[House Report 106-788]
[From the U.S. Government Publishing Office]



                                                                       
106th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     106-788

======================================================================



 
                 RYAN WHITE CARE ACT AMENDMENTS OF 2000

                                _______
                                

 July 25, 2000.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Bliley, from the Committee on Commerce, submitted the following

                              R E P O R T

                             together with

                            ADDITIONAL VIEWS

                        [To accompany H.R. 4807]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Commerce, to whom was referred the bill 
(H.R. 4807) to amend the Public Health Service Act to revise 
and extend programs established under the Ryan White 
Comprehensive AIDS Resources Emergency Act of 1990, and for 
other purposes, having considered the same, report favorably 
thereon with an amendment and recommend that the bill as 
amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................    22
Background and Need for Legislation..............................    22
Hearings.........................................................    45
Committee Consideration..........................................    45
Committee Votes..................................................    45
Committee Oversight Findings.....................................    46
Committee on Government Reform Oversight Findings................    46
New Budget Authority, Entitlement Authority, and Tax 
  Expenditures...................................................    46
Committee Cost Estimate..........................................    46
Congressional Budget Office Estimate.............................    46
Federal Mandates Statement.......................................    54
Advisory Committee Statement.....................................    54
Constitutional Authority Statement...............................    54
Applicability to Legislative Branch..............................    54
Section-by-Section Analysis of the Legislation...................    54
Changes in Existing Law Made by the Bill, as Reported............    68
Additional Views.................................................   114

                               Amendment

  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

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

SEC. 2. TABLE OF CONTENTS.

  The table of contents for this Act is as follows:

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

           Subtitle A--HIV Health Services Planning Councils

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

              Subtitle B--Type and Distribution of Grants

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

                      Subtitle C--Other Provisions

Sec. 121. Use of amounts.
Sec. 122. Application.
Sec. 123. Review of administrative costs and compensation.

                      TITLE II--CARE GRANT PROGRAM

                  Subtitle A--General Grant Provisions

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

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

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

           Subtitle C--Certain Partner Notification Programs

Sec. 221. Grants for compliant partner notification programs.

                 TITLE III--EARLY INTERVENTION SERVICES

                 Subtitle A--Formula Grants for States

Sec. 301. Repeal of program.

                     Subtitle B--Categorical Grants

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

                     Subtitle C--General Provisions

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

                TITLE IV--OTHER PROGRAMS AND ACTIVITIES

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

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

              Subtitle B--General Provisions in Title XXVI

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

                      TITLE V--GENERAL PROVISIONS

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

                        TITLE VI--EFFECTIVE DATE

Sec. 601. Effective date.

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

           Subtitle A--HIV Health Services Planning Councils

SEC. 101. MEMBERSHIP OF COUNCILS.

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

SEC. 102. DUTIES OF COUNCILS.

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

SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVISIONS.

  Section 2602(b) of the Public Health Service Act (42 U.S.C. 300ff-
12(b)) is amended--
          (1) in paragraph (3), by striking subparagraph (C); and
          (2) by adding at the end the following paragraph:
          ``(7) Public deliberations.--With respect to a planning 
        council under paragraph (1), the following applies:
                  ``(A) The council may not be chaired solely by an 
                employee of the grantee under section 2601(a).
                  ``(B) In accordance with criteria established by the 
                Secretary:
                          ``(i) The meetings of the council shall be 
                        open to the public and shall be held only after 
                        adequate notice to the public.
                          ``(ii) The records, reports, transcripts, 
                        minutes, agenda, or other documents which were 
                        made available to or prepared for or by the 
                        council shall be available for public 
                        inspection and copying at a single location.
                          ``(iii) Detailed minutes of each meeting of 
                        the council shall be kept. The accuracy of all 
                        minutes shall be certified to by the chair of 
                        the council.
                          ``(iv) This subparagraph does not apply to 
                        any disclosure of information of a personal 
                        nature that would constitute a clearly 
                        unwarranted invasion of personal privacy, 
                        including any disclosure of medical information 
                        or personnel matters.''.

              Subtitle B--Type and Distribution of Grants

SEC. 111. FORMULA GRANTS.

  (a) Expedited Distribution.--Section 2603(a)(2) of the Public Health 
Service Act (42 U.S.C. 300ff-13(a)(2)) is amended in the first sentence 
by striking ``for each of the fiscal years 1996 through 2000'' and 
inserting ``for a fiscal year''.
  (b) Amount of Grant; Estimate of Living Cases.--
          (1) In general.--Section 2603(a)(3)) of the Public Health 
        Service Act (42 U.S.C. 300ff-13(a)(3)) is amended--
                  (A) in subparagraph (C)(i), by inserting before the 
                semicolon the following: ``, except that (subject to 
                subparagraph (D)), for grants made pursuant to this 
                paragraph for fiscal year 2005 and subsequent fiscal 
                years, the cases counted for each 12-month period 
                beginning on or after July 1, 2004, shall be cases of 
                HIV disease (as reported to and confirmed by such 
                Director) rather than cases of acquired immune 
                deficiency syndrome''; and
                  (B) in subparagraph (C), in the matter after and 
                below clause (ii)(X)--
                          (i) in the first sentence, by inserting 
                        before the period the following: ``, and shall 
                        be reported to the congressional committees of 
                        jurisdiction''; and
                          (ii) by adding at the end the following 
                        sentence: ``Updates shall as applicable take 
                        into account the counting of cases of HIV 
                        disease pursuant to clause (i).''
          (2) Determination of secretary regarding data on hiv cases.--
        Section 2603(a)(3)) of the Public Health Service Act (42 U.S.C. 
        300ff-13(a)(3)) is amended--
                  (A) by redesignating subparagraph (D) as subparagraph 
                (E); and
                  (B) by inserting after subparagraph (C) the following 
                subparagraph:
                  ``(D) Determination of secretary regarding data on 
                hiv cases.--
                          ``(i) In general.--Not later than July 1, 
                        2004, the Secretary shall determine whether 
                        there is data on cases of HIV disease from all 
                        eligible areas (reported to and confirmed by 
                        the Director of the Centers for Disease Control 
                        and Prevention) sufficiently accurate and 
                        reliable for use for purposes of subparagraph 
                        (C)(i). In making such a determination, the 
                        Secretary shall take into consideration the 
                        findings of the study under section 501(b) of 
                        the Ryan White CARE Act Amendments of 2000 
                        (relating to the relationship between 
                        epidemiological measures and health care for 
                        certain individuals with HIV disease), the 
                        fiscal impact of the use of such data, the 
                        impact of the use of such data on the 
                        organization and delivery of HIV-related 
                        services in eligible areas, and the fiscal 
                        impact of not using such data.
                          ``(ii) Effect of adverse determination.--If 
                        under clause (i) the Secretary determines that 
                        data on cases of HIV disease is not 
                        sufficiently accurate and reliable for use for 
                        purposes of subparagraph (C)(i), then 
                        notwithstanding such subparagraph, for any 
                        fiscal year prior to fiscal year 2007 the 
                        references in such subparagraph to cases of HIV 
                        disease do not have any legal effect.
                          ``(iii) Grants and technical assistance 
                        regarding counting of hiv cases.--Of the 
                        amounts appropriated under section 2675 for a 
                        fiscal year, the Secretary shall reserve 
                        amounts to make grants and provide technical 
                        assistance to States and eligible areas with 
                        respect to obtaining data on cases of HIV 
                        disease to ensure that data on such cases is 
                        available from all States and eligible areas as 
                        soon as is practicable but not later than the 
                        beginning of fiscal year 2007.''.
  (c) Increases in Grant.--Section 2603(a)(4)) of the Public Health 
Service Act (42 U.S.C. 300ff-13(a)(4)) is amended to read as follows:
          ``(4) Increases in grant.--
                  ``(A) In general.--For each fiscal year in a 
                protection period for an eligible area, the Secretary 
                shall increase the amount of the grant made pursuant to 
                paragraph (2) for the area to ensure that--
                          ``(i) for the first fiscal year in the 
                        protection period, the grant is not less than 
                        98 percent of the amount of the grant made for 
                        the eligible area pursuant to such paragraph 
                        for the base year for the protection period;
                          ``(ii) for any second fiscal year in such 
                        period, the grant is not less than 95.7 percent 
                        of the amount of such base year grant;
                          ``(iii) for any third fiscal year in such 
                        period, the grant is not less than 91.1 percent 
                        of the amount of the base year grant;
                          ``(iv) for any fourth fiscal year in such 
                        period, the grant is not less than 84.2 percent 
                        of the amount of the base year grant; and
                          ``(v) for any fifth or subsequent fiscal year 
                        in such period, the grant is not less than 75 
                        percent of the amount of the base year grant.
                  ``(B) Base year; protection period.--With respect to 
                grants made pursuant to paragraph (2) for an eligible 
                area:
                          ``(i) The base year for a protection period 
                        is the fiscal year preceding the trigger grant-
                        reduction year.
                          ``(ii) The first trigger grant-reduction year 
                        is the first fiscal year (after fiscal year 
                        2000) for which the grant for the area is less 
                        than the grant for the area for the preceding 
                        fiscal year.
                          ``(iii) A protection period begins with the 
                        trigger grant-reduction year and continues 
                        until the beginning of the first fiscal year 
                        for which the amount of the grant for the area 
                        equals or exceeds the amount of the grant for 
                        the base year for the period.
                          ``(iv) Any subsequent trigger grant-reduction 
                        year is the first fiscal year, after the end of 
                        the preceding protection period, for which the 
                        amount of the grant is less than the amount of 
                        the grant for the preceding fiscal year.''.

SEC. 112. SUPPLEMENTAL GRANTS.

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

                      Subtitle C--Other Provisions

SEC. 121. USE OF AMOUNTS.

  (a) Primary Purposes.--Section 2604(b)(1) of the Public Health 
Service Act (42 U.S.C. 300ff-14(b)(1)) is amended--
          (1) in the matter preceding subparagraph (A), by striking 
        ``HIV-related--'' and inserting ``HIV-related services, as 
        follows:'';
          (2) in subparagraph (A)--
                  (A) by striking ``outpatient'' and all that follows 
                through ``substance abuse treatment and'' and inserting 
                the following: ``Outpatient and ambulatory health 
                services, including substance abuse treatment,''; and
                  (B) by striking ``; and'' and inserting a period;
          (3) in subparagraph (B), by striking ``(B) inpatient case 
        management'' and inserting ``(C) Inpatient case management'';
          (4) by inserting after subparagraph (A) the following 
        subparagraph:
                  ``(B) Outpatient and ambulatory support services 
                (including case management), to the extent that such 
                services facilitate, support, or sustain the delivery, 
                or benefits of health services for individuals and 
                families with HIV disease.''; and
          (5) by adding at the end the following:
                  ``(D) Outreach activities that are intended to 
                identify individuals with HIV disease who are not 
                receiving HIV-related services, and that are--
                          ``(i) necessary to implement the strategy 
                        under section 2602(b)(4)(D), including 
                        activities facilitating the access of such 
                        individuals to HIV-related primary care 
                        services at entities described in paragraph 
                        (3);
                          ``(ii) conducted in a manner consistent with 
                        the requirements under sections 2605(a)(3) and 
                        2651(b)(2); and
                          ``(iii) supplement, and do not supplant, such 
                        activities that are carried out with amounts 
                        appropriated under section 317.''.
  (b) Additional Purposes.--Section 2604(b) (42 U.S.C. 300ff-14(b)) of 
the Public Health Service Act is amended--
          (1) by redesignating paragraph (3) as paragraph (4);
          (2) by inserting after paragraph (2) the following:
          ``(3) Early intervention services.--
                  ``(A) In general.--The purposes for which a grant 
                under section 2601 may be used include providing to 
                individuals with HIV disease early intervention 
                services described in section 2651(b)(2) (including 
                referrals under subparagraph (C) of such section), 
                subject to subparagraph (B). The entities through which 
                such services may be provided under the grant include 
                public health departments, emergency rooms, substance 
                abuse and mental health treatment programs, 
                detoxification centers, detention facilities, clinics 
                regarding sexually transmitted diseases, homeless 
                shelters, HIV disease counseling and testing sites, 
                health care points of entry specified by States or 
                eligible areas, federally qualified health centers, and 
                entities described in section 2652(a).
                  ``(B) Conditions.--With respect to an entity that 
                proposes to provide early intervention services under 
                subparagraph (A), such subparagraph applies only if the 
                entity demonstrates to the satisfaction of the chief 
                elected official for the eligible area involved that--
                          ``(i) Federal, State, or local funds are 
                        otherwise inadequate for the early intervention 
                        services the entity proposes to provide; and
                          ``(ii) the entity will expend funds pursuant 
                        to such subparagraph to supplement and not 
                        supplant other funds available to the entity 
                        for the provision of early intervention 
                        services for the fiscal year involved.''; and
          (3) in paragraph (4) (as so redesignated), by inserting 
        ``youth,'' after ``children,'' each place such term appears;
  (c) Quality Management.--Section 2604 of the Public Health Service 
Act (42 U.S.C. 300ff-14) is amended--
          (1) by redesignating subsections (c) through (f) as 
        subsections (d) through (g), respectively; and
          (2) by inserting after subsection (b) the following:
  ``(c) Quality Management.--
          ``(1) Requirement.--The chief elected official of an eligible 
        area that receives a grant under this part shall provide for 
        the establishment of a quality management program to assess the 
        extent to which HIV health services provided to patients under 
        the grant are consistent with the most recent Public Health 
        Service guidelines for the treatment of HIV disease and related 
        opportunistic infection, and as applicable, to develop 
        strategies for ensuring that such services are consistent with 
        the guidelines.
          ``(2) Use of funds.--From amounts received under a grant 
        awarded under this part for a fiscal year, the chief elected 
        official of an eligible area may (in addition to amounts to 
        which subsection (f)(1) applies) use for activities associated 
        with the quality management program required in paragraph (1) 
        not more than the lesser of--
                  ``(A) 5 percent of amounts received under the grant; 
                or
                  ``(B) $3,000,000.''.

SEC. 122. APPLICATION.

  Section 2605(a) of the Public Health Service Act (42 U.S.C. 300ff-
15(a)) is amended--
          (1) by redesignating paragraphs (3) through (6) as paragraphs 
        (4) through (7), respectively; and
          (2) by inserting after paragraph (2) the following paragraph:
          ``(3) that entities within the eligible area that receive 
        funds under a grant under section 2601(a) will maintain 
        relationships with appropriate entities in the area, including 
        entities described in section 2604(b)(3);''.

SEC. 123. REVIEW OF ADMINISTRATIVE COSTS AND COMPENSATION.

  Each chief elected official of an eligible area (as defined in 
section 2607 of the Public Health Service Act) shall ensure that, not 
later than one year after the date of the enactment of this Act, the 
planning council for the eligible area--
          (1) conducts a review of the existing, available data on the 
        extent to which entities in the area that receive amounts from 
        a grant under section 2601(a) of the Public Health Service Act 
        have from their overall budget expended amounts for 
        administrative costs (including financial compensation and 
        benefits), expressed as a proportion and indicating the growth 
        in such expenditures, including a statement of the average 
        amount expended for such costs per client served and the 
        average amount expended for such costs per client served in 
        providing HIV-related services; and
          (2) makes a determination of whether the financial 
        compensation of any officers or employees of such entities 
        exceeds that of the chief elected official of the eligible 
        area.

                      TITLE II--CARE GRANT PROGRAM

                  Subtitle A--General Grant Provisions

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

  Section 2611(b) of the Public Health Service Act (42 U.S.C. 300ff-
21(b)) is amended by inserting ``youth,'' after ``children,'' each 
place such term appears.

SEC. 202. USE OF GRANTS.

  Section 2612 of the Public Health Service Act (42 U.S.C. 300ff-22) is 
amended--
          (1) by striking ``A State may use'' and inserting ``(a) In 
        General.--A State may use''; and
          (2) by adding at the end the following subsections:
  ``(b) Support Services; Outreach.--The purposes for which a grant 
under this part may be used include delivering or enhancing the 
following:
          ``(1) Support services under section 2611(a) (including case 
        management) to the extent that such services facilitate, 
        support, or sustain the delivery, or benefits of health 
        services for individuals and families with HIV disease.
          ``(2) Outreach activities that are intended to identify 
        individuals with HIV disease who are not receiving HIV-related 
        services, and that are--
                  ``(A) necessary to implement the strategy under 
                section 2617(b)(4)(B);
                  ``(B) conducted in a manner consistent with the 
                requirement under section 2617(b)(6)(G); and
                  ``(C) supplement, and do not supplant, such 
                activities that are carried out with amounts 
                appropriated under section 317.
  ``(c) Early Intervention Services.--
          ``(1) In general.--The purposes for which a grant under this 
        part may be used include providing to individuals with HIV 
        disease early intervention services described in section 
        2651(b)(2) (including referrals under subparagraph (C) of such 
        section), subject to paragraph (2). The entities through which 
        such services may be provided under the grant include public 
        health departments, emergency rooms, substance abuse and mental 
        health treatment programs, detoxification centers, detention 
        facilities, clinics regarding sexually transmitted diseases, 
        homeless shelters, HIV disease counseling and testing sites, 
        health care points of entry specified by States or eligible 
        areas, federally qualified health centers, and entities 
        described in section 2652(a).
          ``(2) Conditions.--With respect to an entity that proposes to 
        provide early intervention services under paragraph (1), such 
        paragraph applies only if the entity demonstrates to the 
        satisfaction of the State involved that--
                  ``(A) Federal, State, or local funds are otherwise 
                inadequate for the early intervention services the 
                entity proposes to provide; and
                  ``(B) the entity will expend funds pursuant to such 
                paragraph to supplement and not supplant other funds 
                available to the entity for the provision of early 
                intervention services for the fiscal year involved.
  ``(d) Quality Management.--
          ``(1) Requirement.--Each State that receives a grant under 
        this part shall provide for the establishment of a quality 
        management program to assess the extent to which HIV health 
        services provided to patients under the grant are consistent 
        with the most recent Public Health Service guidelines for the 
        treatment of HIV disease and related opportunistic infection, 
        and as applicable, to develop strategies for ensuring that such 
        services are consistent with the guidelines.
          ``(2) Use of funds.--From amounts received under a grant 
        awarded under this part for a fiscal year, the State may (in 
        addition to amounts to which section 2618(c)(5) applies) use 
        for activities associated with the quality management program 
        required in paragraph (1) not more than the lesser of--
                  ``(A) 5 percent of amounts received under the grant; 
                or
                  ``(B) $3,000,000.''.

SEC. 203. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

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

SEC. 204. PROVISION OF TREATMENTS.

  Section 2616 of the Public Health Service Act (42 U.S.C. 300ff-26) is 
amended by adding at the end the following subsection:
  ``(e) Use of Health Insurance and Plans.--In carrying out subsection 
(a), a State may expend a grant under this part to provide the 
therapeutics described in such subsection by paying on behalf of 
individuals with HIV disease the costs of purchasing or maintaining 
health insurance or plans whose coverage includes a full range of such 
therapeutics and appropriate primary care services.''.

SEC. 205. STATE APPLICATION.

  (a) Determination of Size and Needs of Population; Comprehensive 
Plan.--Section 2617(b) of the Public Health Service Act (42 U.S.C. 
300ff-27(b)) is amended--
          (1) by redesignating paragraphs (2) through (4) as paragraphs 
        (4) through (6), respectively;
          (2) by inserting after paragraph (1) the following 
        paragraphs:
          ``(2) a determination of the size and demographics of the 
        population of individuals with HIV disease in the State;
          ``(3) a determination of the needs of such population, with 
        particular attention to--
                  ``(A) individuals with HIV disease who are not 
                receiving HIV-related services; and
                  ``(B) disparities in access and services among 
                affected subpopulations and historically underserved 
                communities;''; and
          (3) in paragraph (4) (as so redesignated)--
                  (A) by striking ``comprehensive plan for the 
                organization'' and inserting ``comprehensive plan that 
                describes the organization'';
                  (B) by striking ``, including--'' and inserting ``, 
                and that--'';
                  (C) by redesignating subparagraphs (A) through (C) as 
                subparagraphs (D) through (F), respectively;
                  (D) by inserting before subparagraph (C) the 
                following subparagraphs:
                  ``(A) establishes priorities for the allocation of 
                funds within the State based on--
                          ``(i) size and demographics of the population 
                        of individuals with HIV disease (as determined 
                        under paragraph (2)) and the needs of such 
                        population (as determined under paragraph (3));
                          ``(ii) availability of other governmental and 
                        nongovernmental resources to provide HIV-
                        related services to individuals and families 
                        with HIV disease;
                          ``(iii) capacity development needs resulting 
                        from disparities in the availability of HIV-
                        related services in historically underserved 
                        communities and rural communities; and
                          ``(iv) the efficiency of the administrative 
                        mechanism of the State for rapidly allocating 
                        funds to the areas of greatest need within the 
                        State;
                  ``(B) includes a strategy for identifying individuals 
                with HIV disease who are not receiving such services 
                and for informing the individuals of and enabling the 
                individuals to utilize the services, giving particular 
                attention to eliminating disparities in access and 
                services among affected subpopulations and historically 
                underserved communities, and including discrete goals, 
                a timetable, and an appropriate allocation of funds;
                  ``(C) includes a strategy to coordinate the provision 
                of such services with programs for HIV prevention and 
                for the prevention and treatment of substance abuse, 
                including programs that provide comprehensive treatment 
                services for such abuse;'';
                  (E) in subparagraph (D) (as redesignated by 
                subparagraph (C) of this paragraph), by inserting 
                ``describes'' before ``the services and activities'';
                  (F) in subparagraph (E) (as so redesignated), by 
                inserting ``provides'' before ``a description''; and
                  (G) in subparagraph (F) (as so redesignated), by 
                inserting ``provides'' before ``a description''.
  (b) Public Participation.--Section 2617(b) of the Public Health 
Service Act, as amended by subsection (a) of this section, is amended--
          (1) in paragraph (5), by striking ``HIV'' and inserting ``HIV 
        disease''; and
          (2) in paragraph (6), by amending subparagraph (A) to read as 
        follows:
                  ``(A) the public health agency that is administering 
                the grant for the State engages in a public advisory 
                planning process, including public hearings, that 
                includes the participants under paragraph (5), and 
                entities described in section 2602(b)(2), in developing 
                the comprehensive plan under paragraph (4) and 
                commenting on the implementation of such plan;''.
  (c) Health Care Relationships.--Section 2617(b) of the Public Health 
Service Act, as amended by subsection (a) of this section, is amended 
in paragraph (6)--
          (1) in subparagraph (E), by striking ``and'' at the end;
          (2) in subparagraph (F), by striking the period and inserting 
        ``; and''; and
          (3) by adding at the end the following subparagraph:
                  ``(G) entities within areas in which activities under 
                the grant are carried out will maintain relationships 
                with appropriate entities in the area, including 
                entities described in section 2612(c);''.

SEC. 206. DISTRIBUTION OF FUNDS.

  (a) Minimum Allotment.-- Section 2618(b)(1)(A)(i) of the Public 
Health Service Act (42 U.S.C. 300ff-28(b)(1)(A)(i)) is amended--
          (1) in subclause (I), by striking ``$100,000'' and inserting 
        ``$200,000''; and
          (2) in subclause (II), by striking ``$250,000'' and inserting 
        ``$500,000''.
  (b) Amount of Grant; Estimate of Living Cases.--Section 2618(b)(2) of 
the Public Health Service Act (42 U.S.C. 300ff-28(b)(2)) is amended--
          (1) in subparagraph (D)(i), by inserting before the semicolon 
        the following: ``, except that (subject to subparagraph (E)), 
        for grants made pursuant to this paragraph for fiscal year 2005 
        and subsequent fiscal years, the cases counted for each 12-
        month period beginning on or after July 1, 2004, shall be cases 
        of HIV disease (as reported to and confirmed by such Director) 
        rather than cases of acquired immune deficiency syndrome'';
          (2) by redesignating subparagraphs (E) through (H) as 
        subparagraphs (F) through (I), respectively; and
          (3) by inserting after subparagraph (D) the following 
        subparagraph:
                  ``(E) Determination of secretary regarding data on 
                hiv cases.--If under 2603(a)(3)(D)(i) the Secretary 
                determines that data on cases of HIV disease is not 
                sufficiently accurate and reliable, then 
                notwithstanding subparagraph (D) of this paragraph, for 
                any fiscal year prior to fiscal year 2007 the 
                references in such subparagraph to cases of HIV disease 
                do not have any legal effect.''.
  (c) Increases in Formula Amount.--Section 2618(b) of the Public 
Health Service Act (42 U.S.C. 300ff-28(b)) is amended--
          (1) in paragraph (1)(A)(ii), by inserting before the 
        semicolon the following: ``and then, as applicable, increased 
        under paragraph (2)(H)''; and
          (2) in paragraph (2)--
                  (A) in subparagraph (A)(i), by striking 
                ``subparagraph (H)'' and inserting ``subparagraphs (H) 
                and (I)''; and
                  (B) in subparagraph (H) (as redesignated by 
                subsection (b)(2) of this section), by amending the 
                subparagraph to read as follows:
                  ``(H) Limitation.--
                          ``(i) In general.--The Secretary shall ensure 
                        that the amount of a grant awarded to a State 
                        or territory under section 2611 for a fiscal 
                        year is not less than--
                                  ``(I) with respect to fiscal year 
                                2001, 99 percent;
                                  ``(II) with respect to fiscal year 
                                2002, 98 percent;
                                  ``(III) with respect to fiscal year 
                                2003, 97 percent;
                                  ``(IV) with respect to fiscal year 
                                2004, 96 percent; and
                                  ``(V) with respect to fiscal year 
                                2005, 95 percent;
                        of the amount such State or territory received 
                        for fiscal year 2000 under such section. In 
                        administering this subparagraph, the Secretary 
                        shall, with respect to States or territories 
                        that will under such section receive grants in 
                        amounts that exceed the amounts that such 
                        States received under such section for fiscal 
                        year 2000, proportionally reduce such amounts 
                        to ensure compliance with this subparagraph. In 
                        making such reductions, the Secretary shall 
                        ensure that no such State receives less than 
                        that State received for fiscal year 2000.
                          ``(ii) Ratable reduction.--If the amount 
                        appropriated under section 2677 for a fiscal 
                        year and available for grants under section 
                        2611 is less than the amount appropriated and 
                        available under such section for fiscal year 
                        2000, the limitation contained in clause (i) 
                        shall be reduced by a percentage equal to the 
                        percentage of the reduction in such amounts 
                        appropriated and available.''.
  (d) Territories.--Section 2618(b)(1)(B) of the Public Health Service 
Act (42 U.S.C. 300ff-28(b)(1)(B)) is amended by inserting ``the greater 
of $50,000 or'' after ``shall be''.
  (e) Separate Treatment Drug Grants.--Section 2618(b)(2) of the Public 
Health Service Act, as amended by subsection (b)(3) of this section, is 
amended in subparagraph (I)--
          (1) by redesignating clauses (i) and (ii) as subclauses (I) 
        and (II), respectively;
          (2) by striking ``(I) Appropriations'' and all that follows 
        through ``With respect to'' and inserting the following:
                  ``(I) Appropriations for treatment drug program.--
                          ``(i) Formula grants.--With respect to'';
          (3) in subclause (I) of clause (i) (as designated by 
        paragraphs (1) and (2)), by striking ``100 percent'' and 
        inserting ``98 percent''; and
          (4) by adding at the end the following clause:
                          ``(ii) Supplemental treatment drug grants.--
                                  ``(I) In general.--With respect to 
                                the fiscal year involved, if under 
                                section 2677 an appropriations Act 
                                provides an amount exclusively for 
                                carrying out section 2616, and such 
                                amount is not less than the amount so 
                                provided for the preceding fiscal year, 
                                the Secretary shall reserve 2 percent 
                                of such amount for making grants to 
                                States whose population of individuals 
                                with HIV disease has, as determined by 
                                the Secretary, a need for quantities of 
                                therapeutics described in section 
                                2616(a) greater than the quantities 
                                available pursuant to clause (i). Such 
                                a grant is available for purposes of 
                                obtaining such therapeutics. The 
                                Secretary shall carry out this clause 
                                as a program of discretionary grants, 
                                and not as a program of formula grants.
                                  ``(II) Distribution of grants.--The 
                                Secretary shall disburse all amounts 
                                under grants under subclause (I) for a 
                                fiscal year not later than 240 days 
                                after the date on which the amount 
                                referred to in such subclause with 
                                respect to section 2616 becomes 
                                available.
                                  ``(III) Requirement of matching 
                                funds.--A condition for receiving a 
                                grant under subclause (I) is that the 
                                State agree to make available (directly 
                                or through donations from public or 
                                private entities) non-Federal 
                                contributions toward the costs of 
                                obtaining the therapeutics involved in 
                                an amount that is not less than 25 
                                percent of such costs (determined in 
                                the same manner as under 
                                2617(d)(2)(A)).''.
  (f) Technical Amendment.--Section 2618(b)(3)(B) of the Public Health 
Service Act (42 U.S.C. 300ff-28(b)(3)(B)) is amended by striking ``and 
the Republic of the Marshall Islands'' and inserting ``the Republic of 
the Marshall Islands, the Federated States of Micronesia, and the 
Republic of Palau, and only for purposes of paragraph (1) the 
Commonwealth of Puerto Rico''.

SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

  Subpart I of part B of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-11 et seq.) is amended--
          (1) by striking section 2621; and
          (2) by inserting after section 2620 the following section:

``SEC. 2621. SUPPLEMENTAL GRANTS.

  ``(a) In General.--From amounts available pursuant to subsection (d) 
for a fiscal year, the Secretary shall make grants to States that meet 
the conditions to receive grants under section 2611, and that have one 
or more eligible communities, for the purpose of providing in such 
communities comprehensive services of the type described in section 
2612(a) to supplement the development and care activities, primary 
care, and support services otherwise provided in such communities by 
the State under a grant under section 2611.
  ``(b) Eligible Community.--For purposes of this section, the term 
`eligible community' means a geographic area that--
          ``(1) is not within any eligible area as defined in section 
        2607; and
          ``(2) has a severe need for supplemental financial assistance 
        to combat the HIV epidemic, according to criteria developed by 
        the Secretary in consultation with the States, including 
        evidence of underserved or rural areas or both.
  ``(c) Application.--A grant under subsection (a) may be made to a 
State if the State submits to the Secretary, as part of the State 
application submitted under section 2617, such information as required 
to apply for funds under this section as determined by the Secretary in 
consultation with the States.
  ``(d) Funding.--
          ``(1) In general.--For the purpose of making grants under 
        subsection (a) for a fiscal year, the Secretary shall reserve 
        50 percent of the amount specified in paragraph (2).
          ``(2) Increases in part b funding.--
                  ``(A) In general.--For purposes of paragraph (1), the 
                amount specified in this paragraph is the amount by 
                which the amount appropriated under section 2677 for 
                the fiscal year involved and available for carrying out 
                part B is an increase over the amount so appropriated 
                and available for the preceding fiscal year, subject to 
                subparagraphs (B) and (C).
                  ``(B) Initial allocation year.--The allocation under 
                paragraph (1) shall not be made until the first fiscal 
                year for which the amount appropriated under section 
                2677 for the fiscal year involved and available for 
                carrying out part B is an increase of not less than 
                $20,000,000 over the amount so appropriated and 
                available for fiscal year 2000, subject to subparagraph 
                (C).
                  ``(C) Exclusion regarding separate treatment drug 
                grants.--Each determination under subparagraph (A) or 
                (B) of the amount appropriated under section 2677 for a 
                fiscal year and available for carrying out part B shall 
                be made without regard to any amount to which section 
                2618(b)(2)(I)(i) applies.''.

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

SEC. 211. REPEALS.

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

SEC. 212. GRANTS.

