[House Report 109-695]
[From the U.S. Government Publishing Office]



109th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     109-695

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



 
        RYAN WHITE HIV/AIDS TREATMENT MODERNIZATION ACT OF 2006

                                _______
                                

 September 28, 2006.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

    Mr. Barton of Texas, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                             together with

                            DISSENTING VIEWS

                        [To accompany H.R. 6143]

      [Including cost estimate of the Congressional Budget Office

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 6143) to amend title XXVI of the Public Health 
Service Act to revise and extend the program for providing 
life-saving care for those with HIV/AIDS, having considered the 
same, report favorably thereon without amendment and recommend 
that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................    15
Hearings.........................................................    17
Committee Consideration..........................................    17
Committee Votes..................................................    17
Committee Oversight Findings.....................................    21
Statement of General Performance Goals and Objectives............    21
New Budget Authority, Entitlement Authority, and Tax Expenditures    21
Earmark..........................................................    21
Committee Cost Estimate..........................................    21
Congressional Budget Office Estimate.............................    21
Federal Mandates Statement.......................................    25
Advisory Committee Statement.....................................    25
Constitutional Authority Statement...............................    25
Applicability to Legislative Branch..............................    25
Section-by-Section Analysis of the Legislation...................    26
Changes in Existing Law Made by the Bill, as Reported............    35
Dissenting Views.................................................   139

                          Purpose and Summary

    The purpose of the Ryan White HIV/AIDS Treatment 
Modernization Act (RWHATMA) is to address the unmet care and 
treatment needs of persons living with HIV/AIDS by funding 
primary health care and support services that enhance access to 
and retention in care. RWHATMA reaches over 500,000 individuals 
each year, making it the Federal Government's largest 
discretionary grant program specifically for people living with 
HIV/AIDS.
    Like many health problems, HIV/AIDS disproportionately 
affects people in poverty, racial/ethnic populations, and 
others who are underserved by healthcare and prevention 
systems. HIV/AIDS often leads to poverty due to costly 
healthcare or an inability to work that is often accompanied by 
a loss of employer-related health insurance. RWHATMA-funded 
programs are the ``payer of last resort.'' They fill gaps in 
care not covered by other resources. Most likely users of 
RWHATMA services include people with no other source of 
healthcare and those with Medicaid whose care needs are not 
being met.
    RWHATMA services are intended to reduce the use of more 
costly emergency services and inpatient care, increase access 
to care for underserved populations, and improve the quality of 
life for those infected or affected by the epidemic. It funds 
local and State programs that provide primary medical care and 
support services; healthcare provider training; and technical 
assistance to help funded programs address implementation and 
emerging HIV care need. RWHATMA allows for significant local 
and State control of HIV/AIDS healthcare planning and service 
delivery that has led to many innovative and practical 
approaches to the delivery of care of people living with HIV/
AIDS.
    The bill has a variety of provisions, the explanation of 
and committee views on which follow below:

               A. PROVISIONS APPLICABLE TO SEVERAL TITLES

    Although the last reauthorization of the CARE Act specified 
that the formula distributions in Parts A and B would be based 
on HIV (not AIDS) and AIDS cases, beginning in fiscal year 
2007, several States had not yet switched to names-based HIV 
reporting. Therefore, those States did not have case counts 
that could be certified by the Centers for Disease Control and 
Prevention (CDC). Thus, the Committee provided a particular 
mechanism to all those States to submit data to the Health 
Resources and Services Administration (HRSA), not certified by 
the CDC, in lieu of their names-based HIV data counts. In 
providing this mechanism, the Committee wanted to continue to 
encourage those States to switch to names-based HIV reporting, 
as well as ensure that by fiscal year 2011, all States would 
use names-based CDC-accepted HIV and AIDS cases for formula 
distributions.
    The Committee understands that States which currently 
collect data on persons with HIV that has not progressed to 
AIDS in a code-based format will need to convert their systems 
to one that is names-based. Particularly in large States, this 
may be a difficult and time-consuming process. Under the terms 
of the Committee bill, funds distributed in fiscal year 2011 
will be based on data collected through December 2009.
    In order to reflect the actual incidence of HIV as fairly 
as possible, the Committee recognizes that the Department will 
necessarily need to be more flexible in determining that 
accurate names-based data is being produced in States making 
the transition.
    If the State has a system for collecting data that has been 
agreed to by the CDC, and has begun their collection, the 
Committee intends that as names-based cases are collected, they 
would be added to the count of actual living AIDS cases. In 
addition, the Committee intends that all current code-based 
States could continue to use their code-based data through 
fiscal year 2010. The Secretary, in consultation with the chief 
executive of the State in which the eligible area is located, 
can determine that a system has become operational in the State 
that provides sufficiently accurate and reliable names-based 
reporting of such cases throughout the State. The Committee 
intends that the State must report HIV using a names-based 
system in scientific standards established by CDC to transition 
to a mature names-based system.
    For the purpose of counting living non-AIDS cases of HIV in 
code-based reporting eligible areas, the Committee intends that 
the Secretary use cases reported to HRSA in 2005 for purposes 
of fiscal year 2007, in 2006 for purposes of fiscal year 2008, 
in 2007 for purposes of fiscal year 2009, and in 2008 for 
purposes of fiscal year 2010.
    In February 2006, the Government Accountability Office 
(GAO) released a report entitled ``HIV/AIDS: Changes Needed to 
Improve the Distribution of Ryan White CARE Act and Housing 
Funds.'' The GAO highlighted that ``[f]orty-eight of the 51 
EMAs would have received more funding if there had been no 
hold-harmless provision.'' Further, the GAO noted that the $1.6 
million or seven percent of the Severe Need set-aside within 
the ADAP supplemental was used to provide Title II hold-
harmless protection. Further, ``[t]he potential exists for this 
Title II hold-harmless provision to diminish the size of Severe 
Need grants further in the future if larger amounts are needed 
to fund this hold-harmless protection.'' In recognition of 
these issues, the Committee opted to limit the hold- harmless 
provisions to five percent over the formula funding of the 
previous fiscal year for Part A and Part B during the fiscal 
years 2007 through 2009 after which it formally sunsets. 
Further, rather than provide the hold-harmless funding for Part 
B out of the AIDS Drug Assistance Program (ADAP) supplemental, 
the language explicitly requires that the funding first come 
from the Part B supplemental funding and then subsequently from 
pro-rata reductions. The Committee does not expect the pro-rata 
reduction provisions to be triggered. Rather, out of an 
abundance of caution, these provisions were included in the 
legislation. A similar mechanism exists for Part A in which the 
initial funding for the hold-harmless provisions is initially 
removed from the supplemental pool of funds and then 
subsequently from pro-rata reductions, with the expectation 
that no pro-rata reductions would be required.
    The Committee notes that $9 million from Part A and nearly 
$68 million from Part B of funds appropriated during fiscal 
years 2000 to 2002 are slated to be returned to the Treasury. 
This represents approximately 3 percent of the funds 
appropriated for Part A and Part B during this time period. 
Rather than have those funds revert to the Treasury, the bill 
clarifies the roles of the Secretary and the grantees to ensure 
that those funds are made available in the appropriate 
supplemental pools, while still allowing the grantee the option 
to have one more year to expend those funds.
    The intent of this modernization of the Ryan White CARE Act 
is to improve access to medical treatment and care for 
individuals with HIV/AIDS. Today, with treatment, HIV/AIDS is a 
chronic but manageable disease. The goal of this 
reauthorization is to allow more individuals access to life-
saving treatments.
    To meet this goal, the legislation requires that 75 percent 
of Parts A, B, and C be spent on core medical services, which 
are specific medical care services that are essential to 
treating HIV/AIDS, unless the State provides evidence that 
these services are available to all individuals with HIV/AIDS 
identified and eligible under this bill. This funding will 
allow more people to learn their HIV status, and bring more 
people with HIV/AIDS into medical care.
    It is intended that these funds go to services that 
specifically treat HIV infection, such as medical care and 
antiretroviral drugs. Congress recognizes that support services 
may impact the ability of people with HIV/AIDS to access care; 
however, HIV/AIDS is first and foremost a medical disease. In 
recognition of the need for States to retain some flexibility 
with regard to funding support services needed to achieve 
medical outcomes, the Committee authorizes that the remaining 
25 percent of funds may be spent on support services that 
facilitate access to care.
    In addition, at no time should the seeking and/or granting 
of a waiver by an eligible entity as outlined in sections 105, 
201, and 301 be used to determine or impact an eligible 
entity's need or qualification for supplemental grant funds 
under the bill.
    Within core medical services, many services such as medical 
case management and medical nutrition therapy are not defined. 
Consistent with the reauthorization's emphasis on medical care 
and treatment of HIV/AIDS, the Committee intends that the 
Secretary look to uses and definitions of similar terms such as 
primary care case management services and medical nutrition 
therapy services in Medicare and Medicaid. It is the intent of 
the Committee that registered dietitians or nutrition 
professionals with an equivalent education and training provide 
medical nutrition therapy under this bill.
    The Committee offers additional guidance to its intent 
regarding the application of the core medical services 
requirement and services that may or may not fall within the 
defined list of core medical services. Specifically, nothing in 
the legislation shall be read as limiting the applicability of 
the term ``Medical Case Management,'' in Sections 105, 201, and 
301 to services given by a specific type of provider or given 
in a specific setting or location. The Committee recognizes 
that case management plays a vital role in ensuring that those 
living with HIV/AIDS have access to and remain in care and 
treatment. Accordingly, it is the Committee's intent that the 
provision of funds for medical case management, including 
treatment adherence services, as a core medical service in 
Parts A, B, and C shall include funding case management 
services that increase access to and retention in medical care. 
The Committee understands that such services often are or can 
be provided by a range of trained professionals, including both 
medically credentialed staff and other health professionals.
    The Committee also recognizes that current medical 
standards of care for individuals with HIV/AIDS, as well as for 
those co-infected with hepatitis, include vaccination with 
hepatitis vaccines. The Committee intends that the definition 
of ``outpatient and ambulatory health services'' may include 
vaccinations, and instructs HRSA to make it clear to potential 
grantees that vaccination is a permitted use of funds under all 
parts of the legislation.
    The Committee wishes to clarify that nothing in the 
legislation shall be read as limiting eligible support services 
to the examples listed in the text of the legislation in 
Sections 105, 201, and 301. The legislation delineates some 
examples of support services, but the five examples in the bill 
are not intended to be an exclusive list of possible support 
services. The Committee is aware of and received information 
supporting the validity of other examples of eligible support 
services that were not listed in the text. For instance, the 
Committee has received data to show that food and nutrition 
services as well as emergency and transitional housing may be 
needed for individuals with HIV/AIDS to achieve their medical 
outcomes.
    In addition, the Committee recognizes that AIDS is 
increasingly impacting communities of diverse racial and ethnic 
backgrounds, presenting a variety of linguistic and cultural 
barriers to care. The Committee recognizes and applauds the 
efforts of AIDS service organizations to ensure delivery of 
linguistically and culturally competent care. The Committee 
intends linguistic services to be considered as support 
services for the purposes of funding allocation thereby 
recognizing language services are increasingly important to 
provide needed services to persons with limited English 
proficiency at risk of and living with HIV/AIDS.
    Finally, with regard to case management, the Committee 
intends that case management that is not medical case 
management and is needed for individuals with HIV/AIDS to 
achieve their medical outcomes should be considered to be 
support services. The Committee therefore urges HRSA to 
recognize and support case management services that include, 
but are not limited to, helping HIV-positive individuals 
determine eligibility for and access to various medical and 
support services. Since the majority of HIV-positive 
individuals served by the Ryan White program live in poverty 
and often face multiple challenges, care coordination provided 
by case managers is essential to maximization of resources and 
healthy, productive lives.
    Current HRSA guidance clarifies that entities providing 
Ryan White services need to require that members of a Native 
American tribe receive their services through the Indian Health 
Service. Therefore, to ensure that there was no question 
regarding the guidance, the Committee amended the payer of last 
resort provisions across Ryan White to make that exception 
clear.
    In recognition that HIV infection is growing among Native 
American populations, the planning council representation and 
the statewide planning council requirements are amended to 
clarify that members of these planning bodies should include 
members of a Federally recognized Indian tribe as represented 
in the population. Further, eligibility under Part C and Part D 
were amended to explicitly include health facilities operated 
by or pursuant to a contract with the Indian Health Service to 
ensure ongoing access to key HIV/AIDS services to Native 
American populations. Under Part F, the AIDS Education Training 
Center (AETCs) program was amended to clarify that AETCs should 
provide training that is relevant to Native American 
populations.
    To ensure better accountability and transparency, the 
Committee wanted to encourage additional communication among 
the various entities funded under the RWHATMA. Therefore, the 
key item to assist with the promotion of that coordination was 
the requirement of the designation of a State lead agency to 
facilitate the coordination of programs under the RWHATMA. In 
particular, the State lead agency is to collect and compile an 
audit report every two years from each of the grantees under 
the RWHATMA, as well as put together specific outcome measures 
for the State. Every grantee in the State will need to report 
on those outcome measures, as well as any additional ones that 
the grantee would like to add. Further, although there is 
already a statewide coordinated statement of need process, the 
bill further clarifies that applications for awards to entities 
funded outside of Part B be consistent with the statewide 
coordinated statement of need process.
    The Secretary should review and analyze funding 
dispensation to jurisdictions as it relates to those areas with 
the highest incidence or prevalence of HIV/AIDS, aggregated by 
race and ethnicity.

