[Congressional Record (Bound Edition), Volume 146 (2000), Part 14]
[Senate]
[Pages 21004-21010]
[From the U.S. Government Publishing Office, www.gpo.gov]



                 RYAN WHITE CARE ACT AMENDMENTS OF 2000

  Mr. BROWNBACK. Mr. President, I ask unanimous consent the Chair lay 
before the Senate a message from the House of Representatives to 
accompany S. 2311.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       Resolved, That the bill from the Senate (S. 2311) entitled 
     ``An Act to revise and extend the Ryan White CARE Act 
     programs under title XXVI of the Public Health Service Act, 
     to improve access to health care and the quality of care 
     under such programs, and to provide for the development of 
     increased capacity to provide health care and related support 
     services to individuals and families with HIV disease, and 
     for other purposes'', do pass with amendments.

  Mr. BROWNBACK. I ask unanimous consent the Senate agree to the 
amendments of the House of Representatives.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. JEFFORDS. Mr. President, it gives me great pleasure that the 
Senate is moving to pass the Ryan White Comprehensive AIDS Resources 
and Emergency Act Amendments of 2000, a measure that will reauthorize a 
national program providing primary health care services to people 
living with HIV and AIDS. I especially want to commend Senators Hatch 
and Kennedy for the leadership they have provided since the 
inauguration of the legislation establishing the Ryan White programs 
over a decade ago. I also want to commend Senator Frist whose medical 
expertise played a critical role in key provisions of the bill and 
continues to be an invaluable resource to our efforts on the range of 
health issues that come before the Senate. I want to recognize Senator 
Dodd for his unwavering support for this legislation and people living 
with HIV and AIDS. Finally, I want to acknowledge Senator Enzi's 
recognition of the growing burden that AIDS and HIV have placed on 
rural communities throughout the country and the need to address those 
gaps in services.
  It is also important that we recognize the dedicated efforts of our 
colleagues in the House of Representatives. Chairman Bliley supported 
this bill through its passage and provided critical guidance through 
the negotiations. Representatives Bilirakis, Coburn, and Waxman have 
demonstrated time and time again their commitment to people living with 
AIDS and each has worked diligently to find a compromise to ensure the 
continued services for people with HIV/AIDS. Representatives Brown and 
Dingell have also played important roles in shepherding this bill 
through the legislative process.
  Since its inception in 1990, the Ryan White program has enjoyed broad 
bipartisan support. During the last reauthorization of the Ryan White 
CARE Act in 1996, the measure garnered a vote of 97 to 3 on its final 
passage. As evidence that strong bipartisan support continues, I am 
happy to report that this reauthorization bill was passed unanimously 
by this Chamber in June of this year. The bipartisan support for this 
important legislation underlines the critical need for the assistance 
this Act provides across the Nation.
  With this reauthorization, we mark the ten years through which the 
Ryan White CARE Act has provided needed health care and support 
services to HIV positive people around the country. Titles I and II 
have provided much needed relief to cities and states hardest hit by 
this disease, while Titles III and IV have had a direct role in 
providing healthcare services to underserved communities. Ryan White 
program dollars provide the foundation of care so necessary in fighting 
this epidemic and have allowed States and communities around the 
country to successfully address the needs of people affected by HIV 
disease.
  In recent months a number General Accounting Office studies have 
shown that the CARE Act is providing services and support to people 
with HIV who are most in need and most deserving of our help. The GAO 
found that CARE Act funds are reaching the infected groups that have 
typically been underserved, including the poor, the uninsured, women, 
and ethnic minorities. These groups form a majority of CARE Act clients 
and are being served by the CARE Act in higher proportions than their 
representation in the AIDS population. The GAO also found that CARE Act 
funds support a wide array of primary care and support services, 
including the provision of powerful therapeutic regimens for people 
with HIV/AIDS that have dramatically reduced AIDS diagnoses and deaths.
  Previous efforts to improve this legislation have led to incredible 
reductions in the number of HIV infected babies being born each year 
and, equally important, to increased outreach, counseling, voluntary 
testing, and treatment services being provided to women with HIV 
infection. Between 1993 and 1998, perinatal-acquired AIDS cases 
declined 74 percent in the U.S. In this bill, I have continued to 
support efforts to reach women in need of care for their HIV disease 
and have included provisions to ensure that women, infants and children 
receive resources in accordance with the prevalence of the infection 
among them.
  The AIDS Drug Assistance Program has been another critical success. 
This program has provided people with HIV and AIDS access to newly 
developed, highly effective therapeutics. Because of these drugs, 
people are maintaining their health and living longer. The AIDS death 
rate and the number of new AIDS cases have been dramatically reduced. 
From 1996 to 1998, deaths from AIDS dropped 54 percent while new AIDS 
cases have been reduced by 27 percent. In this reauthorization bill we 
have improved access for underserved and poor communities and increased 
support for services that help maximize the impact of these therapies.
  Despite our great success, the Ryan White program remains as vital to 
the public health of this Nation as it was in 1990 and in 1996. While 
the rate of decline in new AIDS cases and deaths is leveling off, HIV 
infection rates continue to rise in many areas; becoming increasingly 
prevalent in rural and underserved urban areas; and also among women, 
youth, and minority communities. Local and state healthcare systems 
face an increasing burden of disease, despite our success in treating 
and caring for people living with HIV and AIDS. Rural and underserved 
urban areas are often unable to address the complex medical and support 
services needs of people with HIV infection. As the AIDS epidemic 
continues to expand into these areas across the country, this 
legislation will allow us to adapt our care systems to meet the most 
urgent needs in the communities hardest hit by the epidemic.
  The bill being considered today was developed on a bipartisan basis, 
working with other Committee Members, community stakeholders and 
elected officials at the state and local levels from whom we sought 
input to ensure that we addressed the most important problems facing 
communities of people with HIV infection. Finally we have worked 
closely with our colleagues in the House of Representatives to produce 
this agreement. This morning, our colleagues in the House of 
Representatives unanimously passed this

