[Congressional Record (Bound Edition), Volume 152 (2006), Part 18]
[House]
[Pages 23410-23424]
[From the U.S. Government Publishing Office, www.gpo.gov]




        RYAN WHITE HIV/AIDS TREATMENT MODERNIZATION ACT OF 2006

  Mr. BARTON of Texas. Mr. Speaker, I ask unanimous consent to take 
from the Speaker's table the bill (H.R. 6143) to amend title XXVI of 
the Public Health Service Act to revise and extend the program for 
providing life-saving care for those with HIV/AIDS, with a Senate 
amendment thereto, and concur in the Senate amendment.
  The Clerk read the title of the bill.
  The Clerk read the Senate amendment, as follows:

       Senate amendment:
       Strike out all after the enacting clause and insert:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Ryan White 
     HIV/AIDS Treatment Modernization Act of 2006''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

              TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS

Sec. 101. Establishment of program; general eligibility for grants.
Sec. 102. Type and distribution of grants; formula grants.
Sec. 103. Type and distribution of grants; supplemental grants.
Sec. 104. Timeframe for obligation and expenditure of grant funds.
Sec. 105. Use of amounts.
Sec. 106. Additional amendments to part A.
Sec. 107. New program in part A; transitional grants for certain areas 
              ineligible under section 2601.
Sec. 108. Authorization of appropriations for part A.

                         TITLE II--CARE GRANTS

Sec. 201. General use of grants.
Sec. 202. AIDS Drug Assistance Program.
Sec. 203. Distribution of funds.
Sec. 204. Additional amendments to subpart I of part B.
Sec. 205. Supplemental grants on basis of demonstrated need.
Sec. 206. Emerging communities.
Sec. 207. Timeframe for obligation and expenditure of grant funds.
Sec. 208. Authorization of appropriations for subpart I of part B.
Sec. 209. Early diagnosis grant program.
Sec. 210. Certain partner notification programs; authorization of 
              appropriations.

                 TITLE III--EARLY INTERVENTION SERVICES

Sec. 301. Establishment of program; core medical services.
Sec. 302. Eligible entities; preferences; planning and development 
              grants.
Sec. 303. Authorization of appropriations.
Sec. 304. Confidentiality and informed consent.
Sec. 305. Provision of certain counseling services.
Sec. 306. General provisions.

             TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH

Sec. 401. Women, infants, children, and youth.
Sec. 402. GAO Report.

                      TITLE V--GENERAL PROVISIONS

Sec. 501. General provisions.

                  TITLE VI--DEMONSTRATION AND TRAINING

Sec. 601. Demonstration and training.
Sec. 602. AIDS education and training centers.
Sec. 603. Codification of minority AIDS initiative.

                  TITLE VII--MISCELLANEOUS PROVISIONS

Sec. 701. Hepatitis; use of funds.
Sec. 702. Certain references.
Sec. 703. Repeal.

              TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS

     SEC. 101. ESTABLISHMENT OF PROGRAM; GENERAL ELIGIBILITY FOR 
                   GRANTS.

       (a) In General.--Section 2601 of the Public Health Service 
     Act (42 U.S.C. 300ff-11) is amended by striking subsections 
     (b) through (d) and inserting the following:
       ``(b) Continued Status as Eligible Area.--Notwithstanding 
     any other provision of this section, a metropolitan area that 
     is an eligible area for a fiscal year continues to be an 
     eligible area until the metropolitan area fails, for three 
     consecutive fiscal years--
       ``(1) to meet the requirements of subsection (a); and
       ``(2) to have a cumulative total of 3,000 or more living 
     cases of AIDS (reported to and confirmed by the Director of 
     the Centers for Disease Control and Prevention) as of 
     December 31 of the most recent calendar year for which such 
     data is available.
       ``(c) Boundaries.--For purposes of determining eligibility 
     under this part--
       ``(1) with respect to a metropolitan area that received 
     funding under this part in fiscal year 2006, the boundaries 
     of such metropolitan area shall be the boundaries that were 
     in effect for such area for fiscal year 1994; or
       ``(2) with respect to a metropolitan area that becomes 
     eligible to receive funding under this part in any fiscal 
     year after fiscal year 2006, the boundaries of such 
     metropolitan area shall be the boundaries that are in effect 
     for such area when such area initially receives funding under 
     this part.''.
       (b) Technical and Conforming Amendments.--Section 2601(a) 
     of the Public Health Service Act (42 U.S.C. 300ff-11(a)) is 
     amended--
       (1) by striking ``through (d)'' and inserting ``through 
     (c)''; and
       (2) by inserting ``and confirmed by'' after ``reported 
     to''.
       (c) Definition of Metropolitan Area.--Section 2607(2) of 
     the Public Health Service Act (42 U.S.C. 300ff-17(2)) is 
     amended--
       (1) by striking ``area referred'' and inserting ``area that 
     is referred''; and
       (2) by inserting before the period the following: ``, and 
     that has a population of 50,000 or more individuals''.

     SEC. 102. TYPE AND DISTRIBUTION OF GRANTS; FORMULA GRANTS.

       (a) Distribution Percentages.--Section 2603(a)(2) of the 
     Public Health Service Act (42 U.S.C. 300ff-13(a)(2)) is 
     amended--
       (1) in the first sentence--
       (A) by striking ``50 percent of the amount appropriated 
     under section 2677'' and inserting ``66\2/3\ percent of the 
     amount made available under section 2610(b) for carrying out 
     this subpart''; and
       (B) by striking ``paragraph (3)'' and inserting 
     ``paragraphs (3) and (4)''.
       (2) by striking the last sentence.
       (b) Distribution Based on Living Cases of HIV/AIDS.--
     Section 2603(a)(3) of the Public Health Service Act (42 
     U.S.C. 300ff-13(a)(3)) is amended--
       (1) in subparagraph (B), by striking ``estimated living 
     cases of acquired immune deficiency syndrome'' and inserting 
     ``living cases of HIV/AIDS (reported to and confirmed by the 
     Director of the Centers for Disease Control and 
     Prevention)''; and
       (2) by striking subparagraphs (C) through (E) and inserting 
     the following:
       ``(C) Living cases of hiv/aids.--
       ``(i) Requirement of names-based reporting.--Except as 
     provided in clause (ii), the number determined under this 
     subparagraph for an eligible area for a fiscal year for 
     purposes of subparagraph (B) is the number of living names-
     based cases of HIV/AIDS that, as of December 31 of the most 
     recent calendar year for which such data is available, have 
     been reported to and confirmed by the Director of the Centers 
     for Disease Control and Prevention.
       ``(ii) Transition period; exemption regarding non-aids 
     cases.--For each of the fiscal years 2007 through 2009, an 
     eligible area is, subject to clauses (iii) through (v), 
     exempt from the requirement under clause (i) that living 
     names-based non-AIDS cases of HIV be reported unless--

       ``(I) a system was in operation as of December 31, 2005, 
     that provides sufficiently accurate and reliable names-based 
     reporting of such cases throughout the State in which the 
     area is located, subject to clause (viii); or
       ``(II) no later than the beginning of fiscal year 2008 or 
     2009, the Secretary, in consultation with the chief executive 
     of the State in which the area is located, determines that a 
     system has become operational in the State that provides 
     sufficiently accurate and reliable names-based reporting of 
     such cases throughout the State.

       ``(iii) Requirements for exemption for fiscal year 2007.--
     For fiscal year 2007, an exemption under clause (ii) for an 
     eligible area applies only if, by October 1, 2006--

       ``(I)(aa) the State in which the area is located had 
     submitted to the Secretary a plan for making the transition 
     to sufficiently accurate and

[[Page 23411]]

     reliable names-based reporting of living non-AIDS cases of 
     HIV; or
       ``(bb) all statutory changes necessary to provide for 
     sufficiently accurate and reliable reporting of such cases 
     had been made; and
       ``(II) the State had agreed that, by April 1, 2008, the 
     State will begin accurate and reliable names-based reporting 
     of such cases, except that such agreement is not required to 
     provide that, as of such date, the system for such reporting 
     be fully sufficient with respect to accuracy and reliability 
     throughout the area.

       ``(iv) Requirement for exemption as of fiscal year 2008.--
     For each of the fiscal years 2008 through 2010, an exemption 
     under clause (ii) for an eligible area applies only if, as of 
     April 1, 2008, the State in which the area is located is 
     substantially in compliance with the agreement under clause 
     (iii)(II).
       ``(v) Progress toward names-based reporting.--For fiscal 
     year 2009, the Secretary may terminate an exemption under 
     clause (ii) for an eligible area if the State in which the 
     area is located submitted a plan under clause (iii)(I)(aa) 
     and the Secretary determines that the State is not 
     substantially following the plan.
       ``(vi) Counting of cases in areas with exemptions.--

       ``(I) In general.--With respect to an eligible area that is 
     under a reporting system for living non-AIDS cases of HIV 
     that is not names-based (referred to in this subparagraph as 
     `code-based reporting'), the Secretary shall, for purposes of 
     this subparagraph, modify the number of such cases reported 
     for the eligible area in order to adjust for duplicative 
     reporting in and among systems that use code-based reporting.
       ``(II) Adjustment rate.--The adjustment rate under 
     subclause (I) for an eligible area shall be a reduction of 5 
     percent in the number of living non-AIDS cases of HIV 
     reported for the area.

       ``(vii) Multiple political jurisdictions.--With respect to 
     living non-AIDS cases of HIV, if an eligible area is not 
     entirely within one political jurisdiction and as a result is 
     subject to more than one reporting system for purposes of 
     this subparagraph:

       ``(I) Names-based reporting under clause (i) applies in a 
     jurisdictional portion of the area, or an exemption under 
     clause (ii) applies in such portion (subject to applicable 
     provisions of this subparagraph), according to whether names-
     based reporting or code-based reporting is used in such 
     portion.
       ``(II) If under subclause (I) both names-based reporting 
     and code-based reporting apply in the area, the number of 
     code-based cases shall be reduced under clause (vi).

       ``(viii) List of eligible areas meeting standard regarding 
     december 31, 2005.--

       ``(I) In general.--If an eligible area or portion thereof 
     is in a State specified in subclause (II), the eligible area 
     or portion shall be considered to meet the standard described 
     in clause (ii)(I). No other eligible area or portion thereof 
     may be considered to meet such standard.
       ``(II) Relevant states.--For purposes of subclause (I), the 
     States specified in this subclause are the following: Alaska, 
     Alabama, Arkansas, Arizona, Colorado, Florida, Indiana, Iowa, 
     Idaho, Kansas, Louisiana, Michigan, Minnesota, Missouri, 
     Mississippi, North Carolina, North Dakota, Nebraska, New 
     Jersey, New Mexico, New York, Nevada, Ohio, Oklahoma, South 
     Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, 
     Wisconsin, West Virginia, Wyoming, Guam, and the Virgin 
     Islands.

       ``(ix) Rules of construction regarding acceptance of 
     reports.--

       ``(I) Cases of aids.--With respect to an eligible area that 
     is subject to the requirement under clause (i) and is not in 
     compliance with the requirement for names-based reporting of 
     living non-AIDS cases of HIV, the Secretary shall, 
     notwithstanding such noncompliance, accept reports of living 
     cases of AIDS that are in accordance with such clause.
       ``(II) Applicability of exemption requirements.--The 
     provisions of clauses (ii) through (viii) may not be 
     construed as having any legal effect for fiscal year 2010 or 
     any subsequent fiscal year, and accordingly, the status of a 
     State for purposes of such clauses may not be considered 
     after fiscal year 2009.

       ``(x) Program for detecting inaccurate or fraudulent 
     counting.--The Secretary shall carry out a program to monitor 
     the reporting of names-based cases for purposes of this 
     subparagraph and to detect instances of inaccurate reporting, 
     including fraudulent reporting.''.
       (c) Code-Based Areas; Limitation on Increase in Grant.--
     Section 2603(a)(3) of the Public Health Service Act (42 
     U.S.C. 300ff-13(a)), as amended by subsection (b)(2) of this 
     section, is amended by adding at the end the following 
     subparagraph:
       ``(D) Code-based areas; limitation on increase in grant .--
       ``(i) In general.--For each of the fiscal years 2007 
     through 2009, if code-based reporting (within the meaning of 
     subparagraph (C)(vi)) applies in an eligible area or any 
     portion thereof as of the beginning of the fiscal year 
     involved, then notwithstanding any other provision of this 
     paragraph, the amount of the grant pursuant to this paragraph 
     for such area for such fiscal year may not--

       ``(I) for fiscal year 2007, exceed by more than 5 percent 
     the amount of the grant for the area that would have been 
     made pursuant to this paragraph and paragraph (4) for fiscal 
     year 2006 (as such paragraphs were in effect for such fiscal 
     year) if paragraph (2) (as so in effect) had been applied by 
     substituting `66\2/3\ percent' for `50 percent'; and
       ``(II) for each of the fiscal years 2008 and 2009, exceed 
     by more than 5 percent the amount of the grant pursuant to 
     this paragraph and paragraph (4) for the area for the 
     preceding fiscal year.

       ``(ii) Use of amounts involved.--For each of the fiscal 
     years 2007 through 2009, amounts available as a result of the 
     limitation under clause (i) shall be made available by the 
     Secretary as additional amounts for grants pursuant to 
     subsection (b) for the fiscal year involved, subject to 
     paragraph (4) and section 2610(d)(2).''.
       (d) Hold Harmless.--Section 2603(a) of the Public Health 
     Service Act (42 U.S.C. 300ff-13(a)) is amended--
       (1) in paragraph (3)(A)--
       (A) in clause (ii), by striking the period at the end and 
     inserting a semicolon; and
       (B) by inserting after and below clause (ii) the following:

     ``which product shall then, as applicable, be increased under 
     paragraph (4).''.
       (2) by amending paragraph (4) to read as follows:
       ``(4) Increases in grant.--
       ``(A) In general.--For each eligible area that received a 
     grant pursuant to this subsection for fiscal year 2006, the 
     Secretary shall, for each of the fiscal years 2007 through 
     2009, increase the amount of the grant made pursuant to 
     paragraph (3) for the area to ensure that the amount of the 
     grant for the fiscal year involved is not less than the 
     following amount, as applicable to such fiscal year:
       ``(i) For fiscal year 2007, an amount equal to 95 percent 
     of the amount of the grant that would have been made pursuant 
     to paragraph (3) and this paragraph for fiscal year 2006 (as 
     such paragraphs were in effect for such fiscal year) if 
     paragraph (2) (as so in effect) had been applied by 
     substituting `66\2/3\ percent' for `50 percent'.
       ``(ii) For each of the fiscal years 2008 and 2009, an 
     amount equal to 100 percent of the amount of the grant made 
     pursuant to paragraph (3) and this paragraph for fiscal year 
     2007.
       ``(B) Source of funds for increase.--
       ``(i) In general.--From the amounts available for carrying 
     out the single program referred to in section 2609(d)(2)(C) 
     for a fiscal year (relating to supplemental grants), the 
     Secretary shall make available such amounts as may be 
     necessary to comply with subparagraph (A), subject to section 
     2610(d)(2).
       ``(ii) Pro rata reduction.--If the amounts referred to in 
     clause (i) for a fiscal year are insufficient to fully comply 
     with subparagraph (A) for the year, the Secretary, in order 
     to provide the additional funds necessary for such 
     compliance, shall reduce on a pro rata basis the amount of 
     each grant pursuant to this subsection for the fiscal year, 
     other than grants for eligible areas for which increases 
     under subparagraph (A) apply. A reduction under the preceding 
     sentence may not be made in an amount that would result in 
     the eligible area involved becoming eligible for such an 
     increase.
       ``(C) Limitation.--This paragraph may not be construed as 
     having any applicability after fiscal year 2009.''.

     SEC. 103. TYPE AND DISTRIBUTION OF GRANTS; SUPPLEMENTAL 
                   GRANTS.

       Section 2603(b) of the Public Health Service Act (42 U.S.C. 
     300ff-13(b)) is amended--
       (1) in paragraph (1)--
       (A) in the matter preceding subparagraph (A), by striking 
     ``Not later than'' and all that follows through ``the 
     Secretary shall'' and inserting the following: ``Subject to 
     subsection (a)(4)(B)(i) and section 2610(d), the Secretary 
     shall'';
       (B) in subparagraph (B), by striking ``demonstrates the 
     severe need in such area'' and inserting ``demonstrates the 
     need in such area, on an objective and quantified basis,'';
       (C) by striking subparagraph (F) and inserting the 
     following:
       ``(F) demonstrates the inclusiveness of affected 
     communities and individuals with HIV/AIDS;'';
       (D) in subparagraph (G), by striking the period and 
     inserting ``; and''; and
       (E) by adding at the end the following:
       ``(H) demonstrates the ability of the applicant to expend 
     funds efficiently by not having had, for the most recent 
     grant year under subsection (a) for which data is available, 
     more than 2 percent of grant funds under such subsection 
     canceled or covered by any waivers under subsection 
     (c)(3).''; and
       (2) in paragraph (2)--
       (A) in subparagraph (A), by striking ``severe need'' and 
     inserting ``demonstrated need'';
       (B) by striking subparagraph (B) and inserting the 
     following:
       ``(B) Demonstrated need.--The factors considered by the 
     Secretary in determining whether an eligible area has a 
     demonstrated need for purposes of paragraph (1)(B) may 
     include any or all of the following:
       ``(i) The unmet need for such services, as determined under 
     section 2602(b)(4) or other community input process as 
     defined under section 2609(d)(1)(A).
       ``(ii) An increasing need for HIV/AIDS-related services, 
     including relative rates of increase in the number of cases 
     of HIV/AIDS.
       ``(iii) The relative rates of increase in the number of 
     cases of HIV/AIDS within new or emerging subpopulations.
       ``(iv) The current prevalence of HIV/AIDS.
       ``(v) Relevant factors related to the cost and complexity 
     of delivering health care to individuals with HIV/AIDS in the 
     eligible area.
       ``(vi) The impact of co-morbid factors, including co-
     occurring conditions, determined relevant by the Secretary.