  (a) In General.--Section 2625(c) of the Public Health Service Act (42 
U.S.C. 300ff-33) is amended--
          (1) in paragraph (1), by inserting at the end the following 
        subparagraph:
                  ``(F) Making available to pregnant women with HIV 
                disease, and to the infants of women with such disease, 
                treatment services for such disease in accordance with 
                applicable recommendations of the Secretary.'';
          (2) by amending paragraph (2) to read as follows:
          ``(2) Funding.--
                  ``(A) Authorization of appropriations.--For the 
                purpose of carrying out this subsection, there are 
                authorized to be appropriated $30,000,000 for each of 
                the fiscal years 2001 through 2005. Amounts made 
                available under section 2677 for carrying out this part 
                are not available for carrying out this section unless 
                otherwise authorized.
                  ``(B) Allocations for certain states.--
                          ``(i) In general.--Of the amounts 
                        appropriated under subparagraph (A) for a 
                        fiscal year in excess of $10,000,000, the 
                        Secretary shall reserve the applicable 
                        percentage under clause (ii) for making grants 
                        under paragraph (1) to States that under law 
                        (including under regulations or the discretion 
                        of State officials) have--
                                  ``(I) a requirement that all newborn 
                                infants born in the State be tested for 
                                HIV disease; or
                                  ``(II) a requirement that newborn 
                                infants born in the State be tested for 
                                HIV disease in circumstances in which 
                                the attending obstetrician for the 
                                birth does not know the HIV status of 
                                the mother of the infant.
                          ``(ii) Applicable percentage.--For purposes 
                        of clause (i), the applicable amount for a 
                        fiscal year is as follows:
                                  ``(I) For fiscal year 2001, 25 
                                percent.
                                  ``(II) For fiscal year 2002, 50 
                                percent.
                                  ``(III) For fiscal year 2003, 50 
                                percent.
                                  ``(IV) For fiscal year 2004, 75 
                                percent.
                                  ``(V) For fiscal year 2005, 75 
                                percent.
                  ``(C) Certain provisions.--With respect to grants 
                under paragraph (1) that are made with amounts reserved 
                under subparagraph (B) of this paragraph:
                          ``(i) Such a grant may not be made in an 
                        amount exceeding $4,000,000.
                          ``(ii) If pursuant to clause (i) or pursuant 
                        to an insufficient number of qualifying 
                        applications for such grants (or both), the 
                        full amount reserved under subparagraph (B) for 
                        a fiscal year is not obligated, the requirement 
                        under such subparagraph to reserve amounts 
                        ceases to apply.''; and
          (3) by adding at the end the following paragraph:
          ``(4) Maintenance of effort.--A condition for the receipt of 
        a grant under paragraph (1) is that the State involved agree 
        that the grant will be used to supplement and not supplant 
        other funds available to the State to carry out the purposes of 
        the grant.''.
  (b) Special Funding Rule for Fiscal Year 2001.--
          (1) In general.--If for fiscal year 2001 the amount 
        appropriated under paragraph (2)(A) of section 2625(c) of the 
        Public Health Service Act is less than $14,000,000--
                  (A) the Secretary of Health and Human Services shall, 
                for the purpose of making grants under paragraph (1) of 
                such section, reserve from the amount specified in 
                paragraph (2) of this subsection an amount equal to the 
                difference between $14,000,000 and the amount 
                appropriated under paragraph (2)(A) of such section for 
                such fiscal year;
                  (B) the amount so reserved shall, for purposes of 
                paragraph (2)(B)(i) of such section, be considered to 
                have been appropriated under paragraph (2)(A) of such 
                section; and
                  (C) the percentage specified in paragraph 
                (2)(B)(ii)(I) of such section is deemed to be 50 
                percent.
          (2) Allocation from increases in funding for part b.--For 
        purposes of paragraph (1), the amount specified in this 
        paragraph is the amount by which the amount appropriated under 
        section 2677 of the Public Health Service Act for fiscal year 
        2001 and available for grants under section 2611 of such Act is 
        an increase over the amount so appropriated and available for 
        fiscal year 2000.

SEC. 213. STUDY BY INSTITUTE OF MEDICINE.

  Subpart II of part B of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-33 et seq.) is amended by adding at the end the 
following section:

``SEC. 2630. RECOMMENDATIONS FOR REDUCING INCIDENCE OF PERINATAL 
                    TRANSMISSION.

  ``(a) Study by Institute of Medicine.--
          ``(1) In general.--The Secretary shall request the Institute 
        of Medicine to enter into an agreement with the Secretary under 
        which such Institute conducts a study to provide the following:
                  ``(A) For the most recent fiscal year for which the 
                information is available, a determination of the number 
                of newborn infants with HIV born in the United States 
                with respect to whom the attending obstetrician for the 
                birth did not know the HIV status of the mother.
                  ``(B) A determination for each State of any barriers, 
                including legal barriers, that prevent or discourage an 
                obstetrician from making it a routine practice to offer 
                pregnant women an HIV test and a routine practice to 
                test newborn infants for HIV disease in circumstances 
                in which the obstetrician does not know the HIV status 
                of the mother of the infant.
                  ``(C) Recommendations for each State for reducing the 
                incidence of cases of the perinatal transmission of 
                HIV, including recommendations on removing the barriers 
                identified under subparagraph (B).
        If such Institute declines to conduct the study, the Secretary 
        shall enter into an agreement with another appropriate public 
        or nonprofit private entity to conduct the study.
          ``(2) Report.--The Secretary shall ensure that, not later 
        than 18 months after the effective date of this section, the 
        study required in paragraph (1) is completed and a report 
        describing the findings made in the study is submitted to the 
        appropriate committees of the Congress, the Secretary, and the 
        chief public health official of each of the States.
  ``(b) Progress Toward Recommendations.--Each State shall comply with 
the following (as applicable to the fiscal year involved):
          ``(1) For fiscal year 2004, the State shall submit to the 
        Secretary a report describing the actions taken by the State 
        toward meeting the recommendations specified for the State 
        under subsection (a)(1)(C).
          ``(2) For fiscal year 2005 and each subsequent fiscal year--
                  ``(A) the State shall make reasonable progress toward 
                meeting such recommendations; or
                  ``(B) if the State has not made such progress--
                          ``(i) the State shall cooperate with the 
                        Director of the Centers for Disease Control and 
                        Prevention in carrying out activities toward 
                        meeting the recommendations; and
                          ``(ii) the State shall submit to the 
                        Secretary a report containing a description of 
                        any barriers identified under subsection 
                        (a)(1)(B) that continue to exist in the State; 
                        as applicable, the factors underlying the 
                        continued existence of such barriers; and a 
                        description of how the State intends to reduce 
                        the incidence of cases of the perinatal 
                        transmission of HIV.
  ``(c) Submission of Reports to Congress.--The Secretary shall submit 
to the appropriate committees of the Congress each report received by 
the Secretary under subsection (b)(2)(B)(ii).''.

           Subtitle C--Certain Partner Notification Programs

SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICATION PROGRAMS.

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

          ``Subpart III--Certain Partner Notification Programs

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

  ``(a) In General.--In the case of States whose laws or regulations 
are in accordance with subsection (b), the Secretary, subject to 
subsection (c)(2), may make grants to the States for carrying out 
programs to provide partner counseling and referral services.
  ``(b) Description of Compliant State Programs.--For purposes of 
subsection (a), the laws or regulations of a State are in accordance 
with this subsection if under such laws or regulations (including 
programs carried out pursuant to the discretion of State officials) the 
following policies are in effect:
          ``(1) The State requires that the public health officer of 
        the State carry out a program of partner notification to inform 
        partners of individuals with HIV disease that the partners may 
        have been exposed to the disease.
          ``(2)(A) In the case of a health entity that provides for the 
        performance on an individual of a test for HIV disease, or that 
        treats the individual for the disease, the State requires, 
        subject to subparagraph (B), that the entity confidentially 
        report the positive test results to the State public health 
        officer in a manner recommended and approved by the Director of 
        the Centers for Disease Control and Prevention, together with 
        such additional information as may be necessary for carrying 
        out such program.
          ``(B) The State may provide that the requirement of 
        subparagraph (A) does not apply to the testing of an individual 
        for HIV disease if the individual underwent the testing through 
        a program designed to perform the test and provide the results 
        to the individual without the individual disclosing his or her 
        identity to the program. This subparagraph may not be construed 
        as affecting the requirement of subparagraph (A) with respect 
        to a health entity that treats an individual for HIV disease.
          ``(3) The program under paragraph (1) is carried out in 
        accordance with the following:
                  ``(A) Partners are provided with an appropriate 
                opportunity to learn that the partners have been 
                exposed to HIV disease, subject to subparagraph (B).
                  ``(B) The State does not inform partners of the 
                identity of the infected individuals involved.
                  ``(C) Counseling and testing for HIV disease are made 
                available to the partners and to infected individuals, 
                and such counseling includes information on modes of 
                transmission for the disease, including information on 
                prenatal and perinatal transmission and preventing 
                transmission.
                  ``(D) Counseling of infected individuals and their 
                partners includes the provision of information 
                regarding therapeutic measures for preventing and 
                treating the deterioration of the immune system and 
                conditions arising from the disease, and the provision 
                of other prevention-related information.
                  ``(E) Referrals for appropriate services are provided 
                to partners and infected individuals, including 
                referrals for support services and legal aid.
                  ``(F) Notifications under subparagraph (A) are 
                provided in person, unless doing so is an unreasonable 
                burden on the State.
                  ``(G) There is no criminal or civil penalty on, or 
                civil liability for, an infected individual if the 
                individual chooses not to identify the partners of the 
                individual, or the individual does not otherwise 
                cooperate with such program.
                  ``(H) The failure of the State to notify partners is 
                not a basis for the civil liability of any health 
                entity who under the program reported to the State the 
                identity of the infected individual involved.
                  ``(I) The State provides that the provisions of the 
                program may not be construed as prohibiting the State 
                from providing a notification under subparagraph (A) 
                without the consent of the infected individual 
                involved.
          ``(4) The State annually reports to the Director of the 
        Centers for Disease Control and Prevention the number of 
        individuals from whom the names of partners have been sought 
        under the program under paragraph (1), the number of such 
        individuals who provided the names of partners, and the number 
        of partners so named who were notified under the program.
          ``(5) The State cooperates with such Director in carrying out 
        a national program of partner notification, including the 
        sharing of information between the public health officers of 
        the States.
  ``(c) Reporting System for Cases of HIV Disease.--
          ``(1) Preference in making grants through fiscal year 2003.--
        In making grants under subsection (a) for each of the fiscal 
        years 2001 through 2003, the Secretary shall give preference to 
        States whose reporting systems for cases of HIV disease produce 
        data on such cases that is sufficiently accurate and reliable 
        for use for purposes of section 2618(b)(2)(D)(i).
          ``(2) Eligibility condition after fiscal year 2003.--For 
        fiscal year 2004 and subsequent fiscal years, a State may not 
        receive a grant under subsection (a) unless the reporting 
        system of the State for cases of HIV disease produces data on 
        such cases that is sufficiently accurate and reliable for 
        purposes of section 2618(b)(2)(D)(i).
  ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $30,000,000 
for fiscal year 2001, and such sums as may be necessary for each of the 
fiscal years 2002 through 2005.''.

                 TITLE III--EARLY INTERVENTION SERVICES

                 Subtitle A--Formula Grants for States

SEC. 301. REPEAL OF PROGRAM.

  Subpart I of part C of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-41 et seq.) is repealed.

                     Subtitle B--Categorical Grants

SEC. 311. PREFERENCES IN MAKING GRANTS.

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

SEC. 312. PLANNING AND DEVELOPMENT GRANTS.

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

SEC. 313. AUTHORIZATION OF APPROPRIATIONS.

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

                     Subtitle C--General Provisions

SEC. 321. PROVISION OF CERTAIN COUNSELING SERVICES.

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

SEC. 322. ADDITIONAL REQUIRED AGREEMENTS.

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

                TITLE IV--OTHER PROGRAMS AND ACTIVITIES

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

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

  Section 2671 of the Public Health Service Act (42 U.S.C. 300ff-71) is 
amended--
          (1) in subsection (b)--
                  (A) in paragraph (1), by striking subparagraphs (C) 
                and (D) and inserting the following:
                  ``(C) The applicant will demonstrate linkages to 
                research and how access to such research is being 
                offered to patients.''; and
                  (B) by striking paragraphs (3) and (4);
          (2) in subsection (g), by adding at the end the following: 
        ``In addition, the Secretary, in coordination with the Director 
        of such Institutes, shall examine the distribution and 
        availability of appropriate HIV-related research projects with 
        respect to grantees under subsection (a) for purposes of 
        enhancing and expanding HIV-related research, especially within 
        communities that are underrepresented with respect to such 
        projects.'';
          (3) in subsection (f)--
                  (A) by striking the subsection heading and 
                designation and inserting the following:
  ``(f) Administration.--
          ``(1) Application.--''; and
                  (B) by adding at the end the following paragraph:
          ``(2) Quality management program.--A grantee under this 
        section shall implement a quality management program.''; and
          (4) in subsection (j), by striking ``1996 through 2000'' and 
        inserting ``2001 through 2005''.

SEC. 402. AIDS EDUCATION AND TRAINING CENTERS.

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

              Subtitle B--General Provisions in Title XXVI

SEC. 411. EVALUATIONS AND REPORTS.

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

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

  Part D of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff-71 et seq.) is amended--
          (1) by redesignating section 2675 as section 2675A; and
          (2) by inserting after section 2674 the following section:

``SEC. 2675. DATA COLLECTION.

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

SEC. 413. COORDINATION.

  Section 2675A of the Public Health Service Act, as redesignated by 
section 412 of this Act, is amended--
          (1) by amending subsection (a) to read as follows:
  ``(a) Requirement.--The Secretary shall ensure that the Health 
Resources and Services Administration, the Centers for Disease Control 
and Prevention, the Substance Abuse and Mental Health Services 
Administration, and the Health Care Financing Administration coordinate 
the planning, funding, and implementation of Federal HIV programs to 
enhance the continuity of care and prevention services for individuals 
with HIV disease or those at risk of such disease. The Secretary shall 
consult with other Federal agencies, including the Department of 
Veterans Affairs, as needed and utilize planning information submitted 
to such agencies by the States and entities eligible for support.'';
          (2) by redesignating subsections (b) and (c) as subsections 
        (c) and (d), respectively;
          (3) by inserting after subsection (b) the following 
        subsection:
  ``(b) Report.--The Secretary shall biennially prepare and submit to 
the appropriate committees of the Congress a report concerning the 
coordination efforts at the Federal, State, and local levels described 
in this section, including a description of Federal barriers to HIV 
program integration and a strategy for eliminating such barriers and 
enhancing the continuity of care and prevention services for 
individuals with HIV disease or those at risk of such disease.''; and
          (4) in each of subsections (c) and (d) (as redesignated by 
        paragraph (2) of this section), by inserting ``and prevention 
        services'' after ``continuity of care'' each place such term 
        appears.

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

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

SEC. 415. AUDITS.

  Part D of title XXVI of the Public Health Service Act, as amended by 
section 412 of this Act, is amended by inserting after section 2675A 
the following section:

``SEC. 2675B. AUDITS.

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

SEC. 416. ADMINISTRATIVE SIMPLIFICATION.

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

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

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

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

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

``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

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

                      TITLE V--GENERAL PROVISIONS

SEC. 501. STUDIES BY INSTITUTE OF MEDICINE.

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

SEC. 502. DEVELOPMENT OF RAPID HIV TEST.

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

                        TITLE VI--EFFECTIVE DATE

SEC. 601. EFFECTIVE DATE.

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

                          Purpose and Summary

    The Ryan White CARE Act Amendments of 2000 reauthorizes 
programs providing for the comprehensive health care of 
Americans suffering from HIV/AIDS and prevention programs to 
prevent the spread of HIV.

                  Background and Need for Legislation

    Acquired Immunodeficiency Syndrome (AIDS) cases were first 
reported in the United States in 1981. In the two decades 
since, more than 700,000 persons in the United States have been 
diagnosed with AIDS. The General Accounting Office (GAO) 
recently estimated that by the end of 1998, 300,000 persons in 
the United States were living with AIDS, and that as many as 
hundreds of thousands of people in this country are infected 
with the human immunodeficiency virus (HIV), but have not yet 
progressed to AIDS.
    Because persons with AIDS faced problems obtaining 
insurance coverage and access to primary care and support, the 
Congress responded in 1990 by passing the Ryan White 
Comprehensive AIDS Resources Emergency (CARE) Act (P.L. 101-
381). The framework of that Act, as passed, continues in force 
today.
    Title I of the Act provides relief to eligible metropolitan 
areas (EMAs) disproportionately impacted by AIDS. By fiscal 
year (FY) 1991, there were 16 EMAs receiving CARE Act Title I 
funding. Currently, as of FY2000, there are 51 EMAs. Title I 
relief is provided through formula and supplemental grants to 
be used for case management and comprehensive treatment 
services, among other things. Such grants are intended to 
supplement, not supplant, State funding, and have the express 
purpose of delivering or enhancing HIV-related outpatient and 
ambulatory health and support services. These service include 
case management, substance abuse and mental health treatment, 
comprehensive treatment services, and inpatient case management 
services that prevent unnecessary hospitalization or that 
expedite discharges.
    As originally enacted in 1990, a community was entitled to 
be an EMA if the area had more than 2,000 cases of AIDS, or if 
the cumulative per capita incidence of AIDS exceeded one 
quarter of one percent. Under the Ryan White CARE Act 
Amendments of 1996 (P.L. 104-186), this was changed so that 
areas could qualify for funding under Title I if the area has a 
population of 500,000 or more individuals, and the area has 
reported to the Director of the Centers for Disease Control and 
Prevention (CDC) a cumulative total of more than 2,000 cases of 
AIDS for the most recent five calendar years.
    Title I funding is, generally, equally divided amongst 
formula and supplemental grants. Formula grants are distributed 
to EMAs according to a complex distribution factor, taking into 
account the estimated living number of AIDS cases in the EMA. 
The estimated living number of AIDS cases in an EMA is 
determined by the number of AIDS cases reported to, and 
confirmed by, the CDC in the most recent ten year period, 
multiplied (on a yearly basis) by a percentage developed by the 
Secretary of the Department of Health and Human Services. Title 
I supplemental grants are awarded based upon severe need, 
though these grants have been awarded historically in a way 
which results in a doubling of the Title I formula amount.
    One important exception must be noted. The 1990 CARE Act 
distributed formula funds based partially upon the historical 
number of AIDS cases the EMA had experienced, irrespective of 
whether the disease sufferers were still alive. The 1996 CARE 
Act Amendments altered this to allocate funds based upon living 
number of AIDS cases. Because the change from historic 
incidences of AIDS to estimated living AIDS cases per EMA could 
have caused significant disruptions in funding received by 
certain EMAs, the 1996 CARE Act Amendments contained a ``hold 
harmless'' clause. According to this provision, no EMA could 
lose more than five percent, over five years, from the EMA's 
FY1995 Title I formula grant. To fund the ``hold harmless'' 
provision, the amount of Title I supplemental grant funds 
available to all EMAs is reduced accordingly.
    Title I grants are made to the chief elected official of 
the city or county in the EMA that administers the health 
agency providing services to the greatest number of persons 
with AIDS. This chief elected official must establish or 
designate an HIV health services planning council to establish 
priorities for care delivery according to Federal guidelines, 
in order to receive Title I funds. Members of the councils must 
reflect the demographics of the epidemic in the EMA, and it 
shall include representatives of health care providers; 
community-based organizations serving affected populations and 
AIDS service organizations; affected communities, including 
people with HIV disease or AIDS, and historically underserved 
groups and subpopulations; mental health and substance abuse 
providers, and others. The council may not be directly involved 
in the administration of any Title I grant.
    Title II funds provide formula grants to states and 
territories for comprehensive care services including home and 
community-based health care and support services. States use 
such funds to provide services directly or through contracts 
with HIV care consortia. Title II grants are also used to 
provide health insurance coverage for low-income persons 
through Health Insurance Continuation Programs and drug 
treatments for individuals with HIV and AIDS who have limited 
or no coverage from private insurance or Medicaid through AIDS 
Drug Assistance Programs (ADAPs). Prior to FY1996, States 
determined the amount of their Title II funds they would 
dedicate to ADAPs. In FY1996, Congress began appropriating 
ADAP-targeted funds under Title II.
    Grants are awarded to States based upon a weighted formula 
that accounts for two factors: (1) the estimated number of 
living AIDS cases in the State; and (2) the estimated number of 
living AIDS cases in the State who are not in a Title I EMA. 
States with more than 1% of the total AIDS cases reported 
nationally must contribute State matching funds based on a 
formula, and grants may not be made to any State that does not 
make a good faith effort to notify a spouse of an HIV-infected 
patient that the spouse should seek testing.
    Further, Title II provides up to $10 million for States 
which certify that they have in effect regulations or measures 
to adopt CDC guidelines concerning HIV virus counseling and 
voluntary testing for pregnant women. Priority is given to 
States that have the greatest proportion of HIV seroprevalance 
among child bearing women, as determined by the CDC.
    Early intervention services are provided for under Title 
III of the CARE Act. Under this, public and private nonprofit 
entities already providing primary care services to low-income 
and medically underserved populations compete for grants to 
provide HIV testing, risk reduction counseling, case 
management, outreach, medical evaluation, transmission 
prevention, oral health, nutritional and mental health 
services, and clinical care. Community health centers, homeless 
programs, local health departments, family planning programs, 
hemophilia diagnostic and treatment centers, as well as other 
nonprofit community-based programs all compete for Title III 
grants.
    When enacted in 1990, Title IV authorized a number of 
different HIV-related programs, but the only one for which 
funds were appropriated was pediatric demonstration grants. In 
the 1996 CARE Act Amendments, this funded program was replaced 
with a program of grants for coordinated services and access to 
research for women, infants, children and youth. Such grants 
provide opportunities for women, infants, children and youth to 
be voluntary participants in research of potential clinical 
benefit to individuals with HIV and AIDS. Such individuals are 
provided access to health care on an outpatient basis, case 
management, referrals, transportation, child care, and other 
services which enable participation.
    Other programs under the CARE Act which have been funded 
include special projects of national significance for the care 
and treatment of individuals with HIV/AIDS, AIDS Education and 
Training Centers program (AETC), and the AIDS Dental 
Reimbursement program.
    Funding Fairness. The Committee has amended and enhanced 
the CARE Act to respond to significant changes in the HIV/AIDS 
epidemic. It is important to the Committee that no eligible 
metropolitan area lose its ability to provide services 
authorized under the CARE Act. At the same time, it is equally 
important to the Committee that no EMA receive significantly 
more Title I formula funding on a per case basis than other 
similarly-situated EMAs.
    It is the Committee's intention that, over time, each EMA 
should receive Title I formula funds in proportion to its 
estimated number of living HIV cases. The GAO has reported, 
however, that presently one EMA, the San Francisco EMA, 
receives dramatically more Title I funding on a per case basis 
than any other EMA. For example, GAO reports that in FY 1999 
San Francisco spent $5,598 per AIDS case, while the other 50 
EMAs spent between $2,509 and $3,132 per AIDS case. More 
specifically, GAO reported that the San Francisco EMA receives 
roughly 80% more per in Title I grant funds per AIDS case than 
other EMAs.


    A few have defended this disparity by stating that per 
patient cost is higher than other places because the costs of 
care in services in the Bay Area is so inflated. But even if 
CARE Act money were adjusted for funding the cost of providing 
medical care (it presently is not), San Francisco still 
receives far more than any other EMA per capita. The 
accompanying graph uses the Medicare hospital cost wage index 
cost adjuster on the per capita Title I formula and 
discretionary grant money used in chart 1. Even with these 
adjustments, it is clear that the San Francisco EMA still gets 
the most of all EMAs. With similar cost structures as San 
Francisco, Oakland and San Jose in the Bay Area join New York 
at the bottom of Title I funding.


    The present disparity in funding results from the way EMAs 
were funded under Title I when the CARE Act was enacted in 
1990. Originally, EMAs were funded based upon the cumulative 
number of AIDS cases the EMA experienced. In 1996, Title I 
formula funding was altered to compensate EMAs based upon the 
estimated number of living AIDS cases in the EMA, rather than 
the cumulative caseload of living and dead AIDS cases. So that 
certain EMAs would not find their Title I formula funding 
dramatically decreased, a hold harmless provision was included 
in the reauthorization limiting funding cuts to no more than 
five percent, over five years, from the 1995 Title I formula 
amount.
    The GAO reports that presently only the San Francisco EMA 
benefits from this hold harmless provision, thus explaining the 
disparity in funding. During the July 11, 2000 hearing before 
the Subcommittee on Health and Environment, the GAO 
acknowledged that a reason for this is that San Francisco's 
basis of funding, due to the hold harmless, still compensates 
the EMA for individuals who have long ago died.
    To ensure that per case funding is more equitable, H.R. 
4807 reforms the hold harmless provision which limits funding 
reductions to EMAs. According to the provision in this bill, no 
EMA would experience a reduction greater than 25% of its base 
year formula allocation over the next five fiscal years. Such a 
regime would still leave the San Francisco EMA with more Title 
I formula funds on a per case basis than any other EMA, while 
still alleviating some of the unfair funding disparities.
    As a way to protect State funding provided by Title II, the 
legislation contains a hold harmless provision which ensures 
that no State will see more than a one percent cut in Title II 
formula funds per fiscal year. This reflects a continuation of 
present law. It is important to note that no State has 
benefitted from this provision since its enactment.
    The Committee intends that Title I supplemental awards are 
not intended to be allocated on the basis of formula grant 
allocations. Instead, such supplemental awards are to be 
directed to those eligible areas with ``severe need,'' or the 
greatest or expanding public health challenges in confronting 
the epidemic. The Committee has included additional factors to 
be considered in the assessment of severe need, including the 
current prevalence of HIV/AIDS, and the degree of increasing 
and unmet needs for services. Additionally, the Committee 
believes that syphilis, hepatitis B and hepatitis C should be 
regarded as important co-morbidities to HIV/AIDS.
    It is the Committee's strong view that HRSA's Bureau of 
HIV/AIDS should employ standard, quantitative measures to the 
maximum extent possible in lieu of narrative self-reporting 
when awarding supplemental awards. The Committee renews the 
Bureau's obligation to develop in a timely manner a mechanism 
for determining severe need upon the basis of national, 
quantitative incidence data. In this regard, the Committee 
recognizes that adequate and reliable data on HIV prevalence 
may not be uniformly available in all eligible areas on the 
date of enactment. The Committee also notes that ``HIV 
disease'' under the CARE Act encompasses both persons living 
with AIDS as well as persons diagnosed as HIV positive who have 
not developed AIDS.
    Just as importantly, for the first time the CARE Act will 
recognize the need for Title II supplemental grants with the 
passage of H.R. 4807. These grants are intended for areas, 
other than EMAs, experiencing a severe need for supplemental 
financial assistance. Like with Title I supplemental awards, it 
is the Committee's intention that Title II supplemental awards 
should not be allocated in proportion to formula awards, but 
rather on the basis of demonstrated severe need.
    The Committee intends that preference should be given to 
shift Title III grants to addressing the needs of rural areas 
and underserved areas. This preference is intended to further 
shift CARE Act programs towards eliminating disparities in 
access and services among affected subpopulations and 
historically underserved communities.
    The Committee strongly supports the use of Title I funds to 
conduct outreach activities to identify individuals with HIV/
AIDS who are not receiving services, and get them under medical 
care and treatment. President Reagan's HIV Commission concluded 
that ``early diagnosis of HIV infection is essential'' because 
HIV infection ``can be treated more effectively when detected 
early.'' The Committee concurs with these findings and 
acknowledges that the medical breakthroughs which have been 
developed in the twelve years since the issuance of this report 
make early intervention even more important. This authorization 
reflects the Committee's intent to increase the coordination 
between HIV prevention and HIV care and treatment services in 
all CARE Act programs. The Committee expects such activities 
will be of particular importance when focusing on underserved 
populations, and of particular value in bringing into and 
retain in care those individuals who are knowledgeable of their 
status but are not receiving services.
    HIV Reporting. According to CDC, in June 1999 there were an 
estimated 287,946 Americans living with AIDS. Currently, CDC is 
not able to determine how many Americans were living with HIV, 
because only 29 states report HIV cases. CDC expects all states 
to be reporting newly diagnosed HIV cases by 2003 and than an 
additional 1 to 3 years may be needed to get all HIV cases 
entered into such new reporting systems. It is difficult for 
regions without reliable HIV surveillance to adequately address 
the needs or understand the scope of the epidemic.
    The identification of HIV reporting as a serious public 
health concern was identified by the first Presidential 
Commission on HIV, appointed by President Reagan, which issued 
the ``Report of the Presidential Commission on the Human 
Immunodeficiency Virus Epidemic'' on June 24, 1988. According 
to that report:

          The term ``AIDS'' is obsolete. ``HIV infection'' more 
        correctly defines the problem. The medical, public 
        health, political, and community leadership must focus 
        on the full course of HIV infection rather than 
        concentrating on later stages of the disease (ARC and 
        AIDS). Continual focus on AIDS rather than the entire 
        spectrum of HIV disease has left our nation unable to 
        deal adequately with the epidemic. Federal and state 
        data collection efforts must now be focused on early 
        HIV reports, while still collecting data on symptomatic 
        disease.