[[Page 21005]]

legislation that we have before us. The agreements we have reached with 
our House colleagues have been fully explained in an Statement of 
Explanation and I would like unanimous consent that this document be 
printed as part of the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  This bill will double the minimum base funding available to states 
through the CARE Act to assist them in developing systems of care for 
people struggling with HIV and AIDS. The bill also includes a new 
supplemental state grant to target assistance to small and mid-sized 
metropolitan areas to help them address the increasing number of people 
with HIV/AIDS living outside of urban areas that receive assistance 
under Title I of the Act. Rural and underserved areas receive a 
preference for planning, early intervention, and capacity development 
grants under title III. In order to assist states in expanding access 
to appropriate HIV/AIDS therapeutics to low-income people with HIV/
AIDS, a supplemental grant has been added to the AIDS Drug Assistance 
Program.
  The bill remains primarily a system of grants to State and local 
jurisdictions, thereby ensuring that grantees can respond to local 
needs. States, EMAs, and the affected communities will still decide how 
to best prioritize and address the healthcare needs of their HIV-
positive citizens. This bill reinforces the ability of States and EMAs 
to identify and meet local needs.
  Finally, in recognition of the changing nature of the epidemic, I 
have asked the Institute of Medicine to complete a study of the 
financing and delivery of primary care and support services for low 
income, uninsured, and under-insured individuals with HIV disease, 
within 21 months after the enactment of this Act. Changes in HIV 
surveillance and case reporting, and the effects of these changes on 
program funding, will be included in this study. The recommendations 
from this study will help Congress and the Secretary of Health and 
Human Services to ensure the most effective and efficient use of 
Federal funds for HIV and AIDS care and support.
  I am proud that this bill has progressed through the Congress and 
that we will see this bill become law this year. The people struggling 
to overcome the challenges of HIV and AIDS must continue to benefit 
from high quality medical care and access to lifesaving drugs. We have 
made incredible progress in the fight against HIV/AIDS and I want to 
ensure that every person in America in need of assistance benefits from 
our tremendous advances.
  Many groups and individuals have contributed significantly to 
crafting this bill, but I want to acknowledge those at the Health 
Resources and Services Administration. All of the groups united under 
the umbrella of the National Organizations Responding to AIDS (NORA) 
deserve recognition. Representing a diverse community of people with 
AIDS, CARE Act service providers, and administrative agencies, NORA 
clearly and effectively communicated to Congress the needs and 
priorities of their constituents.
  I also want to thank several staff members who have worked long and 
hard to craft this bill and to address the concerns and needs of the 
affected communities. Stephanie Robinson and Idalia Sanchez, for 
Senator Kennedy, were key to reaching agreement on this bill and have 
provided invaluable assistance and support throughout the development 
of this legislation. Dave Larson and Mary Sumpter Johnson, of Senator 
Frist's office, for their support for the needs of rural and 
underserved communities throughout the nation. Similarly, Jeannie 
Ireland with Senator Dodd's office, Helen Rhee, working for Senator 
DeWine, Libby Rolfe, for Mr. Sessions, and Raissa Geary and Mary Jordan 
in Senator Enzi's office, provided valuable input. Without the efforts 
of these staff members, we would not have such a strong, well-balanced, 
and targeted reauthorization bill before us today. I want to also 
express my gratitude and thanks to Bill Baird, Legislative Counsel, who 
worked tirelessly to craft legislative language. Finally, I want to 
acknowledge the contributions of Sean Donohue and William Oscar Fleming 
of my staff who guidance of this effort from the beginning has resulted 
in a bill that enjoys broad bipartisan support and which most 
importantly meets the pressing needs of people with HIV and AIDS.

                               Exhibit 1

    Ryan White CARE Act Amendments of 2000--Managers' Statement of 
                              Explanation

       The Ryan White CARE Act Amendments of 2000 reauthorize 
     Title XXVI of the Public Health Service Act to ensure that 
     individuals living with HIV and AIDS receive health care and 
     related support services. The legislation contains 
     authorization for appropriations and programmatic changes to 
     ensure the CARE Act programs respond to evolving demographic 
     trends in the HIV/AIDS epidemic and advances in treatment and 
     care.
       In March, 1990, Congress enacted the Ryan White CARE Act, 
     honoring Ryan White, a young man who taught the Nation to 
     respond to the HIV/AIDS epidemic with hope and action rather 
     than fear. By the spring of 1990, over 128,000 people had 
     been diagnosed with AIDS in the United States and 78,000 had 
     died of the disease. The CARE Act was reauthorized in 1996, 
     as the epidemic spread to more than 600,000 Americans 
     diagnosed with AIDS and amidst the nationwide recognition 
     that CARE Act programs were indispensable to the care and 
     treatment of Americans with HIV/AIDS.
       The CARE Act Amendments of 2000 marks the second 
     reauthorization of the CARE Act. In the last twenty years, 
     the HIV/AIDS epidemic has claimed over 420,000 American men, 
     women, and children. Today, the Centers for Disease Control 
     and Prevention estimates that there are currently between 
     800,000 and 900,000 persons living with HIV in the United 
     States, with 40,000 new infections annually.
       While there is still no cure, the CARE Act has been 
     instrumental in responding to the public health, social and 
     economic burdens of the HIV/AIDS epidemic. However, the 
     steady expansion and changed demographics of the epidemic, as 
     well as the improved survival time for people living with 
     AIDS, are placing increasing stress on State and local health 
     care systems, community based organizations and families 
     providing care. Most importantly, the epidemic is expanding 
     beyond major cities to smaller cities and rural regions, and 
     disproportionately affecting women, communities of color, 
     children and youth.
       The Ryan White CARE Act Amendments of 2000 preserves the 
     best and proven features of existing CARE Act programs. But 
     the CARE Act Amendments of 2000 also makes important and 
     substantial reforms to respond to the significant changes in 
     the HIV/AIDS epidemic of the last 5 years.
       The Organization of Services Under the CARE Act Amendments 
     of 2000 is as follows:
       Title I. Emergency Relief for Areas with Substantial Need 
     for Services: Provides emergency relief grants to 51 eligible 
     metropolitan areas (EMAs) disproportionately affected by the 
     HIV epidemic to provide primary care and HIV-related support 
     services to people with HIV and AIDS. Half of the Title I 
     funding is distributed by formula; the remaining half is 
     distributed competitively, based on the demonstration of 
     severity of need and other criteria.
       Planning Council membership has been revised to include HIV 
     prevention providers, homeless and housing service providers, 
     and representatives of prisoners. A third of Planning Council 
     members must be individuals with HIV/AIDS receiving care who 
     are not officers, employees or consultants to Title I 
     grantees.
       Title II. CARE Grant Program: Provides formula grants to 
     States, District of Columbia, Puerto Rico and U.S. 
     Territories to improve the quality of health care and support 
     services for individuals with HIV disease and their families. 
     The funds are used: to provide medical support services, to 
     continue health insurance payments, to provide home care 
     services, and, through the AIDS Drug Assistance Programs 
     (ADAP), to provide medications necessary for the care of 
     these individuals. Supplemental formula grants are awarded to 
     States with ``emerging communities'' which are ineligible for 
     grants under Title I.
       Subtitle B provides discretionary grants to States for the 
     reduction of perinatal transmission of HIV, and for HIV 
     counseling, testing, and outreach to pregnant women. Subtitle 
     C provides discretionary grants to States for partner 
     notification, counseling and referral services.
       Title III. Early Intervention Services: Funds nonprofit 
     entitles providing primary care and outpatient early 
     intervention services, including case management, counseling, 
     testing, referrals, and clinical and diagnostic services to 
     individuals diagnosed with HIV. The unfunded program of State 
     formula grants in current law is repealed.
       Title IV. Other Programs and Activities: Provides grants 
     for comprehensive services to children, youth, and women 
     living with HIV and their families. Such services include 
     primary, specialty and psychosocial care, as

