[Congressional Record (Bound Edition), Volume 146 (2000), Part 14]
[House]
[Pages 21016-21047]
[From the U.S. Government Publishing Office, www.gpo.gov]



                 RYAN WHITE CARE ACT AMENDMENTS OF 2000

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

                              H. Res. 611

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

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

                              {time}  1030

  This is largely a noncontroversial bill. As no members of the 
minority testified differently last night at the Committee on Rules, 
this rule should receive unanimous support, and I urge support.
  This reauthorization of the Ryan White CARE Act recognizes the 
changing demographics of the AIDS epidemic in our country in a way that 
truly honors the memory of the courageous young boy for which the bill 
was originally named. Today, there are between 800,000 and 900,000 
persons living with HIV in the United States of America with some 
40,000 new infections annually. This conference report seeks to shift 
resources to the most needy areas while preserving the best features of 
the current programs.
  The gentleman from Virginia (Chairman Bliley) should be commended for 
his leadership and attention to this critical public health issue which 
is of concern to every Member of this body. I am hopeful that the 
progress made on this authorization will spur funding for another 
essential program for individuals afflicted with the HIV virus.
  As my colleagues remember and well know, this House led the way and 
adopted the Ricky Ray Authorization Act in the last Congress. It 
authorized $750 million for compassion assistance and recognition to 
hemophiliacs who contracted AIDS through no fault of their own because 
of contaminated blood products in the 1980s.
  Now, the first installment was provided last year, and this year the 
gentleman from Florida (Chairman Young) of the Committee on 
Appropriations should be commended for exceeding the President's 
request in the House version of the Fiscal Year 2001 Labor-HHS 
appropriation bill for the next installment.
  As negotiations continue and we near the end of this Congress, I am 
hopeful that the White House will become fully engaged on the Ricky Ray 
funding problem and work with leadership and Congress to provide full 
funding for these victims as soon as humanly possible. The need is 
great and the time is now.
  I am confident that, if the White House shows true leadership and 
demonstrates that this problem is really a top priority for them, we 
will be able to move further toward full funding this year. Obviously 
we cannot undo the tragic events of the 1980s, but we can work to 
provide assistance to these individuals before it is any later.
  Mr. Speaker, this rule should engender little debate. It is a fair 
rule for a good bill. I urge its adoption.
  Mr. Speaker, I reserve the balance of my time.
  Mr. HALL of Ohio. Mr. Speaker, I want to thank the gentleman from 
Florida (Mr. Goss) for yielding me the time.
  Mr. Speaker, this is a closed rule. It will allow for the 
consideration of S. 2311, which is called the Ryan White CARE Act 
Amendments of 2000. As the gentleman from Florida has described, this 
rule provides for 1 hour of general debate to be equally divided and 
controlled by the chairman and ranking minority member of the Committee 
on Commerce. Under this closed rule, no amendments can be offered on 
the House floor.
  In 1990, Congress passed the Ryan White Comprehensive AIDS Resources 
Emergency Act. It was known as the Ryan White CARE Act. This law 
created programs to help Americans with AIDS and HIV, the virus that 
causes AIDS, and to slow the spread of HIV.
  These programs expired October 1. The bill we are considering will 
reauthorize and strengthen the Ryan White CARE Act programs by 
expanding access, improving quality, and providing additional services. 
Some of the changes will help target health care services to the people 
who need it the most but who can least afford it.
  Women, children, infants and youth with HIV will especially benefit 
from this bill as will low-income individuals and families. AIDS 
possesses one of the greatest health challenges of our generation, and 
there is no way to avoid its tragic grip. However, an active role by 
the Federal government can, in my opinion, ease the tragedy by reducing 
the number of new HIV cases and by supporting victims and their 
families.
  The Ryan White CARE Act has worked. The Federal funds spent under 
this law have saved lives and reduced suffering. These are dollars that 
could not have been better spent. For example, between 1994 and 1999, 
pediatric AIDS cases declined by nearly 80 percent largely because of 
these programs funded by the Federal Government under this Act.

[[Page 21017]]

  I would like to point out to my colleague that this act offers a 
framework that we should apply to tackling other tragic diseases, such 
as childhood cancer. I hope that Congress will learn from the success 
of this act.
  This legislation extending the Ryan White CARE Act represents our 
best response to dealing with AIDS and its consequences. The bill we 
are considering is a compromise between the previously passed House and 
Senate versions. The Senate version passed by unanimous consent. The 
House version passed by a voice vote under suspension of the rules. I 
am proud to be a cosponsor of this House version.
  Because there is general agreement between the House and Senate, 
there is no need for a formal conference committee.
  I urge my colleagues to vote for the rule and for the bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GOSS. Mr. Speaker, I advise that we have no speakers lined up, 
and I would be prepared to yield back if the gentleman from Ohio (Mr. 
Hall) has no speakers.
  Mr. HALL of Ohio. Mr. Speaker, I yield back the balance of my time.
  Mr. GOSS. Mr. Speaker, I yield back the balance of my time, and I 
move the previous question on the resolution.
  The previous question was ordered.
  The resolution was agreed to.
  A motion to reconsider was laid on the table.
  Mr. COBURN. Mr. Speaker, pursuant to House Resolution 611, I call up 
the Senate bill (S. 2311) to revise and extend the Ryan White CARE Act 
programs under title XXVI of the Public Health Service Act, to improve 
access to health care and the quality of care under such programs, and 
to provide for the development of increased capacity to provide health 
care and related support services to individuals and families with HIV 
disease, and for other purposes, and ask for its immediate 
consideration.
  The Clerk read the title of the Senate bill.
  The SPEAKER pro tempore (Mr. Simpson). Pursuant to House Resolution 
611, the Senate bill is considered read for amendment.
  The text of S. 2311 is as follows:

                                S. 2311

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Ryan White CARE Act 
     Amendments of 2000''.

     SEC. 2. REFERENCES; TABLE OF CONTENTS.

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

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

             TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM

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

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

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

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

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

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

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

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

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

Sec. 161. Authorization of appropriations.

                   TITLE II--MISCELLANEOUS PROVISIONS

Sec. 201. Institute of Medicine study.

             TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM

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

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

       Section 2602 (42 U.S.C. 300ff-12) is amended--
       (1) in subsection (b)--
       (A) in paragraph (2)(C), by inserting before the semicolon 
     the following: ``, including providers of housing and 
     homeless services''; and
       (B) in paragraph (4), by striking ``shall--'' and all that 
     follows and inserting ``shall have the responsibilities 
     specified in subsection (d).''; and
       (2) by adding at the end the following:
       ``(d) Duties of Planning Council.--The planning council 
     established under subsection (b) shall have the following 
     duties:
       ``(1) Priorities for allocation of funds.--The council 
     shall establish priorities for the allocation of funds within 
     the eligible area, including how best to meet each such 
     priority and additional factors that a grantee should 
     consider in allocating funds under a grant, based on the 
     following factors:
       ``(A) The size and demographic characteristics of the 
     population with HIV disease to be served, including, subject 
     to subsection (e), the needs of individuals living with HIV 
     infection who are not receiving HIV-related health services.
       ``(B) The documented needs of the population with HIV 
     disease with particular attention being given to disparities 
     in health services among affected subgroups within the 
     eligible area.
       ``(C) The demonstrated or probable cost and outcome 
     effectiveness of proposed strategies and interventions, to 
     the extent that data are reasonably available.
       ``(D) Priorities of the communities with HIV disease for 
     whom the services are intended.
       ``(E) The availability of other governmental and non-
     governmental resources, including the State medicaid plan 
     under title XIX of the Social Security Act and the State 
     Children's Health Insurance Program under title XXI of such 
     Act to cover health care costs of eligible individuals and 
     families with HIV disease.
       ``(F) Capacity development needs resulting from gaps in the 
     availability of HIV services in historically underserved low-
     income communities.
       ``(2) Comprehensive service delivery plan.--The council 
     shall develop a comprehensive plan for the organization and 
     delivery of health and support services described in section 
     2604. Such plan shall be compatible with any existing State 
     or local plans regarding the provision of such services to 
     individuals with HIV disease.
       ``(3) Assessment of fund allocation efficiency.--The 
     council shall assess the efficiency of the administrative 
     mechanism in rapidly allocating funds to the areas of 
     greatest need within the eligible area.
       ``(4) Statewide statement of need.--The council shall 
     participate in the development of the Statewide coordinated 
     statement of need as initiated by the State public health 
     agency responsible for administering grants under part B.
       ``(5) Coordination with other federal grantees.--The 
     council shall coordinate with Federal grantees providing HIV-
     related services within the eligible area.
       ``(6) Community participation.--The council shall establish 
     methods for obtaining input on community needs and priorities 
     which may include public meetings, conducting focus groups, 
     and convening ad-hoc panels.
       ``(e) Process for Establishing Allocation Priorities.--
       ``(1) In general.--Not later than 24 months after the date 
     of enactment of the Ryan

[[Page 21018]]

     White CARE Act Amendments of 2000, the Secretary shall--
       ``(A) consult with eligible metropolitan areas, affected 
     communities, experts, and other appropriate individuals and 
     entities, to develop epidemiologic measures for establishing 
     the number of individuals living with HIV disease who are not 
     receiving HIV-related health services; and
       ``(B) provide advice and technical assistance to planning 
     councils with respect to the process for establishing 
     priorities for the allocation of funds under subsection 
     (d)(1).
       ``(2) Exception.--Grantees under subsection (d)(1)(A) shall 
     not be required to establish priorities for individuals not 
     in care until epidemiologic measures are developed under 
     paragraph (1).''.

     SEC. 102. QUALITY MANAGEMENT.

       (a) Funds Available for Quality Management.--Section 2604 
     (42 U.S.C. 300ff-14) is amended--
       (1) by redesignating subsections (c) through (f) as 
     subsections (d) through (g), respectively; and
       (2) by inserting after subsection (b) the following:
       ``(c) Quality Management.--
       ``(1) Requirement.--The chief elected official of an 
     eligible area that receives a grant under this part shall 
     provide for the establishment of a quality management program 
     to assess the extent to which medical services provided to 
     patients under the grant are consistent with the most recent 
     Public Health Service guidelines for the treatment of HIV 
     disease and related opportunistic infection and to develop 
     strategies for improvements in the access to and quality of 
     medical services.
       ``(2) Use of funds.--From amounts received under a grant 
     awarded under this part, the chief elected official of an 
     eligible area may use, for activities associated with its 
     quality management program, not more than the lesser of--
       ``(A) 5 percent of amounts received under the grant; or
       ``(B) $3,000,000.''.
       (b) Quality Management Required for Eligibility for 
     Grants.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended--
       (1) by redesignating paragraphs (3) through (6) as 
     paragraphs (5) through (8), respectively; and
       (2) by inserting after paragraph (2) the following:
       ``(3) that the chief elected official of the eligible area 
     will satisfy all requirements under section 2604(c);''.

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

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

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

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

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

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

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

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

     SEC. 107. HOLD HARMLESS PROVISION.

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

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

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

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

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

       (a) General Use of Grants.--Section 2612 (42 U.S.C. 300ff-
     22) is amended--
       (1) by striking ``A State'' and inserting ``(a) In 
     General.--A State''; and
       (2) in the matter following paragraph (5)--
       (A) by striking ``paragraph (2)'' and inserting 
     ``subsection (a)(2) and section 2613'';
       (b) Application.--Section 2617(b) (42 U.S.C. 300ff-27(b)) 
     is amended--
       (1) in paragraph (1)(C)--
       (A) by striking clause (i) and inserting the following:
       ``(i) the size and demographic characteristics of the 
     population with HIV disease to be served, except that by not 
     later than October 1, 2002, the State shall take into account 
     the needs of individuals not in care, based on epidemiologic 
     measures developed by the Secretary in consultation with the 
     State, affected communities, experts, and other appropriate 
     individuals (such State shall not be required to establish 
     priorities for individuals not in care until such 
     epidemiologic measures are developed);'';
       (B) in clause (iii), by striking ``and'' at the end; and
       (C) by adding at the end the following:
       ``(v) the availability of other governmental and non-
     governmental resources;
       ``(vi) the capacity development needs resulting in gaps in 
     the provision of HIV services in historically underserved 
     low-income and rural low-income communities; and
       ``(vii) the efficiency of the administrative mechanism in 
     rapidly allocating funds to the areas of greatest need within 
     the State;''; and
       (2) in paragraph (2)--

[[Page 21019]]

       (A) in subparagraph (B), by striking ``and'' at the end;
       (B) by redesignating subparagraph (C) as subparagraph (F); 
     and
       (C) by inserting after subparagraph (B), the following:
       ``(C) an assurance that capacity development needs 
     resulting from gaps in the provision of services in 
     underserved low-income and rural low-income communities will 
     be addressed; and
       ``(D) with respect to fiscal year 2003 and subsequent 
     fiscal years, assurances that, in the planning and allocation 
     of resources, the State, through systems of HIV-related 
     health services provided under paragraphs (1), (2), and (3) 
     of section 2612(a), will make appropriate provision for the 
     HIV-related health and support service needs of individuals 
     who have been diagnosed with HIV disease but who are not 
     currently receiving such services, based on the epidemiologic 
     measures developed under paragraph (1)(C)(i);''.

     SEC. 122. QUALITY MANAGEMENT.

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

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

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

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

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

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

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

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

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

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

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

     SEC. 128. SUPPLEMENT GRANTS FOR CERTAIN STATES.

       Subpart I of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-11 et seq.) is amended by adding 
     at the end the following:

     ``SEC. 2622. SUPPLEMENTAL GRANTS.

       ``(a) In General.--The Secretary shall award supplemental 
     grants to States determined to be eligible under subsection 
     (b) to enable such States to provide comprehensive services 
     of the type described in section 2612(a) to supplement the 
     services otherwise provided by the State under a grant under 
     this subpart in areas within the State that are not eligible 
     to receive grants under part A.
       ``(b) Eligibility.--To be eligible to receive a 
     supplemental grant under subsection (a) a State shall--
       ``(1) be eligible to receive a grant under this subpart; 
     and
       ``(2) demonstrate to the Secretary that there is severe 
     need (as defined for purposes of section 2603(b)(2)(A) for 
     supplemental financial assistance in areas in the State that 
     are not served through grants under part A.
       ``(c) Application.--A State that desires a grant under this 
     section shall, as part of the State application submitted 
     under section 2617, submit a detailed description of the 
     manner in which the State will use amounts received under the 
     grant and of the severity of need. Such description shall 
     include--
       ``(1) a report concerning the dissemination of supplemental 
     funds under this section and the plan for the utilization of 
     such funds;
       ``(2) a demonstration of the existing commitment of local 
     resources, both financial and in-kind;
       ``(3) a demonstration that the State will maintain HIV-
     related activities at a level that is equal to not less than 
     the level of such activities in the State for the 1-year 
     period preceding the fiscal year for which the State is 
     applying to receive a grant under this part;
       ``(4) a demonstration of the ability of the State to 
     utilize such supplemental financial resources in a manner 
     that is immediately responsive and cost effective;
       ``(5) a demonstration that the resources will be allocated 
     in accordance with the local demographic incidence of AIDS 
     including appropriate allocations for services for infants, 
     children, women, and families with HIV disease;
       ``(6) a demonstration of the inclusiveness of the planning 
     process, with particular emphasis on affected communities and 
     individuals with HIV disease; and
       ``(7) a demonstration of the manner in which the proposed 
     services are consistent with local needs assessments and the 
     statewide coordinated statement of need.
       ``(d) Amount Reserved for Emerging Communities.--
       ``(1) In general.--For awarding grants under this section 
     for each fiscal year, the Secretary shall reserve the greater 
     of 50 percent of the amount to be utilized under subsection 
     (e) for such fiscal year or $5,000,000, to be provided to 
     States that contain emerging communities for use in such 
     communities.

[[Page 21020]]

       ``(2) Definition.--In paragraph (1), the term `emerging 
     community' means a metropolitan area--
       ``(A) that is not eligible for a grant under part A; and
       ``(B) for which there has been reported to the Director of 
     the Centers for Disease Control and Prevention a cumulative 
     total of between 1000 and 1999 cases of acquired immune 
     deficiency syndrome for the most recent period of 5 calendar 
     years for which such data are available.
       ``(e) Appropriations.--With respect to each fiscal year 
     beginning with fiscal year 2001, the Secretary, to carry out 
     this section, shall utilize 50 percent of the amount 
     appropriated under section 2677 to carry out part B for such 
     fiscal year that is in excess of the amount appropriated to 
     carry out such part in fiscal year preceding the fiscal year 
     involved.

     SEC. 129. USE OF TREATMENT FUNDS.

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

     SEC. 130. INCREASE IN MINIMUM ALLOTMENT.

       (a) In General.--Section 2618(b)(1)(A)(i) (42 U.S.C. 300ff-
     28(b)(1)(A)(i)) is amended--
       (1) in subclause (I), by striking ``$100,000'' and 
     inserting ``$200,000''; and
       (2) in subclause (II), by striking ``$250,000'' and 
     inserting ``$500,000''.
       (b) Technical Amendment.--Section 2618(b)(3)(B) (42 U.S.C. 
     300ff-28(b)(3)(B)) is amended by striking ``and the Republic 
     of the Marshall Islands'' and inserting ``, the Republic of 
     the Marshall Islands, the Federated States of Micronesia, and 
     the Republic of Palau''.

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

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

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

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

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

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

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

     SEC. 142. PLANNING AND DEVELOPMENT GRANTS.

       (a) Allowing Planning and Development Grant To Expand 
     Ability To Provide Primary Care Services.--Section 2654(c) 
     (42 U.S.C. 300ff-54(c)) is amended--
       (1) in paragraph (1), to read as follows:
       ``(1) In general.--The Secretary may provide planning and 
     development grants to public and nonprofit private entities 
     for the purpose of--
       ``(A) enabling such entities to provide HIV early 
     intervention services; or
       ``(B) assisting such entities to expand the capacity, 
     preparedness, and expertise to deliver primary care services 
     to individuals with HIV disease in underserved low-income 
     communities on the condition that the funds are not used to 
     purchase or improve land or to purchase, construct, or 
     permanently improve (other than minor remodeling) any 
     building or other facility.''; and
       (2) in paragraphs (2) and (3) by striking ``paragraph (1)'' 
     each place that such appears and inserting ``paragraph 
     (1)(A)''.
       (b) Amount; Duration.--Section 2654(c) (42 U.S.C. 300ff-
     54(c)), as amended by subsection (a), is further amended--
       (1) by redesignating paragraph (4) as paragraph (5); and
       (2) by inserting after paragraph (3) the following:
       ``(4) Amount and duration of grants.--
       ``(A) Early intervention services.--A grant under paragraph 
     (1)(A) may be made in an amount not to exceed $50,000.
       ``(B) Capacity development.--
       ``(i) Amount.--A grant under paragraph (1)(B) may be made 
     in an amount not to exceed $150,000.
       ``(ii) Duration.--The total duration of a grant under 
     paragraph (1)(B), including any renewal, may not exceed 3 
     years.''.
       (c) Increase in limitation.--Section 2654(c)(5) (42 U.S.C. 
     300ff-54(c)(5)), as so redesignated by subsection (b), is 
     amended by striking ``1 percent'' and inserting ``5 
     percent''.

     SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CATEGORICAL 
                   GRANTS.

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

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

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

[[Page 21021]]

       (3) by adding at the end the following:
       ``(5) the applicant will provide for the establishment of a 
     quality management program to assess the extent to which 
     medical services funded under this title that are provided to 
     patients are consistent with the most recent Public Health 
     Service guidelines for the treatment of HIV disease and 
     related opportunistic infections and that improvements in the 
     access to and quality of medical services are addressed.''.

     SEC. 145. PREFERENCE FOR CERTAIN AREAS.

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

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

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

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

     SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.

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

     SEC. 153. EVALUATIONS AND REPORTS.

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

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

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

     ``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

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

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

     SEC. 161. AUTHORIZATION OF APPROPRIATIONS.

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

                   TITLE II--MISCELLANEOUS PROVISIONS

     SEC. 201. INSTITUTE OF MEDICINE STUDY.

       (a) In General.--Not later than 120 days after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall enter into a contract with the Institute of 
     Medicine for the conduct of a study concerning the 
     appropriate epidemiological measures and their relationship 
     to the financing and delivery of primary care and health-
     related support services for low-income, uninsured, and 
     under-insured individuals with HIV disease.
       (b) Requirements.--
       (1) Completion.--The study under subsection (a) shall be 
     completed not later than 21 months after the date on which 
     the contract referred to in such subsection is entered into.
       (2) Issues to be considered.--The study conducted under 
     subsection (a) shall consider--
       (A) the availability and utility of health outcomes 
     measures and data for HIV primary care and support services 
     and the extent to which those measures and data could be used 
     to measure the quality of such funded services;
       (B) the effectiveness and efficiency of service delivery 
     (including the quality of services, health outcomes, and 
     resource use) within the context of a changing health care 
     and therapeutic environment as well as the changing 
     epidemiology of the epidemic;
       (C) existing and needed epidemiological data and other 
     analytic tools for resource planning and allocation 
     decisions, specifically for estimating severity of need of a 
     community and the relationship to the allocations process; 
     and
       (D) other factors determined to be relevant to assessing an 
     individual's or community's ability to gain and sustain 
     access to quality HIV services.
       (c) Report.--Not later than 90 days after the date on which 
     the study is completed under subsection (a), the Secretary of 
     Health and Human Services shall prepare and submit to the 
     appropriate committees of Congress a report describing the 
     manner in which the conclusions and recommendations of the 
     Institute of Medicine can be addressed and implemented.

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

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Ryan White CARE Act 
     Amendments of 2000''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents for this Act is as follows:

 TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

           Subtitle A--HIV Health Services Planning Councils

Sec. 101. Membership of councils.
Sec. 102. Duties of councils.
Sec. 103. Open meetings; other additional provisions.

              Subtitle B--Type and Distribution of Grants

Sec. 111. Formula grants.
Sec. 112. Supplemental grants.

                      Subtitle C--Other Provisions

Sec. 121. Use of amounts.
Sec. 122. Application.

                      TITLE II--CARE GRANT PROGRAM

                  Subtitle A--General Grant Provisions

Sec. 201. Priority for women, infants, and children.
Sec. 202. Use of grants.
Sec. 203. Grants to establish HIV care consortia.
Sec. 204. Provision of treatments.
Sec. 205. State application.
Sec. 206. Distribution of funds.
Sec. 207. Supplemental grants for certain States.

Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission 
                                 of HIV

Sec. 211. Repeals.
Sec. 212. Grants.
Sec. 213. Study by Institute of Medicine.

           Subtitle C--Certain Partner Notification Programs

Sec. 221. Grants for compliant partner notification programs.

                 TITLE III--EARLY INTERVENTION SERVICES

                 Subtitle A--Formula Grants for States

Sec. 301. Repeal of program.

                     Subtitle B--Categorical Grants

Sec. 311. Preferences in making grants.
Sec. 312. Planning and development grants.
Sec. 313. Authorization of appropriations.

[[Page 21022]]

                     Subtitle C--General Provisions

Sec. 321. Provision of certain counseling services.
Sec. 322. Additional required agreements.

                TITLE IV--OTHER PROGRAMS AND ACTIVITIES

 Subtitle A--Certain Programs for Research, Demonstrations, or Training

Sec. 401. Grants for coordinated services and access to research for 
              women, infants, children, and youth.
Sec. 402. AIDS education and training centers.

              Subtitle B--General Provisions in Title XXVI

Sec. 411. Evaluations and reports.
Sec. 412. Data collection through Centers for Disease Control and 
              Prevention.
Sec. 413. Coordination.
Sec. 414. Plan regarding release of prisoners with HIV disease.
Sec. 415. Audits.
Sec. 416. Administrative simplification.
Sec. 417. Authorization of appropriations for parts A and B.

                      TITLE V--GENERAL PROVISIONS

Sec. 501. Studies by Institute of Medicine.
Sec. 502. Development of rapid HIV test.
Sec. 503. Technical corrections.

                        TITLE VI--EFFECTIVE DATE

Sec. 601. Effective date.

 TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

           Subtitle A--HIV Health Services Planning Councils

     SEC. 101. MEMBERSHIP OF COUNCILS.