    Eleven and a half years later, the CDC has implemented 
proposals consistent with proposals made by President Reagan's 
Commission on the Human Immunodeficiency Virus Epidemic.
    To address the challenge of insufficient value being 
derived from AIDS data alone, CDC joined the Council of State 
and Territorial Epidemiologists (CSTE) to recommend in December 
1999 that all states and territories include name surveillance 
for HIV infection as an extension of their AIDS surveillance 
activities. On May 11, 2000,
    Surgeon General Satcher testified before the Subcommittee 
on Health and Environment that he agreed with the CDC and CSTE 
recommendation. In light of the consensus that has finally 
emerged, the Committee believes all jurisdictions should shift 
the focus fromAIDS to the full spectrum of HIV infection for 
improved prevention and care. Federal funding as well should be based 
upon the full extent of the disease rather than only on the late stages 
defined as AIDS. This will ensure more equitable funding and more 
timely and appropriate responses.
    The consequences and human toll of dithering over HIV 
reporting over the last decade has been high, and not just in 
this country. The Committee believes that other public health 
institutions throughout the world have not yet adopted HIV 
reporting, and for this reason the Committee strongly 
recommends that the CDC should work in consultation with HRSA 
on all international HIV/AIDS initiatives to avoid repeating 
mistakes made in the past. The Committee is also concerned 
that, because public health institutions had no data to show 
the rate of growth of HIV cases among various American cultural 
and ethnic communities, communities of color are 
disproportionately affected and infected by the HIV epidemic.
    HIV Case Classification. The Committee is aware of concerns 
that the heterosexual and NIR categories as currently defined 
may result in systematic underreporting of heterosexual cases 
of HIV, which could be detrimental to addressing the prevention 
needs of certain groups, particularly communities of color.
    This classification system may have been satisfactory early 
in the epidemic, but the changing dynamics of the HIV/AIDS 
epidemic require a timely reassessment and refinement of 
current classification methods. The Committee applauds the 
CDC's recognition of State efforts to accomplish these goals, 
including Virginia's efforts to identify NIR cases with 
multiple sex partners. The CDC has indicated that it is also 
currently reassessing HIV/AIDS case classification methods to 
ensure the most adequate understanding of the disease and its 
modes of transmission and to properly allocate and target 
resources to those groups that are increasingly at risk of 
infection, such as African American females.
    Based on this understanding, the Committee urges the 
Secretary to commit to an agenda of coordinated actions with 
the States and patient advocates, including the development and 
validation of rigorous sampling techniques, the promulgation of 
formal guidance to the States, the provision of technical 
assistance to State and local health authorities, and the 
expansion of the CDC's current pilot projects with interested 
States. Finally, the Committee applauds the CDC's commitment to 
hold a public meeting to obtain expert opinion on this issue, 
and its current efforts to consult with the Committee prior to 
the meeting regarding its attendance.
    Demographics and Needs of Populations with HIV Disease. The 
comprehensive service delivery plan is an effective way to 
demonstrate the organization and delivery of CARE Act services 
based upon the planning, priority setting, and funding 
allocation processes conducted by the planning council. The 
intent of the legislation is also to have the additional 
factors reflected in the plan. Those factors include 
disparities in access to medical and health-related support 
services by specific subpopulations; the needs of persons with 
HIV not in care; capacity development needs; and quality of HIV 
primary care and health-related supportive services. Both the 
planning process and the resulting plan should include the 
participation of, and address the needs of, populations and 
subpopulations living with HIV and AIDS.
    The Committee requires that Planning Councils determine the 
size, demographics and needs of the population with HIV 
disease. The Committee recognizes that adequate and reliable 
data on HIV prevalence may not be uniformly available in all 
eligible areas on the date of enactment. Therefore, priorities 
for the allocation of funds and the comprehensive plan should 
reflect HIV prevalence to the extent that data are reasonably 
available. The Committee also notes that ``HIV disease'' under 
the CARE Act encompasses both persons living with AIDS as well 
as persons diagnosed as HIV positive who have not developed 
AIDS.
    The reauthorization bill reflects the Committee position 
that priority setting and funding allocation decisions should 
be based on the size and demographic characteristics of the 
populations with HIV disease in the eligible area. Planning, 
priority setting, and funding allocation processes must take 
into account shifts in the local HIV/AIDS epidemic, existing 
health HIV-related disparities, and resulting negative health 
outcomes.
    The Committee intends Planning Councils to develop a 
strategy to identify individuals with HIV disease who are not 
receiving services and to inform and enable such individuals to 
receive services under Title I. The Committee wants CARE Act 
providers to work actively to bring into and retain in care 
those individuals who are unaware of their HIV status and those 
who are knowledgeable of their status but are not receiving 
services. As part of this process, the Committee believes 
strongly in the importance of Planning Councils focusing on 
eliminating disparities in access and services among affected 
subpopulations and historically underserved communities. The 
Committee recognizes that the availability or lack of HIV 
prevalence data in particular EMAs will be reflected in the 
scope, goals, timetable and allocation of funds for 
implementation of the strategy.
    The Committee also intends Planning Councils to develop a 
strategy to coordinate the provision of Title I services with 
HIV prevention services and substance abuse prevention and 
treatment services. The Committee has amended numerous aspects 
of CARE Act programs to enhance the coordination between HIV 
prevention and HIV care and treatment services. The Committee 
further requests that the Secretary work with title I grant 
recipients and providers to establish epidemiologic measures 
and tools for use by EMAs in identifying the number of 
individuals with HIV infection, especially those who are not in 
care.
    The Committee expects that the development of such measures 
will refine and expand the ability of EMAs and Planning 
Councils to identify and provide services to individuals with 
HIV disease who are not receiving services. The efforts on the 
part of EMAs and Planning Councils to accomplish these 
important tasks, however, should not be delayed until this 
process is complete. Instead, the Committee expects EMAs and 
Planning Councils to establish and implement strategies 
responsive to these urgent needs before the development of 
nationally uniform measures, to the extent that is practicable 
and to which necessary prevalence data is reasonably available.
    Early Intervention Services. The Committee authorizes early 
intervention services as eligible services under certain 
circumstances in Titles I and II. The Committee intends to 
allow grantees to provide certain early intervention services, 
such as HIV counseling, testing, and referral services, to 
individuals at high risk for HIV infection in accordance with 
statewide planning and regional consortia planning activities. 
Additionally, the Committee intends that the types of 
organizations that may provide early intervention services are 
the same as those that provide other HIV-related services 
through Parts B or C of the Act, or are points of access into 
the health care system for individuals at high risk for HIV, as 
specified by States under guidance from HRSA's Bureau of HIV/
AIDS.
    The Committee recognizes that these organizations may 
include traditional community based organizations (CBOs) that 
act as points of entry and/or referral agencies into the health 
care system, especially for traditionally underserved and 
minority populations. This provision is solely for the purpose 
of expanding the scope of primary care services to include HIV 
testing, counseling, and referral. The Committee recognizes the 
importance of early intervention services in increasing access 
to medical services through established relations with a broad 
network of health care entry points and HIV medical providers 
that serve as critical entry points for medical services for 
uninsured, and underinsured, low-income and rural communities. 
The Committee specifically intends that funds not be used to 
supplant other funds available to States for the provision of 
early intervention services and that these funds are utilized 
only when existing Federal, State or local funds are inadequate 
to provide these services. Further, the Committee intends that 
such services need to be provided according to guidelines 
established by the CDC and according to the laws and 
administrative regulations of State and local governments. The 
Committee expects that the Secretary, working with grantees and 
the public health community, will provide guidance to establish 
the appropriate parameters for the use of CARE Act funds for 
these purposes and to coordinate these activities with existing 
early intervention services. The Committee recognizes that 
other funding sources may exist for these services and expects 
all grantees to seek out and use these funds to enhance medical 
care to the extent they are reasonably available.
    The Committee finds that all counseling for HIV-infected 
individuals should emphasize that it is the duty of infected 
individuals to disclose their infected status to their sexual 
partners and others who are they potentially may place at risk 
of infection. The Committee recognizes that proper counseling 
better enables individuals living with HIV to make such 
disclosures. The Committee intends for entities providing care 
under this legislation will provide such counseling and 
emphasize that it is the continuing duty of the infected 
individuals to avoid any behaviors that will expose others to 
HIV.
    The Committee heard testimony in 1998 from an HIV infected 
man who became infected because his partner hid his HIV status 
and did so after counseling from Federally supported 
organizations which did not advise him to disclose. The 
Committee believes that this policy all those who are infected 
should be provided proper advice to disclose and provided the 
counseling to do so. Recent studies have found that the 
continuing epidemic in the United States is being driven by 
infected individuals who do not disclose their status and 
continue to engage in risky behaviors. The Committee believes 
that existing prevention policies have failed to adequately 
address such behavior and have enabled them to continue. This 
provision will provide better secondary prevention and protect 
the infected from other health complications including dual HIV 
infection.
    Rapid HIV Test. The Committee also seeks to expand and 
coordinate efforts at the NIH and FDA to develop rapid HIV 
tests. Accurate and affordable rapid HIV tests have many 
potentially important applications, one of which would be to 
help diagnose pregnant women whose HIV status is not known late 
in pregnancy or at the time of labor. The purpose of this 
initiative is to help increase opportunities for individuals, 
including pregnant women, to learn their HIV status. The 
Committee recognizes that labor is not an ideal time to obtain 
consent for testing or to discuss the implications of a 
positive test result. It is not the intent of this Committee to 
diminish the right of patients to make an informed decision to 
be tested. In establishing or updating relevant guidelines, CDC 
should address how to ensure that the meaningful decision 
making ability of patients is preserved. These guidelines 
should recognize that states have varying laws and policies 
related to the communication of test results. The Committee 
encourages the FDA to facilitate CDC's ability to use rapid HIV 
tests as soon as possible, consistent with the FDA's approval 
process.
    Partner Notification. The results of various regional 
studies confirm that partner notification is a useful and 
effective intervention and prevention tool. Infected 
individuals are less likely to notify partners themselves, but 
will cooperate with programs conducted by public health 
professionals. Studies and surveys have also concluded that 
partners notified about potential exposure to HIV support 
notification programs.
    The Presidential Commission on HIV stated, ``public health 
authorities across the United States must begin immediately to 
institute confidential partner notification, the system by 
which intimate contacts of the person carrying sexually 
transmitted diseases, including HIV, are warned of their 
exposure.''
    Partner notification has proven to be highly effective. Up 
to 90 percent of those who test positive cooperate voluntarily 
with notification. Further, even higher proportions of those 
partners contacted--usually 90% or more--voluntarily obtain an 
HIV test. But only 10 percent or less of people who have 
recently tested HIV-positive manage, by themselves, to notify 
their partners.
    Partner notification is especially important for women 
because many HIV-infected women do not engage in high risk 
behaviors but were infected by a partner who does. Recent 
studies indicate that AIDS develops more quickly in women who 
would therefore benefit from being alerted to their condition 
as early as possible. Partner notification has been credited, 
in part, by the public health community for the fact that 
syphilis cases in the U.S. have fallen to the lowest levels in 
history.
    The Committee heard testimony from the State of Florida, 
which recently enacted a partner notification program, that 
such ``activities are effective interventions for reaching 
individuals at high risk of HIV infection and are unaware of 
their risk.'' States have been successful in reducing the 
number of new HIV infections--contrary to national trends--in 
large part to effective partner notification programs.
    The legislation authorizes $30 million for states to enact 
such policies, but does not require that they do so as a 
condition of eligibility for Title II funding. States with 
systems that are approved by the CDC will receive preference 
for these grants. No State that does not meet the CDC 
surveillance recommendations will be eligible for these funds 
after 2004.
    Vulnerable Populations. The Committee is concerned that not 
all Americans receive the same quality of treatment under the 
CARE Act. As the GAO found in its report entitled ``HIV/AIDS: 
Use of Ryan White CARE Act and Other Assistance Grant Funds'':

          Women also did not fare as well as men on most of the 
        measures. Finally, exposure category was a significant 
        factor; those who had acquired their infection by 
        injecting drugs or through heterosexual sex had less 
        favorable patterns of care than did men who had sex 
        with men [MSM].

Therefore, the Committee strongly encourages the Office of HIV/
AIDS Policy and the Office on Women's Health (OWH) to provide a 
report to Congress on all activities conducted by the US 
Department of Health and Human Services that impact women who 
are infected and affected by HIV/AIDS. The report shall include 
an evaluation by the OWH of the scope and effectiveness of 
these activities. It will also identify gapsin prevention and 
care services and in research involving or targeted towards women 
living with HIV/AIDS. The HHS Secretary shall direct the appropriate 
agencies within the Department to collaborate with the OWH on such a 
report.
    Priority for Women, Infants, Children and Youth. The 
Committee has expanded the existing priority on services for 
women, infants and children to also include youth. The 
Committee intends the term ``youth'' to include persons between 
the ages of 13 and 24, and the term ``children'' to include 
those under the age of 13, including infants.
    The Committee emphasizes that the minimum amount 
established by H.R. 4807 is in no way to be construed as a 
maximum on how much a planning council may spend on these 
populations. The Committee also recognizes that these priority 
populations often comprise a greater proportion of HIV cases 
rather than AIDS cases in a local area. If data on HIV, rather 
than the endstage of AIDS, are available, planning councils 
should take this into account when allocating resources.
    The Committee recognizes that, according to the CDC, young 
people ages 24 and under account for at least half of new HIV 
infections. The Committee urges planning councils to assure 
that more is done to provide appropriate services to youth, 
including prevention, in coordination with Title IV grantees 
operating in the area.
    Perinatal Transmission. Perinatal transmission of HIV is 
the leading cause of pediatric cases AIDS, and the Committee 
recognizes the importance of life-saving newborn screening 
programs. According to the 1998 Institute of Medicine report 
``Reducing the Odds: Public Health Screening Programs'', these 
programs have a long pedigree in the public health profession:

          The first parental screening program mandated by law 
        was for syphilis in the 1930s and 1940s. In early 
        1960s, many states mandated newborn screening for PKU, 
        a condition that can lead to mental retardation without 
        dietary interventions, and other inborn errors of 
        metabolism. Screening for other inborn errors of 
        metabolism (congenital hypothyroidism, galactosemia, 
        homocystinuria, histidenemia, maple syrup urine 
        disease, and tyrosinemia) followed in the 1970s. In the 
        early 1970s, many states initiated mandatory screening 
        for sickle cell disease, a disease that had limited 
        treatment options, in a variety of populations. Later 
        in the same decade, maternal serum alpha-fetoprotein 
        tests were introduced, on a voluntary basis, to help 
        detect neural tube defects. Today, specific tests 
        mandated or recommended as standards of practice vary 
        substantially across state lines. Mandatory prenatal 
        and newborn testing for substance abuse is increasingly 
        common.

    Despite improved progress in developing effective 
strategies to reduce perinatal HIV transmission, the CDC 
estimates that nearly 7,000 HIV-infected women give birth in 
the United States each year and as many as 400 babies continue 
to be born with HIV infection each year. Breastfeeding by HIV-
infected mothers poses additional significant risk of infection 
to babies.
    Even if there were no effective therapies for perinatal HIV 
transmission, routine testing still would benefit the public 
health. As the 1998 IOM report pointed out,

          In 1936, Thomas Parran, the U.S. Surgeon General, 
        established a program for controlling syphilis that 
        included mandatory prenatal blood tests * * *. Although 
        these laws were passed before the introduction of 
        antibiotic treatment, they resulted in rapid decline in 
        congenital transmission through case finding * * * 
        contact tracing, and the difficult and less effective 
        therapies available at the time. Perhaps the most 
        important aspect of these screening programs was that 
        by making testing routine, they overcame the resistance 
        of physicians to risk offending patients by suggesting 
        a test for syphilis.

    Fortunately, medical advances have made it possible to 
nearly eliminate perinatal HIV transmission. In 1994, research 
studies demonstrated that the administration of antiretroviral 
medication during pregnancy, during labor, and to the infant 
immediately following birth can significantly reduce the 
transmission of HIV from an infected mother to her baby. From 
1994 to 1999, as a result of these interventions, pediatric 
AIDS cases resulting from perinatal HIV transmission declined 
by nearly 80 percent. Subsequent studies have indicated that 
cesarean sections further reduce the risk of transmission. 
Studies also indicate that, even if treatment begins shortly 
after birth, antiretroviral therapy can substantially reduce 
the chance that an HIV-exposed child will become infected.
    Due to the availability of interventions to reduce 
perinatal HIV transmission and to improve the health of HIV-
infected women and their children, it is important to increase 
the number of pregnant women who receive prenatal care and are 
tested for HIV. In 1995, the House approved a measure requiring 
universal HIV testing of all newborns. The American Medical 
Association recommends HIV testing for all pregnant women and 
newborns with counseling and recommendations for appropriate 
treatment. The IOM has recommended the adoption of a national 
policy of universal HIV testing, with patient notification, as 
a routine component of prenatal care. Regrettably, according to 
the IOM, 15 percent of HIV-infected pregnant women receive no 
prenatal care at all.
    The routine offering of HIV testing to pregnant women 
should be a standard of care. Sufficient information must be 
provided to a pregnant woman so she can make an informed 
decision to be tested. Studies show that the vast majority of 
pregnant women will accept an HIV test if it is offered to 
them. In addition, testing newborns whose mothers' HIV status 
is unknown helps to ensure that children at risk for HIV are 
identified and provided treatment.
    The offering of HIV testing to pregnant women and to 
newborns whose mothers' HIV status is unknown, combined with 
appropriate counseling and treatment, can significantly reduce 
perinatal HIV transmission, improve access to medical care for 
HIV-infected women and children, and provide opportunities to 
further reduce HIV transmission among adults.
    For the reasons cited above, the Committee finds the 
following: (1) universal, routine offering of HIV testing to 
pregnant women should be a standard of care; (2) HIV testing of 
newborns whose mothers' HIV status is unknown a standard of 
care; and (3) relevant medical organizations, public and 
private payers of health insurance, and public health officials 
should issue or update relevant HIV counseling, testing and 
treatment guidelines accordingly.
    The Committee also recognizes the need for additional 
resources to further reduce perinatal HIV transmission. The 
legislation authorizes an additional $20 million for activities 
to reduce perinatal transmission, including outreach, 
education, testing and treatment for pregnant women and their 
newborns.
    The current statute requires, as a condition of funding, 
that States have regulations or measures to adopt CDC 
guidelines concerning HIVcounseling and testing for pregnant 
women and newborns. Women who initially refuse testing should be 
encouraged to reconsider at later points in their pregnancy. When 
appropriate, pregnant women who accept testing when it is initially 
offered and test negative should be encouraged to get tested again 
later in pregnancy.
    Additionally, consistent with State laws and regulations, 
sufficient information should be provided to all pregnant women 
so they can make an informed decision to be tested for HIV. 
Adequate training and education should be provided to prenatal 
care providers on the risks of perinatal transmission, and the 
importance of offering HIV tests to all pregnant women, the 
benefits of interventions, and the availability of referral 
sites for women who test positive should be emphasized.
    The Committee also believes that it is also important that 
appropriate post-test counseling, referrals, and linkages to 
care for HIV-positive women and their children be provided, and 
that women are not counseled to terminate their pregnancies on 
the basis of HIV status. States should also have to show that 
they are taking steps to increase the proportion of women who 
receive prenatal care, including targeted outreach and 
education efforts in areas with highest numbers of women who 
get no or inadequate prenatal care. Reforms to State insurance 
laws should require that, if health insurance is in effect for 
an individual, the insurer involved may not (without the 
consent of the individual) discontinue the insurance, or alter 
the terms of the insurance, solely on the basis that an 
individual has been tested for HIV or is infected with HIV.
    The Committee has reserved a portion of the additional 
funding for States that conduct HIV testing of all newborns, or 
newborns whose mothers' HIV status is unknown. If newborn 
testing is conducted, in order to maximize the opportunity for 
reduction of perinatal transmission after birth, the Committee 
urges states to assure that test results are provided within 48 
hours. The Committee recognizes that HIV test results for the 
newborn will generally also reveal the HIV status of the 
mother. Therefore, if a newborn tests positive for HIV, it is 
essential for the mother to be informed of the test results and 
provided care in a sensitive manner that is consistent not only 
with CDC guidelines, but also with appropriate measures to 
protect the confidentiality of both mother and child.
    The Committee encourages all states, including those that 
do not apply for this additional funding, to take these steps 
and other activities as necessary to reduce perinatal HIV 
transmission. States are encouraged to coordinate their 
activities with those of Title IV grantees and other entities 
that provide services related to the reduction of perinatal HIV 
transmission. Where appropriate, states are encouraged to 
provide a portion of grants under this section to Title IV 
grantees operating in the State.
    To assure that there are no financial barriers to the 
offering of HIV testing to all pregnant women or to providing 
treatment to reduce perinatal HIV transmission and improve the 
health of HIV-positive women and children, the Committee 
encourages all payers of health insurance, both public and 
private, to assure that HIV testing and treatment during 
pregnancy and for the mother and child are covered benefits.
    The Committee requires that States report to Congress on 
the progress toward meeting the recommendations of the IOM. 
Those who have not made progress toward meeting such 
recommendations must, as a condition of receiving funding, 
cooperate with the CDC and submit a report to the Secretary on 
progress identifying and overcoming barriers to eliminating 
perinatal HIV transmission.
    The Committee does not intend that this bill detrimentally 
affect religious practices or religious freedom. However, 
nothing in this bill is designed to preempt existing or 
prohibit new State religious accommodation laws that allow 
those with religious objections to decline to have their 
newborn infants tested for HIV disease if such exemptions exist 
under state law for other reportable diseases. Further, 
religious accommodation laws enacted by recipient States shall 
have no impact whatsoever on the level of federal funding 
received by the recipient State.
    The Committee heard testimony from Mr. Tom Liberti, Chief, 
Bureau of HIV/AIDS, Florida Department of Health, who detailed 
how the enactment of a successful HIV reporting system enabled 
the state to better address the epidemic, particularly within 
the African-American and Hispanic communities. The availability 
of such a system will better ensure that all communities 
affected are recognized and are receiving appropriate care and 
medical access, thereby reducing disparities and allowing for 
the equitable allocation of funds.
    Minority AIDS Initiative. While the Ryan White CARE Act, in 
general, has had significant success in addressing the needs of 
individuals and communities affected by the disease, ethnic and 
racial minority communities continue to experience disparities 
in health outcomes in terms of HIV and AIDS. The legislation 
includes several provisions that intend to refocus and enhance 
representation, planning, prioritization, and allocation of 
CARE Act resources to address disparities in health outcomes 
and the needs of historically underserved and vulnerable 
communities.
    According to the written testimony of Loretta Davis-
Satterla, Director, Division of HIV/AIDS-STD with the Michigan 
Department of Community Health submitted for the Subcommittee 
on Health and Environment hearing on May 11, 2000:

          In Michigan, confidential HIV reporting has been 
        required by statute since 1989. Confidential HIV 
        reporting has greatly enhanced Michigan's ability to 
        rapidly and effectively respond to the dynamics of this 
        epidemic * * * In contrast to AIDS case surveillance, 
        HIV case surveillance provides data to better 
        characterize populations in which HIV infection has 
        been newly diagnosed, including persons with evidence 
        of recent HIV infection. Compared with persons living 
        with AIDS, those reported living with HIV infection in 
        Michigan are more likely to be women (18% for AIDS vs 
        26% for HIV) and African Americans (55% for AIDS and 
        62% for HIV). Approximately 1% of AIDS cases occurred 
        in both persons aged 13-19 years and 20-24 years. In 
        comparison, 4% of HIV cases occurred in persons aged 
        13-19 years and 13% of HIV cases occurred in persons 
        20-24 years. Thus, AIDS case surveillance alone does 
        not accurately reflect the extent of the HIV epidemic 
        among African Americans, women, adolescents and young 
        adults.

    In addition, the Committee affirms the intent of the 
Minority AIDS Initiative (MAI) in addressing the unique needs 
of ethnic and racial minority communities. The initiative is 
intended to complement and supplement, not supplant, the 
efforts of the Ryan White CARE Act and other national AIDS 
programs. The MAI was instituted in response to the 
overwhelming and disproportionate impact of the HIV epidemic on 
ethnic and racial minority communities.
    The MAI is intended to address the needs of Americans in 
highly impacted communities by enhancing outreach and 
education, strengthening technical assistance, and supporting 
capacity building of ethnic and racial minority community based 
organizations and institutions and providers to deliver 
culturally competent and appropriate HIV-related prevention, 
health care, and support services. The initiative also seeks to 
expand or fund new research initiatives to develop and evaluate 
culturally competent intervention strategies directed towards 
reducing and ultimately eliminating the HIV-related health 
disparities experienced by ethnic and racial minority 
populations. In this regard, the MAI may prove to be a 
significant component of an overall strategy for addressing the 
disease. The Committee encourages the Department of Health and 
Human Services to include the MAI in its efforts to achieve an 
integrated and coordinated system of HIV/AIDS care and 
treatment. With respect to entities that currently receive or 
have received planning grants through special initiatives such 
as the MAI, the Committee intends that these entities will be 
still be eligible for such grants under Part C if they meet the 
appropriate funding criteria.
    MAI funding is intended to be targeted to ethnic and racial 
minority-governed and staffed organizations and where no such 
organization exist, to institutions that have a history of 
providing culturally competent services to the communities and 
populations they are targeting. The funding is intended to 
build capacity and infrastructure within these communities, and 
fill gaps in critically needed HIV and AIDS services. This 
includes providing primary HIV prevention, increasing access to 
HIV and related health and support services, and ensuring 
continuity of care for ethnic and racial minority populations 
and sub-populations including minority women, youth, MSMs, 
substance abusers, homeless, incarcerated and recently-released 
individuals.
    Incarcerated Populations. The Committee recognizes that HIV 
public health interventions implemented in correctional 
settings have great potential to have a significant impact on 
the epidemic. The success of in-prison interventions requires 
continuation of medical treatment and behavior modification 
following release. Post-release failure of inmates to adhere to 
HIV medical regimens may pose public health dangers by 
fostering development and transmission of drug-resistant HIV 
variants. Also, because the vast majority of inmates will be 
released to their communities, prison, jail, and similar 
restricted institutions intervention is vital to reduce HIV 
transmission to the general public. Therefore, the Committee 
believes that improved discharge planning and continuity of 
care between correctional facilities and communities are needed 
to increase the likelihood that HIV-positive releasees will 
obtain the care they need and take precautions to avoid 
spreading the disease. Effective pre-release programs can also 
help inmates make positive changes in their lives to avoid 
returning to crime, with the resulting reduced recidivism rates 
yielding significant benefits to society. The Committee 
therefore urges the Secretary to give favorable consideration 
to grants under the Ryan White CARE Act for programs that 
provide linkages with correctional discharge planning and other 
transitional services needed to help HIV-positive inmates move 
successfully from correctional institutions to their 
communities. These transitional services, which may be needed 
up to six months prior to release, may include, but are not 
limited to, clinical referrals, psychosocial services, 
enrollment in medical care funding programs, a short-term 
supply of medications upon release, HIV pre-release 
identification efforts, HIV prevention education, HIV related 
counseling, coordination and referral, and linkages for 
substance abuse treatment, and HIV related case management 
services and linkages to CARE Act programs in their 
communities.
    In addition to prisons and jails, other residential 
institutions, such as substance abuse treatment facilities and 
mental health institutions, also have a high concentration of 
persons at high risk of HIV infection and pose similar 
intervention opportunities and challenges. The Committee thus 
urges the Secretary to give favorable consideration to grants 
under the Ryan White CARE Act for programs that provide 
discharge planning and other transitional services, including 
the types of services enumerated above, which are needed to 
help HIV-positive institutional residents move successfully 
from institutions to their communities.
    Quality Assurance. The Committee recognizes the importance 
of having CARE Act grantees ensure that quality services are 
provided to people living with HIV and that the quality 
management activities are conducted on an ongoing basis. 
Quality management activities should: assess the extent to 
which HIV health services provided under this grant are 
consistent with Public Health Service guidelines for the 
treatment of HIV and the treatment and prevention of related 
opportunistic infections and, as applicable, lead to the 
development of strategies to ensure that such services are 
consistent with the guidelines and that social support services 
are provided in a manner as to gain or enhance the benefits of 
health care services.
    The Committee expects the Secretary to provide States with 
guidance and technical assistance for establishing quality 
management programs, including disseminating such models that 
have been developed by States and are already being utilized by 
Title II programs and in clinical practice environments. The 
Committee hopes that States will communicate and coordinate 
CARE Act requirements with other payers to the extent possible 
to ensure consistency in quality management activities. The 
Committee expects that most States have quality management 
systems in place already and that they utilize mechanisms such 
as peer chart reviews or patient prescription pattern 
monitoring. The Committee places responsibility on the 
Secretary to ensure that PHS guidelines, as well as population 
characteristics and trends in the use of HIV services, are 
communicated to all CARE Act grantees and sub-grantees. This 
information, the Committee believes, will assist grantees in 
ensuring the highest quality of HIV care among CARE Act 
providers.
    The Committee intends that the Secretary provide 
clarification and guidance regarding the distinction between 
use of CARE Act funds for such program expenditures that are 
covered as either planning and evaluation and funds for program 
support costs. Program support costs are described as any 
expenditure related to the provision of delivering or receiving 
health services supported by CARE Act funds. As applied to the 
clinical quality programs, these costs include, but are not 
limited to, activities such as chart review, peer-to-peer 
review activities, data collection to measure health indicators 
or outcomes, or other types of activities related to the 
development or implementation of a clinical quality improvement 
program. Planning and evaluation costs are related to the 
collection and analysis of system and process indicators for 
purposes of determining the impact and effectiveness of funded 
health-related support services in providing access to and 
support of individuals and communities within the health 
delivery system.
    HIV Consortia. The Committee intends that States continue 
to work with local Consortia to ensure that they identify 
potential disparities in access to HIV care services at the 
local level, with aspecial emphasis on those experiencing 
disparities in access to care, historically underserved populations, 
and HIV infected persons not in care. However, the Committee does not 
intend that States and/or Consortia be mandated to consult with all 
entities referenced as part of the planning process under Part A. The 
Committee intends that States and Consortia will continue to work with 
the appropriate entities in their jurisdictions to assess and plan 
services at the local level. Reference to entities included in the 
Title I planning process is intended to provide guidance to the States 
that such entities are important constituencies which the States should 
endeavor to include in their planning processes. The Committee intends 
that the States require local Consortia to document their efforts to 
identify and address access disparities at the local level, as 
appropriate.
    Title II Comprehensive Plan. The comprehensive service 
delivery plan is an effective way to demonstrate the 
organization and delivery of CARE Act services, based upon the 
planning, priority setting, and funding allocations processes 
conducted by the State. The Committee intends that States may 
demonstrate compliance with the new requirement of an enhanced 
process of public participation by indicating in their 
applications existing mechanisms for consumer and community 
input, and describing how such mechanisms influence the use and 
distribution of funds and the number of persons not in care and 
unmet needs of persons not receiving health services. The 
Committee intends States to develop a strategy to identify 
individuals with HIV disease who are not receiving services and 
to inform and enable such individuals to receive services under 
Title II. The Committee wants CARE Act providers to work 
actively to bring into and retain in care those individuals who 
are unaware of their HIV status and those who are knowledgeable 
of their status but are not receiving services. As part of this 
process, the Committee believes strongly in the importance of 
the States focusing on eliminating disparities in access and 
services among affected subpopulations and historically 
underserved communities. The Committee recognizes that the 
availability or lack of HIV prevalence data in particular 
States will be reflected in the scope, goals, timetable and 
allocation of funds for implementation of the strategy.
    The Committee also intends States to develop a strategy to 
coordinate the provision of Title II services with HIV 
prevention services and substance abuse prevention and 
treatment services. The Committee has amended numerous aspects 
of CARE Act programs to enhance the coordination between HIV 
prevention and HIV care and treatment services.
    The Committee intends that additional factors be reflected 
in the plan such as disparities in access to medical and 
health-related support services by subpopulations. Upon the 
development of measures by the Secretary and Title II grantees, 
as described above, the needs of persons with HIV not in care 
should be considered in the comprehensive plan. Both the 
planning process and the resulting plan should continue to 
include the participation of, and address the needs of, 
populations and subpopulations living with HIV and AIDS. The 
specific needs of populations or subgroups, such as women, 
people of color, persons who are underinsured or uninsured, 
youth, homeless persons, persons living in rural areas, or 
persons with substance abuse or other co-occurring conditions 
within the State need to be specifically addressed. States 
should continue to consider the availability of services 
through other public and private health care payers and 
providers including Medicaid, the State Children's Health 
Insurance Program (SCHIP) and other public and private sources 
of health care reimbursement. States should ensure that there 
are strong coordinating mechanisms between Ryan White and the 
State Medicaid programs to assure optimal health care for 
persons living with HIV disease. States should continue to 
collaborate with other health care and social service providers 
and payers through the Statewide Coordinated Statement of Need 
(SCSN) process. The Committee does not intend to mandate that 
States devote specific portions of their Title II grant funds 
to specific activities. The Committee recognizes the need for 
flexibility for States in the administration of Title II 
programs in order to ensure that local needs are addressed.
    ADAP. The legislation strengthens the ADAP program to 
assist States that are struggling to provide medications to all 
of their needy clients. The Committee has also sought to 
strengthen the ability of local communities, States, and 
service organizations to reach those communities and 
populations that have been historically most underserved, as 
well as those that are experiencing rapid increases in HIV 
infection and AIDS case counts but that have not been brought 
into the care system developed under Ryan White. The purpose of 
these changes is to ensure a strong system of health care 
delivery and access to therapies commensurate with evolving 
needs.
    This section has been amended to permit States to utilize 
funds under this section to purchase and maintain health 
insurance on behalf of individuals with HIV disease whose 
coverage provides a full range of HIV therapeutics and primary 
care services. The Committee recognizes the cost-effectiveness 
and potential cost-savings of such a mechanism in the provision 
of treatments and the fact that several States have already 
fully integrated such mechanisms into their treatment provision 
systems.
    Grants for Coordinated Services and Access to Research for 
Women, Infants, Children and Youth. The Committee does not 
intend to require Title IV applicants to file separate reports 
to the Secretary to demonstrate linkages to research and how 
access to such research is offered to patients. Instead, such 
reporting may be completed as part of the existing grantee 
reporting process. The report on the distribution and 
availability of ongoing and appropriate HIV/AIDS-related 
research projects shall not be interpreted as requiring the 
Secretary to recommend the redistribution of funds for such 
research projects or to act on redistributing these funds based 
on the report's findings.
    Early Intervention Services. The Committee expects that 
EMAs will provide services to American Indian and Native 
American peoples. Native Americans and American Indians are 
eligible for Ryan White services through State and Federal 
citizenship. The Committee supports better co-ordination of 
Ryan White services for Native Americans and American Indians 
in order that they may realize the full potential of HIV/AIDS-
related primary care and support services provided through CARE 
Act funding.
    The Committee also recognizes that the US Department of 
Veterans Affairs is the largest single direct provider of HIV 
care and services in the US. Over 18,000 veterans received HIV 
care at VA facilities in 1999. Veterans with HIV infection are 
eligible to participate in Ryan White Title I programs when 
they meet eligibility requirements set by Title I Planning 
Councils, and EMA plans for the delivery of services must 
account for the availability of VA services. VA facilities are 
eligible providers of HIV health and support services where 
appropriate. The Committee expects that HRSA's Bureau of HIV/
AIDS shall encourage Ryan White grantees to develop 
collaborations between providers and VA facilities to optimize 
coordination and access to care to all persons in Title I EMAs.
    The Committee understands that the Secretary has convened a 
Public Health Service Working Group on HIV Treatment 
Information Dissemination, which has produced recommendations 
and a strategy for the dissemination of HIV treatment 
information to health care providers and patients. Recognizing 
the importance of such a strategy, the Committee intends that 
the Secretary issue and begin implementation of the strategy to 
improve the quality of care received by people living with HIV/
AIDS.
    Administrative Simplification. The Committee is aware of 
the enormous administrative burden that the current grant 
application process places on States and recipients of grants 
under Part A. The Committee is concerned that the current 
application process may divert critical resources from the 
provision of care. Therefore, the Committee directs the 
Secretary to consult with States and recipients of grants under 
Part A regarding the coordinated disbursement of funds under 
Part A with the disbursement of funds under Part B, the 
implementation of a biennial application process under Parts A 
and B, and the overall simplification and streamlining of the 
grant application for funds under Parts A and B. The Committee 
expects that the Secretary will undertake this consultation 
with States and entities receiving funds under Part A in an 
expeditious manner and will work with these States and entities 
to implement agreed upon strategies as soon as possible.
    Audits and Consumer Participation. The Committee intends 
that to the maximum extent possible the funds made available 
through this legislation are intended for the actual medical 
and support services needs of the infected population, and not 
simply ``quality of life'' issues. According to a November 13, 
1997 New York Times story, some services that have been offered 
using Federal funds included ``free dog walking.'' Any funds 
misallocated through frivolity, waste or outright fraud deny 
someone else living with HIV much needed care.
    At the July 11, 2000 hearing the Subcommittee heard 
testimony from Jose Fernando Colon, Coordinator for Pacientes 
de SIDA Pro Politica Sana (AIDS Patients for Sane Policies) in 
San Juan, Puerto Rico. Mr. Colon detailed for the Committee how 
millions of dollars of money intended for AIDS services was 
diverted for personal and political purposes, resulting in 
numerous Federal Court convictions in Puerto Rico. He testified 
that in 1993 the Department of Health and Human Services was 
made aware of possible misconduct, but that no investigation 
was ever conducted.
    The GAO reported to the Congress on October 18, 1999 that 
they had identified two other cases in which fraud and abuse 
have occurred in regard to CARE Act funds. However, the GAO did 
not find such fraud and abuse to be either systemic or 
widespread among grantees or in CARE Act programs. As HRSA 
Administrator Claude Fox, MD testified to the Subcommittee:

          The GAO has looked at it and said there is not a 
        widespread problem. We agree with the provisions in 
        this bill. We want to do everything that we can do 
        within reason to make sure that these funds are well 
        spent. But we do not believe that it is a widespread 
        problem.

