a State
under section 2611 for a fiscal year that has not been
obligated as described in subsection (c) ceases to be
available to the State and shall be made available by the
Secretary for grants under section 2620, in addition to
amounts made available for such grants under section
2623(b)(2).''.
(g) Definitions; Other Technical Amendments.--Section
2618(a) of the Public Health Service Act (42 U.S.C. 300ff-
28(a)) is amended--
(1) in paragraph (1), in the matter preceding subparagraph
(A), by striking ``section 2677'' and inserting ``section
2623'';
(2) in paragraph (1)(A)--
(A) in the matter preceding clause (i), by striking ``each
of the several States and the District of Columbia'' and
inserting ``each of the 50 States, the District of Columbia,
Guam, and the Virgin Islands (referred to in this paragraph
as a `covered State')''; and
(B) in clause (i)--
(i) in subclause (I), by striking ``State or District'' and
inserting ``covered State''; and
(ii) in subclause (II)--
(I) by striking ``State or District'' and inserting
``covered State''; and
(II) by inserting ``and'' after the semicolon; and
(3) in paragraph (1)(B), by striking ``each territory of
the United States, as defined in paragraph (3),'' and
inserting ``each territory other than Guam and the Virgin
Islands'';
(4) in paragraph (2)(C)(i), by striking ``or territory'';
and
(5) by striking paragraph (3).
SEC. 204. ADDITIONAL AMENDMENTS TO SUBPART I OF PART B.
(a) References to Part B.--Subpart I of part B of title
XXVI of the Public Health Service Act (42 U.S.C. 300ff-21 et
seq.) is amended by striking ``this part'' each place such
term appears and inserting ``section 2611''.
(b) Hepatitis.--Section 2614(a)(3) of the Public Health
Service Act (42 U.S.C. 300ff-24(a)(3)) is amended by
inserting ``, including specialty care and vaccinations for
hepatitis co-infection,'' after ``health services''.
(c) Application for Grant.--
(1) Coordination.--Section 2617(b) of the Public Health
Service Act (42 U.S.C. 300ff-27(b)) is amended--
(A) by redesignating paragraphs (4) through (6) as
paragraphs (5) through (7), respectively;
(B) by inserting after paragraph (3), the following:
``(4) the designation of a lead State agency that shall--
``(A) administer all assistance received under this part;
``(B) conduct the needs assessment and prepare the State
plan under paragraph (3);
``(C) prepare all applications for assistance under this
part;
``(D) receive notices with respect to programs under this
title;
``(E) every 2 years, collect and submit to the Secretary
all audits, consistent with Office of Management and Budget
circular A133, from grantees within the State, including
audits regarding funds expended in accordance with this part;
and
``(F) carry out any other duties determined appropriate by
the Secretary to facilitate the coordination of programs
under this title.'';
(C) in paragraph (5) (as so redesignated)--
(i) in subparagraph (E), by striking ``and'' at the end;
and
(ii) by inserting after subparagraph (F) the following:
``(G) includes key outcomes to be measured by all entities
in the State receiving assistance under this title; and'';
and
(D) in paragraph (7) (as so redesignated), in subparagraph
(A)--
(i) by striking ``paragraph (5)'' and inserting ``paragraph
(6)''; and
(ii) by striking ``paragraph (4)'' and inserting
``paragraph (5)''.
(2) Native american representation.--Section 2617(b)(6) of
the Public Health Service Act, as redesignated by paragraph
(1)(A) of this subsection, is amended by inserting before
``representatives of grantees'' the following: ``members of a
Federally recognized Indian tribe as represented in the
State,''.
(3) Payer of last resort.--Section 2617(b)(7)(F)(ii) of the
Public Health Service Act, as redesignated by paragraph
(1)(A) of this subsection, is amended by inserting before the
semicolon the following: ``(except for a program administered
by or providing the services of the Indian Health Service)''.
(d) Matching Funds; Applicability of Requirement.--Section
2617(d)(3) of the Public Health Service Act (42 U.S.C. 300ff-
27(d)(3)) is amended--
(1) in subparagraph (A), by striking ``acquired immune
deficiency syndrome'' and inserting ``HIV/AIDS''; and
(2) in subparagraph (C), by striking ``acquired immune
deficiency syndrome'' and inserting ``HIV/AIDS''.
SEC. 205. SUPPLEMENTAL GRANTS ON BASIS OF DEMONSTRATED NEED.
Subpart I of part B of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-21 et seq.) is amended--
(1) by redesignating section 2620 as section 2621; and
(2) by inserting after section 2619 the following:
``SEC. 2620. SUPPLEMENTAL GRANTS.
``(a) In General.--For the purpose of providing services
described in section 2612(a), the Secretary shall make grants
to States--
``(1) whose applications under section 2617 have
demonstrated the need in the State, on an objective and
quantified basis, for supplemental financial assistance to
provide such services; and
``(2) that did not, for the most recent grant year pursuant
to section 2618(a)(1) or 2618(a)(2)(G)(i) for which data is
available, have more than 2 percent of grant funds under such
sections canceled or covered by any waivers under section
2622(c).
``(b) Demonstrated Need.--The factors considered by the
Secretary in determining whether an eligible area has a
demonstrated need for purposes of subsection (a)(1) may
include any or all of the following:
``(1) The unmet need for such services, as determined under
section 2617(b).
``(2) An increasing need for HIV/AIDS-related services,
including relative rates of increase in the number of cases
of HIV/AIDS.
``(3) The relative rates of increase in the number of cases
of HIV/AIDS within new or emerging subpopulations.
``(4) The current prevalence of HIV/AIDS.
``(5) Relevant factors related to the cost and complexity
of delivering health care to individuals with HIV/AIDS in the
eligible area.
``(6) The impact of co-morbid factors, including co-
occurring conditions, determined relevant by the Secretary.
``(7) The prevalence of homelessness.
``(8) The prevalence of individuals described under section
2602(b)(2)(M).
[[Page H9290]]
``(9) The relevant factors that limit access to health
care, including geographic variation, adequacy of health
insurance coverage, and language barriers.
``(10) The impact of a decline in the amount received
pursuant to section 2618 on services available to all
individuals with HIV/AIDS identified and eligible under this
title.
``(c) Priority in Making Grants.--The Secretary shall
provide funds under this section to a State to address the
decline in services related to the decline in the amounts
received pursuant to section 2618 consistent with the grant
award to the State for fiscal year 2006, to the extent that
the factor under subsection (b)(10) (relating to a decline in
funding) applies to the State.
``(d) Report on the Awarding of Supplemental Funds.--Not
later than 45 days after the awarding of supplemental funds
under this section, the Secretary shall submit to Congress a
report concerning such funds. Such report shall include
information detailing--
``(1) the total amount of supplemental funds available
under this section for the year involved;
``(2) the amount of supplemental funds used in accordance
with the hold harmless provisions of section 2618(a)(2);
``(3) the amount of supplemental funds disbursed pursuant
to subsection (c);
``(4) the disbursement of the remainder of the supplemental
funds after taking into account the uses described in
paragraphs (2) and (3); and
``(5) the rationale used for the amount of funds disbursed
as described under paragraphs (2), (3), and (4).
``(e) Core Medical Services.--The provisions of section
2612(b) apply with respect to a grant under this section to
the same extent and in the same manner as such provisions
apply with respect to a grant made pursuant to section
2618(a)(1).
``(f) Applicability of Grant Authority.--The authority to
make grants under this section applies beginning with the
first fiscal year for which amounts are made available for
such grants under section 2623(b)(1).''.
SEC. 206. EMERGING COMMUNITIES.