       (a) In General.--Section 2602(b) of the Public Health 
     Service Act (42 U.S.C. 300ff-12(b)) is amended--
       (1) in paragraph (1), by striking ``demographics of the 
     epidemic in the eligible area involved,'' and inserting 
     ``demographics of the population of individuals with HIV 
     disease in the eligible area involved,''; and
       (2) in paragraph (2)--
       (A) in subparagraph (C), by inserting before the semicolon 
     the following: ``, including providers of housing and 
     homeless services'';
       (B) in subparagraph (G), by striking ``or AIDS'';
       (C) in subparagraph (K), by striking ``and'' at the end;
       (D) in subparagraph (L), by striking the period and 
     inserting the following: ``, including but not limited to 
     providers of HIV prevention services; and''; and
       (E) by adding at the end the following subparagraph:
       ``(M) representatives of individuals who formerly were 
     Federal, State, or local prisoners, were released from the 
     custody of the penal system during the preceding 3 years, and 
     had HIV disease as of the date on which the individuals were 
     so released.''.
       (b) Conflicts of Interests.--Section 2602(b)(5) of the 
     Public Health Service Act (42 U.S.C. 300ff-12(b)(5)) is 
     amended by adding at the end the following subparagraph:
       ``(C) Composition of council.--The following applies 
     regarding the membership of a planning council under 
     paragraph (1):
       ``(i) Not less than 33 percent of the council shall be 
     individuals who are receiving HIV-related services pursuant 
     to a grant under section 2601(a), are not officers, 
     employees, or consultants to any entity that receives amounts 
     from such a grant, and do not represent any such entity, and 
     reflect the demographics of the population of individuals 
     with HIV disease as determined under paragraph (4)(A). For 
     purposes of the preceding sentence, an individual shall be 
     considered to be receiving such services if the individual is 
     a parent of, or a caregiver for, a minor child who is 
     receiving such services.
       ``(ii) With respect to membership on the planning council, 
     clause (i) may not be construed as having any effect on 
     entities that receive funds from grants under any of parts B 
     through F but do not receive funds from grants under section 
     2601(a), on officers or employees of such entities, or on 
     individuals who represent such entities.''.

     SEC. 102. DUTIES OF COUNCILS.

       (a) In General.--Section 2602(b)(4) of the Public Health 
     Service Act (42 U.S.C. 300ff-12(b)(4)) is amended--
       (1) by redesignating subparagraphs (A) through (E) as 
     subparagraphs (C) through (G), respectively;
       (2) by inserting before subparagraph (C) (as so 
     redesignated) the following subparagraphs:
       ``(A) determine the size and demographics of the population 
     of individuals with HIV disease;
       ``(B) determine the needs of such population, with 
     particular attention to--
       ``(i) individuals with HIV disease who know their HIV 
     status and are not receiving HIV-related services; and
       ``(ii) disparities in access and services among affected 
     subpopulations and historically underserved communities;'';
       (3) in subparagraph (C) (as so redesignated), by striking 
     clauses (i) through (iv) and inserting the following:
       ``(i) size and demographics of the population of 
     individuals with HIV disease (as determined under 
     subparagraph (A)) and the needs of such population (as 
     determined under subparagraph (B));
       ``(ii) demonstrated (or probable) cost effectiveness and 
     outcome effectiveness of proposed strategies and 
     interventions, to the extent that data are reasonably 
     available;
       ``(iii) priorities of the communities with HIV disease for 
     whom the services are intended;
       ``(iv) coordination in the provision of services to such 
     individuals with programs for HIV prevention and for the 
     prevention and treatment of substance abuse, including 
     programs that provide comprehensive treatment for such abuse;
       ``(v) availability of other governmental and non-
     governmental resources, including the State medicaid plan 
     under title XIX of the Social Security Act and the State 
     Children's Health Insurance Program under title XXI of such 
     Act to cover health care costs of eligible individuals and 
     families with HIV disease; and
       ``(vi) capacity development needs resulting from 
     disparities in the availability of HIV-related services in 
     historically underserved communities;'';
       (4) in subparagraph (D) (as so redesignated), by amending 
     the subparagraph to read as follows:
       ``(D) develop a comprehensive plan for the organization and 
     delivery of health and support services described in section 
     2604 that--
       ``(i) includes a strategy for identifying individuals who 
     know their HIV status and are not receiving such services and 
     for informing the individuals of and enabling the individuals 
     to utilize the services, giving particular attention to 
     eliminating disparities in access and services among affected 
     subpopulations and historically underserved communities, and 
     including discrete goals, a timetable, and an appropriate 
     allocation of funds;
       ``(ii) includes a strategy to coordinate the provision of 
     such services with programs for HIV prevention (including 
     outreach and early intervention) and for the prevention and 
     treatment of substance abuse (including programs that provide 
     comprehensive treatment services for such abuse); and
       ``(iii) is compatible with any State or local plan for the 
     provision of services to individuals with HIV disease;'';
       (5) in subparagraph (F) (as so redesignated), by striking 
     ``and'' at the end;
       (6) in subparagraph (G) (as so redesignated)--
       (A) by striking ``public meetings,'' and inserting ``public 
     meetings (in accordance with paragraph (7)),''; and
       (B) by striking the period and inserting ``; and''; and
       (7) by adding at the end the following subparagraph:
       ``(H) coordinate with Federal grantees that provide HIV-
     related services within the eligible area.''.
       (b) Process for Establishing Allocation Priorities.--
     Section 2602 of the Public Health Service Act (42 U.S.C. 
     300ff-12) is amended by adding at the end the following 
     subsection:
       ``(d) Process for Establishing Allocation Priorities.--
     Promptly after the date of the submission of the report 
     required in section 501(b) of the Ryan White CARE Act 
     Amendments of 2000 (relating to the relationship between 
     epidemiological measures and health care for certain 
     individuals with HIV disease), the Secretary, in consultation 
     with planning councils and entities that receive amounts from 
     grants under section 2601(a) or 2611, shall develop 
     epidemiologic measures--
       ``(1) for establishing the number of individuals living 
     with HIV disease who are not receiving HIV-related health 
     services; and
       ``(2) for carrying out the duties under subsection (b)(4) 
     and section 2617(b).''.
       (c) Training.--Section 2602 of the Public Health Service 
     Act (42 U.S.C. 300ff-12), as amended by subsection (b) of 
     this section, is amended by adding at the end the following 
     subsection:
       ``(e) Training Guidance and Materials.--The Secretary shall 
     provide to each chief elected official receiving a grant 
     under 2601(a) guidelines and materials for training members 
     of the planning council under paragraph (1) regarding the 
     duties of the council.''.
       (d) Conforming Amendment.--Section 2603(c) of the Public 
     Health Service Act (42 U.S.C. 300ff-12(b)) is amended by 
     striking ``section 2602(b)(3)(A)'' and inserting ``section 
     2602(b)(4)(C)''.

     SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVISIONS.

       Section 2602(b) of the Public Health Service Act (42 U.S.C. 
     300ff-12(b)) is amended--
       (1) in paragraph (3), by striking subparagraph (C); and
       (2) by adding at the end the following paragraph:
       ``(7) Public deliberations.--With respect to a planning 
     council under paragraph (1), the following applies:
       ``(A) The council may not be chaired solely by an employee 
     of the grantee under section 2601(a).
       ``(B) In accordance with criteria established by the 
     Secretary:
       ``(i) The meetings of the council shall be open to the 
     public and shall be held only after adequate notice to the 
     public.
       ``(ii) The records, reports, transcripts, minutes, agenda, 
     or other documents which were made available to or prepared 
     for or by the council shall be available for public 
     inspection and copying at a single location.

[[Page 21023]]

       ``(iii) Detailed minutes of each meeting of the council 
     shall be kept. The accuracy of all minutes shall be certified 
     to by the chair of the council.
       ``(iv) This subparagraph does not apply to any disclosure 
     of information of a personal nature that would constitute a 
     clearly unwarranted invasion of personal privacy, including 
     any disclosure of medical information or personnel 
     matters.''.

              Subtitle B--Type and Distribution of Grants

     SEC. 111. FORMULA GRANTS.

       (a) Expedited Distribution.--Section 2603(a)(2) of the 
     Public Health Service Act (42 U.S.C. 300ff-13(a)(2)) is 
     amended in the first sentence by striking ``for each of the 
     fiscal years 1996 through 2000'' and inserting ``for a fiscal 
     year''.
       (b) Amount of Grant; Estimate of Living Cases.--
       (1) In general.--Section 2603(a)(3)) of the Public Health 
     Service Act (42 U.S.C. 300ff-13(a)(3)) is amended--
       (A) in subparagraph (C)(i), by inserting before the 
     semicolon the following: ``, except that (subject to 
     subparagraph (D)), for grants made pursuant to this paragraph 
     for fiscal year 2005 and subsequent fiscal years, the cases 
     counted for each 12-month period beginning on or after July 
     1, 2004, shall be cases of HIV disease (as reported to and 
     confirmed by such Director) rather than cases of acquired 
     immune deficiency syndrome''; and
       (B) in subparagraph (C), in the matter after and below 
     clause (ii)(X)--
       (i) in the first sentence, by inserting before the period 
     the following: ``, and shall be reported to the congressional 
     committees of jurisdiction''; and
       (ii) by adding at the end the following sentence: ``Updates 
     shall as applicable take into account the counting of cases 
     of HIV disease pursuant to clause (i).''.
       (2) Determination of secretary regarding data on hiv 
     cases.--Section 2603(a)(3)) of the Public Health Service Act 
     (42 U.S.C. 300ff-13(a)(3)) is amended--
       (A) by redesignating subparagraph (D) as subparagraph (E); 
     and
       (B) by inserting after subparagraph (C) the following 
     subparagraph:
       ``(D) Determination of secretary regarding data on hiv 
     cases.--
       ``(i) In general.--Not later than July 1, 2004, the 
     Secretary shall determine whether there is data on cases of 
     HIV disease from all eligible areas (reported to and 
     confirmed by the Director of the Centers for Disease Control 
     and Prevention) sufficiently accurate and reliable for use 
     for purposes of subparagraph (C)(i). In making such a 
     determination, the Secretary shall take into consideration 
     the findings of the study under section 501(b) of the Ryan 
     White CARE Act Amendments of 2000 (relating to the 
     relationship between epidemiological measures and health care 
     for certain individuals with HIV disease).
       ``(ii) Effect of adverse determination.--If under clause 
     (i) the Secretary determines that data on cases of HIV 
     disease is not sufficiently accurate and reliable for use for 
     purposes of subparagraph (C)(i), then notwithstanding such 
     subparagraph, for any fiscal year prior to fiscal year 2007 
     the references in such subparagraph to cases of HIV disease 
     do not have any legal effect.
       ``(iii) Grants and technical assistance regarding counting 
     of hiv cases.--Of the amounts appropriated under section 318B 
     for a fiscal year, the Secretary shall reserve amounts to 
     make grants and provide technical assistance to States and 
     eligible areas with respect to obtaining data on cases of HIV 
     disease to ensure that data on such cases is available from 
     all States and eligible areas as soon as is practicable but 
     not later than the beginning of fiscal year 2007.''.
       (c) Increases in Grant.--Section 2603(a)(4)) of the Public 
     Health Service Act (42 U.S.C. 300ff-13(a)(4)) is amended to 
     read as follows:
       ``(4) Increases in grant.--
       ``(A) In general.--For each fiscal year in a protection 
     period for an eligible area, the Secretary shall increase the 
     amount of the grant made pursuant to paragraph (2) for the 
     area to ensure that--
       ``(i) for the first fiscal year in the protection period, 
     the grant is not less than 98 percent of the amount of the 
     grant made for the eligible area pursuant to such paragraph 
     for the base year for the protection period;
       ``(ii) for any second fiscal year in such period, the grant 
     is not less than 95 percent of the amount of such base year 
     grant;
       ``(iii) for any third fiscal year in such period, the grant 
     is not less than 92 percent of the amount of the base year 
     grant;
       ``(iv) for any fourth fiscal year in such period, the grant 
     is not less than 89 percent of the amount of the base year 
     grant; and
       ``(v) for any fifth or subsequent fiscal year in such 
     period, if, pursuant to paragraph (3)(D)(ii)), the references 
     in paragraph (3)(C)(i) to HIV disease do not have any legal 
     effect, the grant is not less than 85 percent of the amount 
     of the base year grant.
       ``(B) Special Rule.--If for fiscal year 2005, pursuant to 
     paragraph (3)(D)(ii), data on cases of HIV disease are used 
     for purposes of paragraph (3)(C)(i), the Secretary shall 
     increase the amount of a grant made pursuant to paragraph (2) 
     for an eligible area to ensure that the grant is not less 
     than 98 percent of the amount of the grant made for the area 
     in fiscal year 2004.
       ``(C) Base year; protection period.--With respect to grants 
     made pursuant to paragraph (2) for an eligible area:
       ``(i) The base year for a protection period is the fiscal 
     year preceding the trigger grant-reduction year.
       ``(ii) The first trigger grant-reduction year is the first 
     fiscal year (after fiscal year 2000) for which the grant for 
     the area is less than the grant for the area for the 
     preceding fiscal year.
       ``(iii) A protection period begins with the trigger grant-
     reduction year and continues until the beginning of the first 
     fiscal year for which the amount of the grant determined 
     pursuant to paragraph (2) for the area equals or exceeds the 
     amount of the grant determined under subparagraph (A).
       ``(iv) Any subsequent trigger grant-reduction year is the 
     first fiscal year, after the end of the preceding protection 
     period, for which the amount of the grant is less than the 
     amount of the grant for the preceding fiscal year.''.

     SEC. 112. SUPPLEMENTAL GRANTS.

       (a) In General.--Section 2603(b)(2) of the Public Health 
     Service Act (42 U.S.C. 300ff-13(b)(2)) is amended--
       (1) in the heading for the paragraph, by striking 
     ``Definition'' and inserting ``Amount of grant'';
       (2) by redesignating subparagraphs (A) through (C) as 
     subparagraphs (B) through (D), respectively;
       (3) by inserting before subparagraph (B) (as so 
     redesignated) the following subparagraph:
       ``(A) In general.--The amount of each grant made for 
     purposes of this subsection shall be determined by the 
     Secretary based on a weighting of factors under paragraph 
     (1), with severe need under subparagraph (B) of such 
     paragraph counting one-third.'';
       (4) in subparagraph (B) (as so redesignated)--
       (A) in clause (ii), by striking ``and'' at the end;
       (B) in clause (iii), by striking the period and inserting a 
     semicolon; and
       (C) by adding at the end the following clauses:
       ``(iv) the current prevalence of HIV disease;
       ``(v) an increasing need for HIV-related services, 
     including relative rates of increase in the number of cases 
     of HIV disease; and
       ``(vi) unmet need for such services, as determined under 
     section 2602(b)(4).'';
       (5) in subparagraph (C) (as so redesignated)--
       (A) by striking ``subparagraph (A)'' each place such term 
     appears and inserting ``subparagraph (B)'';
       (B) in the second sentence, by striking ``2 years after the 
     date of enactment of this paragraph'' and inserting ``18 
     months after the date of the enactment of the Ryan White CARE 
     Act Amendments of 2000''; and
       (C) by inserting after the second sentence the following 
     sentence: ``Such a mechanism shall be modified to reflect the 
     findings of the study under section 501(b) of the Ryan White 
     CARE Act Amendments of 2000 (relating to the relationship 
     between epidemiological measures and health care for certain 
     individuals with HIV disease).''; and
       (6) in subparagraph (D) (as so redesignated), by striking 
     ``subparagraph (B)'' and inserting ``subparagraph (C)''.
       (b) Requirements for Application.--Section 2603(b)(1)(E) of 
     the Public Health Service Act (42 U.S.C. 300ff-13(b)(1)(E)) 
     is amended by inserting ``youth,'' after ``children,''.
       (c) Technical and Conforming Amendment.--Section 2603(b) of 
     the Public Health Service Act (42 U.S.C. 300ff-13(b)) is 
     amended--
       (1) by striking paragraph (4);
       (2) by redesignating paragraph (5) as paragraph (4); and
       (3) in paragraph (4) (as so redesignated), in subparagraph 
     (B), by striking ``grants'' and inserting ``grant''.

                      Subtitle C--Other Provisions

     SEC. 121. USE OF AMOUNTS.

       (a) Primary Purposes.--Section 2604(b)(1) of the Public 
     Health Service Act (42 U.S.C. 300ff-14(b)(1)) is amended--
       (1) in the matter preceding subparagraph (A), by striking 
     ``HIV-related--'' and inserting ``HIV-related services, as 
     follows:'';
       (2) in subparagraph (A)--
       (A) by striking ``outpatient'' and all that follows through 
     ``substance abuse treatment and'' and inserting the 
     following: ``Outpatient and ambulatory health services, 
     including substance abuse treatment,''; and
       (B) by striking ``; and'' and inserting a period;
       (3) in subparagraph (B), by striking ``(B) inpatient case 
     management'' and inserting ``(C) Inpatient case management'';
       (4) by inserting after subparagraph (A) the following 
     subparagraph:
       ``(B) Outpatient and ambulatory support services (including 
     case management), to the extent that such services 
     facilitate, enhance, support, or sustain the delivery, 
     continuity, or benefits of health services for individuals 
     and families with HIV disease.''; and
       (5) by adding at the end the following:
       ``(D) Outreach activities that are intended to identify 
     individuals with HIV disease who know their HIV status and 
     are not receiving HIV-related services, and that are--

[[Page 21024]]

       ``(i) necessary to implement the strategy under section 
     2602(b)(4)(D), including activities facilitating the access 
     of such individuals to HIV-related primary care services at 
     entities described in paragraph (3)(A);
       ``(ii) conducted in a manner consistent with the 
     requirements under sections 2605(a)(3) and 2651(b)(2); and
       ``(iii) supplement, and do not supplant, such activities 
     that are carried out with amounts appropriated under section 
     317.''.
       (b) Early Intervention Services.--Section 2604(b) (42 
     U.S.C. 300ff-14(b)) of the Public Health Service Act is 
     amended--
       (1) by redesignating paragraph (3) as paragraph (4); and
       (2) by inserting after paragraph (2) the following:
       ``(3) Early intervention services.--
       ``(A) In general.--The purposes for which a grant under 
     section 2601 may be used include providing to individuals 
     with HIV disease early intervention services described in 
     section 2651(b)(2), with follow-up referral provided for the 
     purpose of facilitating the access of individuals receiving 
     the services to HIV-related health services. The entities 
     through which such services may be provided under the grant 
     include public health departments, emergency rooms, substance 
     abuse and mental health treatment programs, detoxification 
     centers, detention facilities, clinics regarding sexually 
     transmitted diseases, homeless shelters, HIV disease 
     counseling and testing sites, health care points of entry 
     specified by eligible areas, federally qualified health 
     centers, and entities described in section 2652(a) that 
     constitute a point of access to services by maintaining 
     referral relationships.
       ``(B) Conditions.--With respect to an entity that proposes 
     to provide early intervention services under subparagraph 
     (A), such subparagraph applies only if the entity 
     demonstrates to the satisfaction of the chief elected 
     official for the eligible area involved that--
       ``(i) Federal, State, or local funds are otherwise 
     inadequate for the early intervention services the entity 
     proposes to provide; and
       ``(ii) the entity will expend funds pursuant to such 
     subparagraph to supplement and not supplant other funds 
     available to the entity for the provision of early 
     intervention services for the fiscal year involved.''.
       (c) Priority for Women, Infants, and Children.--Section 
     2604(b) (42 U.S.C. 300ff-14(b)) of the Public Health Service 
     Act is amended in paragraph (4) (as redesignated by 
     subsection (b)(1) of this section) by amending the paragraph 
     to read as follows:
       ``(4) Priority for women, infants and children.--
       ``(A) In general.--For the purpose of providing health and 
     support services to infants, children, youth, and women with 
     HIV disease, including treatment measures to prevent the 
     perinatal transmission of HIV, the chief elected official of 
     an eligible area, in accordance with the established 
     priorities of the planning council, shall for each of such 
     populations in the eligible area use, from the grants made 
     for the area under section 2601(a) for a fiscal year, not 
     less than the percentage constituted by the ratio of the 
     population involved (infants, children, youth, or women in 
     such area) with acquired immune deficiency syndrome to the 
     general population in such area of individuals with such 
     syndrome.
       ``(B) Waiver.--With respect the population involved, the 
     Secretary may provide to the chief elected official of an 
     eligible area a waiver of the requirement of subparagraph (A) 
     if such official demonstrates to the satisfaction of the 
     Secretary that the population is receiving HIV-related health 
     services through the State medicaid program under title XIX 
     of the Social Security Act, the State children's health 
     insurance program under title XXI of such Act, or other 
     Federal or State programs.''.
       (d) Quality Management.--Section 2604 of the Public Health 
     Service Act (42 U.S.C. 300ff-14) is amended--
       (1) by redesignating subsections (c) through (f) as 
     subsections (d) through (g), respectively; and
       (2) by inserting after subsection (b) the following:
       ``(c) Quality Management.--
       ``(1) Requirement.--The chief elected official of an 
     eligible area that receives a grant under this part shall 
     provide for the establishment of a quality management program 
     to assess the extent to which HIV health services provided to 
     patients under the grant are consistent with the most recent 
     Public Health Service guidelines for the treatment of HIV 
     disease and related opportunistic infection, and as 
     applicable, to develop strategies for ensuring that such 
     services are consistent with the guidelines for improvement 
     in the access to and quality of HIV health services.
       ``(2) Use of funds.--From amounts received under a grant 
     awarded under this part for a fiscal year, the chief elected 
     official of an eligible area may (in addition to amounts to 
     which subsection (f)(1) applies) use for activities 
     associated with the quality management program required in 
     paragraph (1) not more than the lesser of--
       ``(A) 5 percent of amounts received under the grant; or
       ``(B) $3,000,000.''.

     SEC. 122. APPLICATION.

       (a) In General.--Section 2605(a) of the Public Health 
     Service Act (42 U.S.C. 300ff-15(a)) is amended--
       (1) by redesignating paragraphs (3) through (6) as 
     paragraphs (5) through (8), respectively; and
       (2) by inserting after paragraph (2) the following 
     paragraphs:
       ``(3) that entities within the eligible area that receive 
     funds under a grant under this part will maintain appropriate 
     relationships with entities in the eligible area served that 
     constitute key points of access to the health care system for 
     individuals with HIV disease (including emergency rooms, 
     substance abuse treatment programs, detoxification centers, 
     adult and juvenile detention facilities, sexually transmitted 
     disease clinics, HIV counseling and testing sites, mental 
     health programs, and homeless shelters), and other entities 
     under section 2604(b)(3) and 2652(a), for the purpose of 
     facilitating early intervention for individuals newly 
     diagnosed with HIV disease and individuals knowledgeable of 
     their HIV status but not in care;
       ``(4) that the chief elected official of the eligible area 
     will satisfy all requirements under section 2604(c);''.
       (b) Conforming Amendments.--Section 2605(a) (42 U.S.C. 
     300ff-15(a)(1)) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (A), by striking ``services to 
     individuals with HIV disease'' and inserting ``services as 
     described in section 2604(b)(1)''; and
       (B) in subparagraph (B), by striking ``services for 
     individuals with HIV disease'' and inserting ``services as 
     described in section 2604(b)(1)'';
       (2) in paragraph (7) (as redesignated by subsection (a)(1) 
     of this section), by striking ``and'' at the end;
       (3) in paragraph (8) (as so redesignated), by striking the 
     period and inserting ``; and''; and
       (4) by adding at the end the following paragraph:
       ``(9) that the eligible area has procedures in place to 
     ensure that services provided with funds received under this 
     part meet the criteria specified in section 2604(b)(1).''.

                      TITLE II--CARE GRANT PROGRAM

                  Subtitle A--General Grant Provisions

     SEC. 201. PRIORITY FOR WOMEN, INFANTS, AND CHILDREN.

       Section 2611(b) of the Public Health Service Act (42 U.S.C. 
     300ff-21(b)) is amended to read as follows:
       ``(b) Priority for Women, Infants and Children.--
       ``(1) In general.--For the purpose of providing health and 
     support services to infants, children, youth, and women with 
     HIV disease, including treatment measures to prevent the 
     perinatal transmission of HIV, a State shall for each of such 
     populations use, of the funds allocated under this part to 
     the State for a fiscal year, not less than the percentage 
     constituted by the ratio of the population involved (infants, 
     children, youth, or women in the State) with acquired immune 
     deficiency syndrome to the general population in the State of 
     individuals with such syndrome.
       ``(2) Waiver.--With respect the population involved, the 
     Secretary may provide to a State a waiver of the requirement 
     of paragraph (1) if the State demonstrates to the 
     satisfaction of the Secretary that the population is 
     receiving HIV-related health services through the State 
     medicaid program under title XIX of the Social Security Act, 
     the State children's health insurance program under title XXI 
     of such Act, or other Federal or State programs.''.

     SEC. 202. USE OF GRANTS.

