[Congressional Record Volume 155, Number 153 (Wednesday, October 21, 2009)]
[House]
[Pages H11523-H11533]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          RYAN WHITE HIV/AIDS TREATMENT EXTENSION ACT OF 2009

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
Senate bill (S. 1793) 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.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                S. 1793

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

     SECTION 1. SHORT TITLE; REFERENCES.

       (a) Short Title.--This Act may be cited as the ``Ryan White 
     HIV/AIDS Treatment Extension Act of 2009''.
       (b) References.--Except as otherwise specified, whenever in 
     this Act an amendment is expressed in terms of an amendment 
     to a section or other provision, the reference shall be 
     considered to be made to a section or other provision of the 
     Public Health Service Act (42 U.S.C. 201 et seq.).

     SEC. 2. REAUTHORIZATION OF HIV HEALTH CARE SERVICES PROGRAM.

       (a) Elimination of Sunset Provision.--
       (1) In general.--The Ryan White HIV/AIDS Treatment 
     Modernization Act of 2006 (Public Law 109-415; 120 Stat. 
     2767) is amended by striking section 703.
       (2) Effective date.--Paragraph (1) shall take effect as if 
     enacted on September 30, 2009.
       (3) Contingency provisions.--Notwithstanding section 703 of 
     the Ryan White HIV/AIDS Treatment Modernization Act of 2006 
     (Public Law 109-415; 120 Stat. 2767) and section 139 of the 
     Continuing Appropriations Resolution, 2010--
       (A) the provisions of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff et seq.), as in effect on 
     September 30, 2009, are hereby revived; and
       (B) the amendments made by this Act to title XXVI of the 
     Public Health Service Act

[[Page H11524]]

     (42 U.S.C. 300ff et seq.) shall apply to such title as so 
     revived and shall take effect as if enacted on September 30, 
     2009.
       (b) Part A Grants.--Section 2610(a) (42 U.S.C. 300ff-20(a)) 
     is amended by striking ``and $649,500,000 for fiscal year 
     2009'' and inserting ``$649,500,000 for fiscal year 2009, 
     $681,975,000 for fiscal year 2010, $716,074,000 for fiscal 
     year 2011, $751,877,000 for fiscal year 2012, and 
     $789,471,000 for fiscal year 2013''.
       (c) Part B Grants.--Section 2623(a) (42 U.S.C. 300ff-32(a)) 
     is amended by striking ``and $1,285,200,000 for fiscal year 
     2009'' and inserting ``$1,285,200,000 for fiscal year 2009, 
     $1,349,460,000 for fiscal year 2010, $1,416,933,000 for 
     fiscal year 2011, $1,487,780,000 for fiscal year 2012, and 
     $1,562,169,000 for fiscal year 2013''.
       (d) Part C Grants.--Section 2655 (42 U.S.C. 300ff-55) is 
     amended by striking ``and $235,100,000 for fiscal year 2009'' 
     and inserting ``$235,100,000 for fiscal year 2009, 
     $246,855,000 for fiscal year 2010, $259,198,000 for fiscal 
     year 2011, $272,158,000 for fiscal year 2012, and 
     $285,766,000 for fiscal year 2013''.
       (e) Part D Grants.--Section 2671(i) (42 U.S.C. 300ff-71(i)) 
     is amended by inserting before the period at the end ``, 
     $75,390,000 for fiscal year 2010, $79,160,000 for fiscal year 
     2011, $83,117,000 for fiscal year 2012, and $87,273,000 for 
     fiscal year 2013''.
       (f) Demonstration and Training Grants Under Part F.--
       (1) HIV/AIDS communities, schools, and centers.--Section 
     2692(c) (42 U.S.C. 300ff-111(c)) is amended--
       (A) in paragraph (1)--
       (i) by striking ``is authorized'' and inserting ``are 
     authorized''; and
       (ii) by inserting before the period at the end ``, 
     $36,535,000 for fiscal year 2010, $38,257,000 for fiscal year 
     2011, $40,170,000 for fiscal year 2012, and $42,178,000 for 
     fiscal year 2013'' ; and
       (B) in paragraph (2)--
       (i) by striking ``is authorized'' and inserting ``are 
     authorized''; and
       (ii) by inserting before the period at the end ``, 
     $13,650,000 for fiscal year 2010, $14,333,000 for fiscal year 
     2011, $15,049,000 for fiscal year 2012, and $15,802,000 for 
     fiscal year 2013''.
       (2) Minority aids initiative.--Section 2693 (42 U.S.C. 
     300ff-121) is amended--
       (A) in subsection (a), by striking ``and $139,100,000 for 
     fiscal year 2009.'' and inserting ``$139,100,000 for fiscal 
     year 2009, $146,055,000 for fiscal year 2010, $153,358,000 
     for fiscal year 2011, $161,026,000 for fiscal year 2012, and 
     $169,077,000 for fiscal year 2013. The Secretary shall 
     develop a formula for the awarding of grants under 
     subsections (b)(1)(A) and (b)(1)(B) that ensures that funding 
     is provided based on the distribution of populations 
     disproportionately impacted by HIV/AIDS.'';
       (B) in subsection (b)(2)--
       (i) in subparagraph (A)--

       (I) in the matter preceding clause (i), by striking 
     ``competitive,''; and
       (II) by adding at the end the following:

       ``(iv) For fiscal year 2010, $46,738,000.
       ``(v) For fiscal year 2011, $49,075,000.
       ``(vi) For fiscal year 2012, $51,528,000.
       ``(vii) For fiscal year 2013, $54,105,000.'';
       (ii) in subparagraph (B)--

       (I) in the matter preceding clause (i), by striking 
     ``competitive''; and
       (II) by adding at the end the following:

       ``(iv) For fiscal year 2010, $8,763,000.
       ``(v) For fiscal year 2011, $9,202,000.
       ``(vi) For fiscal year 2012, $9,662,000.
       ``(vii) For fiscal year 2013, $10,145,000.'';
       (iii) in subparagraph (C), by adding at the end the 
     following:
       ``(iv) For fiscal year 2010, $61,343,000.
       ``(v) For fiscal year 2011, $64,410,000.
       ``(vi) For fiscal year 2012, $67,631,000.
       ``(vii) For fiscal year 2013, $71,012,000.'';
       (iv) in subparagraph (D), by striking ``$18,500,000'' and 
     all that follows through the period and inserting the 
     following: ``the following, as applicable:
       ``(i) For fiscal year 2010, $20,448,000.
       ``(ii) For fiscal year 2011, $21,470,000.
       ``(iii) For fiscal year 2012, $22,543,000.
       ``(iv) For fiscal year 2013, $23,671,000.''; and
       (v) in subparagraph (E), by striking ``$8,500,000'' and all 
     that follows through the period and inserting the following: 
     ``the following, as applicable:
       ``(i) For fiscal year 2010, $8,763,000.
       ``(ii) For fiscal year 2011, $9,201,000.
       ``(iii) For fiscal year 2012, $9,662,000.
       ``(iv) For fiscal year 2013, $10,144,000.''; and
       (C) by adding at the end the following:
       ``(d) Synchronization of Minority AIDS Initiative.--For 
     fiscal year 2010 and each subsequent fiscal year, the 
     Secretary shall incorporate and synchronize the schedule of 
     application submissions and funding availability under this 
     section with the schedule of application submissions and 
     funding availability under the corresponding provisions of 
     this title XXVI as follows:
       ``(1) The schedule for carrying out subsection (b)(1)(A) 
     shall be the same as the schedule applicable to emergency 
     assistance under part A.
       ``(2) The schedule for carrying out subsection (b)(1)(B) 
     shall be the same as the schedule applicable to care grants 
     under part B.
       ``(3) The schedule for carrying out subsection (b)(1)(C) 
     shall be the same as the schedule applicable to grants for 
     early intervention services under part C.
       ``(4) The schedule for carrying out subsection (b)(1)(D) 
     shall be the same as the schedule applicable to grants for 
     services through projects for HIV-related care under part D.
       ``(5) The schedule for carrying out subsection (b)(1)(E) 
     shall be the same as the schedule applicable to grants and 
     contracts for activities through education and training 
     centers under section 2692.''.
       (3) HHS report.--Not later than 6 months after the 
     publication of the Government Accountability Office Report on 
     the Minority Aids Initiative described in section 2686, the 
     Secretary of Health and Human Services shall submit to the 
     appropriate committees of Congress a Departmental plan for 
     using funding under section 2693 of the Public Health Service 
     Act (42 U.S.C. 300ff-93) in all relevant agencies to build 
     capacity, taking into consideration the best practices 
     included in such Report.
       (g) GAO Report.--Section 2686 (42 U.S.C. 300ff-86) is 
     amended to read as follows:

     ``SEC. 2686. GAO REPORT.

       ``The Comptroller General of the Government Accountability 
     Office shall, not less than 1 year after the date of 
     enactment of the Ryan White HIV/AIDS Treatment Extension Act 
     of 2009, submit to the appropriate committees of Congress a 
     report describing Minority AIDS Initiative activities across 
     the Department of Health and Human Services, including 
     programs under this title and programs at the Centers for 
     Disease Control and Prevention, the Substance Abuse and 
     Mental Health Services Administration, and other departmental 
     agencies. Such report shall include a history of program 
     activities within each relevant agency and a description of 
     activities conducted, people served and types of grantees 
     funded, and shall collect and describe best practices in 
     community outreach and capacity-building of community based 
     organizations serving the communities that are 
     disproportionately affected by HIV/AIDS.''.

     SEC. 3. EXTENDED EXEMPTION PERIOD FOR NAMES-BASED REPORTING.