                   B. PROVISIONS APPLICABLE TO PART A

    In February 2006, the GAO released a report entitled ``HIV/
AIDS: Changes Needed to Improve the Distribution of Ryan White 
CARE Act and Housing Funds.'' The GAO highlighted that, as of 
2004, that ``[m]ore than half of the eligible metropolitan 
areas (EMAs) received funding in fiscal year 2004 even though 
they were below Title 1 eligibility thresholds.'' In response 
to that information, the Committee opted to revise the 
provisions related to eligibility criteria to ensure that such 
inequity was diminished, while also providing a stabilizing 
force for those metropolitan areas. With that goal, the 
Committee created a two tier structure for all metropolitan 
areas: (1) tier one EMAs with 2000 or more AIDS cases reported 
during the last 5 years; and (2) tier two Transitional areas 
with at least 1000 but fewer than 2000 AIDS cases reported in 
the last five years. EMAs that received funding in fiscal year 
2006 but were not eligible for tier one in fiscal year 2007 
would be added to the tier two category. For all metropolitan 
areas, eligibility would be bifurcated in that eligibility 
would be granted immediately upon crossing the threshold 
criteria. However, if there was a declining number of AIDS 
cases, eligibility would be maintained until the metropolitan 
area was no longer eligible for three consecutive fiscal years 
based on both its incidence and prevalence AIDS case counts.
    Further, in examining the growing rate of HIV/AIDS cases in 
smaller urban areas, the Committee decided that the additional 
requirement that metropolitan areas maintain a population 
threshold of 500,000 was unduly restrictive. Therefore, the 
Committee opted to remove the 500,000-population requirement 
but maintain the metropolitan area requirement of 50,000.
    In further recognizing the need to provide greater 
stability for the care network for those with HIV/AIDS and that 
additional metropolitan areas would likely be eligible under 
the new criteria, the Committee maintained the current 
requirement that the boundaries for the metropolitan areas that 
received funding under Part A maintain their boundaries that 
were set in 1994. However, new entities would have their 
boundaries set at those that were in place at the time that 
they received initial funding under Part A.
    To ensure that more funding is provided via funding 
formulas, the Committee shifted the total amount provided to 
Part A for formulas from 50 percent to 66\2/3\ percent. The 
supplemental pool is comprised of the remaining 33\1/3\ percent 
to be distributed first to fund any applicable hold-harmless 
provisions, then to fund the prioritization of supplemental 
award provision, and finally to fund additional supplemental 
awards for demonstrated need.
    The Committee intends to focus the supplemental grant 
process more specifically on factors important to developing 
the severity of need index, factors which have implications of 
the amount of spending required per person with HIV/AIDS. The 
Committee expects that supplemental awards will be based solely 
on demonstrated need on a competitive basis, according to the 
criteria included in the legislation. The Committee emphasizes 
that the supplemental awards are not guaranteed nor are the 
levels of the awards per grantee guaranteed from year to year. 
In addition, the Committee strongly encourages the use of the 
factor related to the ``impact of a decline in the amount 
received pursuant to subsection (a) on services available to 
all individuals with HIV/AIDS identified and eligible under 
this title'' because the Committee expects, especially after 
the hold-harmless provisions are no longer in effect, that this 
will continue to provide a stabilization factor to communities 
that have a decline in funding, tied to this criteria.
    Transitional areas are treated similar to the EMAs, except 
in two key areas. First, Transitional areas are not required to 
have formal planning councils, although they must have some 
process by which obtain community input to incorporate 
individuals as defined in Section 2602(b)(2) with one 
exception: ``grandfathered'' EMAs. EMAs are required to have 
planning councils for fiscal year 2007 through fiscal year 
2009. The Committee opted to limit that requirement in 
recognition that, after three years, communities in similar 
situations should be similarly treated. Second, Transitional 
areas are not eligible for hold-harmless provisions.
    The Committee focused its efforts on ensuring that the 
money followed the epidemic. Therefore, as funded cities move 
between the various tiers, the general rule is that the funding 
for those entities move with them (given the individuals with 
HIV/AIDS still need services in the area). Thus, the 
legislation builds in special rules to allow the funding to do 
so, while still recognizing that supplemental funding is not 
guaranteed funding.
    If an EMA is no longer eligible for funding due to a 
decrease in the incidence and prevalence of AIDS cases, then 
the formula funding for that EMA would move to either the 
Transitional areas formula pool (if the EMA was then eligible 
as a Transitional area) or to the Part B base formula pool (if 
the EMA was then eligible as either an Emerging Community or 
not separately eligible for funding). Given that the 
supplemental funding is not guaranteed, the supplemental 
funding is deemed to be $500,000 for each grantee, and that 
amount is likewise transferred. The Committee determined the 
$500,000 value by taking the average supplemental grant for the 
grandfathered EMAs in fiscal year 2006. That average was around 
$700,000. Therefore, $500,000 was deemed a reasonable estimate 
of the supplemental funds that should be transferred. However, 
given that the Part A entities share the supplemental pool, 
transfers of funding for the supplemental dollars are only 
allocated when an EMA either moves to an Emerging Community or 
no longer eligible for separate funding. In that situation, the 
supplemental funding deemed to be $500,000 is transferred to 
the Part B base funding.
    If a Transitional area is deemed eligible as an EMA, then 
the formula funding would be transferred to the EMA formula 
pool.