Section 2621 of the Public Health Service Act, as
redesignated by section 205(1) of this Act, is amended--
(1) in the heading for the section, by striking
``SUPPLEMENTAL GRANTS'' and inserting ``EMERGING
COMMUNITIES'';
(2) in subsection (b)--
(A) in paragraph (2), by striking ``and'' at the end;
(B) by redesignating paragraph (3) as paragraph (4); and
(C) by inserting after paragraph (2) the following:
``(3) agree that the grant will be used to provide funds
directly to emerging communities in the State, separately
from other funds under this title that are provided by the
State to such communities; and''.
(3) by striking subsections (d) and (e) and inserting the
following:
``(d) Definitions of Emerging Community.--For purposes of
this section, the term `emerging community' means a
metropolitan area (as defined in section 2607) for which
there has been reported to and confirmed by the Director of
the Centers for Disease Control and Prevention a cumulative
total of at least 500, but fewer than 1,000, cases of AIDS
during the most recent period of 5 calendar years for which
such data are available.
``(e) Continued Status as Emerging Community.--
Notwithstanding any other provision of this section, a
metropolitan area that is an emerging community for a fiscal
year continues to be an emerging community until the
metropolitan area fails, for three consecutive fiscal years--
``(1) to meet the requirements of subsection (d); and
``(2) to have a cumulative total of 750 or more living
cases of AIDS (reported to and confirmed by the Director of
the Centers for Disease Control and Prevention) as of
December 31 of the most recent calendar year for which such
data is available.
``(f) Distribution.--The amount of a grant under subsection
(a) for a State for a fiscal year shall be an amount equal to
the product of--
``(1) the amount available under section 2623(b)(1) for the
fiscal year; and
``(2) a percentage equal to the ratio constituted by the
number of living cases of HIV/AIDS in emerging communities in
the State to the sum of the respective numbers of such cases
in such communities for all States.''.
SEC. 207. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT
FUNDS.
Subpart I of part B of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-21 et seq.), as amended by
section 205, is further amended by adding at the end the
following:
``SEC. 2622. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF
GRANT FUNDS.
``(a) Obligation by End of Grant Year.--Effective for
fiscal year 2007 and subsequent fiscal years, funds from a
grant award made to a State for a fiscal year pursuant to
section 2618(a)(1) or 2618(a)(2)(G), or under section 2620 or
2621, are available for obligation by the State through the
end of the one-year period beginning on the date in such
fiscal year on which funds from the award first become
available to the State (referred to in this section as the
`grant year for the award'), except as provided in subsection
(c)(1).
``(b) Supplemental Grants; Cancellation of Unobligated
Balance of Grant Award.--Effective for fiscal year 2007 and
subsequent fiscal years, if a grant award made to a State for
a fiscal year pursuant to section 2618(a)(2)(G)(ii), or under
section 2620 or 2621, has an unobligated balance as of the
end of the grant year for the award--
``(1) the Secretary shall cancel that unobligated balance
of the award, and shall require the State to return any
amounts from such balance that have been disbursed to the
State; and
``(2) the funds involved shall be made available by the
Secretary as additional amounts for grants pursuant to
section 2620 for the first fiscal year beginning after the
fiscal year in which the Secretary obtains the information
necessary for determining that the balance is required under
paragraph (1) to be canceled, except that the availability of
the funds for such grants is subject to section 2618(a)(2)(H)
as applied for such year.
``(c) Formula Grants; Cancellation of Unobligated Balance
of Grant Award; Waiver Permitting Carryover.--
``(1) In general.--Effective for fiscal year 2007 and
subsequent fiscal years, if a grant award made to a State for
a fiscal year pursuant to section 2618(a)(1) or
2618(a)(2)(G)(i) has an unobligated balance as of the end of
the grant year for the award, the Secretary shall cancel that
unobligated balance of the award, and shall require the State
to return any amounts from such balance that have been
disbursed to the State, unless--
``(A) before the end of the grant year, the State submits
to the Secretary a written application for a waiver of the
cancellation, which application includes a description of the
purposes for which the State intends to expend the funds
involved; and
``(B) the Secretary approves the waiver.
``(2) Expenditure by end of carryover year.--With respect
to a waiver under paragraph (1) that is approved for a
balance that is unobligated as of the end of a grant year for
an award:
``(A) The unobligated funds are available for expenditure
by the State involved for the one-year period beginning upon
the expiration of the grant year (referred to in this section
as the `carryover year').
``(B) If the funds are not expended by the end of the
carryover year, the Secretary shall cancel that unexpended
balance of the award, and shall require the State to return
any amounts from such balance that have been disbursed to the
State.
``(3) Use of cancelled balances.--In the case of any
balance of a grant award that is cancelled under paragraph
(1) or (2)(B), the grant funds involved shall be made
available by the Secretary as additional amounts for grants
under section 2620 for the first fiscal year beginning after
the fiscal year in which the Secretary obtains the
information necessary for determining that the balance is
required under such paragraph to be canceled, except that the
availability of the funds for such grants is subject to
section 2618(a)(2)(H) as applied for such year.
``(4) Corresponding reduction in future grant.--
``(A) In general.--In the case of a State for which a
balance from a grant award made pursuant to section
2618(a)(1) or 2618(a)(2)(G)(i) is unobligated as of the end
of the grant year for the award--
``(i) the Secretary shall reduce, by the same amount as
such unobligated balance, the amount of the grant under such
section for the first fiscal year beginning after the fiscal
year in which the Secretary obtains the information necessary
for determining that such balance was unobligated as of the
end of the grant year (which requirement for a reduction
applies without regard to whether a waiver under paragraph
(1) has been approved with respect to such balance); and
``(ii) the grant funds involved in such reduction shall be
made available by the Secretary as additional funds for
grants under section 2620 for such first fiscal year, subject
to section 2618(a)(2)(H);
except that this subparagraph does not apply to the State if
the amount of the unobligated balance was 2 percent or less.
``(B) Relation to increases in grant.--A reduction under
subparagraph (A) for a State for a fiscal year may not be
taken into account in applying section 2618(a)(2)(H) with
respect to the State for the subsequent fiscal year.
``(d) Treatment of Drug Rebates.--For purposes of this
section, funds that are drug rebates referred to in section
2616(g) may not be considered part of any grant award
referred to in subsection (a).''.
SEC. 208. AUTHORIZATION OF APPROPRIATIONS FOR SUBPART I OF
PART B.
Subpart I of part B of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-21 et seq.), as amended by
section 207, is further amended by adding at the end the
following:
``SEC. 2623. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--For the purpose of carrying out this
subpart, there are authorized to be appropriated
$1,195,500,000 for fiscal year 2007, $1,239,500,000 for
fiscal year 2008, and $1,285,200,000 for fiscal year 2009.
Amounts appropriated under the preceding sentence for a
fiscal year are available for obligation by the Secretary
until the end of the second succeeding fiscal year.
``(b) Reservation of Amounts.--
``(1) Emerging communities.--Of the amount appropriated
under subsection (a) for a fiscal year, the Secretary shall
reserve $5,000,000 for grants under section 2621.
``(2) Supplemental grants.--
``(A) In general.--Of the amount appropriated under
subsection (a) for a fiscal year in excess of the 2006
adjusted amount, the Secretary shall reserve \1/3\ for grants
under section 2620, except that the availability of the
reserved funds for such grants is subject to section
2618(a)(2)(H) as applied for such year, and except that any
amount appropriated exclusively for carrying out section 2616
(and, accordingly, distributed under section 2618(a)(2)(G))
is not subject to this subparagraph.