[[Page 21006]]

     well as HIV outreach and prevention activities. Grantees must 
     demonstrate linkages to, and provide clients with access and 
     education on, HIV/AIDS clinical research.
       Title IV newly authorizes the AIDS Education and Training 
     Centers (AETC), a network of 14 regional centers conducting 
     clinical HIV education and training of health providers, to 
     provide prenatal and gynecological care. The HIV/AIDS Dental 
     Reimbursement program, covering uncompensated oral health 
     care for patients with HIV/AIDS, is expanded to provide 
     community-based care in underserved areas.
       Under Subtitle B, general provisions authorize CDC data 
     collection of CARE Act planning and evaluation, enhanced 
     interagency coordination of HIV services and prevention, 
     development of a plan for the case management of prisoners 
     with HIV, and administrative provisions related to audits, 
     and a plan for simplification of CARE Act grant 
     disbursements.
       Title V. General Provisions: Authorizes Institute of 
     Medicine (IOM) studies and expansion of Federal support for 
     the development of rapid HIV tests. Makes necessary and 
     technical corrections in Title XXVI of the Public Health 
     Service Act.
       A summary of selected provisions is as follows:
       Use of HIV Case Data in Formula Grants: In order to target 
     funding more accurately to reflect the HIV/AIDS epidemic, the 
     Managers have revised and updated the Title I and Title II 
     formulas to make use of data on cases of HIV infection as 
     well as of AIDS. In Fiscal Year (FY) 2005, HIV and AIDS case 
     data is intended to be used in the Title I and Title II 
     formulas.
       However, no later than July 1, 2004, the Secretary shall 
     determine whether HIV case data, as reported to and confirmed 
     by the Director of CDC, is sufficiently accurate and reliable 
     from all eligible areas and States for such use in the 
     formula. The Secretary shall also consider the findings of 
     the Institute of Medicine (IOM) study undertaken under 
     section 501(b).
       If the Secretary makes an adverse determination regarding 
     HIV case data, the Managers intend that only AIDS case data 
     will be used in FY2005 formula allocations. The Secretary 
     shall also provide grants and technical assistance to States 
     and eligible areas to ensure that accurate and reliable HIV 
     case data is available no later than FY2007.
       Planning and priority setting: The Managers have 
     strengthened the capacity of EMAs and States to plan, 
     prioritize, and allocate funds, based on the size and 
     demographic characteristics of the populations with HIV 
     disease in the eligible area. Planning, priority setting, and 
     funding allocation processes must take into account the 
     demographics of the local HIV/AIDS epidemic, existing 
     disparities in access HIV-related health care, and resulting 
     adverse health outcomes. It is the intent of the Managers 
     that CARE Act dollars more closely follow the shifting trends 
     in the local epidemic and address disparities in health care 
     access and health outcomes as well as the need for capacity 
     development within the local and State HIV health care 
     infrastructures.
       The Managers intend both EMAs and States to develop 
     strategies to bring into and retain in care those individuals 
     who are aware of their HIV status but are not receiving 
     services. As part of this process, the Managers place the 
     highest priority on EMAs and States focusing on eliminating 
     disparities in access and services among affected 
     subpopulations and historically underserved communities. The 
     Managers recognize, however, that the relative availability 
     or lack of HIV prevalence data will be reflected in the 
     scope, goals, timetable and allocation of funds for 
     implementation of the strategy.
       The Managers also expect the Secretary to collaborate with 
     Titles I and II grant recipients and providers to develop 
     epidemiologic measures and tools for use in identifying 
     persons with HIV infection who know their HIV status but are 
     not in care. The Managers recognize the difficulty the EMAs 
     and States may experience in identifying persons with HIV 
     infection who are not in care and who may be unknown to any 
     health or social support system. The efforts on the part of 
     EMAs and States to accomplish these important tasks, however, 
     should not be delayed until this process is complete. 
     Instead, the Managers expect Titles I and II grant recipients 
     to establish and implement strategies responsive to these 
     urgent needs before the development of nationally uniform 
     measures, to the extent that is practicable and to which 
     necessary prevalence data is reasonably available.
       The Managers have also authorized outreach activities in 
     Titles I and II intended to identify individuals with HIV 
     disease know their HIV status but are not receiving services. 
     The intent is to ensure that EMAs and States understand that 
     outreach activities which are consistent with early 
     intervention services and necessary to implement the 
     aforementioned strategies, are appropriate uses of Titles I 
     and II funds. It is not the Managers' intent that such 
     activities supplant or otherwise duplicate activities such as 
     case finding, surveillance and social marketing campaigns 
     currently funded and administered by the Centers for Disease 