[[Page 23412]]

       ``(vii) The prevalence of homelessness.
       ``(viii) The prevalence of individuals described under 
     section 2602(b)(2)(M).
       ``(ix) The relevant factors that limit access to health 
     care, including geographic variation, adequacy of health 
     insurance coverage, and language barriers.
       ``(x) The impact of a decline in the amount received 
     pursuant to subsection (a) on services available to all 
     individuals with HIV/AIDS identified and eligible under this 
     title.''; and
       (C) by striking subparagraphs (C) and (D) and inserting the 
     following:
       ``(C) Priority in making grants.--The Secretary shall 
     provide funds under this subsection to an eligible area to 
     address the decline or disruption of all EMA-provided 
     services related to the decline in the amounts received 
     pursuant to subsection (a) consistent with the grant award 
     for the eligible area for fiscal year 2006, to the extent 
     that the factor under subparagraph (B)(x) (relating to a 
     decline in funding) applies to the eligible area.''.

     SEC. 104. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT 
                   FUNDS.

       Section 2603 of the Public Health Service Act (42 U.S.C. 
     300ff-13) is amended--
       (1) by redesignating subsection (c) as subsection (d);
       (2) by inserting after subsection (b) the following:
       ``(c) Timeframe for Obligation and Expenditure of Grant 
     Funds.--
       ``(1) Obligation by end of grant year.--Effective for 
     fiscal year 2007 and subsequent fiscal years, funds from a 
     grant award made pursuant to subsection (a) or (b) for a 
     fiscal year are available for obligation by the eligible area 
     involved through the end of the one-year period beginning on 
     the date in such fiscal year on which funds from the award 
     first become available to the area (referred to in this 
     subsection as the `grant year for the award'), except as 
     provided in paragraph (3)(A).
       ``(2) Supplemental grants; cancellation of unobligated 
     balance of grant award.--Effective for fiscal year 2007 and 
     subsequent fiscal years, if a grant award made pursuant to 
     subsection (b) for an eligible area for a fiscal year has an 
     unobligated balance as of the end of the grant year for the 
     award--
       ``(A) the Secretary shall cancel that unobligated balance 
     of the award, and shall require the eligible area to return 
     any amounts from such balance that have been disbursed to the 
     area; and
       ``(B) the funds involved shall be made available by the 
     Secretary as additional amounts for grants pursuant to 
     subsection (b) for the first fiscal year beginning after the 
     fiscal year in which the Secretary obtains the information 
     necessary for determining that the balance is required under 
     subparagraph (A) to be canceled, except that the availability 
     of the funds for such grants is subject to subsection (a)(4) 
     and section 2610(d)(2) as applied for such year.
       ``(3) Formula grants; cancellation of unobligated balance 
     of grant award; waiver permitting carryover.--
       ``(A) In general.--Effective for fiscal year 2007 and 
     subsequent fiscal years, if a grant award made pursuant to 
     subsection (a) for an eligible area for a fiscal year has an 
     unobligated balance as of the end of the grant year for the 
     award, the Secretary shall cancel that unobligated balance of 
     the award, and shall require the eligible area to return any 
     amounts from such balance that have been disbursed to the 
     area, unless--
       ``(i) before the end of the grant year, the chief elected 
     official of the area submits to the Secretary a written 
     application for a waiver of the cancellation, which 
     application includes a description of the purposes for which 
     the area intends to expend the funds involved; and
       ``(ii) the Secretary approves the waiver.
       ``(B) Expenditure by end of carryover year.--With respect 
     to a waiver under subparagraph (A) that is approved for a 
     balance that is unobligated as of the end of a grant year for 
     an award:
       ``(i) The unobligated funds are available for expenditure 
     by the eligible area involved for the one-year period 
     beginning upon the expiration of the grant year (referred to 
     in this subsection as the `carryover year').
       ``(ii) If the funds are not expended by the end of the 
     carryover year, the Secretary shall cancel that unexpended 
     balance of the award, and shall require the eligible area to 
     return any amounts from such balance that have been disbursed 
     to the area.
       ``(C) Use of cancelled balances.--In the case of any 
     balance of a grant award that is cancelled under subparagraph 
     (A) or (B)(ii), the grant funds involved shall be made 
     available by the Secretary as additional amounts for grants 
     pursuant to subsection (b) for the first fiscal year 
     beginning after the fiscal year in which the Secretary 
     obtains the information necessary for determining that the 
     balance is required under such subparagraph to be canceled, 
     except that the availability of the funds for such grants is 
     subject to subsection (a)(4) and section 2610(d)(2) as 
     applied for such year.
       ``(D) Corresponding reduction in future grant.--
       ``(i) In general.--In the case of an eligible area for 
     which a balance from a grant award under subsection (a) is 
     unobligated as of the end of the grant year for the award--

       ``(I) the Secretary shall reduce, by the same amount as 
     such unobligated balance, the amount of the grant under such 
     subsection for the first fiscal year beginning after the 
     fiscal year in which the Secretary obtains the information 
     necessary for determining that such balance was unobligated 
     as of the end of the grant year (which requirement for a 
     reduction applies without regard to whether a waiver under 
     subparagraph (A) has been approved with respect to such 
     balance); and
       ``(II) the grant funds involved in such reduction shall be 
     made available by the Secretary as additional funds for 
     grants pursuant to subsection (b) for such first fiscal year, 
     subject to subsection (a)(4) and section 2610(d)(2);

     except that this clause does not apply to the eligible area 
     if the amount of the unobligated balance was 2 percent or 
     less.
       ``(ii) Relation to increases in grant.--A reduction under 
     clause (i) for an eligible area for a fiscal year may not be 
     taken into account in applying subsection (a)(4) with respect 
     to the area for the subsequent fiscal year.''; and
       (3) by adding at the end the following:
       ``(e) Report on the Awarding of Supplemental Funds.--Not 
     later than 45 days after the awarding of supplemental funds 
     under this section, the Secretary shall submit to Congress a 
     report concerning such funds. Such report shall include 
     information detailing--
       ``(1) the total amount of supplemental funds available 
     under this section for the year involved;
       ``(2) the amount of supplemental funds used in accordance 
     with the hold harmless provisions of subsection (a)(4);
       ``(3) the amount of supplemental funds disbursed pursuant 
     to subsection (b)(2)(C);
       ``(4) the disbursement of the remainder of the supplemental 
     funds after taking into account the uses described in 
     paragraphs (2) and (3); and
       ``(5) the rationale used for the amount of funds disbursed 
     as described under paragraphs (2), (3), and (4).''.

     SEC. 105. USE OF AMOUNTS.

       Section 2604 of the Public Health Service Act (42 U.S.C. 
     300ff-14) is amended to read as follows:

     ``SEC. 2604. USE OF AMOUNTS.

       ``(a) Requirements.--The Secretary may not make a grant 
     under section 2601(a) to the chief elected official of an 
     eligible area unless such political subdivision agrees that--
       ``(1) subject to paragraph (2), the allocation of funds and 
     services within the eligible area will be made in accordance 
     with the priorities established, pursuant to section 
     2602(b)(4)(C), by the HIV health services planning council 
     that serves such eligible area;
       ``(2) funds provided under section 2601 will be expended 
     only for--
       ``(A) core medical services described in subsection (c);
       ``(B) support services described in subsection (d); and
       ``(C) administrative expenses described in subsection (h); 
     and
       ``(3) the use of such funds will comply with the 
     requirements of this section.
       ``(b) Direct Financial Assistance to Appropriate 
     Entities.--
       ``(1) In general.--The chief elected official of an 
     eligible area shall use amounts from a grant under section 
     2601 to provide direct financial assistance to entities 
     described in paragraph (2) for the purpose of providing core 
     medical services and support services.
       ``(2) Appropriate entities.--Direct financial assistance 
     may be provided under paragraph (1) to public or nonprofit 
     private entities, or private for-profit entities if such 
     entities are the only available provider of quality HIV care 
     in the area.
       ``(c) Required Funding for Core Medical Services.--
       ``(1) In general.--With respect to a grant under section 
     2601 for an eligible area for a grant year, the chief elected 
     official of the area shall, of the portion of the grant 
     remaining after reserving amounts for purposes of paragraphs 
     (1) and (5)(B)(i) of subsection (h), use not less than 75 
     percent to provide core medical services that are needed in 
     the eligible area for individuals with HIV/AIDS who are 
     identified and eligible under this title (including services 
     regarding the co-occurring conditions of the individuals).
       ``(2) Waiver.--
       ``(A) In general.--The Secretary shall waive the 
     application of paragraph (1) with respect to a chief elected 
     official for a grant year if the Secretary determines that, 
     within the eligible area involved--
       ``(i) there are no waiting lists for AIDS Drug Assistance 
     Program services under section 2616; and
       ``(ii) core medical services are available to all 
     individuals with HIV/AIDS identified and eligible under this 
     title.
       ``(B) Notification of waiver status.--When informing the 
     chief elected official of an eligible area that a grant under 
     section 2601 is being made for the area for a grant year, the 
     Secretary shall inform the official whether a waiver under 
     subparagraph (A) is in effect for such year.
       ``(3) Core medical services.--For purposes of this 
     subsection, the term `core medical services', with respect to 
     an individual with HIV/AIDS (including the co-occurring 
     conditions of the individual), means the following services:
       ``(A) Outpatient and ambulatory health services.
       ``(B) AIDS Drug Assistance Program treatments in accordance 
     with section 2616.
       ``(C) AIDS pharmaceutical assistance.
       ``(D) Oral health care.
       ``(E) Early intervention services described in subsection 
     (e).
       ``(F) Health insurance premium and cost sharing assistance 
     for low-income individuals in accordance with section 2615.

[[Page 23413]]

       ``(G) Home health care.
       ``(H) Medical nutrition therapy.
       ``(I) Hospice services.
       ``(J) Home and community-based health services as defined 
     under section 2614(c).
       ``(K) Mental health services.
       ``(L) Substance abuse outpatient care.
       ``(M) Medical case management, including treatment 
     adherence services.
       ``(d) Support Services.--
       ``(1) In general.--For purposes of this section, the term 
     `support services' means services, subject to the approval of 
     the Secretary, that are needed for individuals with HIV/AIDS 
     to achieve their medical outcomes (such as respite care for 
     persons caring for individuals with HIV/AIDS, outreach 
     services, medical transportation, linguistic services, and 
     referrals for health care and support services).
       ``(2) Medical outcomes.--In this subsection, the term 
     `medical outcomes' means those outcomes affecting the HIV-
     related clinical status of an individual with HIV/AIDS.
       ``(e) Early Intervention Services.--
       ``(1) In general.--For purposes of this section, the term 
     `early intervention services' means HIV/AIDS early 
     intervention services described in section 2651(e), with 
     follow-up referral provided for the purpose of facilitating 
     the access of individuals receiving the services to HIV-
     related health services. The entities through which such 
     services may be provided under the grant include public 
     health departments, emergency rooms, substance abuse and 
     mental health treatment programs, detoxification centers, 
     detention facilities, clinics regarding sexually transmitted 
     diseases, homeless shelters, HIV/AIDS counseling and testing 
     sites, health care points of entry specified by eligible 
     areas, federally qualified health centers, and entities 
     described in section 2652(a) that constitute a point of 
     access to services by maintaining referral relationships.
       ``(2) Conditions.--With respect to an entity that proposes 
     to provide early intervention services under paragraph (1), 
     such paragraph shall apply only if the entity demonstrates to 
     the satisfaction of the chief elected official for the 
     eligible area involved that--
       ``(A) Federal, State, or local funds are otherwise 
     inadequate for the early intervention services the entity 
     proposes to provide; and
       ``(B) the entity will expend funds pursuant to such 
     paragraph to supplement and not supplant other funds 
     available to the entity for the provision of early 
     intervention services for the fiscal year involved.
       ``(f) Priority for Women, Infants, Children, and Youth.--
       ``(1) In general.--For the purpose of providing health and 
     support services to infants, children, youth, and women with 
     HIV/AIDS, including treatment measures to prevent the 
     perinatal transmission of HIV, the chief elected official of 
     an eligible area, in accordance with the established 
     priorities of the planning council, shall for each of such 
     populations in the eligible area use, from the grants made 
     for the area under section 2601(a) for a fiscal year, not 
     less than the percentage constituted by the ratio of the 
     population involved (infants, children, youth, or women in 
     such area) with HIV/AIDS to the general population in such 
     area of individuals with HIV/AIDS.
       ``(2) Waiver.--With respect to the population involved, the 
     Secretary may provide to the chief elected official of an 
     eligible area a waiver of the requirement of paragraph (1) if 
     such official demonstrates to the satisfaction of the 
     Secretary that the population is receiving HIV-related health 
     services through the State medicaid program under title XIX 
     of the Social Security Act, the State children's health 
     insurance program under title XXI of such Act, or other 
     Federal or State programs.
       ``(g) Requirement of Status as Medicaid Provider.--
       ``(1) Provision of service.--Subject to paragraph (2), the 
     Secretary may not make a grant under section 2601(a) for the 
     provision of services under this section in a State unless, 
     in the case of any such service that is available pursuant to 
     the State plan approved under title XIX of the Social 
     Security Act for the State--
       ``(A) the political subdivision involved will provide the 
     service directly, and the political subdivision has entered 
     into a participation agreement under the State plan and is 
     qualified to receive payments under such plan; or
       ``(B) the political subdivision will enter into an 
     agreement with a public or nonprofit private entity under 
     which the entity will provide the service, and the entity has 
     entered into such a participation agreement and is qualified 
     to receive such payments.
       ``(2) Waiver.--
       ``(A) In general.--In the case of an entity making an 
     agreement pursuant to paragraph (1)(B) regarding the 
     provision of services, the requirement established in such 
     paragraph shall be waived by the HIV health services planning 
     council for the eligible area if the entity does not, in 
     providing health care services, impose a charge or accept 
     reimbursement available from any third-party payor, including 
     reimbursement under any insurance policy or under any Federal 
     or State health benefits program.
       ``(B) Determination.--A determination by the HIV health 
     services planning council of whether an entity referred to in 
     subparagraph (A) meets the criteria for a waiver under such 
     subparagraph shall be made without regard to whether the 
     entity accepts voluntary donations for the purpose of 
     providing services to the public.
       ``(h) Administration.--
       ``(1) Limitation.--The chief elected official of an 
     eligible area shall not use in excess of 10 percent of 
     amounts received under a grant under this part for 
     administrative expenses.
       ``(2) Allocations by chief elected official.--In the case 
     of entities and subcontractors to which the chief elected 
     official of an eligible area allocates amounts received by 
     the official under a grant under this part, the official 
     shall ensure that, of the aggregate amount so allocated, the 
     total of the expenditures by such entities for administrative 
     expenses does not exceed 10 percent (without regard to 
     whether particular entities expend more than 10 percent for 
     such expenses).
       ``(3) Administrative activities.--For purposes of paragraph 
     (1), amounts may be used for administrative activities that 
     include--
       ``(A) routine grant administration and monitoring 
     activities, including the development of applications for 
     part A funds, the receipt and disbursal of program funds, the 
     development and establishment of reimbursement and accounting 
     systems, the development of a clinical quality management 
     program as described in paragraph (5), the preparation of 
     routine programmatic and financial reports, and compliance 
     with grant conditions and audit requirements; and
       ``(B) all activities associated with the grantee's contract 
     award procedures, including the activities carried out by the 
     HIV health services planning council as established under 
     section 2602(b), the development of requests for proposals, 
     contract proposal review activities, negotiation and awarding 
     of contracts, monitoring of contracts through telephone 
     consultation, written documentation or onsite visits, 
     reporting on contracts, and funding reallocation activities.
       ``(4) Subcontractor administrative activities.--For the 
     purposes of this subsection, subcontractor administrative 
     activities include--
       ``(A) usual and recognized overhead activities, including 
     established indirect rates for agencies;
       ``(B) management oversight of specific programs funded 
     under this title; and
       ``(C) other types of program support such as quality 
     assurance, quality control, and related activities.
       ``(5) Clinical quality management.--
       ``(A) Requirement.--The chief elected official of an 
     eligible area that receives a grant under this part shall 
     provide for the establishment of a clinical quality 
     management program to assess the extent to which HIV health 
     services provided to patients under the grant are consistent 
     with the most recent Public Health Service guidelines for the 
     treatment of HIV/AIDS and related opportunistic infection, 
     and as applicable, to develop strategies for ensuring that 
     such services are consistent with the guidelines for 
     improvement in the access to and quality of HIV health 
     services.
       ``(B) Use of funds.--
       ``(i) In general.--From amounts received under a grant 
     awarded under this subpart for a fiscal year, the chief 
     elected official of an eligible area may use for activities 
     associated with the clinical quality management program 
     required in subparagraph (A) not to exceed the lesser of--

       ``(I) 5 percent of amounts received under the grant; or
       ``(II) $3,000,000.

       ``(ii) Relation to limitation on administrative expenses.--
     The costs of a clinical quality management program under 
     subparagraph (A) may not be considered administrative 
     expenses for purposes of the limitation established in 
     paragraph (1).
       ``(i) Construction.--A chief elected official may not use 
     amounts received under a grant awarded under this part to 
     purchase or improve land, or to purchase, construct, or 
     permanently improve (other than minor remodeling) any 
     building or other facility, or to make cash payments to 
     intended recipients of services.''.

     SEC. 106. ADDITIONAL AMENDMENTS TO PART A.

