[Congressional Record (Bound Edition), Volume 146 (2000), Part 7]
[Senate]
[Pages 9547-9558]
[From the U.S. Government Publishing Office, www.gpo.gov]



                 RYAN WHITE CARE ACT AMENDMENTS OF 2000

  Mr. WARNER. Mr. President, I ask unanimous consent that the Senate 
now proceed to the consideration of Calendar 548, S. 2311.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The assistant legislative clerk read as follows:

       A bill (S. 2311) to revise and extend the Ryan White CARE 
     Act programs under title XXVI of the Public Health Service 
     Act, and for other purposes.

  There being no objection, the Senate proceeded to consider the bill 
(S. 2311) to amend the Ryan White CARE 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 related purposes, which had been reported from the Committee on 
Health, Education, Labor, and Pensions, with an amendment to strike all 
after the enacting clause and insert in lieu thereof the following:

     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--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 requirements.
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 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. 128. Supplement grants for certain States.
Sec. 129. Use of treatment funds.
Sec. 130. Increase in minimum allotment.
Sec. 131. 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.
Sec. 146. Technical amendment.

         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.

[[Page 9548]]



             TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM

       Subtitle A--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 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 this part 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, mental health programs, 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 (7) (as so redesignated), by striking 
     ``and'' at the end thereof;
       (2) in paragraph (8) (as so redesignated), by striking the 
     period and inserting ``; and''; and
       (3) by adding at the end the following:
       ``(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).''.

     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 section 2605(a)(4), that maintains 
     a relationship with an entity described in subclause (I) and 
     that is serving individuals at elevated risk of HIV disease;
       ``(ii) demonstrates to the satisfaction of the chief 
     elected official that Federal, State, or local funds are 
     inadequate for the early intervention services the entity 
     will provide with funds received under this subparagraph; and
       ``(iii) demonstrates to the satisfaction of the chief 
     elected official that funds will be utilized under this 
     subparagraph to supplement not supplant other funds available 
     for such services in the year for which such funds are being 
     utilized.''.
       (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)''.

[[Page 9549]]



     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) Limitation.--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.''.

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

     SEC. 122. QUALITY MANAGEMENT.

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

     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. 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 by adding 
     at the end the following:

[[Page 9550]]



     ``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 emerging communities within the State that 
     are not eligible to receive grants under part A.
       ``(b) Eligibility.--To be eligible to receive a 
     supplemental grant under subsection (a) a State shall--
       ``(1) be eligible to receive a grant under this subpart;
       ``(2) demonstrate the existence in the State of an emerging 
     community as defined in subsection (d)(1); and
       ``(3) submit the information described in subsection (c).
       ``(c) Reporting Requirements.--A State that desires a grant 
     under this section shall, as part of the State application 
     submitted under section 2617, submit a detailed description 
     of the manner in which the State will use amounts received 
     under the grant and of the severity of need. Such description 
     shall include--
       ``(1) a report concerning the dissemination of supplemental 
     funds under this section and the plan for the utilization of 
     such funds in the emerging community;
       ``(2) a demonstration of the existing commitment of local 
     resources, both financial and in-kind;
       ``(3) a demonstration that the State will maintain HIV-
     related activities at a level that is equal to not less than 
     the level of such activities in the State for the 1-year 
     period preceding the fiscal year for which the State is 
     applying to receive a grant under this part;
       ``(4) a demonstration of the ability of the State to 
     utilize such supplemental financial resources in a manner 
     that is immediately responsive and cost effective;
       ``(5) a demonstration that the resources will be allocated 
     in accordance with the local demographic incidence of AIDS 
     including appropriate allocations for services for infants, 
     children, women, and families with HIV disease;
       ``(6) a demonstration of the inclusiveness of the planning 
     process, with particular emphasis on affected communities and 
     individuals with HIV disease; and
       ``(7) a demonstration of the manner in which the proposed 
     services are consistent with local needs assessments and the 
     statewide coordinated statement of need.
       ``(d) Definition of Emerging Community.--In this section, 
     the term `emerging community' means a metropolitan area--
       ``(1) that is not eligible for a grant under part A; and
       ``(2) for which there has been reported to the Director of 
     the Centers for Disease Control and Prevention a cumulative 
     total of between 500 and 1999 cases of acquired immune 
     deficiency syndrome for the most recent period of 5 calendar 
     years for which such data are available.
       ``(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(b)(2)(H), 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(b)(2)(H), 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(b)(2)(H), 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(b)(2)(H).
       ``(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.--The amount of a grant awarded to a 
     State under this section shall be determined by the Secretary 
     based on the formula described in section 2618(b)(2), except 
     that in applying such formula, the Secretary shall--
       ``(A) substitute `1.0' for `.80' in subparagraph (A)(ii)(I) 
     of such section; and
       ``(B) not consider the provisions of subparagraphs 
     (A)(ii)(II) and (C) of such section.''.