     Control and Prevention (CDC). Instead, this authorization 
     reflects the urgency of increasing the coordination between 
     HIV prevention and HIV care and treatment services in all 
     CARE Act programs.
       Hold harmless provisions: The hold-harmless provisions are 
     intended to minimize loss and stabilize systems of care in 
     EMAs and States, while assuring that funds are allocated in 
     Titles I and II to reflect the current distribution and 
     epidemiology of the epidemic.
       The Managers have revised the Title I hold harmless to 
     limit a potential loss in an EMA's formula allocation to a 
     small percentage of the amount allocated to the eligible area 
     in the previous (or base) year. An EMA may lose no more than 
     15 percent of its base formula allocation over five years, 
     beginning with 2 percent in the first year and increasing in 
     subsequent years. If the Secretary determines that data on 
     HIV prevalence are accurate and reliable for use in 
     determining Title I formula grants for Fiscal Year 2005, all 
     EMAs may lose no more than 2 percent of their Fiscal Year 
     2004 formula allocation in that year.
       Should an EMA experience a decline in its Title I formula 
     allocation followed by an intervening year in which there is 
     no decline, its losses in any subsequent, nonconsecutive year 
     of decline would once again be limited to 2 percent (i.e., 
     the intervening year ``resets the clock'').
       The Managers intend to ensure that essential primary care 
     and support services are not compromised by short-term 
     fluctuations in AIDS case counts. Because no new EMA is 
     expected by HRSA's Bureau of HIV/AIDS to require the hold 
     harmless in the first three or four years of this 
     reauthorization period, the Managers expect this policy will 
     shield all eligible areas, save those currently requiring the 
     hold harmless, from any meaningful loss in Title I formula 
     funding.
       Under the Title II holds harmless, a State or territory may 
     lose no more than 1 percent from the previous fiscal year 
     amounts, or 5 percent over the 5-year reauthorization period. 
     This protection extends to base Title II funding (which 
     excludes funds for AIDS Drug Assistance Programs (ADAP)), as 
     well as to overall Title II funding.
       Women, child, infants, and youth set-aside: The Managers 
     are aware of the rising incidence of HIV among youth and 
     women, particularly women of color, and recognize the 
     challenges in assuring them access to primary care and 
     support services for HIV and AIDS. The Managers intend to 
     increase the availability of primary care and health-related 
     supportive services under Title I and Title II for each of 
     the four groups described in the set-aside. Youth are added 
     as a new category within this set-aside. The Managers intend 
     the term ``youth'' to include persons between the ages of 13 
     and 24, and ``children'' to include those under the age of 
     13, including infants.
       The Managers clarify that the set-asides for women, 
     infants, children, and youth with HIV disease be allocated 
     proportionally, based on the percentage of the local HIV-
     infected population that each group represents. The Managers 
     intend that the States and EMAs continue to make every effort 
     to reach and serve women, infants, children, and youth living 
     with HIV/AIDS by allocating sufficient resources under Titles 
     I and II to serve each of these populations. The Managers 
     also recognize that these priority populations often comprise 
     a greater proportion of HIV cases rather than AIDS cases in a 
     local area. This distinction should be taken into account 
     where necessary prevalence data is reasonably available.
       The Managers are aware that these populations may also have 
     access to HIV care through other parts of Title XXVI, 
     Medicaid, State Children's Health Insurance Program (SCHIP), 
     and other Federal and State programs. Therefore, the 
     requirement to proportionally allocate funds provided under 
     Title II to each of these populations may be waived for 
     States which reasonably demonstrate that these populations 
     are receiving adequate care.
       Capacity development: Titles I, II and III of this 
     legislation provide a new focus on strengthening the capacity 
     of minority communities and underserved areas where HIV/AIDS 
     is having a disproportionate impact. Currently, many 
     underserved urban and rural areas are not able to compete 
     successfully for planning grants and early intervention 
     service grants due to the lack of infrastructure and 
     experience with the Ryan White CARE Act programs. This gap in 
     services available is increasingly important, as the HIV and 
     AIDS epidemic extends into rural communities. In addition to 
     authorizing capacity development under Titles I and II, the 
     Managers establish a preference for rural areas under Title 
     III that will allow program administrators to target capacity 
     development grants, planning grants, and the delivery of 
     primary care services to rural communities with a growing 
     need for HIV services. However, urban areas are not excluded 
     from consideration for future grants nor is funding reduced 
     to current grants in urban areas.
       Quality management: The Managers recognize the importance 
     of having CARE Act grantees ensure that quality services are 
     provided to people with HIV and that quality