       Section 2612 of the Public Health Service Act (42 U.S.C. 
     300ff-22) is amended--
       (1) by striking ``A State may use'' and inserting ``(a) In 
     General.--A State may use''; and
       (2) by adding at the end the following subsections:
       ``(b) Support Services; Outreach.--The purposes for which a 
     grant under this part may be used include delivering or 
     enhancing the following:
       ``(1) Outpatient and ambulatory support services under 
     section 2611(a) (including case management) to the extent 
     that such services facilitate, enhance, support, or sustain 
     the delivery, continuity, or benefits of health services for 
     individuals and families with HIV disease.
       ``(2) Outreach activities that are intended to identify 
     individuals with HIV disease who know their HIV status and 
     are not receiving HIV-related services, and that are--
       ``(A) necessary to implement the strategy under section 
     2617(b)(4)(B), including activities facilitating the access 
     of such individuals to HIV-related primary care services at 
     entities described in subsection (c)(1);
       ``(B) conducted in a manner consistent with the requirement 
     under section 2617(b)(6)(G) and 2651(b)(2); and
       ``(C) supplement, and do not supplant, such activities that 
     are carried out with amounts appropriated under section 317.
       ``(c) Early Intervention Services.--
       ``(1) In general.--The purposes for which a grant under 
     this part may be used include providing to individuals with 
     HIV disease

[[Page 21025]]

     early intervention services described in section 2651(b)(2), 
     with follow-up referral provided for the purpose of 
     facilitating the access of individuals receiving the services 
     to HIV-related health services. The entities through which 
     such services may be provided under the grant include public 
     health departments, emergency rooms, substance abuse and 
     mental health treatment programs, detoxification centers, 
     detention facilities, clinics regarding sexually transmitted 
     diseases, homeless shelters, HIV disease counseling and 
     testing sites, health care points of entry specified by 
     States or eligible areas, federally qualified health centers, 
     and entities described in section 2652(a) that constitute a 
     point of access to services by maintaining referral 
     relationships.
       ``(2) Conditions.--With respect to an entity that proposes 
     to provide early intervention services under paragraph (1), 
     such paragraph applies only if the entity demonstrates to the 
     satisfaction of the State involved that--
       ``(A) Federal, State, or local funds are otherwise 
     inadequate for the early intervention services the entity 
     proposes to provide; and
       ``(B) the entity will expend funds pursuant to such 
     paragraph to supplement and not supplant other funds 
     available to the entity for the provision of early 
     intervention services for the fiscal year involved.
       ``(d) Quality Management.--
       ``(1) Requirement.--Each State that receives a grant under 
     this part shall provide for the establishment of a quality 
     management program to assess the extent to which HIV health 
     services provided to patients under the grant are consistent 
     with the most recent Public Health Service guidelines for the 
     treatment of HIV disease and related opportunistic infection, 
     and as applicable, to develop strategies for ensuring that 
     such services are consistent with the guidelines for 
     improvement in the access to and quality of HIV health 
     services.
       ``(2) Use of funds.--From amounts received under a grant 
     awarded under this part for a fiscal year, the State may (in 
     addition to amounts to which section 2618(b)(5) applies) use 
     for activities associated with the quality management program 
     required in paragraph (1) not more than the lesser of--
       ``(A) 5 percent of amounts received under the grant; or
       ``(B) $3,000,000.''.

     SEC. 203. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

       Section 2613 of the Public Health Service Act (42 U.S.C. 
     300ff-23) is amended--
       (1) in subsection (b)(1)--
       (A) in subparagraph (A), by inserting before the semicolon 
     the following: ``, particularly those experiencing 
     disparities in access and services and those who reside in 
     historically underserved communities''; and
       (B) in subparagraph (B), by inserting after ``by such 
     consortium'' the following: ``is consistent with the 
     comprehensive plan under 2617(b)(4) and'';
       (2) in subsection (c)(1)--
       (A) in subparagraph (D), by striking ``and'' after the 
     semicolon at the end;
       (B) in subparagraph (E), by striking the period and 
     inserting ``; and''; and
       (C) by adding at the end the following subparagraph:
       ``(F) demonstrates that adequate planning occurred to 
     address disparities in access and services and historically 
     underserved communities.''; and
       (3) in subsection (c)(2)--
       (A) in subparagraph (B), by striking ``and'' after the 
     semicolon;
       (B) in subparagraph (C), by striking the period and 
     inserting ``; and''; and
       (C) by inserting after subparagraph (C) the following 
     subparagraph:
       ``(D) the types of entities described in section 
     2602(b)(2).''.

     SEC. 204. PROVISION OF TREATMENTS.

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

     SEC. 205. STATE APPLICATION.

       (a) Determination of Size and Needs of Population; 
     Comprehensive Plan.--Section 2617(b) of the Public Health 
     Service Act (42 U.S.C. 300ff-27(b)) is amended--
       (1) by redesignating paragraphs (2) through (4) as 
     paragraphs (4) through (6), respectively;
       (2) by inserting after paragraph (1) the following 
     paragraphs:
       ``(2) a determination of the size and demographics of the 
     population of individuals with HIV disease in the State;
       ``(3) a determination of the needs of such population, with 
     particular attention to--
       ``(A) individuals with HIV disease who know their HIV 
     status and are not receiving HIV-related services; and
       ``(B) disparities in access and services among affected 
     subpopulations and historically underserved communities;''; 
     and
       (3) in paragraph (4) (as so redesignated)--
       (A) by striking ``comprehensive plan for the organization'' 
     and inserting ``comprehensive plan that describes the 
     organization'';
       (B) by striking ``, including--'' and inserting ``, and 
     that--'';
       (C) by redesignating subparagraphs (A) through (C) as 
     subparagraphs (D) through (F), respectively;
       (D) by inserting before subparagraph (C) the following 
     subparagraphs:
       ``(A) establishes priorities for the allocation of funds 
     within the State based on--
       ``(i) size and demographics of the population of 
     individuals with HIV disease (as determined under paragraph 
     (2)) and the needs of such population (as determined under 
     paragraph (3));
       ``(ii) availability of other governmental and non-
     governmental resources, including the State medicaid plan 
     under title XIX of the Social Security Act and the State 
     Children's Health Insurance Program under title XXI of such 
     Act to cover health care costs of eligible individuals and 
     families with HIV disease;
       ``(iii) capacity development needs resulting from 
     disparities in the availability of HIV-related services in 
     historically underserved communities and rural communities; 
     and
       ``(iv) the efficiency of the administrative mechanism of 
     the State for rapidly allocating funds to the areas of 
     greatest need within the State;
       ``(B) includes a strategy for identifying individuals who 
     know their HIV status and are not receiving such services and 
     for informing the individuals of and enabling the individuals 
     to utilize the services, giving particular attention to 
     eliminating disparities in access and services among affected 
     subpopulations and historically underserved communities, and 
     including discrete goals, a timetable, and an appropriate 
     allocation of funds;
       ``(C) includes a strategy to coordinate the provision of 
     such services with programs for HIV prevention (including 
     outreach and early intervention) and for the prevention and 
     treatment of substance abuse (including programs that provide 
     comprehensive treatment services for such abuse);'';
       (E) in subparagraph (D) (as redesignated by subparagraph 
     (C) of this paragraph), by inserting ``describes'' before 
     ``the services and activities'';
       (F) in subparagraph (E) (as so redesignated), by inserting 
     ``provides'' before ``a description''; and
       (G) in subparagraph (F) (as so redesignated), by inserting 
     ``provides'' before ``a description''.
       (b) Public Participation.--Section 2617(b) of the Public 
     Health Service Act, as amended by subsection (a) of this 
     section, is amended--
       (1) in paragraph (5), by striking ``HIV'' and inserting 
     ``HIV disease''; and
       (2) in paragraph (6), by amending subparagraph (A) to read 
     as follows:
       ``(A) the public health agency that is administering the 
     grant for the State engages in a public advisory planning 
     process, including public hearings, that includes the 
     participants under paragraph (5), and the types of entities 
     described in section 2602(b)(2), in developing the 
     comprehensive plan under paragraph (4) and commenting on the 
     implementation of such plan;''.
       (c) Health Care Relationships.--Section 2617(b) of the 
     Public Health Service Act, as amended by subsection (a) of 
     this section, is amended in paragraph (6)--
       (1) in subparagraph (E), by striking ``and'' at the end;
       (2) in subparagraph (F), by striking the period and 
     inserting ``; and''; and
       (3) by adding at the end the following subparagraph:
       ``(G) entities within areas in which activities under the 
     grant are carried out will maintain appropriate relationships 
     with entities in the area served that constitute key points 
     of access to the health care system for individuals with HIV 
     disease (including emergency rooms, substance abuse treatment 
     programs, detoxification centers, adult and juvenile 
     detention facilities, sexually

[[Page 21026]]

     transmitted disease clinics, HIV counseling and testing 
     sites, mental health programs, and homeless shelters), and 
     other entities under section 2612(c) and 2652(a), for the 
     purpose of facilitating early intervention for individuals 
     newly diagnosed with HIV disease and individuals 
     knowledgeable of their HIV status but not in care.''.

     SEC. 206. DISTRIBUTION OF FUNDS.

       (a) Minimum Allotment.--Section 2618 of the Public Health 
     Service Act (42 U.S.C. 300ff-28) is amended--
       (1) by redesignating subsections (b) through (e) as 
     subsections (a) through (d), respectively; and
       (2) in subsection (a) (as so redesignated), in paragraph 
     (1)(A)(i)--
       (A) in subclause (I), by striking ``$100,000'' and 
     inserting ``$200,000''; and
       (B) in subclause (II), by striking ``$250,000'' and 
     inserting ``$500,000''.
       (b) Amount of Grant; Estimate of Living Cases.--Section 
     2618(a) of the Public Health Service Act (as redesignated by 
     subsection (a)(1) of this section) is amended in paragraph 
     (2)--
       (1) in subparagraph (D)(i), by inserting before the 
     semicolon the following: ``, except that (subject to 
     subparagraph (E)), for grants made pursuant to this paragraph 
     or section 2620 for fiscal year 2005 and subsequent fiscal 
     years, the cases counted for each 12-month period beginning 
     on or after July 1, 2004, shall be cases of HIV disease (as 
     reported to and confirmed by such Director) rather than cases 
     of acquired immune deficiency syndrome'';
       (2) by redesignating subparagraphs (E) through (H) as 
     subparagraphs (F) through (I), respectively; and
       (3) by inserting after subparagraph (D) the following 
     subparagraph:
       ``(E) Determination of secretary regarding data on hiv 
     cases.--If under 2603(a)(3)(D)(i) the Secretary determines 
     that data on cases of HIV disease are not sufficiently 
     accurate and reliable, then notwithstanding subparagraph (D) 
     of this paragraph, for any fiscal year prior to fiscal year 
     2007 the references in such subparagraph to cases of HIV 
     disease do not have any legal effect.''.
       (c) Increases in Formula Amount.--Section 2618(a) of the 
     Public Health Service Act (as redesignated by subsection 
     (a)(1) of this section) is amended--
       (1) in paragraph (1)(A)(ii), by inserting before the 
     semicolon the following: ``and then, as applicable, increased 
     under paragraph (2)(H)''; and
       (2) in paragraph (2)--
       (A) in subparagraph (A)(i), by striking ``subparagraph 
     (H)'' and inserting ``subparagraphs (H) and (I)''; and
       (B) in subparagraph (H) (as redesignated by subsection 
     (b)(2) of this section), by amending the subparagraph to read 
     as follows:
       ``(H) Limitation.--
       ``(i) In general.--The Secretary shall ensure that the 
     amount of a grant awarded to a State or territory under 
     section 2611 or subparagraph (I)(i) for a fiscal year is not 
     less than--

       ``(I) with respect to fiscal year 2001, 99 percent;
       ``(II) with respect to fiscal year 2002, 98 percent;
       ``(III) with respect to fiscal year 2003, 97 percent;
       ``(IV) with respect to fiscal year 2004, 96 percent; and
       ``(V) with respect to fiscal year 2005, 95 percent,

     of the amount such State or territory received for fiscal 
     year 2000 under section 2611 or subparagraph (I)(i), 
     respectively (notwithstanding such subparagraph). In 
     administering this subparagraph, the Secretary shall, with 
     respect to States or territories that will under such section 
     receive grants in amounts that exceed the amounts that such 
     States received under such section or subparagraph for fiscal 
     year 2000, proportionally reduce such amounts to ensure 
     compliance with this subparagraph. In making such reductions, 
     the Secretary shall ensure that no such State receives less 
     than that State received for fiscal year 2000.
       ``(ii) Ratable reduction.--If the amount appropriated under 
     section 2677 for a fiscal year and available for grants under 
     section 2611 or subparagraph (I)(i) is less than the amount 
     appropriated and available for fiscal year 2000 under section 
     2611 or subparagraph (I)(i), respectively, the limitation 
     contained in clause (i) for the grants involved shall be 
     reduced by a percentage equal to the percentage of the 
     reduction in such amounts appropriated and available.''.
       (d) Territories.--Section 2618(a) of the Public Health 
     Service Act (as redesignated by subsection (a)(1) of this 
     section) is amended in paragraph (1)(B) by inserting ``the 
     greater of $50,000 or'' after ``shall be''.
       (e) Separate Treatment Drug Grants.--Section 2618(a) of the 
     Public Health Service Act (as redesignated by subsection 
     (a)(1) of this section and amended by subsection (b)(2) of 
     this section) is amended in paragraph (2)(I)--
       (1) by redesignating clauses (i) and (ii) as subclauses (I) 
     and (II), respectively;
       (2) by striking ``(I) Appropriations'' and all that follows 
     through ``With respect to'' and inserting the following:
       ``(I) Appropriations for treatment drug program.--
       ``(i) Formula grants.--With respect to'';
       (3) in subclause (I) of clause (i) (as designated by 
     paragraphs (1) and (2)), by inserting before the semicolon 
     the following: ``, less the percentage reserved under clause 
     (ii)(V)''; and
       (4) by adding at the end the following clause:
       ``(ii) Supplemental treatment drug grants.--

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

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

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

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

       (f) Technical Amendment.--Section 2618(a) of the Public 
     Health Service Act (as redesignated by subsection (a)(1) of 
     this section) is amended in paragraph (3)(B) by striking 
     ``and the Republic of the Marshall Islands'' and inserting 
     ``the Republic of the Marshall Islands, the Federated States 
     of Micronesia, and the Republic of Palau, and only for 
     purposes of paragraph (1) the Commonwealth of Puerto Rico''.

     SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

       Subpart I of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-11 et seq.) is amended--
       (1) by striking section 2621; and
       (2) by inserting after section 2619 the following section:

     ``SEC. 2620. SUPPLEMENTAL GRANTS.

       ``(a) In General.--The Secretary shall award supplemental 
     grants to States determined to be eligible under subsection 
     (b) to enable such States to provide comprehensive services 
     of the type described in section 2612(a) to supplement the 
     services otherwise provided by the State under a grant under 
     this subpart in emerging communities within the State that 
     are not eligible to receive grants under part A.
       ``(b) Eligibility.--To be eligible to receive a 
     supplemental grant under subsection (a), a State shall--
       ``(1) be eligible to receive a grant under this subpart;
       ``(2) demonstrate the existence in the State of an emerging 
     community as defined in subsection (d)(1); and
       ``(3) submit the information described in subsection (c).
       ``(c) Reporting Requirements.--A State that desires a grant 
     under this section shall, as part of the State application 
     submitted under section 2617, submit a detailed description 
     of the manner in which the State will use amounts received 
     under the grant and of the severity of need. Such description 
     shall include--
       ``(1) a report concerning the dissemination of supplemental 
     funds under this section and the plan for the utilization of 
     such funds in the emerging community;
       ``(2) a demonstration of the existing commitment of local 
     resources, both financial and in-kind;
       ``(3) a demonstration that the State will maintain HIV-
     related activities at a level that is equal to not less than 
     the level of such activities in the State for the 1-year 
     period preceding the fiscal year for which the State is 
     applying to receive a grant under this part;

[[Page 21027]]

       ``(4) a demonstration of the ability of the State to 
     utilize such supplemental financial resources in a manner 
     that is immediately responsive and cost effective;
       ``(5) a demonstration that the resources will be allocated 
     in accordance with the local demographic incidence of AIDS 
     including appropriate allocations for services for infants, 
     children, women, and families with HIV disease;
       ``(6) a demonstration of the inclusiveness of the planning 
     process, with particular emphasis on affected communities and 
     individuals with HIV disease; and
       ``(7) a demonstration of the manner in which the proposed 
     services are consistent with local needs assessments and the 
     statewide coordinated statement of need.
       ``(d) Definition of Emerging Community.--In this section, 
     the term `emerging community' means a metropolitan area--
       ``(1) that is not eligible for a grant under part A; and
       ``(2) for which there has been reported to the Director of 
     the Centers for Disease Control and Prevention a cumulative 
     total of between 500 and 1999 cases of acquired immune 
     deficiency syndrome for the most recent period of 5 calendar 
     years for which such data are available (except that, for 
     fiscal year 2005 and subsequent fiscal years, cases of HIV 
     disease shall be counted rather than cases of acquired immune 
     deficiency syndrome if cases of HIV disease are being counted 
     for purposes of section 2618(a)(2)(D)(i)).
       ``(e) Funding.--
       ``(1) In general.--Subject to paragraph (2), with respect 
     to each fiscal year beginning with fiscal year 2001, the 
     Secretary, to carry out this section, shall utilize--
       ``(A) the greater of--
       ``(i) 25 percent of the amount appropriated under 2677 to 
     carry out part B, excluding the amount appropriated under 
     section 2618(a)(2)(I), for such fiscal year that is in excess 
     of the amount appropriated to carry out such part in fiscal 
     year preceding the fiscal year involved; or
       ``(ii) $5,000,000;
     to provide funds to States for use in emerging communities 
     with at least 1000, but less than 2000, cases of AIDS as 
     reported to and confirmed by the Director of the Centers for 
     Disease Control and Prevention for the five year period 
     preceding the year for which the grant is being awarded; and
       ``(B) the greater of--
       ``(i) 25 percent of the amount appropriated under 2677 to 
     carry out part B, excluding the amount appropriated under 
     section 2618(a)(2)(I), for such fiscal year that is in excess 
     of the amount appropriated to carry out such part in fiscal 
     year preceding the fiscal year involved; or
       ``(ii) $5,000,000;

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

Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission 
                                 of HIV

     SEC. 211. REPEALS.

       Subpart II of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-33 et seq.) is amended--
       (1) in section 2626, by striking each of subsections (d) 
     through (f);
       (2) by striking sections 2627 and 2628; and
       (3) by redesignating section 2629 as section 2627.

     SEC. 212. GRANTS.

       (a) In General.--Section 2625(c) of the Public Health 
     Service Act (42 U.S.C. 300ff-33) is amended--
       (1) in paragraph (1), by inserting at the end the following 
     subparagraph:
       ``(F) Making available to pregnant women with HIV disease, 
     and to the infants of women with such disease, treatment 
     services for such disease in accordance with applicable 
     recommendations of the Secretary.'';
       (2) by amending paragraph (2) to read as follows:
       ``(2) Funding.--
       ``(A) Authorization of appropriations.--For the purpose of 
     carrying out this subsection, there are authorized to be 
     appropriated $30,000,000 for each of the fiscal years 2001 
     through 2005. Amounts made available under section 2677 for 
     carrying out this part are not available for carrying out 
     this section unless otherwise authorized.
       ``(B) Allocations for certain states.--
       ``(i) In general.--Of the amounts appropriated under 
     subparagraph (A) for a fiscal year in excess of $10,000,000--

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

       ``(ii) Required testing of newborns.--For purposes of 
     clause (i)(I), the States described in this clause are States 
     that under law (including under regulations or the discretion 
     of State officials) have--

       ``(I) a requirement that all newborn infants born in the 
     State be tested for HIV disease and that the biological 
     mother of each such infant, and the legal guardian of the 
     infant (if other than the biological mother), be informed of 
     the results of the testing; or
       ``(II) a requirement that newborn infants born in the State 
     be tested for HIV disease in circumstances in which the 
     attending obstetrician for the birth does not know the HIV 
     status of the mother of the infant, and that the biological 
     mother of each such infant, and the legal guardian of the 
     infant (if other than the biological mother), be informed of 
     the results of the testing.

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

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

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

       ``(I) For fiscal year 2001, 33 percent.
       ``(II) For fiscal year 2002, 50 percent.
       ``(III) For fiscal year 2003, 67 percent.
       ``(IV) For fiscal year 2004, 75 percent.
       ``(V) For fiscal year 2005, 75 percent.

       ``(C) Certain provisions.--With respect to grants under 
     paragraph (1) that are made with amounts reserved under 
     subparagraph (B) of this paragraph:
       ``(i) Such a grant may not be made in an amount exceeding 
     $4,000,000.
       ``(ii) If pursuant to clause (i) or pursuant to an 
     insufficient number of qualifying applications for such 
     grants (or both), the full amount reserved under subparagraph 
     (B) for a fiscal year is not obligated, the requirement under 
     such subparagraph to reserve amounts ceases to apply.
       ``(iii) In the case of a State that meets the conditions to 
     receive amounts reserved under subparagraph (B)(i)(II), the 
     Secretary shall in making grants consider the following 
     factors:

       ``(I) The extent of the reduction in the rate of new cases 
     of the perinatal transmission of HIV.
       ``(II) The extent of the reduction in the rate of new cases 
     of perinatal cases of acquired immune deficiency syndrome.
       ``(III) The overall incidence of cases of infection with 
     HIV among women of childbearing age.
       ``(IV) The overall incidence of cases of acquired immune 
     deficiency syndrome among women of childbearing age.

[[Page 21028]]

       ``(V) The higher acceptance rate of HIV testing of pregnant 
     women.
       ``(VI) The extent to which women and children with HIV 
     disease are receiving HIV-related health services.
       ``(VII) The extent to which HIV-exposed children are 
     receiving health services appropriate to such exposure.''; 
     and

       (3) by adding at the end the following paragraph:
       ``(4) Maintenance of effort.--A condition for the receipt 
     of a grant under paragraph (1) is that the State involved 
     agree that the grant will be used to supplement and not 
     supplant other funds available to the State to carry out the 
     purposes of the grant.''.
       (b) Special Funding Rule for Fiscal Year 2001.--
       (1) In general.--If for fiscal year 2001 the amount 
     appropriated under paragraph (2)(A) of section 2625(c) of the 
     Public Health Service Act is less than $14,000,000--
       (A) the Secretary of Health and Human Services shall, for 
     the purpose of making grants under paragraph (1) of such 
     section, reserve from the amount specified in paragraph (2) 
     of this subsection an amount equal to the difference between 
     $14,000,000 and the amount appropriated under paragraph 
     (2)(A) of such section for such fiscal year (notwithstanding 
     any other provision of this Act or the amendments made by 
     this Act);
       (B) the amount so reserved shall, for purposes of paragraph 
     (2)(B)(i) of such section, be considered to have been 
     appropriated under paragraph (2)(A) of such section; and
       (C) the percentage specified in paragraph (2)(B)(iv)(I) of 
     such section is deemed to be 50 percent.
       (2) Allocation from increases in funding for part b.--For 
     purposes of paragraph (1), the amount specified in this 
     paragraph is the amount by which the amount appropriated 
     under section 2677 of the Public Health Service Act for 
     fiscal year 2001 and available for grants under section 2611 
     of such Act is an increase over the amount so appropriated 
     and available for fiscal year 2000.

     SEC. 213. STUDY BY INSTITUTE OF MEDICINE.

       Subpart II of part B of title XXVI of the Public Health 
     Service Act, as amended by section 211(3), is amended by 
     adding at the end the following section:

     ``SEC. 2628. RECOMMENDATIONS FOR REDUCING INCIDENCE OF 
                   PERINATAL TRANSMISSION.

       ``(a) Study by Institute of Medicine.--
       ``(1) In general.--The Secretary shall request the 
     Institute of Medicine to enter into an agreement with the 
     Secretary under which such Institute conducts a study to 
     provide the following:
       ``(A) For the most recent fiscal year for which the 
     information is available, a determination of the number of 
     newborn infants with HIV born in the United States with 
     respect to whom the attending obstetrician for the birth did 
     not know the HIV status of the mother.
       ``(B) A determination for each State of any barriers, 
     including legal barriers, that prevent or discourage an 
     obstetrician from making it a routine practice to offer 
     pregnant women an HIV test and a routine practice to test 
     newborn infants for HIV disease in circumstances in which the 
     obstetrician does not know the HIV status of the mother of 
     the infant.
       ``(C) Recommendations for each State for reducing the 
     incidence of cases of the perinatal transmission of HIV, 
     including recommendations on removing the barriers identified 
     under subparagraph (B).

     If such Institute declines to conduct the study, the 
     Secretary shall enter into an agreement with another 
     appropriate public or nonprofit private entity to conduct the 
     study.
       ``(2) Report.--The Secretary shall ensure that, not later 
     than 18 months after the effective date of this section, the 
     study required in paragraph (1) is completed and a report 
     describing the findings made in the study is submitted to the 
     appropriate committees of the Congress, the Secretary, and 
     the chief public health official of each of the States.
       ``(b) Progress Toward Recommendations.--In fiscal year 
     2004, the Secretary shall collect information from the States 
     describing the actions taken by the States toward meeting the 
     recommendations specified for the States under subsection 
     (a)(1)(C).
       ``(c) Submission of Reports to Congress.--The Secretary 
     shall submit to the appropriate committees of the Congress 
     reports describing the information collected under subsection 
     (b).''.

           Subtitle C--Certain Partner Notification Programs

     SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICATION PROGRAMS.