[[Page H9291]]
``(B) 2006 adjusted amount.--For purposes of subparagraph
(A), the term `2006 adjusted amount' means the amount
appropriated for fiscal year 2006 under section 2677(b) (as
such section was in effect for such fiscal year), excluding
any amount appropriated for such year exclusively for
carrying out section 2616 (and, accordingly, distributed
under section 2618(a)(2)(I), as so in effect).''.
SEC. 209. EARLY DIAGNOSIS GRANT PROGRAM.
Section 2625 of the Public Health Service Act (42 U.S.C.
300ff-33) is amended to read as follows:
``SEC. 2625. EARLY DIAGNOSIS GRANT PROGRAM.
``(a) In General.--In the case of States whose laws or
regulations are in accordance with subsection (b), the
Secretary, acting through the Centers for Disease Control and
Prevention, shall make grants to such States for the purposes
described in subsection (c).
``(b) Description of Compliant States.--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), both of the policies
described in paragraph (1) are in effect, or both of the
policies described in paragraph (2) are in effect, as
follows:
``(1)(A) Voluntary opt-out testing of pregnant women.
``(B) Universal testing of newborns.
``(2)(A) Voluntary opt-out testing of clients at sexually
transmitted disease clinics.
``(B) Voluntary opt-out testing of clients at substance
abuse treatment centers.
The Secretary shall periodically ensure that the applicable
policies are being carried out and recertify compliance.
``(c) Use of Funds.--A State may use funds provided under
subsection (a) for HIV/AIDS testing (including rapid
testing), prevention counseling, treatment of newborns
exposed to HIV/AIDS, treatment of mothers infected with HIV/
AIDS, and costs associated with linking those diagnosed with
HIV/AIDS to care and treatment for HIV/AIDS.
``(d) Application.--A State that is eligible for the grant
under subsection (a) shall submit an application to the
Secretary, in such form, in such manner, and containing such
information as the Secretary may require.
``(e) Limitation on Amount of Grant.--A grant under
subsection (a) to a State for a fiscal year may not be made
in an amount exceeding $10,000,000.
``(f) Rule of Construction.--Nothing in this section shall
be construed to pre-empt State laws regarding HIV/AIDS
counseling and testing.
``(g) Definitions.--In this section:
``(1) The term `voluntary opt-out testing' means HIV/AIDS
testing--
``(A) that is administered to an individual seeking other
health care services; and
``(B) in which--
``(i) pre-test counseling is not required but the
individual is informed that the individual will receive an
HIV/AIDS test and the individual may opt out of such testing;
and
``(ii) for those individuals with a positive test result,
post-test counseling (including referrals for care) is
provided and confidentiality is protected.
``(2) The term `universal testing of newborns' means HIV/
AIDS testing that is administered within 48 hours of delivery
to--
``(A) all infants born in the State; or
``(B) all infants born in the State whose mother's HIV/AIDS
status is unknown at the time of delivery.
``(h) Authorization of Appropriations.--Of the funds
appropriated annually to the Centers for Disease Control and
Prevention for HIV/AIDS prevention activities, $30,000,000
shall be made available for each of the fiscal years 2007
through 2009 for grants under subsection (a), of which
$20,000,000 shall be made available for grants to States with
the policies described in subsection (b)(1), and $10,000,000
shall be made available for grants to States with the
policies described in subsection (b)(2). Funds provided under
this section are available until expended.''.
SEC. 210. CERTAIN PARTNER NOTIFICATION PROGRAMS;
AUTHORIZATION OF APPROPRIATIONS.
Section 2631(d) of the Public Health Service Act (42 U.S.C.
300ff-38(d)) is amended by striking ``there are'' and all
that follows and inserting the following: ``there is
authorized to be appropriated $10,000,000 for each of the
fiscal years 2007 through 2009.''.
TITLE III--EARLY INTERVENTION SERVICES
SEC. 301. ESTABLISHMENT OF PROGRAM; CORE MEDICAL SERVICES.
(a) In General.--Section 2651 of the Public Health Service
Act (42 U.S.C. 300ff-51) is amended to read as follows:
``SEC. 2651. ESTABLISHMENT OF A PROGRAM.
``(a) In General.--For the purposes described in subsection
(b), the Secretary, acting through the Administrator of the
Health Resources and Services Administration, may make grants
to public and nonprofit private entities specified in section
2652(a).
``(b) Requirements.--
``(1) In general.--The Secretary may not make a grant under
subsection (a) unless the applicant for the grant agrees to
expend the grant only for--
``(A) core medical services described in subsection (c);
``(B) support services described in subsection (d); and
``(C) administrative expenses as described in section
2664(g)(3).
``(2) Early intervention services.--An applicant for a
grant under subsection (a) shall expend not less than 50
percent of the amount received under the grant for the
services described in subparagraphs (B) through (E) of
subsection (e)(1) for individuals with HIV/AIDS.
``(c) Required Funding for Core Medical Services.--
``(1) In general.--With respect to a grant under subsection
(a) to an applicant for a fiscal year, the applicant shall,
of the portion of the grant remaining after reserving amounts
for purposes of paragraphs (3) and (5) of section 2664(g),
use not less than 75 percent to provide core medical services
that are needed in the area involved for individuals with
HIV/AIDS who are identified and eligible under this title
(including services regarding the co-occurring conditions of
the individuals).
``(2) Waiver.--
``(A) The Secretary shall waive the application of
paragraph (1) with respect to an applicant for a grant if the
Secretary determines that, within the service area of the
applicant--
``(i) there are no waiting lists for AIDS Drug Assistance
Program services under section 2616; and
``(ii) core medical services are available to all
individuals with HIV/AIDS identified and eligible under this
title.
``(B) Notification of waiver status.--When informing an
applicant that a grant under subsection (a) is being made for
a fiscal year, the Secretary shall inform the applicant
whether a waiver under subparagraph (A) is in effect for the
fiscal year.
``(3) Core medical services.--For purposes of this
subsection, the term `core medical services', with respect to
an individual with HIV/AIDS (including the co-occurring
conditions of the individual) means the following services:
``(A) Outpatient and ambulatory health services.
``(B) AIDS Drug Assistance Program treatments under section
2616.
``(C) AIDS pharmaceutical assistance.
``(D) Oral health care.
``(E) Early intervention services described in subsection
(e).
``(F) Health insurance premium and cost sharing assistance
for low-income individuals in accordance with section 2615.
``(G) Home health care.
``(H) Medical nutrition therapy.
``(I) Hospice services.
``(J) Home and community-based health services as defined
under section 2614(c).
``(K) Mental health services.
``(L) Substance abuse outpatient care.
``(M) Medical case management, including treatment
adherence services.
``(d) Support Services.--
``(1) In general.--For purposes of this section, the term
`support services' means services, subject to the approval of
the Secretary, that are needed for individuals with HIV/AIDS
to achieve their medical outcomes (such as respite care for
persons caring for individuals with HIV/AIDS, outreach
services, medical transportation, linguistic services, and
referrals for health care and support services).
``(2) Definition of medical outcomes.--In this section, the
term `medical outcomes' means those outcomes affecting the
HIV-related clinical status of an individual with HIV/AIDS.
``(e) Specification of Early Intervention Services.--
``(1) In general.--The early intervention services referred
to in this section are--
``(A) counseling individuals with respect to HIV/AIDS in
accordance with section 2662;
``(B) testing individuals with respect to HIV/AIDS,
including tests to confirm the presence of the disease, tests
to diagnose the extent of the deficiency in the immune
system, and tests to provide information on appropriate
therapeutic measures for preventing and treating the
deterioration of the immune system and for preventing and
treating conditions arising from HIV/AIDS;
``(C) referrals described in paragraph (2);
``(D) other clinical and diagnostic services regarding HIV/
AIDS, and periodic medical evaluations of individuals with
HIV/AIDS; and
``(E) providing the therapeutic measures described in
subparagraph (B).