[[Page 21007]]

     management activities are conducted on an ongoing basis. 
     Quality management programs are intended to serve grantees in 
     evaluating and improving the quality of primary care and 
     health-related supportive services provided under this act. 
     The quality management program should accomplish a threeford 
     purpose: (1) assist direct service medical providers funded 
     through the CARE Act in assuring that funded services adhere 
     to established HIV clinical practices and Public Health 
     Service (PHS) guidelines to the extent possible; (2) ensure 
     that strategies for improvements to quality medical care 
     include vital health-related supportive services in achieving 
     appropriate access to and adherence with HIV medical care; 
     and (3) ensure that available demographic, clinical, and 
     health care utilization information is used to monitor the 
     spectrum of HIV-related illnesses and trends in the local 
     epidemic.
       The Managers expect the Secretary to provide States with 
     guidance and technical assistance for establishing quality 
     management programs, including disseminating such models as 
     have been developed by States and are already being utilized 
     by Title II programs and in clinical practice environments. 
     Furthermore, the Managers intend that the Secretary provide 
     clarification and guidance regarding the distinction between 
     use of CARE Act funds for such program expenditures that are 
     covered as either planning and evaluation and funds for 
     program support costs. It is not the Managers' intent to 
     divert current program resources or to reassign current 
     program support costs or clinical quality programs to new 
     cost areas, if they are an integral part of a State's current 
     quality management efforts.
       Program support costs are described as any expenditure 
     related to the provision of delivering or receiving health 
     services supported by CARE Act funds. As applied to the 
     clinical quality programs, these costs include, but are not 
     limited to, activities such as chart review, peer-to-peer 
     review activities, data collection to measure health 
     indicators or outcomes, or other types of activities related 
     to the development or implementation of a clinical quality 
     improvement program. Planning and evaluation costs are 
     related to the collection and analysis of system and process 
     indicators for purposes of determining the impact and 
     effectiveness of funded health-related support services in 
     providing access to and support of individuals and 
     communities within the health delivery system.
       Early intervention services: The Managers authorize early 
     intervention services as eligible services under Titles I and 
     II under certain circumstances. The Managers intend to allow 
     grantees to provide certain early intervention services, such 
     as HIV counseling, testing, and referral services, to 
     individuals at high risk for HIV infection, in accordance 
     with State or EMA planning activities. The Managers recognize 
     the range of organizations that may be eligible to provide 
     early intervention services, including other grantees under 
     titles I, II and III such as community based organizations 
     (CBOs) that act as points of entry into the health care 
     system for traditionally underserved and minority 
     populations.
       The Managers believe that referral relationships maintained 
     by providers of early intervention services are essential to 
     increasing the numbers of people with HIV/AIDS who are 
     identified and to bringing them into care earlier in the 
     progression of their disease.
       Health-care related support services: The Managers wish to 
     stress the importance of CARE Act funds in meeting the health 
     care needs of persons and families with HIV disease. The Act 
     requires support services provided through CARE Act funds to 
     be health care related. States and EMAs should ensure that 
     support services meet the objective of increasing access to 
     health care and ongoing adherence with primary care needs. 
     The Managers reaffirm the critical relationship between 
     support service provision and positive health outcomes.
       Title I planning council duties and membership: The 
     Managers have amended numerous aspects of CARE Act programs 
     to enhance the coordination between HIV prevention and HIV/
     AIDS care and treatment services. In this case, Planning 
     Council membership of the providers of HIV prevention 
     services will help assure this coordination. To improve 
     representation of underserved communities, providers of 
     services to homeless populations and representatives of 
     formerly incarcerated individuals with HIV disease are 
     included in planning council membership. It is the intent of 
     the Managers that the needs of all communities affected by 
     HIV/AIDS and all providers working within the service areas 
     be represented. The Managers also intend the Planning 
     Councils more adequately reflect the gender and racial 
     demographics of the HIV/AIDS population within their 
     respective EMAs.
       The Managers also intend that patients and consumers of 
     Title I services constitute a substantial proportion of 
     Planning Council memberships. The prohibited of officers, 
     employees and consultants is not intended to impede the 
     participation of qualified, motivated volunteers with Title I 
     grantees from serving on Planning Councils where they do not 
     maintain significant financial relationships with such 
     grantees. In contrast to such significant financial 
     relationships, volunteers may be reimbursed reasonable 
     incidental costs, including for training and transportation, 
     which help to facilitate their important contribution to the 
     Planning Councils.
       To ensure that new Planning Council members are adequately 
     prepared for full participation in meetings, the Managers 
     direct the Secretary to ensure that proper training and 
     guidance is provided to members of the Councils. The Managers 
     also expect Planning Councils to provide assistance, such as 
     transportation and childcare, to facilitate the participation 
     of consumers, particularly those from affected subpopulations 
     and historically underserved communities.
       Consistent with the ``sunshine'' policies of the Federal 
     Advisory Committee Act (FACA), all meetings of the Planning 
     Councils shall be open to the public and be held after 
     adequate notice to the public. Detailed minutes, records, 
     reports, agenda, and other relevant documents should also be 
     available to the public. The Managers intend for such 
     documents to be available for inspection and copying at a 
     single location, including posting on the Internet.
       Title I supplemental: In order to target funding to areas 
     in greatest need of assistance, severity of need is given a 
     greater weight of 33 percent in the award of Title I 
     supplemental grants. The Managers intend that Title I 
     supplemental awards are not intended to be allocated on the 
     basis of formula grant allocations. Instead, such 
     supplemental awards are to be directed principally to those 
     eligible areas with `severe need,'' or the greatest or 
     expanding public health challenges in confronting the 
     epidemic. The Managers have included additional factors to be 
     considered in the assessment of severe need, including the 
     current prevalence of HIV/AIDS, and the degree of increasing 
     and unmet needs for services. Additionally, the Managers 
     believe that syphilis, hepatitis B and hepatitis C should be 
     regarded as important co-morbidities to HIV/AIDS.
       It is the Managers' strong view that HRSA's Bureau of HIV/
     AIDS should employ standard, quantitative measures to the 
     maximum extent possible in lieu of narrative self-reporting 
     when awarding supplemental awards. The Managers therefore 
     renew the Bureau's obligation to develop in a timely manner a 
     mechanism for determining severe need upon the basis of 
     national, quantitative incidence data. In this regard, the 
     Managers recognize that adequate and reliable data on HIV 
     prevalence may not be uniformly available in all eligible 
     areas on the date of enactment. It is noted, however, that 
     ``HIV disease'' under the CARE Act encompasses both persons 
     living with AIDS as well as persons diagnosed as HIV positive 
     who have not developed AIDS.
       Title II base minimum funding: The minimum Title II base 
     award is increased in order to increase the funding available 
     to States for the capacity development of health system 
     programs and infrastructure. The Federated States of 
     Micronesia and the Republic of Palau are included as entities 
     eligible to receive Title II funds, in recognition of the 
     need to establish a minimum level of funding to assist in 
     building HIV infrastructure.
       Title II public participation: The Managers urge States to 
     strengthen public participation in the Ryan White Title II 
     planning process. While the Managers do not intend that 
     States be mandated to consult with all entities participating 
     in the Title I planning process, reference to such entities 
     is intended to provide guidance to the States that such 
     entities are important constituencies which the States should 
     endeavor to include in their planning processes. Moreover, 
     States may demonstrate compliance with the new requirement of 
     an enhanced process of public participation by providing 
     evidence that existing mechanisms for consumer and community 
     input provide for the participation of such entities. The 
     intent is to allow States to utilize the optimal public 
     advisory planning process, such as special planning bodies or 
     standing advisory groups on HIV/AIDS, for their particular 
     population and circumstances.
       The Managers are also aware of the difficulties that some 
     States with limited resources may encounter in convening 
     public hearings over large geographic or rural areas and 
     encourage the Secretary to work with these States to develop 
     appropriate processes for public input, and to consider such 
     limitations when enforcing these requirements.
       Title II HIV care consortia: The Manager intend that the 
     States continue to work with local consortia to ensure that 
     they identify potential disparities in access to HIV care 
     services at the local level, with a special emphasis on those 
     experiencing disparities in access to care, historically 
     underserved populations, and HIV infected persons not in 
     care. However, the Managers do not intend that States and/or 
     consortia be mandated to consult with all entities 
     participating in the Title I planning process. Rather, 
     reference to such entities is intended to provide guidance to 
     the States that such entities are important constituencies 
     which the States should endeavor to include in their planning 
     processes.
       Title II ``emerging communities'' supplement: There 
     continues to be a growing need to address the geographic 
     expansion of this epidemic, and this Act continues the 
     efforts