H.R. 4807 includes important provisions to prevent and detect 
fraud with CARE Act funds.
    The legislation also contains important provisions which 
ensure that not less than 33% of Title I HIV Health Services 
Planning Councils are composed of individuals who are receiving 
HIV-related services.
    The Committee emphasizes that its intent is to ensure that 
patients and consumers of Title I services constitute a 
substantial proportion of Planning Council memberships. The 
prohibition of officers, employees and consultants is not 
intended to impede the participation of qualified, motivated 
volunteers with Title I grantees from serving on Planning 
Councils where they do not maintain significant financial 
relationships with such grantees. In contrast to such 
significant financial relationships, volunteers may be 
reimbursed reasonable incidental costs, including for training 
and transportation, which help to facilitate their important 
contribution to the Planning Councils.
    The Committee intends that Planning Councils ensure its 
members are knowledgeable about their duties, the functions of 
the Councils, and the Councils' role in the organization and 
delivery of HIV/AIDS health and support services. The provision 
of training guidance and materials to the Councils by HRSA's 
Bureau of HIV/AIDS will go far to ensure that Council members, 
particularly patients and consumers of HIV/AIDS services, can 
serve effectively and improve the allocation of resources and 
the planning and implementation of Title I services.
    The Committee also expects Planning Councils to provide 
assistance, such as transportation and childcare, to facilitate 
the participation of consumers, particularly those from 
affected subpopulations and historically underserved 
communities.
    Further, the bill ensures that grants will be available for 
training members of these planning councils, and that planning 
council meetings will be open to the public. Mr. Colon stated 
that these types of reforms will lead to increased 
accountability, and the Committee agrees with this assessment.
    Further, for the first time, the Committee intends that the 
Secretary may reduce grants to States or political subdivisions 
of States which fail to prepare and submit audits to the 
Secretary. From these audits, the Secretary must annually 
randomly review samples of the audits, ensuring that CARE Act 
funds are being appropriately expended.

                                Hearings

    The Subcommittee on Health and Environment held a hearing 
on July 11, 2000. The Subcommittee received testimony from: 
Claude Earl Fox, M.D., M.P.H., Administrator, Health Resources 
and Services Administration, accompanied by Joseph O'Neil, 
M.D., M.P.H., Associate Administrator, Bureau of HIV/AIDS, 
Health Resources and Services Administration; Ms. Janet 
Heinrich, Associate Director, US General Accounting Office, 
accompanied by Mr. Jerry Fastrup, Assistant Director, US 
General Accounting Office; Ms. Jeanne White, National 
Spokesperson, AIDS Action; Mr. Tom Liberti, Chief, Bureau of 
HIV/AIDS, Florida Department of Health; Guthrie S. Birkhead, 
M.D., M.P.H., Director, AIDS Institute, New York State 
Department of Health; Mr. Joe Davy, Policy Advocate, Columbus 
AIDS Task Force; Ms. Dorothy Mann, Board Member, AIDS Alliance 
for Children, Youth & Families; Mr. Jose F. Colon, Coordinator, 
Pacientes de SIDA Pro Politica Sana and; Mr. Eugene Jackson, 
Deputy Executive Director for Policy, National Association of 
People with AIDS.

                        Committee Consideration

    On July 13, 2000, the Full Committee met in open markup 
session and ordered reported H.R. 4807, the Ryan White CARE Act 
Amendments of 2000, as amended, by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 4807 reported. A motion by Mr. Bliley to order H.R. 4807 
reported to the House, with an amendment, was agreed to by a 
voice vote.
    The following amendments were agreed to by a voice vote:
          An amendment by Mr. Coburn, No. 1, making various 
        technical changes to the bill; and
          An amendment by Mr. Strickland, No. 4, ordering 
        States, consortia, and supplemental grant applicants to 
        seek comment from an expanded body of stakeholders used 
        by Title I EMA cities when preparing their required 
        plans.
    The following amendments were withdrawn by unanimous 
consent:
          An amendment by Ms. Eshoo, No. 2, replacing the 
        ``hold harmless'' provision in the bill with the Senate 
        provision reducing the cut in Title I funds to 2% per 
        year over 5 years; and
          An amendment by Ms. DeGette, No. 3, giving States the 
        option to cover pregnant women under the State 
        Children's Health Insurance Program.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee held legislative and 
oversight hearings and made findings that are reflected in this 
report.

           Committee on Government Reform Oversight Findings

    Pursuant to clause 3(c)(4) of rule XIII of the Rules of the 
House of Representatives, no oversight findings have been 
submitted to the Committee by the Committee on Government 
Reform.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
4807, the Ryan White CARE Act Amendments of 2000, would result 
in no new or increased budget authority, entitlement authority, 
or tax expenditures or revenues.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, July 24, 2000.
Hon. Tom Bliley,
Chairman, Committee on Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 4807, the Ryan 
White CARE Act Amendments of 2000.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Julia 
Christensen.
            Sincerely,
                                           Steven Lieberman
                                    (For Dan L. Crippen, Director).
    Enclosure.

H.R. 4807--Ryan White Care Act Amendments of 2000

    Summary: H.R. 4807 would reauthorize programs in title XXVI 
of the Public Health Services Act, which was created by the 
Ryan White CARE Act (Public Law 101-381). Programs funded under 
the Ryan White CARE Act address the needs of individuals living 
with HIV disease. The bill would amend certain provisions under 
that title to increase access to care and require that care to 
be consistent with the guidelines of the Public Health Service 
(PHS). The bill also would create new grant programs to:
           Pay for health care services for individuals 
        with HIV disease in states ineligible for emergency 
        relief grants;
           Establish partner notification programs in 
        the states, and
           Provide to states technical assistance with 
        setting up data surveillance and reporting systems 
        related to HIV disease and other funding for data 
        collection efforts.
    The Health Resources and Services Administration (HRSA) 
under the Department of Health and Human Services (HHS) 
administers most of the Ryan White CARE Act programs; small 
portions are implemented through the Centers for Disease 
Control and Prevention (CDC) and the National Institutes of 
Health (NIH). Assuming the appropriation of the necessary 
amounts, CBO estimates that implementing H.R. 4807 would cost 
$351 million in 2001 and $6.7 billion over the 2001-2005 
period, without adjusting for inflation. The five-year total 
would be $7 billion if adjustments for inflation are included. 
The legislation would not affect direct spending or receipts; 
therefore, pay-as-you-go procedures would not apply.
    H.R. 4807 contains no private-sector mandates as defined in 
the Unfunded Mandates Reform Act (UMRA). It does contain an 
intergovernmental mandate as defined in UMRA, but it also 
contains new budget authority for grants that may be used by 
states to cover the costs associated with the mandate. 
Consequently, the threshold established in UMRA ($55 million in 
2000, adjusted annually for inflation) would not be exceeded.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 4807 is shown in Table 1. The costs of 
this legislation fall within budget function 550 (health).

                                     TABLE 1.--BUDGETARY IMPACT OF H.R. 4807
----------------------------------------------------------------------------------------------------------------
                                                                     By fiscal year, in millions of dollars--
                                                                 -----------------------------------------------
                                                                   2000    2001    2002    2003    2004    2005
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law:
    Budget Authority \1\........................................   1,605       0       0       0       0       0
    Estimated Outlays...........................................   1,376   1,209     248      64   (\2\)       0

                                        Without Adjustment for Inflation

Proposed Changes:
    Estimated Authorization Level...............................       0   1,711   1,711   1,711   1,711   1,711
    Estimated Outlays...........................................       0     351   1,402   1,608   1,676   1,678
Spending Under H.R. 4807
    Estimated Authorization Level \1\...........................   1,605   1,711   1,711   1,711   1,711   1,711
    Estimated Outlays...........................................   1,376   1,559   1,650   1,672   1,676   1,678

                                         With Adjustments for Inflation

Proposed Changes:
    Estimated Authorization Level...............................       0   1,793   1,766   1,800   1,834   1,866
    Estimated Outlays...........................................       0     356   1,431   1,663   1,764   1,798
Spending Under H.R. 4807:
    Estimated Authorization Level \1\...........................   1,605   1,739   1,766   1,800   1,834   1,866
    Estimated Outlays...........................................   1,376   1,565   1,679   1,728   1,764   1,798
----------------------------------------------------------------------------------------------------------------
\1\ The 2000 level is the amount appropriated for that year for title XXVI programs.
\2\ Less than $500,000.

    Basis of estimate: For this estimate, CBO assumes that the 
bill will be enacted by the end of fiscal year 2000 and that 
outlays will follow historical spending rates for the 
authorized activities. Where specified in H.R. 4807, CBO 
assumes the authorized amounts would be appropriated. Where 
appropriations of such sums as necessary are authorized, CBO 
based its estimates on amounts spent in the past for similar 
types of activities. Table 1 shows two alternative spending 
paths: one assuming no increase to account for inflation, and 
one with annual inflation adjustments.

Reauthorization of existing programs

    The authorizations for appropriations for most of the 
programs under the Ryan White CARE Act expire at the end of 
fiscal year 2000. H.R. 4807 would reauthorize those programs 
for fiscal years 2001 through 2005. Table 2 shows the amount 
appropriated in fiscal year 2000, and the estimated 
authorization levels under H.R. 4807 for fiscal years 2001 
through 2005, with adjustments for inflation.

  TABLE 2.--TITLE XXVI PROGRAMS: APPROPRIATIONS FOR FISCAL YEAR 2000 AND AMOUNTS AUTHORIZED IN H.R. 4807, WITH
                                            ADJUSTMENTS FOR INFLATION
----------------------------------------------------------------------------------------------------------------
                                                                     By fiscal year, in millions of dollars--
                                                                 -----------------------------------------------
                                                                   2000    2001    2002    2003    2004    2005
----------------------------------------------------------------------------------------------------------------
                                          Programs Administered by HRSA

Reauthorizations: \1\
    Part A (Title I of the Ryan White CARE Act) emergency relief     547     556     566     576     586     597
     grants.....................................................
    Part B (Title II) HIV care grants...........................     824     839     853     868     884     900
    Part C (Title III) early intervention services..............     138     141     143     146     149     151
    Part D (Title IV) pediatric AIDS: women, children, and youth      51      52      53      54      55      56
    Part D (Title IV) evaluations and reports...................       0       4       4       4       4       4
    Part F demonstration and training AIDS education and              27      27      28      28      29      29
     training centers...........................................
    Dental reimbursements.......................................       8       8       8       8       9       9
Modifications to Current Programs:
    Planning and capacity development grants....................       0       6       6       6       6       6
    AIDS education and training centers.........................       0      15      17      20      20      21
    Other activities............................................       0       6       1       1       1       1
New programs:
    Supplemental grants for certain states ineligible for Part A       0       0       0       0       3       3
     grants.....................................................
    Complaint partner notification program......................       0      30      31      31      32      32
                                                                 -----------------------------------------------
      Subtotal..................................................   1,595   1,683   1,709   1,743   1,777   1,808

                                          Programs Administered by CDC

HIV-related services for pregnant women and newborns \1\........      10      30      30      30      30      30
Data collection, reports, and other activities..................       0      25      26      26      26      27

                                         Provisions Administered by NIH

Expansion of HIV research funds for affordable HIV testing and         0       1       1       1       1       1
 issuance of reports............................................
                                                                 -----------------------------------------------
      Total Proposed Changes....................................   1,605   1,739   1,766   1,800   1,834  1,866
----------------------------------------------------------------------------------------------------------------
\1\ The 2000 level is the amount appropriated for that year.

    HRSA Programs. The bill would reauthorize several programs 
organized under different parts of the Ryan White Care Act:
      Part A of title XXVI, (also known as title I of 
the Ryan White CARE Act), is the Emergency Relief Grant 
program. It provides grants to eligible metropolitan areas 
(EMAs) severely affected by the HIV epidemic. The funds are 
used for outpatient and ambulatory health care and other 
support services provided by community-based systems to low-
income or under-insured people living with HIV/AIDS.
      Part B, (title II of the act), is the HIV Care 
Grant program. It provides grants to states and territories for 
health care and social support services. Services are delivered 
primarily through consortia of providers of HIV services. Some 
Part B funds also are earmarked to pay for drug treatment for 
certain individuals with HIV disease. In addition, states may 
use grant money to help low-income individuals purchase health 
insurance through Health Insurance Continuation programs.
      Part C, (title III of the act), is the Early 
Intervention Services program. It awards grants to public and 
private nonprofit community-based programs that provide 
comprehensive primary health care services targeting at-risk 
populations and aim to reduce or prevent HIV-related morbidity.
      Part D, (title IV of the act), contains general 
provisions. The pediatric AIDS: women, children, and youth 
program provides funding to improve and expand the primary care 
and support services for special populations living with HIV 
disease. The program aims to increase access to comprehensive, 
coordinated, community-based family-centered systems of care 
for infected individuals and their families.
      Part F \1\ contains the demonstration and 
training programs. It authorizes a network of regional centers 
that conduct HIV/AIDS education and training programs for 
healthcare providers, special projects of national significance 
relating to the development of innovative models of HIV/AIDS 
care, and financial assistance to dental schools for 
uncompensated oral health care costs for patients with HIV 
disease.
---------------------------------------------------------------------------
    \1\ There has never been an appropriation for Part E, which 
requires the Secretary to make grants to state and local governments to 
assist them in disseminating guidelines to emergency responses 
employees regarding reducing the risk in the workplace of becoming 
infected with AIDS.
---------------------------------------------------------------------------
    CBO estimates that reauthorizing those provisions would 
cost $325 million in 2001 and $6.6 billion over the 2001-2005 
period.
    CDC Programs. H.R. 4807 would authorize a CDC-administered 
program that provides HIV-related services to pregnant women 
and newborns. The bill would authorize the appropriation of $30 
million a year and would expand the services covered under the 
program. If at least $10 million is appropriated, part of the 
amount above $10 million would be set aside for states that 
comply with certain requirements such as mandatory testing. CBO 
estimates that this provision would cost $11 million in 2001 
and $122 million over the 2001-2005 period.

Modifications to current programs

    The bill would make several modifications to existing 
programs. Those changes and their estimated budgetary effects 
are described below. In total, CBO estimates that implementing 
these modifications would cost $5 million in 2001 and $102 
million over the 2001-2005 period.
    Planning and Capacity Development Grants. Section 312 of 
H.R. 4807 would authorize a program of capacity development 
grants to assist public and nonprofit private entities in 
expanding their ability to provide primary care and early 
intervention services to individuals with HIV disease in 
underserved communities. Under current law, a maximum of 1 
percent of the amount appropriated for Part C can be used for 
planning grants. H.R. 4807 would increase to 5 percent the 
proportion that could be earmarked for the new capacity 
development grants and the planning grants. The maximum new 
capacity development grantwould be set at $150,000 under the 
bill. CBO estimates this provision would cost $1 million in 2001 and 
$23 million through 2005.
    AIDS Education and Training Centers and Dental 
Reimbursements. H.R. 4807 would allow the Secretary of HHS to 
fund projects to develop and disseminate treatment guidelines 
and protocols for prenatal and gynecological care of women with 
HIV disease. It also would authorize training of health 
professionals in that area. H.R. 4807 would require the 
Secretary to develop and implement a strategy for disseminating 
HIV-related information to health care providers and patients. 
The bill also would modify the dental school grant program to 
allow partnership agreements between dental programs and 
community-based dentists to provide services in unserved areas. 
Finally, the bill would permit certified dental hygiene 
programs to receive reimbursement for uncompensated oral health 
care services provided to individuals with HIV disease under 
the dental reimbursement program. CBO estimates that those 
provisions would cost $3 million in 2001 and $71 million over 
the 2000-2005 period.
    Other HRSA Activities. H.R. 4807 would require that formula 
grants reauthorized under Parts A and B use the number of HIV 
disease cases and AIDS cases in the distribution formulas in 
fiscal year 2005 and subsequent years. This provision would 
have no direct impact on federal spending. The bill would 
require the federal government to assist states with the new 
data requirements that would directly raise their program 
costs.
    Part A grants. The bill would extend indefinitely the 
requirement that 50 percent of appropriated funds for Part A be 
disbursed within 60 days after the appropriation becomes 
available. (Those funds are disbursed in the form of formula 
grants.) A ``hold harmless'' provision in the bill would also 
change the limit on the amount by which grants to states could 
decline from year to year. Those provisions would affect the 
distribution of annual appropriations and the expedited 
disbursement might affect the pattern at which such 
appropriations would be spent during the year (by increasing 
the amounts disbursed within 60 days of appropriation), but CBO 
anticipates that they would not affect total program spending.
    Part B grants. Section 206 of the bill would double the 
minimum Part B base award to $200,000 for states with fewer 
than 90 living cases of AIDS and to $500,000 for states with 90 
or more living cases of AIDS. It would also add the Federated 
States of Micronesia and the Republic of Palau as entities 
eligible to receive Part B funds. The bill also would modify 
the hold harmless formula for Part B grants. CBO estimates 
those changes would cost less than $500,000 in 2001 and $4 
million over the 2001-2005 period.
    Additional HRSA activities and reports. H.R. 4807 would 
require several new activities by the Secretary of HHS and many 
new studies and reports. The Secretary, through the 
Administrator of HRSA and in consultation with grant 
recipients, would be required to conduct a review of several 
administrative procedures for grants provided under Parts A and 
B, and develop new coordinated and more efficient procedures. 
Submission of the various plans for implementing such changes 
to the Congress would be due within 18 to 24 months of 
enactment.
    The bill also would require that the Secretary provide 
training manuals and guidance materials to the Planning Council 
members who make allocation decisions about Part A grants. It 
also would require that the Secretary develop national 
quantitative incidence data and design a mechanism for its use 
in making awards for the supplemental grant money that goes to 
states demonstrating ``severe need.''
    The bill also would require that the Secretary of HHS, in 
consultation with others, develop a plan regarding appropriate 
care following the release of prisoners with HIV disease within 
two years following enactment.
    H.R. 4807 would require federal coordination among federal 
HIV programs concerning planning, funding, and implementation 
issues. This provision would affect programs administered by 
HRSA, CDC, the Substance Abuse and Mental Health Services 
Administration, and the Health Care Financing Administration. 
The bill would require biannual reports to the Congress with an 
analysis of the federal barriers to HIV program integration, 
including proposals to eliminate those barriers, as well as a 
status report on the coordination efforts at the federal, 
state, and local levels.
    The Secretary would be required to request that the 
Institute of Medicine (IOM) complete a study, within two years 
after the enactment of H.R. 4807, regarding the appropriate 
epidemiological measures and their relationship to health-
related support services for certain individuals with HIV. The 
Secretary would have to report to the Congress within 90 days 
of the request's completion. The bill also would require that 
the Secretary request IOM to conduct a study on the reliability 
of surveillance systems used by the states and to issue 
recommendations to improve those systems within three years of 
enactment. H.R. 4807 also would require that the Secretary 
request IOM to conduct a study within 18 months of enactment on 
perinatal transmission of HIV across the states, including an 
analysis of barriers to the testing of newborns and pregnant 
women, and to provide state-by-state recommendations to reduce 
perinatal transmission of HIV.
    CBO estimates those activities and reports would cost about 
$1 million in 2001 and $5 million over 2001 through 2005.

New HRSA programs

    In addition to reauthorizing current programs and making 
certain programmatic changes, the bill would provide 
authorizations for two new provisions in the Ryan White CARE 
Act that would increase program costs. The estimated 
appropriations authorized in the bill for these provisions is 
also shown in Table 2.
    New Supplemental Grants for Certain States. Section 207 of 
H.R. 4807 would create a new supplemental grant program to meet 
HIV care and support needs in areas that are not eligible for 
Part A grants. The Secretary of HHS would be required to 
reserve 50 percent of the increase in funding for Part B grants 
(other than that earmarked for state AIDS drug assistance 
programs, or ADAPs) for these supplemental grants--which would 
be awarded competitively to states in ``severe need'' for 
additional resources. However, the program would not begin 
until the amount appropriated under Part B (excluding ADAP 
funds) is $20 million higher than the amount appropriated in 
2000. Under the inflation-adjusted assumptions used for this 
estimate such a trigger would not be reached until 2004. CBO 
estimates that the new program would have no effect on federal 
spending in 2001 but would cost $3 million over the 2001-2005 
period.
    Compliant Partner Notification Program. H.R. 4807 would 
establish a new grant program for partner notification, 
counseling, and referral services. States would have to 
cooperate with CDC and comply with certain requirements, 
including information sharing between states, to be eligible to 
receive funds. The bill would authorize $30 million for this 
program in 2001 and such sums as necessary through 2005. 
Assuming appropriation of the necessary amounts, CBO estimates 
that implementing this provision would cost $6 million in 2001 
and a total of $121 million through 2005.

NIH activities and reports

    H.R. 4807 would direct the Secretary, through the Director 
of the NIH, to examine the distribution and availability of 
HIV-related clinical research programs for women, infants, 
children, and youth. Although H.R. 4807 does not require 
submission of a report to the Congress, CBO believes the bill's 
intent is to have the results of the evaluation transmitted to 
the Congress. The bill also would require that NIH expand its 
research efforts in the development of rapid HIV tests and to 
provide progress reports to the Congress. CBO estimates that 
those provisions would cost less than $500,000 in 2001 and $5 
million over the 2001-2005 period.

CDC activities and reports

    H.R. 4807 would authorize a new program for CDC to collect 
data and provide information support to the Ryan White program 
and its grantees for planning and evaluation activities. Based 
on the resources CDC currently devotes to supporting the 
improvement of states' HIV surveillance systems, CBO estimates 
that up to an additional 40 percent of that amount would be 
needed, or about $25 million starting in fiscal year 2001. It 
also would require that the Secretary, in consultation with CDC 
and the Food and Drug Administration, submit an analysis of 
issues surrounding pre-market reviews and commercial 
distribution of rapid HIV tests of the Congress within 90 days 
of enactment. In addition, the bill would require the CDC to 
establish guidelines for the use of rapid HIV tests, with 
specific recommendations for states, hospitals, and other 
entities on the availability of HIV tests for administration to 
pregnant women in labor or in late-stage pregnancy with unknown 
HIV status. CBO estimates that those activities and reports 
would increase costs by $9 million in 2001 and $105 million 
over the 2001-2005 period.
    Pay-as-you-go considerations: None.
    Estimated impact on state, local, and tribal governments: 
The bill contains an intergovernmental mandate as defined in 
UMRA because it would require states to implement 
recommendations by the Institute on Medicine for increasing the 
routine testing of pregnant women and newborn children for HIV. 
States would be required to submit reports that describe their 
progress toward implementing the recommendations and barriers 
in the state that inhibit an obstetrician's ability to 
routinely test pregnant women and newborn infants for HIV.
    The bill also would authorize $30 million annually in 
grants for testing and treating case of perinatal HIV. CBO 
assumes that states would be allowed to use these grants to 
comply with the intergovernmental mandate and that the costs of 
the mandate would be well below that amount. The bill also 
would expand the purposes for which a number of grants could be 
used, including outpatient ambulatory and support services, 
inpatient case management, and early intervention. Additional 
requirements for grants include increased outreach, data 
collection, and implementation of quality management 
procedures. Such requirements would not be intergovernmental 
mandates as defined in UMRA because they are conditions of 
federal assistance.
    Estimated impact on the private sector: The bill contains 
no private-sector mandates as defined in UMRA.
    Previous CBO estimate: On May 10, 2000, CBO transmitted a 
cost estimate for S. 2311, the Ryan White CARE Act Amendments 
of 2000, as ordered reported by the Senate Committee on Health, 
Education, Labor, and Pensions on April 12, 2000. The two bills 
would make different changes to the Ryan White CARE Act, and 
the two estimates reflect those differences.
    Estimated prepared by: Federal Costs: For HRSA: Julia M. 
Christensen. For CDC: Jeanne M. De Sa. For NIH: Christopher J. 
Topoleski. Impact on State, Local, and Tribal Governments: Leo 
Lex. Impacts on the Private Sector: Jennifer Bullard.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
Article I, section 8, clause 3, which grants Congress the power 
to regulate commerce with foreign nations, among the several 
States, and with the Indian tribes.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title; table of contents

    This section provides the short title of the legislation, 
the ``Ryan White CARE Act Amendments of 2000,'' and includes a 
table of contents.

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


           Subtitle A--HIV Health Services Planning Councils


Section 101. Membership of councils

    Subsection (a) changes the requirements for representation 
on an HIV Health Services Planning Council. Under current law, 
the Council must reflect in its composition the demographics of 
the epidemic in the eligible area. New language requires that 
the Council reflect in its composition the demographics of the 
population of individuals with HIV disease in the eligible 
area. This subsection clarifies the requirement that 
representatives to the Council from affected communities must 
include people with HIV disease. Representatives to the Council 
who are grantees under other Federal HIV programs may include 
providers of HIV prevention services. This subsection also adds 
the new requirement that the Council include representatives of 
individuals who formerly were Federal, State, or local 
prisoners, were released from the custody of the penal system 
during the preceding three years, and had HIV disease when so 
released.
    Subsection (b) establishes a new requirement that at least 
33% of the Council must be individuals who are receiving HIV-
related services under Part A, the Emergency Relief Grant 
Program, must not be officers, employees, or consultants to any 
entity receiving such a grant, and do not represent such 
entity. An individual will be considered as receiving such 
services if the individual is the parent or caregiver of a 
minor child who is receiving HIV services. This restriction 
does not apply to entities receiving grants under other parts 
of the Ryan White CARE Act.

Section 102. Duties of councils

    Section 102(a) adds to the duties of the HIV Health Service 
Planning Council the requirements to determine the size and 
demographics of the population of individuals with HIV disease 
and the needs of the population, with particular attention to 
individuals with HIV disease who are not receiving HIV-related 
services, and disparities in access and services among affected 
subpopulations and historically underserved communities.
    This provision also rewrites current law on priorities that 
the Council must take into account in allocating of funds. The 
Council must take into account the size and demographics of the 
population with HIV disease; the demonstrated (or probable) 
cost effectiveness and outcome effectiveness of proposed 
strategies; the priorities of the communities for whom the 
services are intended; the availability of government and 
nongovernmental sources of funding, including Medicaid and the 
SCHIP program; and the capacity development needs in 
historically underserved areas. In developing a comprehensive 
plan for the organization and delivery of health and support 
services, the Council must include a strategy for identifying 
individuals with HIV disease who are not receiving services and 
for enabling such individuals to utilize the services, giving 
particular attention to eliminating disparities, and including 
discrete goals, a timetable, and an appropriate allocation of 
funds and a strategy to coordinate the provision of such 
services with programs for HIV prevention and for the 
prevention and treatment of substance abuse. The plan must be 
compatible with any State or local plan providing HIV services. 
The Council must coordinate with Federal grantees that provide 
HIV-related services within their area.
    After receipt of a report by the Institute of Medicine, the 
Secretary of Health and Human Services, in consultation with 
entities that receive grants under Part A and Part B, must 
develop epidemiologic measures for establishing the number of 
individuals living with HIV disease who are not receiving HIV-
related services and carrying out the duties of the Council.
    The Secretary must provide guidelines and materials for 
training members of the planning Council regarding their duties 
to each chief elected official receiving a grant under Part A.

Section 103. Open meetings; other additional provisions

    This section sets forth additional provisions with respect 
to public deliberations of the Planning Council. The Council 
may not be chaired solely by an employee of the grantee under 
Part A. Further, Council meetings must be open to the public 
and held after adequate notice and documents prepared by or 
made available to the Council must be made available for public 
inspection and copying. The Council must keep detailed minutes 
and their accuracy must be certified by the Council chair. This 
section does not apply to the disclosure of personal 
information that would constitute an invasion of privacy, 
including medical or personnel matters.

              Subtitle B--Type and Distribution of Grants


Section 111. Formula grants

    Subsection (a) changes current law, which states that Part 
A grant funds for eligible areas must be distributed not later 
than 60 days after such funds are made available ``for each of 
the fiscal years 1996 through 2000.'' The amendment applies to 
a generic fiscal year.
    Subsection (b) provides that, for grants made for FY2005 
and subsequent fiscal years, the cases counted for each 12-
month period beginning on or after July 1, 2004, must be cases 
of HIV disease (as confirmed by the Centers for Disease Control 
and Prevention(CDC)) rather than cases of acquired immune 
deficiency syndrome as under current law. The update of the 
yearly percentages used to determine grant amounts must be 
reported to the congressional committees of jurisdiction and, 
as applicable, the updates must take into account HIV cases. 
This subsection also requires the Secretary to determine 
whether sufficiently accurate and reliable data exists on cases 
of HIV disease. If the Secretary determines, by July 1, 2004, 
that there is not sufficiently accurate and reliable data on 
cases of HIV disease from all eligible areas, then references 
in this section to cases of HIV disease do not have any legal 
effect. From amounts appropriated for CDC grants on data 
collection, the Secretary is required to reserve funds to make 
grants and provide technical assistance to States and eligible 
areas for obtaining data on cases of HIV disease to ensure that 
data on such cases is available from all States and eligible 
areas as soon as practicable but not later than the beginning 
of FY2007.
    Subsection (c) revises the limitation on the reduction in 
funding for a grant from one fiscal year to the next which may 
occur in certain eligible areas. Under current law, grants made 
under Part A for fiscal year 2000 cannot be less than 95% of 
the amount received by the eligible area in fiscal year 1995. 
This provision stipulates that for each fiscal year in a 
protection period for an eligible area, the amount of the grant 
is increased to ensure that: (1) for the first fiscal year in 
the protection period, the grant is not less than 98% of the 
amount of the grant made for the base year for the protection 
period; (2) for any second fiscal year in such period, the 
grant is not less than 95.7% of the base year grant; (3) for 
any third fiscal year in such period, the grant is not less 
than 91.1% of the base year grant; (4) for any fourth fiscal 
year, the grant is not less than 84.2% of the base year grant; 
and (5) for any fifth or subsequent fiscal year in such period, 
the grant is not less than 75% of the base year grant. This 
provision also defines the base year for a protection period as 
the fiscal year preceding the trigger grant-reduction year. 
Further, it defines the first trigger grant-reduction year as 
the first fiscal year (after FY2000) for which the grant for 
the area is less than the grant for the preceding fiscal year. 
A protection period begins with the trigger grant-reduction 
year and continues until the beginning of the first fiscal year 
for which the grant equals or exceeds the amount of the grant 
for the base year. Any subsequent trigger grant-reduction year 
is the first fiscal year after the end of the preceding 
protection period, for which the grant is less than the grant 
for preceding fiscal year.

Section 112. Supplemental grants

    Current law provides a series of factors to be given 
priority consideration in awarding supplemental grants. 
Subsection (a) directs that the Secretary must count ``severe 
need'' as one-third when weighing factors to determine 
supplemental grant amounts. It also adds as new factors in 
determining severe need the current prevalence of HIV disease, 
the increasing need for HIV-related services, and unmet need 
for such services. Further, it directs the Secretary to develop 
a mechanism to use national, quantitative incidence data not 
later than 18 months after the enactment. The mechanism should 
be modified to reflect the findings of the IOM report on 
epidemiological measures and health care for individuals with 
HIV disease.
    Subsection (b) makes conforming amendments to the statute.

                      Subtitle C--Other Provisions


Section 121. Use of amounts

    The legislation makes some technical changes to the general 
primary purposes for the use of grant funds under Part A 
regarding outpatient and ambulatory health or support services, 
and inpatient case management. Subsection (a) specifically 
defines outpatient and ambulatory support services as including 
case management, to the extent that such services facilitate, 
support, or sustain the delivery, or benefits of health 
services. It also includes outreach activities as a new general 
primary purpose for the use of grant amounts. The outreach 
activities are intended to identify individuals with HIV 
disease who are not receiving HIV-related services.
    Subsection (b) authorizes the use of Title I grants for 
early intervention services. (Under current law, such services 
are only provided under Title III.) The entities which may 
receive grants for such services include: public health 
departments, emergency rooms, substance abuse and mental health 
treatment programs, detoxification centers, detention 
facilities, clinics regarding sexually transmitted diseases, 
homeless shelters, HIV disease counseling and testing sites, 
State health care points of entry or eligible areas, federally 
qualified health centers, and entities providing early 
intervention services. The entity must demonstrate to the chief 
elected official that Federal, State, or local funds are 
inadequate for the services to be provided and that the entity 
will supplement and not supplant other available funds for such 
services.
    Subsection (c) specifies that the chief elected official 
must establish a quality management program to assess the 
extent to which services are consistent with Public Health 
Service guidelines for the treatment of HIV disease, and as 
applicable, to develop strategies to ensure that such services 
are consistent with the guidelines. Restricts spending on such 
program to the lesser of 5% of the Title I grant received or $3 
million.

Section 122. Application

    In addition to other assurances specified under current law 
that are to be included on an application, entities within an 
eligible area that receive grant funds must maintain 
relationships with appropriate entities in the area, including 
those conducting early intervention services.

Section 123. Review of administrative costs and compensation

    Each chief elected official must ensure, not later than one 
year after the date of enactment of this legislation, that the 
planning Council reviews available data on the administrative 
costs (including financial compensation and benefits) of 
entities receiving grants; and determineswhether compensation 
of any officers or employees of such entities exceeds that of the chief 
elected official.

                      TITLE II--CARE GRANT PROGRAM


                  Subtitle A--General Grant Provisions


Section 201. Priority for women, infants, and children

    Under current law, a priority for services is provided for 
women, infants, and children; this section adds youth to this 
group.