                   C. PROVISIONS APPLICABLE TO PART B

    In February 2006, the GAO released a report entitled ``HIV/
AIDS: Changes Needed to Improve the Distribution of Ryan White 
CARE Act and Housing Funds.'' The GAO highlighted that, 
``states with EMAs . . . receive more funding per ELC than 
states without EMAs because cases within EMAs are counted 
twice, once in connection with Title I base grants and once for 
Title II base grants. Eighty percent of Title II base grants is 
determined by the total number of ELCs in the state or 
territory. The remaining 20 percent is based on the number of 
ELCs in each jurisdiction outside the EMA.'' With this 
provision, States with no EMAs receive, on average, $3,592 per 
estimated living case (ELC), while States with more than 75 
percent of their ELCs in EMAs receive $4,955 per ELC, or 33 
percent more per case. In recognition of the issues resulting 
from this distribution pattern, the Committee took two actions.
    First, the Committee recognized that the current system for 
allocating funds did not take into account variations in the 
relative needs of all individuals with HIV/AIDS within the 
State, including specific service needs (e.g., distance to 
care, cost to provide services, services provided through an 
EMA, etc.) and individual needs (e.g., insurance status, HIV or 
AIDS status, etc.). Therefore, the Committee required that the 
Secretary develop a severity of need index (SONI) to replace 
the ``double-counting'' or 80/20 provisions.
    Due to the complexity of these issues coupled with the 
ongoing desire to have a more rational distribution of funds, 
the Committee further required that any new SONI not be in 
effect until fiscal year 2011, while requiring that SONI take 
effect no later than by fiscal year 2013. The Secretary must 
provide the new SONI by January 1 of the calendar year, along 
with additional required documentation, for it to go into 
effect by October 1, the beginning of the next fiscal year. 
This time frame is required so that Congress can do a careful 
consideration of the SONI, including examining information 
required to be submitted by the Secretary which includes the 
methodology and rationale (including field testing), expected 
change in funding allocations, process for community input, 
timeline and process for implementation, and independent 
contractor analysis. Further, to ensure that Congress is 
updated on the progress of the SONI, there is a requirement for 
annual reports for the SONI.
    Second, as a short-term measure, until the SONI is used to 
allocate the Part B base formula more equitably, the Committee 
altered the double-counting or 80/20 provisions to shift more 
resources to States without funding under part A. Thus, the 80/
20 provisions became 75/20/5, with 0.75 (reduced from 0.8) as 
the distribution factor for all cases in the State in which 
every State is eligible, 0.20 as a distribution factor for all 
cases outside of EMAs in a State in which every State is 
eligible, and 0.05 as a distribution factor for all cases 
outside Part A in a State, but only for States without any Part 
A funds.
    The development of a valid SONI has been a work in 
progress, as evidenced by the efforts, authorized by the Ryan 
White Care Act of 2000, of the Institute of Medicine (IOM). In 
its report ``Measuring What Matters'' (2004), the IOM concluded 
at that time that insufficient accurate, universally available, 
unbiased data exist to create a reliable SONI. Subsequent work 
funded by HRSA has revisited existing datasets and analyses, 
and proposed selected elements that may constitute components 
of such an index, but also identified numerous areas of 
insufficient data and/or insufficient rationale for their 
inclusion in an index. It is notable that both the IOM and 
subsequent development processes were focused on the revision 
of indices to inform the allocation of Part A supplemental 
awards.
    The Committee intends the Secretary to make selective use 
of existing research and analyses from these prior attempts, 
and to also identify, evaluate, individually and collectively 
analyze, and experimentally apply an array of indicators toward 
a defensible SONI meaningfully and without bias.
    In addition, the Committee intends for the Secretary to 
engage an objective, independent contractor with broadly 
acknowledged impartiality and expertise to conduct future 
investigations into a new SONI.
    With reference to Section 203(b)(3)(F)(v)(III), the 
Committee intends the Secretary to collect and apply current 
epidemiologic data from jurisdictions, to the degree that HIV/
AIDS and other disease case report data are factored into the 
proposed index, for the purposes of testing the allocation 
impact of the index.
    With reference to Section 203(b)(3)(F)(v)(IV), the 
Committee intends for the Secretary to allow the necessary time 
for community input, so as to allow sufficient time for 
analysis and commentary by interested parties.
    The Committee further intends that any proposed SONI shall 
not provide incentives for jurisdictions to reduce their local 
resource contributions to HIV/AIDS care funded by the RWHATMA, 
including contributions made through State and local programs.
    The ADAP drug lists vary significantly across the country, 
ranging from 19 drugs covered in Guam to nearly 500 in New York 
and open formularies in four jurisdictions--Massachusetts, New 
Hampshire, New Jersey, and the Northern Mariana Islands. While 
the majority of ADAPs (35) cover all 25 FDA-approved 
antiretrovirals on their formularies, 20 ADAPs do not, 
including one that does not provide any protease inhibitors 
(South Dakota). Forty-four ADAPs cover Fuzeon, the only 
approved fusion inhibitor for people with HIV/AIDS. The 
Committee is concerned that individuals eligible for the ADAP 
may not have access to core antiretroviral medications, thereby 
reflecting current inequities in access to care. Therefore, the 
legislation requires ADAPs to include minimum core 
antiretroviral medications. It is the Committee's intent that 
the list merely establishes minimum coverage requirements for 
ADAPs; States may also include additional eligible treatments 
in their ADAPs. Although the Committee considered expanding 
that list to also include opportunistic infection medications, 
given the increased discussion about which drugs would be most 
appropriate on that list, the Committee opted only to focus on 
antiretrovirals at this time and hopes that subsequent 
reauthorizations will reexamine the need to potentially expand 
the list of core medications covered by ADAP. It is also the 
intent of the Committee that the Secretary will develop the 
list of core antiretroviral medications in consultation with 
the Public Health Service.
    The Committee was further concerned to hear reports that 
States may not be reallocating drug rebate dollars back into 
the ADAP. Therefore, the Committee clarified that any drug 
rebates for drugs purchased through the ADAP should be applied 
to the ADAP.
    To ensure that the ADAP supplemental funds were targeted 
toward the purchase of key medications for individuals with 
HIV/AIDS, the Committee opted to limit the overall ADAP 
supplemental activities to those involving the purchase of 
those key medications (either directly or through the purchase 
of health insurance). Therefore, unlike current law, the ADAP 
supplemental pool will no longer be the source of funding for 
the Part B hold-harmless. In addition, the ADAP supplemental 
pool is further enhanced by increasing the amount of the ADAP 
set aside of funds from three to five percent to fund the ADAP 
supplemental pool given the growing need for these funds.
    In addition, the Committee clarifies that all territories 
are eligible for ADAP awards but does not alter the minimum 
amount that each territory may receive under Part B base 
grants.
    The Committee was concerned to hear reports that the 
Secretary found it difficult to rapidly respond to emerging 
needs of particular populations. For instance, in 2003, when 
the Secretary determined through surveillance activities a 
cluster of HIV infection among African-American university 
students, the Secretary had no ability to quickly respond and 
provide additional services to deal with the increased HIV load 
in that area. In response to this situation, the Committee 
believed that it was important to have a small pool of funds 
available to the Secretary to deal with these emerging needs 
and not just the ADAP supplemental funds. Thus, the Committee 
created the Part B base supplemental pool, which is funded 
solely out of one-third of any increased funds provided to Part 
B base over what is provided in fiscal year 2006. The 
supplemental award is modeled after the Part A application, in 
that the criteria are identical, including the prioritization 
for States that meet the required criteria. Further, the 
Committee expects that a State will, under normal 
circumstances, be able to apply for these funds under the same 
application as the formula application. However, in limited 
circumstances, such as the case with the cluster of HIV cases, 
the Secretary may opt to accept supplemental applications 
throughout the year to address emerging needs.
    The Committee opted to keep the second tier of the Emerging 
Communities program within Part B. In doing so, the Committee 
clarified that the funds for the Emerging Communities program, 
although granted to the State, should be allocated to the 
Emerging Community.
    The Committee intends that with respect to Section 209, 
only new CDC funding should be reallocated from the CDC 
appropriation to annually fund the early diagnosis grant 
program. If the amount available each year for these awards is 
not so awarded, it is the intent of the Committee that the 
funds would be available to be awarded for these grants in the 
following years in order to have the necessary funds available 
to provide awards to States as they become eligible to receive 
these awards. It is not the intent of the Committee that funds 
available but not awarded in any year during the 
reauthorization be returned to the Treasury.
    Bringing pregnant women in for care and treatment is the 
essential link to reducing perinatal transmission. Thus, the 
Committee intends that States be allowed the flexibility to use 
their grant awards under this section to recruit pregnant women 
diagnosed with HIV into care, and provide necessary treatment 
and case management to prevent mother-to-child transmission of 
HIV.

                   D. PROVISIONS APPLICABLE TO PART C

    The Committee believed as if it was important to further 
clarify that the purpose of the program under Part C is to 
provide services to underserved populations. Although the 
initial list of grantees would suggest this purpose, the 
Committee believed it important to explicitly clarify this 
point.

                   E. PROVISIONS APPLICABLE TO PART D

    The Committee did not require that entities receiving funds 
under Part D spend 75 percent of their funds on core medical 
services, simply because the current Part D grantees serve more 
of a coordination role, rather than a health care services 
function.
    The Committee believed it was important to limit the 
administrative expenses of Part D grantees. However, in 
defining what was included within administrative expenses, the 
Committee departed from standard definitions of the term, given 
the lack of standardized information on how those grantees are 
allocating and spending those funds. Thus, the Committee 
requested a more thorough GAO review of these activities to 
determine a more appropriate definition of administrative 
expenses. In providing this review, the GAO should examine 
qualitative and quantitative data that are not currently 
captured by Federal data systems. Therefore, the Committee is 
hopeful that during the next reauthorization, this term may be 
revisited, with the additional information obtained from the 
GAO report.
    Part D provides a program of grants for coordinated, 
family-centered services. Part D grantees may engage in a broad 
range of activities to reduce mother-to-child transmission, 
including voluntary testing of pregnant women and treatment to 
reduce mother-to-child transmission. In addition, Part D 
grantees are required to provide individuals with information 
and education on opportunities to participate in HIV/AIDS 
clinical research. Part D is specifically charged with linking 
women, children, youth, and families living with HIV/AIDS to 
care, services, and research.
    Women and young people--in particular, women and youth of 
ethnic and racial minorities--are an increasing portion of new 
HIV infections. The Committee is aware that with a specific 
focus on families, Part D grantees have taken the lead in 
reducing mother-to-child HIV transmission in the United States.
    The Committee intends to clarify that the current focus of 
the Part D activities is on coordinated, family-centered care 
(not research), while still maintaining a strong link with the 
research community. The Committee further intends to clarify 
that the current focus within Part D grantees of recruiting and 
retaining youth in care should continue. The Committee intends 
that Part D grantees continue their coordination with 
organizations that assist youth with reducing and eliminating 
their risk of contracting and transmitting HIV, and conducting 
a range of social and support services including case-finding 
and outreach to identify HIV-infected youth and bring them into 
care.