[[Page 21008]]

     made during the last reauthorization to direct resources and 
     services to areas that are particularly underserved, 
     including rural areas and metropolitan areas with significant 
     AIDS cases that are not eligible for Title I funding. A 
     supplemental formula grant program is created within Title II 
     to meet HIV care and support needs in non-EMA areas. There 
     are a large number of areas within States that do not meet 
     the definition of a Title I EMA but that, nevertheless, 
     experience significant numbers of people living with AIDS. 
     This provision stipulates that these ``emerging 
     communities,'' defined as cities with between 500 and 1,999 
     reported AIDS cases in the most recent 5-year period, be 
     allocated 50 percent of new appropriations to address the 
     growing need in these areas. Funding for this provision is 
     triggered when the allocations to carry out Part B, excluding 
     amounts allocated under section 2618(a)(2)(I), are 
     $20,000,000 in excess of funds available for this part in 
     fiscal year 2000, excluding amounts allocated under section 
     2618(a)(2)(I). States can apply for these supplemental awards 
     by describing the severity of need and the manner in which 
     funds are to be used.
       The Managers intend to acknowledge the challenges faced by 
     many areas with a significant burden of HIV and AIDS and a 
     lack of health care infrastructure or resources to provide 
     HIV care services. This supplemental program allows the 
     Secretary to make grants to States to address HIV service 
     needs in these underserved areas. The Managers understand the 
     necessity to continue to support existing and expanding 
     critical Title II base services.
       AIDS Drug Assistance Program supplemental grant and 
     expanded services: Under this Act, the AIDS Drug Assistance 
     Program (ADAP) has been strengthened to assist States in a 
     number of areas. The Secretary is authorized to reserve 3 
     percent of ADAP appropriations for discretionary supplemental 
     ADAP grants which shall be awarded in accordance with 
     severity of need criteria established by the Secretary. Such 
     criteria shall account for existing eligibility standards, 
     formulary composition and the number of patients with incomes 
     at or below 200 percent of poverty. The Managers also 
     encourage the Secretary to consider such factors as the 
     State's ability to remove restrictions on eligibility based 
     on current medical conditions or income restrictions and to 
     provide HIV therapeutics consistent with PHS guidelines.
       States are also required to match the Federal supplement at 
     a rate of 1:4. The Managers expect the State to continue to 
     maintain current levels of effort in its ADAP funding. The 
     Managers intend that the 25 percent State match required to 
     receive funds under this section be implemented in a flexible 
     manner that recognizes the variations between Federal, State, 
     and programmatic fiscal years.
       In addition, up to 5 percent of ADAP funds will be allowed 
     to support services that directly encourage, support, and 
     enhance adherence with treatment regimens, including medical 
     monitoring, as well as purchase health insurance plans where 
     those plans provided fuller and more cost-effective coverage 
     of AIDS therapies and other needed health care coverage. 
     However, up to 10 percent of ADAP funds may be expended for 
     such purposes if the State demonstrates that such services 
     are essential and do not diminish access to therapeutics. 
     Finally, the Managers recognize that existing Federal policy 
     provides adequate guidelines to states for carrying out 
     provisions under this section.
       Partner notification, perinatal transmission, and 
     counseling services: Discretionary grants are authorized 
     under this Act for partner notification, counseling and 
     referral services. The Managers have also expanded the 
     existing grant program to States for the reduction of 
     perinatal transmission of HIV, and for HIV counseling, 
     testing, and outreach to pregnant woman. Funding for 
     perinatal HIV transmission reduction activities is expanded, 
     with additional grants available to States with newborn 
     testing laws or States with significant reductions in 
     perinatal HIV transmission. In addition, this Act further 
     specifies information to be conveyed to individuals receiving 
     HIV positive test results in order to reduce risk of HIV 
     transmission through sex or needle-sharing practices.
       Coordination of coverage and services: This Act also 
     strengthens the requirements made on the States and EMAs in a 
     number of areas aimed at improving the coordination of 
     coverage and services. Grantees must access the availability 
     of other funding sources, such as Medicaid and the State 
     Children's Health Insurance Program (SCHIP) and improve 
     efforts to ensure that CARE Act funds are coordinated with 
     other available payers.
       Titles II and IV administrative expenses: The 
     administrative cap for the directly funded Title III programs 
     is increased. The administrative cap for Title III grants is 
     raised from 7.5 percent to 10 percent to correspond with the 
     10 percent cap on individual contractors in Title I. The 
     Secretary is directed to review administrative and program 
     support expenses for Title IV, in consultation with grantees. 
     In order to assure that children, youth, women, and families 
     have access to quality HIV-related health and support 
     services and research opportunities, the Secretary is 
     directed to work with Title IV grantees to review expenses 
     related to administrative, program support, and direct 
     service-related activities.
       Title IV access to research: This Act removes the 
     requirement that Title IV grantees enroll a ``significant 
     number'' of patients in research projects. Title IV provides 
     an important link between women, children, and families 
     affected by HIV/AIDS and HIV-related clinical research 
     programs. The ``significant number'' requirement is removed 
     here to eliminate the incentive for providers to 
     inappropriately encourage or pressure patients to enroll in 
     research programs.
       To maintain appropriate access to research opportunities, 
     providers are required to develop better documentation of the 
     linkages between care and research. The Secretary of Health 
     and Human Services (HHS), through the National Institutes of 
     Health (NIH), is also directed to examine the distribution 
     and availability of HIV-related clinical programs for 
     purposes of enhancing and expanding access to clinical 
     trials, including trials funded by NIH, CDC and private 
     sponsors. The Managers encourage the Secretary to assure that 
     NIH-sponsored HIV-related trials are responsive to the need 
     to coordinate the health services received by participants 
     with the achievement of research objectives. Nor do the 
     Managers intend this requirement to require the 
     redistribution of funds for such research projects.
       Part F Dental Reimbursement Program: The Managers have 
     established new grants for community-based health care to 
     support collaborative efforts between dental education 
     programs and community-based providers directed at providing 
     oral health care to patients with HIV disease in currently 
     unserved areas and communities without dental education 
     programs. Although the Dental Program has been tremendously 
     successful, there is still a large HIV/AIDS population that 
     has not benefitted because there is not a dental education 
     institution participating in their area. These patients are 
     also in need of dental services that could be provided at 
     community sites if more community-based providers would 
     partner with a dental school or residency program. In these 
     partnerships, dental students or residents could provide 
     treatment for HIV/AIDs patients in underserved communities 
     under the direction of a community-based dentist who would 
     serve as adjunct faculty. By encouraging dental educational 
     institutions to partner with community-based providers, the 
     Managers intend to address the unmet need in these areas by 
     ensuring that dental treatment for the HIV/AIDS population is 
     available in all areas of the country, not just where dental 
     schools are located.
       Technical assistance and guidance: The Managers reaffirm 
     the Secretary's responsibility in providing needed guidance 
     and tools to grantees in assisting them in carrying out new 
     requirements under this Act. The Secretary is required to 
     work with States and EMAs to establish epidemiologic measures 
     and tools for use in identifying the number of individuals 
     with HIV infection, especially those who are not in care. The 
     legislation requests an IOM study to assist the Secretary in 
     providing this advice to grantees.
       The Managers understand that the Secretary has convened a 
     Public Health Service Working Group on HIV Treatment 
     Information Dissemination, which has produced recommendations 
     and a strategy for the dissemination of HIV treatment 
     information to health care providers and patients. 
     Recognizing the importance of such a strategy, the Managers 
     intend that the Secretary issue and begin implementation of 
     the strategy to improve the quality of care received by 
     people living with HIV/AIDS.
       Data Collection through CDC: The Managers believe that an 
     additional authorization for HIV surveillance activities 
     under the CDC will serve to advance the purposes of the CARE 
     Act. To better identify and bring individuals with HIV/AIDS 
     into care, States and cities may use such funding to enhance 
     their HIV/AIDS reporting systems and expand case finding, 
     surveillance, social marketing campaigns, and other 
     prevention service programs. Notwithstanding its strong 
     interest in improving the coordination between HIV prevention 
     and HIV care and treatment services, the Managers intend that 
     this enhanced funding for CDC and its grantees ensure that 
     CARE Act programs and funds not duplicate or be diverted to 
     activities currently funded and administered by the CDC.
       Coordination: This Act requires the Secretary to submit a 
     plan to Congress concerning the coordination of Health 
     Resources and Services Administration (HRSA), Centers for 
     Disease Control and Prevention (CDC), Substance Abuse and 
     Mental Health Services Administration (SAMHSA), and Health 
     Care Financing Administration (HCFA), to enhance the 
     continuity of care and prevention services for individuals 
     with HIV disease or those at risk of such disease. The 
     Managers believe that much greater effort is required to 
     ensure that the provision of HIV prevention and care services 
     becomes as seamless as possible, and that coordination be 
     pursued at the Federal level, in the States and local 
     communities to eliminate any administrative barriers to the 
     efficient provision of high quality services to individuals 
     with HIV disease.