``(2) Referrals.--The services referred to in paragraph
(1)(C) are referrals of individuals with HIV/AIDS to
appropriate providers of health and support services,
including, as appropriate--
``(A) to entities receiving amounts under part A or B for
the provision of such services;
``(B) to biomedical research facilities of institutions of
higher education that offer experimental treatment for such
disease, or to community-based organizations or other
entities that provide such treatment; or
``(C) to grantees under section 2671, in the case of a
pregnant woman.
``(3) Requirement of availability of all early intervention
services through each grantee.--
``(A) In general.--The Secretary may not make a grant under
subsection (a) unless the applicant for the grant agrees that
each of the early intervention services specified in
paragraph (2) will be available through the grantee. With
respect to compliance with such agreement, such a grantee may
expend the grant to provide the early intervention services
directly, and may expend the grant to enter into agreements
with public or nonprofit private entities, or private for-
profit entities if such entities are the only available
provider of quality HIV care in the area, under which the
entities provide the services.
``(B) Other requirements.--Grantees described in--
``(i) subparagraphs (A), (D), (E), and (F) of section
2652(a)(1) shall use not less than 50 percent of the amount
of such a grant to provide the services described in
subparagraphs (A), (B), (D), and (E) of paragraph (1)
directly and on-site or at sites where other primary care
services are rendered; and
[[Page H9292]]
``(ii) subparagraphs (B) and (C) of section 2652(a)(1)
shall ensure the availability of early intervention services
through a system of linkages to community-based primary care
providers, and to establish mechanisms for the referrals
described in paragraph (1)(C), and for follow-up concerning
such referrals.''.
(b) Administrative Expenses; Clinical Quality Management
Program.--Section 2664(g) of the Public Health Service Act
(42 U.S.C. 300ff-64(g)) is amended--
(1) in paragraph (3), by amending the paragraph to read as
follows:
``(3) the applicant will not expend more than 10 percent of
the grant for administrative expenses with respect to the
grant, including planning and evaluation, except that the
costs of a clinical quality management program under
paragraph (5) may not be considered administrative expenses
for purposes of such limitation;''; and
(2) in paragraph (5), by inserting ``clinical'' before
``quality management''.
SEC. 302. ELIGIBLE ENTITIES; PREFERENCES; PLANNING AND
DEVELOPMENT GRANTS.
(a) Minimum Qualification of Grantees.--Section 2652(a) of
the Public Health Service Act (42 U.S.C. 300ff-52(a)) is
amended to read as follows:
``(a) Eligible Entities.--
``(1) In general.--The entities referred to in section
2651(a) are public entities and nonprofit private entities
that are--
``(A) federally-qualified health centers under section
1905(l)(2)(B) of the Social Security Act;
``(B) grantees under section 1001 (regarding family
planning) other than States;
``(C) comprehensive hemophilia diagnostic and treatment
centers;
``(D) rural health clinics;
``(E) health facilities operated by or pursuant to a
contract with the Indian Health Service;
``(F) community-based organizations, clinics, hospitals and
other health facilities that provide early intervention
services to those persons infected with HIV/AIDS through
intravenous drug use; or
``(G) nonprofit private entities that provide comprehensive
primary care services to populations at risk of HIV/AIDS,
including faith-based and community-based organizations.
``(2) Underserved populations.--Entities described in
paragraph (1) shall serve underserved populations which may
include minority populations and Native American populations,
ex-offenders, individuals with comorbidities including
hepatitis B or C, mental illness, or substance abuse, low-
income populations, inner city populations, and rural
populations.''.
(b) Preferences in Making Grants.--Section 2653 of the
Public Health Service Act (42 U.S.C. 300ff-53) is amended--
(1) in subsection (b)(1)--
(A) in subparagraph (A), by striking ``acquired immune
deficiency syndrome'' and inserting ``HIV/AIDS''; and
(B) in subparagraph (D), by inserting before the semicolon
the following: ``and the number of cases of individuals co-
infected with HIV/AIDS and hepatitis B or C''; and
(2) in subsection (d)(2), by striking ``special
consideration'' and inserting ``preference''.
(c) Planning and Development Grants.--Section 2654(c) of
the Public Health Service Act (42 U.S.C. 300ff-54(c)) is
amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by striking ``HIV''; and
(B) in subparagraph (B), by striking ``HIV'' and inserting
``HIV/AIDS''; and
(2) in paragraph (3), by striking ``or underserved
communities'' and inserting ``areas or to underserved
populations''.
SEC. 303. AUTHORIZATION OF APPROPRIATIONS.
Section 2655 of the Public Health Service Act (42 U.S.C.
300ff-55) is amended by striking ``such sums'' and all that
follows through ``2005''and inserting ``, $218,600,000 for
fiscal year 2007, $226,700,000 for fiscal year 2008, and
$235,100,000 for fiscal year 2009''.
SEC. 304. CONFIDENTIALITY AND INFORMED CONSENT.
Section 2661 of the Public Health Service Act (42 U.S.C.
300ff-61) is amended to read as follows:
``SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT.
``(a) Confidentiality.--The Secretary may not make a grant
under this part unless, in the case of any entity applying
for a grant under section 2651, the entity agrees to ensure
that information regarding the receipt of early intervention
services pursuant to the grant is maintained confidentially
in a manner not inconsistent with applicable law.
``(b) Informed Consent.--The Secretary may not make a grant
under this part unless the applicant for the grant agrees
that, in testing an individual for HIV/AIDS, the applicant
will test an individual only after the individual confirms
that the decision of the individual with respect to
undergoing such testing is voluntarily made.''.
SEC. 305. PROVISION OF CERTAIN COUNSELING SERVICES.
Section 2662 of the Public Health Service Act (42 U.S.C.
300ff-62) is amended to read as follows:
``SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.
``(a) Counseling of Individuals With Negative Test
Results.--The Secretary may not make a grant under this part
unless the applicant for the grant agrees that, if the
results of testing conducted for HIV/AIDS indicate that an
individual does not have such condition, the applicant will
provide the individual information, including--
``(1) measures for prevention of, exposure to, and
transmission of HIV/AIDS, hepatitis B, hepatitis C, and other
sexually transmitted diseases;
``(2) the accuracy and reliability of results of testing
for HIV/AIDS, hepatitis B, and hepatitis C;
``(3) the significance of the results of such testing,
including the potential for developing AIDS, hepatitis B, or
hepatitis C;
``(4) the appropriateness of further counseling, testing,
and education of the individual regarding HIV/AIDS and other
sexually transmitted diseases;
``(5) if diagnosed with chronic hepatitis B or hepatitis C
co-infection, the potential of developing hepatitis-related
liver disease and its impact on HIV/AIDS; and
``(6) information regarding the availability of hepatitis B
vaccine and information about hepatitis treatments.