       (a) Part A Grants.--Section 2603(a)(3) (42 U.S.C. 300ff-
     13(a)(3)) is amended--
       (1) in subparagraph (C)--
       (A) in clause (ii)--
       (i) in the matter preceding subclause (I), by striking 
     ``2009'' and inserting ``2012''; and
       (ii) in subclause (II), by striking ``or 2009'' and 
     inserting ``or a subsequent fiscal year through fiscal year 
     2012'';
       (B) in clause (iv), by striking ``2010'' and inserting 
     ``2012'';
       (C) in clause (v), by inserting ``or a subsequent fiscal 
     year'' after ``2009'';
       (D) in clause (vi)(II), by inserting after ``5 percent'' 
     the following: ``for fiscal years before fiscal year 2012 
     (and 6 percent for fiscal year 2012)'';
       (E) in clause (ix)(II)--
       (i) by striking ``2010'' and inserting ``2013''; and
       (ii) by striking ``2009'' and inserting ``2012''; and
       (F) by adding at the end the following:
       ``(xi) Future fiscal years.--For fiscal years beginning 
     with fiscal year 2013, determinations under this paragraph 
     shall be based only on living names-based cases of HIV/AIDS 
     with respect to the area involved.''; and
       (2) in subparagraph (D)--
       (A) in clause (i)--
       (i) in the matter preceding subclause (I), by striking 
     ``2009'' and inserting ``2012''; and
       (ii) in subclause (II), by striking ``and 2009'' and 
     inserting ``through 2012''; and
       (B) in clause (ii), by striking ``2009'' and inserting 
     ``2012''.
       (b) Part B Grants.--Section 2618(a)(2) (42 U.S.C. 300ff-
     28(a)(2)) is amended--
       (1) in subparagraph (D)--
       (A) in clause (ii)--
       (i) in the matter preceding subclause (I), by striking 
     ``2009'' and inserting ``2012''; and
       (ii) in subclause (II), by striking ``or 2009'' and 
     inserting ``or a subsequent fiscal year through fiscal year 
     2012'';
       (B) in clause (iv), by striking ``2010'' and inserting 
     ``2012'';
       (C) in clause (v), by inserting ``or a subsequent fiscal 
     year'' after ``2009'';
       (D) in clause (vi)(II), by inserting after ``5 percent'' 
     the following: ``for fiscal years before fiscal year 2012 
     (and 6 percent for fiscal year 2012)'';
       (E) in clause (viii)(II)--
       (i) by striking ``2010'' and inserting ``2013''; and
       (ii) by striking ``2009'' and inserting ``2012''; and
       (F) by adding at the end the following:
       ``(x) Future fiscal years.--For fiscal years beginning with 
     fiscal year 2013, determinations under this paragraph shall 
     be based only on living names-based cases of HIV/AIDS with 
     respect to the State involved.''; and
       (2) in subparagraph (E), by striking ``2009'' each place it 
     appears and inserting ``2012''.

     SEC. 4. EXTENSION OF TRANSITIONAL GRANT AREA STATUS.

       (a) Eligibility.--Section 2609 (42 U.S.C. 300ff-19) is 
     amended--
       (1) in subsection (c)(1)--
       (A) in the heading, by striking ``2007'' and inserting 
     ``2011''; and
       (B) by striking ``2007'' each place it appears and 
     inserting ``2011''; and
       (C) by striking ``2006'' and inserting ``2010'';
       (2) in subsection (c)(2)--
       (A) in subparagraph (A)(ii), by striking ``to have a'' and 
     inserting ``subject to subparagraphs (B) and (C), to have 
     a'';
       (B) by redesignating subparagraph (B) as subparagraph (C);
       (C) by inserting after subparagraph (A) the following:

[[Page H11525]]

       ``(B) Permitting margin of error applicable to certain 
     metropolitan areas.--In applying subparagraph (A)(ii) for a 
     fiscal year after fiscal year 2008, in the case of a 
     metropolitan area that has a cumulative total of at least 
     1,400 (and fewer than 1,500) living cases of AIDS as of 
     December 31 of the most recent calendar year for which such 
     data is available, such area shall be treated as having met 
     the criteria of such subparagraph if not more than 5 percent 
     of the total from grants awarded to such area under this part 
     is unobligated as of the end of the most recent fiscal year 
     for which such data is available.''; and
       (D) in subparagraph (C), as so redesignated, by striking 
     ``Subparagraph (A) does not apply'' and inserting 
     ``Subparagraphs (A) and (B) do not apply''; and
       (3) in subsection (d)(1)(B), strike ``2009'' and insert 
     ``2013''.
       (b) Transfer of Amounts Due to Change in Status as 
     Transitional Area.--Subparagraph (B) of section 2610(c)(2) 
     (42 U.S.C. 300ff-20(c)(2)) is amended--
       (1) by striking ``(B)'' and inserting ``(B)(i) subject to 
     clause (ii),'';
       (2) by striking the period at the end and inserting ``; 
     and''; and
       (3) by adding at the end the following:
       ``(ii) for each of fiscal years 2010 through 2013, 
     notwithstanding subsection (a)--
       ``(I) there shall be transferred to the State containing 
     the metropolitan area, for purposes described in section 
     2612(a), an amount (which shall not be taken into account in 
     applying section 2618(a)(2)(H)) equal to--

       ``(aa) for the first fiscal year of the metropolitan area 
     not being a transitional area, 75 percent of the amount 
     described in subparagraph (A)(i) for such area;
       ``(bb) for the second fiscal year of the metropolitan area 
     not being a transitional area, 50 percent of such amount; and
       ``(cc) for the third fiscal year of the metropolitan area 
     not being a transitional area, 25 percent of such amount; and

       ``(II) there shall be transferred and made available for 
     grants pursuant to section 2618(a)(1) for the fiscal year, in 
     addition to amounts available for such grants under section 
     2623, an amount equal to the total amount of the reduction 
     for such fiscal year under subparagraph (A), less the amount 
     transferred for such fiscal year under subclause (I).''.

     SEC. 5. HOLD HARMLESS.

       (a) Part A Grants.--Section 2603(a)(4) (42 U.S.C. 300ff-
     13(a)(4)) is amended--
       (1) in the matter preceding clause (i) in subparagraph 
     (A)--
       (A) by striking ``2006'' and inserting ``2009''; and
       (B) by striking ``2007 through 2009'' and inserting ``2010 
     through 2013'';
       (2) by striking clauses (i) and (ii) in subparagraph (A) 
     and inserting the following:
       ``(i) For fiscal year 2010, an amount equal to 95 percent 
     of the sum of the amount of the grant made pursuant to 
     paragraph (3) and this paragraph for fiscal year 2009.
       ``(ii) For each of the fiscal years 2011 and 2012, an 
     amount equal to 100 percent of the amount of the grant made 
     pursuant to paragraph (3) and this paragraph for fiscal year 
     2010.
       ``(iii) For fiscal year 2013, an amount equal to 92.5 
     percent of the amount of the grant made pursuant to paragraph 
     (3) and this paragraph for fiscal year 2012.''; and
       (3) in subparagraph (C), by striking ``2009'' and inserting 
     ``2013''.
       (b) Part B Grants.--Section 2618(a)(2)(H) (42 U.S.C. 300ff-
     28(a)(2)(H)) is amended--
       (1) in clause (i)(I)--
       (A) by striking ``2007'' and inserting ``2010''; and
       (B) by striking ``2006'' and inserting ``2009'';
       (2) by striking clause (ii) and redesignating clause (iii) 
     as clause (ii);
       (3) in clause (ii), as so redesignated--
       (A) in the heading, by striking ``2008 and 2009'' and 
     inserting ``2011 and 2012'';
       (B) by striking ``2008 and 2009'' and inserting ``2011 and 
     2012''; and
       (C) by striking ``2007'' and inserting ``2010'';
       (4) by inserting after clause (ii), as so redesignated, the 
     following new clause:
       ``(iii) Fiscal year 2013.--For fiscal year 2013, the 
     Secretary shall ensure that the total for a State of the 
     grant pursuant to paragraph (1) and the grant pursuant to 
     subparagraph (F) is not less than 92.5 percent of such total 
     for the State for fiscal year 2012.''; and
       (5) in clause (v), by striking ``2009'' and inserting 
     ``2013''.
       (c) Technical Corrections.--Title XXVI (42 U.S.C. 300ff-11 
     et seq.) is amended--
       (1) in subparagraphs (A)(i) and (H) of section 2618(a)(2), 
     by striking the term ``subparagraph (G)'' each place it 
     appears and inserting ``subparagraph (F)'';
       (2) in sections 2620(a)(2), 2622(c)(1), and 2622(c)(4)(A), 
     by striking ``2618(a)(2)(G)(i)'' and inserting 
     ``2618(a)(2)(F)(i)'';
       (3) in sections 2622(a) and 2623(b)(2)(A), by striking 
     ``2618(a)(2)(G)'' and inserting ``2618(a)(2)(F)''; and
       (4) in section 2622(b), by striking ``2618(a)(2)(G)(ii)'' 
     and inserting ``2618(a)(2)(F)(ii)''.

     SEC. 6. AMENDMENTS TO THE GENERAL GRANT PROVISIONS.

       (a) Administration and Planning Council.--Section 
     2602(b)(4) (42 U.S.C. 300ff-12(b)(4)) is amended--
       (1) in subparagraph (A), by inserting ``, as well as the 
     size and demographics of the estimated population of 
     individuals with HIV/AIDS who are unaware of their HIV 
     status'' after ``HIV/AIDS'';
       (2) in subparagraph (B)--
       (A) in clause (i), by striking ``and'' at the end after the 
     semicolon;
       (B) in clause (ii), by inserting ``and'' after the 
     semicolon; and
       (C) by adding at the end the following:
       ``(iii) individuals with HIV/AIDS who do not know their HIV 
     status;''; and
       (3) in subparagraph (D)--
       (A) in clause (ii), by striking ``and'' at the end after 
     the semicolon;
       (B) in clause (iii), by inserting ``and'' after the 
     semicolon; and
       (C) by adding at the end the following:
       ``(iv) includes a strategy, coordinated as appropriate with 
     other community strategies and efforts, including discrete 
     goals, a timetable, and appropriate funding, for identifying 
     individuals with HIV/AIDS who do not know their HIV status, 
     making such individuals aware of such status, and enabling 
     such individuals to use the health and support services 
     described in section 2604, with particular attention to 
     reducing barriers to routine testing and disparities in 
     access and services among affected subpopulations and 
     historically underserved communities;''.
       (b) Type and Distribution of Grants.--Section 2603(b) (42 
     U.S.C. 300ff-13(b)) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (G), by striking ``and'' at the end 
     after the semicolon;
       (B) in subparagraph (H), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following:
       ``(I) demonstrates success in identifying individuals with 
     HIV/AIDS as described in clauses (i) through (iii) of 
     paragraph (2)(A).''; and
       (2) in paragraph (2)(A), by striking the period and 
     inserting: ``, and demonstrated success in identifying 
     individuals with HIV/AIDS who do not know their HIV status 
     and making them aware of such status counting one-third. In 
     making such determination, the Secretary shall consider--
       ``(i) the number of individuals who have been tested for 
     HIV/AIDS;
       ``(ii) of those individuals described in clause (i), the 
     number of individuals who tested for HIV/AIDS who are made 
     aware of their status, including the number who test 
     positive; and
       ``(iii) of those individuals described in clause (ii), the 
     number who have been referred to appropriate treatment and 
     care.''.
       (c) Application.--Section 2605(b)(1) (42 U.S.C. 300ff-
     15(b)(1)) is amended by inserting ``, including the 
     identification of individuals with HIV/AIDS as described in 
     clauses (i) through (iii) of section 2603(b)(2)(A)'' before 
     the semicolon at the end.

     SEC. 7. INCREASE IN ADJUSTMENT FOR NAMES-BASED REPORTING.