       (a) Reporting of Cases.--Section 2601(a) of the Public 
     Health Service Act (42 U.S.C. 300ff-11(a)) is amended by 
     striking ``for the most recent period'' and inserting 
     ``during the most recent period''.
       (b) Planning Council Representation.--Section 2602(b)(2)(G) 
     of the Public Health Service Act (42 U.S.C. 300ff-
     12(b)(2)(G)) is amended by inserting ``, members of a 
     Federally recognized Indian tribe as represented in the 
     population, individuals co-infected with hepatitis B or C'' 
     after ``disease''.
       (c) Application for Grant.--
       (1) Payer of last resort.--Section 2605(a)(6)(A) of the 
     Public Health Service Act (42 U.S.C. 300ff-15(a)(6)(A)) is 
     amended by inserting ``(except for a program administered by 
     or providing the services of the Indian Health Service)'' 
     before the semicolon.
       (2) Audits.--Section 2605(a) of the Public Health Service 
     Act (42 U.S.C. 300ff-15(a)) is amended--
       (A) in paragraph (8), by striking ``and'' at the end;
       (B) in paragraph (9), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(10) that the chief elected official will submit to the 
     lead State agency under section 2617(b)(4), audits, 
     consistent with Office of Management and Budget circular 
     A133, regarding funds expended in accordance with this part 
     every 2 years and shall include necessary client-based data 
     to compile unmet need calculations and Statewide coordinated 
     statements of need process.''.
       (3) Coordination.--Section 2605(b) of the Public Health 
     Service Act (42 U.S.C. 300ff-15(b)) is amended--

[[Page 23414]]

       (A) in paragraph (3), by striking ``and'' at the end;
       (B) in paragraph (4), by striking the period and inserting 
     a semicolon; and
       (C) by adding at the end the following:
       ``(5) the manner in which the expected expenditures are 
     related to the planning process for States that receive 
     funding under part B (including the planning process 
     described in section 2617(b)); and
       ``(6) the expected expenditures and how those expenditures 
     will improve overall client outcomes, as described under the 
     State plan under section 2617(b), and through additional 
     outcomes measures as identified by the HIV health services 
     planning council under section 2602(b).''.

     SEC. 107. NEW PROGRAM IN PART A; TRANSITIONAL GRANTS FOR 
                   CERTAIN AREAS INELIGIBLE UNDER SECTION 2601.

       (a) In General.--Part A of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-11) is amended--
       (1) by inserting after the part heading the following:

              ``Subpart I--General Grant Provisions''; and

       (2) by adding at the end the following:

                   ``Subpart II--Transitional Grants

     ``SEC. 2609. ESTABLISHMENT OF PROGRAM.

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall make grants for the purpose of 
     providing services described in section 2604 in transitional 
     areas, subject to the same provisions regarding the 
     allocation of grant funds as apply under subsection (c) of 
     such section.
       ``(b) Transitional Areas.--For purposes of this section, 
     the term `transitional area' means, subject to subsection 
     (c), a metropolitan area for which there has been reported to 
     and confirmed by the Director of the Centers for Disease 
     Control and Prevention a cumulative total of at least 1,000, 
     but fewer than 2,000, cases of AIDS during the most recent 
     period of 5 calendar years for which such data are available.
       ``(c) Certain Eligibility Rules.--
       ``(1) Fiscal year 2007.--With respect to grants under 
     subsection (a) for fiscal year 2007, a metropolitan area that 
     received funding under subpart I for fiscal year 2006 but 
     does not for fiscal year 2007 qualify under such subpart as 
     an eligible area and does not qualify under subsection (b) as 
     a transitional area shall, notwithstanding subsection (b), be 
     considered a transitional area.
       ``(2) Continued status as transitional area.--
       ``(A) In general.--Notwithstanding subsection (b), a 
     metropolitan area that is a transitional area for a fiscal 
     year continues, except as provided in subparagraph (B), to be 
     a transitional area until the metropolitan area fails, for 
     three consecutive fiscal years--
       ``(i) to qualify under such subsection as a transitional 
     area; and
       ``(ii) to have a cumulative total of 1,500 or more living 
     cases of AIDS (reported to and confirmed by the Director of 
     the Centers for Disease Control and Prevention) as of 
     December 31 of the most recent calendar year for which such 
     data is available.
       ``(B) Exception regarding status as eligible area.--
     Subparagraph (A) does not apply for a fiscal year if the 
     metropolitan area involved qualifies under subpart I as an 
     eligible area.
       ``(d) Application of Certain Provisions of Subpart I.--
       ``(1) Administration; planning council.--
       ``(A) In general.--The provisions of section 2602 apply 
     with respect to a grant under subsection (a) for a 
     transitional area to the same extent and in the same manner 
     as such provisions apply with respect to a grant under 
     subpart I for an eligible area, except that, subject to 
     subparagraph (B), the chief elected official of the 
     transitional area may elect not to comply with the provisions 
     of section 2602(b) if the official provides documentation to 
     the Secretary that details the process used to obtain 
     community input (particularly from those with HIV) in the 
     transitional area for formulating the overall plan for 
     priority setting and allocating funds from the grant under 
     subsection (a).
       ``(B) Exception.--For each of the fiscal years 2007 through 
     2009, the exception described in subparagraph (A) does not 
     apply if the transitional area involved received funding 
     under subpart I for fiscal year 2006.
       ``(2) Type and distribution of grants; timeframe for 
     obligation and expenditure of grant funds.--
       ``(A) Formula grants; supplemental grants.--The provisions 
     of section 2603 apply with respect to grants under subsection 
     (a) to the same extent and in the same manner as such 
     provisions apply with respect to grants under subpart I, 
     subject to subparagraphs (B) and (C).
       ``(B) Formula grants; increase in grant.--For purposes of 
     subparagraph (A), section 2603(a)(4) does not apply.
       ``(C) Supplemental grants; single program with subpart i 
     program.--With respect to section 2603(b) as applied for 
     purposes of subparagraph (A):
       ``(i) The Secretary shall combine amounts available 
     pursuant to such subparagraph with amounts available for 
     carrying out section 2603(b) and shall administer the two 
     programs as a single program.
       ``(ii) In the single program, the Secretary has discretion 
     in allocating amounts between eligible areas under subpart I 
     and transitional areas under this section, subject to the 
     eligibility criteria that apply under such section, and 
     subject to section 2603(b)(2)(C) (relating to priority in 
     making grants).
       ``(iii) Pursuant to section 2603(b)(1), amounts for the 
     single program are subject to use under sections 2603(a)(4) 
     and 2610(d)(1).
       ``(3) Application; technical assistance; definitions.--The 
     provisions of sections 2605, 2606, and 2607 apply with 
     respect to grants under subsection (a) to the same extent and 
     in the same manner as such provisions apply with respect to 
     grants under subpart I.''.
       (b) Conforming Amendments.--Subpart I of part A of title 
     XXVI of the Public Health Service Act, as designated by 
     subsection (a)(1) of this section, is amended by striking 
     ``this part'' each place such term appears and inserting 
     ``this subpart''.

     SEC. 108. AUTHORIZATION OF APPROPRIATIONS FOR PART A.

       Part A of title XXVI of the Public Health Service Act, as 
     amended by section 106(a), is amended by adding at the end 
     the following:

                   ``Subpart III--General Provisions

     ``SEC. 2610. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--For the purpose of carrying out this 
     part, there are authorized to be appropriated $604,000,000 
     for fiscal year 2007, $626,300,000 for fiscal year 2008, and 
     $649,500,000 for fiscal year 2009. Amounts appropriated under 
     the preceding sentence for a fiscal year are available for 
     obligation by the Secretary until the end of the second 
     succeeding fiscal year.
       ``(b) Reservation of Amounts.--
       ``(1) Fiscal year 2007.--Of the amount appropriated under 
     subsection (a) for fiscal year 2007, the Secretary shall 
     reserve--
       ``(A) $458,310,000 for grants under subpart I; and
       ``(B) $145,690,000 for grants under section 2609.
       ``(2) Subsequent fiscal years.--Of the amount appropriated 
     under subsection (a) for fiscal year 2008 and each subsequent 
     fiscal year--
       ``(A) the Secretary shall reserve an amount for grants 
     under subpart I; and
       ``(B) the Secretary shall reserve an amount for grants 
     under section 2609.
       ``(c) Transfer of Certain Amounts; Change in Status as 
     Eligible Area or Transitional Area.--Notwithstanding 
     subsection (b):
       ``(1) If a metropolitan area is an eligible area under 
     subpart I for a fiscal year, but for a subsequent fiscal year 
     ceases to be an eligible area by reason of section 2601(b)--
       ``(A)(i) the amount reserved under paragraph (1)(A) or 
     (2)(A) of subsection (b) of this section for the first such 
     subsequent year of not being an eligible area is deemed to be 
     reduced by an amount equal to the amount of the grant made 
     pursuant to section 2603(a) for the metropolitan area for the 
     preceding fiscal year; and
       ``(ii)(I) if the metropolitan area qualifies for such first 
     subsequent fiscal year as a transitional area under 2609, the 
     amount reserved under paragraph (1)(B) or (2)(B) of 
     subsection (b) for such fiscal year is deemed to be increased 
     by an amount equal to the amount of the reduction under 
     subparagraph (A) for such year; or
       ``(II) if the metropolitan area does not qualify for such 
     first subsequent fiscal year as a transitional area under 
     2609, an amount equal to the amount of such reduction is, 
     notwithstanding subsection (a), transferred and made 
     available for grants pursuant to section 2618(a)(1), in 
     addition to amounts available for such grants under section 
     2623; and
       ``(B) if a transfer under subparagraph (A)(ii)(II) is made 
     with respect to the metropolitan area for such first 
     subsequent fiscal year, then--
       ``(i) the amount reserved under paragraph (1)(A) or (2)(A) 
     of subsection (b) of this section for such year is deemed to 
     be reduced by an additional $500,000; and
       ``(ii) an amount equal to the amount of such additional 
     reduction is, notwithstanding subsection (a), transferred and 
     made available for grants pursuant to section 2618(a)(1), in 
     addition to amounts available for such grants under section 
     2623.
       ``(2) If a metropolitan area is a transitional area under 
     section 2609 for a fiscal year, but for a subsequent fiscal 
     year ceases to be a transitional area by reason of section 
     2609(c)(2) (and does not qualify for such subsequent fiscal 
     year as an eligible area under subpart I)--
       ``(A) the amount reserved under subsection (b)(2)(B) of 
     this section for the first such subsequent fiscal year of not 
     being a transitional area is deemed to be reduced by an 
     amount equal to the total of--
       ``(i) the amount of the grant that, pursuant to section 
     2603(a), was made under section 2609(d)(2)(A) for the 
     metropolitan area for the preceding fiscal year; and
       ``(ii) $500,000; and
       ``(B) an amount equal to the amount of the reduction under 
     subparagraph (A) for such year is, notwithstanding subsection 
     (a), transferred and made available for grants pursuant to 
     section 2618(a)(1), in addition to amounts available for such 
     grants under section 2623.
       ``(3) If a metropolitan area is a transitional area under 
     section 2609 for a fiscal year, but for a subsequent fiscal 
     year qualifies as an eligible area under subpart I--
       ``(A) the amount reserved under subsection (b)(2)(B) of 
     this section for the first such subsequent fiscal year of 
     becoming an eligible area is deemed to be reduced by an 
     amount equal to the amount of the grant that, pursuant to 
     section 2603(a), was made under section 2609(d)(2)(A) for the 
     metropolitan area for the preceding fiscal year; and

[[Page 23415]]

       ``(B) the amount reserved under subsection (b)(2)(A) for 
     such fiscal year is deemed to be increased by an amount equal 
     to the amount of the reduction under subparagraph (A) for 
     such year.
       ``(d) Certain Transfers; Allocations Between Programs Under 
     Subpart I.--With respect to paragraphs (1)(B)(i) and 
     (2)(A)(ii) of subsection (c), the Secretary shall administer 
     any reductions under such paragraphs for a fiscal year in 
     accordance with the following:
       ``(1) The reductions shall be made from amounts available 
     for the single program referred to in section 2609(d)(2)(C) 
     (relating to supplemental grants).
       ``(2) The reductions shall be made before the amounts 
     referred to in paragraph (1) are used for purposes of section 
     2603(a)(4).
       ``(3) If the amounts referred to in paragraph (1) are not 
     sufficient for making all the reductions, the reductions 
     shall be reduced until the total amount of the reductions 
     equals the total of the amounts referred to in such 
     paragraph.
       ``(e) Rules of Construction Regarding First Subsequent 
     Fiscal Year.--Paragraphs (1) and (2) of subsection (c) apply 
     with respect to each series of fiscal years during which a 
     metropolitan area is an eligible area under subpart I or a 
     transitional area under section 2609 for a fiscal year and 
     then for a subsequent fiscal year ceases to be such an area 
     by reason of section 2601(b) or 2609(c)(2), respectively, 
     rather than applying to a single such series. Paragraph (3) 
     of subsection (c) applies with respect to each series of 
     fiscal years during which a metropolitan area is a 
     transitional area under section 2609 for a fiscal year and 
     then for a subsequent fiscal year becomes an eligible area 
     under subpart I, rather than applying to a single such 
     series.''.

                         TITLE II--CARE GRANTS

     SEC. 201. GENERAL USE OF GRANTS.

       (a) In General.--Section 2612 of the Public Health Service 
     Act (42 U.S.C. 300ff-22) is amended to read as follows:

     ``SEC. 2612. GENERAL USE OF GRANTS.

       ``(a) In General.--A State may use amounts provided under 
     grants made under section 2611 for--
       ``(1) core medical services described in subsection (b);
       ``(2) support services described in subsection (c); and
       ``(3) administrative expenses described in section 
     2618(b)(3).
       ``(b) Required Funding for Core Medical Services.--
       ``(1) In general.--With respect to a grant under section 
     2611 for a State for a grant year, the State shall, of the 
     portion of the grant remaining after reserving amounts for 
     purposes of subparagraphs (A) and (E)(ii)(I) of section 
     2618(b)(3), use not less than 75 percent to provide core 
     medical services that are needed in the State for individuals 
     with HIV/AIDS who are identified and eligible under this 
     title (including services regarding the co-occurring 
     conditions of the individuals).
       ``(2) Waiver.--
       ``(A) In general.--The Secretary shall waive the 
     application of paragraph (1) with respect to a State for a 
     grant year if the Secretary determines that, within the 
     State--
       ``(i) there are no waiting lists for AIDS Drug Assistance 
     Program services under section 2616; and
       ``(ii) core medical services are available to all 
     individuals with HIV/AIDS identified and eligible under this 
     title.
       ``(B) Notification of waiver status.--When informing a 
     State that a grant under section 2611 is being made to the 
     State for a fiscal year, the Secretary shall inform the State 
     whether a waiver under subparagraph (A) is in effect for the 
     fiscal year.
       ``(3) Core medical services.--For purposes of this 
     subsection, the term `core medical services', with respect to 
     an individual infected with HIV/AIDS (including the co-
     occurring conditions of the individual) means the following 
     services:
       ``(A) Outpatient and ambulatory health services.
       ``(B) AIDS Drug Assistance Program treatments in accordance 
     with section 2616.
       ``(C) AIDS pharmaceutical assistance.
       ``(D) Oral health care.
       ``(E) Early intervention services described in subsection 
     (d).
       ``(F) Health insurance premium and cost sharing assistance 
     for low-income individuals in accordance with section 2615.
       ``(G) Home health care.
       ``(H) Medical nutrition therapy.
       ``(I) Hospice services.
       ``(J) Home and community-based health services as defined 
     under section 2614(c).
       ``(K) Mental health services.
       ``(L) Substance abuse outpatient care.
       ``(M) Medical case management, including treatment 
     adherence services.
       ``(c) Support Services.--
       ``(1) In general.--For purposes of this subsection, the 
     term `support services' means services, subject to the 
     approval of the Secretary, that are needed for individuals 
     with HIV/AIDS to achieve their medical outcomes (such as 
     respite care for persons caring for individuals with HIV/
     AIDS, outreach services, medical transportation, linguistic 
     services, and referrals for health care and support 
     services).
       ``(2) Definition of medical outcomes.--In this subsection, 
     the term `medical outcomes' means those outcomes affecting 
     the HIV-related clinical status of an individual with HIV/
     AIDS.
       ``(d) Early Intervention Services.--
       ``(1) In general.--For purposes of this section, the term 
     `early intervention services' means HIV/AIDS early 
     intervention services described in section 2651(e), with 
     follow-up referral provided for the purpose of facilitating 
     the access of individuals receiving the services to HIV-
     related health services. The entities through which such 
     services may be provided under the grant include public 
     health departments, emergency rooms, substance abuse and 
     mental health treatment programs, detoxification centers, 
     detention facilities, clinics regarding sexually transmitted 
     diseases, homeless shelters, HIV/AIDS counseling and testing 
     sites, health care points of entry specified by States, 
     federally qualified health centers, and entities described in 
     section 2652(a) that constitute a point of access to services 
     by maintaining referral relationships.
       ``(2) Conditions.--With respect to an entity that proposes 
     to provide early intervention services under paragraph (1), 
     such paragraph shall apply only if the entity demonstrates to 
     the satisfaction of the chief elected official for the State 
     involved that--
       ``(A) Federal, State, or local funds are otherwise 
     inadequate for the early intervention services the entity 
     proposes to provide; and
       ``(B) the entity will expend funds pursuant to such 
     subparagraph to supplement and not supplant other funds 
     available to the entity for the provision of early 
     intervention services for the fiscal year involved.
       ``(e) Priority for Women, Infants, Children, and Youth.--
       ``(1) In general.--For the purpose of providing health and 
     support services to infants, children, youth, and women with 
     HIV/AIDS, including treatment measures to prevent the 
     perinatal transmission of HIV, a State shall for each of such 
     populations in the eligible area use, from the grants made 
     for the area under section 2601(a) for a fiscal year, not 
     less than the percentage constituted by the ratio of the 
     population involved (infants, children, youth, or women in 
     such area) with HIV/AIDS to the general population in such 
     area of individuals with HIV/AIDS.
       ``(2) Waiver.--With respect to the population involved, the 
     Secretary may provide to a State a waiver of the requirement 
     of paragraph (1) if such State demonstrates to the 
     satisfaction of the Secretary that the population is 
     receiving HIV-related health services through the State 
     medicaid program under title XIX of the Social Security Act, 
     the State children's health insurance program under title XXI 
     of such Act, or other Federal or State programs.
       ``(f) Construction.--A State may not use amounts received 
     under a grant awarded under section 2611 to purchase or 
     improve land, or to purchase, construct, or permanently 
     improve (other than minor remodeling) any building or other 
     facility, or to make cash payments to intended recipients of 
     services.''.
       (b) HIV Care Consortia.--Section 2613 of the Public Health 
     Service Act (42 U.S.C. 300ff-23) is amended--
       (1) in subsection (a), in the matter preceding paragraph 
     (1)--
       (A) by striking ``may use'' and inserting ``may, subject to 
     subsection (f), use''; and
       (B) by striking ``section 2612(a)(1)'' and inserting 
     ``section 2612(a)''; and
       (2) by adding at the end the following subsection:
       ``(f) Allocation of Funds; Treatment as Support Services.--
     For purposes of the requirement of section 2612(b)(1), 
     expenditures of grants under section 2611 for or through 
     consortia under this section are deemed to be support 
     services, not core medical services. The preceding sentence 
     may not be construed as having any legal effect on the 
     provisions of subsection (a) that relate to authorized 
     expenditures of the grant.''.
       (c) Technical Amendments.--Part B of title XXVI of the 
     Public Health Service Act (42 U.S.C. 300ff-21 et seq.) is 
     amended--
       (1) in section 2611--
       (A) in subsection (a), by striking the subsection 
     designation and heading; and
       (B) by striking subsection (b);
       (2) in section 2614--
       (A) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``section 2612(a)(2)'' and inserting 
     ``section 2612(b)(3)(J)''; and
       (B) in subsection (c)(2)(B), by striking ``homemaker or'';
       (3) in section 2615(a) by striking ``section 2612(a)(3)'' 
     and inserting ``section 2612(b)(3)(F)''; and
       (4) in section 2616(a) by striking ``section 2612(a)(5)'' 
     and inserting ``section 2612(b)(3)(B)''.