[[Page 21009]]

       A second plan for submission to Congress focuses on the 
     medical case management and provision of support services to 
     persons with HIV released from Federal or State prisons.
       Administrative simplification: The Managers intend for the 
     Secretary of HHS to explore opportunities to reduce the 
     administrative requirements of Ryan CARE Act grantees through 
     simplifying and streamlining the administrative processes 
     required of grantees and providers under Titles I and II. In 
     consultation with grantees and service providers of both 
     parts, the Secretary is directed to (1) develop a plan for 
     coordinating the disbursement of appropriations for grants 
     under Title I with the disbursement of appropriations for 
     grants under Title II, (2) explore the impact of biennial 
     application for Titles I and II on the efficiency of 
     administration and the administrative burden imposed on 
     grantees and providers under Titles I and II, and (3) develop 
     a plan for simplifying the application process for grants 
     under Titles I and II. It is the intent of the Managers to 
     improve the ability to grantees to comply with administrative 
     requirements while decreasing the amount of staff time and 
     resources spent on administrative requirements.
       Program and service studies: The Managers request that the 
     Secretary, through the IOM, examine changing trends in the 
     HIV/AIDS epidemic and the financing and delivery of primary 
     care and support services for low-income, uninsured 
     individuals with HIV disease. The Secretary is directed to 
     make recommendation regarding the most effective use of 
     scarce Federal resources. The purpose of the study is to 
     examine key factors associated with the effective and 
     efficient financing and delivery of HIV services (including 
     the quality of services, health outcomes, and cost-
     effectiveness). The Managers expect that the study would 
     include examination of CARE Act financing of services in 
     relation to existing public sector financing and private 
     health coverage; general demographics and comorbidities of 
     individuals with HIV disease; regional variations in the 
     financing and costs of HIV service delivery; the availability 
     and utility of health outcomes measures and data for 
     measuring quality of Ryan White funded service; and available 
     epidemiologic tools and data sets necessary for local and 
     national resource planning and allocation decisions, 
     including an assessment of implementation of HIV infection 
     reporting, as it impacts these factors.
       The Managers also require an IOM study focuses on 
     determining the number of newborns with HIV, where the HIV 
     status of the mother is unknown; perinatal HIV transmission 
     reduction efforts in States; and barriers to routine HIV 
     testing of pregnant women and newborns when the mothers' HIV 
     status is unknown. The study is intended to provide States 
     with recommendations on improving perintal prevention 
     services and reducing the number of pediatric HIV/AIDS cases 
     resulting from perinatal transmission.
       Development of Rapid HIV Test: The Managers encourage the 
     Secretary to expedite the availability of rapid HIV tests 
     which are safe, effective, reliable and affordable. The 
     Managers intend that the National Institutes of Health expand 
     research which may lead to such tests. The Managers also 
     intend that the Director of CDC should take primary 
     responsibility, in conjunction with the Commissioner of Food 
     and Drugs, for a report to Congress on the public health need 
     and recommendations for the expedited review of rapid HIV 
     tests. The Managers believe that the Food and Drug 
     Administration should account for the particular applications 
     and urgent need for rapid HIV tests, as articulated by public 
     health experts and the CDC, when determining the specific 
     requirements to which such tests will be held prior to 
     marketing.
       Department of Veterans Affairs: The Managers note that the 
     U.S. Department of Veterans Affairs is the largest single 
     direct provider of HIV care and services in the country. Over 
     18,000 veterans received HIV care at VA facilities in 1999. 
     Veterans with HIV infection are eligible to participate in 
     Ryan White Title I and Title II programs when they meet 
     eligibility requirements set by EMAs and States, whose plans 
     for the delivery of services must account for the 
     availability of VA services. VA facilities are eligible 
     providers of HIV health and support services where 
     appropriate. The Managers expect that HRSA's Bureau of HIV/
     AIDS shall encourage Ryan White grantees to develop 
     collaborations between providers and VA facilities to 
     optimize coordination and access to care to all persons with 
     HIV/AIDS.
       International HIV/AIDS Initiatives: The Managers note that 
     the CARE Act provides a model of service delivery and Federal 
     partnership with States, cities and community-based 
     organizations which should prove valuable in global efforts 
     to combat the HIV/AIDS epidemic. The Managers strongly 
     encourage the Secretary, the Bureau of HIV/AIDS at HRSA, and 
     the CDC to provide technical assistance available to other 
     countries which has already proven invaluable in helping to 
     limit the suffering caused by HIV/AIDS. It is the Managers' 
     hope that the hard-earned knowledge and experience gained in 
     this country can benefit people with HIV/AIDS overseas.

  Mr. KENNEDY. Mr. President, it is a privilege to support the CARE Act 
Amendments of 2000. I commend the many Senators who worked hard and 
well on the issue of HIV and AIDS. Senator Jeffords and Senator Hatch 
have championed this issue since 1990 when the CARE Act was first 
proposed, and Senator Frist has been an impressive leader in recent 
years. Their leadership has and the leadership of many others has 
raised our collective conscience about the HIV/AIDS crisis. Our goal in 
this legislation is to ensure that citizens with HIV disease continue 
to receive the benefits of advances in therapies and a system of 
support that has achieved remarkable success in recent years.
  For 20 years, America has struggled with the devastation caused by 
HIV/AIDS. It is a virus that knows no color, religion, political 
affiliation, or income status. AIDS continues to kill brothers and 
sisters, children and parents, friends and loved ones--all in the prime 
of their lives. This epidemic knows no geographic boundaries and has no 
mercy on those it strikes. HIV/AIDS has become one of the greatest 
public health challenges of our times. The CARE Act has directed needed 
resources to accelerate research, develop effective therapies, and 
support the 900,000 persons and families living with HIV/AIDS in 
America, and it clearly deserves to be extended and expanded.
  AIDS has claimed over 420,000 lives so far in the United States and 
it continues to claim the most vulnerable among us, especially women, 
youth, and minorities. We have good reason to be encouraged by medical 
advances over the past ten years, but we still face an epidemic that 
kills over 47,000 people each year. Like other epidemics before it, 
AIDS is now hitting hardest in areas where knowledge about the disease 
is scarce and poverty is high. The epidemic has dealt a particularly 
severe blow on communities of color, which account for 73 percent of 
all new infections. Women account for 30 percent of new infections. 
Over half of new infections occur in persons under 25.
  An estimated 34 percent of AIDS cases in the U.S. occur in rural 
areas, and this percentage is growing. As the crisis continues year 
after year, it becomes increasingly difficult for anyone to claim that 
AIDS is someone else's problem. We all share in a very real way in 
being touched by the epidemic.
  Fortunately, we have been able to slow the progression of this 
devastating disease. Many people living with HIV and AIDS are alive 
today and leading longer and healthier lives. AIDS deaths declined by 
20 percent between 1997 and 1998, thanks to advances in care and 
effective new treatments. The smallest increase in new AIDS cases--11 
percent--took place in 1999, compared with an 18 percent increase in 
new cases just a year before. We are helping people earlier in their 
disease progression and keeping them healthier longer.
  Nevertheless, an estimated 30 percent of persons living with AIDS do 
not have insurance coverage to pay for costly treatments. As a result, 
heavy demands are placed on community-based organizations and state and 
local governments. For these Americans, the CARE Act Amendments of 2000 
will continue to provide the only means to obtain the care and 
treatment they need.
  In Massachusetts, there has been a 77 percent decline in AIDS and 
HIV-related deaths since 1995. But the number of cases increased in 
women by 11 percent from 1997 to 1998. Fifty-five percent of persons 
living with AIDS in the state are persons of color. Massachusetts is 
fortunate to have a state budget that provides funding for primary 
care, prevention, and surveillance efforts. But no state is 
economically sufficient enough to provide the significant financial 
resources needed to enable all persons living with HIV disease to 
obtain the medical and supportive services they need without the Ryan 
White CARE Act.
  The CARE Act will continue to bring hope to the over 600,000 
individuals it serves each year in dealing with this devastating 
disease. This reauthorization builds on past accomplishments, while 
recognizing the challenge of ensuring access drug treatment for all who 
need it, reducing health disparities