                   F. PROVISIONS APPLICABLE TO PART E

    In an effort to provide more clarity in the overall program 
design, the Committee opted to move many of the general 
provisions, which were included throughout the CARE Act into 
Part E, while eliminating programs which had never been funded 
or re-examined in the last two reauthorizations. Thus, Section 
2681 was formerly Sections 2675; and 2684, 2678.
    However, the Committee also significantly altered former 
sections, given the current structure of the program. For 
instance, the Committee deleted the audit requirements formerly 
under Section 2675A and instead inserted modified requirements 
under Section 2682. In addition, the Committee shifted the 
definitions from Section 2676 to Section 2687. In doing so, the 
Committee provided a more comprehensive definition of ``family-
centered care,'' defined the term ``families with HIV/AIDS,'' 
``youth with HIV,'' and ``co-occurring conditions''; clarified 
the distinction between HIV and AIDS and the treatment of the 
terms within the funding formulas; and deleted definitions 
which were no longer relevant (e.g., designated officer of 
emergency response employees, emergency, emergency response 
employee, employer of emergency response employees, and 
exposed).
    In addition, the Committee added new requirements and 
clarifications under Part E. In particular, the Committee 
believed, after examining the effect of Hurricane Katrina on 
parts of the Gulf Coast, it was important to provide greater 
flexibility of the program after a public health emergency or 
the equivalent thereof. However, in providing that flexibility, 
the committee limited the amount of funds that could be shifted 
in that situation to five percent of the funds available under 
each of the Parts A and B base supplemental pools. Further, the 
Committee believed that it was important, given the reliance on 
names-based HIV and AIDS reporting, that it was clear that the 
Secretary does not receive any personally-identifiable 
information, as given the term in regulations promulgated under 
the Health Insurance Portability and Accountability Act of 
1996. The Committee also added, in Section 2686, a biennial GAO 
report on HIV program integration, particularly for racial and 
ethnic minorities, including activities carried out under the 
codification of the Minority AIDS Initiative under subpart III 
of Part F.

                   G. PROVISIONS APPLICABLE TO PART F

    Given the ongoing desire of the Committee to have client 
level data, the Committee opted to alter the Special Projects 
of National Significance (SPNS) to clarify that SPNS has two 
main goals--(1) funding special programs to develop standard 
electronic client information; and (2) quickly responding to 
emerging needs of individuals receiving assistance under the 
program.
    Within the Minority AIDS Initiative, the Committee intends 
that funds are targeted to address the growing HIV/AIDS 
epidemic and its disproportionate impact upon communities of 
color, including African Americans, Latinos, Native Americans, 
Asian Americans, Native Hawaiians, and Pacific Islanders. 
Department statistics show that racial and ethnic minorities 
represent the highest number of new AIDS cases. While African-
Americans and Hispanics are represented among roughly one-
fourth of the total U.S. population, they account for nearly 
three-fourths of all new AIDS cases. More than 70 percent of 
people living with AIDS are racial and ethnic minorities, and 
HIV has become a leading cause of death for African Americans. 
Additionally, racial and ethnic minorities are now represented 
among the majority of new AIDS cases, as well as among 
Americans living with AIDS.
    The Committee expects the Department to tailor the portion 
of the Ryan White programs that are funded under the Minority 
AIDS Initiative as tightly as possible in order to address the 
growing health problem and maximize the participation of 
minority community based organizations. Funds provided by the 
Minority AIDS Initiative are to supplement, not to supplant, 
any resources, activities, or efforts carried out in other 
parts of the legislation or other programs of the Department to 
ensure such services are culturally competent and 
linguistically appropriate.
    The Committee expects applications submitted for emergency 
assistance and care grants under the Minority AIDS Initiative 
to contain a comprehensive plan to provide services to racial 
and ethnic minorities, with particular attention to individuals 
who know their HIV status and those who are most at risk. This 
plan shall include a determination of the need and use of 
funds; a detailed description of HIV-related services, to 
include the availability of such services; the size and 
demographic of racial and ethnic minority populations to be 
served; and the intent to serve individuals as described in 
Section 2602(b)(2)(M) of the Public Health Services Act.
    The Committee expects emergency assistance funds to be 
provided for competitive, supplemental grants to improve HIV-
related health outcomes among racial and ethnic minorities in 
HIV/AIDS-related access, care and treatment in communities 
where racial and ethnic minorities are underserved with respect 
to such services for HIV/AIDS care and treatment; and bring 
racial and ethnic minorities into HIV/AIDS care and treatment.
    The Committee also expects care grant funds to be provided 
for State HIV care grants to support educational and outreach 
services to increase the number of eligible minorities who 
access HIV/AIDS treatment through ADAP. The Committee strongly 
urges States to maximize the participation of minority 
community-based organizations in delivering these educational 
and outreach services.
    The Committee intends that early intervention services 
funds be provided for planning grants and Early Intervention 
Service (EIS) grants to healthcare providers with a history of 
serving communities of color. The Committee strongly urges the 
Department to maximize the participation of minority community 
based organizations as defined above in planning and delivering 
EIS. Funds should also be made available to regional and local 
technical assistance organizations to assist service providers 
in identifying and increasing the retention of minorities in 
care with an emphasis on women of color and men of color who 
have sex with men (MSM) in highly impacted and underserved 
areas. Within the increase provided, the Department is urged to 
make enhancing the service capacity of existing minority EIS 
providers a priority.
    As part of the Minority AIDS Initiative, the Committee 
expects that education and training centers funds are provided 
to increase the training capacity of AETCs to expand the number 
of community-based minority healthcare professionals with 
treatment expertise and knowledge about the most appropriate 
standards of HIV/AIDS-related treatments and medical care for 
HIV infected adults, adolescents, and children as developed by 
the U.S. Public Health Service. The training of minority 
providers as part of the Minority AIDS Initiative is to be 
implemented through collaborations with Historically Black 
Colleges and Universities (HBCU), Hispanic Serving 
Institutions, and Tribal Colleges. These efforts are designed 
to increase the treatment expertise and HIV knowledge of 
minority front-line providers serving individuals living with 
HIV/AIDS. Funds are also intended to support minority community 
based organizations to train minority providers to deliver 
culturally competent and linguistically appropriate treatment 
education services.

                  H. PROVISIONS APPLICABLE TO TITLE 7

    Most of the approximately five million Americans infected 
with the hepatitis C virus (HCV) are unaware they have a 
transmissible and potentially deadly disease, precluding them 
from initiating treatment and implementing behavioral changes 
that can save their lives.
    The CDC estimates about 25 percent of Americans with HIV/
AIDS are co-infected with HCV. End-stage liver disease 
secondary to chronic hepatitis C infection is now the leading 
cause of death among people with HIV/AIDS in the United States.
    Despite the high rate of mortality due to hepatitis C among 
people with HIV/AIDS, only a handful of traditional AIDS 
service providers, including a few CARE Act grantees, have 
begun to address this critical issue. This issue is 
particularly problematic in large urban areas where the 
majority of HCV/HIV co-infected patients live and receive 
services.
    The main problem is that this is not just a matter of ADAP 
providing HCV drugs for co-infected patients, it relates to all 
medical and social service providers recognizing the impact of 
HCV on persons with HIV, getting the proper training to help 
these individuals, and integrating the appropriate services 
into their programs.
    Part A grantees contracted with over 1,500 agencies to 
offer social support and medical care services to over 800,000 
patients in 2003. The majority of patients served under Part A 
are racial and ethnic minorities, African Americans, in 
particular, who are disproportionately impacted by both HIV and 
HCV. Part A providers, as do providers funded under other parts 
require the guidance, expertise and resources to adequately 
serve their HCV/HIV co-infected patients.
    Some studies have reported that people with co-infection 
have higher levels of hepatitis virus in their blood, more 
rapid progression of liver damage, and a greater rate of death 
due to hepatitis than people with only HCV infection. Other 
recent research found no correlation between HCV progression 
and HIV status. Hepatitis B (HBV) is the most common viral 
hepatitis infection in people with HIV. Given this information 
about HCV and HBV, the Committee took a variety of actions 
throughout the legislation to acknowledge these issues.