       Part B of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-21 et seq.) is amended by adding at the end the 
     following subpart:

          ``Subpart III--Certain Partner Notification Programs

     ``SEC. 2631. GRANTS FOR PARTNER NOTIFICATION PROGRAMS.

       ``(a) In General.--In the case of States whose laws or 
     regulations are in accordance with subsection (b), the 
     Secretary, subject to subsection (c)(2), may make grants to 
     the States for carrying out programs to provide partner 
     counseling and referral services.
       ``(b) Description of Compliant State Programs.--For 
     purposes of subsection (a), the laws or regulations of a 
     State are in accordance with this subsection if under such 
     laws or regulations (including programs carried out pursuant 
     to the discretion of State officials) the following policies 
     are in effect:
       ``(1) The State requires that the public health officer of 
     the State carry out a program of partner notification to 
     inform partners of individuals with HIV disease that the 
     partners may have been exposed to the disease.
       ``(2)(A) In the case of a health entity that provides for 
     the performance on an individual of a test for HIV disease, 
     or that treats the individual for the disease, the State 
     requires, subject to subparagraph (B), that the entity 
     confidentially report the positive test results to the State 
     public health officer in a manner recommended and approved by 
     the Director of the Centers for Disease Control and 
     Prevention, together with such additional information as may 
     be necessary for carrying out such program.
       ``(B) The State may provide that the requirement of 
     subparagraph (A) does not apply to the testing of an 
     individual for HIV disease if the individual underwent the 
     testing through a program designed to perform the test and 
     provide the results to the individual without the individual 
     disclosing his or her identity to the program. This 
     subparagraph may not be construed as affecting the 
     requirement of subparagraph (A) with respect to a health 
     entity that treats an individual for HIV disease.
       ``(3) The program under paragraph (1) is carried out in 
     accordance with the following:
       ``(A) Partners are provided with an appropriate opportunity 
     to learn that the partners have been exposed to HIV disease, 
     subject to subparagraph (B).
       ``(B) The State does not inform partners of the identity of 
     the infected individuals involved.
       ``(C) Counseling and testing for HIV disease are made 
     available to the partners and to infected individuals, and 
     such counseling includes information on modes of transmission 
     for the disease, including information on prenatal and 
     perinatal transmission and preventing transmission.
       ``(D) Counseling of infected individuals and their partners 
     includes the provision of information regarding therapeutic 
     measures for preventing and treating the deterioration of the 
     immune system and conditions arising from the disease, and 
     the provision of other prevention-related information.
       ``(E) Referrals for appropriate services are provided to 
     partners and infected individuals, including referrals for 
     support services and legal aid.
       ``(F) Notifications under subparagraph (A) are provided in 
     person, unless doing so is an unreasonable burden on the 
     State.
       ``(G) There is no criminal or civil penalty on, or civil 
     liability for, an infected individual if the individual 
     chooses not to identify the partners of the individual, or 
     the individual does not otherwise cooperate with such 
     program.
       ``(H) The failure of the State to notify partners is not a 
     basis for the civil liability of any health entity who under 
     the program reported to the State the identity of the 
     infected individual involved.
       ``(I) The State provides that the provisions of the program 
     may not be construed as prohibiting the State from providing 
     a notification under subparagraph (A) without the consent of 
     the infected individual involved.
       ``(4) The State annually reports to the Director of the 
     Centers for Disease Control and Prevention the number of 
     individuals from whom the names of partners have been sought 
     under the program under paragraph (1), the number of such 
     individuals who provided the names of partners, and the 
     number of partners so named who were notified under the 
     program.
       ``(5) The State cooperates with such Director in carrying 
     out a national program of partner notification, including the 
     sharing of information between the public health officers of 
     the States.
       ``(c) Reporting System for Cases of HIV Disease; Preference 
     in Making Grants.--In making grants under subsection (a), the 
     Secretary shall give preference to States whose reporting 
     systems for cases of HIV disease produce data on such cases 
     that is sufficiently accurate and reliable for use for 
     purposes of section 2618(a)(2)(D)(i).
       ``(d) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $30,000,000 for fiscal year 2001, and such sums 
     as may be necessary for each of the fiscal years 2002 through 
     2005.''.

                 TITLE III--EARLY INTERVENTION SERVICES

                 Subtitle A--Formula Grants for States

     SEC. 301. REPEAL OF PROGRAM.

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

[[Page 21029]]

       (3) in section 2664--
       (A) in subsection (e)(5), by striking ``2642(b) or'';
       (B) in subsection (f)(2), by striking ``2642(b) or''; and
       (C) by striking subsection (h).

                     Subtitle B--Categorical Grants

     SEC. 311. PREFERENCES IN MAKING GRANTS.

       Section 2653 of the Public Health Service Act (42 U.S.C. 
     300ff-53) is amended by adding at the end the following 
     subsection:
       ``(d) Certain Areas.--Of the applicants who qualify for 
     preference under this section--
       ``(1) the Secretary shall give preference to applicants 
     that will expend the grant under section 2651 to provide 
     early intervention under such section in rural areas; and
       ``(2) the Secretary shall give special consideration to 
     areas that are underserved with respect to such services.''.

     SEC. 312. PLANNING AND DEVELOPMENT GRANTS.

       (a) In General.--Section 2654(c)(1) of the Public Health 
     Service Act (42 U.S.C. 300ff-54(c)(1)) is amended by striking 
     ``planning grants'' and all that follows and inserting the 
     following: ``planning grants to public and nonprofit private 
     entities for purposes of--
       ``(A) enabling such entities to provide HIV early 
     intervention services; and
       ``(B) assisting the entities in expanding their capacity to 
     provide HIV-related health services, including early 
     intervention services, in low-income communities and affected 
     subpopulations that are underserved with respect to such 
     services (subject to the condition that a grant pursuant to 
     this subparagraph may not be expended to purchase or improve 
     land, or to purchase, construct, or permanently improve, 
     other than minor remodeling, any building or other 
     facility).''.
       (b) Amount; Duration.--Section 2654(c) of the Public Health 
     Service Act (42 U.S.C. 300ff-54(c)) is further amended--
       (1) by redesignating paragraph (4) as paragraph (5); and
       (2) by inserting after paragraph (3) the following:
       ``(4) Amount and duration of grants.--
       ``(A) Early intervention services.--A grant under paragraph 
     (1)(A) may be made in an amount not to exceed $50,000.
       ``(B) Capacity development.--
       ``(i) Amount.--A grant under paragraph (1)(B) may be made 
     in an amount not to exceed $150,000.
       ``(ii) Duration.--The total duration of a grant under 
     paragraph (1)(B), including any renewal, may not exceed 3 
     years.''.
       (c) Increase in Limitation.--Section 2654(c)(5) of the 
     Public Health Service Act (42 U.S.C. 300ff-54(c)(5)), as 
     redesignated by subsection (b), is amended by striking ``1 
     percent'' and inserting ``5 percent''.

     SEC. 313. AUTHORIZATION OF APPROPRIATIONS.

       Section 2655 of the Public Health Service Act (42 U.S.C. 
     300ff-55) is amended by striking ``in each of'' and all that 
     follows and inserting ``for each of the fiscal years 2001 
     through 2005.''.

                     Subtitle C--General Provisions

     SEC. 321. PROVISION OF CERTAIN COUNSELING SERVICES.

       Section 2662(c)(3) of the Public Health Service Act (42 
     U.S.C. 300ff-62(c)(3)) is amended--
       (1) in the matter preceding subparagraph (A), by striking 
     ``counseling on--'' and inserting ``counseling--'';
       (2) in each of subparagraphs (A), (B), and (D), by 
     inserting ``on'' after the subparagraph designation; and
       (3) in subparagraph (C)--
       (A) by striking ``(C) the benefits'' and inserting ``(C)(i) 
     that explains the benefits''; and
       (B) by inserting after clause (i) (as designated by 
     subparagraph (A) of this paragraph) the following clause:
       ``(ii) that emphasizes it is the duty of infected 
     individuals to disclose their infected status to their sexual 
     partners and their partners in the sharing of hypodermic 
     needles; that provides advice to infected individuals on the 
     manner in which such disclosures can be made; and that 
     emphasizes that it is the continuing duty of the individuals 
     to avoid any behaviors that will expose others to HIV.''.

     SEC. 322. ADDITIONAL REQUIRED AGREEMENTS.

       Section 2664(g) of the Public Health Service Act (42 U.S.C. 
     300ff-64(g)) is amended--
       (1) in paragraph (3)--
       (A) by striking ``7.5 percent'' and inserting ``10 
     percent''; and
       (B) by striking ``and'' after the semicolon at the end;
       (2) in paragraph (4), by striking the period and inserting 
     ``; and''; and
       (3) by adding at the end the following paragraph:
       ``(5) the applicant will provide for the establishment of a 
     quality management program--
       ``(A) to assess the extent to which medical services funded 
     under this title that are provided to patients are consistent 
     with the most recent Public Health Service guidelines for the 
     treatment of HIV disease and related opportunistic 
     infections, and as applicable, to develop strategies for 
     ensuring that such services are consistent with the 
     guidelines; and
       ``(B) to ensure that improvements in the access to and 
     quality of HIV health services are addressed.''.

                TITLE IV--OTHER PROGRAMS AND ACTIVITIES

 Subtitle A--Certain Programs for Research, Demonstrations, or Training

     SEC. 401. GRANTS FOR COORDINATED SERVICES AND ACCESS TO 
                   RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND 
                   YOUTH.

       (a) Elimination of Requirement To Enroll Significant 
     Numbers of Women and Children.--Section 2671(b) (42 U.S.C. 
     300ff-71(b)) is amended--
       (1) in paragraph (1), by striking subparagraphs (C) and (D) 
     and inserting the following:
       ``(C) The applicant will demonstrate linkages to research 
     and how access to such research is being offered to 
     patients.''; and
       (2) by striking paragraphs (3) and (4).
       (b) Information and Education.--Section 2671(d) (42 U.S.C. 
     300ff-71(d)) is amended by adding at the end the following:
       ``(4) The applicant will provide individuals with 
     information and education on opportunities to participate in 
     HIV/AIDS-related clinical research.''.
       (c) Quality Management; Administrative Expenses Ceiling.--
     Section 2671(f) (42 U.S.C. 300ff-71(f)) is amended--
       (1) by striking the subsection heading and designation and 
     inserting the following:
       ``(f) Administration.--
       ``(1) Application.--''; and
       (2) by adding at the end the following:
       ``(2) Quality management program.--A grantee under this 
     section shall implement a quality management program to 
     assess the extent to which HIV health services provided to 
     patients under the grant are consistent with the most recent 
     Public Health Service guidelines for the treatment of HIV 
     disease and related opportunistic infection, and as 
     applicable, to develop strategies for ensuring that such 
     services are consistent with the guidelines for improvement 
     in the access to and quality of HIV health services.''.
       (d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g)) 
     is amended by adding at the end the following: ``The 
     Secretary acting through the Director of NIH, shall examine 
     the distribution and availability of ongoing and appropriate 
     HIV/AIDS-related research projects to existing sites under 
     this section for purposes of enhancing and expanding 
     voluntary access to HIV-related research, especially within 
     communities that are not reasonably served by such projects. 
     Not later than 12 months after the date of enactment of the 
     Ryan White CARE Act Amendments of 2000, the Secretary shall 
     prepare and submit to the appropriate committees of Congress 
     a report that describes the findings made by the Director and 
     the manner in which the conclusions based on those findings 
     can be addressed.''.
       (e) Administrative Expenses.--Section 2671 of the Public 
     Health Service Act (42 U.S.C. 300ff-71) is amended--
       (1) by redesignating subsections (i) and (j) as subsections 
     (j) and (k), respectively; and
       (2) by inserting after subsection (h) the following 
     subsection:
       ``(i) Limitation on Administrative Expenses.--
       ``(1) Determination by secretary.--Not later than 12 months 
     after the date of enactment of the Ryan White Care Act 
     Amendments of 2000, the Secretary, in consultation with 
     grantees under this part, shall conduct a review of the 
     administrative, program support, and direct service-related 
     activities that are carried out under this part to ensure 
     that eligible individuals have access to quality, HIV-related 
     health and support services and research opportunities under 
     this part, and to support the provision of such services.
       ``(2) Requirements.--
       ``(A) In general.--Not later than 180 days after the 
     expiration of the 12-month period referred to in paragraph 
     (1) the Secretary, in consultation with grantees under this 
     part, shall determine the relationship between the costs of 
     the activities referred to in paragraph (1) and the access of 
     eligible individuals to the services and research 
     opportunities described in such paragraph.
       ``(B) Limitation.--After a final determination under 
     subparagraph (A), the Secretary may not make a grant under 
     this part unless the grantee complies with such requirements 
     as may be included in such determination.''.
       (f) Authorization of Appropriations.--Section 2671 of the 
     Public Health Service Act (42 U.S.C. 300ff-71) is amended in 
     subsection (j) (as redesignated by subsection (e)(1) of this 
     section) by striking ``fiscal years 1996 through 2000'' and 
     inserting ``fiscal years 2001 through 2005''.

     SEC. 402. AIDS EDUCATION AND TRAINING CENTERS.

       (a) Schools; Centers.--
       (1) In general.--Section 2692(a)(1) of the Public Health 
     Service Act (42 U.S.C. 300ff-111(a)(1)) is amended--
       (A) in subparagraph (A)--
       (i) by striking ``training'' and inserting ``to train'';
       (ii) by striking ``and including'' and inserting ``, 
     including''; and
       (iii) by inserting before the semicolon the following: ``, 
     and including (as applicable to the type of health 
     professional involved), prenatal and other gynecological care 
     for women with HIV disease'';

[[Page 21030]]

       (B) in subparagraph (B), by striking ``and'' after the 
     semicolon at the end;
       (C) in subparagraph (C), by striking the period and 
     inserting ``; and''; and
       (D) by adding at the end the following:
       ``(D) to develop protocols for the medical care of women 
     with HIV disease, including prenatal and other gynecological 
     care for such women.''.
       (2) Dissemination of treatment guidelines; medical 
     consultation activities.--Not later than 90 days after the 
     date of the enactment of this Act, the Secretary of Health 
     and Human Services shall issue and begin implementation of a 
     strategy for the dissemination of HIV treatment information 
     to health care providers and patients.
       (b) Dental Schools.--Section 2692(b) of the Public Health 
     Service Act (42 U.S.C. 300ff-111(b)) is amended--
       (1) by amending paragraph (1) to read as follows:
       ``(1) In general.--
       ``(A) Grants.--The Secretary may make grants to dental 
     schools and programs described in subparagraph (B) to assist 
     such schools and programs with respect to oral health care to 
     patients with HIV disease.
       ``(B) Eligible applicants.--For purposes of this 
     subsection, the dental schools and programs referred to in 
     this subparagraph are dental schools and programs that were 
     described in section 777(b)(4)(B) as such section was in 
     effect on the day before the date of the enactment of the 
     Health Professions Education Partnerships Act of 1998 (Public 
     Law 105-392) and in addition dental hygiene programs that are 
     accredited by the Commission on Dental Accreditation.'';
       (2) in paragraph (2), by striking ``777(b)(4)(B)'' and 
     inserting ``the section referred to in paragraph (1)(B)''; 
     and
       (3) by inserting after paragraph (4) the following 
     paragraph:
       ``(5) Community-based care.--The Secretary may make grants 
     to dental schools and programs described in paragraph (1)(B) 
     that partner with community-based dentists to provide oral 
     health care to patients with HIV disease in unserved areas. 
     Such partnerships shall permit the training of dental 
     students and residents and the participation of community 
     dentists as adjunct faculty.''.
       (c) Authorization of Appropriations.--
       (1) Schools; centers.--Section 2692(c)(1) of the Public 
     Health Service Act (42 U.S.C. 300ff-111(c)(1)) is amended by 
     striking ``fiscal years 1996 through 2000'' and inserting 
     ``fiscal years 2001 through 2005''.
       (2) Dental schools.--Section 2692(c)(2) of the Public 
     Health Service Act (42 U.S.C. 300ff-111(c)(2)) is amended to 
     read as follows:
       ``(2) Dental schools.--
       ``(A) In general.--For the purpose of grants under 
     paragraphs (1) through (4) of subsection (b), there are 
     authorized to be appropriated such sums as may be necessary 
     for each of the fiscal years 2001 through 2005.
       ``(B) Community-based care.--For the purpose of grants 
     under subsection (b)(5), there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2001 through 2005.''.

              Subtitle B--General Provisions in Title XXVI

     SEC. 411. EVALUATIONS AND REPORTS.

       Section 2674(c) of the Public Health Service Act (42 U.S.C. 
     300ff-74(c)) is amended by striking ``1991 through 1995'' and 
     inserting ``2001 through 2005''.

     SEC. 412. DATA COLLECTION THROUGH CENTERS FOR DISEASE CONTROL 
                   AND PREVENTION.

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


         ``data collection regarding programs under title xxvi

       ``Sec. 318B. For the purpose of collecting and providing 
     data for program planning and evaluation activities under 
     title XXVI, there are authorized to be appropriated to the 
     Secretary (acting through the Director of the Centers for 
     Disease Control and Prevention) such sums as may be necessary 
     for each of the fiscal years 2001 through 2005. Such 
     authorization of appropriations is in addition to other 
     authorizations of appropriations that are available for such 
     purpose.''.

     SEC. 413. COORDINATION.

       Section 2675 of the Public Health Service Act (42 U.S.C. 
     300ff-75) is amended--
       (1) by amending subsection (a) to read as follows:
       ``(a) Requirement.--The Secretary shall ensure that the 
     Health Resources and Services Administration, the Centers for 
     Disease Control and Prevention, the Substance Abuse and 
     Mental Health Services Administration, and the Health Care 
     Financing Administration coordinate the planning, funding, 
     and implementation of Federal HIV programs to enhance the 
     continuity of care and prevention services for individuals 
     with HIV disease or those at risk of such disease. The 
     Secretary shall consult with other Federal agencies, 
     including the Department of Veterans Affairs, as needed and 
     utilize planning information submitted to such agencies by 
     the States and entities eligible for support.'';
       (2) by redesignating subsections (b) and (c) as subsections 
     (c) and (d), respectively;
       (3) by inserting after subsection (b) the following 
     subsection:
       ``(b) Report.--The Secretary shall biennially prepare and 
     submit to the appropriate committees of the Congress a report 
     concerning the coordination efforts at the Federal, State, 
     and local levels described in this section, including a 
     description of Federal barriers to HIV program integration 
     and a strategy for eliminating such barriers and enhancing 
     the continuity of care and prevention services for 
     individuals with HIV disease or those at risk of such 
     disease.''; and
       (4) in each of subsections (c) and (d) (as redesignated by 
     paragraph (2) of this section), by inserting ``and prevention 
     services'' after ``continuity of care'' each place such term 
     appears.

     SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH HIV 
                   DISEASE.

       Section 2675 of the Public Health Service Act, as amended 
     by section 413(2) of this Act, is amended by adding at the 
     end the following subsection:
       ``(e) Recommendations Regarding Release of Prisoners.--
     After consultation with the Attorney General and the Director 
     of the Bureau of Prisons, with States, with eligible areas 
     under part A, and with entities that receive amounts from 
     grants under part A or B, the Secretary, consistent with the 
     coordination required in subsection (a), shall develop a plan 
     for the medical case management of and the provision of 
     support services to individuals who were Federal or State 
     prisoners and had HIV disease as of the date on which the 
     individuals were released from the custody of the penal 
     system. The Secretary shall submit the plan to the Congress 
     not later than 2 years after the date of the enactment of the 
     Ryan White CARE Act Amendments of 2000.''.

     SEC. 415. AUDITS.

       Part D of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-71 et seq.) is amended by inserting after 
     section 2675 the following section:

     ``SEC. 2675A. AUDITS.

       ``For fiscal year 2002 and subsequent fiscal years, the 
     Secretary may reduce the amounts of grants under this title 
     to a State or political subdivision of a State for a fiscal 
     year if, with respect to such grants for the second preceding 
     fiscal year, the State or subdivision fails to prepare audits 
     in accordance with the procedures of section 7502 of title 
     31, United States Code. The Secretary shall annually select 
     representative samples of such audits, prepare summaries of 
     the selected audits, and submit the summaries to the 
     Congress.''.

     SEC. 416. ADMINISTRATIVE SIMPLIFICATION.

       Part D of title XXVI of the Public Health Service Act, as 
     amended by section 415 of this Act, is amended by inserting 
     after section 2675A the following section:

     ``SEC. 2675B. ADMINISTRATIVE SIMPLIFICATION REGARDING PARTS A 
                   AND B.

       ``(a) Coordinated Disbursement.--After consultation with 
     the States, with eligible areas under part A, and with 
     entities that receive amounts from grants under part A or B, 
     the Secretary shall develop a plan for coordinating the 
     disbursement of appropriations for grants under part A with 
     the disbursement of appropriations for grants under part B in 
     order to assist grantees and other recipients of amounts from 
     such grants in complying with the requirements of such parts. 
     The Secretary shall submit the plan to the Congress not later 
     than 18 months after the date of the enactment of the Ryan 
     White CARE Act Amendments of 2000. Not later than 2 years 
     after the date on which the plan is so submitted, the 
     Secretary shall complete the implementation of the plan, 
     notwithstanding any provision of this title that is 
     inconsistent with the plan.
       ``(b) Biennial Applications.--After consultation with the 
     States, with eligible areas under part A, and with entities 
     that receive amounts from grants under part A or B, the 
     Secretary shall make a determination of whether the 
     administration of parts A and B by the Secretary, and the 
     efficiency of grantees under such parts in complying with the 
     requirements of such parts, would be improved by requiring 
     that applications for grants under such parts be submitted 
     biennially rather than annually. The Secretary shall submit 
     such determination to the Congress not later than 2 years 
     after the date of the enactment of the Ryan White CARE Act 
     Amendments of 2000.
       ``(c) Application Simplification.--After consultation with 
     the States, with eligible areas under part A, and with 
     entities that receive amounts from grants under part A or B, 
     the Secretary shall develop a plan for simplifying the 
     process for applications under parts A and B. The Secretary 
     shall submit the plan to the Congress not later than 18 
     months after the date of the enactment of the Ryan White CARE 
     Act Amendments of 2000. Not later than 2 years after the date 
     on which the plan is so submitted, the Secretary shall 
     complete the implementation of the plan, notwithstanding any 
     provision of this title that is inconsistent with the 
     plan.''.

     SEC. 417. AUTHORIZATION OF APPROPRIATIONS FOR PARTS A AND B.

       Section 2677 of the Public Health Service Act (42 U.S.C. 
     300ff-77) is amended to read as follows:

     ``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) Part A.--For the purpose of carrying out part A, 
     there are authorized to be appropriated such sums as may be 
     necessary for each of the fiscal years 2001 through 2005.

[[Page 21031]]

       ``(b) Part B.--For the purpose of carrying out part B, 
     there are authorized to be appropriated such sums as may be 
     necessary for each of the fiscal years 2001 through 2005.''.

                      TITLE V--GENERAL PROVISIONS

     SEC. 501. STUDIES BY INSTITUTE OF MEDICINE.

       (a) State Surveillance Systems on Prevalence of HIV.--The 
     Secretary of Health and Human Services (referred to in this 
     section as the ``Secretary'') shall request the Institute of 
     Medicine to enter into an agreement with the Secretary under 
     which such Institute conducts a study to provide the 
     following:
       (1) A determination of whether the surveillance system of 
     each of the States regarding the human immunodeficiency virus 
     provides for the reporting of cases of infection with the 
     virus in a manner that is sufficient to provide adequate and 
     reliable information on the number of such cases and the 
     demographic characteristics of such cases, both for the State 
     in general and for specific geographic areas in the State.
       (2) A determination of whether such information is 
     sufficiently accurate for purposes of formula grants under 
     parts A and B of title XXVI of the Public Health Service Act.
       (3) With respect to any State whose surveillance system 
     does not provide adequate and reliable information on cases 
     of infection with the virus, recommendations regarding the 
     manner in which the State can improve the system.
       (b) Relationship Between Epidemiological Measures and 
     Health Care for Certain Individuals With HIV Disease.--
       (1) In general.--The Secretary shall request the Institute 
     of Medicine to enter into an agreement with the Secretary 
     under which such Institute conducts a study concerning the 
     appropriate epidemiological measures and their relationship 
     to the financing and delivery of primary care and health-
     related support services for low-income, uninsured, and 
     under-insured individuals with HIV disease.
       (2) Issues to be considered.--The Secretary shall ensure 
     that the study under paragraph (1) considers the following:
       (A) The availability and utility of health outcomes 
     measures and data for HIV primary care and support services 
     and the extent to which those measures and data could be used 
     to measure the quality of such funded services.
       (B) The effectiveness and efficiency of service delivery 
     (including the quality of services, health outcomes, and 
     resource use) within the context of a changing health care 
     and therapeutic environment, as well as the changing 
     epidemiology of the epidemic, including determining the 
     actual costs, potential savings, and overall financial impact 
     of modifying the program under title XIX of the Social 
     Security Act to establish eligibility for medical assistance 
     under such title on the basis of infection with the human 
     immunodeficiency virus rather than providing such assistance 
     only if the infection has progressed to acquired immune 
     deficiency syndrome.
       (C) Existing and needed epidemiological data and other 
     analytic tools for resource planning and allocation 
     decisions, specifically for estimating severity of need of a 
     community and the relationship to the allocations process.
       (D) Other factors determined to be relevant to assessing an 
     individual's or community's ability to gain and sustain 
     access to quality HIV services.
       (c) Other Entities.--If the Institute of Medicine declines 
     to conduct a study under this section, the Secretary shall 
     enter into an agreement with another appropriate public or 
     nonprofit private entity to conduct the study.
       (d) Report.--The Secretary shall ensure that--
       (1) not later than 3 years after the date of the enactment 
     of this Act, the study required in subsection (a) is 
     completed and a report describing the findings made in the 
     study is submitted to the appropriate committees of the 
     Congress; and
       (2) not later than 2 years after the date of the enactment 
     of this Act, the study required in subsection (b) is 
     completed and a report describing the findings made in the 
     study is submitted to such committees.