     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 inserting ``; 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) 
     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 increase 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, the Secretary shall 
     consider eligibility standards and formulary composition.
       ``(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 HIV/AIDS-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 shall reserve 3 
     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) Territories.--Section 2618(b)(1)(B) (42 U.S.C. 300ff-
     28(b)(1)(B)) is amended by inserting ``the greater of $50,000 
     or'' after ``shall be''.
       (c) 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, and only for purposes of paragraph (1) 
     the Commonwealth of Puerto Rico''.

     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

[[Page 9551]]

       (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
       (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.--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 determined to be rural and 
     underserved for the purposes of providing health care to 
     individuals infected with HIV or diagnosed with AIDS.''.

     SEC. 146. TECHNICAL AMENDMENT.

       Section 2652(a) (42 U.S.C. 300ff-52(a)) is amended--
       (1) by striking paragraphs (1) and (2) and inserting the 
     following:
       ``(1) health centers under section 330;''; and
       (2) by redesignating paragraphs (3) through (6) as 
     paragraphs (2) through (5), respectively.

         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. 
     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) 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''.
       (c) Dental Schools and Programs.--Section 2692(b) of the 
     Public Health Service Act (42 U.S.C. 300ff-111(b)) is 
     amended--
       (1) in paragraph (1), by striking ``777(b)(4)(B)'' and 
     inserting ``777(b)(4)(B) (as such section existed on the day 
     before the date of enactment of the Health Professions 
     Education Partnerships Act of 1998 (Public Law 105-392)) and 
     dental hygiene programs that are accredited by the Commission 
     on Dental Accreditation''; and
       (2) in paragraph (2), by striking ``777(b)(4)(B)'' and 
     inserting ``777(b)(4)(B) (as such section existed on the day 
     before the date of enactment of the Health Professions 
     Education Partnerships Act of 1998 (Public Law 105-392))''.

[[Page 9552]]



                   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.


                           Amendment No. 3190

  Mr. WARNER. Mr. President, Senator Jeffords has an amendment at the 
desk for himself and others.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:

       The Senator from Virginia (Mr. Warner), for Mr. Jeffords, 
     Mr. Kennedy and Mr. Frist, proposes an amendment numbered 
     3190.