                  Background and Need for Legislation

    In March 1990, Congress enacted the Ryan White CARE Act 
(CARE ACT), honoring Ryan White, a young man who taught the 
Nation to respond to the HIV/AIDS epidemic with hope and action 
rather than with fear. By spring 1990, over 128,000 people had 
been diagnosed with AIDS in the United States; 78,000 had died 
of the disease. The CARE Act was reauthorized in 1996 and 2000, 
in recognition of the fact that the epidemic continued to 
spread and that primary care and support services provided 
through the Act were still vitally important to people with HIV 
and AIDS and the healthcare systems in their communities.
    Today, more than 944,306 cases of AIDS have been reported 
to the CDC. More than 529,113 men, women, and children have 
died as the epidemic has spread over the last 25 years, to both 
new populations and new geographic areas. The epidemic 
continues to grow, touching larger numbers of people and more 
segments of our society. The heterosexual transmission rate 
continues to increase; women and minorities are increasingly 
being affected. Rural areas of the country are now feeling the 
full impact of the epidemic. Those areas must now confront the 
same social, economic, and personal challenges that the 
original urban epicenters have been facing since 1981.
    The continued expansion of the AIDS epidemic in America is 
a certainty. Yet, diagnosed AIDS cases measure only a portion 
of the problem. The CDC estimates that there are between 
1,039,000 and 1,185,000 people currently living with HIV in the 
United States, with 40,000 new infections annually. In addition 
to new infections and persons living with HIV infection who are 
not in care, individuals in treatment are living longer with 
the disease, increasing demands on the healthcare system. 
Hundreds of thousands of these Americans will require 
healthcare services for HIV-related conditions in the future. 
This will continue to challenge the Nation's healthcare system.
    While a cure for HIV has eluded scientists, science has 
made significant progress in developing treatments for HIV. 
Therapies now exist that, for many people, can help slow the 
progression of HIV and allow the immune system to recover some 
of its ability to resist opportunistic infections associated 
with AIDS. These therapies have drastically reduced the number 
of deaths from AIDS and the number of new AIDS cases over the 
last four years. In addition, prenatal administration of 
Zidovudine (also known as AZT) along with active outreach to 
and counseling of pregnant women have nearly eliminated the 
perinatal transmission of HIV. These developments have resulted 
in longer survival rates for people diagnosed with AIDS and 
have highlighted the importance of and need for early 
intervention and early treatment.
    Public policy must follow the expanding epidemic and 
incorporate the advances in scientific and medical information 
regarding HIV. Effective policy should also address the 
increasing service needs that the epidemic creates and 
integrate the advances in knowledge, understanding, and 
treatment of the disease. With the introduction of potent 
antiretroviral therapies, for example, patient demand for 
financial assistance has increased rapidly, precipitating a 
financial crisis in AIDS drug assistance programs across the 
country. As the epidemic, the affected communities and 
populations, and the medical response continue to change, 
public policy must be flexible enough to meet unexpected 
challenges.
    The Ryan White CARE Act originally responded to the need 
for HIV primary care and support services. The major focus of 
public policy prior to the CARE Act was on research, public 
education, surveillance, and prevention. These activities are 
still a necessary priority and continue to receive attention 
and funding through the National Institutes of Health and the 
CDC. In contrast, the CARE Act has helped people with HIV/AIDS 
to obtain primary care and support services to save and improve 
their lives. The CARE Act has played a critical role in the 
Nation's response to the AIDS epidemic.
    The public health burden and the economic burden of the 
AIDS epidemic have not been reduced since the CARE Act was 
passed. While the CARE Act has been a lifeline of support to 
many people, the continued need for services grows faster than 
the resources available. In fact, the steady expansion and 
changed demographics of the epidemic and the increasing 
survival rates for people living with HIV/AIDS have increased 
the stress on local healthcare systems in some areas. This 
strain is believed both in urban centers where the epidemic 
continues to rage, and in smaller cities and rural areas, where 
the epidemic is expanding rapidly.
    The Ryan White CARE Act Amendments of 2000 preserved and 
improved upon the best aspects of the original CARE Act. At the 
same time, in recognition of the changes that have taken place 
over the last five years, the Committee has also made some 
necessary alterations. To address the geographic expansion of 
this epidemic, this reauthorization continues the efforts made 
during the last reauthorization to direct resources and 
services to areas that are particularly underserved, including 
rural areas and metropolitan areas with significant HIV and 
AIDS cases that are not eligible for Part A funding. There is 
also a new focus on strengthening the capacity of rural and 
minority communities to address the epidemic. Furthermore, ADAP 
has been strengthened 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 the Ryan 
White program. The purpose of these changes is to ensure a 
strong system of health care delivery and access to therapies 
commensurate with evolving needs.

                                Hearings

    The Subcommittee on Health held a hearing on Reauthorizing 
the Ryan White CARE Act: How to Improve the Program to Ensure 
Access to Care on April 27, 2006. The Subcommittee received 
testimony from: Elizabeth Duke, Ph.D., Administrator, Health 
Resources and Services Administration, U.S. Department of 
Health and Human Services; Kevin Fenton, MD, Ph.D., Director, 
National Center for HIV, STD, and TB Prevention, Centers for 
Disease Control and Prevention, U.S. Department of Health and 
Human Services; and Marcia Crosse, Ph.D., Director, Health Care 
Group, Government Accountability Office.

                        Committee Consideration

    On Wednesday, September 20, 2006, the Full Committee met in 
open markup session and ordered a Committee Print entitled the 
Ryan White HIV/AIDS Treatment Modernization Act of 2006 
favorably reported to the House, amended, by a record vote of 
38 yeas and 10 nays, a quorum being present. A request by Mr. 
Barton to allow a report to be filed on a bill to be 
introduced, and that the actions of the Committee be deemed as 
actions on that bill, was agreed to by unanimous consent.

                            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. The 
following are the recorded votes taken on amendments offered to 
the measure, including the names of those Members voting for 
and against. A motion by Mr. Barton to order the Committee 
Print entitled the Ryan White HIV/AIDS Treatment Modernization 
Act of 2006 favorably reported to the House, amended, was 
agreed to by a record vote of 38 yeas and 10 nays.


                      Committee Oversight Findings

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

         Statement of General Performance Goals and Objectives

    The goal of the Ryan White HIV/AIDS Treatment Modernization 
Act is to address the unmet care and treatment needs of persons 
living with HIV/AIDS by funding primary health care and support 
services that enhance access to and retention in care.

   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. 
6143, Ryan White HIV/AIDS Treatment Modernization Act of 2006, 
would result in no new or increased budget authority, 
entitlement authority, or tax expenditures or revenues.

                                Earmark

    In compliance with H. Res. 1000 as passed the House of 
Representatives on September 14, 2006, the Committee finds that 
H.R. 6143, Ryan White HIV/AIDS Treatment Modernization Act of 
2006, contains no earmarks.

                        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:
                                                September 27, 2006.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 6143, the Ryan 
White HIV/AIDS Treatment Modernization Act of 2006.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Camile 
Williams.
            Sincerely,
                                          Donald B. Marron,
                                                   Acting Director.
    Enclosure.

H.R. 6143--Ryan White HIV/AIDS Treatment Modernization Act of 2006

    Summary: H.R. 6143 would reauthorize the Ryan White program 
in title XXVI of the Public Health Service Act. The Ryan White 
program provides grants to fund medical care and other support 
services for individuals with HIV/AIDS. The bill would modify 
certain provisions while maintaining the overall structure of 
the existing program.
    H.R. 6143 would authorize the appropriation of about $2.3 
billion for fiscal year 2007 and $12.2 billion over the 2007-
2011 period. Although authorization for the Ryan White program 
expired in fiscal year 2005, about $2 billion was appropriated 
for the program for fiscal year 2006. Assuming the 
appropriation of the specified amounts, CBO estimates that 
implementing H.R. 6143 would cost $501 million in fiscal year 
2007 and $9.6 billion over the 2007-2011 period. Enacting the 
bill would not affect direct spending or revenues.
    H.R. 6143 contains no private-sector or intergovernmental 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 6143 is shown in Table 1. The costs of 
this legislation fall within budget function 550 (health).

                                     TABLE 1.--BUDGETARY IMPACT OF H.R. 6143
----------------------------------------------------------------------------------------------------------------
                                                                     By fiscal year, in millions of dollars--
                                                                 -----------------------------------------------
                                                                   2006    2007    2008    2009    2010    2011
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law for the Ryan White Program:
    Budget Authority \1\........................................   2,038       0       0       0       0       0
    Estimated Outlays...........................................   1,523   1,324     271      41       0       0
Proposed Changes:
    Estimated Authorization Level...............................       0   2,279   2,357   2,438   2,523   2,610
    Estimated Outlays...........................................       0     501   1,931   2,271   2,395   2,478
Spending Under H.R. 6143 for the Ryan White Program:
    Estimated Authorization Level \1\...........................   2,038   2,279   2,357   2,438   2,523   2,610
    Estimated Outlays...........................................   1,523   1,825   2,202   2,312   2,395  2,478
----------------------------------------------------------------------------------------------------------------
\1\ The 2006 level is the amount appropriated for that year for the Ryan White program.

    Basis of estimate: H.R. 6143 would authorize appropriations 
for the Ryan White program for fiscal years 2007 through 2011. 
The Health Resources and Services Administration (HRSA) under 
the Department of Health and Human Services (HHS) administers 
most of the Ryan White program and works with the Centers for 
Disease Control and Prevention (CDC) and other federal health 
programs to plan and implement federal HIV/AIDS programs.
    Table 2 shows the authorization levels specified in the 
bill. Assuming the appropriation of the specified amounts, CBO 
estimates that implementing the bill would cost $501 million in 
fiscal year 2007 and $9.6 billion over the 2007-2011 period. 
For the purposes of this estimate, CBO assumes the bill will be 
enacted near the beginning of fiscal year 2007 and that outlays 
will follow historical spending rates for the Ryan White 
program.

         TABLE 2.--AUTHORIZATIONS OF APPROPRIATIONS IN H.R. 6143
------------------------------------------------------------------------
                                      By fiscal year, in millions of
                                                 dollars--
                                 ---------------------------------------
                                   2007    2008    2009    2010    2011
------------------------------------------------------------------------
Title I (grants to local             604     626     650     674     699
 governments)...................
Title II (grants to states).....   1,206   1,250   1,295   1,343   1,392
Title III (early intervention        219     227     235     244     253
 services)......................
Title IV (women, infants, and         72      72      72      72      72
 children)......................
Title V (general provisions) \1\  ......  ......  ......  ......  ......
Title VI (demonstration and          179     183     187     191     195
 training)......................
                                 ---------------------------------------
      Total Proposed Changes....   2,279   2,357   2,438   2,523  2,610
------------------------------------------------------------------------
\1\ The bill does not specify any authorization levels for title V. CBO
  estimates that changes to the funding required for activities under
  that title would be negligible.