     SEC. 502. DEVELOPMENT OF RAPID HIV TEST.

       (a) Expansion, Intensification, and Coordination of 
     Research and Other Activities.--
       (1) In general.--The Director of NIH shall expand, 
     intensify, and coordinate research and other activities of 
     the National Institutes of Health with respect to the 
     development of reliable and affordable tests for HIV disease 
     that can rapidly be administered and whose results can 
     rapidly be obtained (in this section referred to a ``rapid 
     HIV test'').
       (2) Report to congress.--The Director of NIH shall 
     periodically submit to the appropriate committees of Congress 
     a report describing the research and other activities 
     conducted or supported under paragraph (1).
       (3) Authorization of appropriations.--For the purpose of 
     carrying out this subsection, there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2001 through 2005.
       (b) Premarket Review of Rapid HIV Tests.--
       (1) In general.--Not later than 90 days after the date of 
     the enactment of this Act, the Secretary, in consultation 
     with the Director of the Centers for Disease Control and 
     Prevention and the Commissioner of Food and Drugs, shall 
     submit to the appropriate committees of the Congress a report 
     describing the progress made towards, and barriers to, the 
     premarket review and commercial distribution of rapid HIV 
     tests. The report shall--
       (A) assess the public health need for and public health 
     benefits of rapid HIV tests, including the minimization of 
     false positive results through the availability of multiple 
     rapid HIV tests;
       (B) make recommendations regarding the need for the 
     expedited review of rapid HIV test applications submitted to 
     the Center for Biologics Evaluation and Research and, if such 
     recommendations are favorable, specify criteria and 
     procedures for such expedited review; and
       (C) specify whether the barriers to the premarket review of 
     rapid HIV tests include the unnecessary application of 
     requirements--
       (i) necessary to ensure the efficacy of devices for donor 
     screening to rapid HIV tests intended for use in other 
     screening situations; or
       (ii) for identifying antibodies to HIV subtypes of rare 
     incidence in the United States to rapid HIV tests intended 
     for use in screening situations other than donor screening.
       (c) Guidelines of Centers for Disease Control and 
     Prevention.--Promptly after commercial distribution of a 
     rapid HIV test begins, the Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall establish or update guidelines that include 
     recommendations for States, hospitals, and other appropriate 
     entities regarding the ready availability of such tests for 
     administration to pregnant women who are in labor or in the 
     late stage of pregnancy and whose HIV status is not known to 
     the attending obstetrician.

     SEC. 503. TECHNICAL CORRECTIONS.

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

                        TITLE VI--EFFECTIVE DATE

     SEC. 601. EFFECTIVE DATE.

       This Act and the amendments made by this Act take effect 
     October 1, 2000, or upon the date of the enactment of this 
     Act, whichever occurs later.

  The SPEAKER pro tempore. Pursuant to House Resolution 611, the 
gentleman from Oklahoma (Mr. Coburn) and the gentleman from Ohio (Mr. 
Brown) each will control 30 minutes.
  The Chair recognizes the gentleman from Oklahoma (Mr. Coburn).
  Mr. COBURN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this is a bill that is long overdue. Before we get into 
the topic of discussions on this bill, I think it is important that the 
American public know that this reauthorization is going to allow at 
least $1 billion per year to be spent in Ryan White CARE Act policies 
and procedures. Also, the American public should know that we are going 
to spend about $10 billion a year on this epidemic, both in terms of 
research, drug treatments, and all associated factors with it.
  As we think about that, if we were to apply the same efforts to many 
other diseases in our country, we would be achieving far more than we 
are today.
  This bill is long overdue. It is long overdue in a lot of ways. It is 
long overdue because the government has failed through the CDC and the 
FDA and the NIH to appropriately handle this epidemic.
  Two decades ago, the HIV/AIDS epidemic was recognized. Our Federal 
response to HIV/AIDS epidemic at that time was to ignore proven public 
health policies. This bill institutes for the first time in the Ryan 
White CARE Act proven public health policies that will, in fact, make a 
difference in the number of people who are infected.
  These include ensuring medical access to all who are infected, not a 
special select few; early intervention in

[[Page 21032]]

people who are infected; reliable disease surveillance and partner 
notification, including a responsibility to not infect anyone else with 
this disease. We will also, for the first time, recognize all of those 
living with HIV rather than focusing exclusively on those with AIDS.
  There are many other noteworthy changes made by this bill. Waiting 
lists to access life-saving HIV medications under the AIDS Drug 
Assistance program will be eliminated. Prevention will be incorporated 
as part of the comprehensive care program. Planning councils will be 
more representative of the infected population. Patients who rely on 
the CARE Act for their well-being will be given a greater voice in 
priority setting, and accountability safeguards will ensure that 
Federal AIDS funds will be spent on needed patient care. This bill will 
also provide Federal assistance to States to ensure that all pregnant 
women with HIV and their children are identified and provided care.
  One of the most promising victories in the battle against AIDS was a 
1994 finding that the administration of a drug could significantly 
reduce the chance that a child born to an HIV positive mother would 
become infected. Yet, despite these miracles, a significant number of 
women still are not tested for HIV during their pregnancy, and hundreds 
of children are needlessly infected each year with an incurable disease 
that will prematurely claim their lives.
  This bill will provide up to $400 million annually to any State that 
makes identifying and ensuring proper care for HIV and infected women 
and their HIV-exposed newborns a priority.
  The two States with such baby AIDS laws, New York and Connecticut, 
have experienced great success. Universal newborn HIV testing has 
resulted in the identification of all HIV-exposed births and has 
allowed hospital and health department staff to ensure that over 98 
percent of HIV positive mothers are aware of their HIV status and have 
newborns referred for early diagnosis and care of HIV infection. That 
is according to Dr. Guthrie Birkhead, the director of the New York AIDS 
Institute.
  Dr. Birkhead noted that the rates of prenatal care have been 
increasing, not decreasing as we were told would happen. There has been 
no detectable change in prenatal participation trends that might be 
related to the newborn testing program.
  The Connecticut baby AIDS law, which requires every newborn to be 
screened for HIV if the mother's status is unknown, was enacted almost 
a year ago. In the first 10 months, 26 newborns who were perinatally 
exposed to HIV have been identified. This is more than four times as 
many as were diagnosed with HIV in the previous 3 years combined.
  This substantial financial incentive amounts to a Federal endorsement 
of universal HIV newborn testing as a routine medical practice. I must 
regrettably note that the organization in my profession that purports 
to represent physicians who care for mothers and women has yet to 
endorse this. The question we ought to ask ourselves is why the 
American College of Obstetricians and Gynecologists, knowing that we 
can save children's lives and we can treat women, has failed to yet 
endorse this.
  This bill will also provide additional resources to support partner 
notification programs so that everyone who has been exposed to HIV is 
given the right to know that exposure. In addition, it will empower 
those who are infected to protect others from infection by providing 
prevention counseling as a part of a comprehensive care program. This 
includes providing advice on how to disclose one's HIV status to a 
potential partner and emphasizing to those living with HIV that they 
have a responsibility not to give this disease to anyone else.
  Finally, the bill recognizes everyone living with HIV and guarantees 
access to life-saving treatment to all who are infected. Current 
funding formulas are based on AIDS infection, the end stage of HIV 
infection. The CDC only recently recommended that States begin tracking 
the full scope of the epidemic, not just AIDS. The American public 
ought to be asking why has it waited so long.
  Over 12 years ago, the Presidential Commission on HIV warned the 
continual focus on AIDS rather than the full spectrum of HIV disease 
has left our Nation unable to deal adequately with the epidemic. Well, 
this bill changes that. This observation was absolutely correct. Yet, 
it was ignored by the CDC and Federal policy makers. The results have 
been devastating.
  While our attention was placed on AIDS, the virus silently spread 
through communities of color, and more and more women became 
unknowingly infected. Only now are AIDS statistics revealing the paths 
that the virus took 10 years ago. Unfortunately, the casualties are 
increasingly rising for women and women of color.
  While women and African-Americans comprise the majority of new HIV 
infections, they also receive less appropriate care according to the 
General Accounting Office. This is a direct result of the CARE Act's 
misplaced emphasis on AIDS data and determining funding and priority 
setting. That has changed with this bill.
  All of these changes, while long overdue, will do much to improve our 
Nation's responsibilities to HIV and AIDS by ensuring medical access to 
all of those who are infected and by providing the proper care for all.
  Mr. Speaker, I include the following letter for the Record, as 
follows:

                                    General Accounting Office,

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


                               Background

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

[[Page 21033]]

     to the number of living AIDS cases. In fiscal year 2000, Los 
     Angeles had 6.9 percent of all AIDS cases nationally and 
     received 6.7 percent of title I funding. Similarly, Miami had 
     4.4 percent of all AIDS cases and received 4.3 percent of 
     title I funding. EMAs received $1,290 in title I funds per 
     AIDS case in fiscal year 2000. However, because of the hold-
     harmless provision, San Francisco's grant award was 
     substantially higher: it received $2,360 per AIDS case, or 80 
     percent more than other EMAs. As a consequence, San Francisco 
     received 6.7 percent of title I formula funding even though 
     it had just 3.8 percent of all living AIDS cases.


                RESULTS OF DIFFERENT FUNDING APPROACHES

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

                                         and Public Health Issues.

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

                              {time}  1045

  Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  I first want to commend the gentleman from Oklahoma (Mr. Coburn) and 
the gentleman from California (Mr. Waxman) for their outstanding work 
on the Ryan White CARE Act Amendments of 2000.
  I also want to acknowledge the gentlewoman from California (Ms. 
Eshoo). Her constituents should know she worked exceptionally hard on 
this bill, particularly on those provisions with particular 
significance to San Francisco. The same can be said of the gentlewoman 
from California (Ms. Pelosi). She deserves a great deal of credit and 
praise for her ongoing involvement and input on these provisions.
  This bill required a tremendous amount of work and negotiation. Staff 
members Paul Kim and Roland Foster put in a staggering number of hours, 
and it shows in the quality of the final product. John Ford, Marc 
Wheat, Karen Nelson, Eleanor Dehoney also deserves our thanks, as well 
as Stacey Rampey and Scott Boule.
  Over the last several years, much has been written about ``The 
changing face of AIDS.'' This is not a wholly accurate 
characterization. HIV/AIDS is not a moving target. It does not leave 
one population when it moves to another population. Instead, HIV/AIDS 
expands to absorb new populations while continuing its progression in 
groups already affected by the virus.
  When the AIDS epidemic surfaced in this country 19 years ago, white 
gay males were the at-risk population. That has not changed. The 
population still is at an elevated risk. But the epidemic has expanded 
its reach dramatically in these 2 decades. The latest HIV/AIDS 
statistics show that African American and Latino communities are 
significantly over-represented in the number of new HIV infections. 
African Americans comprise 12 percent of the population but accounted 
for more than 50 percent of the estimated 40,000 new HIV infections in 
1999.
  The aggressive nature of this virus calls for an equally aggressive 
response, and it speaks to the importance of updating and reauthorizing 
the Ryan White Act. Ryan White programs get information and services to 
the people who need them. They combat the illness as well as the 
alienation and isolation that can be one of its most disabling effects.
  If HIV/AIDS is a war, and it is set to kill more people worldwide 
than World War I, World War II, Korea, and Vietnam combined, then the 
Ryan White programs are this Nation's front line defenses. The act was 
created in memory of Ryan White, a young teenager who became a national 
hero in the fight against HIV/AIDS. Ryan wanted to attend school. He 
wanted to be treated like other young people. Those seem like modest 
goals, but he had to overcome tremendous obstacles to achieve them.
  Ryan was a hemophiliac and contracted HIV through a bad blood 
transfusion. But he fought against ignorance, he fought against fear, 
he fought against prejudice on behalf of all individuals with HIV/AIDS. 
Ryan died on April 8, 1990, at the age of 18. Ten years after his 
death, the law named after him carries on his legacy.
  The Ryan White CARE Act has made a tremendous difference in the lives 
of people living with HIV/AIDS. In my district, which includes much of 
Ohio's only title I-eligible metropolitan area, so-called EMA, Ryan 
White programs provide primary care and support services and the kinds 
of medications that can tame HIV/AIDS into a chronic, rather than an 
acute, illness. There is more to do, and the Ryan White Act will 
continue to play a pivotal role.
  In Ohio, while AIDS deaths have declined, the incidence of HIV/AIDS 
has increased dramatically. After declining steadily, the incidence of 
HIV/AIDS among young gay males is again on the rise. HIV/AIDS is 
expanding into new populations while continuing to spread in those 
populations originally at risk. Prevention is vital; treatment is 
vital; Ryan White programs are vital.
  During the 13th International AIDS Conference held in Durbin, South 
Africa, scientists shared some amazing research findings. These 
findings provide sorely needed hope for developing nations ravaged by 
HIV/AIDS. The research indicates that the so-called AIDS cocktails, 
which have revolutionized HIV/AIDS treatment in the U.S. and other 
industrialized nations, can be successfully used even in countries 
lacking a sophisticated health care infrastructure.
  That does not mean it will be easy. There must have been times when 
Ryan White himself felt overwhelmed by the intransigence, the 
callousness, and the hatred that he encountered. This Nation should 
fight AIDS here and abroad with that sense of commitment that he had. 
Reauthorizing Ryan White is part of that commitment, and I urge its 
passage.
  Mr. Speaker, I reserve the balance of my time.
  Mr. COBURN. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Florida (Mr. Bilirakis), the chairman of the 
Subcommittee on Health of the Committee on Commerce.
  Mr. BILIRAKIS. Mr. Speaker, I thank the gentleman for yielding me 
this time and for being here to lead our side on this very, very 
significant bill.
  I too arise in support of this amendment to S. 2311, the Ryan White 
CARE Act Amendments of 2000. This final legislation is the result of 
negotiations between the Senate and the House, and the resulting bill 
is designed to bring the CARE Act into the 21st century.
  I salute my committee colleagues, the gentleman from Oklahoma (Mr. 
Coburn) and the gentleman from California (Mr. Waxman), for their 
excellent work on this legislation; and I urge Members to support its 
passage.
  My Subcommittee on Health and Environment held a hearing on the bill, 
and the full Committee on Commerce approved it by voice vote after 
adopting several bipartisan amendments to further refine and strengthen 
this very important measure.

[[Page 21034]]

  Before the August recess, the House approved legislation to 
reauthorize the Ryan White CARE Act with strong bipartisan support. The 
act provides critical funding to address the needs of patients living 
with HIV and AIDS. S. 2311 reflects the agreements reached between the 
House and the Senate, and I expect this bill to be signed into law in 
the near future.
  The Ryan White Comprehensive AIDS Resources Emergency, or ``CARE'' 
Act as we call it, was enacted in 1990 and Congress approved bipartisan 
legislation to reauthorize the law in 1996. The Ryan White CARE Act 
provides critical funding for health and social services to the 
estimated 1 million Americans living with HIV and AIDS. The bill before 
us will ensure that these patients continue to receive the care and 
medications they need to enhance and prolong their lives.
  The bill makes an important change by relying on the number of HIV-
infected individuals as opposed to only the number of persons living 
with AIDS as the basis for allocating funding under titles I and II of 
the Ryan White CARE Act. By targeting resources to the front line of 
the epidemic, we will be able to reduce transmission rates and ensure 
the necessary infrastructure is in place to provide care to HIV-
positive individuals as soon as possible.
  This change will allow the Federal Government to be proactive instead 
of reactive in the fight against HIV and AIDS. It should be noted, 
however, Mr. Speaker, that this shift will only occur when reliable 
data on HIV prevalence is available.
  The bill also includes a ``hold harmless'' provision to ensure that 
no metropolitan area will suffer a drastic reduction in CARE Act funds. 
The bill which originally passed the House would have hurt certain 
cities such as San Francisco. In this regard, Mr. Speaker, I will 
submit for the Record a letter that GAO sent to the gentleman from 
Oklahoma (Mr. Coburn). After lengthy negotiations, it has been agreed 
the hold harmless reduction will be a compromised 15 percent over the 
next 5 years.
  The Ryan White CARE Act must be reauthorized to improve our public 
health strategies. The bill before us will ensure that the HIV/AIDS 
epidemic can be tracked more accurately and that appropriate funding 
and information about this disease can be directed effectively. I have 
been very encouraged to hear from patient advocates in support of this 
measure. For example, AIDS Action stated that it is ``very pleased with 
the compromise bill that has been negotiated between the House and the 
Senate. It represents a modernization of the CARE Act and will allow us 
to provide quality care for people with HIV and AIDS.''
  In closing, Mr. Speaker, I want to again recognize the hard work of 
all the Members and their staffs, whose bipartisan efforts advanced 
this reauthorization bill. The gentleman from Oklahoma (Mr. Coburn) and 
the gentleman from California (Mr. Waxman), who I mentioned previously, 
and staff members Roland Foster and Paul Kim worked very hard to 
advance this measure in the House, working with Senators Jeffords, 
Frist, and Kennedy. And obviously, working with my counterpart on the 
other side in the subcommittee, the gentleman from Ohio (Mr. Brown), 
the gentleman from Michigan (Mr. Dingell), et cetera, we were able to 
craft this compromise legislation.
  It is a critical piece of legislation that can literally save lives, 
and I urge all Members to join me today in supporting this important 
legislation.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 5 minutes to the gentlewoman 
from California (Ms. Pelosi), who has been one of the real leaders in 
this whole process in pulling this bill together.
  Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding me this 
time, and I want to compliment him on his great leadership on this 
legislation; he and the gentleman from Florida (Mr. Bilirakis) for 
their leadership, and I associate myself with the comments that the 
gentleman from Florida made in recognition of those who worked so hard 
to make it a success; and, if it is allowed, to especially recognize 
the work of Senator Kennedy for bringing about the compromises that 
exist in this bill.
  The gentleman from California (Mr. Waxman) has been a champion in 
Congress since the onset of the AIDS epidemic, and his leadership is 
very much in evidence in this bill; and the ranking member, the 
gentleman from Ohio (Mr. Brown), helped us through some difficult times 
here, but I think the product is one that this whole body can 
wholeheartedly support. That is why, Mr. Speaker, I rise in strong 
support of the reauthorization of the Ryan White CARE Act.
  Passage of this vital legislation is the most important action this 
Congress can take on the issue of AIDS this year. And I would like to 
thank again the Committee on Commerce, the gentleman from Michigan (Mr. 
Dingell), the gentleman from Virginia (Mr. Bliley), the gentleman from 
Florida (Mr. Bilirakis), the gentleman from California (Mr. Waxman), 
the gentleman from Ohio (Mr. Brown), and also point out the 
distinguished work of the gentlewoman from California (Ms. Eshoo).
  The gentlewoman from California (Ms. Eshoo) lives in the same 
metropolitan area that I do. We are in the same area for care and 
treatment and prevention for people with HIV/AIDS. This is about care 
today, but her leadership on the committee has been indispensable to 
the success that we see here today with this legislation.
  Since the beginning of the AIDS epidemic, my district in San 
Francisco has been one of the most severely impacted in the country. 
When I came to the Congress 13 years ago, we had already lost over 
13,000 of our friends and loved ones to the AIDS epidemic. That is 
13,000, 13 years ago. We have suffered greatly, but we have learned a 
lot we would like the rest of the country to benefit from as we have 
responded to this challenge.
  The Ryan White CARE Act was modeled on a system of community-based 
care that we developed to face the crisis in the 1980s. As a result of 
this work early in the epidemic, San Francisco produced data that 
showed the country that comprehensive HIV/AIDS care and services not 
only saved lives but also saved money and valuable health care 
resources. Today, the CARE Act programs provide foundation for care and 
treatment for low-income individuals with HIV and AIDS.
  The recent declines we have seen in AIDS deaths are a direct result 
of the therapies and services that have been made more widely available 
through the CARE Act to large numbers of uninsured and underinsured 
people with HIV and AIDS. Each year, the CARE Act ensures that 
approximately half a million people, 500,000 people, living with HIV 
and AIDS have access to the medical services, including pharmaceuticals 
that are needed to sustain and prolong life. This represents 
approximately two-thirds of the individuals living with HIV/AIDS in 
this country.
  Although great strides have been made, there is much more to be done. 
The combination therapies that have brought us so much hope are still 
not reaching all those in need. The changing nature of the HIV/AIDS 
epidemic, along with the continuing impact of it in traditionally 
affected communities, has created new challenges for the CARE Act. 
People of color now represent the majority of new AIDS cases, and the 
proportion of new AIDS cases among women has grown from 11 percent in 
1990 to 23 percent in most recent statistics.
  In addition, new HIV infections have remained constant at 40,000 
cases per year. These new infections, combined with the decline in AIDS 
deaths, means more individuals than ever before are living with HIV and 
in need of treatment regimens that are costly, complicated and 
lifelong. As a result, the demand on HIV care providers has grown.
  The Ryan White CARE Act's remarkable ability to adapt to the changing 
nature of the AIDS epidemic was confirmed earlier this year when a GAO 
report concluded that the CARE Act is helping our public health 
infrastructure adjust to these new challenges by

[[Page 21035]]

directing services to African Americans, Hispanics, and women in higher 
proportions than their representation in the AIDS population.
  Again, I thank our colleagues, including the gentleman from Oklahoma 
(Mr. Coburn) and the Committee on Commerce for their great work. This 
program is an important example of the way that effective leadership at 
the Federal, State, and local levels can translate into improved health 
outcomes for the people of this country. I think it also is a wonderful 
example of bipartisanship, where we can all come together and give what 
I hope will be unanimous support for this act. I urge my colleagues to 
vote ``yes'' on the reauthorization.
  Mr. Speaker, I serve on the Subcommittee on Labor, Health and Human 
Services, and Education of the Committee on Appropriations, and one of 
the priorities we have there is research, prevention, and care for 
people with HIV/AIDS.