     SEC. 202. AIDS DRUG ASSISTANCE PROGRAM.

       (a) Requirement of Minimum Drug List.--Section 2616 of the 
     Public Health Service Act (42 U.S.C. 300ff-26) is amended--
       (1) in subsection (c), by striking paragraph (1) and 
     inserting the following:
       ``(1) ensure that the therapeutics included on the list of 
     classes of core antiretroviral therapeutics established by 
     the Secretary under subsection (e) are, at a minimum, the 
     treatments provided by the State pursuant to this section;'';
       (2) by redesignating subsection (e) as subsection (f); and
       (3) by inserting after subsection (d) the following:
       ``(e) List of Classes of Core Antiretroviral 
     Therapeutics.--For purposes of subsection (c)(1), the 
     Secretary shall develop and maintain a list of classes of 
     core antiretroviral therapeutics, which list shall be based 
     on the therapeutics included in the guidelines of the 
     Secretary known as the Clinical

[[Page 23416]]

     Practice Guidelines for Use of HIV/AIDS Drugs, relating to 
     drugs needed to manage symptoms associated with HIV. The 
     preceding sentence does not affect the authority of the 
     Secretary to modify such Guidelines.''.
       (b) Drug Rebate Program.--Section 2616 of the Public Health 
     Service Act, as amended by subsection (a)(2) of this section, 
     is amended by adding at the end the following:
       ``(g) Drug Rebate Program.--A State shall ensure that any 
     drug rebates received on drugs purchased from funds provided 
     pursuant to this section are applied to activities supported 
     under this subpart, with priority given to activities 
     described under this section.''.

     SEC. 203. DISTRIBUTION OF FUNDS.

       (a) Distribution Based on Living Cases of HIV/AIDS.--
       (1) State distribution factor.--Section 2618(a)(2) of the 
     Public Health Service Act (42 U.S.C. 300ff-28(a)(2)) is 
     amended--
       (A) in subparagraph (B), by striking ``estimated number of 
     living cases of acquired immune deficiency syndrome in the 
     eligible area involved'' and inserting ``number of living 
     cases of HIV/AIDS in the State involved''; and
       (B) by amending subparagraph (D) to read as follows:
       ``(D) Living cases of hiv/aids.--
       ``(i) Requirement of names-based reporting.--Except as 
     provided in clause (ii), the number determined under this 
     subparagraph for a State for a fiscal year for purposes of 
     subparagraph (B) is the number of living names-based cases of 
     HIV/AIDS in the State that, as of December 31 of the most 
     recent calendar year for which such data is available, have 
     been reported to and confirmed by the Director of the Centers 
     for Disease Control and Prevention.
       ``(ii) Transition period; exemption regarding non-aids 
     cases.--For each of the fiscal years 2007 through 2009, a 
     State is, subject to clauses (iii) through (v), exempt from 
     the requirement under clause (i) that living non-AIDS names-
     based cases of HIV be reported unless--

       ``(I) a system was in operation as of December 31, 2005, 
     that provides sufficiently accurate and reliable names-based 
     reporting of such cases throughout the State, subject to 
     clause (vii); or
       ``(II) no later than the beginning of fiscal year 2008 or 
     2009, the Secretary, after consultation with the chief 
     executive of the State, determines that a system has become 
     operational in the State that provides sufficiently accurate 
     and reliable names-based reporting of such cases throughout 
     the State.

       ``(iii) Requirements for exemption for fiscal year 2007.--
     For fiscal year 2007, an exemption under clause (ii) for a 
     State applies only if, by October 1, 2006--

       ``(I)(aa) the State had submitted to the Secretary a plan 
     for making the transition to sufficiently accurate and 
     reliable names-based reporting of living non-AIDS cases of 
     HIV; or
       ``(bb) all statutory changes necessary to provide for 
     sufficiently accurate and reliable reporting of such cases 
     had been made; and
       ``(II) the State had agreed that, by April 1, 2008, the 
     State will begin accurate and reliable names-based reporting 
     of such cases, except that such agreement is not required to 
     provide that, as of such date, the system for such reporting 
     be fully sufficient with respect to accuracy and reliability 
     throughout the area.

       ``(iv) Requirement for exemption as of fiscal year 2008.--
     For each of the fiscal years 2008 through 2010, an exemption 
     under clause (ii) for a State applies only if, as of April 1, 
     2008, the State is substantially in compliance with the 
     agreement under clause (iii)(II).
       ``(v) Progress toward names-based reporting.--For fiscal 
     year 2009, the Secretary may terminate an exemption under 
     clause (ii) for a State if the State submitted a plan under 
     clause (iii)(I)(aa) and the Secretary determines that the 
     State is not substantially following the plan.
       ``(vi) Counting of cases in areas with exemptions.--

       ``(I) In general.--With respect to a State that is under a 
     reporting system for living non-AIDS cases of HIV that is not 
     names-based (referred to in this subparagraph as `code-based 
     reporting'), the Secretary shall, for purposes of this 
     subparagraph, modify the number of such cases reported for 
     the State in order to adjust for duplicative reporting in and 
     among systems that use code-based reporting.
       ``(II) Adjustment rate.--The adjustment rate under 
     subclause (I) for a State shall be a reduction of 5 percent 
     in the number of living non-AIDS cases of HIV reported for 
     the State.

       ``(vii) List of states meeting standard regarding December 
     31, 2005.--

       ``(I) In general.--If a State is specified in subclause 
     (II), the State shall be considered to meet the standard 
     described in clause (ii)(I). No other State may be considered 
     to meet such standard.
       ``(II) Relevant states.--For purposes of subclause (I), the 
     States specified in this subclause are the following: Alaska, 
     Alabama, Arkansas, Arizona, Colorado, Florida, Indiana, Iowa, 
     Idaho, Kansas, Louisiana, Michigan, Minnesota, Missouri, 
     Mississippi, North Carolina, North Dakota, Nebraska, New 
     Jersey, New Mexico, New York, Nevada, Ohio, Oklahoma, South 
     Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, 
     Wisconsin, West Virginia, Wyoming, Guam, and the Virgin 
     Islands.

       ``(viii) Rules of construction regarding acceptance of 
     reports.--

       ``(I) Cases of aids.--With respect to a State that is 
     subject to the requirement under clause (i) and is not in 
     compliance with the requirement for names-based reporting of 
     living non-AIDS cases of HIV, the Secretary shall, 
     notwithstanding such noncompliance, accept reports of living 
     cases of AIDS that are in accordance with such clause.
       ``(II) Applicability of exemption requirements.--The 
     provisions of clauses (ii) through (vii) may not be construed 
     as having any legal effect for fiscal year 2010 or any 
     subsequent fiscal year, and accordingly, the status of a 
     State for purposes of such clauses may not be considered 
     after fiscal year 2009.

       ``(ix) Program for detecting inaccurate or fraudulent 
     counting.--The Secretary shall carry out a program to monitor 
     the reporting of names-based cases for purposes of this 
     subparagraph and to detect instances of inaccurate reporting, 
     including fraudulent reporting.''.
       (2) Non-ema distribution factor.--Section 2618(a)(2)(C) of 
     the Public Health Service Act (42 U.S.C. 300ff-28(a)(2)(C)) 
     is amended--
       (A) in clause (i), by striking ``estimated number of living 
     cases of acquired immune deficiency syndrome'' each place 
     such term appears and inserting ``number of living cases of 
     HIV/AIDS''; and
       (B) in clause (ii), by amending such clause to read as 
     follows:
       ``(ii) a number equal to the sum of--

       ``(I) the total number of living cases of HIV/AIDS that are 
     within areas in such State that are eligible areas under 
     subpart I of part A for the fiscal year involved, which 
     individual number for an area is the number that applies 
     under section 2601 for the area for such fiscal year; and
       ``(II) the total number of such cases that are within areas 
     in such State that are transitional areas under section 2609 
     for such fiscal year, which individual number for an area is 
     the number that applies under such section for the fiscal 
     year.''.

       (b) Formula Amendments Generally.--Section 2618(a)(2) of 
     the Public Health Service Act (42 U.S.C. 300ff-28(a)(2)) is 
     amended--
       (1) in subparagraph (A)--
       (A) by striking ``The amount referred to'' in the matter 
     preceding clause (i) and all that follows through the end of 
     clause (i) and inserting the following: ``For purposes of 
     paragraph (1), the amount referred to in this paragraph for a 
     State (including a territory) for a fiscal year is, subject 
     to subparagraphs (E) and (F)--
       ``(i) an amount equal to the amount made available under 
     section 2623 for the fiscal year involved for grants pursuant 
     to paragraph (1), subject to subparagraph (G); and''; and
       (B) in clause (ii)--
       (i) in subclause (I)--

       (I) by striking ``.80'' and inserting ``0.75''; and
       (II) by striking ``and'' at the end;

       (ii) in subclause (II)--

       (I) by inserting ``non-EMA'' after ``respective''; and
       (II) by striking the period and inserting ``; and''; and

       (iii) by adding at the end the following:

       ``(III) if the State does not for such fiscal year contain 
     any area that is an eligible area under subpart I of part A 
     or any area that is a transitional area under section 2609 
     (referred to in this subclause as a `no-EMA State'), the 
     product of 0.05 and the ratio of the number of cases that 
     applies for the State under subparagraph (D) to the sum of 
     the respective numbers of cases that so apply for all no-EMA 
     States.'';

       (2) by striking subparagraphs (E) through (H);
       (3) by inserting after subparagraph (D) the following 
     subparagraphs:
       ``(E) Code-based states; limitation on increase in grant.--
       ``(i) In general.--For each of the fiscal years 2007 
     through 2009, if code-based reporting (within the meaning of 
     subparagraph (D)(vi)) applies in a State as of the beginning 
     of the fiscal year involved, then notwithstanding any other 
     provision of this paragraph, the amount of the grant pursuant 
     to paragraph (1) for the State may not for the fiscal year 
     involved exceed by more than 5 percent the amount of the 
     grant pursuant to this paragraph for the State for the 
     preceding fiscal year, except that the limitation under this 
     clause may not result in a grant pursuant to paragraph (1) 
     for a fiscal year that is less than the minimum amount that 
     applies to the State under such paragraph for such fiscal 
     year.
       ``(ii) Use of amounts involved.--For each of the fiscal 
     years 2007 through 2009, amounts available as a result of the 
     limitation under clause (i) shall be made available by the 
     Secretary as additional amounts for grants pursuant to 
     section 2620, subject to subparagraph (H).''; and
       (4) by redesignating subparagraph (I) as subparagraph (F).
       (c) Separate ADAP Grants.--Section 2618(a)(2)(G) of the 
     Public Health Service Act (42 U.S.C. 300ff-28(a)(2)(G)), as 
     redesignated by subsection (b)(4) of this section, is 
     amended--
       (1) in clause (i)--
       (A) in the matter preceding subclause (I), by striking 
     ``section 2677'' and inserting ``section 2623'';
       (B) in subclause (II), by striking the period at the end 
     and inserting a semicolon; and
       (C) by adding after and below subclause (II) the following:

     ``which product shall then, as applicable, be increased under 
     subparagraph (H).'';
       (2) in clause (ii)--
       (A) by striking subclauses (I) through (III) and inserting 
     the following:

       ``(I) In general.--From amounts made available under 
     subclause (V), the Secretary shall award supplemental grants 
     to States described in subclause (II) to enable such States 
     to purchase and distribute to eligible individuals under 
     section 2616(b) pharmaceutical therapeutics described under 
     subsections (c)(2) and (e) of such section.

[[Page 23417]]

       ``(II) Eligible states.--For purposes of subclause (I), a 
     State shall be an eligible State if the State did not have 
     unobligated funds subject to reallocation under section 
     2618(d) in the previous fiscal year and, in accordance with 
     criteria established by the Secretary, demonstrates a severe 
     need for a grant under this clause. For purposes of 
     determining severe need, the Secretary shall consider 
     eligibility standards, formulary composition, the number of 
     eligible individuals to whom a State is unable to provide 
     therapeutics described in section 2616(a), and an 
     unanticipated increase of eligible individuals with HIV/AIDS.
       ``(III) State requirements.--The Secretary may not make a 
     grant to a State under this clause unless the State agrees 
     that the State will make available (directly or through 
     donations of public or private entities) non-Federal 
     contributions toward the activities to be carried out under 
     the grant in an amount equal to $1 for each $4 of Federal 
     funds provided in the grant, except that the Secretary may 
     waive this subclause if the State has otherwise fully 
     complied with section 2617(d) with respect to the grant year 
     involved. The provisions of this subclause shall apply to 
     States that are not required to comply with such section 
     2617(d).''.

       (B) in subclause (IV), by moving the subclause two ems to 
     the left;
       (C) in subclause (V), by striking ``3 percent'' and 
     inserting ``5 percent''; and
       (D) by striking subclause (VI); and
       (3) by adding at the end the following clause:
       ``(iii) Code-based states; limitation on increase in 
     formula grant.--The limitation under subparagraph (E)(i) 
     applies to grants pursuant to clause (i) of this subparagraph 
     to the same extent and in the same manner as such limitation 
     applies to grants pursuant to paragraph (1), except that the 
     reference to minimum grants does not apply for purposes of 
     this clause. Amounts available as a result of the limitation 
     under the preceding sentence shall be made available by the 
     Secretary as additional amounts for grants under clause (ii) 
     of this subparagraph.''.
       (d) Hold Harmless.--Section 2618(a)(2) of the Public Health 
     Service Act (42 U.S.C. 300ff-28(a)(2)), as amended by 
     subsection (b)(4) of this section, is amended by adding at 
     the end the following subparagraph:
       ``(H) Increase in formula grants.--
       ``(i) Assurance of amount.--

       ``(I) General rule.--For fiscal year 2007, the Secretary 
     shall ensure, subject to clauses (ii) through (iv), that the 
     total for a State of the grant pursuant to paragraph (1) and 
     the grant pursuant to subparagraph (G) is not less than 95 
     percent of such total for the State for fiscal year 2006.
       ``(II) Rule of construction.--With respect to the 
     application of subclause (I), the 95 percent requirement 
     under such subclause shall apply with respect to each grant 
     awarded under paragraph (1) and with respect to each grant 
     awarded under subparagraph (G).

       ``(ii) Fiscal year 2007.--For purposes of clause (i) as 
     applied for fiscal year 2007, the references in such clause 
     to subparagraph (G) are deemed to be references to 
     subparagraph (I) as such subparagraph was in effect for 
     fiscal year 2006.
       ``(iii) Fiscal years 2008 and 2009.--For each of the fiscal 
     years 2008 and 2009, the Secretary shall ensure that the 
     total for a State of the grant pursuant to paragraph (1) and 
     the grant pursuant to subparagraph (G) is not less than 100 
     percent of such total for the State for fiscal year 2007.
       ``(iv) Source of funds for increase.--

       ``(I) In general.--From the amount reserved under section 
     2623(b)(2) for a fiscal year, and from amounts available for 
     such section pursuant to subsection (d) of this section, the 
     Secretary shall make available such amounts as may be 
     necessary to comply with clause (i).
       ``(II) Pro rata reduction.--If the amounts referred to in 
     subclause (I) for a fiscal year are insufficient to fully 
     comply with clause (i) for the year, the Secretary, in order 
     to provide the additional funds necessary for such 
     compliance, shall reduce on a pro rata basis the amount of 
     each grant pursuant to paragraph (1) for the fiscal year, 
     other than grants for States for which increases under clause 
     (i) apply and other than States described in paragraph 
     (1)(A)(i)(I). A reduction under the preceding sentence may 
     not be made in an amount that would result in the State 
     involved becoming eligible for such an increase.