    Grants to local governments: Title I of the H.R. 6143 would 
modify and authorize provisions in prior law that directed the 
Secretary of Health and Human Services to make two types of 
grants to local governments. Formula grants would be awarded to 
governments in metropolitan areas with a population of at least 
50,000 and at least 500 AIDS cases. Those grants would be 
allocated based on the number of people living with HIV or 
AIDS. The Secretary would award supplemental grants after 
determining that an applicant had demonstrated need for AIDS-
related services.
    For title I grants, the bill would authorize the 
appropriation of $604 million for fiscal year 2007 and $3.3 
billion over the 2007-2011 period. Assuming the appropriation 
of the specified amounts, and based on historical spending 
patterns for the program, CBO estimates that implementing title 
I would cost $133 million in fiscal year 2007 and $2.5 billion 
over the 2007-2011 period.
    Counting HIV/AIDS Cases. Under the prior authorization for 
the Ryan White program, the formula grants were allocated based 
on the number of AIDS cases. The bill would modify the 
allocation formula to include both HIV cases and AIDS cases. 
H.R. 6143 also would apply a uniform national adjustment factor 
in jurisdictions where the reporting system does not produce an 
unduplicated count of HIV/AIDS cases.
    Cap on Core Medical Services. The bill would require 
grantees to spend at least 75 percent of grant funds on primary 
care services and other core medical services. The remaining 
funds could be used for support services needed to achieve 
medical outcomes. That requirement could be waived if the 
grantees' service area does not have a waiting list for the 
AIDS Drug Assistance Program (ADAP) and core medical services 
are available to all individuals with HIV/AIDS.
    Hold-Harmless Provision. H.R. 6143 would establish a hold-
harmless mechanism for grantees that received a formula grant 
for 2006. If the specified amounts are not appropriated for 
fiscal years 2007 through 2009, the bill would require the 
Secretary to reduce funding for supplemental grants, if 
necessary, to maintain formula grants at 95 percent of the 
amount awarded in the previous year.
    Unobligated Balances. The bill would require the recipients 
of supplemental grants to return any unobligated balances to 
the Secretary at the end of the grant year. It also would 
require the recipients of formula grants to return unobligated 
balances at the end of a grant year unless the recipient 
submits a plan to spend those balances in the coming year. 
Funds that remain unexpended for two years must be returned. 
The Secretary would redistribute the returned funds as 
supplemental grants.
    Grants to states: Title II would modify provisions in prior 
law that directed the Secretary to make grants to states and 
territories for medical and support services that are delivered 
primarily through consortia of providers. States also would be 
required to use some of their grant funds to pay for drug 
treatment through ADAP.
    The bill would authorize the appropriation for those grants 
to states of $1.2 billion for fiscal year 2007 and $6.5 billion 
over the 2007-2011 period. Assuming the appropriation of the 
specified amounts, and based on historical spending patterns 
for the program, CBO estimates that implementing title II would 
cost $265 million in fiscal year 2007 and $5.1 billion over the 
2007-2011 period.
    ADAP Minimum Drug List. H.R. 6143 would require the 
Secretary to develop a list of core antiretroviral therapeutics 
to ensure the inclusion of those drugs on the ADAP formulary. 
States could also include other drugs on that formulary. In 
addition, the bill would require that rebates for drugs 
purchased with Ryan White funds be used for activities under 
ADAP.
    Early Diagnosis Grant Program. The bill would authorize CDC 
to make grants to eligible states to pay for certain services 
including HIV/AIDS testing, prevention counseling, and 
treatment of newborns exposed to HIV/AIDS or mothers infected 
with HIV/AIDS. To be eligible for those grants, a state must 
have qualifying early diagnosis program--either voluntary 
testing of pregnant women with universal testing of newborns, 
or voluntary testing of clients at clinics for sexually-
transmitted diseases and at substance-abuse centers.
    Early intervention systems: Title III would authorize HRSA 
to make grants to public and nonprofit entities to pay for 
community-based programs that provide comprehensive primary-
care services aimed at preventing or reducing HIV-related 
morbidity. The bill would require grantees to provide 
counseling and information about hepatitis A, B, and C. It also 
would require grantees to develop an electronic information 
system to improve the grantee's ability to report client-level 
data.
    For those grants, the bill would authorize the 
appropriation of $219 million for fiscal year 2007 and $1.2 
billion over the 2007-2011 period. Assuming the appropriation 
of the specified amounts, and based on historical spending 
patterns for the program, CBO estimates that implementing title 
III would cost $48 million in fiscal year 2007 and $923 million 
over the 2007-2011 period.
    Women, infants, and children: Title IV would authorize HRSA 
to make grants to public and nonprofit entities to improve and 
expand primary care and support services for women, infants, or 
children with HIV/AIDS and for their families.
    For those grants, the bill would authorize the 
appropriation of $72 million for fiscal year 2007 and $359 
million over the 2007-2011 period. Assuming the appropriation 
of the specified amounts, and based on historical spending 
patterns for the program, CBO estimates that implementing title 
IV would cost $16 million in fiscal year 2007 and $286 million 
over the 2007-2011 period.
    General provisions: Title V would require coordination 
among federal HIV programs concerning planning, funding, and 
implementation plans. Those federal programs include HRSA, CDC, 
the Substance Abuse and Mental Health Services Administration, 
and the Centers for Medicare and Medicaid Services. CBO 
estimates the costs of such activities would be negligible.
    Demonstration and training programs: Title VI would 
authorize HRSA to make grants to certain schools and centers 
that conduct HIV/AIDS education and training programs for 
healthcare providers. The bill also would require an evaluation 
to address the disproportionate impact of HIV/AIDS and 
disparities in access, treatment, care, and outcomes for racial 
and ethnic minorities. In addition, the bill would authorize 
grants to support the development of information technology to 
report client-level data and help respond to emerging needs of 
populations served by the Ryan White program.
    For those grants, the bill would authorize the 
appropriation of $179 million for fiscal year 2007 and $935 
million over the 2007-2011 period. Assuming the appropriation 
of the specified amounts, and based on historical spending 
patterns for the program, CBO estimates that implementing title 
VI would cost $39 million in fiscal year 2007 and $737 million 
over the 2007-2011 period.
    Intergovernmental and private-sector impact: H.R. 6143 
contains no private-sector or intergovernmental mandates as 
defined in UMRA. The bill would alter some grant conditions 
related to funding of HIV/AIDS programs, in some cases placing 
new requirements on grant recipients, and in other cases 
affording such recipients greater flexibility in the use of 
these funds. Any costs associated with complying with new grant 
conditions would be incurred voluntarily.
    Estimate prepared by: Federal costs: Camile Williams; 
Impact on State, local, and tribal governments: Leo Lex; Impact 
on the private sector: Noelia Duchovny.
    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

    Section 1 establishes the short title of the Act as the 
``Ryan White HIV/AIDS Treatment Modernization Act of 2006,'' 
and contains the table of contents.

              TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS

Section 101. Establishment of program; general eligibility for grants

    Section 101 maintains the current initial eligibility 
threshold to qualify as an eligible metropolitan area (EMA)--
metropolitan areas (defined as 50,000 or more people) with 
2,000 or more cumulative AIDS cases reported to the Centers for 
Disease Control and Prevention (CDC) in the last five years. 
Eligibility is maintained until a grantee falls below the 
eligibility threshold and below an overall prevalence test 
(3,000 living AIDS cases) in a given year for three consecutive 
years at which time the EMA would move down to the appropriate 
tier or out of Part A funding eligibility.
    Boundaries for currently funded metropolitan areas remain 
as those that applied to the metropolitan area in 1994. 
Boundaries for new metropolitan areas would be determined at 
time of entry. Eligibility for new metropolitan areas shall be 
determined on an annual basis, as per 2607(2).

Section 102. Type and distribution of grants; formula grants

    Section 102 changes the formula distribution from 50 
percent to 66 2/3 percent. The funds are distributed by formula 
based on living names-based HIV (not AIDS) and living names-
based AIDS case counts. The following jurisdictions must use 
their names-based HIV and names-based AIDS case counts for 
purposes of determining their formula funding: Alaska, Alabama, 
Arkansas, Arizona, Colorado, Florida, Indiana, Iowa, Idaho, 
Kansas, Louisiana, Michigan, Minnesota, Missouri, Mississippi, 
North Carolina, North Dakota, Nebraska, New Jersey, New Mexico, 
New York, Nevada, Ohio, Oklahoma, South Carolina, South Dakota, 
Tennessee, Texas, Utah, Virginia, Wisconsin, West Virginia, and 
Wyoming.
    There is a four-year exemption (fiscal years 2007 through 
2010) from the required use of names-based HIV (not AIDS) and 
living names-based AIDS case counts for all other States, if 
certain conditions are met. These code-based jurisdictions may 
use their reported code-based counts of living HIV (not AIDS), 
adjusted by the national duplication rate of five percent, in 
lieu of the names-based HIV counts, if: (1) the State will by 
October 1, 2006, have submitted a transition plan for reporting 
names-based HIV counts (as accepted by the Director of CDC) or 
(2) not later than October 1, 2006, the State will have made 
all necessary statutory changes to allow for the collection of 
names-based HIV data (as accepted by the Director of CDC); and 
by April 1, 2008, begin reporting names-based HIV counts (as 
determined by the Director of CDC). This exemption is not 
available for formula distribution for fiscal year 2011 or any 
subsequent fiscal year since all funding will be based on 
names-based living HIV (not AIDS) and living AIDS cases. In 
addition, a code-based State may not receive more than a five 
percent increase over the preceding fiscal year.
    For Part A entities that cross State boundaries, the cases 
for each State will be treated as per the status for that 
State. For example, the District of Columbia EMA, which crosses 
the District of Columbia, Maryland, and Virginia, and the cases 
within the District of Columbia and Maryland would be treated 
under the exemption, while the names-based cases for Virginia 
would be counted.
    The Secretary will reexamine the readiness of a State to 
switch from exemption status to counting only names-based 
counts on an annual basis. This determination must be made by 
the beginning of the fiscal year in consultation with the chief 
executive of the State in which the area is located. The 
Secretary will carry out a program to monitor the reporting of 
names-based cases and to detect instances of inaccurate 
reporting, including fraudulent reporting.
    Section 102 also changes the hold-harmless provisions under 
current law. Under section 102, hold-harmless would apply to 
all EMAs for fiscal years 2007 through 2009 at 95 percent of 
the formula amount of the previous fiscal year. The hold-
harmless will not be applicable after 2009. In allocating funds 
for the hold-harmless provisions, the funding will first come 
from the Part A supplemental grant pool. Once the funds from 
the Part A supplemental grant pool are exhausted, then there 
will be a pro rata reduction across all EMAs.