       (a) Part A Grants.--
       (1) Formula grants.--Section 2603(a)(3)(C)(vi) (42 U.S.C. 
     300ff-13(a)(3)(C)(vi)) is amended by adding at the end the 
     following:

       ``(III) Increased adjustment for certain areas previously 
     using code-based reporting.--For purposes of this 
     subparagraph for each of fiscal years 2010 through 2012, the 
     Secretary shall deem the applicable number of living cases of 
     HIV/AIDS in an area that were reported to and confirmed by 
     the Centers for Disease Control and Prevention to be 3 
     percent higher than the actual number if--

       ``(aa) for fiscal year 2007, such area was a transitional 
     area;
       ``(bb) fiscal year 2007 was the first year in which the 
     count of living non-AIDS cases of HIV in such area, for 
     purposes of this section, was based on a names-based 
     reporting system; and
       ``(cc) the amount of funding that such area received under 
     this part for fiscal year 2007 was less than 70 percent of 
     the amount of funding (exclusive of funds that were 
     identified as being for purposes of the Minority AIDS 
     Initiative) that such area received under such part for 
     fiscal year 2006.''.
       (2) Supplemental grants.--Section 2603(b)(2) (42 U.S.C. 
     300ff-13(b)(2)) is amended by adding at the end the 
     following:
       ``(D) Increased adjustment for certain areas previously 
     using code-based reporting.--For purposes of this subsection 
     for each of fiscal years 2010 through 2012, the Secretary 
     shall deem the applicable number of living cases of HIV/AIDS 
     in an area that were reported to and confirmed by the Centers 
     for Disease Control and Prevention to be 3 percent higher 
     than the actual number if the conditions described in items 
     (aa) through (cc) of subsection (a)(3)(C)(vi)(III) are all 
     satisfied.''.
       (b) Part B Grants.--Section 2618(a)(2)(D)(vi) (42 U.S.C. 
     300ff-28(a)(2)(D)(vi)) is amended by adding at the end the 
     following:

       ``(III) Increased adjustment for certain states previously 
     using code-based reporting.--For purposes of this 
     subparagraph for each of fiscal years 2010 through 2012, the 
     Secretary shall deem the applicable number of living cases of 
     HIV/AIDS in a State that were reported to and confirmed by 
     the Centers for Disease Control and Prevention to be 3 
     percent higher than the actual number if--

       ``(aa) there is an area in such State that satisfies all of 
     the conditions described in items (aa) through (cc) of 
     section 2603(a)(3)(C)(vi)(III); or
       ``(bb)(AA) fiscal year 2007 was the first year in which the 
     count of living non-AIDS cases of HIV in such area, for 
     purposes of this part, was based on a names-based reporting 
     system; and

[[Page H11526]]

       ``(BB) the amount of funding that such State received under 
     this part for fiscal year 2007 was less than 70 percent of 
     the amount of funding that such State received under such 
     part for fiscal year 2006.''.

     SEC. 8. TREATMENT OF UNOBLIGATED FUNDS.

       (a) Eligibility for Supplemental Grants.--Title XXVI (42 
     U.S.C. 300ff-11 et seq.) is amended--
       (1) in section 2603(b)(1)(H) (42 U.S.C. 300ff-13(b)(1)(H)), 
     by striking ``2 percent'' and inserting ``5 percent''; and
       (2) in section 2620(a)(2) (42 U.S.C. 300ff-29a(a)(2)), by 
     striking ``2 percent'' and inserting ``5 percent''.
       (b) Corresponding Reduction in Future Grant.--
       (1) In general.--Title XXVI (42 U.S.C. 300ff-11 et seq.) is 
     amended--
       (A) in section 2603(c)(3)(D)(i)(42 U.S.C. 300ff-
     13(c)(3)(D)(i)), in the matter following subclause (II), by 
     striking ``2 percent'' and inserting ``5 percent''; and
       (B) in section 2622(c)(4)(A) (42 U.S.C. 300ff-
     31a(c)(4)(A)), in the matter following clause (ii), by 
     striking ``2 percent'' and inserting ``5 percent''.
       (2) Authority regarding administration of provision.--Title 
     XXVI (42 U.S.C. 300ff-11 et seq.) is amended--
       (A) in section 2603(c) (42 U.S.C. 300ff-13(c)), by adding 
     at the end the following:
       ``(4) Authority regarding administration of provisions.--In 
     administering paragraphs (2) and (3) with respect to the 
     unobligated balance of an eligible area, the Secretary may 
     elect to reduce the amount of future grants to the area under 
     subsection (a) or (b), as applicable, by the amount of any 
     such unobligated balance in lieu of cancelling such amount as 
     provided for in paragraph (2) or (3)(A). In such case, the 
     Secretary may permit the area to use such unobligated balance 
     for purposes of any such future grant. An amount equal to 
     such reduction shall be available for use as additional 
     amounts for grants pursuant to subsection (b), subject to 
     subsection (a)(4) and section 2610(d)(2). Nothing in this 
     paragraph shall be construed to affect the authority of the 
     Secretary under paragraphs (2) and (3), including the 
     authority to grant waivers under paragraph (3)(A). The 
     reduction in future grants authorized under this paragraph 
     shall be notwithstanding the penalty required under paragraph 
     (3)(D) with respect to unobligated funds.'';
       (B) in section 2622 (42 U.S.C. 300ff-31a), by adding at the 
     end the following:
       ``(e) Authority Regarding Administration of Provisions.--In 
     administering subsections (b) and (c) with respect to the 
     unobligated balance of a State, the Secretary may elect to 
     reduce the amount of future grants to the State under section 
     2618, 2620, or 2621, as applicable, by the amount of any such 
     unobligated balance in lieu of cancelling such amount as 
     provided for in subsection (b) or (c)(1). In such case, the 
     Secretary may permit the State to use such unobligated 
     balance for purposes of any such future grant. An amount 
     equal to such reduction shall be available for use as 
     additional amounts for grants pursuant to section 2620, 
     subject to section 2618(a)(2)(H). Nothing in this paragraph 
     shall be construed to affect the authority of the Secretary 
     under subsections (b) and (c), including the authority to 
     grant waivers under subsection (c)(1). The reduction in 
     future grants authorized under this subsection shall be 
     notwithstanding the penalty required under subsection (c)(4) 
     with respect to unobligated funds.'';
       (C) in section 2603(b)(1)(H) (42 U.S.C. 300ff-13(b)(1)(H)), 
     by striking ``canceled'' and inserting ``canceled, offset 
     under subsection (c)(4),''; and
       (D) in section 2620(a)(2) (42 U.S.C. 300ff-29a(a)(2)), by 
     striking ``canceled'' and inserting ``canceled, offset under 
     section 2622(e),''.
       (c) Consideration of Waiver Amounts in Determining 
     Unobligated Balances.--
       (1) Part a grants.--Section 2603(c)(3)(D)(i)(I) (42 U.S.C. 
     300ff-14(c)(3)(D)(i)(I)) is amended by inserting after 
     ``unobligated balance'' the following: ``(less any amount of 
     such balance that is the subject of a waiver of cancellation 
     under subparagraph (A))''.
       (2) Part b grants.--Section 2622(c)(4)(A)(i) (42 U.S.C. 
     300ff--31a(c)(4)(A)(i)) is amended by inserting after 
     ``unobligated balance'' the following: ``(less any amount of 
     such balance that is the subject of a waiver of cancellation 
     under paragraph (1))''.

     SEC. 9. APPLICATIONS BY STATES.

       Section 2617(b) (42 U.S.C. Section 300ff-27(b)) is 
     amended--
       (1) in paragraph (6), by striking ``and'' at the end;
       (2) in paragraph (7), by striking the period at the end and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(8) a comprehensive plan--
       ``(A) containing an identification of individuals with HIV/
     AIDS as described in clauses (i) through (iii) of section 
     2603(b)(2)(A) and the strategy required under section 
     2602(b)(4)(D)(iv);
       ``(B) describing the estimated number of individuals within 
     the State with HIV/AIDS who do not know their status;
       ``(C) describing activities undertaken by the State to find 
     the individuals described in subparagraph (A) and to make 
     such individuals aware of their status;
       ``(D) describing the manner in which the State will provide 
     undiagnosed individuals who are made aware of their status 
     with access to medical treatment for their HIV/AIDS; and
       ``(E) describing efforts to remove legal barriers, 
     including State laws and regulations, to routine testing.''.

     SEC. 10. ADAP REBATE FUNDS.

       (a) Use of Unobligated Funds.--Section 2622(d) (42 U.S.C. 
     300ff-31a(d)) is amended by adding at the end the following: 
     ``If an expenditure of ADAP rebate funds would trigger a 
     penalty under this section or a higher penalty than would 
     otherwise have applied, the State may request that for 
     purposes of this section, the Secretary deem the State's 
     unobligated balance to be reduced by the amount of rebate 
     funds in the proposed expenditure. Notwithstanding 
     2618(a)(2)(F), any unobligated amount under section 
     2618(a)(2)(F)(ii)(V) that is returned to the Secretary for 
     reallocation shall be used by the Secretary for--
       ``(1) the ADAP supplemental program if the Secretary 
     determines appropriate; or
       ``(2) for additional amounts for grants pursuant to section 
     2620.''.
       (b) Technical Correction.--Subclause (V) of section 
     2618(a)(2)(F)(ii) (42 U.S.C. 300ff-28(a)(2)(F)(ii)) is 
     amended by striking ``, subject to subclause (VI)''.

     SEC. 11. APPLICATION TO PRIMARY CARE SERVICES.

       (a) In General.--Section 2671 (42 U.S.C. 300ff-71), as 
     amended, is amended--
       (1) by redesignating subsection (i) as subsection (j);
       (2) in subsection (g), by striking ``subsection (i)'' and 
     inserting ``subsection (j)''; and
       (3) by inserting after subsection (h) the following:
       ``(i) Application to Primary Care Services.--Nothing in 
     this part shall be construed as requiring funds under this 
     part to be used for primary care services when payments are 
     available for such services from other sources (including 
     under titles XVIII, XIX, and XXI of the Social Security 
     Act).''.
       (b) Provision of Care Through Memorandum of 
     Understanding.--Section 2671(a) (42 U.S.C. 300ff-71(a)) is 
     amended by striking ``(directly or through contracts)'' and 
     inserting ``(directly or through contracts or memoranda of 
     understanding)''.

     SEC. 12. NATIONAL HIV/AIDS TESTING GOAL.

       Part E of title XXVI (42 U.S.C. 300ff-81 et seq.) is 
     amended--
       (1) by redesignating section 2688 as section 2689; and
       (2) by inserting after section 2687 the following:

     ``SEC. 2688. NATIONAL HIV/AIDS TESTING GOAL.