       ``(v) Applicability.--This paragraph may not be construed 
     as having any applicability after fiscal year 2009.''.
       (e) Administrative Expenses; Clinical Quality Management.--
     Section 2618(b) of the Public Health Service Act (42 U.S.C. 
     300ff-28(b)) is amended--
       (1) by redesignating paragraphs (2) through (7) as 
     paragraphs (1) through (6);
       (2) in paragraph (2) (as so redesignated)--
       (A) by striking ``paragraph (5)'' and inserting ``paragraph 
     (4)''; and
       (B) by striking ``paragraph (6)'' and inserting ``paragraph 
     (5)'';
       (3) in paragraph (3) (as so redesignated)--
       (A) by amending subparagraph (A) to read as follows:
       ``(A) In general.--Subject to paragraph (4,) and except as 
     provided in paragraph (5), a State may not use more than 10 
     percent of amounts received under a grant awarded under 
     section 2611 for administration.'';
       (B) by redesignating subparagraphs (B) and (C) as 
     subparagraphs (C) and (D), respectively;
       (C) by inserting after subparagraph (A) the following:
       ``(B) Allocations.--In the case of entities and 
     subcontractors to which a State allocates amounts received by 
     the State under a grant under section 2611, the State shall 
     ensure that, of the aggregate amount so allocated, the total 
     of the expenditures by such entities for administrative 
     expenses does not exceed 10 percent (without regard to 
     whether particular entities expend more than 10 percent for 
     such expenses).'';
       (D) in subparagraph (C) (as so redesignated), by inserting 
     before the period the following: ``, including a clinical 
     quality management program under subparagraph (E)''; and
       (E) by adding at the end the following:
       ``(E) Clinical quality management.--
       ``(i) Requirement.--Each State that receives a grant under 
     section 2611 shall provide for the establishment of a 
     clinical quality management program to assess the extent to 
     which HIV health services provided to patients under the 
     grant are consistent with the most recent Public Health 
     Service guidelines for the treatment of HIV/AIDS and related 
     opportunistic infection, and as applicable, to develop 
     strategies for ensuring that such services are consistent 
     with the guidelines for improvement in the access to and 
     quality of HIV health services.
       ``(ii) Use of funds.--

       ``(I) In general.--From amounts received under a grant 
     awarded under section 2611 for a fiscal year, a State may use 
     for activities associated with the clinical quality 
     management program required in clause (i) not to exceed the 
     lesser of--

       ``(aa) 5 percent of amounts received under the grant; or
       ``(bb) $3,000,000.

       ``(II) Relation to limitation on administrative expenses.--
     The costs of a clinical quality management program under 
     clause (i) may not be considered administrative expenses for 
     purposes of the limitation established in subparagraph 
     (A).'';

       (4) in paragraph (4) (as so redesignated)--
       (A) by striking ``paragraph (6)'' and inserting ``paragraph 
     (5)''; and
       (B) by striking ``paragraphs (3) and (4)'' and inserting 
     ``paragraphs (2) and (3)''; and
       (5) in paragraph (5) (as so redesignated), by striking 
     ``paragraphs (3)'' and all that follows through ``(5),'' and 
     inserting the following: ``paragraphs (2) and (3), may, 
     notwithstanding paragraphs (2) through (4),''.
       (f) Reallocation for Supplemental Grants.--Section 2618(d) 
     of the Public Health Service Act (42 U.S.C. 300ff-28(d)) is 
     amended to read as follows:
       ``(d) Reallocation.--Any portion of a grant made to a State 
     under section 2611 for a fiscal year that has not been 
     obligated as described in subsection (c) ceases to be 
     available to the State and shall be made available by the 
     Secretary for grants under section 2620, in addition to 
     amounts made available for such grants under section 
     2623(b)(2).''.
       (g) Definitions; Other Technical Amendments.--Section 
     2618(a) of the Public Health Service Act (42 U.S.C. 300ff-
     28(a)) is amended--
       (1) in paragraph (1), in the matter preceding subparagraph 
     (A), by striking ``section 2677'' and inserting ``section 
     2623'';
       (2) in paragraph (1)(A)--
       (A) in the matter preceding clause (i), by striking ``each 
     of the several States and the District of Columbia'' and 
     inserting ``each of the 50 States, the District of Columbia, 
     Guam, and the Virgin Islands (referred to in this paragraph 
     as a `covered State')''; and
       (B) in clause (i)--
       (i) in subclause (I), by striking ``State or District'' and 
     inserting ``covered State''; and
       (ii) in subclause (II)--

       (I) by striking ``State or District'' and inserting 
     ``covered State''; and
       (II) by inserting ``and'' after the semicolon; and

       (3) in paragraph (1)(B), by striking ``each territory of 
     the United States, as defined in paragraph (3),'' and 
     inserting ``each territory other than Guam and the Virgin 
     Islands'';
       (4) in paragraph (2)(C)(i), by striking ``or territory''; 
     and
       (5) by striking paragraph (3).

     SEC. 204. ADDITIONAL AMENDMENTS TO SUBPART I OF PART B.

       (a) References to Part B.--Subpart I of part B of title 
     XXVI of the Public Health Service Act (42 U.S.C. 300ff-21 et 
     seq.) is amended by striking ``this part'' each place such 
     term appears and inserting ``section 2611''.
       (b) Hepatitis.--Section 2614(a)(3) of the Public Health 
     Service Act (42 U.S.C. 300ff-24(a)(3)) is amended by 
     inserting ``, including specialty care and vaccinations for 
     hepatitis co-infection,'' after ``health services''.
       (c) Application for Grant.--
       (1) Coordination.--Section 2617(b) of the Public Health 
     Service Act (42 U.S.C. 300ff-27(b)) is amended--
       (A) by redesignating paragraphs (4) through (6) as 
     paragraphs (5) through (7), respectively;
       (B) by inserting after paragraph (3), the following:
       ``(4) the designation of a lead State agency that shall--
       ``(A) administer all assistance received under this part;
       ``(B) conduct the needs assessment and prepare the State 
     plan under paragraph (3);
       ``(C) prepare all applications for assistance under this 
     part;
       ``(D) receive notices with respect to programs under this 
     title;
       ``(E) every 2 years, collect and submit to the Secretary 
     all audits, consistent with Office of

[[Page 23418]]

     Management and Budget circular A133, from grantees within the 
     State, including audits regarding funds expended in 
     accordance with this part; and
       ``(F) carry out any other duties determined appropriate by 
     the Secretary to facilitate the coordination of programs 
     under this title.'';
       (C) in paragraph (5) (as so redesignated)--
       (i) in subparagraph (E), by striking ``and'' at the end; 
     and
       (ii) by inserting after subparagraph (F) the following:
       ``(G) includes key outcomes to be measured by all entities 
     in the State receiving assistance under this title; and''; 
     and
       (D) in paragraph (7) (as so redesignated), in subparagraph 
     (A)--
       (i) by striking ``paragraph (5)'' and inserting ``paragraph 
     (6)''; and
       (ii) by striking ``paragraph (4)'' and inserting 
     ``paragraph (5)''.
       (2) Native american representation.--Section 2617(b)(6) of 
     the Public Health Service Act, as redesignated by paragraph 
     (1)(A) of this subsection, is amended by inserting before 
     ``representatives of grantees'' the following: ``members of a 
     Federally recognized Indian tribe as represented in the 
     State,''.
       (3) Payer of last resort.--Section 2617(b)(7)(F)(ii) of the 
     Public Health Service Act, as redesignated by paragraph 
     (1)(A) of this subsection, is amended by inserting before the 
     semicolon the following: ``(except for a program administered 
     by or providing the services of the Indian Health Service)''.
       (d) Matching Funds; Applicability of Requirement.--Section 
     2617(d)(3) of the Public Health Service Act (42 U.S.C. 300ff-
     27(d)(3)) is amended--
       (1) in subparagraph (A), by striking ``acquired immune 
     deficiency syndrome'' and inserting ``HIV/AIDS''; and
       (2) in subparagraph (C), by striking ``acquired immune 
     deficiency syndrome'' and inserting ``HIV/AIDS''.

     SEC. 205. SUPPLEMENTAL GRANTS ON BASIS OF DEMONSTRATED NEED.

       Subpart I of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-21 et seq.) is amended--
       (1) by redesignating section 2620 as section 2621; and
       (2) by inserting after section 2619 the following:

     ``SEC. 2620. SUPPLEMENTAL GRANTS.

       ``(a) In General.--For the purpose of providing services 
     described in section 2612(a), the Secretary shall make grants 
     to States--
       ``(1) whose applications under section 2617 have 
     demonstrated the need in the State, on an objective and 
     quantified basis, for supplemental financial assistance to 
     provide such services; and
       ``(2) that did not, for the most recent grant year pursuant 
     to section 2618(a)(1) or 2618(a)(2)(G)(i) for which data is 
     available, have more than 2 percent of grant funds under such 
     sections canceled or covered by any waivers under section 
     2622(c).
       ``(b) Demonstrated Need.--The factors considered by the 
     Secretary in determining whether an eligible area has a 
     demonstrated need for purposes of subsection (a)(1) may 
     include any or all of the following:
       ``(1) The unmet need for such services, as determined under 
     section 2617(b).
       ``(2) An increasing need for HIV/AIDS-related services, 
     including relative rates of increase in the number of cases 
     of HIV/AIDS.
       ``(3) The relative rates of increase in the number of cases 
     of HIV/AIDS within new or emerging subpopulations.
       ``(4) The current prevalence of HIV/AIDS.
       ``(5) Relevant factors related to the cost and complexity 
     of delivering health care to individuals with HIV/AIDS in the 
     eligible area.
       ``(6) The impact of co-morbid factors, including co-
     occurring conditions, determined relevant by the Secretary.
       ``(7) The prevalence of homelessness.
       ``(8) The prevalence of individuals described under section 
     2602(b)(2)(M).
       ``(9) The relevant factors that limit access to health 
     care, including geographic variation, adequacy of health 
     insurance coverage, and language barriers.
       ``(10) The impact of a decline in the amount received 
     pursuant to section 2618 on services available to all 
     individuals with HIV/AIDS identified and eligible under this 
     title.
       ``(c) Priority in Making Grants.--The Secretary shall 
     provide funds under this section to a State to address the 
     decline in services related to the decline in the amounts 
     received pursuant to section 2618 consistent with the grant 
     award to the State for fiscal year 2006, to the extent that 
     the factor under subsection (b)(10) (relating to a decline in 
     funding) applies to the State.
       ``(d) Report on the Awarding of Supplemental Funds.--Not 
     later than 45 days after the awarding of supplemental funds 
     under this section, the Secretary shall submit to Congress a 
     report concerning such funds. Such report shall include 
     information detailing--
       ``(1) the total amount of supplemental funds available 
     under this section for the year involved;
       ``(2) the amount of supplemental funds used in accordance 
     with the hold harmless provisions of section 2618(a)(2);
       ``(3) the amount of supplemental funds disbursed pursuant 
     to subsection (c);
       ``(4) the disbursement of the remainder of the supplemental 
     funds after taking into account the uses described in 
     paragraphs (2) and (3); and
       ``(5) the rationale used for the amount of funds disbursed 
     as described under paragraphs (2), (3), and (4).
       ``(e) Core Medical Services.--The provisions of section 
     2612(b) apply with respect to a grant under this section to 
     the same extent and in the same manner as such provisions 
     apply with respect to a grant made pursuant to section 
     2618(a)(1).
       ``(f) Applicability of Grant Authority.--The authority to 
     make grants under this section applies beginning with the 
     first fiscal year for which amounts are made available for 
     such grants under section 2623(b)(1).''.

     SEC. 206. EMERGING COMMUNITIES.

       Section 2621 of the Public Health Service Act, as 
     redesignated by section 205(1) of this Act, is amended--
       (1) in the heading for the section, by striking 
     ``SUPPLEMENTAL GRANTS'' and inserting ``EMERGING 
     COMMUNITIES'';
       (2) in subsection (b)--
       (A) in paragraph (2), by striking ``and'' at the end;
       (B) by redesignating paragraph (3) as paragraph (4); and
       (C) by inserting after paragraph (2) the following:
       ``(3) agree that the grant will be used to provide funds 
     directly to emerging communities in the State, separately 
     from other funds under this title that are provided by the 
     State to such communities; and''.
       (3) by striking subsections (d) and (e) and inserting the 
     following:
       ``(d) Definitions of Emerging Community.--For purposes of 
     this section, the term `emerging community' means a 
     metropolitan area (as defined in section 2607) for which 
     there has been reported to and confirmed by the Director of 
     the Centers for Disease Control and Prevention a cumulative 
     total of at least 500, but fewer than 1,000, cases of AIDS 
     during the most recent period of 5 calendar years for which 
     such data are available.
       ``(e) Continued Status as Emerging Community.--
     Notwithstanding any other provision of this section, a 
     metropolitan area that is an emerging community for a fiscal 
     year continues to be an emerging community until the 
     metropolitan area fails, for three consecutive fiscal years--
       ``(1) to meet the requirements of subsection (d); and
       ``(2) to have a cumulative total of 750 or more living 
     cases of AIDS (reported to and confirmed by the Director of 
     the Centers for Disease Control and Prevention) as of 
     December 31 of the most recent calendar year for which such 
     data is available.
       ``(f) Distribution.--The amount of a grant under subsection 
     (a) for a State for a fiscal year shall be an amount equal to 
     the product of--
       ``(1) the amount available under section 2623(b)(1) for the 
     fiscal year; and
       ``(2) a percentage equal to the ratio constituted by the 
     number of living cases of HIV/AIDS in emerging communities in 
     the State to the sum of the respective numbers of such cases 
     in such communities for all States.''.

     SEC. 207. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT 
                   FUNDS.

       Subpart I of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-21 et seq.), as amended by 
     section 205, is further amended by adding at the end the 
     following:

     ``SEC. 2622. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF 
                   GRANT FUNDS.

       ``(a) Obligation by End of Grant Year.--Effective for 
     fiscal year 2007 and subsequent fiscal years, funds from a 
     grant award made to a State for a fiscal year pursuant to 
     section 2618(a)(1) or 2618(a)(2)(G), or under section 2620 or 
     2621, are available for obligation by the State through the 
     end of the one-year period beginning on the date in such 
     fiscal year on which funds from the award first become 
     available to the State (referred to in this section as the 
     `grant year for the award'), except as provided in subsection 
     (c)(1).
       ``(b) Supplemental Grants; Cancellation of Unobligated 
     Balance of Grant Award.--Effective for fiscal year 2007 and 
     subsequent fiscal years, if a grant award made to a State for 
     a fiscal year pursuant to section 2618(a)(2)(G)(ii), or under 
     section 2620 or 2621, has an unobligated balance as of the 
     end of the grant year for the award--
       ``(1) the Secretary shall cancel that unobligated balance 
     of the award, and shall require the State to return any 
     amounts from such balance that have been disbursed to the 
     State; and
       ``(2) the funds involved shall be made available by the 
     Secretary as additional amounts for grants pursuant to 
     section 2620 for the first fiscal year beginning after the 
     fiscal year in which the Secretary obtains the information 
     necessary for determining that the balance is required under 
     paragraph (1) to be canceled, except that the availability of 
     the funds for such grants is subject to section 2618(a)(2)(H) 
     as applied for such year.
       ``(c) Formula Grants; Cancellation of Unobligated Balance 
     of Grant Award; Waiver Permitting Carryover.--
       ``(1) In general.--Effective for fiscal year 2007 and 
     subsequent fiscal years, if a grant award made to a State for 
     a fiscal year pursuant to section 2618(a)(1) or 
     2618(a)(2)(G)(i) has an unobligated balance as of the end of 
     the grant year for the award, the Secretary shall cancel that 
     unobligated balance of the award, and shall require the State 
     to return any amounts from such balance that have been 
     disbursed to the State, unless--
       ``(A) before the end of the grant year, the State submits 
     to the Secretary a written application for a waiver of the 
     cancellation, which application includes a description of the 
     purposes

[[Page 23419]]

     for which the State intends to expend the funds involved; and
       ``(B) the Secretary approves the waiver.
       ``(2) Expenditure by end of carryover year.--With respect 
     to a waiver under paragraph (1) that is approved for a 
     balance that is unobligated as of the end of a grant year for 
     an award:
       ``(A) The unobligated funds are available for expenditure 
     by the State involved for the one-year period beginning upon 
     the expiration of the grant year (referred to in this section 
     as the `carryover year').
       ``(B) If the funds are not expended by the end of the 
     carryover year, the Secretary shall cancel that unexpended 
     balance of the award, and shall require the State to return 
     any amounts from such balance that have been disbursed to the 
     State.
       ``(3) Use of cancelled balances.--In the case of any 
     balance of a grant award that is cancelled under paragraph 
     (1) or (2)(B), the grant funds involved shall be made 
     available by the Secretary as additional amounts for grants 
     under section 2620 for the first fiscal year beginning after 
     the fiscal year in which the Secretary obtains the 
     information necessary for determining that the balance is 
     required under such paragraph to be canceled, except that the 
     availability of the funds for such grants is subject to 
     section 2618(a)(2)(H) as applied for such year.
       ``(4) Corresponding reduction in future grant.--
       ``(A) In general.--In the case of a State for which a 
     balance from a grant award made pursuant to section 
     2618(a)(1) or 2618(a)(2)(G)(i) is unobligated as of the end 
     of the grant year for the award--
       ``(i) the Secretary shall reduce, by the same amount as 
     such unobligated balance, the amount of the grant under such 
     section for the first fiscal year beginning after the fiscal 
     year in which the Secretary obtains the information necessary 
     for determining that such balance was unobligated as of the 
     end of the grant year (which requirement for a reduction 
     applies without regard to whether a waiver under paragraph 
     (1) has been approved with respect to such balance); and
       ``(ii) the grant funds involved in such reduction shall be 
     made available by the Secretary as additional funds for 
     grants under section 2620 for such first fiscal year, subject 
     to section 2618(a)(2)(H);

     except that this subparagraph does not apply to the State if 
     the amount of the unobligated balance was 2 percent or less.
       ``(B) Relation to increases in grant.--A reduction under 
     subparagraph (A) for a State for a fiscal year may not be 
     taken into account in applying section 2618(a)(2)(H) with 
     respect to the State for the subsequent fiscal year.
       ``(d) Treatment of Drug Rebates.--For purposes of this 
     section, funds that are drug rebates referred to in section 
     2616(g) may not be considered part of any grant award 
     referred to in subsection (a).''.