  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. JEFFORDS. Mr. President, it gives me great pleasure today that 
the Senate is considering the Ryan White Comprehensive AIDS Resources 
and Emergency Act Amendments of 2000, a measure that will reauthorize a 
national program providing primary health care services to people 
living with HIV and AIDS. I especially want to commend Senators Hatch 
and Kennedy for the leadership they have provided since the 
inauguration of the legislation establishing the Ryan White programs 
over a decade ago. I also want to commend Senator Frist whose medical 
expertise played a critical role in key provisions of the bill and 
continues to be an invaluable resource to our efforts on the range of 
health issues that come before the Senate. I want to recognize Senator 
Dodd for his unwavering support for this legislation and people living 
with HIV and AIDS. Finally, I want to acknowledge Senator Enzi's 
recognition of the growing burden that AIDS and HIV have placed on 
rural communities throughout the country and the need to address those 
gaps in services.
  Since its inception in 1990, the Ryan White program has enjoyed broad 
bipartisan support. During the last reauthorization of the Ryan White 
CARE Act in 1996, the measure garnered a vote of 97 to 3 on its final 
passage. As evidence that strong bipartisan support continues, I am 
happy to report that last month this reauthorization bill was passed 
unanimously out of committee. The bipartisan support for this important 
legislation underlines the critical need for the assistance this Act 
provides across the nation.
  With this reauthorization, we mark the ten years through which the 
Ryan White CARE Act has provided needed health care and support 
services to HIV positive people around the country. Titles I and II 
have provided much needed relief to cities and states hardest hit by 
this disease, while Titles III and IV have had a direct role in 
providing healthcare services to underserved communities. Ryan White 
program dollars provide the foundation of care so necessary in fighting 
this epidemic and have allowed States and communities around the 
country to successfully address the needs of people affected by HIV 
disease.
  In a recently released report, the General Accounting Office found 
that CARE Act funds are reaching the infected groups that have 
typically been underserved, including the poor, the uninsured, women, 
and ethnic minorities. In fact, these groups form a majority of CARE 
Act clients and are being served by the CARE Act in higher proportions 
than their representation in the AIDS population. The GAO also found 
that CARE Act funds support a wide array of primary care and support 
services, including the provision of powerful therapeutic regimens for 
people with HIV/AIDS that have dramatically reduced AIDS diagnoses and 
deaths.
  Much has occurred to change the course of the AIDS epidemic since the 
last reauthorization. During the last reauthorization, Congressman 
Coburn and our colleague, Senator Frist, focused our attention on the 
needs of women living with HIV/AIDS and the problems associated with 
perinatal transmission of HIV. Since then, the CARE Act has helped to 
dramatically reduce mother-to-child transmission through more effective 
outreach, counseling, and voluntary testing of mothers at risk for HIV 
infection. Between 1993 and 1998, perinatal-acquired AIDS cases 
declined 74% in the U.S. In this bill, I have continued to support 
efforts to reach women in need of care for their HIV disease and have 
included provisions to ensure that women, infants and children receive 
resources in accordance with the prevalence of the infection among 
them.
  Another key success has been the AIDS Drug Assistance Program. This 
program has provided people with HIV and AIDS access to newly 
developed, highly effective therapeutics. Because of these drugs, 
people are maintaining their health and living longer. The AIDS death 
rate and the number of new AIDS cases have been dramatically reduced. 
From 1996 to 1998, deaths from AIDS dropped 54% while new AIDS cases 
have been reduced by 27%. However, these treatments are very expensive, 
do not provide a cure, and do not work for everyone.
  AIDS, HIV, the people it infects and families that it has affected 
are not in the news today as often as they have been in the past. But 
for too many of us, this lack of bad news has created a false sense of 
complacency. While the rate of decline in new AIDS cases and deaths is 
leveling off, HIV infection rates continue to rise in many areas; 
becoming increasingly prevalent in rural and underserved urban areas; 
and also among women, youth, and minority communities. Local and state 
healthcare systems face an increasing burden of disease, despite our 
success in treating and caring for people living with HIV and AIDS. 
Unfortunately, rural and underserved urban areas are often unable to 
address the complex medical and support services needs of people with 
HIV infection. Thus, Ryan White programs remain as vital to the public 
health of this nation as it was in 1990 and in 1996. As the AIDS 
epidemic reaches into rural areas and into underserved urban 
communities across the country, this legislation will allow us to adapt 
our care systems to meet the most urgent needs in the communities 
hardest hit by the epidemic.
  The bill being considered today was developed on a bipartisan basis, 
working with other Committee Members, community stakeholders and 
elected officials at the state and local levels from whom we sought 
input to ensure that we addressed the most important problems facing 
communities of people with HIV infection. I held a hearing in March 
before the Committee on Health, Education, Labor and Pensions to learn 
whether the program has been successful and whether it needed to be 
changed. We received testimony from Ryan White's mother, Jeanne White, 
from Surgeon General David Satcher, from a person living with AIDS, as 
well as state and local officials familiar with the importance of this 
program. I especially want to commend Dr. Chris Grace of Vermont who 
testified as to the particular challenges of providing

[[Page 9553]]