Section 202. Use of grants

    Under current law, Part B grants funds may be used to 
provide a variety of health services for individuals and 
families with HIV disease including: outpatient and ambulatory 
health and support services; inpatient case management; 
outreach activities; establishment and operation of HIV care 
consortia; home-based and community-based care services; 
continuity of health insurance coverage; and, therapeutics to 
treat HIV disease. This section specifies that States may use 
Part B grant funds for: (1) support services, including case 
management, to the extent that such services facilitate, 
support, or sustain the delivery, or benefits of health 
services for individuals and families with HIV disease; (2) 
outreach activities that are intended to identify individuals 
with HIV disease who are not receiving HIV-related services; 
(3) early intervention services (under current law, such 
services are only provided under Title III); and (4) quality 
management program to assess the extent to which services are 
consistent with Public Health Service guidelines for the 
treatment of HIV disease, and as applicable, to develop 
strategies to ensure that such services are consistent with the 
guidelines. It also restricts spending on quality management to 
the lesser of 5% of the Part B grant received or $3 million. 
(The guidelines and restrictions governing Part B grants for 
quality management are the same as those required for Part A.)

Section 203. Grants to establish HIV CARE consortia

    This section adds new language regarding the assurances and 
the application submitted by a consortium to a State for Part B 
grant assistance. Current law requests that a consortium 
provide a number of assurances along with the application to a 
State for Part B grant funds. It stipulates that a consortium 
must provide the State with assurances that it has identified 
populations with HIV disease, particularly those experiencing 
disparities in access and services and those who reside in 
historically underserved communities. In addition, the 
consortium must provide assurances that its service plan is 
consistent with the State comprehensive plan for the 
organization and delivery of HIV health care and support 
services. The consortium must also demonstrate in the 
application for Part B grant funds that adequate planning 
occurred to address disparities in access and services in 
historically underserved communities.

Section 204. Provision of treatments

    This section makes changes in how States may use funds 
under Part B to provide treatments for individuals with HIV 
disease. Current law authorizes States to provide prescription 
drugs to low-income individuals with HIV disease. New language 
allows a State to expend grants to pay, on behalf of 
individuals with HIV disease, the costs of purchasing or 
maintaining health insurance or plans whose coverage includes a 
full range of such therapeutics and appropriate primary care 
services.

Section 205. State application

    Subsection (a) makes additions to the information that must 
be included in the State application for Part B funds (these 
changes are similar to those made to the duties of the Planning 
Council under Title). This subsection specifies that a State 
application must contain determinations of: (1) the size and 
demographics of the population of individuals with HIV disease; 
and (2) the needs of the population, with particular attention 
to individuals with HIV disease who are not receiving HIV-
related services, and disparities in access and services among 
affected subpopulations and historically underserved 
communities.
    The State application must provide a comprehensive plan 
that, in addition to current law requirements, establishes 
priorities for the allocation of funds based on: size and 
demographics of the population with HIV disease; the 
availability of other governmental and nongovernmental 
resources; the capacity development needs resulting from 
disparities in the availability of HIV-related services in 
historically underserved communities and rural communities; and 
the efficiency of the administrative mechanism of the State for 
rapidly allocating funds to the areas of greatest need. The 
comprehensive plan must also include: (1) a strategy for 
identifying individuals with HIV disease who are not receiving 
services and for enabling such individuals to utilize the 
services, giving particular attention to eliminating 
disparities, and including discrete goals, a timetable, and an 
appropriate allocation of funds; and (2) a strategy to 
coordinate the provision of such services with programs for HIV 
prevention and for the prevention and treatment of substance 
abuse.
    Subsection (b) revises the public hearing process. Current 
law provides that the public health agency administering the 
grant for the State will conduct public hearings concerning the 
proposed use and distribution of funds received under Part B. 
This subsection specifies that the public health agency 
administering the grant for the State must engage in a public 
advisory planning process, including public hearings, when 
developing the comprehensive plan for the State application. 
This public advisory planning process must include the same 
participants represented when developing the statewide 
coordinated statement of need and shall to the extent possible 
include entities described in section 2602(b)(2).
    Subsection (c) requires that, along with the State 
application for Part B funds, the State must provide an 
assurance that entities located within areas in which grant 
activities are carried out must maintain relationships with 
appropriate entities in the area, including those providing 
early intervention services.

Section 206. Distribution of funds

    Subsection (a) doubles the minimum allotments for grants 
under Part B. For States with less than 90 living cases of 
AIDS, the minimum grant is $200,000 instead of $100,000 in 
current law. The minimum grant for States with 90 or more 
living cases of AIDS is$500,000 instead of $250,000 in current 
law. In addition, each territory is eligible for a minimum funding 
level of $50,000; current law does not provide a minimum funding level 
for territories.
    Current law uses an estimate of the number of living cases 
of AIDS within the State or territory in the formula which 
determines the amount of a State grant under Part B. Subsection 
(b) provides that when estimating living cases for grants made 
for FY2005 and subsequent fiscal years, the cases counted for 
each 12-month period beginning on or after July 1, 2004, shall 
be cases of HIV disease (as confirmed by CDC) rather than cases 
of AIDS, as in current law. However, if the Secretary 
determines by July 1, 2004, that there is not sufficiently 
accurate and reliable data on cases of HIV disease from all 
eligible areas, then references in this section to cases of HIV 
disease do not have any legal effect.
    Subsection (c) revises the limitation on the reduction in 
funding for a grant from one fiscal year to the next which may 
occur in certain States.
    Subsection (d) provides that each territory is eligible for 
a minimum funding level of $50,000, duplicating a change made 
in this bill by section 206, subsection (a).
    Subsection (e) authorizes the Secretary to reserve 2% of 
AIDS drug assistance program funds to make grants to States 
whose HIV patients have a need for therapeutics that is not 
being met by the current ADAP program within the State. These 
grants are discretionary grants and not formula grants. It also 
requires such grants to be distributed not later than 240 days 
after ADAP funds become available. States must match such 
grants with non-federal contributions of not less than 25% of 
the costs.
    In current law, the term ``territory of the United States'' 
is defined as American Samoa, the Commonwealth of the Northern 
Mariana Islands and the Republic of the Marshall Islands. 
``State'' is defined as the 50 States, the District of 
Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, 
and Guam. Subsection (f) amends the definition of the 
territories to include the Federated States of Micronesia, the 
Republic of Palau, and for purposes of determining minimum 
grant level, the Commonwealth of Puerto Rico.

Section 207. Supplemental grants for certain states

    This section removes a section of current law, which is 
replaced by section 413. A new supplemental grant program is 
created for States that have eligible communities with a severe 
need for comprehensive HIV-related services and which are not 
eligible for grants under Part A. States must submit an 
application that details the need for services in such 
communities. The program becomes effective when the amount 
appropriated to Title II (excluding ADAP) is at least $20 
million greater than the appropriation for Title II in FY2000.

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


Section 211. Repeals

    This section repeals provisions regarding the testing of 
pregnant women and newborn infants.

Section 212. Grants

    Subsection (a) includes treatment services, in accordance 
with applicable recommendations of the Secretary, for pregnant 
women (with HIV disease) and their infants as an additional 
purpose for making grants. Under current law, this section 
allows the Secretary to make grants to States that have adopted 
the CDC guidelines on HIV counseling and voluntary testing of 
pregnant women. Such grants are used for: counseling pregnant 
women on HIV disease; outreach efforts to women at risk of HIV 
who are not receiving prenatal care; voluntary testing; and, 
offsetting various State costs in implementing this section. 
Authorizes $30 million for each of fiscal years 2001 through 
2005. When such appropriations are in excess of $10 million, 
the Secretary must reserve a percentage for making grants to 
States that under law have a requirement that all newborn 
infants be tested for HIV disease; or a requirement that 
newborn infants born in the State be tested for HIV disease 
where the attending obstetrician does not know the HIV status 
of the mother. The percentages to be reserved are: 25% for 
FY2001, 50% for FY2002, 50% for FY2003, 75% for FY2004, and 75% 
for FY2005. No grant may exceed $4 million and if the reserved 
amounts are not obligated, then the requirement to reserve such 
amounts will not apply. A State in receipt of such funds under 
this section must agree that the grant will supplement and not 
supplant other available funds to carry out the purposes of the 
grant.
    Subsection (b) establishes a special funding rule if FY2001 
appropriations are less than $14 million for this section. The 
Secretary is required to reserve certain amounts from increased 
FY2001 funding for Title II that is above such appropriations 
for FY2000.

Section 213. Study by Institute of Medicine

    This section adds a new section requiring the Secretary to 
request that the Institute of Medicine conduct a study to: (1) 
determine the number of newborn infants with HIV born in the 
United States where the attending obstetrician did not know the 
HIV status of the mother; (2) determine State barriers that 
prevent or discourage an obstetrician from making it a routine 
practice to offer pregnant women an HIV test and a routine 
practice to test newborn infants for HIV disease in 
circumstances in which the obstetrician does not know the HIV 
status of the mother; and (3) provide recommendations for each 
State for reducing perinatal transmission of HIV. It requires 
the report to be submitted to the appropriate congressional 
committees, the Secretary, and the chief public health official 
of each State. Beginning in FY2004, each State is required to 
report to the Secretary on progress being made toward meeting 
such recommendations. For FY2005 and each subsequent fiscal 
year, the State must demonstrate that it has made reasonable 
progress toward meeting the recommendations. If the State has 
not made reasonable progress, the State must cooperate with the 
CDC Director in carrying out activities toward meeting the 
recommendations, and the State must submit a report to the 
Secretary containing a description of any barriers that 
continue to exist in the State and a description of how the 
State intends to reduce the incidence of perinatal HIV cases. 
The Secretary must make funds under section 212 grants 
available to the States for the purposes of this section and is 
required to submit the State reports to the appropriate 
congressional committees.
    The Committee recognizes that the IOM completed a report on 
this topic in 1998. It is not the intent of the Committee to 
duplicate any material compiled for that report. The study is 
to make broad recommendations for each State to and assist 
States in reducing the incidence of perinatal HIV transmission. 
The Committee recognizesthat some States have had few, if any, 
such cases in recent years. An analysis of the efforts of these states 
may provide useful information to states that continue to have higher 
rates of perinatal HIV transmission.

           Subtitle C--Certain Partner Notification Programs


Section 221. Grants for compliant partner notification programs

    This section adds a new subpart to the Ryan White CARE Act 
that provides grants for partner notification programs. It 
authorizes appropriations of $30 million for FY2001 and such 
sums as necessary for each of the fiscal years 2002 through 
2005 for grants to States to carry out programs to provide 
partner counseling and referral services. In order to receive a 
grant under this new subpart, a State must have the following 
policies in effect: (1) a program for partner notification to 
inform partners of individuals with HIV disease that the 
partners may have been exposed to HIV; (2) a system for 
confidentially reporting positive test results for HIV; (3) 
specific counseling and referral measures; (4) reports to CDC 
on the number of individuals solicited for names of partners, 
the number who provided the names, and the number of notified 
partners; (5) cooperation with CDC in a national program of 
partner notification in which information is shared between 
public health officers of the States. In making grants, the 
Secretary must give preference for each of the fiscal years 
FY2001 through FY2003 to States whose reporting systems for 
cases of HIV disease produce sufficiently accurate and reliable 
data. A State may not receive a grant for FY2004 or subsequent 
fiscal years unless its reporting system produces reliable 
data.

                 TITLE III--EARLY INTERVENTION SERVICES


                 Subtitle A--Formula Grants for States


Section 301. Repeal of program

    This section repeals subpart I of part C of title XXVI of 
the PHSA. (Subpart I was not reauthorized in 1995.) Subpart I 
provided formula grants to States for early intervention 
services such as HIV testing and counseling, other clinical or 
diagnostic services, and referrals to providers of health 
support services or biomedical research facilities.

                     Subtitle B--Categorical Grants


Section 311. Preferences in making grants

    Under current law, the Secretary must give preference to 
any qualified applicants that are experiencing an increase in 
the burden of providing services regarding HIV disease. This 
new provision adds that the Secretary must give preference to 
those that will expend the grant to provide services in 
underserved or rural areas.

Section 312. Planning and development grants

    Current law allows the use of planning and development 
grants to assist entities in expanding their capacity to 
provide early intervention services. Subsection (a) provides 
that the grants are to be used to assist entities in expanding 
their capacity to provide services, including early 
intervention, in low-income communities and affected 
subpopulations that are underserved. Such grants may not be 
used to purchase or improve land, or to purchase, construct, or 
permanently improve any building or other facility.
    Current law provides that planning grants under this 
section to provide early intervention services may not exceed 
$50,000. Subsection (b) specifies that grants for early 
intervention services under paragraph (1)(A) may not exceed 
$50,000, and grants for capacity development for low-income and 
underserved populations under paragraph (1)(B) may not exceed 
$150,000 and their duration may not exceed three years.
    Subsection (c) increases to five percent (currently one 
percent) the amount of appropriations for this subpart that may 
be used to carry out this section.

Section 313. Authorization of appropriations

    This section extends authorized appropriations of such sums 
as necessary for this subpart for each of the fiscal years 2001 
through 2005.

                     Subtitle C--General Provisions


Section 321. Provision of certain counseling services

    Presently, current law specifies what additional 
information (such as early interventions services, health care 
referrals) is to be conveyed to an individual receiving a 
positive result on an HIV test. This section adds new language 
specifying that when grant applicants counsel individuals 
regarding a positive HIV test result, they must provide 
counseling that: (1) emphasizes the duty of infected 
individuals to disclose their infected status to their sexual 
partners and their partners in the sharing of hypodermic 
needles; (2) provides advice on the manner in which such 
disclosures can be made; and (3) emphasizes the continuing duty 
to avoid any behaviors that will expose others to HIV.

Section 322. Additional required agreements

    This section adds new language provides that the applicant 
will not expend more than 10%, instead of the current 7.5%, for 
administrative expenses, including planning and evaluation of 
the grant. In addition, new language specifies that applicants 
are required to establish a quality management program to 
assess the extent to which medical services under this title 
are consistent with the most recent Public Health Service 
guidelines for the treatment of HIV disease and related 
opportunistic infections and that improvements in access to and 
quality of medical services are addressed.

                TITLE IV--OTHER PROGRAMS AND ACTIVITIES


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


Section 401. Grants for coordinated services and access to research for 
        women, infants, children, and youth

    This section removes language in current law specifying 
that a significant number of women, infants, children and youth 
who are patients of the applicant will be participating in 
research projects. This section provides new language 
specifying that grant applicants mustdemonstrate linkages to 
research and how access to such research is being offered to patients. 
The Secretary, in coordination with the Director of the National 
Institutes of Health (NIH), is required to examine the distribution and 
availability of appropriate HIV-related research projects to enhance 
and expand HIV-related research, especially in communities that are 
under represented with respect to such projects. Grantees must also 
implement a quality management program. Authorized appropriations are 
extended through FY2005.

Section 402. AIDS education and training centers

    The Committee believes that the Dental Reimbursement 
Program is a cost-effective program that provides quality oral 
health care to people living with HIV/AIDS, and trains 
providers to effectively and safely deliver care to these 
patients. The Committee has reauthorized the program and 
maintained its current format of providing retrospective 
reimbursement to dental schools and residency programs. In 
addition, the Committee has established new grants for 
community-based care to support collaborative efforts between 
dental education programs and community-based providers 
directed at providing oral health care to patients with HIV 
disease in currently unserved areas and communities without 
dental education programs.
    Although the Dental Program has been successful, there is 
still a large HIV/AIDS population that has not benefitted 
because there is not a dental education institution 
participating in their area. These patients are also in need of 
dental services that could be provided at community sites if 
more community-based providers would partner with a dental 
school or residency program. In these partnerships, dental 
students or residents could provide treatment for HIV/AIDS 
patients in underserved communities under the direction of a 
community-based dentist who would serve as adjunct faculty. By 
encouraging dental educational institutions to partner with 
community-based providers, the Committee intends to address the 
unmet need in these areas by ensuring that dental treatment for 
the HIV/AIDS population is available in all areas of the 
country, not just where dental schools are located.
    Current law allows eligible entities to use grant funds for 
the training of health personnel in the diagnosis, treatment 
and prevention of HIV disease, including the prevention of the 
perinatal transmission of the disease and the prevention and 
treatment of opportunistic infections. Subsection (a) provides 
that grants may be used to train health professionals in 
prenatal and other gynecological care for women with HIV 
disease. The Secretary may also make grants to such entities to 
develop protocols for the medical care of women with HIV 
disease, including prenatal and other gynecological care. In 
addition, the bill directs the Secretary to, not later than 90 
days after enactment, issue and begin implementation of a 
strategy for the dissemination of HIV treatment information to 
health care providers and patients.
    Under current law, the Secretary may make grants to assist 
schools and programs with respect to oral health care to 
patients with HIV disease. Such schools and programs include: 
(1) dental schools and post doctoral dental education programs; 
and (2) dental hygiene programs that are accredited by the 
Commission on Dental Accreditation. Subsection (b) provides 
that the Secretary may also make grants to schools and 
programs, as described in the previous sentence, that partner 
with community-based dentists to provide oral health care to 
patients with HIV disease in unserved areas. The partnerships 
must permit the training of dental students and residents and 
the participation of community dentists as adjunct faculty.
    Subsection (c) authorizes appropriations of such sums as 
necessary for programs under this section for fiscal years 2001 
through 2005.

              Subtitle B--General Provisions in Title XXVI


Section 411. Evaluations and reports

    This section authorizes appropriations for the Secretary to 
evaluate programs under the Ryan White CARE Act for each of the 
fiscal years 2001 through 2005.

Section 412. Data collection through centers for disease control and 
        prevention

    This section redesignates section 2675 as section 2675A, 
and adds a new section 2675 which authorizes appropriations to 
the Secretary (acting through the Director of CDC) of such sums 
as may be necessary for each of the fiscal years 2001 through 
2005 to collect and provide data for program planning and 
evaluation activities. That authorization is in addition to 
other authorizations for such purpose.

Section 413. Coordination

    Current law provides that the Secretary will assure that 
the Health Resources and Services Administration (HRSA) and CDC 
will coordinate the planning and funding of programs authorized 
under this title to assure that health support services for 
individuals with HIV disease are integrated with each other and 
that the continuity of care of individuals with HIV is 
enhanced. This section provides that the Secretary must ensure 
that there is coordination of the planning, funding, and 
implementation of Federal HIV programs regarding continuity of 
care and prevention services among the following agencies: 
HRSA, CDC, SAMHSA, and the Health Care Financing Administration 
(HCFA). In addition, the Secretary must consult with other 
Federal agencies, including the Department of Veterans Affairs, 
as needed and utilize planning information submitted to such 
agencies by the States. This section also requires that the 
Secretary report biennially to the appropriate congressional 
committees on the coordination efforts at the Federal, State, 
and local levels. The report should include a description of 
Federal barriers to HIV program integration and a strategy for 
eliminating such barriers. It also inserts ``prevention 
services'' after the term ``continuity of care'' each place the 
term appears.

Section 414. Plan regarding release of prisoners with HIV disease

    This section adds a new subsection to section 2675A which 
directs the Secretary to develop a plan for the medical case 
management of and the provision of support services to 
individuals who were Federal or State prisoners and had HIV 
disease on the date they were released from custody. The 
Secretary must consult with the Attorney General, the Director 
of the Bureau of Prisons, the States, eligible areas and 
certain grant recipients in developing such plan. The Secretary 
must report to the Congress on such a plan not later than two 
years after the date of enactment of this legislation.

Section 415. Audits

    Section 2675B stipulates that for FY2002 and subsequent 
fiscal years, the Secretary may reduce grant amounts to a State 
or politicalsubdivision of a State for a fiscal year, if the 
State or subdivision fails to prepare audits for the second preceding 
fiscal year. The Secretary must annually submit representative samples 
of such audits to the Congress.

Section 416. Administrative simplification

    Section 2675C requires the Secretary, after consultations 
with specified entities receiving grants under this title, to: 
(1) Develop a plan for coordinating the disbursement of grants 
to eligible areas under Part A with the disbursement of grants 
to States under Part B; (2) make a determination on whether the 
efficiency of grantees would be improved by their submitting 
applications biennially rather than annually; and (3) develop a 
plan for simplifying the process for applications by eligible 
areas under Part A and States under Part B. The Secretary must 
submit both plans to the Congress not later than 18 months 
after the date of enactment of this bill. The Secretary must 
submit the determination to Congress not later than 2 years 
after the date of enactment. The Secretary must complete 
implementation of both plans not later than 2 years after the 
date of their submission.

Section 417. Authorization of appropriations for Parts A and B

    This section authorizes appropriations for fiscal years 
2001 through 2005 to carry out Part A (Title I) grants to 
eligible areas, and Part B (Title II) CARE grants to States.

                      TITLE V--GENERAL PROVISIONS


Section 501. Studies by Institute of Medicine

    Subsection (a) requires that the Secretary ask the 
Institute of Medicine to conduct a study that provides the 
following: (1) a determination of whether the surveillance 
system of each State regarding HIV provides for the reporting 
of cases of infection in a manner that is sufficient to provide 
adequate and reliable information on the number of such cases 
and the demographic characteristics of such cases, both for the 
State in general and for specific geographic areas; (2) a 
determination of whether such information is sufficiently 
accurate for purposes of grant formulas to eligible areas under 
Part A and States under Part B; and (3) recommendations on the 
manner in which a State can improve its surveillance system.
    Subsection (b) requires that the Secretary ask the 
Institute of Medicine to conduct a study on appropriate 
epidemiologic measures and their relation to the financing and 
delivery of health services to low-income, uninsured and 
underinsured people living with HIV disease. The study should 
consider existing and needed health care and epidemiological 
data and its relation to efficiency and effectiveness of care 
delivery, quality of care, resource allocation, and access to 
HIV services. The study should also determine the actual costs, 
potential savings, and financial impact of modifying the 
Medicaid program to establish eligibility for medical 
assistance on the basis of HIV infection rather than providing 
assistance only if the infection has progressed to AIDS.
    Subsection (c) authorizes the Secretary to contract with 
other entities if the Institute of Medicine declines to conduct 
the study. Subsection (d) directs the Secretary to report to 
the appropriate congressional committees not later than three 
years after the date of enactment of this Act for the 
surveillance study, and not later than two years after 
enactment for the epidemiological study.

Section 502. Development of rapid HIV test

    Subsection (a) requires the Director of NIH to expand, 
intensify, and coordinate research and other activities of NIH 
for the development of reliable and affordable tests for HIV 
disease that can rapidly be administered and whose results can 
be rapidly obtained. Requires periodic progress reports to the 
appropriate congressional committees. It also authorizes 
appropriations as necessary for FY2001 through 2005.
    Subsection (b) requires that the Secretary, in consultation 
with the Director of CDC and the Commissioner of Food and 
Drugs, submit to the appropriate committees a report describing 
the progress made towards, and barriers to, the premarket 
review and commercial distribution of rapid HIV tests. The 
report must (1) to assess the public health need for, and 
benefits of, rapid HIV tests; (2) make recommendations 
regarding the need for expedited review of rapid HIV test 
applications submitted to the Center for Biologics Evaluation 
and Research (including criteria for expedited review for 
favorable recommendations); and (3) specify whether the 
barriers to premarket review include the unnecessary 
application of requirements concerning donor screening.
    Subsection (c) requires that the Director of CDC, promptly 
after commercial distribution of a rapid HIV test begins, 
establish or update guidelines that include recommendations for 
States, hospitals, and other appropriate entities regarding the 
ready availability of such tests for administration to pregnant 
women who are in labor or in the late stage of pregnancy and 
whose HIV status is not known to the attending obstetrician.

                        TITLE VI--EFFECTIVE DATE


Section 601. Effective date

    This section establishes the effective date of the 
legislation as October 1, 2000, or upon the date of its 
enactment, whichever occurs later.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *



              TITLE XXVI--HIV HEALTH CARE SERVICES PROGRAM

Part A--Emergency Relief for Areas With Substantial Need for Services

           *       *       *       *       *       *       *



SEC. 2602. ADMINISTRATION AND PLANNING COUNCIL.

  (a) * * *
  (b) HIV Health Services Planning Council.--
          (1) Establishment.--To be eligible for assistance 
        under this part, the chief elected official described 
        in subsection (a)(1) shall establish or designate an 
        HIV health services planning council that shall reflect 
        in its composition the [demographics of the epidemic in 
        the eligible area involved,] demographics of the 
        population of individuals with HIV disease in the 
        eligible area involved, with particular consideration 
        given to disproportionately affected and historically 
        underserved groups and subpopulations. Nominations for 
        membership on the council shall be identified through 
        an open process and candidates shall be selected based 
        on locally delineated and publicized criteria. Such 
        criteria shall include a conflict-of-interest standard 
        that is in accordance with paragraph (5).
          (2) Representation.--The HIV health services planning 
        council shall include representatives of--
                  (A) * * *

           *       *       *       *       *       *       *

                  (G) affected communities, including people 
                with HIV disease [or AIDS] and historically 
                underserved groups and subpopulations;

           *       *       *       *       *       *       *

                  (K) grantees under section 2671, or, if none 
                are operating in the area, representatives of 
                organizations with a history of serving 
                children, youth, women, and families living 
                with HIV and operating in the area; [and]
                  (L) grantees under other Federal HIV 
                programs[.], including but not limited to 
                providers of HIV prevention services; and
                  (M) representatives of individuals who 
                formerly were Federal, State, or local 
                prisoners, were released from the custody of 
                the penal system during the preceding three 
                years, and had HIV disease as of the date on 
                which the individuals were so released.
          (3) Method of providing for council.--
                  (A) * * *

           *       *       *       *       *       *       *

                  [(C) Chairperson.--A planning council may not 
                be chaired solely by an employee of the 
                grantee.]

           *       *       *       *       *       *       *

          (4) Duties.--The planning council established or 
        designated under paragraph (1) shall--
                  (A) determine the size and demographics of 
                the population of individuals with HIV disease;
                  (B) determine the needs of such population, 
                with particular attention to--
                          (i) individuals with HIV disease who 
                        are not receiving HIV-related services; 
                        and
                          (ii) disparities in access and 
                        services among affected subpopulations 
                        and historically underserved 
                        communities;
                  [(A)] (C) establish priorities for the 
                allocation of funds within the eligible area, 
                including how best to meet each such priority 
                and additional factors that a grantee should 
                consider in allocating funds under a grant 
                based on the--
                          [(i) documented needs of the HIV-
                        infected population;
                          [(ii) cost and outcome effectiveness 
                        of proposed strategies and 
                        interventions, to the extent that such 
                        data are reasonably available (either 
                        demonstrated or probable);
                          [(iii) priorities of the HIV-infected 
                        communities for whom the services are 
                        intended; and
                          [(iv) availability of other 
                        governmental and nongovernmental 
                        resources;]
                          (i) size and demographics of the 
                        population of individuals with HIV 
                        disease (as determined under 
                        subparagraph (A)) and the needs of such 
                        population (as determined under 
                        subparagraph (B));
                          (ii) demonstrated (or probable) cost 
                        effectiveness and outcome effectiveness 
                        of proposed strategies and 
                        interventions, to the extent that data 
                        are reasonably available;
                          (iii) priorities of the communities 
                        with HIV disease for whom the services 
                        are intended;
                          (iv) availability of other 
                        governmental and nongovernmental 
                        resources to provide HIV-related 
                        services to individuals and families 
                        with HIV disease, including the State 
                        plan under title XIX of the Social 
                        Security Act (relating to the Medicaid 
                        program) and the program under title 
                        XXI of such Act (relating to the 
                        program for State children's health 
                        insurance); and
                          (v) capacity development needs 
                        resulting from disparities in the 
                        availability of HIV-related services in 
                        historically underserved communities;
                  [(B) develop a comprehensive plan for the 
                organization and delivery of health services 
                described in section 2604 that is compatible 
                with any existing State or local plan regarding 
                the provision of health services to individuals 
                with HIV disease;]
                  (D) develop a comprehensive plan for the 
                organization and delivery of health and support 
                services described in section 2604 that--
                          (i) includes a strategy for 
                        identifying individuals with HIV 
                        disease who are not receiving such 
                        services and for informing the 
                        individuals of and enabling the 
                        individuals to utilize the services, 
                        giving particular attention to 
                        eliminating disparities in access and 
                        services among affected subpopulations 
                        and historically underserved 
                        communities, and including discrete 
                        goals, a timetable, and an appropriate 
                        allocation of funds;
                          (ii) includes a strategy to 
                        coordinate the provision of such 
                        services with programs for HIV 
                        prevention and for the prevention and 
                        treatment of substance abuse, including 
                        programs that provide comprehensive 
                        treatment services for such abuse; and
                          (iii) is compatible with any State or 
                        local plan for the provision of 
                        services to individuals with HIV 
                        disease;
                  [(C)] (E) assess the efficiency of the 
                administrative mechanism in rapidly allocating 
                funds to the areas of greatest need within the 
                eligible area, and at the discretion of the 
                planning council, assess the effectiveness, 
                either directly or through contractual 
                arrangements, of the services offered in 
                meeting the identified needs;
                  [(D)] (F) participate in the development of 
                the statewide coordinated statement of need 
                initiated by the State public health agency 
                responsible for administering grants under part 
                B; [and]
                  [(E)] (G) establish methods for obtaining 
                input on community needs and priorities which 
                may include [public meetings,] public meetings 
                (in accordance with paragraph (7)), conducting 
                focus groups, and convening ad-hoc panels[.]; 
                and
                  (H) coordinate with Federal grantees that 
                provide HIV-related services within the 
                eligible area.

           *       *       *       *       *       *       *

          (5) Conflicts of interest.--
                  (A) * * *

           *       *       *       *       *       *       *

                  (C) Composition of council.--The following 
                applies regarding the membership of a planning 
                council under paragraph (1):
                          (i) Not less than 33 percent of the 
                        council shall be individuals who are 
                        receiving HIV-related services pursuant 
                        to a grant under section 2601(a), are 
                        not officers, employees, or consultants 
                        to any entity that receives amounts 
                        from such a grant, and do not represent 
                        any such entity, and reflect the 
                        demographics of the population of 
                        individuals with HIV disease as 
                        determined under paragraph (4)(A). For 
                        purposes of the preceding sentence, an 
                        individual shall be considered to be 
                        receiving such services if the 
                        individual is a parent of, or a 
                        caregiver for, a minor child who is 
                        receiving such services.
                          (ii) With respect to membership on 
                        the planning council, clause (i) may 
                        not be construed as having any effect 
                        on entities that receive funds from 
                        grants under any of parts B through F 
                        but do not receive funds from grants 
                        under section 2601(a), on officers or 
                        employees of such entities, or on 
                        individuals who represent such 
                        entities.

           *       *       *       *       *       *       *

          (7) Public deliberations.--With respect to a planning 
        council under paragraph (1), the following applies:
                  (A) The council may not be chaired solely by 
                an employee of the grantee under section 
                2601(a).
                  (B) In accordance with criteria established 
                by the Secretary:
                          (i) The meetings of the council shall 
                        be open to the public and shall be held 
                        only after adequate notice to the 
                        public.
                          (ii) The records, reports, 
                        transcripts, minutes, agenda, or other 
                        documents which were made available to 
                        or prepared for or by the council shall 
                        be available for public inspection and 
                        copying at a single location.
                          (iii) Detailed minutes of each 
                        meeting of the council shall be kept. 
                        The accuracy of all minutes shall be 
                        certified to by the chair of the 
                        council.
                          (iv) This subparagraph does not apply 
                        to any disclosure of information of a 
                        personal nature that would constitute a 
                        clearly unwarranted invasion of 
                        personal privacy, including any 
                        disclosure of medical information or 
                        personnel matters.

           *       *       *       *       *       *       *

  (d) Process for Establishing Allocation Priorities.--Promptly 
after the date of the submission of the report required in 
section 501(b) of the Ryan White CARE Act Amendments of 2000 
(relating to the relationship between epidemiological measures 
and health care for certain individuals with HIV disease), the 
Secretary, in consultation with entities that receive amounts 
from grants under section 2601(a) or 2611, shall develop 
epidemiologic measures--
          (1) for establishing the number of individuals living 
        with HIV disease who are not receiving HIV-related 
        health services; and
          (2) for carrying out the duties under subsection 
        (b)(4) and section 2617(b).
  (e) Training Guidance and Materials.--The Secretary shall 
provide to each chief elected official receiving a grant under 
2601(a) guidelines and materials for training members of the 
planning council under paragraph (1) regarding the duties of 
the council.

SEC. 2603. TYPE AND DISTRIBUTION OF GRANTS.