       ``(a) In General.--Not later than January 1, 2010, the 
     Secretary shall establish a national HIV/AIDS testing goal of 
     5,000,000 tests for HIV/AIDS annually through federally-
     supported HIV/AIDS prevention, treatment, and care programs, 
     including programs under this title and other programs 
     administered by the Centers for Disease Control and 
     Prevention.
       ``(b) Annual Report.--Not later than January 1, 2011, and 
     annually thereafter, the Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall submit to Congress a report describing, with regard to 
     the preceding 12-month reporting period--
       ``(1) whether the testing goal described in subsection (a) 
     has been met;
       ``(2) the total number of individuals tested through 
     federally-supported and other HIV/AIDS prevention, treatment, 
     and care programs in each State;
       ``(3) the number of individuals who--
       ``(A) prior to such 12-month period, were unaware of their 
     HIV status; and
       ``(B) through federally-supported and other HIV/AIDS 
     prevention, treatment, and care programs, were diagnosed and 
     referred into treatment and care during such period;
       ``(4) any barriers, including State laws and regulations, 
     that the Secretary determines to be a barrier to meeting the 
     testing goal described in subsection (a);
       ``(5) the amount of funding the Secretary determines 
     necessary to meet the annual testing goal in the following 12 
     months and the amount of Federal funding expended to meet the 
     testing goal in the prior 12-month period; and
       ``(6) the most cost-effective strategies for identifying 
     and diagnosing individuals who were unaware of their HIV 
     status, including voluntary testing with pre-test counseling, 
     routine screening including opt-out testing, partner 
     counseling and referral services, and mass media campaigns.
       ``(c) Review of Program Effectiveness.--Not later than 1 
     year after the date of enactment of this section, the 
     Secretary, in consultation with the Director of the Centers 
     for Disease Control and Prevention, shall submit a report to 
     Congress based on a comprehensive review of each of the 
     programs and activities conducted by the Centers for Disease 
     Control and Prevention as part of the Domestic HIV/AIDS 
     Prevention Activities, including the following:
       ``(1) The amount of funding provided for each program or 
     activity.
       ``(2) The primary purpose of each program or activity.
       ``(3) The annual goals for each program or activity.
       ``(4) The relative effectiveness of each program or 
     activity with relation to the other programs and activities 
     conducted by the Centers for Disease Control and Prevention, 
     based on the--
       ``(A) number of previously undiagnosed individuals with 
     HIV/AIDS made aware of their status and referred into the 
     appropriate treatment;

[[Page H11527]]

       ``(B) amount of funding provided for each program or 
     activity compared to the number of undiagnosed individuals 
     with HIV/AIDS made aware of their status;
       ``(C) program's contribution to the National HIV/AIDS 
     testing goal; and
       ``(D) progress made toward the goals described in paragraph 
     (3).
       ``(5) Recommendations if any to Congress on ways to 
     allocate funding for domestic HIV/AIDS prevention activities 
     and programs in order to achieve the National HIV/AIDS 
     testing goal.
       ``(d) Coordination With Other Federal Activities.--In 
     pursuing the National HIV/AIDS testing goal, the Secretary, 
     where appropriate, shall consider and coordinate with other 
     national strategies conducted by the Federal Government to 
     address HIV/AIDS.''.

     SEC. 13. NOTIFICATION OF POSSIBLE EXPOSURE TO INFECTIOUS 
                   DISEASES.

       Title XXVI (42 U.S.C. 300ff-11 et seq.) is amended by 
     adding at the end the following:

   ``PART G--NOTIFICATION OF POSSIBLE EXPOSURE TO INFECTIOUS DISEASES

     ``SEC. 2695. INFECTIOUS DISEASES AND CIRCUMSTANCES RELEVANT 
                   TO NOTIFICATION REQUIREMENTS.

       ``(a) In General.--Not later than 180 days after the date 
     of the enactment of this part, the Secretary shall complete 
     the development of--
       ``(1) a list of potentially life-threatening infectious 
     diseases, including emerging infectious diseases, to which 
     emergency response employees may be exposed in responding to 
     emergencies;
       ``(2) guidelines describing the circumstances in which such 
     employees may be exposed to such diseases, taking into 
     account the conditions under which emergency response is 
     provided; and
       ``(3) guidelines describing the manner in which medical 
     facilities should make determinations for purposes of section 
     2695B(d).
       ``(b) Specification of Airborne Infectious Diseases.--The 
     list developed by the Secretary under subsection (a)(1) shall 
     include a specification of those infectious diseases on the 
     list that are routinely transmitted through airborne or 
     aerosolized means.
       ``(c) Dissemination.--The Secretary shall--
       ``(1) transmit to State public health officers copies of 
     the list and guidelines developed by the Secretary under 
     subsection (a) with the request that the officers disseminate 
     such copies as appropriate throughout the States; and
       ``(2) make such copies available to the public.

     ``SEC. 2695A. ROUTINE NOTIFICATIONS WITH RESPECT TO AIRBORNE 
                   INFECTIOUS DISEASES IN VICTIMS ASSISTED.

       ``(a) Routine Notification of Designated Officer.--
       ``(1) Determination by treating facility.--If a victim of 
     an emergency is transported by emergency response employees 
     to a medical facility and the medical facility makes a 
     determination that the victim has an airborne infectious 
     disease, the medical facility shall notify the designated 
     officer of the emergency response employees who transported 
     the victim to the medical facility of the determination.
       ``(2) Determination by facility ascertaining cause of 
     death.--If a victim of an emergency is transported by 
     emergency response employees to a medical facility and the 
     victim dies at or before reaching the medical facility, the 
     medical facility ascertaining the cause of death shall notify 
     the designated officer of the emergency response employees 
     who transported the victim to the initial medical facility of 
     any determination by the medical facility that the victim had 
     an airborne infectious disease.
       ``(b) Requirement of Prompt Notification.--With respect to 
     a determination described in paragraph (1) or (2) of 
     subsection (a), the notification required in each of such 
     paragraphs shall be made as soon as is practicable, but not 
     later than 48 hours after the determination is made.

     ``SEC. 2695B. REQUEST FOR NOTIFICATION WITH RESPECT TO 
                   VICTIMS ASSISTED.

       ``(a) Initiation of Process by Employee.--If an emergency 
     response employee believes that the employee may have been 
     exposed to an infectious disease by a victim of an emergency 
     who was transported to a medical facility as a result of the 
     emergency, and if the employee attended, treated, assisted, 
     or transported the victim pursuant to the emergency, then the 
     designated officer of the employee shall, upon the request of 
     the employee, carry out the duties described in subsection 
     (b) regarding a determination of whether the employee may 
     have been exposed to an infectious disease by the victim.
       ``(b) Initial Determination by Designated Officer.--The 
     duties referred to in subsection (a) are that--
       ``(1) the designated officer involved collect the facts 
     relating to the circumstances under which, for purposes of 
     subsection (a), the employee involved may have been exposed 
     to an infectious disease; and
       ``(2) the designated officer evaluate such facts and make a 
     determination of whether, if the victim involved had any 
     infectious disease included on the list issued under 
     paragraph (1) of section 2695(a), the employee would have 
     been exposed to the disease under such facts, as indicated by 
     the guidelines issued under paragraph (2) of such section.
       ``(c) Submission of Request to Medical Facility.--
       ``(1) In general.--If a designated officer makes a 
     determination under subsection (b)(2) that an emergency 
     response employee may have been exposed to an infectious 
     disease, the designated officer shall submit to the medical 
     facility to which the victim involved was transported a 
     request for a response under subsection (d) regarding the 
     victim of the emergency involved.
       ``(2) Form of request.--A request under paragraph (1) shall 
     be in writing and be signed by the designated officer 
     involved, and shall contain a statement of the facts 
     collected pursuant to subsection (b)(1).
       ``(d) Evaluation and Response Regarding Request to Medical 
     Facility.--
       ``(1) In general.--If a medical facility receives a request 
     under subsection (c), the medical facility shall evaluate the 
     facts submitted in the request and make a determination of 
     whether, on the basis of the medical information possessed by 
     the facility regarding the victim involved, the emergency 
     response employee was exposed to an infectious disease 
     included on the list issued under paragraph (1) of section 
     2695(a), as indicated by the guidelines issued under 
     paragraph (2) of such section.
       ``(2) Notification of exposure.--If a medical facility 
     makes a determination under paragraph (1) that the emergency 
     response employee involved has been exposed to an infectious 
     disease, the medical facility shall, in writing, notify the 
     designated officer who submitted the request under subsection 
     (c) of the determination.
       ``(3) Finding of no exposure.--If a medical facility makes 
     a determination under paragraph (1) that the emergency 
     response employee involved has not been exposed to an 
     infectious disease, the medical facility shall, in writing, 
     inform the designated officer who submitted the request under 
     subsection (c) of the determination.
       ``(4) Insufficient information.--
       ``(A) If a medical facility finds in evaluating facts for 
     purposes of paragraph (1) that the facts are insufficient to 
     make the determination described in such paragraph, the 
     medical facility shall, in writing, inform the designated 
     officer who submitted the request under subsection (c) of the 
     insufficiency of the facts.
       ``(B)(i) If a medical facility finds in making a 
     determination under paragraph (1) that the facility possesses 
     no information on whether the victim involved has an 
     infectious disease included on the list under section 
     2695(a), the medical facility shall, in writing, inform the 
     designated officer who submitted the request under subsection 
     (c) of the insufficiency of such medical information.
       ``(ii) If after making a response under clause (i) a 
     medical facility determines that the victim involved has an 
     infectious disease, the medical facility shall make the 
     determination described in paragraph (1) and provide the 
     applicable response specified in this subsection.
       ``(e) Time for Making Response.--After receiving a request 
     under subsection (c) (including any such request resubmitted 
     under subsection (g)(2)), a medical facility shall make the 
     applicable response specified in subsection (d) as soon as is 
     practicable, but not later than 48 hours after receiving the 
     request.
       ``(f) Death of Victim of Emergency.--
       ``(1) Facility ascertaining cause of death.--If a victim 
     described in subsection (a) dies at or before reaching the 
     medical facility involved, and the medical facility receives 
     a request under subsection (c), the medical facility shall 
     provide a copy of the request to the medical facility 
     ascertaining the cause of death of the victim, if such 
     facility is a different medical facility than the facility 
     that received the original request.
       ``(2) Responsibility of facility.--Upon the receipt of a 
     copy of a request for purposes of paragraph (1), the duties 
     otherwise established in this part regarding medical 
     facilities shall apply to the medical facility ascertaining 
     the cause of death of the victim in the same manner and to 
     the same extent as such duties apply to the medical facility 
     originally receiving the request.
       ``(g) Assistance of Public Health Officer.--
       ``(1) Evaluation of response of medical facility regarding 
     insufficient facts.--
       ``(A) In the case of a request under subsection (c) to 
     which a medical facility has made the response specified in 
     subsection (d)(4)(A) regarding the insufficiency of facts, 
     the public health officer for the community in which the 
     medical facility is located shall evaluate the request and 
     the response, if the designated officer involved submits such 
     documents to the officer with the request that the officer 
     make such an evaluation.
       ``(B) As soon as is practicable after a public health 
     officer receives a request under subparagraph (A), but not 
     later than 48 hours after receipt of the request, the public 
     health officer shall complete the evaluation required in such 
     paragraph and inform the designated officer of the results of 
     the evaluation.
       ``(2) Findings of evaluation.--
       ``(A) If an evaluation under paragraph (1)(A) indicates 
     that the facts provided to the medical facility pursuant to 
     subsection (c) were sufficient for purposes of determinations 
     under subsection (d)(1)--
       ``(i) the public health officer shall, on behalf of the 
     designated officer involved, resubmit the request to the 
     medical facility; and
       ``(ii) the medical facility shall provide to the designated 
     officer the applicable response specified in subsection (d).
       ``(B) If an evaluation under paragraph (1)(A) indicates 
     that the facts provided in the