     SEC. 208. AUTHORIZATION OF APPROPRIATIONS FOR SUBPART I OF 
                   PART B.

       Subpart I of part B of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-21 et seq.), as amended by 
     section 207, is further amended by adding at the end the 
     following:

     ``SEC. 2623. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--For the purpose of carrying out this 
     subpart, there are authorized to be appropriated 
     $1,195,500,000 for fiscal year 2007, $1,239,500,000 for 
     fiscal year 2008, and $1,285,200,000 for fiscal year 2009. 
     Amounts appropriated under the preceding sentence for a 
     fiscal year are available for obligation by the Secretary 
     until the end of the second succeeding fiscal year.
       ``(b) Reservation of Amounts.--
       ``(1) Emerging communities.--Of the amount appropriated 
     under subsection (a) for a fiscal year, the Secretary shall 
     reserve $5,000,000 for grants under section 2621.
       ``(2) Supplemental grants.--
       ``(A) In general.--Of the amount appropriated under 
     subsection (a) for a fiscal year in excess of the 2006 
     adjusted amount, the Secretary shall reserve \1/3\ for grants 
     under section 2620, except that the availability of the 
     reserved funds for such grants is subject to section 
     2618(a)(2)(H) as applied for such year, and except that any 
     amount appropriated exclusively for carrying out section 2616 
     (and, accordingly, distributed under section 2618(a)(2)(G)) 
     is not subject to this subparagraph.
       ``(B) 2006 adjusted amount.--For purposes of subparagraph 
     (A), the term `2006 adjusted amount' means the amount 
     appropriated for fiscal year 2006 under section 2677(b) (as 
     such section was in effect for such fiscal year), excluding 
     any amount appropriated for such year exclusively for 
     carrying out section 2616 (and, accordingly, distributed 
     under section 2618(a)(2)(I), as so in effect).''.

     SEC. 209. EARLY DIAGNOSIS GRANT PROGRAM.

       Section 2625 of the Public Health Service Act (42 U.S.C. 
     300ff-33) is amended to read as follows:

     ``SEC. 2625. EARLY DIAGNOSIS GRANT PROGRAM.

       ``(a) In General.--In the case of States whose laws or 
     regulations are in accordance with subsection (b), the 
     Secretary, acting through the Centers for Disease Control and 
     Prevention, shall make grants to such States for the purposes 
     described in subsection (c).
       ``(b) Description of Compliant States.--For purposes of 
     subsection (a), the laws or regulations of a State are in 
     accordance with this subsection if, under such laws or 
     regulations (including programs carried out pursuant to the 
     discretion of State officials), both of the policies 
     described in paragraph (1) are in effect, or both of the 
     policies described in paragraph (2) are in effect, as 
     follows:
       ``(1)(A) Voluntary opt-out testing of pregnant women.
       ``(B) Universal testing of newborns.
       ``(2)(A) Voluntary opt-out testing of clients at sexually 
     transmitted disease clinics.
       ``(B) Voluntary opt-out testing of clients at substance 
     abuse treatment centers.

     The Secretary shall periodically ensure that the applicable 
     policies are being carried out and recertify compliance.
       ``(c) Use of Funds.--A State may use funds provided under 
     subsection (a) for HIV/AIDS testing (including rapid 
     testing), prevention counseling, treatment of newborns 
     exposed to HIV/AIDS, treatment of mothers infected with HIV/
     AIDS, and costs associated with linking those diagnosed with 
     HIV/AIDS to care and treatment for HIV/AIDS.
       ``(d) Application.--A State that is eligible for the grant 
     under subsection (a) shall submit an application to the 
     Secretary, in such form, in such manner, and containing such 
     information as the Secretary may require.
       ``(e) Limitation on Amount of Grant.--A grant under 
     subsection (a) to a State for a fiscal year may not be made 
     in an amount exceeding $10,000,000.
       ``(f) Rule of Construction.--Nothing in this section shall 
     be construed to pre-empt State laws regarding HIV/AIDS 
     counseling and testing.
       ``(g) Definitions.--In this section:
       ``(1) The term `voluntary opt-out testing' means HIV/AIDS 
     testing--
       ``(A) that is administered to an individual seeking other 
     health care services; and
       ``(B) in which--
       ``(i) pre-test counseling is not required but the 
     individual is informed that the individual will receive an 
     HIV/AIDS test and the individual may opt out of such testing; 
     and
       ``(ii) for those individuals with a positive test result, 
     post-test counseling (including referrals for care) is 
     provided and confidentiality is protected.
       ``(2) The term `universal testing of newborns' means HIV/
     AIDS testing that is administered within 48 hours of delivery 
     to--
       ``(A) all infants born in the State; or
       ``(B) all infants born in the State whose mother's HIV/AIDS 
     status is unknown at the time of delivery.
       ``(h) Authorization of Appropriations.--Of the funds 
     appropriated annually to the Centers for Disease Control and 
     Prevention for HIV/AIDS prevention activities, $30,000,000 
     shall be made available for each of the fiscal years 2007 
     through 2009 for grants under subsection (a), of which 
     $20,000,000 shall be made available for grants to States with 
     the policies described in subsection (b)(1), and $10,000,000 
     shall be made available for grants to States with the 
     policies described in subsection (b)(2). Funds provided under 
     this section are available until expended.''.

     SEC. 210. CERTAIN PARTNER NOTIFICATION PROGRAMS; 
                   AUTHORIZATION OF APPROPRIATIONS.

       Section 2631(d) of the Public Health Service Act (42 U.S.C. 
     300ff-38(d)) is amended by striking ``there are'' and all 
     that follows and inserting the following: ``there is 
     authorized to be appropriated $10,000,000 for each of the 
     fiscal years 2007 through 2009.''.

                 TITLE III--EARLY INTERVENTION SERVICES

     SEC. 301. ESTABLISHMENT OF PROGRAM; CORE MEDICAL SERVICES.

       (a) In General.--Section 2651 of the Public Health Service 
     Act (42 U.S.C. 300ff-51) is amended to read as follows:

     ``SEC. 2651. ESTABLISHMENT OF A PROGRAM.

       ``(a) In General.--For the purposes described in subsection 
     (b), the Secretary, acting through the Administrator of the 
     Health Resources and Services Administration, may make grants 
     to public and nonprofit private entities specified in section 
     2652(a).
       ``(b) Requirements.--
       ``(1) In general.--The Secretary may not make a grant under 
     subsection (a) unless the applicant for the grant agrees to 
     expend the grant only for--
       ``(A) core medical services described in subsection (c);
       ``(B) support services described in subsection (d); and
       ``(C) administrative expenses as described in section 
     2664(g)(3).
       ``(2) Early intervention services.--An applicant for a 
     grant under subsection (a) shall expend not less than 50 
     percent of the amount received under the grant for the 
     services described in subparagraphs (B) through (E) of 
     subsection (e)(1) for individuals with HIV/AIDS.
       ``(c) Required Funding for Core Medical Services.--
       ``(1) In general.--With respect to a grant under subsection 
     (a) to an applicant for a fiscal year, the applicant shall, 
     of the portion of the grant remaining after reserving amounts 
     for purposes of paragraphs (3) and (5) of section 2664(g), 
     use not less than 75 percent to provide core medical services 
     that are needed in the area involved for individuals with 
     HIV/AIDS who are identified and eligible under this title 
     (including services regarding the co-occurring conditions of 
     the individuals).
       ``(2) Waiver.--
       ``(A) The Secretary shall waive the application of 
     paragraph (1) with respect to an applicant for a grant if the 
     Secretary determines that, within the service area of the 
     applicant--

[[Page 23420]]

       ``(i) there are no waiting lists for AIDS Drug Assistance 
     Program services under section 2616; and
       ``(ii) core medical services are available to all 
     individuals with HIV/AIDS identified and eligible under this 
     title.
       ``(B) Notification of waiver status.--When informing an 
     applicant that a grant under subsection (a) is being made for 
     a fiscal year, the Secretary shall inform the applicant 
     whether a waiver under subparagraph (A) is in effect for the 
     fiscal year.
       ``(3) Core medical services.--For purposes of this 
     subsection, the term `core medical services', with respect to 
     an individual with HIV/AIDS (including the co-occurring 
     conditions of the individual) means the following services:
       ``(A) Outpatient and ambulatory health services.
       ``(B) AIDS Drug Assistance Program treatments under section 
     2616.
       ``(C) AIDS pharmaceutical assistance.
       ``(D) Oral health care.
       ``(E) Early intervention services described in subsection 
     (e).
       ``(F) Health insurance premium and cost sharing assistance 
     for low-income individuals in accordance with section 2615.
       ``(G) Home health care.
       ``(H) Medical nutrition therapy.
       ``(I) Hospice services.
       ``(J) Home and community-based health services as defined 
     under section 2614(c).
       ``(K) Mental health services.
       ``(L) Substance abuse outpatient care.
       ``(M) Medical case management, including treatment 
     adherence services.
       ``(d) Support Services.--
       ``(1) In general.--For purposes of this section, the term 
     `support services' means services, subject to the approval of 
     the Secretary, that are needed for individuals with HIV/AIDS 
     to achieve their medical outcomes (such as respite care for 
     persons caring for individuals with HIV/AIDS, outreach 
     services, medical transportation, linguistic services, and 
     referrals for health care and support services).
       ``(2) Definition of medical outcomes.--In this section, the 
     term `medical outcomes' means those outcomes affecting the 
     HIV-related clinical status of an individual with HIV/AIDS.
       ``(e) Specification of Early Intervention Services.--
       ``(1) In general.--The early intervention services referred 
     to in this section are--
       ``(A) counseling individuals with respect to HIV/AIDS in 
     accordance with section 2662;
       ``(B) testing individuals with respect to HIV/AIDS, 
     including tests to confirm the presence of the disease, tests 
     to diagnose the extent of the deficiency in the immune 
     system, and tests to provide information on appropriate 
     therapeutic measures for preventing and treating the 
     deterioration of the immune system and for preventing and 
     treating conditions arising from HIV/AIDS;
       ``(C) referrals described in paragraph (2);
       ``(D) other clinical and diagnostic services regarding HIV/
     AIDS, and periodic medical evaluations of individuals with 
     HIV/AIDS; and
       ``(E) providing the therapeutic measures described in 
     subparagraph (B).
       ``(2) Referrals.--The services referred to in paragraph 
     (1)(C) are referrals of individuals with HIV/AIDS to 
     appropriate providers of health and support services, 
     including, as appropriate--
       ``(A) to entities receiving amounts under part A or B for 
     the provision of such services;
       ``(B) to biomedical research facilities of institutions of 
     higher education that offer experimental treatment for such 
     disease, or to community-based organizations or other 
     entities that provide such treatment; or
       ``(C) to grantees under section 2671, in the case of a 
     pregnant woman.
       ``(3) Requirement of availability of all early intervention 
     services through each grantee.--
       ``(A) In general.--The Secretary may not make a grant under 
     subsection (a) unless the applicant for the grant agrees that 
     each of the early intervention services specified in 
     paragraph (2) will be available through the grantee. With 
     respect to compliance with such agreement, such a grantee may 
     expend the grant to provide the early intervention services 
     directly, and may expend the grant to enter into agreements 
     with public or nonprofit private entities, or private for-
     profit entities if such entities are the only available 
     provider of quality HIV care in the area, under which the 
     entities provide the services.
       ``(B) Other requirements.--Grantees described in--
       ``(i) subparagraphs (A), (D), (E), and (F) of section 
     2652(a)(1) shall use not less than 50 percent of the amount 
     of such a grant to provide the services described in 
     subparagraphs (A), (B), (D), and (E) of paragraph (1) 
     directly and on-site or at sites where other primary care 
     services are rendered; and
       ``(ii) subparagraphs (B) and (C) of section 2652(a)(1) 
     shall ensure the availability of early intervention services 
     through a system of linkages to community-based primary care 
     providers, and to establish mechanisms for the referrals 
     described in paragraph (1)(C), and for follow-up concerning 
     such referrals.''.
       (b) Administrative Expenses; Clinical Quality Management 
     Program.--Section 2664(g) of the Public Health Service Act 
     (42 U.S.C. 300ff-64(g)) is amended--
       (1) in paragraph (3), by amending the paragraph to read as 
     follows:
       ``(3) the applicant will not expend more than 10 percent of 
     the grant for administrative expenses with respect to the 
     grant, including planning and evaluation, except that the 
     costs of a clinical quality management program under 
     paragraph (5) may not be considered administrative expenses 
     for purposes of such limitation;''; and
       (2) in paragraph (5), by inserting ``clinical'' before 
     ``quality management''.

     SEC. 302. ELIGIBLE ENTITIES; PREFERENCES; PLANNING AND 
                   DEVELOPMENT GRANTS.

       (a) Minimum Qualification of Grantees.--Section 2652(a) of 
     the Public Health Service Act (42 U.S.C. 300ff-52(a)) is 
     amended to read as follows:
       ``(a) Eligible Entities.--
       ``(1) In general.--The entities referred to in section 
     2651(a) are public entities and nonprofit private entities 
     that are--
       ``(A) federally-qualified health centers under section 
     1905(l)(2)(B) of the Social Security Act;
       ``(B) grantees under section 1001 (regarding family 
     planning) other than States;
       ``(C) comprehensive hemophilia diagnostic and treatment 
     centers;
       ``(D) rural health clinics;
       ``(E) health facilities operated by or pursuant to a 
     contract with the Indian Health Service;
       ``(F) community-based organizations, clinics, hospitals and 
     other health facilities that provide early intervention 
     services to those persons infected with HIV/AIDS through 
     intravenous drug use; or
       ``(G) nonprofit private entities that provide comprehensive 
     primary care services to populations at risk of HIV/AIDS, 
     including faith-based and community-based organizations.
       ``(2) Underserved populations.--Entities described in 
     paragraph (1) shall serve underserved populations which may 
     include minority populations and Native American populations, 
     ex-offenders, individuals with comorbidities including 
     hepatitis B or C, mental illness, or substance abuse, low-
     income populations, inner city populations, and rural 
     populations.''.
       (b) Preferences in Making Grants.--Section 2653 of the 
     Public Health Service Act (42 U.S.C. 300ff-53) is amended--
       (1) in subsection (b)(1)--
       (A) in subparagraph (A), by striking ``acquired immune 
     deficiency syndrome'' and inserting ``HIV/AIDS''; and
       (B) in subparagraph (D), by inserting before the semicolon 
     the following: ``and the number of cases of individuals co-
     infected with HIV/AIDS and hepatitis B or C''; and
       (2) in subsection (d)(2), by striking ``special 
     consideration'' and inserting ``preference''.
       (c) Planning and Development Grants.--Section 2654(c) of 
     the Public Health Service Act (42 U.S.C. 300ff-54(c)) is 
     amended--
       (1) in paragraph (1)--
       (A) in subparagraph (A), by striking ``HIV''; and
       (B) in subparagraph (B), by striking ``HIV'' and inserting 
     ``HIV/AIDS''; and
       (2) in paragraph (3), by striking ``or underserved 
     communities'' and inserting ``areas or to underserved 
     populations''.

     SEC. 303. AUTHORIZATION OF APPROPRIATIONS.

       Section 2655 of the Public Health Service Act (42 U.S.C. 
     300ff-55) is amended by striking ``such sums'' and all that 
     follows through ``2005''and inserting ``, $218,600,000 for 
     fiscal year 2007, $226,700,000 for fiscal year 2008, and 
     $235,100,000 for fiscal year 2009''.

     SEC. 304. CONFIDENTIALITY AND INFORMED CONSENT.

       Section 2661 of the Public Health Service Act (42 U.S.C. 
     300ff-61) is amended to read as follows:

     ``SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT.

       ``(a) Confidentiality.--The Secretary may not make a grant 
     under this part unless, in the case of any entity applying 
     for a grant under section 2651, the entity agrees to ensure 
     that information regarding the receipt of early intervention 
     services pursuant to the grant is maintained confidentially 
     in a manner not inconsistent with applicable law.
       ``(b) Informed Consent.--The Secretary may not make a grant 
     under this part unless the applicant for the grant agrees 
     that, in testing an individual for HIV/AIDS, the applicant 
     will test an individual only after the individual confirms 
     that the decision of the individual with respect to 
     undergoing such testing is voluntarily made.''.

     SEC. 305. PROVISION OF CERTAIN COUNSELING SERVICES.

       Section 2662 of the Public Health Service Act (42 U.S.C. 
     300ff-62) is amended to read as follows:

     ``SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.