  (a) Grants Based on Relative Need of Area.--
          (1) * * *
          (2) Expedited distribution.--Not later than 60 days 
        after an appropriation becomes available to carry out 
        this part [for each of the fiscal years 1996 through 
        2000] for a fiscal year, the Secretary shall, except in 
        the case of waivers granted under section 2605(c), 
        disburse 50 percent of the amount appropriated under 
        section 2677 for such fiscal year through grants to 
        eligible areas under section 2601(a), in accordance 
        with paragraph (3). The Secretary shall reserve an 
        additional percentage of the amount appropriated under 
        section 2677 for a fiscal year for grants under part A 
        to make grants to eligible areas under section 2601(a) 
        in accordance with paragraph (4).
          (3) Amount of grant.--
                  (A) * * *

           *       *       *       *       *       *       *

                  (C) Estimate of living cases.--The amount 
                determined in this subparagraph is an amount 
                equal to the product of--
                          (i) the number of cases of acquired 
                        immune deficiency syndrome in the 
                        eligible area during each year in the 
                        most recent 120-month period for which 
                        data are available with respect to all 
                        eligible areas, as indicated by the 
                        number of such cases reported to and 
                        confirmed by the Director of the 
                        Centers for Disease Control and 
                        Prevention for each year during such 
                        period, except that (subject to 
                        subparagraph (D)), for grants made 
                        pursuant to this paragraph for fiscal 
                        year 2005 and subsequent fiscal years, 
                        the cases counted for each 12-month 
                        period beginning on or after July 1, 
                        2004, shall be cases of HIV disease (as 
                        reported to and confirmed by such 
                        Director) rather than cases of acquired 
                        immune deficiency syndrome; and
                          (ii) with respect to--
                                  (I) * * *

           *       *       *       *       *       *       *

                                  (X) the tenth year during 
                                such period, .88.
                The yearly percentage described in subparagraph 
                (ii) shall be updated biennially by the 
                Secretary, after consultation with the Centers 
                for Disease Control and Prevention, and shall 
                be reported to the congressional committees of 
                jurisdiction. The first such update shall occur 
                prior to the determination of grant awards 
                under this part for fiscal year 1998. Updates 
                shall as applicable take into account the 
                counting of cases of HIV disease pursuant to 
                clause (i).
                  (D) Determination of secretary regarding data 
                on hiv cases.--
                          (i) In general.--Not later than July 
                        1, 2004, the Secretary shall determine 
                        whether there is data on cases of HIV 
                        disease from all eligible areas 
                        (reported to and confirmed by the 
                        Director of the Centers for Disease 
                        Control and Prevention) sufficiently 
                        accurate and reliable for use for 
                        purposes of subparagraph (C)(i). In 
                        making such a determination, the 
                        Secretary shall take into consideration 
                        the findings of the study under section 
                        501(b) of the Ryan White CARE Act 
                        Amendments of 2000 (relating to the 
                        relationship between epidemiological 
                        measures and health care for certain 
                        individuals with HIV disease), the 
                        fiscal impact of the use of such data, 
                        the impact of the use of such data on 
                        the organization and delivery of HIV-
                        related services in eligible areas, and 
                        the fiscal impact of not using such 
                        data.
                          (ii) Effect of adverse 
                        determination.--If under clause (i) the 
                        Secretary determines that data on cases 
                        of HIV disease is not sufficiently 
                        accurate and reliable for use for 
                        purposes of subparagraph (C)(i), then 
                        notwithstanding such subparagraph, for 
                        any fiscal year prior to fiscal year 
                        2007 the references in such 
                        subparagraph to cases of HIV disease do 
                        not have any legal effect.
                          (iii) Grants and technical assistance 
                        regarding counting of hiv cases.--Of 
                        the amounts appropriated under section 
                        2675 for a fiscal year, the Secretary 
                        shall reserve amounts to make grants 
                        and provide technical assistance to 
                        States and eligible areas with respect 
                        to obtaining data on cases of HIV 
                        disease to ensure that data on such 
                        cases is available from all States and 
                        eligible areas as soon as is 
                        practicable but not later than the 
                        beginning of fiscal year 2007.
                  [(D)] (E) Unexpended funds.--The Secretary 
                may, in determining the amount of a grant for a 
                fiscal year under this paragraph, adjust the 
                grant amount to reflect the amount of 
                unexpended and uncanceled grant funds remaining 
                at the end of the fiscal year preceding the 
                year for which the grant determination is to be 
                made. The amount of any such unexpended funds 
                shall be determined using the financial status 
                report of the grantee.
          [(4) Increase in grant.--With respect to an eligible 
        area under section 2601(a), the Secretary shall 
        increase the amount of a grant under paragraph (2) for 
        a fiscal year to ensure that such eligible area 
        receives not less than--
                  [(A) with respect to fiscal year 1996, 100 
                percent;
                  [(B) with respect to fiscal year 1997, 99 
                percent;
                  [(C) with respect to fiscal year 1998, 98 
                percent;
                  [(D) with respect to fiscal year 1999, 96.5 
                percent; and
                  [(E) with respect to fiscal year 2000, 95 
                percent;
        of the amount allocated for fiscal year 1995 to such 
        entity under this subsection.]
          (4) Increases in grant.--
                  (A) In general.--For each fiscal year in a 
                protection period for an eligible area, the 
                Secretary shall increase the amount of the 
                grant made pursuant to paragraph (2) for the 
                area to ensure that--
                          (i) for the first fiscal year in the 
                        protection period, the grant is not 
                        less than 98 percent of the amount of 
                        the grant made for the eligible area 
                        pursuant to such paragraph for the base 
                        year for the protection period;
                          (ii) for any second fiscal year in 
                        such period, the grant is not less than 
                        95.7 percent of the amount of such base 
                        year grant;
                          (iii) for any third fiscal year in 
                        such period, the grant is not less than 
                        91.1 percent of the amount of the base 
                        year grant;
                          (iv) for any fourth fiscal year in 
                        such period, the grant is not less than 
                        84.2 percent of the amount of the base 
                        year grant; and
                          (v) for any fifth or subsequent 
                        fiscal year in such period, the grant 
                        is not less than 75 percent of the 
                        amount of the base year grant.
                  (B) Base year; protection period.--With 
                respect to grants made pursuant to paragraph 
                (2) for an eligible area:
                          (i) The base year for a protection 
                        period is the fiscal year preceding the 
                        trigger grant-reduction year.
                          (ii) The first trigger grant-
                        reduction year is the first fiscal year 
                        (after fiscal year 2000) for which the 
                        grant for the area is less than the 
                        grant for the area for the preceding 
                        fiscal year.
                          (iii) A protection period begins with 
                        the trigger grant-reduction year and 
                        continues until the beginning of the 
                        first fiscal year for which the amount 
                        of the grant for the area equals or 
                        exceeds the amount of the grant for the 
                        base year for the period.
                          (iv) Any subsequent trigger grant-
                        reduction year is the first fiscal 
                        year, after the end of the preceding 
                        protection period, for which the amount 
                        of the grant is less than the amount of 
                        the grant for the preceding fiscal 
                        year.
  (b) Supplemental Grants.--
          (1) In general.--Not later than 150 days after the 
        date on which appropriations are made under section 
        2677 for a fiscal year, the Secretary shall disburse 
        the remainder of amounts not disbursed under section 
        2603(a)(2) for such fiscal year for the purpose of 
        making grants under section 2601(a) to eligible areas 
        whose application under section 2605(b)--
                  (A) * * *

           *       *       *       *       *       *       *

                  (E) demonstrates that resources will be 
                allocated in accordance with the local 
                demographic incidence of AIDS including 
                appropriate allocations for services for 
                infants, children, youth, women, and families 
                with HIV disease;

           *       *       *       *       *       *       *

          (2) [Definition] Amount of grant.--
                  (A) In general.--The amount of each grant 
                made for purposes of this subsection shall be 
                determined by the Secretary based on a 
                weighting of factors under paragraph (1), with 
                severe need under subparagraph (B) of such 
                paragraph counting one-third.
                  [(A)] (B) Severe need.--In determining severe 
                need in accordance with paragraph (1)(B), the 
                Secretary shall consider the ability of the 
                qualified applicant to expend funds efficiently 
                and the impact of relevant factors on the cost 
                and complexity of delivering health care and 
                support services to individuals with HIV 
                disease in the eligible area, including factors 
                such as--
                          (i) sexually transmitted diseases, 
                        substance abuse, tuberculosis, severe 
                        mental illness, or other comorbid 
                        factors determined relevant by the 
                        Secretary;
                          (ii) new or growing subpopulations of 
                        individuals with HIV disease; [and]
                          (iii) homelessness[.];
                          (iv) the current prevalence of HIV 
                        disease;
                          (v) an increasing need for HIV-
                        related services, including relative 
                        rates of increase in the number of 
                        cases of HIV disease; and
                          (vi) unmet need for such services, as 
                        determined under section 2602(b)(4).
                  [(B)] (C) Prevalence.--In determining the 
                impact of the factors described in subparagraph 
                [(A)] (B), the Secretary shall, to the extent 
                practicable, use national, quantitative 
                incidence data that are available for each 
                eligible area. Not later than [2 years after 
                the date of enactment of this paragraph] 18 
                months after the date of the enactment of the 
                Ryan White CARE Act Amendments of 2000, the 
                Secretary shall develop a mechanism to utilize 
                such data. Such a mechanism shall be modified 
                to reflect the findings of the study under 
                section 501(b) of the Ryan White CARE Act 
                Amendments of 2000 (relating to the 
                relationship between epidemiological measures 
                and health care for certain individuals with 
                HIV disease). In the absence of such data, the 
                Secretary may consider a detailed description 
                and qualitative analysis of severe need, as 
                determined under subparagraph [(A)] (B), 
                including any local prevalence data gathered 
                and analyzed by the eligible area.
                  [(C)] (D) Priority.--Subsequent to the 
                development of the quantitative mechanism 
                described in subparagraph [(B)] (C), the 
                Secretary shall phase in, over a 3-year period 
                beginning in fiscal year 1998, the use of such 
                a mechanism to determine the severe need of an 
                eligible area compared to other eligible areas 
                and to determine, in part, the amount of 
                supplemental funds awarded to the eligible area 
                under this part.
          [(4) Amount of grant.--The amount of each grant made 
        for purposes of this subsection shall be determined by 
        the Secretary based on the application submitted by the 
        eligible area under section 2605(b).]
          [(5)] (4) Failure to submit.--
                  (A) * * *

           *       *       *       *       *       *       *


SEC. 2604. USE OF AMOUNTS.

  (a) * * *
  (b) Primary Purposes.--
          (1) In general.--The chief elected official shall use 
        amounts received under a grant under section 2601 to 
        provide direct financial assistance to entities 
        described in paragraph (2) for the purpose of 
        delivering or enhancing [HIV- 
        related--] HIV-related services, as follows:
                  (A) [outpatient and ambulatory health and 
                support services, including case management, 
                substance abuse treatment and] Outpatient and 
                ambulatory health services, including substance 
                abuse treatment, mental health treatment, and 
                comprehensive treatment services, which shall 
                include treatment education and prophylactic 
                treatment for opportunistic infections, for 
                individuals and families with HIV disease[; 
                and].
                  (B) Outpatient and ambulatory support 
                services (including case management), to the 
                extent that such services facilitate, support, 
                or sustain the delivery, or benefits of health 
                services for individuals and families with HIV 
                disease.
                  [(B) inpatient case management] (C) Inpatient 
                case management services that prevent 
                unnecessary hospitalization or that expedite 
                discharge, as medically appropriate, from 
                inpatient facilities.
                  (D) Outreach activities that are intended to 
                identify individuals with HIV disease who are 
                not receiving HIV-related services, and that 
                are--
                          (i) necessary to implement the 
                        strategy under section 2602(b)(4)(D), 
                        including activities facilitating the 
                        access of such individuals to HIV-
                        related primary care services at 
                        entities described in paragraph (3);
                          (ii) conducted in a manner consistent 
                        with the requirements under sections 
                        2605(a)(3) and 2651(b)(2); and
                          (iii) supplement, and do not 
                        supplant, such activities that are 
                        carried out with amounts appropriated 
                        under section 317.

           *       *       *       *       *       *       *

          (3) Early intervention services.--
                  (A) In general.--The purposes for which a 
                grant under section 2601 may be used include 
                providing to individuals with HIV disease early 
                intervention services described in section 
                2651(b)(2) (including referrals under 
                subparagraph (C) of such section), subject to 
                subparagraph (B). The entities through which 
                such services may be provided under the grant 
                include public health departments, emergency 
                rooms, substance abuse and mental health 
                treatment programs, detoxification centers, 
                detention facilities, clinics regarding 
                sexually transmitted diseases, homeless 
                shelters, HIV disease counseling and testing 
                sites, health care points of entry specified by 
                States or eligible areas, federally qualified 
                health centers, and entities described in 
                section 2652(a).
                  (B) Conditions.--With respect to an entity 
                that proposes to provide early intervention 
                services under subparagraph (A), such 
                subparagraph applies only if the entity 
                demonstrates to the satisfaction of the chief 
                elected official for the eligible area involved 
                that--
                          (i) Federal, State, or local funds 
                        are otherwise inadequate for the early 
                        intervention services the entity 
                        proposes to provide; and
                          (ii) the entity will expend funds 
                        pursuant to such subparagraph to 
                        supplement and not supplant other funds 
                        available to the entity for the 
                        provision of early intervention 
                        services for the fiscal year involved.
          [(3)] (4) Priority for women, infants and children.--
        For the purpose of providing health and support 
        services to infants, children, youth, and women with 
        HIV disease, including treatment measures to prevent 
        the perinatal transmission of HIV, the chief elected 
        official of an eligible area, in accordance with the 
        established priorities of the planning council, shall 
        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 in such area 
        of infants, children, youth, and women with acquired 
        immune deficiency syndrome to the general population in 
        such area of individuals with such syndrome.
  (c) Quality Management.--
          (1) Requirement.--The chief elected official of an 
        eligible area that receives a grant under this part 
        shall provide for the establishment of a quality 
        management program to assess the extent to which HIV 
        health services provided to patients under the grant 
        are consistent with the most recent Public Health 
        Service guidelines for the treatment of HIV disease and 
        related opportunistic infection, and as applicable, to 
        develop strategies for ensuring that such services are 
        consistent with the guidelines.
          (2) Use of funds.--From amounts received under a 
        grant awarded under this part for a fiscal year, the 
        chief elected official of an eligible area may (in 
        addition to amounts to which subsection (f)(1) applies) 
        use for activities associated with the quality 
        management program required in paragraph (1) not more 
        than the lesser of--
                  (A) 5 percent of amounts received under the 
                grant; or
                  (B) $3,000,000.
  [(c)] (d) Limited Expenditures for Personnel Needs.--
          (1) * * *

           *       *       *       *       *       *       *

  [(d)] (e) Requirement of Status as Medicaid Provider.--
          (1) * * *
  [(e)] (f) Administration.--
          (1) In general.--The chief executive officer of an 
        eligible area shall not use in excess of 5 percent of 
        amounts receivedunder a grant awarded under this part 
for administration. In the case of entities and subcontractors to which 
such officer allocates amounts received by the officer under the grant, 
the officer 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).

           *       *       *       *       *       *       *

  [(f)] (g) Construction.--A State 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. 2605. APPLICATION.

  (a) In General.--To be eligible to receive a grant under 
section 2601, an eligible area shall prepare and submit to the 
Secretary an application, in accordance with subsection (c) 
regarding a single application and grant award, at such time, 
in such form, and containing such information as the Secretary 
shall require, including assurances adequate to ensure--
          (1) * * *

           *       *       *       *       *       *       *

          (3) that entities within the eligible area that 
        receive funds under a grant under section 2601(a) will 
        maintain relationships with appropriate entities in the 
        area, including entities described in section 
        2604(b)(3);
          [(3)] (4) that entities within the eligible area that 
        will receive funds under a grant provided under section 
        2601(a) shall participate in an established HIV 
        community-based continuum of care if such continuum 
        exists within the eligible area;
          [(4)] (5) that funds received under a grant awarded 
        under this part will not be utilized to make payments 
        for any item or service to the extent that payment has 
        been made, or can reasonably be expected to be made, 
        with respect to that item or service--
                  (A) under any State compensation program, 
                under an insurance policy, or under any Federal 
                or State health benefits program; or
                  (B) by an entity that provides health 
                services on a prepaid basis;
          [(5)] (6) to the maximum extent practicable, that--
                  (A) HIV health care and support services 
                provided with assistance made available under 
                this part will be provided without regard--
                          (i) * * *

           *       *       *       *       *       *       *

          [(6)] (7) that the applicant has participated, or 
        will agree to participate, in the statewide coordinated 
        statement of need process where it has been initiated 
        by the State public health agency responsible for 
        administering grants under part B, and ensure that the 
        services provided under the comprehensive plan are 
        consistent with the statewide coordinated statement of 
        need.

           *       *       *       *       *       *       *


                       Part B--Care Grant Program

                  Subpart I--General Grant Provisions

SEC. 2611. GRANTS.

  (a) * * *
  (b) Priority for Women, Infants and Children.--For the 
purpose of providing health and support services to infants, 
children, youth, and women with HIV disease, including 
treatment measures to prevent the perinatal transmission of 
HIV, a State shall use, of the funds allocated under this part 
to the State for a fiscal year, not less than the percentage 
constituted by the ratio of the population in the State of 
infants, children, youth, and women with acquired immune 
deficiency syndrome to the general population in the State of 
individuals with such syndrome.

           *       *       *       *       *       *       *


SEC. 2612. GENERAL USE OF GRANTS.

  (a) In General.--A State may use amounts provided under 
grants made under this part--
          (1) * * *
  (b) Support Services; Outreach.--The purposes for which a 
grant under this part may be used include delivering or 
enhancing the following:
          (1) Support services under section 2611(a) (including 
        case management) to the extent that such services 
        facilitate, support, or sustain the delivery, or 
        benefits of health services for individuals and 
        families with HIV disease.
          (2) Outreach activities that are intended to identify 
        individuals with HIV disease who are not receiving HIV-
        related services, and that are--
                  (A) necessary to implement the strategy under 
                section 2617(b)(4)(B);
                  (B) conducted in a manner consistent with the 
                requirement under section 2617(b)(6)(G); and
                  (C) supplement, and do not supplant, such 
                activities that are carried out with amounts 
                appropriated under section 317.
  (c) Early Intervention Services.--
          (1) In general.--The purposes for which a grant under 
        this part may be used include providing to individuals 
        with HIV disease early intervention services described 
        in section 2651(b)(2) (including referrals under 
        subparagraph (C) of such section), subject to paragraph 
        (2). The entities through which such services may be 
        provided under the grant include public health 
        departments, emergency rooms, substance abuse and 
        mental health treatment programs, detoxification 
        centers, detention facilities, clinics regarding 
        sexually transmitted diseases, homeless shelters, HIV 
        disease counseling and testing sites, health care 
        points of entry specified by States or eligible areas, 
        federally qualified health centers, and entities 
        described in section 2652(a).
          (2) Conditions.--With respect to an entity that 
        proposes to provide early intervention services under 
        paragraph (1), such paragraph applies only if the 
        entity demonstrates to the satisfaction of the State 
        involved that--
                  (A) Federal, State, or local funds are 
                otherwise inadequate for the early intervention 
                services the entity proposes to provide; and
                  (B) the entity will expend funds pursuant to 
                such paragraph to supplement and not supplant 
                other funds available to the entity for the 
                provision of early intervention services for 
                the fiscal year involved.
  (d) Quality Management.--
          (1) Requirement.--Each State that receives a grant 
        under this part shall provide for the establishment of 
        a quality management program to assess the extent to 
        which HIV health services provided to patients under 
        the grant are consistent with the most recent Public 
        Health Service guidelines for the treatment of HIV 
        disease and related opportunistic infection, and as 
        applicable, to develop strategies for ensuring that 
        such services are consistent with the guidelines.
          (2) Use of funds.--From amounts received under a 
        grant awarded under this part for a fiscal year, the 
        State may (in addition to amounts to which section 
        2618(c)(5) applies) use for activities associated with 
        the quality management program required in paragraph 
        (1) not more than the lesser of--
                  (A) 5 percent of amounts received under the 
                grant; or
                  (B) $3,000,000.

SEC. 2613. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

  (a) * * *
  (b) Assurances.--
          (1) Requirement.--To receive assistance from a State 
        under subsection (a), an applicant consortium shall 
        provide the State with assurances that--
                  (A) within any locality in which such 
                consortium is to operate, the populations and 
                subpopulations of individuals and families with 
                HIV disease have been identified by the 
                consortium, particularly those experiencing 
                disparities in access and services and those 
                who reside in historically underserved 
                communities;
                  (B) the service plan established under 
                subsection (c)(2) by such consortium is 
                consistent with the comprehensive plan under 
                2617(b)(4) and addresses the special care and 
                service needs of the populations and 
                subpopulations identified under subparagraph 
                (A); and

           *       *       *       *       *       *       *

  (c) Application.--
          (1) In general.--To receive assistance from the State 
        under subsection (a), a consortium shall prepare and 
        submit to the State, an application that--
                  (A) * * *

           *       *       *       *       *       *       *

                  (D) demonstrates that the consortium has 
                created a mechanism to evaluate periodically--
                          (i) * * *
                          (ii) the cost-effectiveness of the 
                        mechanisms employed by the consortium 
                        to deliver comprehensive care; [and]
                  (E) demonstrates that the consortium will 
                report to the State the results of the 
                evaluations described in subparagraph (D) and 
                shall make available to the State or the 
                Secretary, on request, such data and 
                information on the program methodology that may 
                be required to perform an independent 
                evaluation[.]; and
                  (F) demonstrates that adequate planning 
                occurred to address disparities in access and 
                services and historically underserved 
                communities.
          (2) Consultation.--In establishing the plan required 
        under paragraph (1)(B), the consortium shall consult 
        with--
                  (A) * * *
                  (B) not less than one community-based 
                organization that is organized solely for the 
                purpose of providing HIV-related support 
                services to individuals with HIV disease; [and]
                  (C) grantees under section 2671, or, if none 
                are operating in the area, representatives in 
                the area of organizations with a history of 
                serving children, youth, women, and families 
                living with HIV[.]; and
                  (D) entities described in section 2602(b)(2).
        The organization to be consulted under subparagraph (B) 
        shall be at the discretion of the applicant consortium.

           *       *       *       *       *       *       *


SEC. 2616. PROVISION OF TREATMENTS.

  (a) * * *

           *       *       *       *       *       *       *

  (e) Use of Health Insurance and Plans.--In carrying out 
subsection (a), a State may expend a grant under this part to 
provide the therapeutics described in such subsection by paying 
on behalf of individuals with HIV disease the costs of 
purchasing or maintaining health insurance or plans whose 
coverage includes a full range of such therapeutics and 
appropriate primary care services.

SEC. 2617. STATE APPLICATION.

  (a) * * *
  (b) Description of Intended Uses and Agreements.--The 
application submitted under subsection (a) shall contain--
          (1) * * *
          (2) a determination of the size and demographics of 
        the population of individuals with HIV disease in the 
        State;
          (3) a determination of the needs of such population, 
        with particular attention to--
                  (A) individuals with HIV disease who are not 
                receiving HIV-related services; and
                  (B) disparities in access and services among 
                affected subpopulations and historically 
                underserved communities;
          [(2)] (4) a [comprehensive plan for the organization] 
        comprehensive plan that describes the organization and 
        delivery of HIV health care and support services to be 
        funded with assistance received under this part that 
        shall include a description of the purposes for which 
        the State intends to use such assistance[, including--
        ], and that--
                  (A) establishes priorities for the allocation 
                of funds within the State based on--
                          (i) size and demographics of the 
                        population of individuals with HIV 
                        disease (as determined under paragraph 
                        (2)) and the needs of such population 
                        (as determined under paragraph (3));
                          (ii) availability of other 
                        governmental and nongovernmental 
                        resources to provide HIV-related 
                        services to individuals and families 
                        with HIV disease;
                          (iii) capacity development needs 
                        resulting from disparities in the 
                        availability of HIV-related services in 
                        historically underserved communities 
                        and rural communities; and
                          (iv) the efficiency of the 
                        administrative mechanism of the State 
                        for rapidly allocating funds to the 
                        areas of greatest need within the 
                        State;
                  (B) includes a strategy for identifying 
                individuals with HIV disease who are not 
                receiving such services and for informing the 
                individuals of and enabling the individuals to 
                utilize the services, giving particular 
                attention to eliminating disparities in access 
                and services among affected subpopulations and 
                historically underserved communities, and 
                including discrete goals, a timetable, and an 
                appropriate allocation of funds;
                  (C) includes a strategy to coordinate the 
                provision of such services with programs for 
                HIV prevention and for the prevention and 
                treatment of substance abuse, including 
                programs that provide comprehensive treatment 
                services for such abuse;
                  [(A)] (D) describes the services and 
                activities to be provided and an explanation of 
                the manner in which the elements of the program 
                to be implemented by the State with such 
                assistance will maximize the quality of health 
                and support services available to individuals 
                with HIV disease throughout the State;
                  [(B)] (E) provides a description of the 
                manner in which services funded with assistance 
                provided under this part will be coordinated 
                with other available related services for 
                individuals with HIV disease; and
                  [(C)] (F) provides a description of how the 
                allocation and utilization of resources are 
                consistent with the statewide coordinated 
                statement of need (including traditionally 
                underserved populations and subpopulations) 
                developed in partnership with other grantees in 
                the State that receive funding under this 
                title; and
          [(3)] (5) an assurance that the public health agency 
        administering the grant for the State will periodically 
        convene a meeting of individuals with HIV disease, 
        representatives of grantees under each part under this 
        title, providers, and public agency representatives for 
        the purpose of developing a statewide coordinated 
        statement of need; and
          [(4)] (6) an assurance by the State that--
                  [(A) the public health agency that is 
                administering the grant for the State will 
                conduct public hearings concerning the proposed 
                use and distribution of the assistance to be 
                received under this part;]
                  (A) the public health agency that is 
                administering the grant for the State engages 
                in a public advisory planning process, 
                including public hearings, that includes the 
                participants under paragraph (5), and entities 
                described in section 2602(b)(2), in developing 
                the comprehensive plan under paragraph (4) and 
                commenting on the implementation of such plan;

           *       *       *       *       *       *       *

                  (E) the State will maintain HIV-related 
                activities at a level that is equal to not less 
                than the level of such expenditures by the 
                State for the 1-year period preceding the 
                fiscal year for which the State is applying to 
                receive a grant under this part; [and]
                  (F) the State will ensure that grant funds 
                are not utilized to make payments for any item 
                or service to the extent that payment has been 
                made, or can reasonably be expected to be made, 
                with respect to that item or service--
                          (i) * * *
                          (ii) by an entity that provides 
                        health services on a prepaid basis[.]; 
                        and
                  (G) entities within areas in which activities 
                under the grant are carried out will maintain 
                relationships with appropriate entities in the 
                area, including entities described in section 
                2612(c);

           *       *       *       *       *       *       *


SEC. 2618. DISTRIBUTION OF FUNDS.

  (b) Amount of Grant to State.--
          (1) Minimum allotment.--Subject to the extent of 
        amounts made available under section 2677, the amount 
        of a grant to be made under this part for--
                  (A) each of the several States and the 
                District of Columbia for a fiscal year shall be 
                the greater of--
                          (i)(I) with respect to a State or 
                        District that has less than 90 living 
                        cases of acquired immune deficiency 
                        syndrome, as determined under paragraph 
                        (2)(D), [$100,000] $200,000; or
                          (II) with respect to a State or 
                        District that has 90 or more living 
                        cases of acquired immune deficiency 
                        syndrome, as determined under paragraph 
                        (2)(D), [$250,000] $500,000;
                          (ii) an amount determined under 
                        paragraph (2) and then, as applicable, 
                        increased under paragraph (2)(H); and
                  (B) each territory of the United States, as 
                defined in paragraph (3), shall be the greater 
                of $50,000 or an amount determined under 
                paragraph (2).
          (2) Determination.--
                  (A) Formula.--The amount referred to in 
                paragraph (1)(A)(ii) for a State and paragraph 
                (1)(B) for a territory of the United States 
                shall be the product of--
                          (i) an amount equal to the amount 
                        appropriated under section 2677 for the 
                        fiscal year involved for grants under 
                        part B, subject to [subparagraph (H)] 
                        subparagraphs (H) and (I); and

           *       *       *       *       *       *       *

                  (D) Estimate of living cases.--The amount 
                determined in this subparagraph is an amount 
                equal to the product of--
                          (i) the number of cases of acquired 
                        immune deficiency syndrome in the State 
                        or territory during each year in the 
                        most recent 120-month period for which 
                        data are available with respect to all 
                        States and territories, as indicated by 
                        the number of such cases reported to 
                        and confirmed by the Director of the 
                        Centers for Disease Control and 
                        Prevention for each year during such 
                        period, except that (subject to 
                        subparagraph (E)), for grants made 
                        pursuant to this paragraph for fiscal 
                        year 2005 and subsequent fiscal years, 
                        the cases counted for each 12-month 
                        period beginning on or after July 1, 
                        2004, shall be cases of HIV disease (as 
                        reported to and confirmed by such 
                        Director) rather than cases of acquired 
                        immune deficiency syndrome; and
                  (E) Determination of secretary regarding data 
                on hiv cases.--If under 2603(a)(3)(D)(i) the 
                Secretary determines that data on cases of HIV 
                disease is not sufficiently accurate and 
                reliable, then notwithstanding subparagraph (D) 
                of this paragraph, for any fiscal year prior to 
                fiscal year 2007 the references in such 
                subparagraph to cases of HIV disease do not 
                have any legal effect.
                  [(E)] (F) Puerto rico, virgin islands, 
                guam.--For purposes of subparagraph (D), the 
                cost index for Puerto Rico, the Virgin Islands, 
                and Guam shall be 1.0.
                  [(F)] (G) Unexpended funds.--The Secretary 
                may, in determining the amount of a grant for a 
                fiscal year under this subsection, adjust the 
                grant amount to reflect the amount of 
                unexpended and uncanceled grant funds remaining 
                at the end of the fiscal year preceding the 
                year for which the grant determination is to be 
                made. The amount of any such unexpended funds 
                shall be determined using the financial status 
                report of the grantee.
                  [(G) Limitation.--
                          [(i) In general.--The Secretary shall 
                        ensure that the amount of a grant 
                        awarded to a State or territory for a 
                        fiscal year under this part is equal to 
                        not less than--
                                  [(I) with respect to fiscal 
                                year 1996, 100 percent;
                                  [(II) with respect to fiscal 
                                year 1997, 99 percent;
                                  [(III) with respect to fiscal 
                                year 1998, 98 percent;
                                  [(IV) with respect to fiscal 
                                year 1999, 96.5 percent; and
                                  [(V) with respect to fiscal 
                                year 2000, 95 percent;
                        of the amount such State or territory 
                        received for fiscal year 1995 under 
                        this part. In administering this 
                        subparagraph, the Secretary shall, with 
                        respect to States that will receive 
                        grants in amounts that exceed the 
                        amounts that such States received under 
                        this part in fiscal year 1995, 
                        proportionally reduce such amounts to 
                        ensure compliance with this 
                        subparagraph. In making such 
                        reductions, the Secretary shall ensure 
                        that no such State receives less than 
                        that State received for fiscal year 
                        1995.
                          [(ii) Ratable reduction.--If the 
                        amount appropriated under section 2677 
                        and available for allocation under this 
                        part is less than the amount 
                        appropriated and available under this 
                        part for fiscal year 1995, the 
                        limitation contained in clause (i) 
                        shall be reduced by a percentage equal 
                        to the percentage of the reduction in 
                        such amounts appropriated and 
                        available.]
                  (H) Limitation.--
                          (i) In general.--The Secretary shall 
                        ensure that the amount of a grant 
                        awarded to a State or territory under 
                        section 2611 for a fiscal year is not 
                        less than--
                                  (I) with respect to fiscal 
                                year 2001, 99 percent;
                                  (II) with respect to fiscal 
                                year 2002, 98 percent;
                                  (III) with respect to fiscal 
                                year 2003, 97 percent;
                                  (IV) with respect to fiscal 
                                year 2004, 96 percent; and
                                  (V) with respect to fiscal 
                                year 2005, 95 percent;
                        of the amount such State or territory 
                        received for fiscal year 2000 under 
                        such section. In administering this 
                        subparagraph, the Secretary shall, with 
                        respect to States or territories that 
                        will under such section receive grants 
                        in amounts that exceed the amounts that 
                        such States received under such section 
                        for fiscal year 2000, proportionally 
                        reduce such amounts to ensure 
                        compliance with this subparagraph. In 
                        making such reductions, the Secretary 
                        shall ensure that no such State 
                        receives less than that State received 
                        for fiscal year 2000.
                          (ii) Ratable reduction.--If the 
                        amount appropriated under section 2677 
                        for a fiscal year and available for 
                        grants under section 2611 is less than 
                        the amount appropriated and available 
                        under such section for fiscal year 
                        2000, the limitation contained in 
                        clause (i) shall be reduced by a 
                        percentage equal to the percentage of 
                        the reduction in such amounts 
                        appropriated and available.
                  [(H) Appropriations for treatment drug 
                program.--With respect to]
                  (I) Appropriations for treatment drug 
                program.--
                          (i) Formula grants.--With respect to 
                        the fiscal year involved, if under 
                        section 2677 an appropriations Act 
                        provides an amount exclusively for 
                        carrying out section 2616, the portion 
                        of such amount allocated to a State 
                        shall be the product of--
                          [(i)] (I) [100] 98 percent of such 
                        amount; and
                          [(ii)] (II) the percentage 
                        constituted by the ratio of the State 
                        distribution factor for the State (as 
                        determined under subparagraph (B)) to 
                        the sum of the State distribution 
                        factors for all States.
                          (ii) Supplemental treatment drug 
                        grants.--
                                  (I) In general.--With respect 
                                to the fiscal year involved, if 
                                under section 2677 an 
                                appropriations Act provides an 
                                amount exclusively for carrying 
                                out section 2616, and such 
                                amount is not less than the 
                                amount so provided for the 
                                preceding fiscal year, the 
                                Secretary shall reserve 2 
                                percent of such amount for 
                                making grants to States whose 
                                population of individuals with 
                                HIV disease has, as determined 
                                by the Secretary, a need for 
                                quantities of therapeutics 
                                described in section 2616(a) 
                                greater than the quantities 
                                available pursuant to clause 
                                (i). Such a grant is available 
                                for purposes of obtaining such 
                                therapeutics. The Secretary 
                                shall carry out this clause as 
                                a program of discretionary 
                                grants, and not as a program of 
                                formula grants.
                                  (II) Distribution of 
                                grants.--The Secretary shall 
                                disburse all amounts under 
                                grants under subclause (I) for 
                                a fiscal year not later than 
                                240 days after the date on 
                                which the amount referred to in 
                                such subclause with respect to 
                                section 2616 becomes available.
                                  (III) Requirement of matching 
                                funds.--A condition for 
                                receiving a grant under 
                                subclause (I) is that the State 
                                agree to make available 
                                (directly or through donations 
                                from public or private 
                                entities) non-Federal 
                                contributions toward the costs 
                                of obtaining the therapeutics 
                                involved in an amount that is 
                                not less than 25 percent of 
                                such costs (determined in the 
                                same manner as under 
                                2617(d)(2)(A)).