                              {time}  1100

  We want to focus heavily on prevention. We must continue our research 
for a cure. We are trying to find a vaccine and, hopefully, that will 
happen before not too long. But we must never forget the people out 
there who are diagnosed with HIV and AIDS now.
  I am pleased that the bill eventually will recognize and count those 
infected with HIV but not full-blown cases of AIDS in the numbers and 
in the formula. I wish that would have been sooner. But, nonetheless, 
there is the recognition. I commend the legislators on the committee, 
members of the committee, for making that distinction and having it be 
a part of our formula down the road.
  Once again, Mr. Speaker, I want to commend the gentleman from 
California (Mr. Waxman) who I see now on the floor. As I said earlier, 
he has been a champion since day one on this issue. We have all been 
very well-served by his leadership, that of the gentleman from Ohio 
(Mr. Brown) and others.
  I urge my colleagues to vote aye.
  Mr. COBURN. Mr. Speaker, I ask unanimous consent that the remainder 
of the time on our side be controlled by the gentleman from Florida 
(Mr. Bilirakis).
  The SPEAKER pro tempore (Mr. Simpson). Is there objection to the 
request of the gentleman from Oklahoma?
  There was no objection.
  Mr. BILIRAKIS. Mr. Speaker, I yield 3\1/2\ minutes to the gentlewoman 
from Maryland (Mrs. Morella).
  Mrs. MORELLA. Mr. Speaker, I thank the gentleman for yielding me the 
time.
  Mr. Speaker, I rise in strong support of the Ryan White CARE Act 
Amendments of 2000. I want to thank the gentleman from Florida 
(Chairman Bilirakis) for his leadership in bringing this bill to the 
floor and the gentleman from Ohio (Mr. Brown), the ranking member, for 
his role in so doing.
  And also, there are other colleagues of ours who deserve particular 
attention. The gentleman from Oklahoma (Mr. Coburn), the gentleman from 
California (Mr. Waxman) and the gentleman from Ohio (Mr. Brown) worked 
very hard. They were dedicated in their commitment and their hard work 
has paid off for these critical programs.
  The CARE Act represents the largest authorization of Federal funds 
specifically designated to provide health and social services to people 
infected with HIV. Declaring an AIDS emergency, Congress passed the 
Ryan White Comprehensive AIDS Resources Emergency Act in August of 
1990. Six years later, we voted to reauthorize the CARE Act by a 
unanimous vote in the House of Representatives and a 97-3 vote in the 
Senate.
  Over the last 9 years, the CARE Act has helped increase the 
availability of primary care health and support services especially for 
the uninsured and underinsured persons with HIV disease. The multi-
title structure of the CARE Act has worked effectively to dramatically 
improve the quality of life for people living with HIV and their 
families. It has helped to reduce cost of inpatient care and increase 
access to care for underserved populations, including people of color.
  The legislation we are considering today revises the grant formulas 
to shift the emphasis of the programs away from treating people with 
full-blown AIDS to people with the viral precursor, HIV, of AIDS. This 
legislation includes a new formula beginning in 2005 for distributing 
funds to States and cities based on the number of both AIDS and HIV 
cases compared to the current formula, which allocates funds based 
solely on AIDS cases.
  Also included in this measure is $20 million to reduce HIV mother-to-
child transmission. The bill also addresses prevention of the disease 
by including $30 million for tracking the disease and encouraging 
people to notify their partners.
  Additionally, those receiving care through Ryan White programs are 
required to enroll in counseling programs.
  Today, promising new drug therapies have brought new hope and new 
challenges to the battle against the epidemic, but these new drugs do 
not constitute a cure and an effective vaccine is still years away. 
Moreover, the treatments do not work for everyone, they are difficult 
to access especially for communities of color, and their long-term 
efficacy remains unknown. Nonetheless, AIDS deaths have declined 
dramatically in the last 3 years and more people are living longer with 
HIV.
  The HIV/AIDS epidemic thus remains an enormous health emergency in 
the United States, and it will remain so into this century. The state 
of the epidemic points to an increase rather than a decrease in the 
overall need for health care, drug treatment, social services. As a 
Nation, we must continue our effort to expand access to these services 
for people living with HIV/AIDS, particularly in communities of color 
and women.
  This Ryan White CARE Act has proven to be an essential and effective 
part of the Federal response to the HIV/AIDS crisis. This legislation 
will ensure we continue this response.
  I certainly ask this body to support this comprehensive, meaningful 
and truly successful legislation.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 4\1/2\ minutes to the 
gentleman from California (Mr. Waxman) who played a very central role 
in the negotiations on this bill.
  Mr. WAXMAN. Mr. Speaker, I thank the gentleman for yielding me the 
time.
  Mr. Speaker, I rise in strong support of S. 2311, the Ryan White CARE 
Act Amendments of 2000.
  As the original author of the Ryan White CARE Act and the coauthor of 
the House reauthorization bill, H.R. 4807, I want to applaud the 
Members and the staffs on both sides of the aisle for moving this 
crucial legislation with such speed and bipartisan cooperation.
  I want to recognize the gentleman from Oklahoma (Mr. Coburn) for his 
commitment to reauthorizing this Act and his leadership in fashioning 
the compromises that allowed us to move the bill I think virtually 
unanimously through the House and to get an agreement with the Senate. 
He made this consensus legislation a reality.
  The gentleman from Florida (Chairman Bilirakis), the gentleman from 
Ohio (Mr. Brown), the gentleman from Virginia (Chairman Bliley), and 
the gentleman from Michigan (Mr. Dingell) have lent their unqualified 
support. And numerous Members, including the gentlewoman from 
California (Ms. Pelosi), the gentleman from New York (Mr. Towns), the 
gentlewoman from California (Ms. Eshoo), the gentleman from Texas (Mr. 
Rodriguez) and the gentlewoman from the Virgin Islands (Mrs. 
Christensen) have helped ensure its passage.
  Mr. Speaker, the original CARE Act was enacted in the wake of a 
decade of lost opportunities. I told this House in 1990 that, ``Having 
missed our opportunity to provide an ounce of prevention, we must now 
prepare to pay for pounds and pounds of cure.''
  Today, the AIDS epidemic is everywhere. It threatens everyone. But 
there is still no vaccine and there is still no cure. Nevertheless, the 
Ryan White CARE Act has made an enormous difference. It provides care 
to tens of

[[Page 21036]]

thousands of Americans living with HIV/AIDS. It helps their families 
cope with the burdens of AIDS and HIV infection, and it provides 
urgently needed funding to community providers and hospitals to combat 
the epidemic.
  Today's overwhelming bipartisan support for the CARE Act demonstrates 
that Congress understands how crucial it is to the health and welfare 
of our country.
  Mr. Speaker, this legislation preserves the best features of the CARE 
Act while making reforms to better respond to a changing epidemic.
  First and foremost, this legislation better addresses the needs of 
individuals with HIV who have not developed AIDS. In 2004, we will 
determine whether to use nationwide data on HIV infection in the CARE 
Act. I believe this will happen, and I have been told by the State of 
California that they will have such data by 2004.
  We also call on States and cities to do more to reach those who are 
not receiving care and to serve the needs of our historically 
underserved communities. We call for ending lingering disparities in 
care and for better coordination of HIV/AIDS treatment with prevention.
  We have also focused CARE Act programs on the needs of vulnerable 
populations. Funds will be allocated to better reflect the proportions 
of women, children, infants and youth with HIV. I expect this will 
increase such funding for those populations in the future.
  This legislation also greatly expands our national effort to 
eliminate the perinatal transmission of HIV/AIDS. These new funds will 
help bring the number of babies born with HIV in our country down to 
zero.
  We also redirect funding to cities and States in the greatest need of 
assistance. The title I and title II ``hold harmless'' provisions have 
been revised to ensure a manageable transition to funding allocations 
which better reflect the epidemic. At the same time, potential 
disruptions in patient care are minimized. And the title I, title II, 
and AIDS Drug Assistance Program (ADAP) supplemental grants will assist 
cities and States with the greatest need of funds.
  These are the principal reforms to the CARE Act. They will expand 
access, improve quality, and enhance services for individuals with HIV 
and AIDS.
  Regrettably, Mr. Speaker, much more could be done and much more needs 
to be done. We must expand Medicaid to provide care to individuals with 
HIV who have not developed AIDS. We must lead the global search for an 
effective HIV vaccine and a cure for AIDS. And we must provide 
resources and our hard-earned expertise to help other countries combat 
the epidemic.
  For today, though, I am pleased that we will fulfill the expectations 
of Jeanne White, the mother of Ryan White, and of so many Americans 
living with HIV and AIDS by reauthorizing the Ryan White CARE Act.
  Mr. Speaker, I rise in strong support of the Ryan White CARE Act 
Amendments.
  As the original author of the Ryan White CARE Act and the co-author 
of the House reauthorization bill, H.R. 4807, I want to applaud the 
Members and the staff on both sides of the aisle for moving this 
crucial legislation with such speed and bipartisan cooperation.
  I want to recognize Dr. Coburn for his commitment to reauthorizing 
the CARE Act. He has made this consensus legislation a reality. 
Chairman Bilirakis and Mr. Brown, Chairman Bliley and Mr. Dingell have 
lent their unqualified support. And numerous Members, including Ms. 
Pelosi, Mr. Towns, Mr. Eshoo, Mr. Rodriguez and Dr. Christensen, have 
helped ensure its passage.
  Mr. Speaker, the original CARE Act was enacted in the wake of a 
decade of lost opportunities. I told this House in 1990 that, ``Having 
missed our opportunity to provide an ounce of prevention, we must now 
prepare to pay for pounds and pounds of cure.''
  Ten years ago, there were those who spoke of the AIDS epidemic as a 
thing of the past. There were those who dismissed the disease as a 
danger to others, and not themselves. And there were those who opposed 
the Ryan White CARE Act.
  Mr. Speaker, they were wrong then, and they are wrong today. The AIDS 
epidemic is everywhere. It threatens everyone. It is devastating the 
globe from Russia to subSaharan Africa. And there is still no vaccine. 
There is still no cure.
  But in the face of these challenges, the CARE Act has made a 
difference. The CARE Act provides care to tens of thousands of 
Americans living with HIV/AIDS. If helps their families cope with the 
burdens of AIDS and HIV infection. And it provides urgently needed 
funding to community providers and hospitals to combat the epidemic.
  Today's overwhelming bipartisan support for the CARE Act demonstrates 
that Congress understands how crucial it is to the health and welfare 
of our country.
  Let me highlight the important ways this legislation preserves the 
best and proven features of the CARE Act, while making important and 
substantial reforms to better respond to a changing epidemic. I am 
particularly pleased that this consensus House and Senate legislation 
reflects virtually all of the provisions and agreements reached by this 
House in H.R. 4807.
  Most important of all, this legislation better addresses the needs of 
individuals with HIV who have not developed AIDS. With 40,000 new 
infections every year and improved prospects for delaying the onset of 
AIDS, the number of new deaths from AIDS has declined but the number of 
individuals with HIV is rising inexorably. In response, this 
legislation calls on the Secretary of Health and Human Services to 
determine in 2004 whether we have nationwide data on accurate and 
reliable cases of HIV infection which can be used in allocating CARE 
Act funds. I believe this will happen, and I have been told by the 
State of California that they are confident they will have such data by 
2004.
  We also call on States and cities to better determine the number and 
demographics of individuals with HIV. We require special efforts to 
reach those who are not receiving care and serve the needs of our 
historically underserved communities. We call for ending lingering 
disparities in care. And we require States, cities and the Federal 
government to develop new strategies to better coordinate HIV/AIDS 
treatment with prevention.
  The need for better coordination cuts across systems of care, Federal 
agencies, States, cities, providers and community organizations. Ten 
years ago, I described the CARE Act as providing ``a continuum of 
prevention services--counseling and testing, diagnostics for those who 
test positive, and therapeutics for those whose diagnostics indicate a 
medical intervention.'' Patients receiving care under the CARE Act 
today deserve seamless continuity between testing, counseling, 
treatments, support and prevention services.
  Just last week, the Institute of Medicine released a comprehensive 
report on our nation's HIV prevention efforts. They concluded that 
``prevention services for HIV-infected people should be integrated into 
the standard of care at all primary care centers, sexually-transmitted 
disease clinics, drug treatment facilities, and mental health 
centers.'' This is precisely what we set out to accomplish in H.R. 
4807, and this policy is reflected fully in this final consensus 
legislation.
  This legislation also strengthens the responsiveness of CARE Act 
programs to the public. Title I Planning Councils will include a 
greater number of independent individuals with HIV/AIDS. Planning 
Council meetings and records will be exposed to greater public 
``sunshine.'' All Planning Council members will receive improved 
training. And States will make their planning more accessible to a 
broader range of public stakeholders.
  We have also focused CARE Act programs on the needs of vulnerable 
populations. Just yesterday, the Office of National AIDS Policy 
announced that half of the 40,000 new HIV infections every year occur 
among our teens and young adults. In this legislation, funds will be 
allocated to better reflect the proportions of women, children, infants 
and youth with HIV. I expect this will increase such funding for these 
populations in the future.
  We have also strengthened the Title IV program for medical care, 
social services, and access to research for low-income children, youth, 
women and families. States and cities must develop novel strategies to 
coordinate their HIV/AIDS services and substance abuse services. And 
the Secretary of Health and Human Services must develop a plan in 
consultation with the Attorney General for the treatment of prisoners 
with HIV/AIDS.
  This legislation greatly expands our national effort to eliminate the 
perinatal transmission of HIV/AIDS. The last ten years have seen a 
dramatic decline in such cases, due largely to the treatment of 
pregnant mothers with zidovudine. In an important compromise, we have 
increased an existing $10 million CARE Act grant program by $20 
million, with a proportion of new funds set aside for States with 
either mandatory newborn testing or significant declines in perinatal 
transmission. I am confident these funds will be well spent on offering 
counseling and testing to all pregnant

[[Page 21037]]

women, outreach to high-risk women and other innovative prevention 
efforts.
  Funding has also been redirected to cities and States with the 
greatest need of additional assistance. The Title I and Title II ``hold 
harmless'' provisions have been revised to ensure a manageable 
transition to funding allocations which better reflect the current 
distribution and epidemiology of the epidemic. This will be 
accomplished while minimizing potential disruptions in care for 
individuals with HIV/AIDS. Under Title II, States' base funds as well 
as their total funding will be held harmless to a small percentage of 
loss.
  Under Title I, a city's potential loss in its formula allocation is 
limited to a percentage of the amount allocated to the city in the base 
year preceding its need for the hold harmless. In its fifth, 
consecutive year of need for the hold harmless, a city would lose no 
more than 15 percent of its base year allocation. Such losses would not 
be compounded, as was contemplated in the original Senate bill. But if 
the Secretary determines that data on HIV prevalence will be used in 
Title I formula grants in 2005, no city may lose more than 2 percent of 
its 2004 formula allocation in 2005.
  Additionally, Title I supplemental grants and new AIDS Drug 
Assistance Program (ADAP) supplemental grants will be directed to 
cities and States with ``severe need'' for such funding, based on more 
objective and quantitative criteria. And new Title II supplemental 
formula grants will be given to ``emerging communities'' with AIDS case 
counts which fall below the threshold for Title I eligibility.
  These are the principal reforms to the CARE Act. They will expand 
access, improve quality and enhance services for individuals with HIV/
AIDS. And I want to recognize the hard work of House staff, including 
Roland Foster, Paul Kim, Karen Nelson, Marc Wheat, John Ford, Eleanor 
Dehoney, Brent Delmonte, Katie Porter, Anne Esposito and House 
Legislative Counsel Pete Goodloe, in making this possible.
  Mr. Speaker, much more could be done and much more needs to be done. 
We must expand Medicaid to provide care to individuals with HIV who 
have not developed AIDS. We must lead the global search for an 
effective HIV vaccine and a cure to AIDS. And we must provide resources 
and our hard-earned expertise to help other countries combat the 
epidemic.
  For today, though, I am pleased we will fulfill the expectations of 
Jeanne White, the mother of Ryan White, and of so many Americans living 
with HIV and AIDS by reauthorizing the Ryan White CARE Act.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from 
New York (Mr. Gilman) the chairman of the Committee on International 
Relations.
  Mr. GILMAN. Mr. Speaker, I thank the gentleman for yielding me the 
time.
  Mr. Speaker, I rise today in support of S. 2311, the Ryan White CARE 
Act Amendments as adopted by the Senate. It is a primary source of 
Federal AIDS prevention and treatment funding. I commend the gentleman 
from Florida (Mr. Bilirakis), the subcommittee chairman on health and 
environment; the gentleman from Oklahoma (Mr. Coburn); the gentleman 
from Ohio (Mr. Brown); and the gentleman from California (Mr. Waxman) 
for their full support of this important measure.
  This legislation accomplishes many of our most important HIV goals: 
modifying the eligibility requirements and allocation formulas for 
grants to State and local governments; giving States increased 
flexibility to provide a wider range of treatments and support 
services; emphasizing the provision of services for women, infants, and 
children by substituting special grant set-asides; capping 
administrative and evaluation expenses for the grant programs; and 
requiring States to implement the Center for Disease Control guidelines 
regarding HIV testing and counseling for pregnant women.
  Also included in this measure is an important fund, $20 million, to 
reduce HIV transmission from mothers to their babies and $30 million 
for tracking the disease and encouraging people to notify their 
partners, and provisions to require people receiving care through Ryan 
White programs to enroll in counseling programs.
  In short, Mr. Speaker, this legislation not only demonstrates the 
bipartisan humanitarian spirit of this Congress, but also in working 
together in areas of mutual concern that we can accomplish worthy 
goals.
  Accordingly, I am in strong support of the Ryan White CARE Amendments 
and I urge our colleagues to adopt it at the earliest possible date.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2\1/2\ minutes to the 
gentlewoman from California (Mrs. Capps) who is a registered nurse and 
has been a real leader on all kinds of public health issues.
  Mrs. CAPPS. Mr. Speaker, I thank my colleague for yielding me the 
time.
  Mr. Speaker, I rise in strong support of the Ryan White CARE Act 
Amendments of 2000. I commend my colleagues on the Committee on 
Commerce and others for all of their hard work.
  Today's medical advances allow many individuals with AIDS to lead 
longer and more productive lives. However, as patients live longer, the 
cost of their care and treatment has placed an ever-greater demand on 
community-based organizations and State and local governments.
  In the face of these challenges, the Ryan White CARE Act has made a 
great difference. This CARE Act provides care to tens of thousands of 
Americans living with HIV/AIDS.
  Recently I spoke with the Health Educator, Jayne Brechwald, with the 
Santa Barbara County Health Care Services in my district. She works on 
a daily basis with members of the community who benefit greatly from 
Ryan White funding. She spoke in strong support of funding for crucial 
services such as Meals on Wheels, food banks, housing counseling. She 
also praised programs which help those diagnosed navigate the options 
available for them. These include the medical care, education, and 
dental care that are so important during this terrifying time in a 
person's life.
  In Jayne's words, ``Ryan White funding is really about local control. 
The program requires that we do a needs assessment every year so that 
we have a very targeted, specific idea of how the population we serve 
is changing and how the funding is being utilized.''
  I believe that the Ryan White Act represents the Federal Government 
at its best. This program defers to local expertise, while providing 
the needed helping hand of targeted Federal funding.
  Mr. Speaker, I applaud this legislation and urge its passage.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman 
from Pennsylvania (Mr. Greenwood).
  Mr. GREENWOOD. Mr. Speaker, I thank the gentleman for yielding me the 
time. I also thank the gentleman from Florida (Mr. Bilirakis) for his 
leadership on this issue; as well as the minority chair of the 
Subcommittee on Health, the gentleman from Ohio (Mr. Brown); and the 
gentleman from Oklahoma (Mr. Coburn) and the gentleman from California 
(Mr. Waxman) for their collaboration. Anytime the gentleman from 
Oklahoma (Mr. Coburn) and the gentleman from California (Mr. Waxman) 
agree on something, it has got to be pretty close to right on.
  Mr. Speaker, I also want to thank Dorothy Mann from the Philadelphia 
area, a friend of mine, who helped negotiate one of the toughest 
aspects of this bill; and that has to do with the testing of newborns.

                              {time}  1115

  AIDS is clearly the worst epidemic in modern history. It is a 
tragedy, and it has struck down so many millions of people around the 
world. But of all of its victims, certainly the children, the newborns, 
are the most innocent and the ones who tug most heavily on our hearts.
  Four million women become pregnant in this country every year and 
7,000 of those 4 million women are HIV positive. Several hundred of the 
babies that they bear will be born HIV positive. Of those little 
children, fully half of them will die before they reach the age of 3; 
and by the age of 5, 90 percent of them have perished. So obviously 
anything that can be done to rescue these children from that horrible 
fate needs to be done. When a woman's HIV status is known during her 
pregnancy, in two-thirds of the cases the child can be prevented from 
becoming HIV positive with AZT treatments that are given during 
pregnancy, during labor

[[Page 21038]]

and several weeks afterwards, and Cesarian deliveries seem to very 
dramatically reduce the likelihood that the child will become HIV 
positive.
  What we have done in this bill to try to solve the logjam between 
those who do and those who do not believe in mandatory testing is we 
have put $30 million in here to go to those States that either have 
mandatory testing laws or do the most through a variety of programs to 
reduce the incidence of HIV being passed on to newborns. In New York, 
they have had a law on the books for 3 years; and they have been able 
to identify every child who could potentially become exposed to HIV 
through delivery. They have been able to prevent all of that. In 98 
percent of the cases, the mother has been able to get treatment. It has 
been wildly successful.
  This bill goes a long way to making sure that that track record will 
apply to every State in the Union.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the 
distinguished gentlewoman from the District of Columbia (Ms. Norton).
  Ms. NORTON. Mr. Speaker, I thank the gentleman for yielding time, and 
I thank him and his partners on the other side for their hard work in 
bringing this most important legislation to the floor.
  This week, the surgeon general was quoted as saying the epidemic has 
evolved to become increasingly an epidemic of people of color, of women 
and of the young. We have got to get rid of this epidemic, not let it 
evolve; and what we are doing here this morning will have a great deal 
to do with getting rid of it.
  The disease has moved to a devastating place, Mr. Speaker, to the 
poorest communities of color. Blacks are only 12 percent of the 
population. They are 50 percent of the new cases. Almost 80 percent of 
the new cases among women are black and Latino women. Half of the new 
cases occur in youth. We are now finding that we have to educate each 
new cohort perhaps every 4 or 5 years of gay men because the newest 
cohort needs to learn what those that have passed on in their 20s 
perhaps had to learn. We are dealing with a preventable disease. But 
when people get this disease, they need our care and they need our 
love.
  I am grateful to the gay and lesbian community of this country for 
the way in which they brought this issue to the forefront and now have 
helped us gather a bipartisan majority for the Ryan White bill. If we 
continue to do what we are doing today, we will show what we all know, 
that this is a disease, unlike heart disease and unlike cancer, that we 
can prevent. This is a disease that we can eliminate. I thank all of 
those who contributed to this moment on the House floor.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from California (Ms. Woolsey).
  Ms. WOOLSEY. Mr. Speaker, I rise in support of H.R. 4807, to 
reauthorize the Ryan White CARE Act. This reauthorization is very 
important to our Nation. It is particularly important to my 
constituents in the North Bay across the Golden Gate Bridge from San 
Francisco, and for all of the people in the entire San Francisco Bay 
region. This act provides crucial services for care and treatment for 
individuals with HIV and AIDS. To date, the CARE act has worked to 
dramatically improve the quality of life for people living with HIV and 
for their families. It has reduced the use of costly inpatient care as 
well as increased the access to high-quality care for underserved 
populations.
  By supporting this important legislation, Mr. Speaker, we are 
ensuring that the thousands of Americans living with HIV/AIDS can 
continue to receive the care and the treatment that is absolutely 
necessary for their comfort and for their survival.
  Mr. Speaker, we must spare no effort to fight the HIV/AIDS epidemic. 
By reauthorizing the Ryan White CARE Act, we are taking a positive step 
to successfully dealing with this very deadly disease. We must adopt 
the reauthorization.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman 
from Illinois (Mr. Davis).
  Mr. DAVIS of Illinois. Mr. Speaker, I rise today in strong support of 
the Ryan White CARE Act. And I rise because this legislation has meant 
so much to so many people throughout the country. The Ryan White CARE 
Act has meant so much that there are many people who feel as they tell 
their stories that without it they simply would not be alive.
  Mr. John Davis, the newly elected cochair of the city of Chicago's 
HIV services planning council, says if it was not for the Ryan White 
CARE Act, he would probably be dead. Mr. Davis, a former heroin addict, 
says that his road to recovery began with him seeking help at a Ryan 
White-funded housing program.
  Like Mr. Davis, thousands of others throughout the country have had 
the same experiences. Mr. Derrick Hicks from Chicago is able to live 
longer and get access to medications he may not otherwise be able to 
afford. And so, as we continue to see the impact and the effects of 
this program throughout the country, I simply rise to support it and 
say that without it many people would not have had the quality of life. 
I urge continued support.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself the balance of my 
time.
  I again ask for this House's support for the Ryan White CARE Act. It 
is a tremendous testament to bipartisanship support and the negotiating 
skills of the gentleman from Oklahoma (Mr. Coburn) and the gentleman 
from California (Mr. Waxman) and their staffs. I ask for unanimous 
support from this House for this very good legislation that will make a 
big difference in dealing with this dreadful disease.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I would like to echo the remarks that the gentleman from 
Ohio (Mr. Brown) just made. I had planned to do so, also. It is just 
amazing what can be done from a bipartisan standpoint if people really 
are sincere and really care about solving an issue rather than being 
concerned about demagoguery, if you will, or with some of the things 
that take place. The fact that the gentleman from Oklahoma (Mr. Coburn) 
and the gentleman from California (Mr. Waxman) worked so well on this 
and were able to get it done speaks well for both of them and for the 
Congress when it works in that way.
  Mr. Speaker, I yield the balance of my time to the gentleman from 
Oklahoma (Mr. Coburn).
  Mr. COBURN. Mr. Speaker, I want to first recognize Paul Kim for his 
great help on the gentleman from California's (Mr. Waxman) staff; Marc 
Wheat, the majority counsel on our side; and Roland Foster, a staff 
member of mine who has been with me for 6 years since I have been in 
Congress.
  This is a good bill. There is no question about it. But this bill is 
not enough. Forty thousand people this year are going to become 
infected with HIV. It does not have to happen. We should be asking the 
CDC, we should be asking the FDA, we should be asking the NIH why they 
would not use proven public health policy to stop this epidemic.
  The best way to treat people with HIV today is to make sure no one 
else ever encounters this disease. This is a preventable disease. 
Although we have gone a long way from where we were in putting in the 
public health policies that should be there, they are still not there. 
The reason they are not there is not a good enough reason. We have 
proven in the medical community that we can secure and hold 
confidentially anybody's HIV status. We have been perfect on that 
score. And to use that as a reason now not to move to the next step, I 
challenge my friend, the gentleman from Ohio (Mr. Brown), and I 
challenge the gentleman from Florida (Mr. Bilirakis) that in the next 
Congress and the Congress that follows that you will look very closely 
at what public health policies could do to prevent that 40,000 people 
from never getting the disease.
  We know. We handled the tuberculosis epidemic in this country. We 
stopped it dead with a whole lot less effort. This is something we can 
accomplish. We have proven with this bill