Section 103. Type and distribution of grants; supplemental grants

    Section 103 changes the criteria for awarding Part A 
supplemental grants. All references to ``severe need'' in 
current law are changed to ``demonstrated need.'' Factors of 
demonstrated need may include: (1) unmet need for such 
services, as determined under Section 2602(b)(4) or other 
community input process as defined under Section 2609(d)(1)(A); 
(2) an increasing need for HIV/AIDS-related services, including 
relative rates of increase in the number of HIV/AIDS; (3) the 
relative rates of increase in the number of cases of HIV/AIDS 
within new or emerging subpopulations; (4) the current 
prevalence of HIV/AIDS; (5) relevant factors related to the 
cost and complexity of delivering health care to individuals 
with HIV/AIDS in the eligible area; (6) the impact of co-morbid 
factors, including co-occurring conditions, determined relevant 
by the Secretary; (7) the prevalence of homelessness; (8) the 
prevalence of individuals who were Federal, State, or local 
prisoners and released from the custody of the penal system 
during the preceding three years with HIV disease as of the 
date of release; (9) the relevant factors that limit access to 
health care, including geographic variation, adequacy of health 
insurance coverage, and language barriers; and (10) the impact 
of a decline in the amount received under the formula grant on 
services available to all individuals with HIV/AIDS identified 
and eligible under the title.
    In making the supplemental grant awards, the Secretary 
shall give priority to the area to address the decline in 
services related to the decline in the amounts received in the 
formula grant consistent with the grant award for the eligible 
area for fiscal year 2006, to the extent that factor (10) above 
relating to a decline in funding applies to the eligible area.
    Grantees must also demonstrate the ability to expend funds 
efficiently by not having had more than two percent of grant 
funds under such subsection canceled or covered by any waivers 
for the most recent grant year.

Section 104. Timeframe for obligation and expenditure of grant funds

    Section 104 provides the timeframe for obligation and 
expenditure of grant funds. The obligation of funds must be 
made by the end of the grant year. The Secretary shall cancel 
any unobligated supplemental funds at the end of the grant year 
and the returned funds shall be made available by the Secretary 
as additional amounts for grants. Any eligible area that has 
unobligated formula funds is required to return the funds to 
the Secretary or submit a waiver application describing how 
they intend to use the funds in the succeeding grant year. If 
the funds are not expended in the following grant year they 
will be returned to the Secretary and redistributed as 
supplemental grants. The Secretary may adjust the grant amount 
to reflect the amount of unexpended and uncanceled grant funds 
that remain at the end of a fiscal year above two percent of 
the formula grant award.

Section 105. Use of amounts

    Section 105 sets forth the requirements for how eligible 
areas must use funds. Funds provided under this section may be 
expended only for core medical services, support services, and 
administrative expenses. Not less than 75 percent of funds must 
be spent on the defined core medical services. The remaining 25 
percent, subject to the approval of the Secretary, may be used 
for support services (not defined) needed to achieve medical 
outcomes (therein ``75/25 requirement''). Medical outcome is 
defined as those outcomes affecting the HIV-related clinical 
status of an individual with HIV/AIDS. The 75/25 requirement 
shall be waived by the Secretary if, in the grantee's service 
area: (1) there are not waiting lists for the AIDS Drug 
Assistance Program (ADAP) services; and (2) core medical 
services are available to all individuals with HIV/AIDS. 
However, if the requirement is thereby waived, the funds are 
still subject to the approval of the Secretary and must be 
needed to achieve medical outcomes. A grantee may not spend 
more that 10 percent on administrative costs (includes 
activities carried out by planning councils), which is applied 
before the 75/25 requirement.
    The section also specifies that not less than the 
percentage based on the ratio of Women, Infants, Children, and 
Youth with HIV/AIDS to the general population of HIV/AIDS 
should be given for each grant made unless an area can 
demonstrate that the population involved is receiving HIV-
related health services through the State Medicaid program, the 
State Children's Health Insurance Program, or other Federal or 
State programs. The section also maintains the current law 
provisions regarding funds used for clinical quality management 
programs. These funds may be applied before the 75/25 
requirement.

Section 106. Additional amendments to Part A

    Section 106 provides additional amendments to Part A. It 
requires that planning councils include representation from 
members of a federally recognized Indian tribe and individuals 
with hepatitis B or C co-infection, when appropriate. It 
exempts the Indian Health Service from the payer of last resort 
provision. It requires that the chief elected official, 
responsible for the Part A grant, submit to the lead State 
agency audits regarding its expended funds every two years. In 
addition, the section provides for better coordination. As part 
of the grant application, a grantee will: (1) need to provide a 
narrative about how the activities are coordinated with the 
State and other grantees within that State; and (2) specify how 
the expenditures under the grant will improve overall outcomes 
(as outlined by the State) or through additional outcome 
measures.

Section 107. New program in Part A; Transitional grants for certain 
        areas ineligible under section 2601

    Section 107 establishes a new eligible entity for Part A 
funds--Transitional areas. These entities are eligible to 
receive Part A Transitional area funds if there are 1,000-1999 
cumulative AIDS cases in a metropolitan area (50,000 or more 
people) reported in the last five years. Grandfathered EMAs are 
automatically classified as Transitional areas for fiscal year 
2007. Eligibility is maintained until a grantee falls below the 
eligibility threshold and below an overall prevalence test 
(1,500 living AIDS cases) for three consecutive years at which 
time it would no longer be eligible for Part A funding. 
Eligibility to become an EMA or new Transitional area in Part A 
is determined on an annual basis. Formula funding and $500,000 
from the supplemental grant pool moves with the grantee into 
the Part B base formula pool if the grantee no longer qualifies 
as a Part A eligible area. If the Transitional area becomes 
eligible for EMA funding under Part A, the formula funding 
follows the areas into the EMA formula funding pool. Boundaries 
are defined as the boundaries established for the Transitional 
area at the time of initial funding under Ryan White for new 
grantees under Part A. For entities that received funding 
previously from Part A, the boundaries are as they were in 
1994.
    Planning councils are voluntary, except for 
``grandfathered'' EMAs for fiscal years 2007 through 2009. 
After fiscal year 2009, the chief elected official can opt not 
to have a planning council, but must demonstrate that he/she 
consulted with individuals with HIV in formulating the overall 
plan for spending the funding.
    Hold-harmless provisions for EMAs under Part A do not apply 
for Transitional areas. One-third of all Part A funds (EMA and 
Transitional areas) will be pooled together for supplemental 
funding and two-thirds will be distributed by formula. The same 
provision under Section 104 regarding the timeframe for 
obligation and expenditure of grant funds applies to 
Transitional areas.

Section 108. Authorization of appropriations for Part A

    Section 108 authorizes a 3.7 percent increase in 
authorization levels for each of fiscal years 2008-2011. Fiscal 
year 2007 is the base year. As described in Sections 101 and 
107, if an eligible area falls from EMA to Transitional area 
status, its formula funding moves with it to the formula 
funding pool for Transitional areas. If an eligible area moves 
between Part A and Part B, then its formula funding and 
$500,000 from the Part A supplemental grant pool would move 
from the Part A supplemental grant pool into the Part B base 
formula funding.

                         TITLE II--CARE GRANTS

Section 201. General use of grants

    Section 201 includes the same 75/25 requirement for core 
medical services for States receiving Part B grants as section 
105 for Part A grants. Additionally, expenditures of grants for 
or through consortia are deemed to be support services, not 
core medical services. Section 201 also includes the same 
requirement that a grantee may not spend more that 10 percent 
on administrative costs (includes activities carried out by 
planning councils), which is applied before the 75/25 
requirement. This section also includes the same provisions 
regarding priority for women, infants, children, and youth with 
HIV/AIDS and use of funds for clinical quality management 
programs.

Section 202. AIDS Drug Assistance Program

    Section 202 establishes a minimum drug list that includes 
the classes of drugs under the Public Health Service guidelines 
for core antiretroviral (ARV) therapeutics. It ensures that 
rebates for drugs purchased with Ryan White funds must be 
redirected to activities under the program.

Section 203. Distribution of funds

    Section 203 changes the current funding distribution as 
follows: for fiscal years 2007 through 2011, 0.75 instead of 
0.80 is calculated for all of the HIV/AIDS cases in the State; 
0.20 is calculated based on all of the HIV/AIDS cases that are 
not counted for purposes of receiving Part A funds, and 0.05 is 
calculated for all of the HIV/AIDS cases for States not 
receiving any Part A funds (therein the ``75-20-5 distribution 
factor'').
    The same requirements for counting names-based HIV and AIDS 
case counts, including exemptions from the requirements that 
were set forth in Section 102 apply to the distribution of 
formula funds under this section. Code-based States' gains are 
capped at 5 percent over the previous fiscal year.
    This section provides movement towards collection of 
client-level data and the creation of a Severity of Need Index 
(SONI). If, by January 1, 2010, the Secretary notifies 
appropriate committees of Congress that a new SONI is ready, 
75-20-5 distribution factor is eliminated and the new SONI will 
be used for formula allocations in fiscal year 2011, subject to 
the Congressional Review Act. The Secretary shall notify the 
appropriate committee of Congress that the Secretary has 
developed a SONI by January 1, 2012, and the SONI will replace 
the 75-20-5 funding distribution factor for fiscal year 2013, 
subject to the Congressional Review Act. The Secretary must 
provide the following information regarding the methodology and 
rationale behind developing the SONI and an independent 
contractor analysis this, as well as expected changes in 
funding allocations, information regarding community input and 
the timeline and process for implementation. This section 
requires annual reports from the Health Resources and Services 
Administration (HRSA) about their progress toward obtaining 
client level data and developing SONI.
    This section also increases the ADAP supplemental fund pool 
from 3 percent to 5 percent and no hold-harmless provisions are 
drawn from the ADAP supplemental pool. A State is eligible if 
the State did not have unobligated funds subject to 
reallocation in the previous fiscal year and demonstrates 
severe need for the grant. The Secretary shall consider certain 
specified criteria when determining need. A State cannot 
receive a demonstrated need supplemental award unless it makes 
available non-federal contributions in an amount equal to $1 
for each $4 of Federal funds provided for the grant. The 
Secretary shall waive the match for the severe need 
supplemental award, as long as the State provided its Part B 
base formula match.
    This section provides for a hold-harmless for States for 
fiscal years 2007 through 2009 at 95 percent of the formula 
amount of the previous fiscal year. The Part B overall hold-
harmless is triggered when the sum of the amounts received in 
the ADAP base award and Part B base formula award equals less 
than 95 percent of the previous year's award. In allocating 
funds for the hold-harmless provisions, the funding will first 
be deducted from the Part B (not ADAP) supplemental pool. Once 
the funds from the Part B (not ADAP) supplemental pool are 
exhausted, then there will be a pro rata reduction, removing 
from those reductions those States needing the hold-harmless 
provisions and States receiving the small state minimum.