           *       *       *       *       *       *       *

          (3) Definitions.--As used in this subsection--
                  (A) * * *
                  (B) the term ``territory of the United 
                States'' means, American Samoa, the 
                Commonwealth of the NorthernMariana Islands, 
[and the Republic of the Marshall Islands]  the Republic of the 
Marshall Islands, the Federated States of Micronesia, and the Republic 
of Palau, and only for purposes of paragraph (1) the Commonwealth of 
Puerto Rico.

           *       *       *       *       *       *       *


[SEC. 2621. COORDINATION.

  [The Secretary shall ensure that the Health Resources and 
Services Administration, the Centers for Disease Control and 
Prevention, and the Substance Abuse and Mental Health Services 
Administration coordinate the planning and implementation of 
Federal HIV programs in order to facilitate the local 
development of a complete continuum of HIV-related services for 
individuals with HIV disease and those at risk of such disease. 
Not later than October 1, 1996, and biennially thereafter, the 
Secretary shall submit to the appropriate committees of the 
Congress a report concerning coordination efforts under this 
title at the Federal, State, and local levels, including a 
statement of whether and to what extent there exist Federal 
barriers to integrating HIV-related programs.]

SEC. 2621. SUPPLEMENTAL GRANTS.

  (a) In General.--From amounts available pursuant to 
subsection (d) for a fiscal year, the Secretary shall make 
grants to States that meet the conditions to receive grants 
under section 2611, and that have one or more eligible 
communities, for the purpose of providing in such communities 
comprehensive services of the type described in section 2612(a) 
to supplement the development and care activities, primary 
care, and support services otherwise provided in such 
communities by the State under a grant under section 2611.
  (b) Eligible Community.--For purposes of this section, the 
term ``eligible community'' means a geographic area that--
          (1) is not within any eligible area as defined in 
        section 2607; and
          (2) has a severe need for supplemental financial 
        assistance to combat the HIV epidemic, according to 
        criteria developed by the Secretary in consultation 
        with the States, including evidence of underserved or 
        rural areas or both.
  (c) Application.--A grant under subsection (a) may be made to 
a State if the State submits to the Secretary, as part of the 
State application submitted under section 2617, such 
information as required to apply for funds under this section 
as determined by the Secretary in consultation with the States.
  (d) Funding.--
          (1) In general.--For the purpose of making grants 
        under subsection (a) for a fiscal year, the Secretary 
        shall reserve 50 percent of the amount specified in 
        paragraph (2).
          (2) Increases in part b funding.--
                  (A) In general.--For purposes of paragraph 
                (1), the amount specified in this paragraph is 
                the amount by which the amount appropriated 
                under section 2677 for the fiscal year involved 
                and available for carrying out part B is an 
                increase over the amount so appropriated and 
                available for the preceding fiscal year, 
                subject to subparagraphs (B) and (C).
                  (B) Initial allocation year.--The allocation 
                under paragraph (1) shall not be made until the 
                first fiscal year for which the amount 
                appropriated under section 2677 for the fiscal 
                year involved and available for carrying out 
                part B is an increase of not less than 
                $20,000,000 over the amount so appropriated and 
                available for fiscal year 2000, subject to 
                subparagraph (C).
                  (C) Exclusion regarding separate treatment 
                drug grants.--Each determination under 
                subparagraph (A) or (B) of the amount 
                appropriated under section 2677 for a fiscal 
                year and available for carrying out part B 
                shall be made without regard to any amount to 
                which section 2618(b)(2)(I)(i) applies.

           *       *       *       *       *       *       *


Subpart II--Provisions Concerning Pregnancy and Perinatal Transmission 
                                 of HIV

SEC. 2625. CDC GUIDELINES FOR PREGNANT WOMEN.

  (a) * * *

           *       *       *       *       *       *       *

  (c) Additional Funds Regarding Women and Infants.--
          (1) In general.--If a State provides the 
        certification required in subsection (a) and is 
        receiving funds under part B for a fiscal year, the 
        Secretary may (from the amounts available pursuant to 
        paragraph (2)) make a grant to the State for the fiscal 
        year for the following purposes:
                  (A) * * *

           *       *       *       *       *       *       *

                  (F) Making available to pregnant women with 
                HIV disease, and to the infants of women with 
                such disease, treatment services for such 
                disease in accordance with applicable 
                recommendations of the Secretary.
          [(2) Funding.--For purposes of carrying out this 
        subsection, there are authorized to be appropriated 
        $10,000,000 for each of the fiscal years 1996 through 
        2000. Amounts made available under section 2677 for 
        carrying out this part are not available for carrying 
        out this section unless otherwise authorized.]
          (2) Funding.--
                  (A) Authorization of appropriations.--For the 
                purpose of carrying out this subsection, there 
                are authorized to be appropriated $30,000,000 
                for each of the fiscal years 2001 through 2005. 
                Amounts made available under section 2677 for 
                carrying out this part are not available for 
                carrying out this section unless otherwise 
                authorized.
                  (B) Allocations for certain states.--
                          (i) In general.--Of the amounts 
                        appropriated under subparagraph (A) for 
                        a fiscal year in excess of $10,000,000, 
                        the Secretary shall reserve the 
                        applicable percentage under clause (ii) 
                        for making grants under paragraph (1) 
                        to States that under law (including 
                        under regulations or the discretion of 
                        State officials) have--
                                  (I) a requirement that all 
                                newborn infants born in the 
                                State be tested for HIV 
                                disease; or
                                  (II) a requirement that 
                                newborn infants born in the 
                                State be tested for HIV disease 
                                in circumstances in which the 
                                attending obstetrician for the 
                                birth does not know the HIV 
                                status of the mother of the 
                                infant.
                          (ii) Applicable percentage.--For 
                        purposes of clause (i), the applicable 
                        amount for a fiscal year is as follows:
                                  (I) For fiscal year 2001, 25 
                                percent.
                                  (II) For fiscal year 2002, 50 
                                percent.
                                  (III) For fiscal year 2003, 
                                50 percent.
                                  (IV) For fiscal year 2004, 75 
                                percent.
                                  (V) For fiscal year 2005, 75 
                                percent.
                  (C) Certain provisions.--With respect to 
                grants under paragraph (1) that are made with 
                amounts reserved under subparagraph (B) of this 
                paragraph:
                          (i) Such a grant may not be made in 
                        an amount exceeding $4,000,000.
                          (ii) If pursuant to clause (i) or 
                        pursuant to an insufficient number of 
                        qualifying applications for such grants 
                        (or both), the full amount reserved 
                        under subparagraph (B) for a fiscal 
                        year is not obligated, the requirement 
                        under such subparagraph to reserve 
                        amounts ceases to apply.

           *       *       *       *       *       *       *

          (4) Maintenance of effort.--A condition for the 
        receipt of a grant under paragraph (1) is that the 
        State involved agree that the grant will be used to 
        supplement and not supplant other funds available to 
        the State to carry out the purposes of the grant.

           *       *       *       *       *       *       *


SEC. 2626. PERINATAL TRANSMISSION OF HIV DISEASE; CONTINGENT 
                    REQUIREMENT REGARDING STATE GRANTS UNDER THIS PART.

  (a) * * *

           *       *       *       *       *       *       *

  [(d) Determination by Secretary.--Not later than 180 days 
after the expiration of the 18-month period beginning on the 
date on which the system is implemented under subsection (c), 
the Secretary shall publish in the Federal Register a 
determination of whether it has become a routine practice in 
the provision of health care in the United States to carry out 
each of the activities described in paragraphs (1) through (4) 
of section 2627. In making the determination, the Secretary 
shall consult with the States and with other public or private 
entities that have knowledge or expertise relevant to the 
determination.
  [(e) Contingent Applicability.--
          [(1) In general.--If the determination published in 
        the Federal Register under subsection (d) is that (for 
        purposes of such subsection) the activities involved 
        have become routine practices, paragraph (2) shall 
        apply on and after the expiration of the 18-month 
        period beginning on the date on which the determination 
        is so published.
          [(2) Requirement.--Subject to subsection (f), the 
        Secretary shall not make a grant under part B to a 
        State unless the State meets not less than one of the 
        following requirements:
                  [(A) A 50 percent reduction (or a comparable 
                measure for States with less than 10 cases) in 
                the rate of new cases of AIDS (recognizing that 
                AIDS is a suboptimal proxy for tracking HIV in 
                infants and was selected because such data is 
                universally available) as a result of perinatal 
                transmission as compared to the rate of such 
                cases reported in 1993 (a State may use HIV 
                data if such data is available).
                  [(B) At least 95 percent of women in the 
                State who have received at least two prenatal 
                visits (consultations) prior to 34 weeks 
                gestation with a health care provider or 
                provider group have been tested for the human 
                immunodeficiency virus.
                  [(C) The State has in effect, in statute or 
                through regulations, the requirements specified 
                in paragraphs (1) through (5) of section 2627.
  [(f) Limitation Regarding Availability of Funds.--With 
respect to an activity described in any of paragraphs (1) 
through (4) of section 2627, the requirements established by a 
State under this section apply for purposes of this section 
only to the extent that the following sources of funds are 
available for carrying out the activity:
          [(1) Federal funds provided to the State in grants 
        under part B or under section 2625, or through other 
        Federal sources under which payments for routine HIV 
        testing, counseling or treatment are an eligible use.
          [(2) Funds that the State or private entities have 
        elected to provide, including through entering into 
        contracts under which health benefits are provided. 
        This section does not require any entity to expend non-
        Federal funds.

[SEC. 2627. TESTING OF PREGNANT WOMEN AND NEWBORN INFANTS.

  [An activity or requirement described in this section is any 
of the following:
          [(1) In the case of newborn infants who are born in 
        the State and whose biological mothers have not 
        undergone prenatal testing for HIV disease, that each 
        such infant undergo testing for such disease.
          [(2) That the results of such testing of a newborn 
        infant be promptly disclosed in accordance with the 
        following, as applicable to the infant involved:
                  [(A) To the biological mother of the infant 
                (without regard to whether she is the legal 
                guardian of the infant).
                  [(B) If the State is the legal guardian of 
                the infant:
                          [(i) To the appropriate official of 
                        the State agency with responsibility 
                        for the care of the infant.
                          [(ii) To the appropriate official of 
                        each authorized agency providing 
                        assistance in the placement of the 
                        infant.
                          [(iii) If the authorized agency is 
                        giving significant consideration to 
                        approving an individual as a foster 
                        parent of the infant, to the 
                        prospective foster parent.
                          [(iv) If the authorized agency is 
                        giving significant consideration to 
                        approving an individual as an adoptive 
                        parent of the infant, to the 
                        prospective adoptive parent.
                  [(C) If neither the biological mother nor the 
                State is the legal guardian of the infant, to 
                another legal guardian of the infant.
                  [(D) To the child's health care provider.
          [(3) That, in the case of prenatal testing for HIV 
        disease that is conducted in the State, the results of 
        such testing be promptly disclosed to the pregnant 
        woman involved.
          [(4) That, in disclosing the test results to an 
        individual under paragraph (2) or (3), appropriate 
        counseling on the human immunodeficiency virus be made 
        available to the individual (except in the case of a 
        disclosure to an official of a State or an authorized 
        agency).
          [(5) With respect to State insurance laws, that such 
        laws require--
                  [(A) that, if health insurance is in effect 
                for an individual, the insurer involved may not 
                (without the consent of the individual) 
                discontinue the insurance, or alter the terms 
                of the insurance (except as provided in 
                subparagraph (C)), solely on the basis that the 
                individual is infected with HIV disease or 
                solely on the basis that the individual has 
                been tested for the disease or its 
                manifestation;
                  [(B) that subparagraph (A) does not apply to 
                an individual who, in applying for the health 
                insurance involved, knowingly misrepresented 
                the HIV status of the individual; and
                  [(C) that subparagraph (A) does not apply to 
                any reasonable alteration in the terms of 
                health insurance for an individual with HIV 
                disease that would have been made if the 
                individual had a serious disease other than HIV 
                disease.
        For purposes of this subparagraph, a statute or 
        regulation shall be deemed to regulate insurance for 
        purposes of this paragraph only to the extent that such 
        statute or regulation is treated as regulating 
        insurance for purposes of section 514(b)(2) of the 
        Employee Retirement Income Security Act of 1974.]

           *       *       *       *       *       *       *


SEC. 2630. RECOMMENDATIONS FOR REDUCING INCIDENCE OF PERINATAL 
                    TRANSMISSION.

  (a) Study by Institute of Medicine.--
          (1) In general.--The Secretary shall request the 
        Institute of Medicine to enter into an agreement with 
        the Secretary under which such Institute conducts a 
        study to provide the following:
                  (A) For the most recent fiscal year for which 
                the information is available, a determination 
                of the number of newborn infants with HIV born 
                in the United States with respect to whom the 
                attending obstetrician for the birth did not 
                know the HIV status of the mother.
                  (B) A determination for each State of any 
                barriers, including legal barriers, that 
                prevent or discourage an obstetrician from 
                making it a routine practice to offer pregnant 
                women an HIV test and a routine practice to 
                test newborn infants for HIV disease in 
                circumstances in which the obstetrician does 
                not know the HIV status of the mother of the 
                infant.
                  (C) Recommendations for each State for 
                reducing the incidence of cases of the 
                perinatal transmission of HIV, including 
                recommendations on removing the barriers 
                identified under subparagraph (B).
        If such Institute declines to conduct the study, the 
        Secretary shall enter into an agreement with another 
        appropriate public or nonprofit private entity to 
        conduct the study.
          (2) Report.--The Secretary shall ensure that, not 
        later than 18 months after the effective date of this 
        section, the study required in paragraph (1) is 
        completed and a report describing the findings made in 
        the study is submitted to the appropriate committees of 
        the Congress, the Secretary, and the chief public 
        health official of each of the States.
  (b) Progress Toward Recommendations.--Each State shall comply 
with the following (as applicable to the fiscal year involved):
          (1) For fiscal year 2004, the State shall submit to 
        the Secretary a report describing the actions taken by 
        the State toward meeting the recommendations specified 
        for the State under subsection (a)(1)(C).
          (2) For fiscal year 2005 and each subsequent fiscal 
        year--
                  (A) the State shall make reasonable progress 
                toward meeting such recommendations; or
                  (B) if the State has not made such progress--
                          (i) the State shall cooperate with 
                        the Director of the Centers for Disease 
                        Control and Prevention in carrying out 
                        activities toward meeting the 
                        recommendations; and
                          (ii) the State shall submit to the 
                        Secretary a report containing a 
                        description of any barriers identified 
                        under subsection (a)(1)(B) that 
                        continue to exist in the State; as 
                        applicable, the factors underlying the 
                        continued existence of such barriers; 
                        and a description of how the State 
                        intends to reduce the incidence of 
                        cases of the perinatal transmission of 
                        HIV.
  (c) Submission of Reports to Congress.--The Secretary shall 
submit to the appropriate committees of the Congress each 
report received by the Secretary under subsection 
(b)(2)(B)(ii).

           Subpart III--Certain Partner Notification Programs

SEC. 2631. GRANTS FOR PARTNER NOTIFICATION PROGRAMS.

  (a) In General.--In the case of States whose laws or 
regulations are in accordance with subsection (b), the 
Secretary, subject to subsection (c)(2), may make grants to the 
States for carrying out programs to provide partner counseling 
and referral services.
  (b) Description of Compliant State Programs.--For purposes of 
subsection (a), the laws or regulations of a State are in 
accordance with this subsection if under such laws or 
regulations (including programs carried out pursuant to the 
discretion of State officials) the following policies are in 
effect:
          (1) The State requires that the public health officer 
        of the State carry out a program of partner 
        notification to inform partners of individuals with HIV 
        disease that the partners may have been exposed to the 
        disease.
          (2)(A) In the case of a health entity that provides 
        for the performance on an individual of a test for HIV 
        disease, or that treats the individual for the disease, 
        the State requires, subject to subparagraph (B), that 
        the entity confidentially report the positive test 
        results to the State public health officer in a manner 
        recommended and approved by the Director of the Centers 
        for Disease Control and Prevention, together with such 
        additional information as may be necessary for carrying 
        out such program.
          (B) The State may provide that the requirement of 
        subparagraph (A) does not apply to the testing of an 
        individual for HIV disease if the individual underwent 
        the testing through a program designed to perform the 
        test and provide the results to the individual without 
        the individual disclosing his or her identity to the 
        program. This subparagraph may not be construed as 
        affecting the requirement of subparagraph (A) with 
        respect to a health entity that treats an individual 
        for HIV disease.
          (3) The program under paragraph (1) is carried out in 
        accordance with the following:
                  (A) Partners are provided with an appropriate 
                opportunity to learn that the partners have 
                been exposed to HIV disease, subject to 
                subparagraph (B).
                  (B) The State does not inform partners of the 
                identity of the infected individuals involved.
                  (C) Counseling and testing for HIV disease 
                are made available to the partners and to 
                infected individuals, and such counseling 
                includes information on modes of transmission 
                for the disease, including information on 
                prenatal and perinatal transmission and 
                preventing transmission.
                  (D) Counseling of infected individuals and 
                their partners includes the provision of 
                information regarding therapeutic measures for 
                preventing and treating the deterioration of 
                the immune system and conditions arising from 
                the disease, and the provision of other 
                prevention-related information.
                  (E) Referrals for appropriate services are 
                provided to partners and infected individuals, 
                including referrals for support services and 
                legal aid.
                  (F) Notifications under subparagraph (A) are 
                provided in person, unless doing so is an 
                unreasonable burden on the State.
                  (G) There is no criminal or civil penalty on, 
                or civil liability for, an infected individual 
                if the individual chooses not to identify the 
                partners of the individual, or the individual 
                does not otherwise cooperate with such program.
                  (H) The failure of the State to notify 
                partners is not a basis for the civil liability 
                of any health entity who under the program 
                reported to the State the identity of the 
                infected individual involved.
                  (I) The State provides that the provisions of 
                the program may not be construed as prohibiting 
                the State from providing a notification under 
                subparagraph (A) without the consent of the 
                infected individual involved.
          (4) The State annually reports to the Director of the 
        Centers for Disease Control and Prevention the number 
        of individuals from whom the names of partners have 
        been sought under the program under paragraph (1), the 
        number of such individuals who provided the names of 
        partners, and the number of partners so named who were 
        notified under the program.
          (5) The State cooperates with such Director in 
        carrying out a national program of partner 
        notification, including the sharing of information 
        between the public health officers of the States.
  (c) Reporting System for Cases of HIV Disease.--
          (1) Preference in making grants through fiscal year 
        2003.--In making grants under subsection (a) for each 
        of the fiscal years 2001 through 2003, the Secretary 
        shall give preference to States whose reporting systems 
        for cases of HIV disease produce data on such cases 
        that is sufficiently accurate and reliable for use for 
        purposes of section 2618(b)(2)(D)(i).
          (2) Eligibility condition after fiscal year 2003.--
        For fiscal year 2004 and subsequent fiscal years, a 
        State may not receive a grant under subsection (a) 
        unless the reporting system of the State for cases of 
        HIV disease produces data on such cases that is 
        sufficiently accurate and reliable for purposes of 
        section 2618(b)(2)(D)(i).
  (d) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $30,000,000 for fiscal year 2001, and such sums as 
may be necessary for each of the fiscal years 2002 through 
2005.

           *       *       *       *       *       *       *


                  Part C--Early Intervention Services

                 [Subpart I--Formula Grants for States

[SEC. 2641. ESTABLISHMENT OF PROGRAM.

  [(a) Allotments for States.--For the purposes described in 
subsection (b), the Secretary, acting through the Director of 
the Centers for Disease Control and Prevention and in 
consultation with the Administrator of the Health Resources and 
Services Administration, shall for each of the fiscal years 
1991 through 1995 make an allotment for each State in an amount 
determined in accordance with section 2649. The Secretary shall 
make payments, as grants, to each State from the allotment for 
the State for the fiscal year involved if the Secretary 
approves for the fiscal year an application submitted by the 
State pursuant to section 2665.
  [(b) Purposes of Grants.--
          [(1) In general.--The Secretary may not make a grant 
        under subsection (a) unless the State involved agrees 
        to expend the grant for the purposes of providing, on 
        an outpatient basis, each of the early intervention 
        services specified in paragraph (2) with respect to HIV 
        disease.
          [(2) Specification of early intervention services.--
        The early intervention services referred to in 
        paragraph (1) are--
                  [(A) counseling individuals with respect to 
                HIV disease in accordance with section 2662;
                  [(B) testing individuals with respect to such 
                disease, 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 the disease;
                  [(C) referrals described in paragraph (3);
                  [(D) other clinical and diagnostic services 
                with respect to HIV disease, and periodic 
                medical evaluations of individuals with the 
                disease; and
                  [(E) providing the therapeutic measures 
                described in subparagraph (B).
          [(3) Referrals.--The services referred to in 
        paragraph (2)(C) are referrals of individuals with HIV 
        disease 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 pregnant women.
          [(4) Requirement of availability of all early 
        intervention services through each grantee.--The 
        Secretary may not make a grant under subsection (a) 
        unless the State involved agrees that each of the early 
        intervention services specified in paragraph (2) will 
        be available through the State. With respect to 
        compliance with such agreement, a State 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 
        under which the entities provide the services.
          [(5) Optional services.--A State receiving a grant 
        under subsection (a)--
                  [(A) may expend not more than 5 percent of 
                the grant to provide early intervention 
                services through making grants to hospitals 
                that--
                          [(i) for the most recent fiscal year 
                        for which the data is available, have 
                        admitted--
                                  [(I) not fewer than 250 
                                individuals with acquired 
                                immune deficiency syndrome; or
                                  [(II) a number of such 
                                individuals constituting 20 
                                percent of the number of 
                                inpatients of the hospital 
                                admitted during such period;
                          [(ii) agree to offer and encourage 
                        such services with respect to 
                        inpatients of the hospitals; and
                          [(iii) agree that subsections (c) and 
                        (d) of section 2644 will apply to the 
                        hospitals to the same extent and in the 
                        same manner as such subsections apply 
                        to entities described in such section;
                  [(B) may expend the grant to provide outreach 
                services to individuals who may have HIV 
                disease, or may be at risk of the disease, and 
                who may be unaware of the availability and 
                potential benefits of early treatment of the 
                disease, and to provide outreach services to 
                health care professionals who may be unaware of 
                such availability and potential benefits; and
                  [(C) may, in the case of individuals who seek 
                early intervention services from the grantee, 
                expend the grant--
                          [(i) for case management to provide 
                        coordination in the provision of health 
                        care services to the individuals and to 
                        review the extent of utilization of the 
                        services by the individuals; and
                          [(ii) to provide assistance to the 
                        individuals regarding establishing the 
                        eligibility of the individuals for 
                        financial assistance and services under 
                        Federal, State, or local programs 
                        providing for health services, mental 
                        health services, social services, or 
                        other appropriate services.
          [(6) Allocations.--
                  [(A) Subject to subparagraphs (B) and (C), 
                the Secretary may not make a grant under 
                subsection (a) unless the State involved 
                agrees--
                          [(i) to expend not less than 35 
                        percent of the grant to provide the 
                        early intervention services specified 
                        in subparagraphs (A) through (C) of 
                        paragraph (2); and
                          [(ii) to expend not less than 35 
                        percent of the grant to provide the 
                        early intervention services specified 
                        in subparagraphs (D) and (E) of such 
                        paragraph.
                  [(B) With respect to compliance with the 
                agreement under subparagraph (A), amounts 
                reserved by a State for fiscal year 1991 for 
                purposes of clauses (i) and (ii) of such 
                subparagraph may be expended to provide the 
                services specified in paragraph (5).
                  [(C) The Secretary shall ensure that, of the 
                amounts appropriated under section 2650 for 
                fiscal year 1991, an amount equal to 
                $130,000,000 is expended to provide the early 
                intervention services specified in 
                subparagraphs (A) through (C) of paragraph (2).

[SEC. 2642. PROVISION OF SERVICES THROUGH MEDICAID PROVIDERS.

  [(a) In General.--Subject to subsection (b), the Secretary 
may not make a grant under section 2641 to a State unless, in 
the case of any service described in subsection (b) of such 
section that is available pursuant to the State plan approved 
under title XIX of the Social Security Act for the State--
          [(1) the State will provide the service through a 
        State entity, and the State entity has entered into a 
        participation agreement under the State plan and is 
        qualified to receive payments under such plan; or
          [(2) the State 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.
  [(b) Waiver Regarding Certain Secondary Agreements.--
          [(1) In general.--In the case of an entity making an 
        agreement pursuant to subsection (a)(2) regarding the 
        provision of services, the requirement established in 
        such subsection regarding a participation agreement 
        shall be waived by the Secretary 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.
          [(2) Acceptance of voluntary donations.--A 
        determination by the Secretary of whether an entity 
        referred to in paragraph (1) 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.

[SEC. 2643. REQUIREMENT OF MATCHING FUNDS.

  [(a) In General.--In the case of any State to which the 
criterion described in subsection (c) applies, the Secretary 
may not make a grant under section 2641 unless the State agrees 
that, with respect to the costs to be incurred by the State in 
carrying out the purpose referred to in such subsection, the 
State will, subject to subsection (b)(2), make available 
(directly or through donations from public or private entities) 
non-Federal contributions toward such costs in an amount equal 
to--
          [(1) for the first fiscal year for which such 
        criterion applies to the State, not less than 16\2/3\ 
        percent of such costs ($1 for each $5 of Federal funds 
        provided in the grant);
          [(2) for any second such fiscal year, not less than 
        20 percent of such costs ($1 for each $4 of Federal 
        funds provided in the grant);
          [(3) for any third such fiscal year, not less than 25 
        percent of such costs ($1 for each $3 of Federal funds 
        provided in the grant); and
          [(4) for any subsequent fiscal year, not less than 
        33\1/3\ percent of such costs ($1 for each $2 of 
        Federal funds provided in the grant).
  [(b) Determination of Amount of Non-Federal Contribution.--
          [(1) In general.--Non-Federal contributions required 
        in subsection (a) may be in cash or in kind, fairly 
        evaluated, including plant, equipment, or services. 
        Amounts provided by the Federal Government, and any 
        portion of any service subsidized by the Federal 
        Government, may not be included in determining the 
        amount of such non-Federal contributions.
          [(2) Inclusion of certain amounts.--
                  [(A) In making a determination of the amount 
                of non-Federal contributions made by a State 
                for purposes of subsection (a), the Secretary 
                shall, subject to subparagraph (B), include any 
                non-Federal contributions provided by the State 
                for HIV-related services, without regard to 
                whether the contributions are made for programs 
                established pursuant to this title.
                  [(B) In making a determination for purposes 
                of subparagraph (A), the Secretary may not 
                include any non-Federal contributions provided 
                by the State as a condition of receiving 
                Federal funds under any program under this 
                title (except for the program established in 
                section 2641) or under other provisions of law.
  [(c) Applicability of Matching Requirement.--
          [(1) Percentage of national number of cases.--
                  [(A) The criterion referred to in subsection 
                (a) is, with respect to a State, that the 
                number of cases of acquired immune deficiency 
                syndrome reported to and confirmed by the 
                Director of the Centers for Disease Control and 
                Prevention for the State for the period 
                described in subparagraph (B) constitutes more 
                than 1 percent of the number of such cases 
                reported to and confirmed by the Director for 
                the United States for such period.
                  [(B) The period referred to in subparagraph 
                (A) is the 2-year period preceding the fiscal 
                year for which the State involved is applying 
                to receive a grant under section 2641.
          [(2) Exemption.--For purposes of paragraph (1), the 
        number of cases of acquired immune deficiency syndrome 
        reported and confirmed for the Commonwealth of Puerto 
        Rico for any fiscal year shall be deemed to be less 
        than 1 percent.
  [(d) Diminished State Contribution.--With respect to a State 
that does not make available the entire amount of the non-
Federal contribution referred to in subsection (a), the State 
shall continue to be eligible to receive Federal funds under a 
grant under section 2641, except that the Secretary in 
providing Federal funds under the grant shall provide such 
funds (in accordance with the ratios prescribed in paragraph 
(1)) only with respect to the amount of funds contributed by 
such State.

[SEC. 2644. OFFERING AND ENCOURAGING EARLY INTERVENTION SERVICES.

  [(a) In General.--The Secretary may not make a grant under 
section 2641 unless, in the case of entities to which the State 
provides amounts from the grant for the provision of early 
intervention services, the State involved agrees that--
          [(1) if the entity is a health care provider that 
        regularly provides treatment for sexually transmitted 
        diseases, the entity will offer and encourage such 
        services with respect to individuals to whom the entity 
        provides such treatment;
          [(2) if the entity is a health care provider that 
        regularly provides treatment for intravenous substance 
        abuse, the entity will offer and encourage such 
        services with respect to individuals to whom the entity 
        provides such treatment;
          [(3) if the entity is a family planning clinic, the 
        entity will offer and encourage such services with 
        respect to individuals to whom the entity provides 
        family planning services and whom the entity has reason 
        to believe has HIV disease; and
          [(4) if the entity is a health care provider that 
        provides treatment for tuberculosis, the entity will 
        offer and encourage such services with respect to 
        individuals to whom the entity provides such treatment.
  [(b) Sufficiency of Amount of Grant.--With respect to 
compliance with the agreement made under subsection (a), an 
entity to which subsection (a) applies may be required to 
offer, encourage, and provide early intervention services only 
to the extent that the amount of the grant is sufficient to pay 
the costs of offering, encouraging, and providing the services.
  [(c) Criteria for Offering and Encouraging.--Subject to 
section 2641(b)(4), an entity to which subsection (a) applies 
is, for purposes of such subsection, offering and encouraging 
early intervention services with respect to the individuals 
involved if the entity--
          [(1) offers such services to the individuals, and 
        encourages the individuals to receive the services, as 
        a regular practice in the course of providing the 
        health care involved; and
          [(2) provides the early intervention services only 
        with the consent of the individuals.

[SEC. 2645. NOTIFICATION OF CERTAIN INDIVIDUALS RECEIVING BLOOD 
                    TRANSFUSIONS.

  [(a) In General.--The Secretary may not make a grant under 
section 2641 unless the State involved provides assurances 
satisfactory to the Secretary that, with respect to individuals 
in the State receiving, between January 1, 1978, and April 1, 
1985 (inclusive), a transfusion of whole blood or a blood-
clotting factor, the State will provide public education and 
information for the purpose of--
          [(1) encouraging the population of such individuals 
        to receive early intervention services; and
          [(2) informing such population of any health 
        facilities in the geographic area involved that provide 
        such services.
  [(b) Rule of Construction.--An agreement made under 
subsection (a) may not be construed to require that, in 
carrying out the activities described in such subsection, a 
State receiving a grantunder section 2641 provide individual 
notifications to the individuals described in such subsection.

[SEC. 2646. REPORTING AND PARTNER NOTIFICATION.

  [(a) Reporting.--The Secretary may not make a grant under 
section 2641 unless, with respect to testing for HIV disease, 
the State involved provides assurances satisfactory to the 
Secretary that the State will require that any entity carrying 
out such testing confidentially report to the State public 
health officer information sufficient--
          [(1) to perform statistical and epidemiological 
        analyses of the incidence in the State of cases of such 
        disease;
          [(2) to perform statistical and epidemiological 
        analyses of the demographic characteristics of the 
        population of individuals in the State who have the 
        disease; and
          [(3) to assess the adequacy of early intervention 
        services in the State.
  [(b) Partner Notification.--The Secretary may not make a 
grant under section 2641 unless the State involved provides 
assurances satisfactory to the Secretary that the State will 
require that the public health officer of the State, to the 
extent appropriate in the determination of the officer, carry 
out a program of partner notification regarding cases of HIV 
disease.
  [(c) Rules of Construction.--An agreement made under this 
section may not be construed--
          [(1) to require or prohibit any State from providing 
        that identifying information concerning individuals 
        with HIV disease is required to be submitted to the 
        State; or
          [(2) to require any State to establish a requirement 
        that entities other than the public health officer of 
        the State are required to make the notifications 
        referred to in subsection (b).

[SEC. 2647. REQUIREMENT OF STATE LAW PROTECTION AGAINST INTENTIONAL 
                    TRANSMISSION.