       ``(a) Counseling of Individuals With Negative Test 
     Results.--The Secretary may not make a grant under this part 
     unless the applicant for the grant agrees that, if the 
     results of testing conducted for HIV/AIDS indicate that an 
     individual does not have such condition, the applicant will 
     provide the individual information, including--
       ``(1) measures for prevention of, exposure to, and 
     transmission of HIV/AIDS, hepatitis B, hepatitis C, and other 
     sexually transmitted diseases;
       ``(2) the accuracy and reliability of results of testing 
     for HIV/AIDS, hepatitis B, and hepatitis C;
       ``(3) the significance of the results of such testing, 
     including the potential for developing AIDS, hepatitis B, or 
     hepatitis C;
       ``(4) the appropriateness of further counseling, testing, 
     and education of the individual

[[Page 23421]]

     regarding HIV/AIDS and other sexually transmitted diseases;
       ``(5) if diagnosed with chronic hepatitis B or hepatitis C 
     co-infection, the potential of developing hepatitis-related 
     liver disease and its impact on HIV/AIDS; and
       ``(6) information regarding the availability of hepatitis B 
     vaccine and information about hepatitis treatments.
       ``(b) Counseling of Individuals With Positive Test 
     Results.--The Secretary may not make a grant under this part 
     unless the applicant for the grant agrees that, if the 
     results of testing for HIV/AIDS indicate that the individual 
     has such condition, the applicant will provide to the 
     individual appropriate counseling regarding the condition, 
     including--
       ``(1) information regarding--
       ``(A) measures for prevention of, exposure to, and 
     transmission of HIV/AIDS, hepatitis B, and hepatitis C;
       ``(B) the accuracy and reliability of results of testing 
     for HIV/AIDS, hepatitis B, and hepatitis C; and
       ``(C) the significance of the results of such testing, 
     including the potential for developing AIDS, hepatitis B, or 
     hepatitis C;
       ``(2) reviewing the appropriateness of further counseling, 
     testing, and education of the individual regarding HIV/AIDS 
     and other sexually transmitted diseases; and
       ``(3) providing counseling--
       ``(A) on the availability, through the applicant, of early 
     intervention services;
       ``(B) on the availability in the geographic area of 
     appropriate health care, mental health care, and social and 
     support services, including providing referrals for such 
     services, as appropriate;
       ``(C)(i) that explains the benefits of locating and 
     counseling any individual by whom the infected individual may 
     have been exposed to HIV/AIDS, hepatitis B, or hepatitis C 
     and any individual whom the infected individual may have 
     exposed to HIV/AIDS, hepatitis B, or hepatitis C; and
       ``(ii) that emphasizes it is the duty of infected 
     individuals to disclose their infected status to their sexual 
     partners and their partners in the sharing of hypodermic 
     needles; that provides advice to infected individuals on the 
     manner in which such disclosures can be made; and that 
     emphasizes that it is the continuing duty of the individuals 
     to avoid any behaviors that will expose others to HIV/AIDS, 
     hepatitis B, or hepatitis C; and
       ``(D) on the availability of the services of public health 
     authorities with respect to locating and counseling any 
     individual described in subparagraph (C);
       ``(4) if diagnosed with chronic hepatitis B or hepatitis C 
     co-infection, the potential of developing hepatitis-related 
     liver disease and its impact on HIV/AIDS; and
       ``(5) information regarding the availability of hepatitis B 
     vaccine.
       ``(c) Additional Requirements Regarding Appropriate 
     Counseling.--The Secretary may not make a grant under this 
     part unless the applicant for the grant agrees that, in 
     counseling individuals with respect to HIV/AIDS, the 
     applicant will ensure that the counseling is provided under 
     conditions appropriate to the needs of the individuals.
       ``(d) Counseling of Emergency Response Employees.--The 
     Secretary may not make a grant under this part to a State 
     unless the State agrees that, in counseling individuals with 
     respect to HIV/AIDS, the State will ensure that, in the case 
     of emergency response employees, the counseling is provided 
     to such employees under conditions appropriate to the needs 
     of the employees regarding the counseling.
       ``(e) Rule of Construction Regarding Counseling Without 
     Testing.--Agreements made pursuant to this section may not be 
     construed to prohibit any grantee under this part from 
     expending the grant for the purpose of providing counseling 
     services described in this section to an individual who does 
     not undergo testing for HIV/AIDS as a result of the grantee 
     or the individual determining that such testing of the 
     individual is not appropriate.''.

     SEC. 306. GENERAL PROVISIONS.

       (a) Applicability of Certain Requirements.--Section 2663 of 
     the Public Health Service Act (42 U.S.C. 300ff-63) is amended 
     by striking ``will, without'' and all that follows through 
     ``be carried'' and inserting ``with funds appropriated 
     through this Act will be carried''.
       (b) Additional Required Agreements.--Section 2664(a) of the 
     Public Health Service Act (42 U.S.C. 300ff-64(a)) is 
     amended--
       (1) in paragraph (1)--
       (A) in subparagraph (A), by striking ``and'' at the end;
       (B) in subparagraph (B), by striking ``and'' at the end; 
     and
       (C) by adding at the end the following:
       ``(C) information regarding how the expected expenditures 
     of the grant are related to the planning process for 
     localities funded under part A (including the planning 
     process described in section 2602) and for States funded 
     under part B (including the planning process described in 
     section 2617(b)); and
       ``(D) a specification of the expected expenditures and how 
     those expenditures will improve overall client outcomes, as 
     described in the State plan under section 2617(b);'';
       (2) in paragraph (2), by striking the period and inserting 
     a semicolon; and
       (3) by adding at the end the following:
       ``(3) the applicant agrees to provide additional 
     documentation to the Secretary regarding the process used to 
     obtain community input into the design and implementation of 
     activities related to such grant; and
       ``(4) the applicant agrees to submit, every 2 years, to the 
     lead State agency under section 2617(b)(4) audits, consistent 
     with Office of Management and Budget circular A133, regarding 
     funds expended in accordance with this title and shall 
     include necessary client level data to complete unmet need 
     calculations and Statewide coordinated statements of need 
     process.''.
       (c) Payer of Last Resort.--Section 2664(f)(1)(A) of the 
     Public Health Service Act (42 U.S.C. 300ff-64(f)(1)(A)) is 
     amended by inserting ``(except for a program administered by 
     or providing the services of the Indian Health Service)'' 
     before the semicolon.

             TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH

     SEC. 401. WOMEN, INFANTS, CHILDREN, AND YOUTH.

       Part D of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-71 et seq.) is amended to read as follows:

             ``PART D--WOMEN, INFANTS, CHILDREN, AND YOUTH

     ``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO 
                   RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND 
                   YOUTH.

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall award grants to public and nonprofit 
     private entities (including a health facility operated by or 
     pursuant to a contract with the Indian Health Service) for 
     the purpose of providing family-centered care involving 
     outpatient or ambulatory care (directly or through contracts) 
     for women, infants, children, and youth with HIV/AIDS.
       ``(b) Additional Services for Patients and Families.--Funds 
     provided under grants awarded under subsection (a) may be 
     used for the following support services:
       ``(1) Family-centered care including case management.
       ``(2) Referrals for additional services including--
       ``(A) referrals for inpatient hospital services, treatment 
     for substance abuse, and mental health services; and
       ``(B) referrals for other social and support services, as 
     appropriate.
       ``(3) Additional services necessary to enable the patient 
     and the family to participate in the program established by 
     the applicant pursuant to such subsection including services 
     designed to recruit and retain youth with HIV.
       ``(4) The provision of information and education on 
     opportunities to participate in HIV/AIDS-related clinical 
     research.
       ``(c) Coordination With Other Entities.--A grant awarded 
     under subsection (a) may be made only if the applicant 
     provides an agreement that includes the following:
       ``(1) The applicant will coordinate activities under the 
     grant with other providers of health care services under this 
     Act, and under title V of the Social Security Act, including 
     programs promoting the reduction and elimination of risk of 
     HIV/AIDS for youth.
       ``(2) The applicant will participate in the statewide 
     coordinated statement of need under part B (where it has been 
     initiated by the public health agency responsible for 
     administering grants under part B) and in revisions of such 
     statement.
       ``(3) The applicant will every 2 years submit to the lead 
     State agency under section 2617(b)(4) audits regarding funds 
     expended in accordance with this title and shall include 
     necessary client-level data to complete unmet need 
     calculations and Statewide coordinated statements of need 
     process.
       ``(d) Administration; Application.--A grant may only be 
     awarded to an entity under subsection (a) if an application 
     for the grant is submitted to the Secretary and the 
     application is in such form, is made in such manner, and 
     contains such agreements, assurances, and information as the 
     Secretary determines to be necessary to carry out this 
     section. Such application shall include the following:
       ``(1) Information regarding how the expected expenditures 
     of the grant are related to the planning process for 
     localities funded under part A (including the planning 
     process outlined in section 2602) and for States funded under 
     part B (including the planning process outlined in section 
     2617(b)).
       ``(2) A specification of the expected expenditures and how 
     those expenditures will improve overall patient outcomes, as 
     outlined as part of the State plan (under section 2617(b)) or 
     through additional outcome measures.
       ``(e) Annual Review of Programs; Evaluations.--
       ``(1) Review regarding access to and participation in 
     programs.--With respect to a grant under subsection (a) for 
     an entity for a fiscal year, the Secretary shall, not later 
     than 180 days after the end of the fiscal year, provide for 
     the conduct and completion of a review of the operation 
     during the year of the program carried out under such 
     subsection by the entity. The purpose of such review shall be 
     the development of recommendations, as appropriate, for 
     improvements in the following:
       ``(A) Procedures used by the entity to allocate 
     opportunities and services under subsection (a) among 
     patients of the entity who are women, infants, children, or 
     youth.
       ``(B) Other procedures or policies of the entity regarding 
     the participation of such individuals in such program.

[[Page 23422]]

       ``(2) Evaluations.--The Secretary shall, directly or 
     through contracts with public and private entities, provide 
     for evaluations of programs carried out pursuant to 
     subsection (a).
       ``(f) Administrative Expenses.--
       ``(1) Limitation.--A grantee may not use more than 10 
     percent of amounts received under a grant awarded under this 
     section for administrative expenses.
       ``(2) Clinical quality management program.--A grantee under 
     this section shall implement a clinical quality management 
     program to assess the extent to which HIV health services 
     provided to patients under the grant are consistent with the 
     most recent Public Health Service guidelines for the 
     treatment of HIV/AIDS and related opportunistic infection, 
     and as applicable, to develop strategies for ensuring that 
     such services are consistent with the guidelines for 
     improvement in the access to and quality of HIV health 
     services.
       ``(g) Training and Technical Assistance.--From the amounts 
     appropriated under subsection (i) for a fiscal year, the 
     Secretary may use not more than 5 percent to provide, 
     directly or through contracts with public and private 
     entities (which may include grantees under subsection (a)), 
     training and technical assistance to assist applicants and 
     grantees under subsection (a) in complying with the 
     requirements of this section.
       ``(h) Definitions.--In this section:
       ``(1) Administrative expenses.--The term `administrative 
     expenses' means funds that are to be used by grantees for 
     grant management and monitoring activities, including costs 
     related to any staff or activity unrelated to services or 
     indirect costs.
       ``(2) Indirect costs.--The term `indirect costs' means 
     costs included in a Federally negotiated indirect rate.
       ``(3) Services.--The term `services' means--
       ``(A) services that are provided to clients to meet the 
     goals and objectives of the program under this section, 
     including the provision of professional, diagnostic, and 
     therapeutic services by a primary care provider or a referral 
     to and provision of specialty care; and
       ``(B) services that sustain program activity and contribute 
     to or help improve services under subparagraph (A).
       ``(i) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated, $71,800,000 for each of the fiscal years 2007 
     through 2009.''.

     SEC. 402. GAO REPORT.

       Not later than 24 months after the date of enactment of 
     this Act, the Comptroller General of the Government 
     Accountability Office shall conduct an evaluation, and submit 
     to Congress a report, concerning the funding provided for 
     under part D of title XXVI of the Public Health Service Act 
     to determine--
       (1) how funds are used to provide the administrative 
     expenses, indirect costs, and services, as defined in section 
     2671(h) of such title, for individuals with HIV/AIDS;
       (2) how funds are used to provide the administrative 
     expenses, indirect costs, and services, as defined in section 
     2671(h) of such title, to family members of women, infants, 
     children, and youth infected with HIV/AIDS;
       (3) how funds are used to provide family-centered care 
     involving outpatient or ambulatory care authorized under 
     section 2671(a) of such title;
       (4) how funds are used to provide additional services 
     authorized under section 2671(b) of such title; and
       (5) how funds are used to help identify HIV-positive 
     pregnant women and their children who are exposed to HIV and 
     connect them with care that can improve their health and 
     prevent perinatal transmission.

                      TITLE V--GENERAL PROVISIONS

     SEC. 501. GENERAL PROVISIONS.

       Part E of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-80 et seq.) is amended to read as follows:

                      ``PART E--GENERAL PROVISIONS

     ``SEC. 2681. COORDINATION.

       ``(a) Requirement.--The Secretary shall ensure that the 
     Health Resources and Services Administration, the Centers for 
     Disease Control and Prevention, the Substance Abuse and 
     Mental Health Services Administration, and the Centers for 
     Medicare & Medicaid Services coordinate the planning, 
     funding, and implementation of Federal HIV programs 
     (including all minority AIDS initiatives of the Public Health 
     Service, including under section 2693) to enhance the 
     continuity of care and prevention services for individuals 
     with HIV/AIDS or those at risk of such disease. The Secretary 
     shall consult with other Federal agencies, including the 
     Department of Veterans Affairs, as needed and utilize 
     planning information submitted to such agencies by the States 
     and entities eligible for assistance under this title.
       ``(b) Report.--The Secretary shall biennially prepare and 
     submit to the appropriate committees of the Congress a report 
     concerning the coordination efforts at the Federal, State, 
     and local levels described in this section, including a 
     description of Federal barriers to HIV program integration 
     and a strategy for eliminating such barriers and enhancing 
     the continuity of care and prevention services for 
     individuals with HIV/AIDS or those at risk of such disease.
       ``(c) Integration by State.--As a condition of receipt of 
     funds under this title, a State shall provide assurances to 
     the Secretary that health support services funded under this 
     title will be integrated with other such services, that 
     programs will be coordinated with other available programs 
     (including Medicaid), and that the continuity of care and 
     prevention services of individuals with HIV/AIDS is enhanced.
       ``(d) Integration by Local or Private Entities.--As a 
     condition of receipt of funds under this title, a local 
     government or private nonprofit entity shall provide 
     assurances to the Secretary that services funded under this 
     title will be integrated with other such services, that 
     programs will be coordinated with other available programs 
     (including Medicaid), and that the continuity of care and 
     prevention services of individuals with HIV is enhanced.

     ``SEC. 2682. AUDITS.

       ``(a) In General.--For fiscal year 2009, and each 
     subsequent fiscal year, the Secretary may reduce the amounts 
     of grants under this title to a State or political 
     subdivision of a State for a fiscal year if, with respect to 
     such grants for the second preceding fiscal year, the State 
     or subdivision fails to prepare audits in accordance with the 
     procedures of section 7502 of title 31, United States Code. 
     The Secretary shall annually select representative samples of 
     such audits, prepare summaries of the selected audits, and 
     submit the summaries to the Congress.
       ``(b) Posting on the Internet.--All audits that the 
     Secretary receives from the State lead agency under section 
     2617(b)(4) shall be posted, in their entirety, on the 
     Internet website of the Health Resources and Services 
     Administration.

     ``SEC. 2683. PUBLIC HEALTH EMERGENCY.

       ``(a) In General.--In an emergency area and during an 
     emergency period, the Secretary shall have the authority to 
     waive such requirements of this title to improve the health 
     and safety of those receiving care under this title and the 
     general public, except that the Secretary may not expend more 
     than 5 percent of the funds allocated under this title for 
     sections 2620 and section 2603(b).
       ``(b) Emergency Area and Emergency Period.--In this 
     section:
       ``(1) Emergency area.--The term `emergency area' means a 
     geographic area in which there exists--
       ``(A) an emergency or disaster declared by the President 
     pursuant to the National Emergencies Act or the Robert T. 
     Stafford Disaster Relief and Emergency Assistance Act; or
       ``(B) a public health emergency declared by the Secretary 
     pursuant to section 319.
       ``(2) Emergency period.--The term `emergency period' means 
     the period in which there exists--
       ``(A) an emergency or disaster declared by the President 
     pursuant to the National Emergencies Act or the Robert T. 
     Stafford Disaster Relief and Emergency Assistance Act; or
       ``(B) a public health emergency declared by the Secretary 
     pursuant to section 319.
       ``(c) Unobligated Funds.--If funds under a grant under this 
     section are not expended for an emergency in the fiscal year 
     in which the emergency is declared, such funds shall be 
     returned to the Secretary for reallocation under sections 
     2603(b) and 2620.

     ``SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

       ``None of the funds appropriated under this title shall be 
     used to fund AIDS programs, or to develop materials, designed 
     to promote or encourage, directly, intravenous drug use or 
     sexual activity, whether homosexual or heterosexual. Funds 
     authorized under this title may be used to provide medical 
     treatment and support services for individuals with HIV.

     ``SEC. 2685. PRIVACY PROTECTIONS.

       ``(a) In General.--The Secretary shall ensure that any 
     information submitted to, or collected by, the Secretary 
     under this title excludes any personally identifiable 
     information.
       ``(b) Definition.--In this section, the term `personally 
     identifiable information' has the meaning given such term 
     under the regulations promulgated under section 264(c) of the 
     Health Insurance Portability and Accountability Act of 1996.

     ``SEC. 2686. GAO REPORT.

       ``The Comptroller General of the Government Accountability 
     Office shall biennially submit to the appropriate committees 
     of Congress a report that includes a description of Federal, 
     State, and local barriers to HIV program integration, 
     particularly for racial and ethnic minorities, including 
     activities carried out under subpart III of part F, and 
     recommendations for enhancing the continuity of care and the 
     provision of prevention services for individuals with HIV/
     AIDS or those at risk for such disease. Such report shall 
     include a demonstration of the manner in which funds under 
     this subpart are being expended and to what extent the 
     services provided with such funds increase access to 
     prevention and care services for individuals with HIV/AIDS 
     and build stronger community linkages to address HIV 
     prevention and care for racial and ethnic minority 
     communities.