``(b) Counseling of Individuals With Positive Test
Results.--The Secretary may not make a grant under this part
unless the applicant for the grant agrees that, if the
results of testing for HIV/AIDS indicate that the individual
has such condition, the applicant will provide to the
individual appropriate counseling regarding the condition,
including--
``(1) information regarding--
``(A) measures for prevention of, exposure to, and
transmission of HIV/AIDS, hepatitis B, and hepatitis C;
``(B) the accuracy and reliability of results of testing
for HIV/AIDS, hepatitis B, and hepatitis C; and
``(C) the significance of the results of such testing,
including the potential for developing AIDS, hepatitis B, or
hepatitis C;
``(2) reviewing the appropriateness of further counseling,
testing, and education of the individual regarding HIV/AIDS
and other sexually transmitted diseases; and
``(3) providing counseling--
``(A) on the availability, through the applicant, of early
intervention services;
``(B) on the availability in the geographic area of
appropriate health care, mental health care, and social and
support services, including providing referrals for such
services, as appropriate;
``(C)(i) that explains the benefits of locating and
counseling any individual by whom the infected individual may
have been exposed to HIV/AIDS, hepatitis B, or hepatitis C
and any individual whom the infected individual may have
exposed to HIV/AIDS, hepatitis B, or hepatitis C; and
``(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/AIDS,
hepatitis B, or hepatitis C; and
``(D) on the availability of the services of public health
authorities with respect to locating and counseling any
individual described in subparagraph (C);
``(4) if diagnosed with chronic hepatitis B or hepatitis C
co-infection, the potential of developing hepatitis-related
liver disease and its impact on HIV/AIDS; and
``(5) information regarding the availability of hepatitis B
vaccine.
``(c) Additional Requirements Regarding Appropriate
Counseling.--The Secretary may not make a grant under this
part unless the applicant for the grant agrees that, in
counseling individuals with respect to HIV/AIDS, the
applicant will ensure that the counseling is provided under
conditions appropriate to the needs of the individuals.
``(d) Counseling of Emergency Response Employees.--The
Secretary may not make a grant under this part to a State
unless the State agrees that, in counseling individuals with
respect to HIV/AIDS, the State will ensure that, in the case
of emergency response employees, the counseling is provided
to such employees under conditions appropriate to the needs
of the employees regarding the counseling.
``(e) Rule of Construction Regarding Counseling Without
Testing.--Agreements made pursuant to this section may not be
construed to prohibit any grantee under this part from
expending the grant for the purpose of providing counseling
services described in this section to an individual who does
not undergo testing for HIV/AIDS as a result of the grantee
or the individual determining that such testing of the
individual is not appropriate.''.
SEC. 306. GENERAL PROVISIONS.
(a) Applicability of Certain Requirements.--Section 2663 of
the Public Health Service Act (42 U.S.C. 300ff-63) is amended
by striking ``will, without'' and all that follows through
``be carried'' and inserting ``with funds appropriated
through this Act will be carried''.
(b) Additional Required Agreements.--Section 2664(a) of the
Public Health Service Act (42 U.S.C. 300ff-64(a)) is
amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by striking ``and'' at the end;
(B) in subparagraph (B), by striking ``and'' at the end;
and
(C) by adding at the end the following:
``(C) information regarding how the expected expenditures
of the grant are related to the planning process for
localities funded under part A (including the planning
process described in section 2602) and for States funded
under part B (including the planning process described in
section 2617(b)); and
``(D) a specification of the expected expenditures and how
those expenditures will improve overall client outcomes, as
described in the State plan under section 2617(b);'';
(2) in paragraph (2), by striking the period and inserting
a semicolon; and
[[Page H9293]]
(3) by adding at the end the following:
``(3) the applicant agrees to provide additional
documentation to the Secretary regarding the process used to
obtain community input into the design and implementation of
activities related to such grant; and
``(4) the applicant agrees to submit, every 2 years, to the
lead State agency under section 2617(b)(4) audits, consistent
with Office of Management and Budget circular A133, regarding
funds expended in accordance with this title and shall
include necessary client level data to complete unmet need
calculations and Statewide coordinated statements of need
process.''.
(c) Payer of Last Resort.--Section 2664(f)(1)(A) of the
Public Health Service Act (42 U.S.C. 300ff-64(f)(1)(A)) is
amended by inserting ``(except for a program administered by
or providing the services of the Indian Health Service)''
before the semicolon.
TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH
SEC. 401. WOMEN, INFANTS, CHILDREN, AND YOUTH.
Part D of title XXVI of the Public Health Service Act (42
U.S.C. 300ff-71 et seq.) is amended to read as follows:
``PART D--WOMEN, INFANTS, CHILDREN, AND YOUTH
``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO
RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND
YOUTH.
``(a) In General.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall award grants to public and nonprofit
private entities (including a health facility operated by or
pursuant to a contract with the Indian Health Service) for
the purpose of providing family-centered care involving
outpatient or ambulatory care (directly or through contracts)
for women, infants, children, and youth with HIV/AIDS.
``(b) Additional Services for Patients and Families.--Funds
provided under grants awarded under subsection (a) may be
used for the following support services:
``(1) Family-centered care including case management.
``(2) Referrals for additional services including--
``(A) referrals for inpatient hospital services, treatment
for substance abuse, and mental health services; and
``(B) referrals for other social and support services, as
appropriate.
``(3) Additional services necessary to enable the patient
and the family to participate in the program established by
the applicant pursuant to such subsection including services
designed to recruit and retain youth with HIV.
``(4) The provision of information and education on
opportunities to participate in HIV/AIDS-related clinical
research.
``(c) Coordination With Other Entities.--A grant awarded
under subsection (a) may be made only if the applicant
provides an agreement that includes the following:
``(1) The applicant will coordinate activities under the
grant with other providers of health care services under this
Act, and under title V of the Social Security Act, including
programs promoting the reduction and elimination of risk of
HIV/AIDS for youth.
``(2) The applicant will participate in the statewide
coordinated statement of need under part B (where it has been
initiated by the public health agency responsible for
administering grants under part B) and in revisions of such
statement.
``(3) The applicant will every 2 years submit to the lead
State agency under section 2617(b)(4) audits regarding funds
expended in accordance with this title and shall include
necessary client-level data to complete unmet need
calculations and Statewide coordinated statements of need
process.
``(d) Administration; Application.--A grant may only be
awarded to an entity under subsection (a) if an application
for the grant is submitted to the Secretary and the
application is in such form, is made in such manner, and
contains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out this
section. Such application shall include the following:
``(1) Information regarding how the expected expenditures
of the grant are related to the planning process for
localities funded under part A (including the planning
process outlined in section 2602) and for States funded under
part B (including the planning process outlined in section
2617(b)).
``(2) A specification of the expected expenditures and how
those expenditures will improve overall patient outcomes, as
outlined as part of the State plan (under section 2617(b)) or
through additional outcome measures.
``(e) Annual Review of Programs; Evaluations.--
``(1) Review regarding access to and participation in
programs.--With respect to a grant under subsection (a) for
an entity for a fiscal year, the Secretary shall, not later
than 180 days after the end of the fiscal year, provide for
the conduct and completion of a review of the operation
during the year of the program carried out under such
subsection by the entity. The purpose of such review shall be
the development of recommendations, as appropriate, for
improvements in the following:
``(A) Procedures used by the entity to allocate
opportunities and services under subsection (a) among
patients of the entity who are women, infants, children, or
youth.
``(B) Other procedures or policies of the entity regarding
the participation of such individuals in such program.
``(2) Evaluations.--The Secretary shall, directly or
through contracts with public and private entities, provide
for evaluations of programs carried out pursuant to
subsection (a).
``(f) Administrative Expenses.--
``(1) Limitation.--A grantee may not use more than 10
percent of amounts received under a grant awarded under this
section for administrative expenses.
``(2) Clinical quality management program.--A grantee under
this section shall implement a clinical quality management
program to assess the extent to which HIV health services
provided to patients under the grant are consistent with the
most recent Public Health Service guidelines for the
treatment of HIV/AIDS and related opportunistic infection,
and as applicable, to develop strategies for ensuring that
such services are consistent with the guidelines for
improvement in the access to and quality of HIV health
services.
``(g) Training and Technical Assistance.--From the amounts
appropriated under subsection (i) for a fiscal year, the
Secretary may use not more than 5 percent to provide,
directly or through contracts with public and private
entities (which may include grantees under subsection (a)),
training and technical assistance to assist applicants and
grantees under subsection (a) in complying with the
requirements of this section.