  [(a) In General.--The Secretary may not make a grant under 
section 2641 to a State unless the chief executive officer 
determines that the criminal laws of the State are adequate to 
prosecute any HIV infected individual, subject to the condition 
described in subsection (b), who--
          [(1) makes a donation of blood, semen, or breast 
        milk, if the individual knows that he or she is 
        infected with HIV and intends, through such donation, 
        to expose another HIV in the event that the donation is 
        utilized;
          [(2) engages in sexual activity if the individual 
        knows that he or she is infected with HIV and intends, 
        through such sexual activity, to expose another to HIV; 
        and
          [(3) injects himself or herself with a hypodermic 
        needle and subsequently provides the needle to another 
        person for purposes of hypodermic injection, if the 
        individual knows that he or she is infected and 
        intends, through the provision of the needle, to expose 
        another to such etiologic agent in the event that the 
        needle is utilized.
  [(b) Consent to Risk of Transmission.--The State laws 
described in subsection (a) need not apply to circumstances 
under which the conduct described in paragraphs (1) through (3) 
of subsection (a) if the individual who is subjected to the 
behavior involved knows that the other individual is infected 
and provides prior informed consent to the activity.
  [(c) State Certification With Respect to Required Laws.--With 
respect to complying with subsection (a) as a condition of 
receiving a grant under section 2641, the Secretary may not 
require a State to enact any statute, or to issue any 
regulation, if the chief executive officer of the State 
certifies to the Secretary that the laws of the State are 
adequate. The existence of a criminal law of general 
application, which can be applied to the conduct described in 
paragraphs (1) through (3) of subsection (a), is sufficient for 
compliance with this section.
  [(d) Time Limitations With Respect to Required Laws.--With 
respect to receiving a grant under section 2641, if a State is 
unable to certify compliance with subsection (a), the Secretary 
may make a grant to a State under such section if--
          [(1) for each of the fiscal years 1991 and 1992, the 
        State provides assurances satisfactory to the Secretary 
        that by not later than October 1, 1992, the State will 
        have in place or will establish the prohibitions 
        described in subsection (a); and
          [(2) for fiscal year 1993 and subsequent fiscal 
        years, the State has established such prohibitions.

[SEC. 2648. TESTING AND OTHER EARLY INTERVENTION SERVICES FOR STATE 
                    PRISONERS.

  [(a) In General.--In addition to grants under section 2641, 
the Secretary may make grants to States for the purpose of 
assisting the States in providing early intervention services 
to individuals sentenced by the State to a term of 
imprisonment. The Secretary may make such a grant only if the 
State involved requires, subject to subsection (d), that--
          [(1) the services be provided to such individuals; 
        and
          [(2) each such individual be informed of the 
        requirements of subsection (c) regarding testing and be 
        informed of the results of such testing of the 
        individual.
  [(b) Requirement of Matching Funds.--
          [(1) In general.--The Secretary may not make a grant 
        under subsection (a) unless the State involved agrees 
        that, with respect to the costs to be incurred by the 
        State in carrying out the purpose described in such 
        subsection, the State will make available (directly or 
        through donations from public or private entities) non-
        Federal contributions toward such costs in an amount 
        equal to--
                  [(A) for the first fiscal year of payments 
                under the grant, not less than $1 for each $2 
                of Federal funds provided in the grant; and
                  [(B) for any subsequent fiscal year of such 
                payments, not less than $1 for each $1 of 
                Federal funds provided in the grant.
          [(2) Determination of amount of non-federal 
        contribution.--Non-Federal contributions required in 
        paragraph (1) may be in cash or in kind, fairly 
        evaluated, including plant, equipment, or services. 
        Amounts provided by the Federal Government, and 
        services (or portions of services) subsidized by the 
        Federal Government, may not be included in determining 
        the amount of such non-Federal contributions.
  [(c) Testing.--The Secretary may not make a grant under 
subsection (a) unless--
          [(1) the State involved requires that, subject to 
        subsection (d), any individual sentenced by the State 
        to a term of imprisonment be tested for HIV disease--
                  [(A) upon entering the State penal system; 
                and
                  [(B) during the 30-day period preceding the 
                date on which the individual is released from 
                such system;
          [(2) with respect to informing employees of the penal 
        system of the results of such testing of the 
        individual, the State--
                  [(A) upon the request of any such employee, 
                provides the results to the employee in any 
                case in which the medical officer of the prison 
                determines that there is a reasonable basis for 
                believing that the employee has been exposed by 
                the individual to such disease; and
                  [(B) informs the employees of the 
                availability to the employees of such results 
                under the conditions described in subparagraph 
                (A);
          [(3) with respect to informing the spouse of the 
        individual of the results of such testing of the 
        individual, the State--
                  [(A) upon the request of the spouse, provides 
                such results to the spouse prior to any 
                conjugal visit and provides such results to the 
                spouse during the period described in paragraph 
                (1)(B); and
                  [(B) informs the spouse of the availability 
                to the spouse of such results under the 
                conditions described in subparagraph (A);
          [(4) with respect to such testing upon entering the 
        State penal system of such an individual who has been 
        convicted of rape or aggravated sexual assault, the 
        State--
                  [(A) upon the request of the victim of the 
                rape or assault, provides such results to the 
                victim; and
                  [(B) informs the victim of the availability 
                to the victim of such results; and
          [(5) the State, except as provided in any of 
        paragraphs (2) through (4), maintains the 
        confidentiality of the results of testing for HIV 
        disease in each prison operated by the State or with 
        amounts provided by the State, and makes disclosures of 
        such results only as medically necessary.
  [(d) Determination of Prisons Subject to Requirement.--
          [(1) In general.--The Secretary may not make a grant 
        under subsection (a) unless the State involved agrees 
        that the requirement established in such subsection 
        regarding the provision of early intervention services 
        to inmates will apply only to inmates who are 
        incarcerated in prisons with respect to which the State 
        public health officer, after consultation with the 
        chief State correctional officer, has, on the basis of 
        the criteria described in paragraph (2), determined 
        that the provision of such services is appropriate with 
        respect to the public health and safety.
          [(2) Description of criteria.--The criteria to be 
        considered for purposes of paragraph (1) are--
                  [(A) with respect to the geographic areas in 
                which inmates of the prison involved resided 
                before incarceration in the prison--
                          [(i) the severity of the epidemic of 
                        HIV disease in the areas during the 
                        period in which the inmates resided in 
                        the areas; and
                          [(ii) the incidence, in the areas 
                        during such period, of behavior that 
                        places individuals at significant risk 
                        of developing HIV disease; and
                  [(B) the extent to which medical examinations 
                conducted by the State for inmates of the 
                prison involved indicate that the inmates have 
                engaged in such behavior.
  [(e) Applicability of Provisions Regarding Informed Consent, 
Counseling, and Other Matters.--The Secretary may not make a 
grant under subsection (a) unless the State involved agrees 
that sections 2641(b)(4), 2662, and 2664(c) will apply to the 
provision of early intervention services pursuant to the grant 
in the same manner and to the same extent as such sections 
apply to the provision of such services by grantees under 
section 2641.
  [(f) Requirement of Application.--The Secretary may not make 
a grant under subsection (a) unless 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.
  [(g) Rule of Construction.--With respect to testing inmates 
of State prisons for HIV disease without the consent of the 
inmates, the agreements made under this section may not be 
construed to authorize, prohibit, or require any State to 
conduct such testing, except as provided in subparagraphs (A) 
and (B) of subsection (c)(1).
  [(h) Authorization of Appropriations.--To carry out this 
section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 1988 through 
1995.

[SEC. 2649. DETERMINATION OF AMOUNT OF ALLOTMENTS.

  [(a) Minimum Allotment.--Subject to the extent of amounts 
made available in appropriations Acts, the amount of an 
allotment under section 2641(a) for a State for a fiscal year 
shall be the greater of--
          [(1) $100,000 for each of the several States, the 
        District of Columbia, and the Commonwealth of Puerto 
        Rico, and $50,000 for each of the territories of the 
        United States other than the Commonwealth of Puerto 
        Rico; and
          [(2) an amount determined under subsection (b).
  [(b) Determination Under Formula.--The amount referred to in 
subsection (a)(2) is the product of--
          [(1) an amount equal to the amount appropriated under 
        section 2650 for the fiscal year involved; and
          [(2) a percentage equal to the quotient of--
                  [(A) an amount equal to the number of cases 
                of acquired immune deficiency syndrome reported 
                to and confirmed by the Director of the Centers 
                for Disease Control and Prevention for the 
                State involved for the most recent fiscal year 
                for which such data is available; divided by
                  [(B) an amount equal to the number of cases 
                of acquired immune deficiency syndrome reported 
                to and confirmed by the Director of the Centers 
                for Disease Control and Prevention for the 
                United States for the most recent fiscal year 
                for which such data is available.
  [(c) Certain Allocations by Secretary.--
          [(1) Discretionary grants to certain states.--After 
        determining the amount of an allotment under subsection 
        (a) for a fiscal year, the Secretary shall reduce the 
        amount of the allotment of each State by 10 percent. 
        From the amounts available as a result of such 
        reductions, the Secretary shall, on a discretionary 
        basis, make grants to States receiving allotments for 
        the fiscal year involved. Such grants shall be made 
        subject to each of the agreements and assurances 
        required as a condition of receiving grants under 
        section 2641.
          [(2) Grants to certain political subdivisions.--
                  [(A)(i) In the case of a State containing any 
                political subdivision described in clause (ii), 
                the Secretary shall, subject to subparagraph 
                (B), make a reduction in the amount of the 
                allotment under subsection (a) for the State 
                for each fiscal year in an amount necessary for 
                carrying out subparagraphs (B) and (C) with 
                respect to the political subdivision. Any such 
                reduction shall be in addition to the reduction 
                required in paragraph (1) for the fiscal year 
                involved.
                  [(ii) The political subdivision referred to 
                in clause (i) is any political subdivision that 
                received a cooperative agreement from the 
                Secretary, acting through the Director of the 
                Centers for Disease Control and Prevention, for 
                fiscal year 1990 for programs to provide 
                counseling and testing with respect to acquired 
                immune deficiency syndrome.
                  [(B) In the case of a State described in 
                subparagraph (A), the Secretary shall, from the 
                amounts made available as a result of 
                reductions under such subparagraph, make a 
                grant each fiscal year to each political 
                subdivision described in such subparagraph that 
                exists in the State if the political 
                subdivision involved agrees that the provisions 
                of subparts II and III will apply to the 
                political subdivision to the same extent and in 
                the same manner as such subparts apply to 
                entities receiving grants under section 
                2651(a).
                  [(C) Grants under subparagraph (B) for a 
                fiscal year for a political subdivision shall 
                be provided in an amount equal to the amount 
                received by the political subdivision in fiscal 
                year 1990 under the cooperative agreement 
                described in subparagraph (A).
  [(d) Disposition of Certain Funds Appropriated for 
Allotments.--
          [(1) In general.--Any amounts available pursuant to 
        paragraph (2) shall, in accordance with paragraph (3), 
        be allotted by the Secretary each fiscal year to States 
        receiving payments under section 2641(a) for the fiscal 
        year (other than any State referred to in paragraph 
        (2)(C)). The Secretary shall make payments, as grants, 
        to each such State from any such allotment for the 
        State for the fiscal year involved.
          [(2) Specification of amounts.--The amounts referred 
        to in paragraph (1) are any amounts that are not paid 
        to States under section 2641(a) as a result of--
                  [(A) the failure of any State to submit an 
                application under section 2651;
                  [(B) the failure, in the determination of the 
                Secretary, of any State to prepare the 
                application in compliance with such section or 
                to submit the application within a reasonable 
                period of time; or
                  [(C) any State informing the Secretary that 
                the State does not intend to expend the full 
                amount of the allotment made to the State.
          [(3) Amount of allotment.--The amount of an allotment 
        under paragraph (1) for a State for a fiscal year shall 
        be an amount equal to the product of--
                  [(A) an amount equal to the amount available 
                pursuant to paragraph (2) for the fiscal year 
                involved; and
                  [(B) the percentage determined under 
                subsection (b)(2) for the State.
  [(e) Transition Rules.--
          [(1) For the fiscal years 1991 through 1993, the 
        amount of an allotment under section 2641 shall be the 
        greater of the amount determined under subsection (a) 
        and an amount equal to the amount applicable under 
        paragraph (2) for the fiscal year involved.
          [(2) For purposes of paragraph (1)--
                  [(A) the amount applicable for fiscal year 
                1991 is an amount equal to the amount received 
                by the State involved from the Secretary, 
                acting through the Director of the Centers for 
                Disease Control and Prevention, for fiscal year 
                1990 for the provision of counseling and 
                testing services with respect to HIV;
                  [(B) the amount applicable for fiscal year 
                1992 is 85 percent of the amount specified in 
                subparagraph (A); and
                  [(C) the amount applicable for fiscal year 
                1993 is 70 percent of the amount specified in 
                subparagraph (A).

[SEC. 2649A. MISCELLANEOUS PROVISIONS.

  [The Secretary may not make a grant under section 2641 
unless--
          [(1) the State involved submits to the Secretary a 
        comprehensive plan for the organization and delivery of 
        the early intervention services to be funded with the 
        grant that includes a description of the purposes for 
        which the State intends to use such assistance, 
        including--
                  [(A) the services and activities to be 
                provided and an explanation of the manner in 
                which the elements of the program to be 
                implemented by the State with the grant will 
                maximize the quality of early intervention 
                services available to individuals with HIV 
                disease throughout the State; and
                  [(B) a description of the manner in which 
                services funded with the grant will be 
                coordinated with other available related 
                services for individuals with HIV disease; and
          [(2) the State agrees that--
                  [(A) the public health agency administering 
                the grant will conduct public hearings 
                regarding the proposed use and distribution of 
                the grant;
                  [(B) to the maximum extent practicable, early 
                intervention services delivered pursuant to the 
                grant will be provided without regard to the 
                ability of the individual to pay for such 
                services and without regard to the current or 
                past health condition of the individual with 
                HIV disease;
                  [(C) early intervention services under the 
                grant will be provided in settings accessible 
                to low-income individuals with HIV disease; and
                  [(D) outreach to low-income individuals with 
                HIV disease will be provided to inform such 
                individuals of the services available pursuant 
                to the grant.

[SEC. 2650. AUTHORIZATION OF APPROPRIATIONS.

  For the purpose of making grants under section 2641, there 
are authorized to be appropriated $230,000,000 for fiscal year 
1991, and such sums as may be necessary for each of the fiscal 
years 1992 through 1995.

           *       *       *       *       *       *       *


Subpart II--Categorical Grants

           *       *       *       *       *       *       *



SEC. 2653. PREFERENCES IN MAKING GRANTS.

  (a) * * *

           *       *       *       *       *       *       *

  (d) Underserved and Rural Areas.--Of the applicants who 
qualify for preference under this section, the Secretary shall 
give preference to applicants that will expend the grant under 
section 2651 to provide early intervention under such section 
in rural areas or in areas that are underserved with respect to 
such services.

SEC. 2654. MISCELLANEOUS PROVISIONS.

  (a) * * *

           *       *       *       *       *       *       *

  (c) Planning and Development Grants.--
          (1) In general.--The Secretary may provide [planning 
        grants, in an amount not to exceed $50,000 for each 
        such grant, to public and nonprofit private entities 
        for the purpose of enabling such entities to provide 
        HIV early intervention services.] planning grants to 
        public and nonprofit private entities for purposes of--
                  (A) enabling such entities to provide HIV 
                early intervention services; and
                  (B) assisting the entities in expanding their 
                capacity to provide HIV-related health 
                services, including early intervention 
                services, in low-income communities and 
                affected subpopulations that are underserved 
                with respect to such services (subject to the 
                condition that a grant pursuant to this 
                subparagraph may not be expended to purchase or 
                improve land, or to purchase, construct, or 
                permanently improve, other than minor 
                remodeling, any building or other facility).

           *       *       *       *       *       *       *

          (4) Amount and duration of grants.--
                  (A) Early intervention services.--A grant 
                under paragraph (1)(A) may be made in an amount 
                not to exceed $50,000.
                  (B) Capacity development.--
                          (i) Amount.--A grant under paragraph 
                        (1)(B) may be made in an amount not to 
                        exceed $150,000.
                          (ii) Duration.--The total duration of 
                        a grant under paragraph (1)(B), 
                        including any renewal, may not exceed 3 
                        years.
          [(4)] (5) Limitation.--Not to exceed [1] 5 percent of 
        the amount appropriated for a fiscal year under section 
        2655 may be used to carry out this section.

SEC. 2655. AUTHORIZATION OF APPROPRIATIONS.

  For the purpose of making grants under section 2651, there 
are authorized to be appropriated such sums as may be necessary 
[in each of the fiscal years 1996, 1997, 1998, 1999, and 2000.] 
for each of the fiscal years 2001 through 2005.

Subpart III--General Provisions

           *       *       *       *       *       *       *


SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.

  (a) * * *

           *       *       *       *       *       *       *

  (c) 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 disease indicate that the individual has the disease, 
the applicant will provide to the individual appropriate 
counseling regarding such disease, including--
          (1) * * *

           *       *       *       *       *       *       *

          (3) providing counseling [on]--
                  (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) the benefits] (C)(i) that explains the 
                benefits of locating and counseling any 
                individual by whom the infected individual may 
                have been exposed to HIV and any individual 
                whom the infected individual may have exposed 
                to HIV; 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;
                  (D) on the availability of the services of 
                public health authorities with respect to 
                locating and counseling any individual 
                described in subparagraph (C).

           *       *       *       *       *       *       *


SEC. 2664. ADDITIONAL REQUIRED AGREEMENTS.

  (a) * * *

           *       *       *       *       *       *       *

  (g) Administration of Grant.--The Secretary may not make a 
grant under this part unless the applicant for the grant agrees 
that--
          (1) * * *

           *       *       *       *       *       *       *

          (3) the applicant will not expend more than [7.5] 10 
        percent including planning and evaluation of the grant 
        for administrative expenses with respect to the grant; 
        [and]
          (4) the applicant will submit evidence that the 
        proposed program is consistent with the statewide 
        coordinated statement of need and agree to participate 
        in the ongoing revision of such statement of need[.]; 
        and
          (5) the applicant will provide for the establishment 
        of a quality management program to assess the extent to 
        which medical services funded under this title that are 
        provided to patients are consistent with the most 
        recent Public Health Service guidelines for the 
        treatment of HIV disease and related opportunistic 
        infections and that improvements in the access to and 
        quality of medical services are addressed.

           *       *       *       *       *       *       *


                       Part D--General Provisions

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

  (a) * * *
  (b) Provisions Regarding Participation in Research.--
          (1) In general.--With respect to the projects of 
        research with which an applicant under subsection (a) 
        is concerned, the Secretary may make a grant under such 
        subsection to the applicant only if the following 
        conditions are met:
                  (A) * * *

           *       *       *       *       *       *       *

                  [(C) For the first and second fiscal years 
                for which grants under subsection (a) are to be 
                made to the applicant, the applicant agrees 
                that, not later than the end of the second 
                fiscal year of receiving such a grant, a 
                significant number of women, infants, children, 
                and youth who are patients of the applicant 
                will be participating in the projects of 
                research.
                  [(D) Except as provided in paragraph (3) (and 
                paragraph (4), as applicable), for the third 
                and subsequent fiscal years for which such 
                grants are to be made to the applicant, the 
                Secretary has determined that a significant 
                number of such individuals are participating in 
                the projects.]
                  (C) The applicant will demonstrate linkages 
                to research and how access to such research is 
                being offered to patients.

           *       *       *       *       *       *       *

          [(3) Significant participation; consideration by 
        secretary of certain circumstances.--In administering 
        the requirement of paragraph (1)(D), the Secretary 
        shall take into account circumstances in which a 
        grantee under subsection (a) is temporarily unable to 
        comply with the requirement for reasons beyond the 
        control of the grantee, and shall in such circumstances 
        provide to the grantee a reasonable period of 
        opportunity in which to reestablish compliance with the 
        requirement.
          [(4) Significant participation; temporary waiver for 
        original grantees.--
                  [(A) In general.--In the case of an applicant 
                under subsection (a) who received a grant under 
                such subsection for fiscal year 1995, the 
                Secretary may, subject to subparagraph (B), 
                provide to the applicant a waiver of the 
                requirement of paragraph (1)(D) if the 
                Secretary determines that the applicant is 
                making reasonable progress toward meeting the 
                requirement.
                  [(B) Termination of authority for waivers.--
                The Secretary may not provide any waiver under 
                subparagraph (A) on or after October 1, 1998. 
                Any such waiver provided prior to such date 
                terminates on such date, or on such earlier 
                date as the Secretary may specify.]
  [(f) Application.--]
  (f) Administration.--
          (1) Application.--A grant under subsection (a) may be 
        made only 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.
          (2) Quality management program.--A grantee under this 
        section shall implement a quality management program.
  (g) Coordination With National Institutes of Health.--The 
Secretary shall develop and implement a plan that provides for 
the coordination of the activities of the National Institutes 
of Health with the activities carried out under this section. 
In carrying out the preceding sentence, the Secretary shall 
ensure that projects of research conducted or supported by such 
Institutes are made aware of applicants and grantees under 
subsection (a), shall require that the projects, as 
appropriate, enter into arrangements for purposes of such 
subsection, and shall require that each project entering into 
such an arrangement inform the applicant or granteeunder such 
subsection of the needs of the project for the participation of women, 
infants, children, and youth. In addition, the Secretary, in 
coordination with the Director of such Institutes, shall examine the 
distribution and availability of appropriate HIV-related research 
projects with respect to grantees under subsection (a) for purposes of 
enhancing and expanding HIV-related research, especially within 
communities that are underrepresented with respect to such projects.

           *       *       *       *       *       *       *

  (j) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years [1996 through 2000] 2001 through 2005.

           *       *       *       *       *       *       *


SEC. 2674. EVALUATIONS AND REPORTS.

  (a) * * *

           *       *       *       *       *       *       *

  (c) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section, such sums as may be 
necessary for each of the fiscal years [1991 through 1995] 2001 
through 2005.

           *       *       *       *       *       *       *


SEC. 2675. DATA COLLECTION.

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

SEC. [2675] 2675A. COORDINATION.

  [(a) Requirement.--The Secretary shall assure that the Health 
Resources and Services Administration and the Centers for 
Disease Control and Prevention will coordinate the planning of 
the funding of programs authorized under this title to assure 
that health support services for individuals with HIV disease 
are integrated with each other and that the continuity of care 
of individuals with HIV disease is enhanced. In coordinating 
the allocation of funds made available under this title the 
Health Resources and Services Administration and the Centers 
for Disease Control and Prevention shall utilize planning 
information submitted to such agencies by the States and 
entities eligible for support.]
  (a) Requirement.--The Secretary shall ensure that the Health 
Resources and Services Administration, the Centers for Disease 
Control and Prevention, the Substance Abuse and Mental Health 
Services Administration, and the Health Care Financing 
Administration coordinate the planning, funding, and 
implementation of Federal HIV programs to enhance the 
continuity of care and prevention services for individuals with 
HIV disease or those at risk of such disease. The Secretary 
shall consult with other Federal agencies, including the 
Department of Veterans Affairs, as needed and utilize planning 
information submitted to such agencies by the States and 
entities eligible for support.
  (b) Report.--The Secretary shall biennially prepare and 
submit to the appropriate committees of the Congress a report 
concerning the coordination efforts at the Federal, State, and 
local levels described in this section, including a description 
of Federal barriers to HIV program integration and a strategy 
for eliminating such barriers and enhancing the continuity of 
care and prevention services for individuals with HIV disease 
or those at risk of such disease.
  [(b)] (c) Integration by State.--As a condition of receipt of 
funds under this title, a State shall assure the Secretary that 
health support services funded under this title will be 
integrated with each other, that programs will be coordinated 
with other available programs (including Medicaid) and that the 
continuity of care and prevention services of individuals with 
HIV disease is enhanced.
  [(c)] (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 assure the 
Secretary that services funded under this title will be 
integrated with each other, 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.
  (e) Recommendations Regarding Release of Prisoners.--After 
consultation with the Attorney General and the Director of the 
Bureau of Prisons, with States, with eligible areas under part 
A, and with entities that receive amounts from grants under 
part A or B, the Secretary, consistent with the coordination 
required in subsection (a), shall develop a plan for the 
medical case management of and the provision of support 
services to individuals who were Federal or State prisoners and 
had HIV disease as of the date on which the individuals were 
released from the custody of the penal system. The Secretary 
shall submit the plan to the Congress not later than two years 
after the date of the enactment of the Ryan White CARE Act 
Amendments of 2000.

SEC. 2675B. AUDITS.

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

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

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

[SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

  [(a) In General.--Subject to subsection (b), there are 
authorized to be appropriated to make grants under parts A and 
B, such sums as may be necessary for each of the fiscal years 
1996 through 2000.
  [(b) Development of Methodology.--
          [(1) In general.--With respect to each of the fiscal 
        years 1997 through 2000, the Secretary shall develop 
        and implement a methodology for adjusting the 
        percentages allocated to part A and part B to account 
        for grants to new eligible areas under part A and other 
        relevant factors. Not later than July 1, 1996, the 
        Secretary shall prepare and submit to the appropriate 
        committees of Congress a report regarding the findings 
        with respect to the methodology developed under this 
        paragraph.
          [(2) Failure to implement.--If the Secretary 
        determines that such a methodology under paragraph (1) 
        cannot be developed, there are authorized to be 
        appropriated--
                  [(A) such sums as may be necessary to carry 
                out part A for each of the fiscal years 1997 
                through 2000; and
                  [(B) such sums as may be necessary to carry 
                out part B for each of the fiscal years 1997 
                through 2000.]

SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

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

           *       *       *       *       *       *       *


PART F--DEMONSTRATION AND TRAINING

           *       *       *       *       *       *       *


            Subpart II--AIDS Education and Training Centers

SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.

  (a) Schools; Centers.--
          (1) In general.--The Secretary may make grants and 
        enter into contracts to assist public and nonprofit 
        private entities and schools and academic health 
        science centers in meeting the costs of projects--
                  (A) [training] to train health personnel, 
                including practitioners in programs under this 
                title and other community providers, in the 
                diagnosis, treatment, and prevention of HIV 
                disease, including the prevention of the 
                perinatal transmission of the disease [and 
                including], including measures for the 
                prevention and treatment of opportunistic 
                infections, and including (as applicable to the 
                type of health professional involved), prenatal 
                and other gynecological care for women with HIV 
                disease;
                  (B) to train the faculty of schools of, and 
                graduate departments or programs of, medicine, 
                nursing, osteopathic medicine, dentistry, 
                public health, allied health, and mental health 
                practice to teach health professions students 
                to provide for the health care needs of 
                individuals with HIV disease; [and]
                  (C) to develop and disseminate curricula and 
                resource materials relating to the care and 
                treatment of individuals with such disease and 
                the prevention of the disease among individuals 
                who are at risk of contracting the disease[.]; 
                and
                  (D) to develop protocols for the medical care 
                of women with HIV disease, including prenatal 
                and other gynecological care for such women.

           *       *       *       *       *       *       *

  (b) Dental Schools.--
          [(1) In general.--The Secretary may make grants to 
        assist dental schools and programs described in section 
        777(b)(4)(B) with respect to oral health care to 
        patients with HIV disease.]
          (1) In general.--
                  (A) Grants.--The Secretary may make grants to 
                dental schools and programs described in 
                subparagraph (B) to assist such schools and 
                programs with respect to oral health care to 
                patients with HIV disease.
                  (B) Eligible applicants.--For purposes of 
                this subsection, the dental schools and 
                programs referred to in this subparagraph are 
                dental schools and programs that were described 
                in section 777(b)(4)(B) as such section was in 
                effect on the day before the date of enactment 
                of the Health Professions Education 
                Partnerships Act of 1998 (Public Law 105-392) 
                and in addition dental hygiene programs that 
                are accredited by the Commission on Dental 
                Accreditation.
          (2) Application.--Each dental school or program 
        described in section [777(b)(4)(B)] the section 
        referred to in paragraph (1)(B) may annually submit an 
        application documenting the unreimbursed costs of oral 
        health care provided to patients with HIV disease by 
        that school or hospital during the prior year.

           *       *       *       *       *       *       *

          (5) Community-based care.--The Secretary may make 
        grants to dental schools and programs described in 
        paragraph (1)(B) that partner with community-based 
        dentists to provide oral health care to patients with 
        HIV disease in unserved areas. Such partnerships shall 
        permit the training of dental students and residents 
        and the participation of community dentists as adjunct 
        faculty.
  (c) Authorization of Appropriations.--
          (1) Schools; centers.--For the purpose of grants 
        under subsection (a), there are authorized to be 
        appropriated such sums as may be necessary for each of 
        the [fiscal years 1996 through 2000] fiscal years 2001 
        through 2005.
          [(2) Dental schools.--For the purpose of grants under 
        subsection (b), there are authorized to be appropriated 
        such sums as may be necessary for each of the fiscal 
        years 1996 through 2000.]
          (2) Dental schools.--
                  (A) In general.--For the purpose of grants 
                under paragraphs (1) through (4) of subsection 
                (b), there are authorized to be appropriated 
                such sums as may be necessary for each of the 
                fiscal years 2001 through 2005.
                  (B) Community-based care.--For the purpose of 
                grants under subsection (b)(5), there are 
                authorized to be appropriated such sums as may 
                be necessary for each of the fiscal years 2001 
                through 2005.

           *       *       *       *       *       *       *


                            ADDITIONAL VIEWS

    While I support the overall goal of the Coburn-Waxman Ryan 
White CARE Act Amendments of 2000, H.R. 4807, I must take issue 
with one key provision of the bill, the ``hold harmless'' 
provision for Title I Eligible Metropolitan Areas (EMAs). I 
herewith express my strong objections to this provision and 
urge that it be modified.
    The original CARE Act legislation of 1990 included two 
factors in Title I formula grants: cumulative AIDS cases and 
``density.'' The ``density factor'' took into account the 
number of AIDS cases per 100,000 people in a given EMA. When 
the CARE Act was reauthorized in 1996, the criteria for Title I 
formula grants were changed. A ``ten year weighted case band,'' 
which gives greater ``weight'' to recently diagnosed AIDS cases 
on the theory that this information is more likely to measure 
``living AIDS cases,'' was substituted for the count of 
cumulative AIDS cases and the density factor was eliminated 
entirely. These changes, particularly the removal of the 
density factor, necessitated the inclusion of a ``hold 
harmless'' provision to prevent EMAs from experiencing dramatic 
funding losses.
    Under current law, a Title I EMA can lose no more than one 
percent of its funding each year, allowing for a five percent 
loss over five years. H.R. 4807 would alter this dramatically 
by allowing an EMA to lose 25 percent of its funding over five 
years. The result will be a rapid decline among systems of care 
and reduced access to vital HIV/AIDS services.
    The Senate bill reauthorizing the CARE Act, S. 2301, alters 
the ``hold harmless'' provision to allow for a 10 percent 
reduction in funding for an EMA over five years, a doubling of 
the rate in the current law. The Senate provision allows for a 
reasonable redirecting of resources without undermining systems 
of care through huge funding losses. I urge the Conferees to 
adopt the Senate provision when this bill goes to Conference.
    The 25 percent formula reduction included in H.R. 4807 is 
troubling for many reasons. The only EMA likely to experience 
the full 25% reduction in funding is San Francisco, meaning 
that this change will directly impact my constituents. 


    It has been stated that San Francisco receives ``too much'' 
money relative to the number of people living with HIV/AIDS. 
This is false. The AIDS epidemic is still a national crisis and 
no EMA, including San Francisco, receives enough CARE Act 
funding to meet all the needs of those living with HIV/AIDS. As 
more people with HIV live longer due to life-saving but 
expensive combination therapies, the strain on public health 
systems is increasing, not decreasing. Reducing an EMA's Title 
I funding by 25 percent would seriously destabilize systems of 
care in that community. 


     The ten year weighted case band that is used to allocate 
Title I formula funding seriously undercounts the number of 
people accessing CARE Act services. As noted previously, a 
recently diagnosed AIDS case is given greater ``weight'' under 
this formula. However, the use of highly active antiretroviral 
therapy has made this method of measurement far less accurate. 
Combination therapies have allowed many people with AIDS to 
live longer than 10 years and prevented many with HIV from 
advancing to an AIDS diagnosis as quickly as in the past. As a 
result, more people than ever are utilizing CARE Act services 
but many of them aren't being counted in the current Title I 
formula methodology. The hold harmless provision in H.R. 4807 
would have the effect of punishing EMAs like San Francisco for 
effective intervention to care for and prolong the lives of 
those with HIV.
    Proponents of the 25 percent hold harmless provision have 
offered a per capita analysis of each EMA to show that San 
Francisco receives too much in CARE Act funds. This argument is 
misleading and obscures the fact that CARE Act funding is 
designed to support public health systems in cities where large 
numbers of AIDS cases threaten the system with collapse and is 
not tied to individuals with AIDS. A per capita analysis 
ignores other relevant factors as well, such as the wide 
variance in cost of care among geographic areas, making direct 
comparison very difficult. Similarly, CARE Act services are 
accessed at varying rates in different areas.
    I support the reauthorization of the Ryan White CARE Act; 
however, it's vital that the more moderate Senate position on 
the hold harmless issue be adopted in Conference and I urge my 
colleagues to do so.

                                                     Anna G. Eshoo.

                                
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