     ``SEC. 2687. SEVERITY OF NEED INDEX.

       ``(a) Development of Index.--Not later than September 30, 
     2008, the Secretary shall develop and submit to the 
     appropriate committees of Congress a severity of need index 
     in accordance with subsection (c).
       ``(b) Definition of Severity of Need Index.--In this 
     section, the term `severity of need index' means the index of 
     the relative needs of individuals within a State or area, as 
     identified by a number of different factors, and is a factor 
     or set of factors that is multiplied by the number of living 
     HIV/AIDS cases in a State or area, providing different 
     weights to those cases based on needs. Such factors or set of 
     factors may be different for different components of the 
     provisions under this title.
       ``(c) Requirements for Secretarial Submission.--When the 
     Secretary submits to the appropriate committees of Congress 
     the severity of

[[Page 23423]]

     need index under subsection (a), the Secretary shall provide 
     the following:
       ``(1) Methodology for and rationale behind developing the 
     severity of need index, including information related to the 
     field testing of the severity of need index.
       ``(2) An independent contractor analysis of activities 
     carried out under paragraph (1).
       ``(3) Information regarding the process by which the 
     Secretary received community input regarding the application 
     and development of the severity of need index.
       ``(d) Annual Reports.--If the Secretary fails to submit the 
     severity of need index under subsection (a) in either of 
     fiscal years 2007 or 2008, the Secretary shall prepare and 
     submit to the appropriate committees of Congress a report for 
     such fiscal year--
       ``(1) that updates progress toward having client level 
     data;
       ``(2) that updates the progress toward having a severity of 
     need index, including information related to the methodology 
     and process for obtaining community input; and
       ``(3) that, as applicable, states whether the Secretary 
     could develop a severity of need index before fiscal year 
     2009.

     ``SEC. 2688. DEFINITIONS.

       ``For purposes of this title:
       ``(1) AIDS.--The term `AIDS' means acquired immune 
     deficiency syndrome.
       ``(2) Co-occurring conditions.--The term `co-occurring 
     conditions' means one or more adverse health conditions in an 
     individual with HIV/AIDS, without regard to whether the 
     individual has AIDS and without regard to whether the 
     conditions arise from HIV.
       ``(3) Counseling.--The term `counseling' means such 
     counseling provided by an individual trained to provide such 
     counseling.
       ``(4) Family-centered care.--The term `family-centered 
     care' means the system of services described in this title 
     that is targeted specifically to the special needs of 
     infants, children, women and families. Family-centered care 
     shall be based on a partnership between parents, 
     professionals, and the community designed to ensure an 
     integrated, coordinated, culturally sensitive, and community-
     based continuum of care for children, women, and families 
     with HIV/AIDS.
       ``(5) Families with hiv/aids.--The term `families with HIV/
     AIDS' means families in which one or more members have HIV/
     AIDS.
       ``(6)  HIV.--The term `HIV' means infection with the human 
     immunodeficiency virus.
       ``(7) HIV/AIDS.--
       ``(A) In general.--The term `HIV/AIDS' means HIV, and 
     includes AIDS and any condition arising from AIDS.
       ``(B) Counting of cases.--The term `living cases of HIV/
     AIDS', with respect to the counting of cases in a geographic 
     area during a period of time, means the sum of--
       ``(i) the number of living non-AIDS cases of HIV in the 
     area; and
       ``(ii) the number of living cases of AIDS in the area.
       ``(C) Non-aids cases.--The term `non-AIDS', with respect to 
     a case of HIV, means that the individual involved has HIV but 
     does not have AIDS.
       ``(8) Human immunodeficiency virus.--The term `human 
     immunodeficiency virus' means the etiologic agent for AIDS.
       ``(9) Official poverty line.--The term `official poverty 
     line' means the poverty line established by the Director of 
     the Office of Management and Budget and revised by the 
     Secretary in accordance with section 673(2) of the Omnibus 
     Budget Reconciliation Act of 1981.
       ``(10) Person.--The term `person' includes one or more 
     individuals, governments (including the Federal Government 
     and the governments of the States), governmental agencies, 
     political subdivisions, labor unions, partnerships, 
     associations, corporations, legal representatives, mutual 
     companies, joint-stock companies, trusts, unincorporated 
     organizations, receivers, trustees, and trustees in cases 
     under title 11, United States Code.
       ``(11) State.--
       ``(A) In general.--The term `State' means each of the 50 
     States, the District of Columbia, and each of the 
     territories.
       ``(B) Territories.--The term `territory' means each of 
     American Samoa, Guam, the Commonwealth of Puerto Rico, the 
     Commonwealth of the Northern Mariana Islands, the Virgin 
     Islands, the Republic of the Marshall Islands, the Federated 
     States of Micronesia, and Palau.
       ``(12) Youth with hiv.--The term `youth with HIV' means 
     individuals who are 13 through 24 years old and who have HIV/
     AIDS.''.

                  TITLE VI--DEMONSTRATION AND TRAINING

     SEC. 601. DEMONSTRATION AND TRAINING.

       Subpart I of part F of title XXVI of the Public Health 
     Service Act (42 U.S.C. 300ff-101 et seq.) is amended to read 
     as follows:

         ``Subpart I--Special Projects of National Significance

     ``SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

       ``(a) In General.--Of the amount appropriated under each of 
     parts A, B, C, and D for each fiscal year, the Secretary 
     shall use the greater of $20,000,000 or an amount equal to 3 
     percent of such amount appropriated under each such part, but 
     not to exceed $25,000,000, to administer special projects of 
     national significance to--
       ``(1) quickly respond to emerging needs of individuals 
     receiving assistance under this title; and
       ``(2) to fund special programs to develop a standard 
     electronic client information data system to improve the 
     ability of grantees under this title to report client-level 
     data to the Secretary.
       ``(b) Grants.--The Secretary shall award grants under 
     subsection (a) to entities eligible for funding under parts 
     A, B, C, and D based on--
       ``(1) whether the funding will promote obtaining client 
     level data as it relates to the creation of a severity of 
     need index, including funds to facilitate the purchase and 
     enhance the utilization of qualified health information 
     technology systems;
       ``(2) demonstrated ability to create and maintain a 
     qualified health information technology system;
       ``(3) the potential replicability of the proposed activity 
     in other similar localities or nationally;
       ``(4) the demonstrated reliability of the proposed 
     qualified health information technology system across a 
     variety of providers, geographic regions, and clients; and
       ``(5) the demonstrated ability to maintain a safe and 
     secure qualified health information system; or
       ``(6) newly emerging needs of individuals receiving 
     assistance under this title.
       ``(c) Coordination.--The Secretary may not make a grant 
     under this section unless the applicant submits evidence that 
     the proposed program is consistent with the statewide 
     coordinated statement of need, and the applicant agrees to 
     participate in the ongoing revision process of such statement 
     of need.
       ``(d) Privacy Protection.--The Secretary may not make a 
     grant under this section for the development of a qualified 
     health information technology system unless the applicant 
     provides assurances to the Secretary that the system will, at 
     a minimum, comply with the privacy regulations promulgated 
     under section 264(c) of the Health Insurance Portability and 
     Accountability Act of 1996.
       ``(e) Replication.--The Secretary shall make information 
     concerning successful models or programs developed under this 
     part available to grantees under this title for the purpose 
     of coordination, replication, and integration. To facilitate 
     efforts under this subsection, the Secretary may provide for 
     peer-based technical assistance for grantees funded under 
     this part.''.

     SEC. 602. AIDS EDUCATION AND TRAINING CENTERS.

       (a) Amendments Regarding Schools and Centers.--Section 
     2692(a)(2) of the Public Health Service Act (42 U.S.C. 300ff-
     111(a)(2)) is amended--
       (1) in subparagraph (A)--
       (A) by inserting ``and Native Americans'' after ``minority 
     individuals''; and
       (B) by striking ``and'' at the end;
       (2) in subparagraph (B), by striking the period and 
     inserting ``; and''; and
       (3) by adding at the end the following:
       ``(C) train or result in the training of health 
     professionals and allied health professionals to provide 
     treatment for hepatitis B or C co-infected individuals.''.
       (b) Authorizations of Appropriations for Schools, Centers, 
     and Dental Programs.--Section 2692(c) of the Public Health 
     Service Act (42 U.S.C. 300ff-111(c)) is amended to read as 
     follows:
       ``(c) Authorization of Appropriations.--
       ``(1) Schools; centers.--For the purpose of awarding grants 
     under subsection (a), there is authorized to be appropriated 
     $34,700,000 for each of the fiscal years 2007 through 2009.
       ``(2) Dental schools.--For the purpose of awarding grants 
     under subsection (b), there is authorized to be appropriated 
     $13,000,000 for each of the fiscal years 2007 through 
     2009.''.

     SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE.

       Part F of title XXVI of the Public Health Service Act (42 
     U.S.C. 300ff-101 et seq.) is amended by adding at the end the 
     following:

                ``Subpart III--Minority AIDS Initiative

     ``SEC. 2693. MINORITY AIDS INITIATIVE.

       ``(a) In General.--For the purpose of carrying out 
     activities under this section to evaluate and address the 
     disproportionate impact of HIV/AIDS on, and the disparities 
     in access, treatment, care, and outcomes for, racial and 
     ethnic minorities (including African Americans, Alaska 
     Natives, Latinos, American Indians, Asian Americans, Native 
     Hawaiians, and Pacific Islanders), there are authorized to be 
     appropriated $131,200,000 for fiscal year 2007, $135,100,000 
     for fiscal year 2008, and $139,100,000 for fiscal year 2009.
       ``(b) Certain Activities.--
       ``(1) In general.--In carrying out the purpose described in 
     subsection (a), the Secretary shall provide for--
       ``(A) emergency assistance under part A;
       ``(B) care grants under part B;
       ``(C) early intervention services under part C;
       ``(D) services through projects for HIV-related care under 
     part D; and
       ``(E) activities through education and training centers 
     under section 2692.
       ``(2) Allocations among activities.--Activities under 
     paragraph (1) shall be carried out by the Secretary in 
     accordance with the following:
       ``(A) For competitive, supplemental grants to improve HIV-
     related health outcomes to reduce existing racial and ethnic 
     health disparities, the Secretary shall, of the amount 
     appropriated under subsection (a) for a fiscal year, reserve 
     the following, as applicable:
       ``(i) For fiscal year 2007, $43,800,000.
       ``(ii) For fiscal year 2008, $45,400,000.
       ``(iii) For fiscal year 2009, $47,100,000.

[[Page 23424]]

       ``(B) For competitive grants used for supplemental support 
     education and outreach services to increase the number of 
     eligible racial and ethnic minorities who have access to 
     treatment through the program under section 2616 for 
     therapeutics, the Secretary shall, of the amount appropriated 
     for a fiscal year under subsection (a), reserve the 
     following, as applicable:
       ``(i) For fiscal year 2007, $7,000,000.
       ``(ii) For fiscal year 2008, $7,300,000.
       ``(iii) For fiscal year 2009, $7,500,000.
       ``(C) For planning grants, capacity-building grants, and 
     services grants to health care providers who have a history 
     of providing culturally and linguistically appropriate care 
     and services to racial and ethnic minorities, the Secretary 
     shall, of the amount appropriated for a fiscal year under 
     subsection (a), reserve the following, as applicable:
       ``(i) For fiscal year 2007, $53,400,000.
       ``(ii) For fiscal year 2008, $55,400,000.
       ``(iii) For fiscal year 2009, $57,400,000.
       ``(D) For eliminating racial and ethnic disparities in the 
     delivery of comprehensive, culturally and linguistically 
     appropriate care services for HIV disease for women, infants, 
     children, and youth, the Secretary shall, of the amount 
     appropriated under subsection (a), reserve $18,500,000 for 
     each of the fiscal years 2007 through 2009.
       ``(E) For increasing the training capacity of centers to 
     expand the number of health care professionals with treatment 
     expertise and knowledge about the most appropriate standards 
     of HIV disease-related treatments and medical care for racial 
     and ethnic minority adults, adolescents, and children with 
     HIV disease, the Secretary shall, of the amount appropriated 
     under subsection (a), reserve $8,500,000 for each of the 
     fiscal years 2007 through 2009.
       ``(c) Consistency With Prior Program.--With respect to the 
     purpose described in subsection (a), the Secretary shall 
     carry out this section consistent with the activities carried 
     out under this title by the Secretary pursuant to the 
     Departments of Labor, Health and Human Services, and 
     Education, and Related Agencies Appropriations Act, 2002 
     (Public Law 107-116).''.

                  TITLE VII--MISCELLANEOUS PROVISIONS

     SEC. 701. HEPATITIS; USE OF FUNDS.

       Section 2667 of the Public Health Service Act (42 U.S.C. 
     300ff-67) is amended--
       (1) in paragraph (2), by striking ``and'' at the end;
       (2) in paragraph (3), by striking the period and inserting 
     ``; and''; and
       (3) by adding at the end the following:
       ``(4) shall provide information on the transmission and 
     prevention of hepatitis A, B, and C, including education 
     about the availability of hepatitis A and B vaccines and 
     assisting patients in identifying vaccination sites.''.

     SEC. 702. CERTAIN REFERENCES.

       Title XXVI of the Public Health Service Act (42 U.S.C. 
     300ff et seq.) is amended--
       (1) by striking ``acquired immune deficiency syndrome'' 
     each place such term appears, other than in section 2687(1) 
     (as added by section 501 of this Act), and inserting 
     ``AIDS'';
       (2) by striking ``such syndrome'' and inserting ``AIDS''; 
     and
       (3) by striking ``HIV disease'' each place such term 
     appears and inserting ``HIV/AIDS''.

     SEC. 703. REPEAL.

       Effective on October 1, 2009, title XXVI of the Public 
     Health Service Act (42 U.S.C. 300ff et seq.) is repealed.

  Mr. BARTON of Texas (during the reading). Mr. Speaker, I ask 
unanimous consent that the Senate amendment be considered as read and 
printed in the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. ENGEL. Mr. Speaker, as home to 17 percent of the Nation's AIDS 
population, there are few pieces of legislation we will pass this year 
that are as profoundly important to New York as the Ryan White CARE 
Act. New York remains the epicenter of the HIV/AIDS crisis, leading the 
Nation in both the number of persons living with HIV/AIDS and the 
number of new cases of HIV/AIDS each year.
  This vital program which provides lifesaving services for individuals 
with HIV/AIDS has unfortunately been relegated to a vicious formula 
fight over the past year pitting States against each other, with a lot 
of false statements being lodged along the way. I want to be clear that 
despite what some may say, the HIV/AIDS epidemic has not ``shifted,'' 
it has expanded. One-half of all people living with AIDS reside in five 
States: New York, California, Florida, Texas and New Jersey. Three of 
these States: NY, NJ, and FL, will continue to face losses under this 
reauthorization. There is no question that other States have mounting 
epidemics and they are absolutely entitled and deserving of more 
funding.
  An ideal Ryan White bill would have ensured that every State had 
enough money to meet their full needs. I offered an amendment in 
committee to increase funding for the bill with Mr. Towns, Ms. Eshoo 
and Mrs. Capps. It failed on an essentially party line vote, which is a 
shame as this will minimize our ability to alleviate the growing unmet 
need for HIV/AIDS treatment services in our communities nationwide.
  However, there is no question that through hard work and real 
compromise the bill that we will vote on today is dramatically better 
than the Ryan White bill we voted on September 28. I am proud to have 
been able to help negotiate changes with my House and Senate colleagues 
that will contain essential protections for New York and other States. 
While, NY will still endure losses that I believe are unjust for the 
State that remains the epicenter of the AIDS Crisis, the most draconian 
cuts have largely been mitigated and no longer threaten to decimate our 
State's system of care. For this we can all be proud.
  I am also pleased that the troubling Severity of Need Index (SONI) 
provision, which would have taken State and local resources into 
account when determining Federal funding has been improved. We have 
always viewed caring for our HIV/AIDS patients as a partnership between 
the local, State and Federal governments and strongly believe the 
Severity of Need Index is a powerful disincentive for States and local 
areas to take action. In this bill, HRSA will be allowed to work 
towards developing a SONI but will be prohibited from using it to 
determine Federal funding in this reauthorization. Another victory for 
responsible public policy.
  Finally, it was an astute decision to intentionally shorten this 
reauthorization from 5 to 3 years to incentivize the stakeholders and 
authorizing committees to work swiftly and astutely on crafting a new 
Ryan White bill that will be more just for all HIV/AIDS patients 
nationwide.
  Is this the bill I wanted? Of course not. I remain concerned that 
States' differing HIV surveillance systems will prevent funding from 
truly following the epidemic during the 3 years of the reauthorization. 
However, I am grateful that this bill strongly limits formula losses to 
counter potential undeserved funding shifts.
  So, in the end, our mutual compromise has resulted in a new bill that 
we can accept if not embrace. I wish to thank all the people who worked 
so hard on this bill, including John Ford and William Garner of Mr. 
Dingell's staff who strove to accommodate so many varying regional 
concerns about HIV/AIDS. I am grateful for the tireless efforts of the 
NY delegation, the New York Department of Health and NYC Mayor's office 
who worked many long nights and weekends with us to help advocate for 
the best possible bill we could negotiate. This was certainly a team 
effort, and I know that the knowledge gained from the countless hours 
of discussions we have had over the past year will strengthen our 
ability to craft an even better Ryan White reauthorization in 3 years.
  The SPEAKER pro tempore. Is there objection to the original request 
of the gentleman from Texas?
  There was no objection.
  A motion to reconsider was laid on the table.

                          ____________________