``(h) Definitions.--In this section:
``(1) Administrative expenses.--The term `administrative
expenses' means funds that are to be used by grantees for
grant management and monitoring activities, including costs
related to any staff or activity unrelated to services or
indirect costs.
``(2) Indirect costs.--The term `indirect costs' means
costs included in a Federally negotiated indirect rate.
``(3) Services.--The term `services' means--
``(A) services that are provided to clients to meet the
goals and objectives of the program under this section,
including the provision of professional, diagnostic, and
therapeutic services by a primary care provider or a referral
to and provision of specialty care; and
``(B) services that sustain program activity and contribute
to or help improve services under subparagraph (A).
``(i) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated, $71,800,000 for each of the fiscal years 2007
through 2009.''.
SEC. 402. GAO REPORT.
Not later than 24 months after the date of enactment of
this Act, the Comptroller General of the Government
Accountability Office shall conduct an evaluation, and submit
to Congress a report, concerning the funding provided for
under part D of title XXVI of the Public Health Service Act
to determine--
(1) how funds are used to provide the administrative
expenses, indirect costs, and services, as defined in section
2671(h) of such title, for individuals with HIV/AIDS;
(2) how funds are used to provide the administrative
expenses, indirect costs, and services, as defined in section
2671(h) of such title, to family members of women, infants,
children, and youth infected with HIV/AIDS;
(3) how funds are used to provide family-centered care
involving outpatient or ambulatory care authorized under
section 2671(a) of such title;
(4) how funds are used to provide additional services
authorized under section 2671(b) of such title; and
(5) how funds are used to help identify HIV-positive
pregnant women and their children who are exposed to HIV and
connect them with care that can improve their health and
prevent perinatal transmission.
TITLE V--GENERAL PROVISIONS
SEC. 501. GENERAL PROVISIONS.
Part E of title XXVI of the Public Health Service Act (42
U.S.C. 300ff-80 et seq.) is amended to read as follows:
``PART E--GENERAL PROVISIONS
``SEC. 2681. COORDINATION.
``(a) Requirement.--The Secretary shall ensure that the
Health Resources and Services Administration, the Centers for
Disease Control and Prevention, the Substance Abuse and
Mental Health Services Administration, and the Centers for
Medicare & Medicaid Services coordinate the planning,
funding, and implementation of Federal HIV programs
(including all minority AIDS initiatives of the Public Health
Service, including under section 2693) to enhance the
continuity of care and prevention services for individuals
with HIV/AIDS or those at risk of such disease. The Secretary
shall consult with other Federal agencies, including the
Department of Veterans Affairs, as needed and utilize
planning information submitted to such agencies by the States
and entities eligible for assistance under this title.
``(b) Report.--The Secretary shall biennially prepare and
submit to the appropriate committees of the Congress a report
concerning the coordination efforts at the Federal, State,
and local levels described in this section, including a
description of Federal barriers to HIV program integration
and a strategy for eliminating such barriers and enhancing
the continuity of care and prevention services for
individuals with HIV/AIDS or those at risk of such disease.
``(c) Integration by State.--As a condition of receipt of
funds under this title, a State shall provide assurances to
the Secretary that health support services funded under this
title will be integrated with other such services, that
programs will be coordinated with other available programs
(including Medicaid), and that the continuity of care and
prevention services of individuals with HIV/AIDS is enhanced.
``(d) Integration by Local or Private Entities.--As a
condition of receipt of funds under this title, a local
government or private nonprofit entity shall provide
assurances to the Secretary that services funded under this
title will
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be integrated with other such services, that programs will be
coordinated with other available programs (including
Medicaid), and that the continuity of care and prevention
services of individuals with HIV is enhanced.
``SEC. 2682. AUDITS.
``(a) In General.--For fiscal year 2009, and each
subsequent fiscal year, the Secretary may reduce the amounts
of grants under this title to a State or political
subdivision of a State for a fiscal year if, with respect to
such grants for the second preceding fiscal year, the State
or subdivision fails to prepare audits in accordance with the
procedures of section 7502 of title 31, United States Code.
The Secretary shall annually select representative samples of
such audits, prepare summaries of the selected audits, and
submit the summaries to the Congress.
``(b) Posting on the Internet.--All audits that the
Secretary receives from the State lead agency under section
2617(b)(4) shall be posted, in their entirety, on the
Internet website of the Health Resources and Services
Administration.
``SEC. 2683. PUBLIC HEALTH EMERGENCY.
``(a) In General.--In an emergency area and during an
emergency period, the Secretary shall have the authority to
waive such requirements of this title to improve the health
and safety of those receiving care under this title and the
general public, except that the Secretary may not expend more
than 5 percent of the funds allocated under this title for
sections 2620 and section 2603(b).
``(b) Emergency Area and Emergency Period.--In this
section:
``(1) Emergency area.--The term `emergency area' means a
geographic area in which there exists--
``(A) an emergency or disaster declared by the President
pursuant to the National Emergencies Act or the Robert T.
Stafford Disaster Relief and Emergency Assistance Act; or
``(B) a public health emergency declared by the Secretary
pursuant to section 319.
``(2) Emergency period.--The term `emergency period' means
the period in which there exists--
``(A) an emergency or disaster declared by the President
pursuant to the National Emergencies Act or the Robert T.
Stafford Disaster Relief and Emergency Assistance Act; or
``(B) a public health emergency declared by the Secretary
pursuant to section 319.
``(c) Unobligated Funds.--If funds under a grant under this
section are not expended for an emergency in the fiscal year
in which the emergency is declared, such funds shall be
returned to the Secretary for reallocation under sections
2603(b) and 2620.
``SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.
``None of the funds appropriated under this title shall be
used to fund AIDS programs, or to develop materials, designed
to promote or encourage, directly, intravenous drug use or
sexual activity, whether homosexual or heterosexual. Funds
authorized under this title may be used to provide medical
treatment and support services for individuals with HIV.
``SEC. 2685. PRIVACY PROTECTIONS.
``(a) In General.--The Secretary shall ensure that any
information submitted to, or collected by, the Secretary
under this title excludes any personally identifiable
information.
``(b) Definition.--In this section, the term `personally
identifiable information' has the meaning given such term
under the regulations promulgated under section 264(c) of the
Health Insurance Portability and Accountability Act of 1996.
``SEC. 2686. GAO REPORT.
``The Comptroller General of the Government Accountability
Office shall biennially submit to the appropriate committees
of Congress a report that includes a description of Federal,
State, and local barriers to HIV program integration,
particularly for racial and ethnic minorities, including
activities carried out under subpart III of part F, and
recommendations for enhancing the continuity of care and the
provision of prevention services for individuals with HIV/
AIDS or those at risk for such disease. Such report shall
include a demonstration of the manner in which funds under
this subpart are being expended and to what extent the
services provided with such funds increase access to
prevention and care services for individuals with HIV/AIDS
and build stronger community linkages to address HIV
prevention and care for racial and ethnic minority
communities.
``SEC. 2687. SEVERITY OF NEED INDEX.
``(a) Development of Index.--Not later than September 30,
2008, the Secretary shall develop and submit to the
appropriate committees of Congress a severity of need index
in accordance with subsection (c).
``(b) Definition of Severity of Need Index.--In this
section, the term `severity of need index' means the index of
the relative needs of individuals within a State or area, as
identified by a number of different factors, and is a factor
or set of factors that is multiplied by the number of living
HIV/AIDS cases in a State or area, providing different
weights to those cases based on needs. Such factors or set of
factors may be different for different components of the
provisions under this title.