[[Page 21039]]

that if we will work and talk together and understand each other's 
motivations, problems and concerns, that through discussion and 
bipartisan approach that we can solve those problems. The 40,000 people 
out there this year that are going to get infected deserve for us to do 
that. As I leave this body, what I would ask is the Members of this 
body, look at real problems, not the political things that surround it; 
and if we will do that, 40,000 people will not be infected.
  I thank the gentleman from Ohio (Mr. Brown) for his work. The 
gentleman from California (Mr. Waxman) has been great to work with. I 
appreciate the ability that we can express ourselves through true 
concern and solve a problem. I would hope that every Member of this 
body will support this bill.
  I also would leave one message with my colleagues. There are diseases 
much greater than this disease that face our country today. Diabetes 
will take tons more people than HIV. Breast cancer will take tons more 
people than HIV. And yet we are not anywhere close to the same dollar 
commitment in those diseases as we are HIV. Because we have had a 
misguided policy on treatment of HIV, we are spending dollars that 
could be spent in other areas. I would beg the body to look at that.
  Mr. BLILEY. Mr. Speaker, I rise in support of this amendment to S. 
2311, the Ryan White CARE Act Amendments of 2000. I congratulate Dr. 
Coburn and Mr. Waxman for their excellent work on this legislation, and 
salute my colleagues on the Commerce Committee who, through workmanlike 
diligence and thoughtfulness, have dramatically improved the way the 
Ryan White CARE Act will work now and into the future.
  Before the August recess, the House acted on a bi-partisan basis to 
authorize the Ryan White CARE Act. This very important Act provides 
funding to address the needs of those living with HIV and AIDS. Because 
of the importance of this legislation, I made it a priority to resolve 
the differences between the House-passed bill and the bill passed in 
the other body. As the newsletter AIDS Policy and Law reported, ``The 
negotiators decided to use the House bill, sponsored by Representatives 
Tom Coburn, and Henry Waxman, as the vehicle for renewing the statute 
through fiscal year 2005. The Senate bill was scrapped, with only a few 
of its provisions being folded into the Coburn-Waxman H.R. 4807.'' The 
negotiating team, which included my staff and those from the offices of 
Representatives Bilirakis, Waxman, Dingell, Brown, Senators Jeffords, 
Frist, and Kennedy, achieved a good compromise. I have an additional 
statement that explains our work in greater detail that I will enter 
into the record for myself and the negotiators just mentioned. I 
commend the passage of this important legislation to my colleagues.
  As many of my colleagues may recall, President Reagan's HIV 
Commission concluded that ``early diagnosis of HIV infection is 
essential'' because HIV infection ``can be treated more effectively 
when detected early.'' The medical breakthroughs which have been 
developed in the twelve years since the inception of this report make 
early intervention even more important than ever, and I am pleased that 
this legislation recognizes that partner counseling and referral 
activities are the most effective early intervention to identify those 
who do not know their status in the early stages of the disease.
  Very importantly, this bill begins the process of basing Ryan White 
CARE Act funding on HIV cases, not AIDS cases. Such a change will 
ensure that Ryan White CARE Act dollars go where the disease is growing 
quickly, not to the areas with the highest historical incidences of 
AIDS. It also provides incentives for States to implement 
recommendations belatedly issued by the Centers for Disease Control and 
Prevention to move to HIV reporting systems, one of the most important 
public health initiatives in America at the close of the 20th Century.
  It is a national tragedy that public health officials in the States 
were unable or unwilling to move to HIV reporting years ago. The 
identification of HIV reporting as a serious public health concern was 
identified by the first Presidential Commission on HIV, appointed by 
President Ronald Reagan, which stated that ``The term `AIDS' is 
obsolete. `HIV infection' more correctly defines the problem. The 
medical, public health, political, and community leadership must focus 
on the full course of HIV infection rather than concentrating on later 
stages of the disease . . . Continual focus on AIDS rather than the 
entire spectrum of HIV disease has left our nation unable to deal 
adequately with the epidemic. Federal and state data collection efforts 
must now be focused on early HIV reports, while still collecting data 
on symptomatic disease.''
  It is imperative that the Ryan White CARE Act be reauthorized to 
provide the incentives to move public health in the right direction so 
that the HIV/AIDS epidemic can be tracked more accurately, and 
appropriate funding and information about this disease be better 
directed.
  As many of my colleagues will recall, when we last brought the Ryan 
White bill to the floor in July, the most contentious issue was the 
bill's ``hold harmless'' provision. The bill which originally passed 
the House would have trimmed the substantial overpayments received by 
San Francisco so that it would eventually receive no more per capita 
than any other metropolitan area.
  After lengthy negotiations, it has been agreed that the hold harmless 
reduction will be a compromise between the original House and Senate 
provisions, which will now be a reduction of 15% over the next five 
years to slow the transition to equitable funding.
  I ask my colleagues to join with me in support of this important 
legislation that moves us in the right direction as we enter the 21st 
Century.

                 Ryan White CARE Act Amendments of 2000


                   Managers' Statement of Explanation

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


                             I. Background

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


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

       Title I. Emergency Relief for Areas with Substantial Need 
     for Services: Provides emergency relief grants to 51 eligible 
     metropolitan areas (EMAs) disproportionately affected by the 
     HIV epidemic to provide primary care and HIV-related support 
     services to people with HIV and AIDS. Half of the Title I 
     funding is distributed by formula; the remaining half is 
     distributed competitively, based on the demonstration of 
     severity of need and other criteria.
       Planning Council membership has been revised to include HIV 
     prevention providers, homeless and housing service providers, 
     and representatives of prisoners. A third of Planning Council 
     members must be individuals with HIV/AIDS receiving care who 
     are not officers, employees or consultants to Title I 
     grantees.
       Title II. CARE Grant Program: Provides formula grants to 
     States, District of Columbia, Puerto Rico and U.S. 
     territories to improve the quality of health care and support 
     services for individuals with HIV disease and their families. 
     The funds are used: to provide medical support services, to 
     continue health insurance payments, to provide home care

[[Page 21040]]

     services, and, through the AIDS Drug Assistance Programs 
     (ADAP), to provide medications necessary for the care of 
     these individuals. Supplemental formula grants are awarded to 
     States with ``emerging communities'' which are ineligible for 
     grants under Title I.
       Subtitle B provides discretionary grants to States for the 
     reduction of perinatal transmission of HIV, and for HIV 
     counseling, testing, and outreach to pregnant women. Subtitle 
     C provides discretionary grants to States for partner 
     notification, counseling and referral services.
       Title III. Early Intervention Services: Funds nonprofit 
     entities providing primary care and outpatient early 
     intervention services, including case management, counseling, 
     testing, referrals, and clinical and diagnostic services to 
     individuals diagnosed with HIV. The unfunded program of State 
     formula grants in current law is repeated.
       Title IV. Other Programs and Activities: Provides grants 
     for comprehensive services to children, youth, and women 
     living with HIV and their families. Such services include 
     primary, specialty and psychosocial care, as well as HIV 
     outreach and prevention activities. Grantees must demonstrate 
     linkages to, and provide clients with access and education 
     on, HIV/AIDS clinical research.
       Title IV newly authorizes the AIDS Education and Training 
     Centers (AETC), a network of 14 regional centers conducting 
     clinical HIV education and training of health providers, to 
     provide prenatal and gynecological care. The HIV/AIDS Dental 
     Reimbursement program, covering uncompensated oral health 
     care for patients with HIV/AIDS, is expanded to provide 
     community-based care in underserved areas.
       Under Subtitle B, general provisions authorize CDC data 
     collection for CARE Act planning and evaluation, enhanced 
     interagency coordination of HIV services and prevention, 
     development of a plan for the case management of prisoners 
     with HIV, and administrative provisions related to audits, 
     and a plan for simplification of CARE Act grant 
     disbursements.
       Title V. General Provisions: Authorizes Institute of 
     Medicine (IOM) studies and expansion of Federal support for 
     the development of rapid HIV tests. Makes necessary and 
     technical corrections in Title XXVI of the Public Health 
     Service Act.


                  III. Summary of Selected Provisions

     Use of HIV Case Data in Formula Grants
       In order to target funding more accurately to reflect the 
     HIV/AIDS epidemic, the Managers have revised and updated the 
     Title I and Title II formulas to make use of data on cases of 
     HIV infection as well as of AIDS. In Fiscal Year (FY) 2005, 
     HIV and AIDS case data is intended to be used in the Title I 
     and Title II formulas.
       However, no later than July 1, 2004, the Secretary shall 
     determine whether HIV case data, as reported to and confirmed 
     by the Director of CDC, is sufficiently accurate and reliable 
     from all eligible areas and States for such use in the 
     formula. The Secretary shall also consider the findings of 
     the Institute of Medicine (IOM) study undertaken under 
     section 501(b).
       If the Secretary makes an adverse determination regarding 
     HIV case data, the Managers intend that only AIDS case data 
     will be used in FY2005 formula allocations. The Secretary 
     shall also provide grants and technical assistance to States 
     and eligible areas to ensure that accurate and reliable HIV 
     case data is available no later than FY2007.
     Planning and priority setting
       The Managers have strengthened the capacity of EMAs and 
     States to plan, prioritize, and allocate funds, based on the 
     size and demographic characteristics of the populations with 
     HIV disease in the eligible area. Planning, priority setting, 
     and funding allocation processes must take into account the 
     demographics of the local HIV/AIDS epidemic, existing 
     disparities in access HIV-related health care, and resulting 
     adverse health outcomes. It is the intent of the Managers 
     that CARE Act dollars more closely follow the shifting trends 
     in the local epidemic and address disparities in health care 
     access and health outcomes as well as the need for capacity 
     development within the local and State HIV health care 
     infrastructures.
       The Managers intend both EMAs and States to develop 
     strategies to bring into and retain in care those individuals 
     who are aware of their HIV status but are not receiving 
     services. As part of this process, the Managers place the 
     highest priority on EMAs and States focusing on eliminating 
     disparities in access and services among affected 
     subpopulations and historically underserved communities. The 
     Managers recognize, however, that the relative availability 
     or lack of HIV prevalence data will be reflected in the 
     scope, goals, timetable and allocation of funds for 
     implementation of the strategy.
       The Managers also expect the Secretary to collaborate with 
     Title I and II grant recipients and providers to develop 
     epidemiologic measures and tools for use in identifying 
     persons with HIV infection who know their HIV status but are 
     not in care. The Managers recognize the difficulty the EMAs 
     and States may experience in identifying persons with HIV 
     infection who are not in care and who may be unknown to any 
     health or social support system. The efforts on the part of 
     EMAs and States to accomplish these important tasks, however, 
     should not be delayed until this process is complete. 
     Instead, the Managers expect Title I and II grant recipients 
     to establish and implement strategies responsive to these 
     urgent needs before the development of nationally uniform 
     measures, to the extent that is practicable and to which 
     necessary prevalence data is reasonably available.
       The Managers have also authorized outreach activities in 
     Title I and II intended to identify individuals with HIV 
     disease know their HIV status but are not receiving services. 
     The intent is to ensure that EMAs and States understand that 
     outreach activities which are consistent with early 
     intervention services and necessary to implement the 
     aforementioned strategies, are appropriate uses of Title I 
     and II funds. It is not the Managers' intent that such 
     activities supplant or otherwise duplicate activities such as 
     case finding, surveillance and social marketing campaigns 
     currently funded and administered by the Centers for Disease 
     Control and Prevention (CDC). Instead, this authorization 
     reflects the urgency of increasing the coordination between 
     HIV prevention and HIV care and treatment services in all 
     CARE Act programs.
     Hold harmless provisions
       The hold-harmless provisions are intended to minimize loss 
     and stabilize systems of care in EMAs and States, while 
     assuring that funds are allocated in Title I and II to 
     reflect the current distribution and epidemiology of the 
     epidemic.
       The Managers have revised the Title I hold harmless to 
     limit a potential loss in an EMA's formula allocation to a 
     small percentage of the amount allocated to the eligible are 
     in the previous (or base) year. An EMA may lose no more than 
     15 percent of its base formula allocation over five years, 
     beginning with 2 percent in the first year and increasing in 
     subsequent years. If the Secretary determines that data on 
     HIV prevalence are accurate and reliable for use in 
     determining Title I formula grants for Fiscal Year 2005, all 
     EMAs may lose no more than 2 percent of their Fiscal Year 
     2004 formula allocation in that year.
       Should an EMA experience a decline in its Title I formula 
     allocation followed by an intervening year in which there is 
     not decline, its losses in any subsequent, nonconsecutive 
     year of decline would once again be limited to 2 percent 
     (ie., the intervening year `resets the clock').
       The Managers intend to ensure that essential primary care 
     and support services are not compromised by short-term 
     fluctuations in AIDS case counts. Because no new EMA is 
     expected by HRSA's Bureau of HIV/AIDS to require that hold 
     harmless in the first three or four years of this 
     reauthorization period, the Managers expect this policy will 
     shield all eligible areas, save those currently requiring the 
     hold harmless, from any meaningful loss in Title I formula 
     funding.
       Under the Title II hold harmless, a State or territory may 
     lose no more than 1 percent from the previous fiscal year 
     amounts, or 5 percent over the 5-year reauthorization period. 
     This protection extends to base Title II funding (which 
     excludes funds for AIDS Drug Assistance Programs (ADAP)), as 
     well as to overall Title II funding.
     Women, child, infants, and youth set-aside
       The Managers are aware of the rising incidence of HIV among 
     youth and women, particularly women of color, and recognize 
     the challenges in assuring them access to primary care and 
     support services for HIV and AIDS. The Managers intend to 
     increase the availability of primary care and health-related 
     supportive services under Title I and Title II for each of 
     the four groups described in the set-aside. Youth are added 
     as a new category within this set-aside. The Managers intend 
     the term ``youth'' to include persons between the ages of 13 
     and 24, and ``children'' to include those under the age of 
     13, including infants.
       The Managers clarify that the set-asides for women, 
     infants, children, and youth with HIV disease be allocated 
     proportionally, based on the percentage of the local HIV-
     infected population that each group represents. The Managers 
     intend that the States and EMAs continue to make every effort 
     to reach and serve women, infants, children, and youth living 
     with HIV/AIDS by allocating sufficient resources under Titles 
     I and II to serve each of these populations. The Managers 
     also recognize that these priority populations often comprise 
     a greater proportion of HIV cases rather than AIDS cases in a 
     local area. This distinction should be taken into account 
     where necessary prevalence data is reasonably available.
       The Mangers are aware that these populations may also have 
     access to HIV care through other parts of Title XXVI, 
     Medicaid, State Children's Health Insurance Program (SCHIP), 
     and other Federal and State programs. Therefore, the 
     requirements to proportionally allocate funds provided under 
     Title II to each of these populations may be waived for 
     States which reasonably demonstrate that these populations 
     are receiving adequate care.

[[Page 21041]]


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

[[Page 21042]]

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

[[Page 21043]]

     and begin implementation of the strategy to improve the 
     quality of care received by people living with HIV/AIDS.
     Data collection through CDC
       The Managers believe that an additional authorization for 
     HIV surveillance activities under the CDC will serve to 
     advance the purposes of the CARE Act. To better identify and 
     bring individuals with HIV/AIDS into care, States and cities 
     may use such funding to enhance their HIV/AIDS reporting 
     systems and expand case finding, surveillance, social 
     marketing campaigns, and other prevention service programs. 
     Notwithstanding its strong interest in improving the 
     coordination between HIV prevention and HIV care and 
     treatment services, the Managers intend that this enhanced 
     funding for CDC and its grantees ensure that CARE Act 
     programs and funds not duplicate or be diverted to activities 
     currently funded and administered by the CDC.
     Coordination
       This Act requires the Secretary to submit a plan to 
     Congress concerning the coordination of Health Resources and 
     Services Administration (HRSA), Centers for Disease Control 
     and Prevention (CDC), Substance Abuse and Mental Health 
     Services Administration (SAMHSA), and Health Care Financing 
     Administration (HCFA), to enhance the continuity of care and 
     prevention services for individuals with HIV disease or those 
     at risk of such disease. The Managers believe that much 
     greater effort is required to ensure that the provision of 
     HIV prevention and care services becomes as seamless as 
     possible, and that coordination be pursued at the Federal 
     level, in the States and local communities to eliminate any 
     administrative barriers to the efficient provision of high 
     quality services to individuals with HIV disease.
       A second plan for submission to Congress focuses on the 
     medical case management and provision of support services to 
     persons with HIV released from Federal or State prisons.
     Administrative simplification
       The Managers intend for the Secretary of HHS to explore 
     opportunities to reduce the administrative requirements of 
     Ryan CARE Act grantees through simplifying and streamlining 
     the administrative processes required of grantees and 
     providers under Titles I and II. In consultation with 
     grantees and service providers of both parts, the Secretary 
     is directed to (1) develop a plan for coordinating the 
     disbursement of appropriations for grants under Title I with 
     the disbursement of appropriations for grants under Title II, 
     (2) explore the impact of biennial application for Titles I 
     and II on the efficiency of administration and the 
     administrative burden imposed on grantees and providers under 
     Titles I and II, and (3) develop a plan for simplifying the 
     application process for grants under Titles I and II. It is 
     the intent of the Managers to improve the ability of grantees 
     to comply with administrative requirements while decreasing 
     the amount of staff time and resources spent on 
     administrative requirements.
     Program and service studies
       The Managers request that the Secretary, through the IOM, 
     examine changing trends in the HIV/AIDS epidemic and the 
     financing and delivery of primary care and support services 
     for low-income, uninsured, and underinsured and individuals 
     with HIV disease. The Secretary is directed to make 
     recommendation regarding the most effective use of scarce 
     Federal resources. The purpose of the study is to examine key 
     factors associated with the effective and efficient financing 
     and delivery of HIV services (including the quality of 
     services, health outcomes, and cost-effectiveness). The 
     Managers expect that the study would include examination of 
     CARE Act financing of services in relation to existing public 
     sector financing and private health coverage; general 
     demographics and comorbidities of individuals with HIV 
     disease; regional variations in the financing and costs of 
     HIV service delivery; the availability and utility of health 
     outcomes measures and data for measuring quality of Ryan 
     White funded service; and available epidemiological tools and 
     data sets necessary for local and national resource planning 
     and allocation decisions, including an assessment of 
     implementation of HIV infection reporting, as it impacts 
     these factors.
       The Managers also require an IOM study focuses on 
     determining the number of newborns with HIV, where the HIV 
     status of the mother is unknown; perinatal HIV transmission 
     reduction efforts in States; and barriers to routine HIV 
     testing of pregnant women and newborns when the mothers' HIV 
     status is unknown. The study is intended to provide States 
     with recommendations on improving perinatal prevention 
     services and reducing the number of pediatric HIV/AIDS cases 
     resulting from perinatal transmission.
     Development of Rapid HIV Test
       The Managers encourage the Secretary to expedite the 
     availability of rapid HIV tests which are safe, effective, 
     reliable and affordable. The Managers intend that the 
     National Institutes of Health expand research which may lead 
     to such tests. The Managers also intend that the Director of 
     CDC should take primary responsibility, in conjunction with 
     the Commissioner of Food and Drugs, for a report to Congress 
     on the public health need and recommendations for the 
     expedited review of rapid HIV tests. The Managers believe 
     that the Food and Drug Administration should account for the 
     particular applications and urgent need for rapid HIV tests, 
     as articulated by public health experts and the CDC, when 
     determining the specific requirements to which such tests 
     will be held prior to marketing.
     Department of Veterans Affairs
       The Managers note that the U.S. Department of Veterans 
     Affairs is the largest single direct provider of HIV care and 
     services in the country. Over 18,000 veterans received HIV 
     care at VA facilities in 1999. Veterans with HIV infection 
     are eligible to participate in Ryan White Title I and Title 
     II programs when they meet eligibility requirements set by 
     EMAs and States, whose plans for the delivery of services 
     must account for the availability of VA services. VA 
     facilities are eligible providers of HIV health and support 
     services where appropriate. The Managers expect that HRSA's 
     Bureau of HIV/AIDS shall encourage Ryan White grantees to 
     develop collaborations between providers and VA facilities to 
     optimize coordination and access to care to all persons with 
     HIV/AIDS.
     International HIV/AIDS Initiatives
       The Managers note that the CARE Act provides a model of 
     service delivery and Federal partnerships with States, cities 
     and community-based organizations which should prove valuable 
     in global efforts to combat the HIV/AIDS epidemic. The 
     Managers strongly encourage the Secretary, the Bureau of HIV/
     AIDS at HRSA, and the CDC to provide technical assistance 
     available to other countries which has already proven 
     invaluable in helping to limit the suffering caused by HIV/
     AIDS. It is the Managers' hope that the hard-earned knowledge 
     and experience gained in this country can benefit people with 
     HIV/AIDS overseas.
  Ms. ESHOO. Mr. Speaker, I strongly support S. 2311, the Ryan White 
Care Act Amendments of 2000. Enactment of this legislation will truly 
make a difference in people's lives.
  The Ryan White CARE Act, without question, was the most important 
legislation Congress has ever enacted for people living with HIV and 
AIDS. Every year, CARE Act funds provide lifesaving medical and social 
services for tens of thousands of uninsured and underinsured Americans 
battling these devastating diseases. AIDS medications, viral load 
testing, treatment education, and case management are just a few of the 
essential support services provided by federal CARE Act dollars.
  Each of the programs created under the CARE Act services a specific 
need yet, combined, they make up the health care and social service 
safety net of last resort. Since it's creation in 1990, reliability and 
stability have been the two cornerstones of the Ryan White law. When we 
passed the House version of the reauthorization in July, I spoke out 
against a provision that ran directly contrary to this safety net 
principle. A 25 percent reduction in the ``hold harmless'' that was 
part of the original House bill would have caused a rapid 
destabilization of systems of care in the Bay Area and potentially 
around the country. I fought that provision and I'm so pleased that the 
bill before us today includes a more equitable formula that reflects 
the changing face of the disease without gutting funding to any one 
Eligible Metropolitan Area (EMA).
  More people than ever are living with HIV/AIDS and the CARE Act must 
keep pace with the increasing demands. When the CARE Act was passed in 
1990, there were 155,619 AIDS cases. In 1996, there were 481,234 cases. 
Today, America has 733,374 recorded cases of HIV/AIDS. AIDS is the 
leading cause of death among African Americans between the ages of 25-
44 and the second leading cause of death among Latinos in the same age 
group. HIV/AIDS are still very much with us and we must ensure that all 
those infected get the medical and social services they need to live 
longer, more productive lives.
  And that's exactly what's been happening. Access to new medications 
and treatments, such as combination antiretroviral therapies, has 
significantly lengthened the life expectancy of people with HIV/AIDS. 
People with AIDS are living longer and those with HIV aren't 
progressing as quickly to full-blown AIDS. Thankfully, it's no longer 
necessarily a death sentence. This, in turn, underscores the increasing 
need for services. As people live longer, their dependence on CARE Act 
programs greatly increases; hence, the importance of reauthorizing the 
Ryan White Act.
  So, I thank my colleagues, Senators Kennedy and Jeffords and 
Representatives Brown, Waxman and Coburn, and their staffs, for their 
work on S. 2311 and for their dedication to reauthorizing the CARE Act 
this year. It's a good bill that will do wonderful things for people 
across this country. I urge my colleagues' enthusiastic support.
  Mrs. CHRISTENSEN. Mr. Speaker, I rise in support of S. 2311, Ryan 
White Care Act. I