[[Page H11528]]

     request to the medical facility were insufficient for 
     purposes of determinations specified in subsection (c)--
       ``(i) the public health officer shall provide advice to the 
     designated officer regarding the collection and description 
     of appropriate facts; and
       ``(ii) if sufficient facts are obtained by the designated 
     officer--

       ``(I) the public health officer shall, on behalf of the 
     designated officer involved, resubmit the request to the 
     medical facility; and
       ``(II) the medical facility shall provide to the designated 
     officer the appropriate response under subsection (c).

     ``SEC. 2695C. PROCEDURES FOR NOTIFICATION OF EXPOSURE.

       ``(a) Contents of Notification to Officer.--In making a 
     notification required under section 2695A or section 
     2695B(d)(2), a medical facility shall provide--
       ``(1) the name of the infectious disease involved; and
       ``(2) the date on which the victim of the emergency 
     involved was transported by emergency response employees to 
     the medical facility involved.
       ``(b) Manner of Notification.--If a notification under 
     section 2695A or section 2695B(d)(2) is mailed or otherwise 
     indirectly made--
       ``(1) the medical facility sending the notification shall, 
     upon sending the notification, inform the designated officer 
     to whom the notification is sent of the fact that the 
     notification has been sent; and
       ``(2) such designated officer shall, not later than 10 days 
     after being informed by the medical facility that the 
     notification has been sent, inform such medical facility 
     whether the designated officer has received the notification.

     ``SEC. 2695D. NOTIFICATION OF EMPLOYEE.

       ``(a) In General.--After receiving a notification for 
     purposes of section 2695A or 2695B(d)(2), a designated 
     officer of emergency response employees shall, to the extent 
     practicable, immediately notify each of such employees who--
       ``(1) responded to the emergency involved; and
       ``(2) as indicated by guidelines developed by the 
     Secretary, may have been exposed to an infectious disease.
       ``(b) Certain Contents of Notification to Employee.--A 
     notification under this subsection to an emergency response 
     employee shall inform the employee of--
       ``(1) the fact that the employee may have been exposed to 
     an infectious disease and the name of the disease involved;
       ``(2) any action by the employee that, as indicated by 
     guidelines developed by the Secretary, is medically 
     appropriate; and
       ``(3) if medically appropriate under such criteria, the 
     date of such emergency.
       ``(c) Responses Other Than Notification of Exposure.--After 
     receiving a response under paragraph (3) or (4) of subsection 
     (d) of section 2695B, or a response under subsection (g)(1) 
     of such section, the designated officer for the employee 
     shall, to the extent practicable, immediately inform the 
     employee of the response.

     ``SEC. 2695E. SELECTION OF DESIGNATED OFFICERS.

       ``(a) In General.--For the purposes of receiving 
     notifications and responses and making requests under this 
     part on behalf of emergency response employees, the public 
     health officer of each State shall designate 1 official or 
     officer of each employer of emergency response employees in 
     the State.
       ``(b) Preference in Making Designations.--In making the 
     designations required in subsection (a), a public health 
     officer shall give preference to individuals who are trained 
     in the provision of health care or in the control of 
     infectious diseases.

     ``SEC. 2695F. LIMITATION WITH RESPECT TO DUTIES OF MEDICAL 
                   FACILITIES.

       ``The duties established in this part for a medical 
     facility--
       ``(1) shall apply only to medical information possessed by 
     the facility during the period in which the facility is 
     treating the victim for conditions arising from the 
     emergency, or during the 60-day period beginning on the date 
     on which the victim is transported by emergency response 
     employees to the facility, whichever period expires first; 
     and
       ``(2) shall not apply to any extent after the expiration of 
     the 30-day period beginning on the expiration of the 
     applicable period referred to in paragraph (1), except that 
     such duties shall apply with respect to any request under 
     section 2695B(c) received by a medical facility before the 
     expiration of such 30-day period.

     ``SEC. 2695G. MISCELLANEOUS PROVISIONS.

       ``(a) Liability of Medical Facilities, Designated Officers, 
     Public Health Officers, and Governing Entities.--This part 
     may not be construed to authorize any cause of action for 
     damages or any civil penalty against any medical facility, 
     any designated officer, any other public health officer, or 
     any governing entity of such facility or officer for failure 
     to comply with the duties established in this part.
       ``(b) Testing.--This part may not, with respect to victims 
     of emergencies, be construed to authorize or require a 
     medical facility to test any such victim for any infectious 
     disease.
       ``(c) Confidentiality.--This part may not be construed to 
     authorize or require any medical facility, any designated 
     officer of emergency response employees, or any such 
     employee, to disclose identifying information with respect to 
     a victim of an emergency or with respect to an emergency 
     response employee.
       ``(d) Failure To Provide Emergency Services.--This part may 
     not be construed to authorize any emergency response employee 
     to fail to respond, or to deny services, to any victim of an 
     emergency.
       ``(e) Notification and Reporting Deadlines.--In any case in 
     which the Secretary determines that, wholly or partially as a 
     result of a public health emergency that has been determined 
     pursuant to section 319(a), individuals or public or private 
     entities are unable to comply with the requirements of this 
     part, the Secretary may, notwithstanding any other provision 
     of law, temporarily suspend, in whole or in part, the 
     requirements of this part as the circumstances reasonably 
     require. Before or promptly after such a suspension, the 
     Secretary shall notify the Congress of such action and 
     publish in the Federal Register a notice of the suspension.
       ``(f) Continued Application of State and Local Law.--
     Nothing in this part shall be construed to limit the 
     application of State or local laws that require the provision 
     of data to public health authorities.

     ``SEC. 2695H. INJUNCTIONS REGARDING VIOLATION OF PROHIBITION.

       ``(a) In General.--The Secretary may, in any court of 
     competent jurisdiction, commence a civil action for the 
     purpose of obtaining temporary or permanent injunctive relief 
     with respect to any violation of this part.
       ``(b) Facilitation of Information on Violations.--The 
     Secretary shall establish an administrative process for 
     encouraging emergency response employees to provide 
     information to the Secretary regarding violations of this 
     part. As appropriate, the Secretary shall investigate alleged 
     such violations and seek appropriate injunctive relief.

     ``SEC. 2695I. APPLICABILITY OF PART.

       ``This part shall not apply in a State if the chief 
     executive officer of the State certifies to the Secretary 
     that the law of the State is substantially consistent with 
     this part.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Tennessee (Mr. Roe) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their 
remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. I yield myself such time as I may consume.
  Mr. Speaker, I rise in strong support of S. 1793, the Ryan White HIV/
AIDS Treatment Extension Act of 2009, as passed by the Senate. The 
Energy and Commerce Committee has filed a report which constitutes the 
legislative history for the House version of this bill. The House bill 
is nearly identical to the bill before us today.
  We worked closely with our Republican colleagues, and I would like to 
thank Congressmen Waxman, Barton, and Deal for their hard work on this 
issue. We also worked with our Senate colleagues to come together on 
this legislation, and I am proud to say that what we have before us 
today is both bipartisan and bicameral.
  The Ryan White CARE Act was named after a young boy who contracted 
the AIDS virus from a blood transfusion and sadly lost his life to this 
horrible disease. Since his death in 1990, we as a Nation have made 
great strides in preventing and treating HIV/AIDS in large part due to 
the Ryan White program.
  Not so long ago, an HIV/AIDS diagnosis was a guaranteed death 
sentence. Today, many patients are living full and long lives due to 
the advancements in treatment and the complicated but effective mix of 
drugs and therapies that are currently on the market.
  In addition, we have made huge progress on education, awareness, and 
prevention. New knowledge of the disease has allowed for better and 
more targeted prevention programs that have effectively slowed the 
spread of HIV/AIDS.
  In spite of these advancements, however, Mr. Speaker, there are 
nearly 40,000 new HIV infections reported each year, and according to 
the CDC, approximately 1.1 million Americans are currently living with 
the disease and approximately 51,000 people in my home State of New 
Jersey. Since the beginning of this epidemic, an estimated 580,000 
Americans with AIDS have died.
  It is more crucial than ever given the high numbers of Americans 
suffering