``(c) Requirements for Secretarial Submission.--When the
Secretary submits to the appropriate committees of Congress
the severity of need index under subsection (a), the
Secretary shall provide the following:
``(1) Methodology for and rationale behind developing the
severity of need index, including information related to the
field testing of the severity of need index.
``(2) An independent contractor analysis of activities
carried out under paragraph (1).
``(3) Information regarding the process by which the
Secretary received community input regarding the application
and development of the severity of need index.
``(d) Annual Reports.--If the Secretary fails to submit the
severity of need index under subsection (a) in either of
fiscal years 2007 or 2008, the Secretary shall prepare and
submit to the appropriate committees of Congress a report for
such fiscal year--
``(1) that updates progress toward having client level
data;
``(2) that updates the progress toward having a severity of
need index, including information related to the methodology
and process for obtaining community input; and
``(3) that, as applicable, states whether the Secretary
could develop a severity of need index before fiscal year
2009.
``SEC. 2688. DEFINITIONS.
``For purposes of this title:
``(1) AIDS.--The term `AIDS' means acquired immune
deficiency syndrome.
``(2) Co-occurring conditions.--The term `co-occurring
conditions' means one or more adverse health conditions in an
individual with HIV/AIDS, without regard to whether the
individual has AIDS and without regard to whether the
conditions arise from HIV.
``(3) Counseling.--The term `counseling' means such
counseling provided by an individual trained to provide such
counseling.
``(4) Family-centered care.--The term `family-centered
care' means the system of services described in this title
that is targeted specifically to the special needs of
infants, children, women and families. Family-centered care
shall be based on a partnership between parents,
professionals, and the community designed to ensure an
integrated, coordinated, culturally sensitive, and community-
based continuum of care for children, women, and families
with HIV/AIDS.
``(5) Families with hiv/aids.--The term `families with HIV/
AIDS' means families in which one or more members have HIV/
AIDS.
``(6) HIV.--The term `HIV' means infection with the human
immunodeficiency virus.
``(7) HIV/AIDS.--
``(A) In general.--The term `HIV/AIDS' means HIV, and
includes AIDS and any condition arising from AIDS.
``(B) Counting of cases.--The term `living cases of HIV/
AIDS', with respect to the counting of cases in a geographic
area during a period of time, means the sum of--
``(i) the number of living non-AIDS cases of HIV in the
area; and
``(ii) the number of living cases of AIDS in the area.
``(C) Non-aids cases.--The term `non-AIDS', with respect to
a case of HIV, means that the individual involved has HIV but
does not have AIDS.
``(8) Human immunodeficiency virus.--The term `human
immunodeficiency virus' means the etiologic agent for AIDS.
``(9) Official poverty line.--The term `official poverty
line' means the poverty line established by the Director of
the Office of Management and Budget and revised by the
Secretary in accordance with section 673(2) of the Omnibus
Budget Reconciliation Act of 1981.
``(10) Person.--The term `person' includes one or more
individuals, governments (including the Federal Government
and the governments of the States), governmental agencies,
political subdivisions, labor unions, partnerships,
associations, corporations, legal representatives, mutual
companies, joint-stock companies, trusts, unincorporated
organizations, receivers, trustees, and trustees in cases
under title 11, United States Code.
``(11) State.--
``(A) In general.--The term `State' means each of the 50
States, the District of Columbia, and each of the
territories.
``(B) Territories.--The term `territory' means each of
American Samoa, Guam, the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Mariana Islands, the Virgin
Islands, the Republic of the Marshall Islands, the Federated
States of Micronesia, and Palau.
``(12) Youth with hiv.--The term `youth with HIV' means
individuals who are 13 through 24 years old and who have HIV/
AIDS.''.
TITLE VI--DEMONSTRATION AND TRAINING
SEC. 601. DEMONSTRATION AND TRAINING.
Subpart I of part F of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-101 et seq.) is amended to read
as follows:
``Subpart I--Special Projects of National Significance
``SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.
``(a) In General.--Of the amount appropriated under each of
parts A, B, C, and D for each fiscal year, the Secretary
shall use the greater of $20,000,000 or an amount equal to 3
percent of such amount appropriated under each such part, but
not to exceed $25,000,000, to administer special projects of
national significance to--
``(1) quickly respond to emerging needs of individuals
receiving assistance under this title; and
``(2) to fund special programs to develop a standard
electronic client information data system to improve the
ability of grantees under this title to report client-level
data to the Secretary.
``(b) Grants.--The Secretary shall award grants under
subsection (a) to entities eligible for funding under parts
A, B, C, and D based on--
``(1) whether the funding will promote obtaining client
level data as it relates to the creation of a severity of
need index, including funds to facilitate the purchase and
enhance the utilization of qualified health information
technology systems;
``(2) demonstrated ability to create and maintain a
qualified health information technology system;
[[Page H9295]]
``(3) the potential replicability of the proposed activity
in other similar localities or nationally;
``(4) the demonstrated reliability of the proposed
qualified health information technology system across a
variety of providers, geographic regions, and clients; and
``(5) the demonstrated ability to maintain a safe and
secure qualified health information system; or
``(6) newly emerging needs of individuals receiving
assistance under this title.
``(c) Coordination.--The Secretary may not make a grant
under this section unless the applicant submits evidence that
the proposed program is consistent with the statewide
coordinated statement of need, and the applicant agrees to
participate in the ongoing revision process of such statement
of need.
``(d) Privacy Protection.--The Secretary may not make a
grant under this section for the development of a qualified
health information technology system unless the applicant
provides assurances to the Secretary that the system will, at
a minimum, comply with the privacy regulations promulgated
under section 264(c) of the Health Insurance Portability and
Accountability Act of 1996.
``(e) Replication.--The Secretary shall make information
concerning successful models or programs developed under this
part available to grantees under this title for the purpose
of coordination, replication, and integration. To facilitate
efforts under this subsection, the Secretary may provide for
peer-based technical assistance for grantees funded under
this part.''.
SEC. 602. AIDS EDUCATION AND TRAINING CENTERS.
(a) Amendments Regarding Schools and Centers.--Section
2692(a)(2) of the Public Health Service Act (42 U.S.C. 300ff-
111(a)(2)) is amended--
(1) in subparagraph (A)--
(A) by inserting ``and Native Americans'' after ``minority
individuals''; and
(B) by striking ``and'' at the end;
(2) in subparagraph (B), by striking the period and
inserting ``; and''; and
(3) by adding at the end the following:
``(C) train or result in the training of health
professionals and allied health professionals to provide
treatment for hepatitis B or C co-infected individuals.''.
(b) Authorizations of Appropriations for Schools, Centers,
and Dental Programs.--Section 2692(c) of the Public Health
Service Act (42 U.S.C. 300ff-111(c)) is amended to read as
follows:
``(c) Authorization of Appropriations.--
``(1) Schools; centers.--For the purpose of awarding grants
under subsection (a), there is authorized to be appropriated
$34,700,000 for each of the fiscal years 2007 through 2009.
``(2) Dental schools.--For the purpose of awarding grants
under subsection (b), there is authorized to be appropriated
$13,000,000 for each of the fiscal years 2007 through
2009.''.
SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE.
Part F of title XXVI of the Public Health Service Act (42
U.S.C. 300ff-101 et seq.) is amended by adding at the end the
following:
``Subpart III--Minority AIDS Initiative
``SEC. 2693. MINORITY AIDS INITIATIVE.
``(a) In General.--For the purpose of carrying out
activities under this section to evaluate and address the
disproportionate impact of HIV/AIDS on, and the disparities
in access, treatment, care, and outcomes for, racial and
ethnic minorities (including African Americans, Alaska
Natives, Latinos, American Indians, Asian Americans, Native
Hawaiians, and Pacific Islanders), there are authorized to be
appropriated $131,200,000 for fiscal year 2007, $135,100,000
for fiscal year 2008, and $139,100,000 for fiscal year 2009.