care to people living with HIV/AIDS in rural, and sometimes remote, 
parts of the country. It was clear from our witnesses' statements that, 
despite the successes, challenges remain.
  To address these challenges, we have developed a bill that will 
improve access to care in underserved urban and rural areas. My bill 
will double the minimum base funding available to states through the 
CARE Act to assist them in developing systems of care for people 
struggling with HIV and AIDS. The bill also includes a new supplemental 
state grant to target assistance to small and mid-sized metropolitan 
areas to help them address the increasing number of people with HIV/
AIDS living outside of urban areas that receive assistance under Title 
I of the Act. Rural and underserved areas receive a preference for 
planning, early intervention, and capacity development grants under 
title III. In order to assist states in expanding access to appropriate 
HIV/AIDS therapeutics to low-income people with HIV/AIDS, a 
supplemental grant has been added to the AIDS Drug Assistance Program.
  The bill remains primarily a system of grants to State and local 
jurisdictions, thereby ensuring that grantees can respond to local 
needs. States, EMAs, and the affected communities will still decide how 
to best prioritize and address the healthcare needs of their HIV-
positive citizens. This bill reinforces the ability of States and EMAs 
to identify and meet local needs.
  Finally, in recognition of the changing nature of the epidemic, I 
have asked the Institute of Medicine to complete a study of the 
financing and delivery of primary care and support services for low 
income, uninsured, and under-insured individuals with HIV disease, 
within 21 months after the enactment of this Act. Changes in HIV 
surveillance and case reporting, and the effects of these changes on 
program funding, will be included in this study. The recommendations 
from this study will help Congress and the Secretary of Health and 
Human Services to ensure the most effective and efficient use of 
Federal funds for HIV and AIDS care and support.
  I intend to see this bill become law this year so that the people 
struggling to overcome the challenges of HIV and AIDS continue to 
benefit from high quality medical care and access to lifesaving drugs. 
We have made incredible progress in the fight against HIV/AIDS and I 
want to be sure that every person in America in need of assistance 
benefits from our tremendous advances.
  Many groups and individuals have contributed significantly to 
crafting this bill, but I want to acknowledge those at the Health 
Resources and Services Administration, especially Dr. Joseph O'Neill, 
Associate Administrator of the HIV/AIDS bureau; John Palenicek, 
Director of the Office of Policy and Program Development; Doug Morgan, 
Director of the Division of Service Systems; and Howard Lerner, 
Principal Adviser for Telehealth and International Collaboration, HIV/
AIDS. All of the groups united under the umbrella of the National 
Organizations Responding to AIDS (NORA) deserve recognition. 
Representing a diverse community of people with AIDS, CARE Act service 
providers, and administrative agencies, NORA clearly and effectively 
communicated to Congress the needs and priorities of their 
constituents.
  I also want to thank several staff members who have worked long and 
hard to craft this bill and to address the concerns and needs of the 
affected communities. Sean Donohue and William Oscar Fleming have 
guided this effort from the beginning, building consensus across the 
many policy issues, resulting in a bill that meets the pressing needs 
of people with HIV and AIDS and enjoys broad bipartisan support. 
Stephanie Robinson and Idalia Sanchez, for Senator Kennedy, were key to 
reaching agreement on this bill and have provided invaluable assistance 
and support throughout the development of this legislation. I would 
also like to recognize Dave Larson and Mary Sumpter Johnson, of Senator 
Frist's office, for their support for the needs of rural and 
underserved communities throughout the nation. Similarly, Jeannie 
Ireland with Senator Dodd's office, Helen Rhee, working for Senator 
DeWine, Libby Rolfe, for Mr. Sessions, and Raissa Geary and Mary Jordan 
in Senator Enzi's office, provided valuable input. Without the efforts 
of these staff members, we would not have such a strong, well-balanced, 
and targeted reauthorization bill before us today.
  Mr. WARNER. Mr. President, I ask unanimous consent that the amendment 
be agreed to, the committee substitute be agreed to, as amended, the 
bill be read a third time and passed, the motion to reconsider be laid 
upon the table, and that any statements relating to the bill be printed 
in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 3190) was agreed to.
  The committee amendment in the nature of a substitute, as amended, 
was agreed to.
  The bill (S. 2311), as amended, was read a third time and passed, 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--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 requirements.
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 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. 128. Supplement grants for certain States.
Sec. 129. Use of treatment funds.
Sec. 130. Increase in minimum allotment.
Sec. 131. 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.
Sec. 146. Technical amendment.

         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.

[[Page 9554]]



             TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM

       Subtitle A--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 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 this part 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, mental health programs, 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 (7) (as so redesignated), by striking 
     ``and'' at the end thereof;
       (2) in paragraph (8) (as so redesignated), by striking the 
     period and inserting ``; and''; and
       (3) by adding at the end the following:
       ``(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).''.

     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 section 2605(a)(4), that maintains 
     a relationship with an entity described in subclause (I) and 
     that is serving individuals at elevated risk of HIV disease;
       ``(ii) demonstrates to the satisfaction of the chief 
     elected official that Federal, State, or local funds are 
     inadequate for the early intervention services the entity 
     will provide with funds received under this subparagraph; and
       ``(iii) demonstrates to the satisfaction of the chief 
     elected official that funds will be

[[Page 9555]]

     utilized under this subparagraph to supplement not supplant 
     other funds available for such services in the year for which 
     such funds are being utilized.
       (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) Limitation.--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.''.

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

     SEC. 122. QUALITY MANAGEMENT.

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

[[Page 9556]]

       ``(B) demonstrates to the State's satisfaction that other 
     Federal, State, or local funds are inadequate for the early 
     intervention services the entity will provide with funds 
     received under this paragraph; and
       ``(C) demonstrates to the satisfaction of the State that 
     funds will be utilized under this paragraph to supplement not 
     supplant other funds available for such services in the year 
     for which such funds are being utilized.''.