[[Page H11529]]

from this disease that we have the Ryan White program. Accounting for 
roughly 19 percent of all Federal funds that are used on HIV/AIDS care, 
the program provides treatment and support services to individuals and 
families living with the AIDS virus and serves over half a million low-
income Americans. This program is without a doubt extremely vital in 
our battle against this epidemic.
  The bill before us today does a number of things. It reauthorizes the 
Ryan White program for 4 years. It increases the authorization amounts 
to account for the increased number of individuals living with the HIV/
AIDS diagnosis. The bill eliminates the sunset provisions so that never 
again will patients have to fear that their services will abruptly end. 
It allows States who are still reporting using a code-based system to 
continue transitioning to a names-based system without disrupting the 
provision of care to patients, and it ensures that no area receives too 
much of a cut in funding from the previous year while also making sure 
that the money does get directed to those areas of the country that are 
hardest hit by the HIV/AIDS epidemic.
  This is a strong bill, Mr. Speaker, that will ensure continued health 
care services for millions of Americans who depend on them with their 
lives. And I urge my colleagues to join me in voting for this vitally 
important bill.
  I reserve the balance of my time.
  Mr. ROE of Tennessee. Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield to the gentlewoman from California 
(Mrs. Capps) for 2 minutes.
  Mrs. CAPPS. Thank you to my colleague.
  Mr. Speaker, I am rising in strong support of the Ryan White HIV/AIDS 
Treatment Extension Act, and I want to add my thanks and my 
acknowledgment to the great work of our committee's chairmen, the 
ranking members, to swiftly move this extension through the process in 
a bipartisan and bicameral manner.
  The Ryan White HIV/AIDS program has been the critical safety net for 
Americans diagnosed with HIV and AIDS. Since its inception, we have 
watched diagnosis and treatment evolve to a point where we can now 
manage HIV as a chronic condition rather than as a fatal disease.
  This issue is especially important in my home State of California, 
which has the second-largest disease burden in the United States and a 
significant number of new cases each year, particularly among the 
Latino population. And in today's world, California--like some other 
States--is experiencing a severe budget crisis. State HIV and AIDS 
funding has been drastically reduced.
  My district serves as the main source of HIV services between Los 
Angeles and San Francisco, and I want to ensure that central coast 
providers have all the resources they need to care for their patients. 
We need to make sure HIV patients and their families' livelihoods 
aren't interrupted by our failure to act.
  This legislation really is a stopgap measure that we need to ensure 
that nobody loses their existing services. I am pleased that we haven't 
hesitated to address the most pressing funding and logistical needs, 
especially those that affect distribution of funds to population 
centers.
  I am looking forward to the next authorization, when we can address 
all of the lingering improvements that are necessary to make Ryan White 
HIV/AIDS programs operate in an even better way for patients. As HIV 
research and care evolves, we must also respond accordingly. I urge my 
colleagues to vote in favor of the Ryan White HIV/AIDS Treatment 
Extension Act.
  Mr. ROE of Tennessee. Mr. Speaker, I ask unanimous consent to yield 
my time to the gentleman from Texas (Mr. Barton) to control.
  The SPEAKER pro tempore. Without objection, the gentleman from Texas 
is recognized.
  There was no objection.
  Mr. BARTON of Texas. Mr. Speaker, I thank the gentleman from 
Tennessee for his leadership on this issue until I could arrive on the 
floor.
  Mr. Speaker, I rise in support of the Ryan White HIV/AIDS Treatment 
Extension Act of 2009. This is the second reauthorization of this piece 
of legislation. It was originally passed approximately 10 years ago. It 
was reauthorized the first time, I believe, 4 years ago and expired at 
the end of this month. And so with the leadership of Chairman Waxman 
and Subcommittee Chairman Pallone, with the support of Ranking Member 
Deal, myself, and Congresswoman Mary Bono, we have been working with 
the majority to bring this bill to the floor and reauthorize it because 
of the importance of the programs which it has jurisdiction over.
  This is a program which has provided care for millions of Americans 
that have been affected by HIV and AIDS. It provides primary care 
services and drug assistance as a payer of last resort for those 
individuals that have these afflictions.
  The bill before us includes several legislative priorities that I 
would like to highlight. It does allow States additional time to report 
their HIV/AIDS cases by names versus the old, inaccurate code-based 
system but does not release States of the requirement to move towards 
the more accurate name-based reporting.
  The bill also continues reforms that were put in place 3 years ago 
that will move these programs closer to ensuring that funds are 
allocated to the existing need--and I am going to highlight existing 
need--for States and localities. The legislation establishes a new HIV/
AIDS testing goal of 5 million citizens through Federally supported 
HIV/AIDS prevention, treatment, and care programs.
  The bill also reestablishes the notification of possible exposure to 
infectious disease provisions, which will allow notification to 
emergency responders of a possible communicable infectious disease.
  Mr. Speaker, I am an original cosponsor of this legislation in this 
Congress and was chairman 3 years ago when we reauthorized it. This is 
a high priority for the country and the committee. And again, I am very 
pleased that Chairman Waxman and Subcommittee Chairman Pallone agreed 
to a regular order process so that we could reauthorize this bill in a 
timely fashion.
  With that, Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I would yield 2 minutes to our full 
committee chair from California (Mr. Waxman), who was the original 
sponsor of the Ryan White Act and has been working on this for years.
  Mr. WAXMAN. Mr. Speaker, swift passage of this bill is absolutely 
essential to the nearly half a million people served by the Ryan White 
program. Representatives Pallone, Deal, Barton, and I worked with the 
Senate in a bipartisan and bicameral fashion to develop the bill before 
us today. We didn't see eye-to-eye on everything, but we all agreed 
that the HIV/AIDS epidemic isn't a partisan issue and that the Ryan 
White program must continue.
  This bill contains improvements that will strengthen and grow the 
program over the next 4 years.
  I would like to thank the administration, as well as the over 300 
HIV/AIDS organizations who developed consensus recommendations that 
immensely helped the process. The Congressional Black, Hispanic, and 
Asian Pacific American Caucuses also provided vitally important input.
  I would like to thank all of the House staff that worked on the bill: 
Camille Sealy, Elana Leventhal, Naomi Seiler, Aarti Shah, Melissa 
Bartlett, Blake Fulenwider, and Ryan Long.

                              {time}  1045

  Finally, I would like to thank Chairman Pallone, Ranking Member Deal 
and Ranking Member Barton for their work on this important piece of 
legislation.
  I urge all Members to support it.
  Mr. BARTON of Texas. Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to my colleague from 
New Jersey (Mr. Pascrell).
  Mr. PASCRELL. Mr. Speaker, I want to congratulate Mr. Waxman and Mr. 
Barton, Mr. Deal and Mr. Pallone, our Chair of the Subcommittee. This 
is tough work.
  I rise to express my deep support for the reauthorization of the Ryan 
White HIV/AIDS program; a debt of thanks to Chairman Pallone for your 
outstanding work in New Jersey.

[[Page H11530]]

  For nearly two decades now, the Ryan White program has made it 
possible for individuals living with HIV/AIDS to access life-saving 
services. In the program's early years, I served as the chairman of the 
Paterson-Passaic-Bergen HIV Planning Council, and I saw firsthand how 
the Ryan White program reduces health disparities and improves and 
extends the lives of thousands. Families have been held together 
because of Ryan White legislation. I see that firsthand day after day.
  New Jersey has the fifth largest HIV/AIDS epidemic in the Nation. In 
my hometown, we have over 1,700 individuals living with HIV/AIDS. Even 
after 20 years of progress, these sobering facts are a reminder that we 
still have work to do.
  I urge my colleagues to join with me in passing this legislation to 
extend and provide additional much-needed funding for the vital 
services provided by the Ryan White program.
  Mr. BARTON of Texas. Mr. Speaker, I continue to reserve.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California (Ms. Lee).
  Ms. LEE of California. Let me thank the gentleman from New Jersey for 
yielding and also for your leadership, and also to our chairman because 
this is such an important bill. I want to thank both sides for crafting 
this bipartisan--bicameral, really--compromise. I also wanted to thank 
you and say that we appreciate your taking into consideration the 
concerns of the Congressional Black Caucus, the Congressional Hispanic 
Caucus, and the Congressional Asian Pacific American Caucus.
  This bill will strengthen the Minority AIDS Initiative by moving it 
back to a formula-based grant system requiring a GAO study and a 
subsequent Department plan by HHS to ensure that the Minority AIDS 
Initiative functions as it was intended. This initiative was begun 
under the leadership of Congresswoman Maxine Waters in the late 
nineties and it's working, but it hasn't been fully funded and the 
resources haven't really been directed to where the need is the 
greatest.
  We have, as you know, a devastating epidemic in the United States, 
and young gay men, minorities, people of color, and women are facing 
the brunt of it. We've got to do a better job in protecting those who 
are most at risk while taking care of those already infected.
  I am pleased that the President is developing a National AIDS 
Strategy to guide our response to this epidemic. As one who has worked 
consistently over the years on the global HIV pandemic both here and 
abroad, I think we need a PEPFAR, a domestic PEPFAR. But this is a 
compromise bill. It will increase the funding 5 percent each year, but 
I think we must do more.
  Also, let me just say that we have to really take a look at some of 
the interventions that we know will work which are tough political 
issues to address, such as needle exchange, such as comprehensive sex 
education, such as this real epidemic. And it is in our prisons. So we 
have to take many, many steps to really begin to look at how to turn 
this around and to stamp HIV/AIDS from the face of the Earth.
  So I just want to thank you Mr. Pallone and Mr. Waxman, and all of 
you who have taken the lead in putting this bill together.
  Mr. BARTON of Texas. Mr. Speaker, I continue to reserve.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
the Virgin Islands, Dr. Christensen, who is also a member of our 
committee.
  Mrs. CHRISTENSEN. Thank you for yielding.
  Mr. Speaker, I rise today--on behalf of the more than half million 
low-income Americans living with HIV/AIDS who rely on this program--in 
full support of the Ryan White HIV/AIDS Treatment Extension Act of 
2009, particularly those in my community where we have the second 
highest incidence of AIDS in the country.
  I applaud the leadership and hard work of Chairmen Pallone and Waxman 
and Ranking Members Barton and Deal, as well as those in the other 
body, for this bipartisan, bicameral bill.
  The Ryan White program plays a pivotal role in addressing the unique 
health care challenges facing low-income Americans with HIV/AIDS and 
their families. I would have liked to have seen a more robust 
investment in this program to end the ADAP waiting lists and more 
support for the National Minority AIDS Education and Training Center at 
Howard University, especially when minorities are making up the vast 
majority of people with HIV/AIDS. But we have the opportunity today to 
provide assistance to large and midsize cities, States, and territories 
with high HIV/AIDS incidence and/or prevalence, and to expand access to 
care and support services for women, infants, children, and youth.
  I am particularly pleased that we improve the Minority AIDS 
Initiative by going back to formula funding and by removing some of the 
barriers to funding that prevented many eligible entities from 
applying.
  As a physician who cared for AIDS patients from the outset of the 
epidemic, I cannot express enough how today--how voting in full support 
of this bill--will mean so much to the hardworking Americans who 
deserve the opportunity, just like all of us here, to achieve their 
lives' potentials.
  Mr. BARTON of Texas. I continue to reserve, Mr. Speaker.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California, Ms. Lynn Woolsey.
  Ms. WOOLSEY. Thank you, Chairman Pallone, for all of your efforts in 
regards to HIV/AIDS and the efforts that you support, that we support, 
that we must continue.
  I rise in strong support of H.R. 3792, the Ryan White HIV/AIDS 
Treatment Extension Act of 2009. This legislation provides important 
funding for lifesaving medical and support services that individuals 
with HIV/AIDS depend upon.
  With this reauthorization, we're ensuring that several of the 
Transitional Grant Areas that were slated to lose access to these 
grants will continue to receive funding. One of the TGAs is Santa Rosa, 
California, in my district, which is north of San Francisco. This 
important change will ensure that Santa Rosa will be able to continue 
to provide a continuity of care to patients with HIV/AIDS.
  The Bay Area is an example for all of us of just how important the 
funding is that we provide now, and how necessary it is that we 
increase this funding and that we pay particular attention to 
prevention of HIV/AIDS; then we won't need so much over time to cure 
and provide care. But until we prevent, we will be working to help 
those who are already afflicted.
  Again, I urge my colleagues to support this legislation.
  Mr. BARTON of Texas. We continue to reserve, Mr. Speaker.
  Mr. PALLONE. Mr. Speaker, I will yield myself such time as I may 
consume.
  I just wanted to stress the importance of this in my home State of 
New Jersey. I know that in my district in New Brunswick we have the 
headquarters for the Hyacinth Foundation, which is one of the 
organizations that receives some of the money under the Ryan White Act. 
The type of work that they have been doing over the last few years to 
help with HIV/AIDS patients is just incredible. Obviously, we need more 
research, but the services and the treatment that are provided are 
really lifesaving for a lot of these patients, and it is so important.
  I know that there was some concern about the time running out because 
of the authorization expiring, but now we are going to guarantee that 
this money continues. In fact, this bill does not have a sunset 
provision so that these programs will continue. We won't face this 
problem of having another deadline in the future. So that is really 
crucial, and I can't stress it enough.
  At this time, I would like to yield such time as she may consume to 
Representative Lee again.
  Ms. LEE of California. Thank you again for yielding.
  I just wanted to take a moment to call your attention to several 
efforts in my own home State and my own home county. One is in Alameda 
County.
  I believe it was in 1999, we had to declare a state of emergency in 
the African American community, and that state of emergency helped 
focus attention on what was taking place in the African American 
community. It helped us really begin to garner resources for those 
wonderful community-based programs which have survived through this 
period, but they