[[Page 21044]]

am very thankful that were are acting on this very important bill, 
before we run out of time, to ensure that individuals living with HIV 
and AIDS will receive the health care and related supported services 
that they need. While, S. 2311 is not perfect, it does provide the 
necessary authorizations for appropriations and programmatic changes to 
ensure that the CARE Act is responsive to the evolving demographic 
trends in the HIV/AIDS epidemic and advances in treatment care.
  I am also pleased that one of my major concerns with the House bill 
to reauthorize the CARE Act, HR 4807, involving incentives for HIV 
testing of pregnant women and infants, is not in the bill before us 
today. I oppose mandatory testing of any sub-population, and I strongly 
believe, that this body must give full consideration to the IOM study 
as it relates to this issue.
  I am encouraged that S. 2311 also changes city and state funding 
formulas to encompass all who are infected with HIV and not just 
provide resources for individuals who have progressed to AIDS. This 
change responds to the changing nature of the epidemic and the newer 
treatment protocols, which begin medication earlier.
  It allows for treatment programs to begin and expand critical 
prevention efforts. This bill also more effectively represents the 
burden of the disease and the need for care. In addition, this measure 
makes a concerted effort to support the fact, that the funding 
``needs'' to follow the trends of the disease (which are 
disproportionately and increasingly affecting people of color).
  It also encourages reporting of HIV infections by states (many do not 
now report). Such adherence to reporting, will improve our ability to 
be more progressive and get in front of this epidemic by increasing 
prevention and outreach efforts.
  Another major area that is of critical concern to the Congressional 
Black Caucus and the communities we represent (which are primarily 
people of color), is the community planning councils, their 
composition, effectiveness and operations. This process has not worked 
well for many disenfranchised communities under existing authorization. 
Community input is essential to effective service provision at the 
local level. Therefore, we are encouraged by the requirement in the 
bill that planning, priority setting and funding allocation processes 
must take into account the demographics of the local HIV/AIDs epidemic, 
existing disparities in access to HIV--related care.
  In this regard, I also encourage that African Americans and other 
people of color be appropriately represented in the clinical trials and 
investigator pools based on the trends of the disease.
  I would be remiss if, I did not say that based on the past 
epidemiology, and several studies and forecasts, FY 2001 funding for 
the all important ADAP program falls around $100 million dollars short 
of what will be needed to provide treatment to those infected.
  This dramatic shortfall represents the many low income, uninsured and 
under-insured Americans who will not receive appropriate care, and 
further puts this country far from where we need to be in fighting this 
epidemic and saving the lives of those infected and most at-risk.
  We in the Caucus and our partners in the Congress and the communities 
we serve, remain vigilant in the nation's fight against the HIV/AIDS 
crisis. The Ryan White Care Act is the lifeline to countless Americans 
infected with HIV and AIDS. It is our best ammunition in the war 
against this devastating disease that is plaguing our nation. Clearly, 
we in the U.S. Congress must not wait until this disease begins to 
mirror the pandemic in Africa. An enhanced, strengthened, responsive 
and adequately funded Ryan White Care Act is absolutely essential to 
intensified care, treatment, prevention and outreach.
  I urge my colleagues to support this much needed and important bill.
  Mr. HORN. Mr. Speaker, I rise to express my strong support for the 
Ryan White Care Act Amendments of 2000. Over the past ten years, the 
Ryan White Care Act has represented a unique partnership between 
federal, state and local officials in delivering prevention and 
treatment services to those affected by this disease.
  The good news is the Care Act has expanded access to high quality 
health care, which is more important than ever in accommodating the 
growing numbers of people living with HIV and AIDS. As a result, it is 
important that federal funds distributed to states and cities most 
impacted by the disease, such as Long Beach, are needs-based. These 
amendments are an important step towards the equitable distribution of 
federal resources for people living with HIV and AIDS.
  These amendments will also allow heavily impacted areas such as Long 
Beach to use their funds now for early intervention services, so they 
can locate people living with HIV and get them into care. With HIV 
infecting more than 40,000 Americans each year--at an average treatment 
cost of $200,000 per individual--prevention strategies remain the most 
cost effective use of public health dollars.
  Today, there are nearly 3800 AIDS cases in Long Beach alone. The Ryan 
White Care Act Amendments will go a long way in improving access to 
health care for these Americans, in addition to slowing the rate of new 
infections, especially in communities of color. I am pleased to lend my 
support to this important bill and encourage all my colleagues to do 
the same.
  Ms. SCHAKOWSKY. Mr. Speaker, I rise in strong support of S. 2311, the 
Ryan White CARE Act Amendments of 2000. This bill will make a real and 
profound difference in the lives of persons living with HIV/AIDS by 
providing resources for essential primary care health and support 
services.
  The Ryan White CARE Act was first passed in 1990. Since that time, 
the face of the HIV/AIDS epidemic has changed but the need for the Ryan 
White CARE Act has not. Today, it is more important than ever that we 
act to expand access to health and social services.
  Since coming to Congress, I have had the opportunity to visit with 
many of my constituents who have benefited from the Ryan White CARE 
Act. Person after person has told me that, without this Act, they would 
be unable to afford the treatments needed so that they can remain 
healthy and productive members of their community. As members of 
Congress, we have supported increased medical research efforts that 
have led to promising treatment advances for people living with HIV/
AIDS. The Ryan White CARE Act helps to ensure that people can actually 
obtain that treatment. It helps them find affordable housing and 
employment opportunities. It is a program that works and deserves our 
continued support.
  In my district, as in other parts of the country, the HIV/AIDS 
epidemic continues to threaten individuals, families and communities. I 
want to recognize the outstanding efforts of many in combating this 
crisis, both here and in the Chicagoland area. In particular, I want to 
thank Representative Henry Waxman for his outstanding leadership. As 
the original sponsor of the Ryan White CARE Act, he has worked to make 
sure that it remains effective and is flexible enough to address the 
changing nature of this epidemic.
  I also want to point out the enormous efforts of the City of Chicago 
and, specifically, the Department of Public Health. Mayor Richard Daley 
has developed a strategic plan to provide a comprehensive response to 
this epidemic, working with providers, prevention experts, community 
representatives and, most importantly, people living with HIV/AIDS. 
Recognizing that today there are more people living with an AIDS 
diagnosis in Chicago than at any other time, the City is working to 
prevent new infections, provide access to drug therapies and other 
treatments, improve other services such as affordable housing, and 
ensure that resources are used as effectively as possible to reflect 
changing needs. Reauthorization of the Ryan White CARE Act with 
adequate funding is essential to meeting those goals. I also want to 
point out the important work of the AIDS Foundation of Chicago and 
Chicago Health Outreach in this effort.
  Finally, we must recognize that women and people of color represent a 
disproportionate number of new AIDS cases. Many of those impacted are 
uninsured, have no regular access to primary care services, and are 
unable to afford anti-HIV therapies. I am working with the Evanston 
Health Department and the faith community in my district to reach out 
to these communities and provide information on prevention and 
available services. Therefore, I am pleased that S. 2311 makes 
improvements in the Ryan White CARE Act to help eliminate disparities 
in access to services and outreach to underserved communities.
  I urge my colleagues to support the Ryan White CARE Act 
reauthorization and to follow up on this action by providing full 
appropriation levels for its essential services.
  Mr. TOWNS. Mr. Speaker, I rise in support of S. 2311, which 
reauthorizes ``The Ryan White CARE Act''.
  HIV infection and AIDS in Brooklyn remains a difficult battle. The 
Centers for Disease Control found that minorities now account for more 
than half of all new cases in the United States. AIDS now kills more 
black men that gunshot wounds. And, it is also the leading cause of 
death for Hispanic men ages 25 to 44. This disease has equally affected 
women and children in minority communities. Eighty-four percent of the 
AIDS cases involving children, age 12 and under, can be found in the 
black community. And, AIDS has now become the second leading cause of 
death for black women

[[Page 21045]]

and the third leading cause for Hispanic women.
  I have witnessed these statistics first hand. My congressional 
district has the highest incidence of new AIDS cases of any area in New 
York City. Brownsville has more people living with AIDS than 12 States. 
It has the second highest number of blacks living with AIDS in all of 
New York City. In addition, East New York and the Ft. Greene 
neighborhoods have large populations of women living with AIDS.
  Yet, we have not witnessed either the research or treatment and care 
dollars following the change in disease patterns. While Brooklyn is the 
epicenter of this disease in New York City, the majority of the Ryan 
White and NIH funds are still going to organizations which do not serve 
this constituency. In response to language which I worked to include in 
this legislation, hopefully, this trend will be halted. And, minority 
communities, like Brownsville, Ft. Greene and East New York, will 
receive their fair share of treatment dollars.
  I am very pleased that with today's floor consideration of the Ryan 
White CARE Act we will be able to continue to bring resources to those 
communities and people who are impacted by AIDS and HIV infection. And, 
I would urge my colleagues to vote for its passage.
  Mr. RUSH. Mr. Speaker, I would like to take this opportunity to 
commend Mr. Waxman and Mr. Coburn for their hard work on the 
reauthorization of the Ryan White CARE Act of 2000. The Ryan White CARE 
Act provides grants to eligible metropolitan areas that are 
disproportionately affected by the HIV epidemic; it provides grants to 
the states and territories to provide health care support services to 
people living with HIV/AIDS; it provides programs which support 
outpatient HIV early intervention services for low-income, medically 
underserved people in existing primary care systems; and it provides 
services for children, youth, women and families in a comprehensive, 
community-based, family-centered system of care.
  I am glad to see that the Ryan White CARE Act Amendment of 2000 which 
I am a cosponsor, addresses the needs of people living with HIV and 
AIDS. As we witness the dramatic changes taking place in other world 
nations now confronting exploding epidemics of HIV/AIDS, we recognize 
that the course of the HIV epidemic is also changing.
  Racial and ethnic minorities are increasingly becoming affected with 
this dreadful disease at an alarming rate. With adequate funding, the 
Ryan White CARE Act can continue providing medical services to people 
living with HIV/AIDS, which can help to improve their quality of life.
  Mr. Speaker, I would like to thank all of my colleagues who have come 
to the floor today to speak on the importance of reauthorizing the Ryan 
White CARE Act of 2000. I am pleased that this important piece of 
legislation passed the House and Senate and that the leadership 
considered this important reauthorization before the end of this 
congressional session.
  Mr. NADLER. Mr. Speaker, I rise in strong support of S. 2311, the 
Ryan White CARE Act Amendments of 2000. This is important bipartisan 
legislation and I am pleased to see it on the floor today on its way to 
swift passage. I want to thank the authors for hearing the concerns 
that were raised when the bill first came through the House, and I 
believe we have reached a good compromise.
  Mr. Speaker, the AIDS epidemic has ravaged our communities throughout 
the country. The statistics are devastating. Through December 1998, 
nearly 700,000 people had been diagnosed with AIDS. Over 400,000 of 
these people have died. The Centers for Disease Control and Prevention 
estimates that over 40,000 people become infected with HIV each year 
with an estimated 600,000 to 900,000 people living with HIV today.
  As a nation, we could have thrown up our hands and given up in the 
face of this terrible tragedy. But in 1990, in one of the great 
legislative achievements of the last decade, Congress took action to 
address this emergency and passed the Ryan White CARE Act. The CARE Act 
is a comprehensive program providing treatment and support services to 
those living with HIV and AIDS. It has brought hope and a little 
humanity to this terrifying crisis.
  The CARE Act is a model of how we can accomplish great things in this 
chamber. By working together, we have produced a program that provides 
vital health services to people across the country while targeting 
communities most in need. It is an efficient program that has been an 
unqualified success.
  We haven't found a cure for AIDS yet, but scientists are making 
promising discoveries every day, bringing hope that we may one day rid 
ourselves of this disease once and for all. Until then, there is the 
CARE Act, reaching out to people who are suffering with HIV and AIDS 
today and who need our help to lead healthy and productive lives. This 
is a humane program that deserves our strong support.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise in strong support for a 
cause that must be sustained and implemented in America today. S. 2311, 
``Ryan White CARE Act of 2000'' will reauthorize the funds for programs 
while also changing the formula for current distribution of Ryan White 
programs. Mr. Speaker, I support this measure that builds on continuing 
efforts to safeguard the lives of those suffering the most. 
Accordingly, I applaud the efforts to bring this important legislation 
to the floor today before the end of the 106th Congress.
  Thanks to the persuasive skills by those working on behalf of those 
afflicted with the HIV/AIDS epidemic, the funding formula within this 
legislation will actually ensure that minorities are properly covered. 
The legislation maintains the integrity of the multistructure of the 
CARE Act, allowing funds to be targeted to the areas hardest hit by the 
HIV and AIDS epidemic. In addition, I am pleased that the legislation 
maintains and, in fact, strengthens the decision-making authority of 
local planning councils and allows resources to be used to locate and 
bring more individuals into the health care system. Further, I am also 
delighted to learn that the bill will provide more individuals with 
early intervention services, such as counseling and testing.
  This bill will give states the option to readily extend Medicaid 
coverage to people living with HIV. If adopted, states will have the 
ability to add poor and low-income uninsured persons living with HIV to 
the list of persons categorically eligible for Medicaid. This is very 
important for people of the 18th Congressional District of Texas who 
deserve every opportunity to getting the proper coverage it is so 
critical that they receive quality care. There are HIV-infected persons 
in my district and across America that need some relief immediately and 
thus I am pleased by the Medicaid provision in the legislation.
  Under current rules, most people living with HIV are ineligible for 
Medicaid until they have progressed to AIDS and are disabled. Yet, new 
treatment, such as highly active antiretrovial therapy (HAART), are 
successfully delaying the progression from HIV infection to AIDS. That 
is exciting, Mr. Speaker. We can turn this situation around. These 
advances, along with access to comprehensive health care, have improved 
the health and quality of life for many people living with HIV. 
However, without access to Medicaid these advances will remain out of 
reach for thousands of poor and low-income uninsured people living with 
HIV.
  Early access to HIV treatment through Medicaid, as provided by this 
legislation, will result in a reduction of new AIDS cases, increase the 
quality of life of thousands living with HIV, reduce high medical 
interventions such as inpatient hospitalizations and terminal care, 
increase tax revenues and reduce costs in the SSI and SSDI programs.
  Another initiative, that effects personally my 18th district in 
Texas, is the establishment of a new supplementary competitive grant 
program for states in ``severe need''. HHS must consider the importance 
of HIV and AIDS, the increased need for service along with the level of 
unmet need. HHS also must look at disparities in the access to services 
for historically underserved communities. Acknowledgment of loopholes 
is being met and solutions being made to combat the destitute situation 
many underserved communities find themselves in.
  Finally, I believe it is significant that the reauthorization of the 
Ryan White Act has the strong support of the Human Rights Campaign and 
AIDS Action, two organizations that has done monumental work in the 
promotion of better health care and other critical benefits for those 
afflicted with HIV/AIDS. As a result of their hard work, we have a 
bipartisan effort that finally begins to seek to reach out to 
minorities in unprecedented fashion.
  Congress has long recognized the broad scope of benefits of CARE Act 
programs to those impacted by the HIV and AIDS. We need to continue 
helping those in need and redouble our efforts to eliminate the 
epidemic of HIV/AIDS. Mr. Speaker, I strongly urge my colleagues to 
strongly support this legislation.
  Mr. HOLT. Mr. Speaker, I rise today to express my strong support for 
passing S. 2311 to reauthorize the Ryan White CARE Act.
  I am proud to be a cosponsor of the House reauthorization (H.R. 4807) 
that we passed by voice vote on July 27, 2000. I am equally proud to 
stand in support of Senate bill 2311. I urge my colleagues to continue 
their support for these amendments by voting for S. 2311, and help 
ensure that those with AIDS will continue to receive the support and 
resources they need.

[[Page 21046]]

  Mr. Speaker, we all know the troubling statistics. Since its 
inception, AIDS has claimed over 400,000 lives in the United States. An 
estimated 900,000 Americans are living with HIV/AIDS today. Women 
account for 30 percent of new infections. Over half of all new 
infections occur in persons under 25. As the AIDS crisis has continued 
year after year, it has become more and more difficult for anyone to 
claim that AIDS is someone else's problem.
  Since 1990, the CARE Act has helped establish a comprehensive, 
community-based continuum of care for uninsured and under-insured 
people living with HIV and AIDS, including access to primary medical 
care, pharmaceuticals, and support services. The CARE Act provides 
services to people who would not otherwise have access to care.
  As a result of the CARE Act, many people with HIV and AIDS are 
leading longer and healthier lives today.
  Mr. Speaker, since my election to Congress, I have strongly supported 
increases in funding for medical research. As the spouse of a 
physician, I have a special affinity for those suffering from life-
threatening illnesses. I know some believe that government is the 
problem and not the solution. But the truth is the opposite: in times 
of great human suffering and injustice, our government has acted to 
help our fellow citizens overcome life-threatening conditions and 
situations. Federal aid for the Ryan White CARE Act is a prime example 
of the good government can do in the face of tragedy and national 
danger.
  By passing S. 2311, we are making clear that the AIDS epidemic in the 
United States will receive the attention and public health response it 
deserves.
  By passing S. 2311 today, Mr. Speaker, we will affirm our commitment 
to people living with HIV/AIDS and their families. We will also be 
affirming our dedication to sound public policy. By reauthorizing the 
CARE Act, today, Mr. Speaker, we will give hope and a real chance for a 
better life to thousands of HIV/AIDS victims.
  Mr. DINGELL. Mr. Speaker, I rise today to express my strong support 
for S. 2311, the Ryan White CARE Act Amendments of 2000. This is an 
excellent bill and it deserves our immediate consideration and support.
  I want to take particular note of the way in which this bill has been 
developed. This bill comes to us by way of a remarkable bipartisan 
effort led by my good friend and colleague Representative Waxman and 
from the other side of the aisle, Representative Coburn. Given the 
complexity of the Ryan White program and the potentially controversial 
nature of the subject matter, the fact that we will pass a good bill at 
this time of year with a strong bipartisan vote is a tribute to them.
  Our colleagues in the other body have also worked hard on this bill 
and are to be congratulated for their effort. Senators Jeffords, 
Kennedy, and Frist have been solid partners in forging the legislation 
before us today.
  The CDC estimates that more than 900,000 persons in America are now 
living with HIV. Approximately one-third of these persons know they are 
infected and are receiving treatment. Another third know they are 
infected, but are not receiving treatment. Another third does not know 
they are infected. Another complication is that HIV infections are 
occurring in every region of the country and in every kind of 
situation. Underserved areas, such as rural areas, are having a 
particularly difficult time because they lack the infrastructure of 
proven prevention and treatment programs.
  In brief, S. 2311 keeps those programs that have withstood the test 
of time. Just as significantly, it makes changes where they were 
needed. The four titles of the Ryan White CARE Act contain a variety of 
grants and formulas that distribute funds at the state and local 
levels. As we all know, changing programs of this kind is never easy. 
In this case, we have successfully blended the need for change with the 
need for continuity of care for those areas that have been especially 
hard hit by the HIV/AIDS epidemic. On this point, let me note the great 
work of our colleagues Representatives Eshoo, Towns and Pelosi. I note, 
also, that a listing of all of the changes made to the Ryan White 
program by this bill is set forth in the statement of managers that 
will be included in the record of today's proceedings.
  Finally, Mr. Speaker, I wish to acknowledge the work of ranking 
member of the Health and Environment Subcommittee, Representative 
Brown, and the Subcommittee Chairman, Representative Bilirakis. They 
have forged a solid working relationship on a variety of bills that 
have come before us this year and we are grateful for their hard work 
and cooperation.
  The SPEAKER pro tempore (Mr. Simpson). All time for debate has 
expired.
  Pursuant to House Resolution 611, the previous question is ordered on 
the Senate bill, as amended.
  The question is on the third reading of the Senate bill.
  The Senate bill was ordered to be read a third time, and was read the 
third time.
  The SPEAKER pro tempore. The question is on the passage of the Senate 
bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. BILIRAKIS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The vote was taken by electronic device, and there were--yeas 411, 
nays 0, not voting 22, as follows:

                             [Roll No. 512]

                               YEAS--411

     Abercrombie
     Ackerman
     Aderholt
     Allen
     Andrews
     Archer
     Armey
     Baca
     Bachus
     Baird
     Baker
     Baldacci
     Baldwin
     Ballenger
     Barcia
     Barr
     Barrett (NE)
     Barrett (WI)
     Bartlett
     Barton
     Bass
     Becerra
     Bentsen
     Bereuter
     Berman
     Berry
     Biggert
     Bilbray
     Bilirakis
     Bishop
     Blagojevich
     Bliley
     Blumenauer
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bono
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brady (TX)
     Brown (FL)
     Brown (OH)
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Cannon
     Capps
     Capuano
     Cardin
     Carson
     Castle
     Chabot
     Chambliss
     Chenoweth-Hage
     Clayton
     Clement
     Clyburn
     Coble
     Coburn
     Collins
     Combest
     Condit
     Conyers
     Cook
     Cooksey
     Costello
     Cox
     Coyne
     Cramer
     Crane
     Crowley
     Cubin
     Cummings
     Cunningham
     Danner
     Davis (FL)
     Davis (IL)
     Davis (VA)
     Deal
     DeFazio
     DeGette
     Delahunt
     DeLauro
     DeLay
     DeMint
     Deutsch
     Diaz-Balart
     Dickey
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doolittle
     Doyle
     Dreier
     Duncan
     Dunn
     Edwards
     Ehlers
     Ehrlich
     Emerson
     Engel
     English
     Etheridge
     Evans
     Everett
     Ewing
     Farr
     Fattah
     Filner
     Fletcher
     Foley
     Forbes
     Ford
     Fossella
     Fowler
     Frank (MA)
     Frelinghuysen
     Frost
     Gallegly
     Ganske
     Gejdenson
     Gekas
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gonzalez
     Goode
     Goodlatte
     Goodling
     Gordon
     Goss
     Graham
     Granger
     Green (TX)
     Green (WI)
     Greenwood
     Gutierrez
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hansen
     Hastings (FL)
     Hastings (WA)
     Hayes
     Hayworth
     Herger
     Hill (IN)
     Hill (MT)
     Hilleary
     Hilliard
     Hinchey
     Hinojosa
     Hobson
     Hoeffel
     Hoekstra
     Holden
     Holt
     Hooley
     Horn
     Hostettler
     Houghton
     Hoyer
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Inslee
     Isakson
     Istook
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Jenkins
     John
     Johnson (CT)
     Johnson, E.B.
     Johnson, Sam
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kasich
     Kelly
     Kennedy
     Kildee
     Kilpatrick
     Kind (WI)
     Kingston
     Kleczka
     Knollenberg
     Kolbe
     Kucinich
     Kuykendall
     LaFalce
     LaHood
     Lampson
     Lantos
     Largent
     Larson
     Latham
     LaTourette
     Leach
     Lee
     Levin
     Lewis (CA)
     Lewis (GA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Lofgren
     Lowey
     Lucas (KY)
     Lucas (OK)
     Luther
     Maloney (NY)
     Manzullo
     Markey
     Martinez
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McCrery
     McDermott
     McGovern
     McHugh
     McInnis
     McIntyre
     McKeon
     McKinney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Metcalf
     Mica
     Millender-McDonald
     Miller, Gary
     Miller, George
     Minge
     Mink
     Moakley
     Mollohan
     Moore
     Moran (KS)
     Moran (VA)
     Morella
     Myrick
     Nadler
     Napolitano
     Neal
     Nethercutt
     Ney
     Northup
     Norwood
     Nussle
     Oberstar
     Olver
     Ortiz
     Ose
     Owens
     Oxley
     Packard
     Pallone
     Pascrell
     Pastor
     Payne
     Pease
     Pelosi
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pickett
     Pitts
     Pombo
     Pomeroy
     Porter
     Portman
     Price (NC)
     Pryce (OH)
     Quinn
     Radanovich
     Rahall
     Ramstad
     Regula
     Reyes
     Reynolds
     Riley
     Rivers
     Rodriguez
     Roemer
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Rothman
     Roukema
     Roybal-Allard
     Royce
     Rush
     Ryan (WI)
     Ryun (KS)
     Sabo
     Salmon
     Sanchez
     Sanders
     Sandlin
     Sanford
     Sawyer
     Saxton
     Scarborough
     Schaffer
     Schakowsky
     Scott

[[Page 21047]]


     Sensenbrenner
     Serrano
     Sessions
     Shadegg
     Shaw
     Shays
     Sherman
     Sherwood
     Shimkus
     Shows
     Shuster
     Simpson
     Sisisky
     Skeen
     Skelton
     Slaughter
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Snyder
     Souder
     Spence
     Spratt
     Stabenow
     Stark
     Stearns
     Stenholm
     Strickland
     Stump
     Stupak
     Sununu
     Talent
     Tancredo
     Tanner
     Tauscher
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Terry
     Thomas
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Thune
     Thurman
     Tiahrt
     Tierney
     Toomey
     Towns
     Traficant
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Velazquez
     Visclosky
     Vitter
     Walden
     Walsh
     Wamp
     Waters
     Watkins
     Watt (NC)
     Watts (OK)
     Waxman
     Weiner
     Weldon (FL)
     Weldon (PA)
     Weller
     Wexler
     Weygand
     Whitfield
     Wicker
     Wilson
     Wolf
     Woolsey
     Wu
     Wynn
     Young (AK)

                             NOT VOTING--22

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

                              {time}  1151

  So the Senate bill was passed.
  The result of the vote was announced as above recorded.
  The title of the Senate bill was amended so as to read: ``A bill to 
amend the Public Health Service Act to revise and extend programs 
established under the Ryan White Comprehensive AIDS Resources Emergency 
Act of 1990, and for other purposes.''.
  A motion to reconsider was laid on the table.
  Stated for:
  Mr. MALONEY of Connecticut. Mr. Speaker, I was unavoidably detained 
during rollcall vote No. 512. Had I been present I would have voted 
``yes.''

                          ____________________