``(b) Certain Activities.--
``(1) In general.--In carrying out the purpose described in
subsection (a), the Secretary shall provide for--
``(A) emergency assistance under part A;
``(B) care grants under part B;
``(C) early intervention services under part C;
``(D) services through projects for HIV-related care under
part D; and
``(E) activities through education and training centers
under section 2692.
``(2) Allocations among activities.--Activities under
paragraph (1) shall be carried out by the Secretary in
accordance with the following:
``(A) For competitive, supplemental grants to improve HIV-
related health outcomes to reduce existing racial and ethnic
health disparities, the Secretary shall, of the amount
appropriated under subsection (a) for a fiscal year, reserve
the following, as applicable:
``(i) For fiscal year 2007, $43,800,000.
``(ii) For fiscal year 2008, $45,400,000.
``(iii) For fiscal year 2009, $47,100,000.
``(B) For competitive grants used for supplemental support
education and outreach services to increase the number of
eligible racial and ethnic minorities who have access to
treatment through the program under section 2616 for
therapeutics, the Secretary shall, of the amount appropriated
for a fiscal year under subsection (a), reserve the
following, as applicable:
``(i) For fiscal year 2007, $7,000,000.
``(ii) For fiscal year 2008, $7,300,000.
``(iii) For fiscal year 2009, $7,500,000.
``(C) For planning grants, capacity-building grants, and
services grants to health care providers who have a history
of providing culturally and linguistically appropriate care
and services to racial and ethnic minorities, the Secretary
shall, of the amount appropriated for a fiscal year under
subsection (a), reserve the following, as applicable:
``(i) For fiscal year 2007, $53,400,000.
``(ii) For fiscal year 2008, $55,400,000.
``(iii) For fiscal year 2009, $57,400,000.
``(D) For eliminating racial and ethnic disparities in the
delivery of comprehensive, culturally and linguistically
appropriate care services for HIV disease for women, infants,
children, and youth, the Secretary shall, of the amount
appropriated under subsection (a), reserve $18,500,000 for
each of the fiscal years 2007 through 2009.
``(E) For increasing the training capacity of centers to
expand the number of health care professionals with treatment
expertise and knowledge about the most appropriate standards
of HIV disease-related treatments and medical care for racial
and ethnic minority adults, adolescents, and children with
HIV disease, the Secretary shall, of the amount appropriated
under subsection (a), reserve $8,500,000 for each of the
fiscal years 2007 through 2009.
``(c) Consistency With Prior Program.--With respect to the
purpose described in subsection (a), the Secretary shall
carry out this section consistent with the activities carried
out under this title by the Secretary pursuant to the
Departments of Labor, Health and Human Services, and
Education, and Related Agencies Appropriations Act, 2002
(Public Law 107-116).''.
TITLE VII--MISCELLANEOUS PROVISIONS
SEC. 701. HEPATITIS; USE OF FUNDS.
Section 2667 of the Public Health Service Act (42 U.S.C.
300ff-67) is amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(4) shall provide information on the transmission and
prevention of hepatitis A, B, and C, including education
about the availability of hepatitis A and B vaccines and
assisting patients in identifying vaccination sites.''.
SEC. 702. CERTAIN REFERENCES.
Title XXVI of the Public Health Service Act (42 U.S.C.
300ff et seq.) is amended--
(1) by striking ``acquired immune deficiency syndrome''
each place such term appears, other than in section 2687(1)
(as added by section 501 of this Act), and inserting
``AIDS'';
(2) by striking ``such syndrome'' and inserting ``AIDS'';
and
(3) by striking ``HIV disease'' each place such term
appears and inserting ``HIV/AIDS''.
SEC. 703. REPEAL.
Effective on October 1, 2009, title XXVI of the Public
Health Service Act (42 U.S.C. 300ff et seq.) is repealed.
Mr. BARTON of Texas (during the reading). Mr. Speaker, I ask
unanimous consent that the Senate amendment be considered as read and
printed in the Record.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. ENGEL. Mr. Speaker, as home to 17 percent of the Nation's AIDS
population, there are few pieces of legislation we will pass this year
that are as profoundly important to New York as the Ryan White CARE
Act. New York remains the epicenter of the HIV/AIDS crisis, leading the
Nation in both the number of persons living with HIV/AIDS and the
number of new cases of HIV/AIDS each year.
This vital program which provides lifesaving services for individuals
with HIV/AIDS has unfortunately been relegated to a vicious formula
fight over the past year pitting States against each other, with a lot
of false statements being lodged along the way. I want to be clear that
despite what some may say, the HIV/AIDS epidemic has not ``shifted,''
it has expanded. One-half of all people living with AIDS reside in five
States: New York, California, Florida, Texas and New Jersey. Three of
these States: NY, NJ, and FL, will continue to face losses under this
reauthorization. There is no question that other States have mounting
epidemics and they are absolutely entitled and deserving of more
funding.
An ideal Ryan White bill would have ensured that every State had
enough money to meet their full needs. I offered an amendment in
committee to increase funding for the bill with Mr. Towns, Ms. Eshoo
and Mrs. Capps. It failed on an essentially party line vote, which is a
shame as this will minimize our ability to alleviate the growing unmet
need for HIV/AIDS treatment services in our communities nationwide.
However, there is no question that through hard work and real
compromise the bill that we will vote on today is dramatically better
than the Ryan White bill we voted on September 28. I am proud to have
been able to help negotiate changes with my House and Senate colleagues
that will contain essential protections for New York and other States.
While, NY will still endure losses that I believe are unjust for the
State that remains the epicenter of the AIDS Crisis, the most draconian
cuts have largely been mitigated and no longer threaten to decimate our
State's system of care. For this we can all be proud.
I am also pleased that the troubling Severity of Need Index (SONI)
provision, which would have taken State and local resources into
account when determining Federal funding has been improved. We have
always viewed caring for our HIV/AIDS patients as a partnership between
the local, State and Federal governments and strongly believe the
Severity of Need Index is a powerful disincentive for States and local
areas to take action. In this bill, HRSA will be allowed to work
towards developing a SONI but will be prohibited from
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using it to determine Federal funding in this reauthorization. Another
victory for responsible public policy.
Finally, it was an astute decision to intentionally shorten this
reauthorization from 5 to 3 years to incentivize the stakeholders and
authorizing committees to work swiftly and astutely on crafting a new
Ryan White bill that will be more just for all HIV/AIDS patients
nationwide.
Is this the bill I wanted? Of course not. I remain concerned that
States' differing HIV surveillance systems will prevent funding from
truly following the epidemic during the 3 years of the reauthorization.
However, I am grateful that this bill strongly limits formula losses to
counter potential undeserved funding shifts.
So, in the end, our mutual compromise has resulted in a new bill that
we can accept if not embrace. I wish to thank all the people who worked
so hard on this bill, including John Ford and William Garner of Mr.
Dingell's staff who strove to accommodate so many varying regional
concerns about HIV/AIDS. I am grateful for the tireless efforts of the
NY delegation, the New York Department of Health and NYC Mayor's office
who worked many long nights and weekends with us to help advocate for
the best possible bill we could negotiate. This was certainly a team
effort, and I know that the knowledge gained from the countless hours
of discussions we have had over the past year will strengthen our
ability to craft an even better Ryan White reauthorization in 3 years.
The SPEAKER pro tempore. Is there objection to the original request
of the gentleman from Texas?
There was no objection.
A motion to reconsider was laid on the table.
____________________