[[Page H11531]]

need additional resources if we are going to really tackle this 
epidemic. And so this reauthorization will really help with our state 
of emergency and those organizations that are helping on the ground 
with minimal resources doing wonderful work.
  Secondly, in my city where our great former colleague, Mayor Ron 
Dellums, former Congressman Ron Dellums, serves as Mayor, we have 
initiated, under his leadership, a ``Get Tested'' campaign, which is 
really about making sure that prevention and education is provided in a 
very real way to those most at risk. This campaign is working, and 
again, reauthorization of Ryan White will really help make sure that 
this campaign is fully successful. Getting tested is such an important 
strategy, and I would encourage Members, as we move forward and focus 
on this reauthorization, to make sure that we take some leadership and 
get tested and show why testing is a key strategy to prevention and 
education.
  Finally, let me say, and I know Ms. Capps mentioned the budget crisis 
in California. I have talked with many of my AIDS providers--and as I 
said earlier, with minimal resources, they are doing unbelievable 
work--and now, with not only California but other States in this budget 
crisis, these organizations are losing their funding. And so, again, 
the reauthorization of Ryan White is going to help these organizations 
stay in business and help them provide the services that are 
desperately needed.
  So once again, I just have to thank you, Chairman Pallone, thank all 
of you for this reauthorization. And though it's not everything we 
want, I know it's a compromise, and it's going to go a long way in 
helping.
  Mr. PALLONE. At this time, Mr. Speaker, I have no additional 
speakers. I just want to thank my colleagues on the Republican side, 
Mr. Barton and Mr. Deal, for making this a truly bipartisan piece of 
legislation.
  At this point, I would urge passage of the bill and yield back the 
balance of my time.
  Mr. BARTON of Texas. Well, I appreciate the opportunity to close the 
debate.
  This is an important piece of legislation. It has been worked over 
several years on a bipartisan basis. Chairman Waxman and Chairman 
Pallone have been extremely positive and very gentlemanly in their 
approach to this bill. We are glad that it is being reauthorized in a 
timely fashion. We urge a strong bipartisan vote of ``yes'' on this 
bill.
  Ms. PELOSI. Mr. Speaker, for almost two decades, the Ryan White Act 
has played an essential role in the development and maintenance of 
systems of care for people living with HIV and AIDS. Today, Congress 
has the opportunity to continue this lifesaving work.
  Essential to our efforts has been the leadership of Chairman Frank 
Pallone of the Energy and Commerce Subcommittee on Health. And I want 
to especially acknowledge Chairman Henry Waxman for his decades of 
magnificent and determined leadership in the fight against HIV/AIDS. 
From day one of this epidemic, Henry Waxman has been on the frontlines 
leading the charge.
  I also want to pay tribute to another great leader who was there from 
day one of this epidemic: Senator Edward M. Kennedy. Senator Kennedy 
was tireless in his efforts to ensure the federal government, and the 
entire health system, eventually rose to the challenge of this crisis 
with the resources and commitment it demanded. His legacy lives on in 
the Ryan White Act and the hundreds of thousands of people each year it 
helps access the medication and primary care they need to stay healthy.
  As everyone knows, San Francisco was hit early and was hit hard by 
the devastation of AIDS. But San Franciscans responded to the needs of 
our neighbors by developing a system of community-based care that 
became the model for the Ryan White CARE Act when it was first enacted 
in 1990. As a result, San Francisco produced data that showed the 
country comprehensive HIV/AIDS care and services not only saves lives, 
but also saves money by keeping people healthy and productive.
  Today, Ryan White-funded initiatives are a fundamental component of 
the systems of care upon which low income individuals with HIV and AIDS 
rely. Declines in AIDS deaths are a direct result of the therapies and 
services that have been made more widely available through the Ryan 
White Act to large numbers of uninsured and under-insured people living 
with HIV and AIDS.
  Each year, this legislation ensures access to lifesaving medical 
services, including pharmaceuticals, for over 500,000 clients--almost 
half of the individuals living with HIV/AIDS in this country. Passage 
of the Ryan White reauthorization will continue to increase access to 
primary care and medications by providing additional resources and 
facilitating the transition to HIV reporting.
  The Ryan White Act has always focused on establishing and maintaining 
effective systems of health care. This means avoiding drastic cuts that 
destabilize existing resources. For this reason, many of us were 
disappointed when the Bush Administration implemented the 2006 
reauthorization in a way that caused drastic cuts to several 
jurisdictions, including the San Francisco Eligible Metropolitan Area. 
Unfortunately, Senate Republicans objected to correcting these 
implementation flaws in this reauthorization. However, I remain 
committed to responding to these needs through the appropriations 
process, as we have done each year since the Bush Administration first 
attempted to impose these destabilizing cuts.
  The Ryan White HIV/AIDS Treatment Extension Act will continue our 
commitment to hundreds of thousands of low income people living with 
HIV/AIDS. In so doing, we will save lives, save money, and help create 
a healthier America. I urge my colleagues to vote ``yes.''
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today in 
support of the Ryan White HIV/AIDS Treatment Extension Act of 2009.
  This important program has helped numerous people across the country 
living with HIV/AIDS by helping to provide funding to states, urban 
areas, insurance providers, and other organizations for HIV/AIDS 
related care. It is estimated that the Ryan White Program helps more 
than half of a million people annually, and legislation to extend this 
program is incredibly important for those individuals' wellbeing. 
Reauthorized three times since it was first enacted in 1990 in response 
to the growing HIV/AIDS crisis, this legislation will help to modernize 
the program to address present day concerns.
  I would be remiss as well if I did not discuss the disproportionate 
impact that HIV/AIDS has on minority communities and particularly the 
African-American community. Although African-Americans account for 
about 13 percent of the U.S. population, they constitute roughly half 
of all Americans who become infected with HIV/AIDS. According to the 
Center for Disease Control, the rate of AIDS diagnoses for African-
American adults and adolescents is ten times higher than the rate for 
whites and three times higher than the rate for Latinos. Truly these 
numbers are way too high, and we must resolve anew to continue to fight 
this terrible disease.
  I encourage my colleagues to join me in supporting the Ryan White 
HIV/AIDS Treatment Extension Act so that we can offer care to those 
individuals who are suffering with HIV/AIDS and combat the disease as 
well.
  Ms. CASTOR of Florida. Mr. Speaker, I rise today in strong support of 
the Ryan White HIV/AIDS Treatment Extension Act of 2009.
  In my home State of Florida and in my community in the Tampa Bay 
area, Ryan White Services are vital. This critical program helps to 
preserve the lives of many in our communities living with HIV and AIDS. 
I have heard from so many of my neighbors in recent weeks, pleading 
that Congress act to ensure that this lifeline continues--today we 
answer their plea.
  In 2004, Ryan White assisted well over 100,000 patients in Florida 
and nearly 13,000 family members of people living with HIV/AIDS. Those 
numbers continue to rise.
  My community is very active in the Ryan White program. There are many 
nonprofit organizations that help to facilitate Ryan White and put the 
program dollars to good use.
  I'd like to thank all of the participating organizations in my home 
town for their work with Ryan White--Metropolitan Charities in both 
Tampa and St. Petersburg, Operation Hope of Pinellas and the AIDS 
Service Association of Pinellas, to name just a few that are changing 
lives for my neighbors.
  Mr. Speaker, the Ryan White Program is the only true safety net for 
many people living with HIV/AIDS to compensate for the lack of health 
insurance and care that is often not covered by insurers. I look 
forward to reporting to my neighbors that they can rest assured that 
this vital program will not be lost.
  Mr. KLEIN of Florida. Mr. Speaker, I rise today in strong support of 
S. 1793, the Ryan White HIV/AIDS Treatment Extension Act of 2009, and 
thank the distinguished Chairman of the Energy and Commerce Committee, 
Mr. Waxman, and Ranking Member Barton, as well as the Health 
Subcommittee Chair, Mr. Pallone, and Ranking Member Deal, for bringing 
this important bill to the floor before the Ryan White program ends at 
the end of the month.
  The Ryan White program is our nation's keystone public health program 
for the prevention and treatment of HIV/AIDS. Originally enacted in 
1990, the Ryan White program provides federal funds to states and 
metropolitan