     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. 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 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 emerging communities within the State that 
     are not eligible to receive grants under part A.
       ``(b) Eligibility.--To be eligible to receive a 
     supplemental grant under subsection (a) a State shall--
       ``(1) be eligible to receive a grant under this subpart;
       ``(2) demonstrate the existence in the State of an emerging 
     community as defined in subsection (d)(1); and
       ``(3) submit the information described in subsection (c).
       ``(c) Reporting Requirements.--A State that desires a grant 
     under this section shall, as part of the State application 
     submitted under section 2617, submit a detailed description 
     of the manner in which the State will use amounts received 
     under the grant and of the severity of need. Such description 
     shall include--
       ``(1) a report concerning the dissemination of supplemental 
     funds under this section and the plan for the utilization of 
     such funds in the emerging community;
       ``(2) a demonstration of the existing commitment of local 
     resources, both financial and in-kind;
       ``(3) a demonstration that the State will maintain HIV-
     related activities at a level that is equal to not less than 
     the level of such activities in the State for the 1-year 
     period preceding the fiscal year for which the State is 
     applying to receive a grant under this part;
       ``(4) a demonstration of the ability of the State to 
     utilize such supplemental financial resources in a manner 
     that is immediately responsive and cost effective;
       ``(5) a demonstration that the resources will be allocated 
     in accordance with the local demographic incidence of AIDS 
     including appropriate allocations for services for infants, 
     children, women, and families with HIV disease;
       ``(6) a demonstration of the inclusiveness of the planning 
     process, with particular emphasis on affected communities and 
     individuals with HIV disease; and
       ``(7) a demonstration of the manner in which the proposed 
     services are consistent with local needs assessments and the 
     statewide coordinated statement of need.
       ``(d) Definition of Emerging Community.--In this section, 
     the term `emerging community' means a metropolitan area--
       ``(1) that is not eligible for a grant under part A; and
       ``(2) for which there has been reported to the Director of 
     the Centers for Disease Control and Prevention a cumulative 
     total of between 500 and 1999 cases of acquired immune 
     deficiency syndrome for the most recent period of 5 calendar 
     years for which such data are available.
       ``(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(b)(2)(H), 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(b)(2)(H), 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(b)(2)(H), 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(b)(2)(H).
       ``(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.--The amount of a grant awarded to a 
     State under this section shall be determined by the Secretary 
     based on the formula described in section 2618(b)(2), except 
     that in applying such formula, the Secretary shall--
       ``(A) substitute `1.0' for `.80' in subparagraph (A)(ii)(I) 
     of such section; and
       ``(B) not consider the provisions of subparagraphs 
     (A)(ii)(II) and (C) of such section.''.

     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 inserting ``; 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) 
     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 increase 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, the Secretary shall 
     consider eligibility standards and formulary composition.
       ``(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 HIV/AIDS-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 shall reserve 3 
     percent of any amount

[[Page 9557]]

     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) Territories.--Section 2618(b)(1)(B) (42 U.S.C. 300ff-
     28(b)(1)(B)) is amended by inserting ``the greater of $50,000 
     or'' after ``shall be''.
       (c) 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, and only for purposes of paragraph (1) 
     the Commonwealth of Puerto Rico''.

     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
       (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.--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 determined to be rural and 
     underserved for the purposes of providing health care to 
     individuals infected with HIV or diagnosed with AIDS.''.

     SEC. 146. TECHNICAL AMENDMENT.

       Section 2652(a) (42 U.S.C. 300ff-52(a)) is amended--
       (1) striking paragraphs (1) and (2) and inserting the 
     following:
       ``(1) health centers under section 330;''; and
       (2) by redesignating paragraphs (3) through (6) as 
     paragraphs (2) through (5), respectively.

         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. 
     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) 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,

[[Page 9558]]

     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''.
       (c) Dental Schools and Programs.--Section 2692(b) of the 
     Public Health Service Act (42 U.S.C. 300ff-111(b)) is 
     amended--
       (1) in paragraph (1), by striking ``777(b)(4)(B)'' and 
     inserting ``777(b)(4)(B) (as such section existed on the day 
     before the date of enactment of the Health Professions 
     Education Partnerships Act of 1998 (Public Law 105-392)) and 
     dental hygiene programs that are accredited by the Commission 
     on Dental Accreditation''; and
       (2) in paragraph (2), by striking ``777(b)(4)(B)'' and 
     inserting ``777(b)(4)(B) (as such section existed on the day 
     before the date of enactment of the Health Professions 
     Education Partnerships Act of 1998 (Public Law 105-392))''.

                   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.

                          ____________________