[[Page 21010]]

in vulnerable populations, and improve the distribution and quality of 
services.
  Funds totaling $3.4 billion over the next five years will target the 
hardest hit 51 metropolitan areas in the country under Title I of the 
Act. Local planning and priority-setting under Title I assures that 
each of the eligible metropolitan areas responds to local HIV/AIDS 
needs. Safeguards are put in place to ensure that Title I areas are 
protected from drastic shifts in funding that can destabilize their HIV 
care infrastructure by limiting these losses to a maximum of 15 percent 
over its FY 2000 levels without compounded the effects of the loss from 
year to year. We also have assured EMAs the opportunity to reset the 
clock each time they find they do not need hold harmless protection in 
order to allow them the needed time and resources to plan prioritize, 
and redirect resources in response to major shifts that may occur in 
funding and in the local epidemic.
  Under Title II, $4.4 billion over the next five years will provide 
emergency relief to assist states in developing their HIV health care 
infrastructure. These funds will also provide life-sustaining drugs to 
over 61,000 persons each month. In addition, these funds will provide 
assistance for emerging communities that are increasingly affected by 
HIV/AIDS, but do not currently qualify for additional assistance, while 
assuring that base Title II funding losses do not occur in any fiscal 
year for any state or territory.
  Title III programs will receive $730 million during the five year 
period to assist over 200 local health centers and other primary health 
care providers in communities with a significant and disproportionate 
need for HIV care. Many of these communities are located in the hardest 
hit areas, serving low income communities. An additional $30 million in 
funds under Title III will provide planning and capacity development 
grants for hard-to-reach urban and rural communities.
  In Title IV, $2700 million over the next five years will be used to 
meet the specific needs of women, infants, youth, and families. An 
additional $42 million will assure that oral health care is available 
to persons with HIV/AIDS who are uninsured. One hundred and forty-one 
million dollars in funding over the five-year period will assure that 
we continue our investment in improving the skills of the healthcare 
workforce.
  In total, the CARE Act will authorize over $8.5 billion in funding to 
fight HIVS/AIDS over the next five years.
  I commend the dedication of the AIDS community and the Administration 
in working with Congress over the past year to bring forward the best 
possible legislation. I also commend Sean Donohue and William Fleming 
of Senator Jeffords' staff, Dave Larsen of Senator Frist's staff, and 
Stephanie Robinson and Idalia Sanchez of my staff for their effective 
work on this landmark legislation.
  The Senate's action today reaffirms our long-standing commitment to 
provide greater help to those with HIV/AIDS and to families touched by 
this devastating disease. America has the resources to win the battle 
against AIDS. We must face this disease with the same courage 
demonstrated by Ryan White, the young man with hemophilia who 
contracted AIDS through blood transfusions, and for whom the original 
act was named. Ryan White touched the world's heart through his valiant 
effort to speak out against the ignorance and discrimination faced by 
persons living with AIDS. This legislation carries on his brave work 
and I urge the Senate to approve it.
  Mr. FRIST. Mr. President, I am pleased to acknowledge the final 
Senate passage of the Ryan White CARE Act Amendments of 2000 today, 
which follows the actions of House of Representatives earlier this 
morning. This important bill forms a unique partnership between 
federal, local, and state governments; non-profit community 
organizations, health care and supportive service providers. For the 
last decade, this Act has successfully provided much needed assistance 
in health care costs and support services for low-income, uninsured and 
underinsured individuals with HIV/AIDS.
  Through programs such as the AIDS Drug Assistance Program, ADAP, 
which provides access to pharmaceuticals, the CARE Act has helped 
extend and even save lives. Last year alone, nearly 100,000 people 
living with HIV and AIDS received access to drug therapy because of the 
CARE Act. Half the people served by the CARE Act have family incomes of 
less than $10,000 annually, which is less than the $12,000 annual 
average cost of new drug ``cocktails'' for treatment. The CARE Act is 
critical in ensuring that the number of people living with AIDS 
continues to increase, as effective new drug therapies are keeping HIV-
infected persons healthy longer and dramatically reducing the death 
rate. Investments in enabling patients with HIV to live healthier and 
more productive lives have helped to reduce overall health costs. For 
example, the National Center for Health Statistics reported that the 
nation has seen a 30 percent decline in HIV related hospitalizations, 
producing nearly one million fewer HIV related hospital days and a 
savings of more than $1 billion.
  During the 104th Congress, I had the pleasure of working with Senator 
Kassebaum on the Ryan White CARE Act Amendments of 1996 to ensure that 
this needed law was extended. Senator Jeffords, who has done a terrific 
job in crafting this bill, has already outlined some specifics of this 
legislation, however, I would like to conclude by discussing a specific 
provision which I am grateful Senator Jeffords included in this 
reauthorization.
  This bill contains a provision, under Title II of this Act, 
addressing the fact that the face of this disease is changing as AIDS 
moves into communities which have not been impacted as great as several 
Title I grantees. One important aspect of this provision is the 
creation of supplemental grants for emerging metropolitan communities, 
which do not qualify for Title I funding but have reported between 500 
and 2,000 AIDS cases in the last five years. For cities that have 
between 1,000 and 2,000 AIDS cases this provision would provide cities, 
including Memphis and Nashville, at least $5 million in new funding to 
divide each year, or 25 percent of new monies under Title II, whichever 
is greater. For cities with 500 to 999 AIDS cases in the last five 
years, at least $5 million in new funding each year will be divided, or 
25 percent of new monies under Title II, whichever is greater. This 
provision will be implemented as soon as the appropriation level for 
Title II, excluding the ADAP program, is increased by $20 million above 
the FY2000 funding level. Once implemented, this program would remain 
in place every year after the initial trigger level is met with at 
least $10 million coming from the Title II funding to support this 
needed effort.
  Mr. President, I would like to thank Senator Jeffords for his 
leadership on this issue, and Sean Donohue and William Fleming of his 
staff for all their expertise in drafting this bill. I would also like 
to thank Senator Kennedy and Stephanie Robinson of his staff for their 
work and dedication to this issue. And finally I would like to think 
Dave Larson and Mary Sumpter Johnson of my health staff for their work 
on passage of this bill.

                          ____________________