[[Page H11532]]

areas for health care costs and support services for people living with 
HIV and AIDS. Some of these services include medical care, drug 
treatments, dental care, home health care, and outpatient mental health 
and substance abuse treatment. Over half a million low-income people 
with HIV/AIDS receive critical health care services through Ryan White, 
and a third of them lack any health insurance at all.
  In addition to preauthorizing the Ryan White program for four years, 
S. 1793 will increase funding for all programs by 5 percent to meet the 
growing needs of states, communities, and individuals. Of particular 
interest for my constituents is the increased funding for the Emergency 
Relief program, which provides grants to metropolitan areas with very 
high numbers of AIDS cases for primary care and support services like 
hospice care, housing, and transportation.
  Unfortunately, the City of Ft. Lauderdale, which is in my 
congressional district, has the fourth highest AIDS rate in America, 
behind only San Francisco, New York, and Miami. This puts an enormous 
strain on local resources. Although Broward County has worked very hard 
to be as efficient as possible with the services they provide, this 5 
percent funding increase will be a welcome relief during these 
difficult economic times.
  I am also pleased to see that S. 1793 increases the unobligated fund 
requirement from 2 percent to 5 percent. As it stands now, this 
provision penalizes Part A and B grantees if they have more than 2 
percent of their award unobligated at the end of a grant year. The 
consequence is that programs are ineligible to compete for supplemental 
components of their awards, creating an undue burden on grantees like 
Broward County who face state and county budget factors such as hiring 
freezes, purchasing delays and spending caps among other funding 
obstacles. Boosting this level to 5 percent will create a more 
realistic requirement for unobligated funds, and I thank the 
distinguished chairmen and ranking members for correcting this 
important problem.
  Mr. Speaker, it was 28 years ago that the Center for Disease Control 
and Prevention issued its first warning for AIDS. In the interim, far 
too many people have died from this terrible disease. But thanks to 
this hallmark safety net program, the Ryan White program provides a 
vital lifeline to hundreds of thousands of people living with HIV/AIDS. 
We cannot let this lifeline end at the end of the month. We must pass 
this program today so that everyone living with HIV/AIDS can know that 
our great country will be there to help them when they need it most.
  Mr. VAN HOLLEN. Mr. Speaker, I rise in strong support of this 
legislation reauthorizing the Ryan White CARE Act. I want to commend 
Chairmen Waxman and Pallone as well as Ranking Members Barton and Deal 
for working in a bipartisan and bicameral fashion in bringing this bill 
before the House today.
  For over two decades, the Ryan White program has been serving people 
living with HIV and AIDS. It provides medical care, treatment and 
support services to more than half a million people each year. As a 
result of this vital and important program, we have some of the best 
HIV and AIDS treatment programs in the world. Without this critical 
safety net, several of our nation's most vulnerable populations would 
not have access or receive the care and treatment they desperately 
need.
  Maryland is one of the States hardest hit by the HIV epidemic. 
According to the Centers for Disease Control and Prevention, it has the 
fifth highest estimated rate of living AIDS cases per 100,000 people. 
Approximately 28,000 Marylanders live with HIV. I am pleased that the 
legislation continues the current extended exemption policy for 2 years 
for those States with maturing names-based HIV case data, such as 
Maryland, that recently made the transition from the code-based system 
in determining how much Ryan White funding States receive.
  Unfortunately, the Ryan White program was scheduled to sunset on 
September 30. It is now operating under a short-term extension. It is 
critical that Congress reauthorizes the Ryan White program so that we 
can continue to provide necessary and lifesaving services to those 
affected with HIV and AIDS. I urge my colleagues to support the Ryan 
White HIV/AIDS Treatment Extension Act.
  Mr. CONYERS. Mr. Speaker, I rise in strong support of the Ryan White 
HIV/AIDS Treatment Extension Act of 2009, S. 1793. In our efforts to 
assist those with HIV/AIDS, the Ryan White Program has been at the 
forefront, offering lifesaving care for those with this disease.
  The Ryan White HIV/AIDS Program allocates federal funds to 
metropolitan areas and states to assist in reducing health care costs 
and increasing support services for individuals and families affected 
by the human immunodeficiency virus or acquired immune deficiency 
syndrome. The Ryan White Program has been able to serve more than half 
a million low-income citizens living with HIV/AIDS each year. Of these 
constituents with HIV/AIDS, 33 percent of them are uninsured and an 
additional 56 percent are underinsured. This program is facilitated by 
the Health Resources and Services Administration of the Department of 
Health and Human Services. Composed of four major parts, the Ryan White 
HIV/AIDS Program provides grants to urban areas, directs funds to 
states and territories, pays for the AIDS Drug Assistance Program, and 
provides grants to both public and private nonprofit entities for 
family-centered care. This bill also allows for the continued funding 
for the Minority AIDS Initiative, a program that is attempting to 
address the impact of this disease on racial minorities.
  In December 2006, Congress reauthorized the Ryan White HIV/AIDS 
Program until September 30, 2009. With 1.1 million persons in the U.S. 
living with diagnosed or undiagnosed AIDS/HIV, we must ensure that the 
Ryan White HIV/AIDS Program and the Minority AIDS Initiative are fully 
funded so that vital services to our neighbors are not cut.
  I strongly support the Ryan White HIV/AIDS Program Act and its 
mission of providing direct care to patients in need. I urge my 
colleagues to do the same.
  Ms. ROS-LEHTINEN. Mr. Speaker, I rise to support swift passage of the 
Ryan White HIV/AIDS Treatment Extension Act.
  As you know, the Ryan White HIV/AIDS Treatment Program is an 
innovative and effective program that funds HIV/AIDS treatment for low-
income, uninsured, and underinsured people. The program provides 
funding to cities, States, as well as directly to select clinics and 
care providers for core medical and support services.
  In 2009 alone, my home State of Florida received over $209 million in 
funding through Ryan White to assist countless low-income Americans 
living with HIV/AIDS.
  And while HIV/AIDS is certainly a global and national epidemic, for 
my congressional district and all of south Florida it is an intensely 
local one. We know firsthand its impact on individual lives and 
families in our community.
  Miami-Dade County ranks second among large metropolitan areas for 
people living with AIDS. There are over 32,000 people living with AIDS 
in Miami-Dade alone. And nearly 12,000 have HIV that has yet to 
progress to AIDS. These are just the cases we know about.
  The fight against HIV/AIDS has many elements, but I cannot stress 
enough how important the Ryan White Program is within this greater 
undertaking.
  While our commitment to the fight against HIV/AIDS must be both 
proactive as well as reactive:
  Proactive in working together to halt the growth of this epidemic 
through our efforts at prevention and awareness;
  Reactive in our providing of care and treatment earlier in the course 
of the disease;
  Ryan White demonstrates that we must not, and we will not, ever 
forget about those already afflicted with this terrible disease.
  We all recognize the tremendous results that the Ryan White Program 
has had on providing care for those suffering from HIV/AIDS in the 
United States. Extending this important program is not just a priority, 
but a necessity.
  I know that through programs such as Ryan White we can, and will, 
save and improve the lives of countless individuals in my Congressional 
District and throughout the United States.
  I again urge my colleagues to vote in favor of this beneficial bill 
and look forward to the day when we can call the fight against HIV/AIDS 
won.
  Ms. WASSERMAN SCHULTZ. Mr. Speaker, I rise in strong support of the 
Ryan White HIV/AIDS Treatment Extension Act.
  The Ryan White Act is lifesaving legislation that funds a vast array 
of innovative and effective services that form the healthcare safety 
net for uninsured and underinsured Americans living with HIV/AIDS. Ryan 
White programs are ``payer of last resort,'' which subsidize treatment 
when no other resources are available.
  The program provides medical care, drugs, and support services for 
500,000 people a year. It's been a huge success in reducing sickness 
and death from HIV disease and helping people live longer, more 
healthy, and productive lives. The Ryan White programs also provide 
funding and technical assistance to local and state primary medical 
care providers, support services, healthcare provider and training 
programs.
  Congress must extend this critical law to ensure that vital services 
are not withheld from people who so desperately need them.
  We must pass this legislation, so that Ryan's legacy lives on with 
his message of love, compassion, and hope.
  Mr. GENE GREEN of Texas. Mr. Speaker, I rise today in strong support 
of S. 1793, the Ryan White HIV/AIDS Treatment Extension Act of 2009.
  Since its establishment in 1990, the Ryan White CARE Act has 
delivered vital funding to States and urban areas with large numbers of 
individual living with the AIDS virus.

[[Page H11533]]

  In Texas, the number of individuals living with HIV and AIDS 
increased in the last 10 years. Texas has one of the largest HIV and 
AIDS populations in the country and we rely heavily on Ryan White 
dollars to provide quality life-prolonging care to Texans living with 
HIV and AIDS.
  We currently have two Eligible Metropolitan Areas and 3 Transitional 
Grant Areas under Ryan White CARE Act in our State.
  Houston is currently the eighth largest Eligible Metropolitan Area in 
the Nation, with 10,000 individuals living with AIDS and Ryan White 
funding helped to provide critical health care and support services to 
more than 18,000 individuals in Houston in 2006.
  In my community in Harris County, our Hospital District utilizes more 
than $26 million each year to coordinate essential health care and 
support services for more than 21,000 individuals in our community 
living with HIV and AIDS.
  The importance of this program cannot be overestimated; without CARE 
Act funds, many Americans living with HIV and AIDS would have no other 
source for treatment.
  The Senate passed their version of the Ryan White HIV/AIDS Treatment 
Extension Act of 2009 on Monday and I am pleased we were able to work 
out a bipartisan and bicameral resolution which is reflected in this 
bill.
  Without this vital legislation, millions of individuals would lose 
their HIV and AIDS treatment and support services. I am pleased we 
worked swiftly to send this to the President.
  Mr. ENGEL. Mr. Speaker, I rise in strong support of the Ryan White 
CARE Act.
  The Ryan White CARE Act holds a very special significance to New York 
State. As home to 16 percent of the Nation's AIDS population, New York 
remains the epicenter of the HIV/AIDS crisis. New York has nearly 
120,000 residents living with HIV/AIDS and our State and cities have 
been proud to partner with the Federal Government in providing care for 
many of these individuals.
  New York State receives more than $300 million in Ryan White funds 
under all parts of the act to provide a range of health care and 
support services. Through Ryan White programs, 22,000 uninsured New 
Yorkers receive medications and ambulatory care services and thousands 
more receive other essential services such as mental health, case 
management, nutrition, and treatment adherence support services. These 
individuals must be guaranteed uninterrupted access to these vital 
services.
  It is critical that Congress act swiftly on the reauthorization of 
the Ryan White Reauthorization which nationwide provides lifesaving 
medications, health care and support services to over 500,000 people. 
As you know, unlike most reauthorizations Congress inserted a sunset 
provision into the act in 2006 requiring Congressional action by 
September 30, 2009. While we extended temporary funding for the program 
in the recent CR, it is important that we do not delay enactment of a 
full reauthorization so that our States, cities and localities can be 
assured of a stable source of needed funding.
  While 3 years ago, this reauthorization was the subject of much 
disagreement and dissent, we are in a different place today. 
Fortunately, members on both sides of the aisle, and more than 250 
organizations in the United States have worked hard over the past year 
to develop legislative principles where there is much agreement.
  This bill will provide immeasurable assistance to more than half a 
million low-income people served by the Ryan White CARE Act programs. I 
urge all my colleagues to support it.
  Mr. BARTON of Texas. Mr. Speaker, I yield back the balance of my 
time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, S. 1793.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. ROE of Tennessee. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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