Section 204. Additional amendments to subpart I of Part B

    Section 204 provides additional amendments to subpart I of 
Part B. It requires States to designate a lead State agency 
that administers all assistance received; conducts a needs 
assessment and prepares a State plan; prepares all 
applications; receives notices regarding programs; collects and 
submits to the Secretary every two years all audits from 
grantees within the State, including an audit regarding funds 
expended; carries out any other duties determined by the 
Secretary to facilitate the coordination of the program. Each 
grant application submitted must include key outcomes to be 
measured by all entities in the State receiving assistance 
under Part B.
    This section also requires representation by Federally 
recognized Indian tribes in the planning process and exempts 
the Indian Health Service from the payer of last resort 
provision.

Section 205. Supplemental grants on basis of demonstrated need

    Section 205 creates a new Part B base supplemental grant 
pool with enumerated criteria for determining whether a State 
has a demonstrated need for supplemental awards as under 
Section 103. It also provides for the prioritization of a 
supplemental grant award for States that meet the criteria set 
forth in the section, similar to that provided under Section 
103.

Section 206. Emerging communities

    Section 206 clarifies that grants received will be used to 
provide funds directly to Emerging Communities and are separate 
from Part B funds. Eligibility to be an Emerging Community is 
500-999 cumulative AIDS cases reported in the last five years. 
Eligibility would be maintained until a grantee went below the 
eligibility threshold and below an overall prevalence test (750 
living AIDS cases) for three consecutive years, at which time 
it would become ineligible.

Section 207. Timeframe for obligation and expenditure of grant funds

    Section 207 has the same provisions in Section 104 
regarding the timeframe for obligation and expenditure of 
funds, except that unobligated funds are reallocated to the 
Part B supplemental grant pool.

Section 208. Authorization of appropriations for subpart I of Part B

    Section 208 provides an increase of $70 million in 
authorized funds for fiscal year 2007 and a 3.7 percent 
increase in authorization levels for each of fiscal years 2008 
through 2011. Five million dollars of the authorized 
appropriations are set aside each year of the reauthorization 
for Emerging Communities. The new Part B base supplemental 
grant pool is funded by setting aside one-third of any 
additional funds appropriated for Part B base (not ADAP) over 
the fiscal year 2006 level.

Section 209. Early Diagnosis Grant Program

    Section 209 authorizes $30 million for fiscal years 2007 
through 2011 for the new Early Diagnosis Grant Program awards. 
Twenty million dollars of this amount shall be distributed to 
those States that offer voluntary opt-out testing of pregnant 
women and universal testing of newborns. Ten million dollars of 
this amount shall be distributed to those States that offer 
voluntary opt-out testing of clients at sexually transmitted 
disease clinics and voluntary opt-out testing of clients at 
substance abuse treatment centers.

Section 210. Certain partner notification programs; authorization of 
        appropriations

    Section 210 authorizes $10 million for each of fiscal years 
2007 through 2011 for certain partner notification programs.

                 TITLE III--EARLY INTERVENTION SERVICES

Section 301. Establishment of program; core medical services

    Section 301 provides for grants to certain public and 
nonprofit entities and applies the same 75/25 requirement for 
core medical services and the same administrative expense cap 
(including the provision regarding funds used for the clinical 
quality management program) contained in sections 105 and 201.

Section 302. Eligible Entities; Preferences; Planning and Development 
        Grants

    Section 302 provides a defined list of eligible entities 
for purposes of awarding Part C grants. It specifies that Part 
C grantees serve underserved populations and provides examples 
of these populations. It adds to the preference in making 
grants the number of cases of individuals co-infected with HIV/
AIDS and hepatitis B or C as a consideration.

Section 303. Authorization of appropriations

    Section 303 provides an increase of $25 million in 
authorized fund for fiscal year 2007 and authorizes a 3.7 
percent increase in authorization levels for each of fiscal 
years 2008 through 2011.

Section 304. Confidentiality and informed consent

    Section 304 includes provisions regarding the 
confidentiality of information regarding the receipt of early 
intervention services, and use of informed consent.

Section 305. Provision of certain counseling services

    Section 305 includes provisions regarding the counseling of 
individuals with negative HIV/AIDS test results, as well as the 
counseling of individuals with positive HIV/AIDS test results. 
It also includes a provision regarding the counseling of 
emergency response employees.

Section 306. General provisions

    Section 306 requires Part C grantees to submit information 
on how grant expenditures are related to the planning process 
for eligible areas funded under Part A and States funded under 
Part B, as well as how grant expenditures will improve overall 
client outcomes. The grant applicant must agree to provide 
additional documentation on how the community provided input 
into the proposed grant activities. The applicant must also 
agree to submit, to the lead State agency, audits every two 
years regarding fund expenditures and the necessary client-
level data to complete unmet need calculations and Statewide 
coordinated statements of need process.
    This section also exempts the Indian Health Service from 
the payer of last resort provision.

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

Section 401. Women, infants, children, and youth

    Section 401 clarifies that a health facility operated by or 
pursuant to a contract with the Indian Health Service is 
eligible as a direct grantee. It also clarifies that the 
current focus of the Title IV activities is on family-centered 
care (not research), while still maintaining a strong link with 
the research community. It specifies that the applicant must 
coordinate with other providers of health care services and 
dictates that every grantee must submit an audit regarding 
funds expended to their State every two years. Administrative 
expenses are capped at 10 percent (funds used for clinical 
quality management programs are not included in this cap). No 
more than five percent of funds may be used to provide training 
and technical assistance to grantees. Grantees must complete an 
annual review and evaluation of Part D programs. This section 
authorizes $71.8 million for each of fiscal years 2007-2011.

Section 402. GAO report

    Section 402 requires the Government Accountability Office 
(GAO) to conduct an evaluation, and submit to Congress a 
report, concerning the funding provided under Part D.

                      TITLE V--GENERAL PROVISIONS

Section 501. General provisions

    Section 501 requires coordination among Federal agencies 
for planning, funding, and implementing Federal HIV programs. 
It requires States and local government and private nonprofits 
to ensure Ryan White services are integrated with other 
programs. It requires every grantee to submit an audit to its 
State (or, in the case of a State, to the Secretary) every 
other year. Audits will be posted on the Internet.
    This section also provides the Secretary with flexibility 
to ensure individuals receiving services through this program 
have access to care in the case of a public health emergency or 
equivalent thereof. It requires the Secretary to ensure that 
any information submitted to, or collected by, the Secretary 
excludes any personally identifiable information.
    The section requires GAO to submit biennially to the 
appropriate committees of Congress a report that includes a 
description of Federal, State, and local barriers to HIV 
program integration, particularly for racial and ethnic 
minorities, and recommendations for enhancing the continuity of 
care.

                  TITLE VI--DEMONSTRATION AND TRAINING

Section 601. Demonstrations and training

    Section 601 requires the SPNS program to focus on: (1) 
development of health information technology systems to support 
client-level data, as it relates to the severity of need index; 
and (2) responding to emerging needs of populations served by 
Ryan White. Twenty million dollars is allocated for development 
of health information technology systems and $5 million is 
allocated for emerging needs.

Section 602. AIDS education and training centers

    Section 602 provides a preference to projects that train 
health professionals to provide treatment to Native American 
HIV/AIDS patients. It also clarifies that training of health 
professionals may be related to hepatitis B and C.
    This section authorizes $34,700,000 for each of fiscal 
years 2007 through 2011 for schools and centers and $13,000,000 
for each of fiscal years for 2007 through 2011 for dental 
schools.

Section 603. Codification of Minority AIDS Initiative

    Section 603 codifies the Minority AIDS Initiative and 
provides a 3.7% annual increase in authorization levels for 
each of fiscal years 2008 through 2011.

                  TITLE VII--MISCELLANEOUS PROVISIONS

Section 701. Hepatitis; use of funds

    Section 701 specifies that information shall be provided on 
the transmission and prevention of hepatitis A, B, and C, 
including education about the availability of hepatitis A and B 
vaccines and assisting patients in identifying vaccination 
sites.

Section 702. Certain definitions

    Section 702 includes definitions of certain references 
throughout the bill.

         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

                  Subpart I--General Grant Provisions

SEC. 2601. ESTABLISHMENT OF PROGRAM OF GRANTS.

  (a) Eligible Areas.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, shall, subject to subsections (b) [through (d)] 
through (c), make grants in accordance with section 2603 for 
the purpose of assisting in the provision of the services 
specified in section 2604 in any metropolitan area for which 
there has been reported to and confirmed by the Director of the 
Centers for Disease Control and Prevention a cumulative total 
of more than 2,000 cases of [acquired immune deficiency 
syndrome for the most recent period] AIDS during the most 
recent period of 5 calendar years for which such data are 
available.
  [(b) Requirement Regarding Confirmation of Cases.--The 
Secretary may not make a grant under subsection (a) for a 
metropolitan area unless, before making any payments under the 
grant, the cases of acquired immune deficiency syndrome 
reported for purposes of such subsection have been confirmed by 
the Secretary, acting through the Director of the Centers for 
Disease Control and Prevention.
  [(c) Requirements Regarding Population.--
          [(1) Number of individuals.--
                  [(A) In general.--Except as provided in 
                subparagraph (B), the Secretary may not make a 
                grant under this section for a metropolitan 
                area unless the area has a population of 
                500,000 or more individuals.
                  [(B) Limitation.--Subparagraph (A) does not 
                apply to any metropolitan area that was an 
                eligible area under this part for fiscal year 
                1995 or any prior fiscal year.
          [(2) Geographic boundaries.--For purposes of 
        eligibility under this part, the boundaries of each 
        metropolitan area are the boundaries that were in 
        effect for the area for fiscal year 1994.
  [(d) Continued Status as Eligible Area.--Notwithstanding any 
other provision of this section, a metropolitan area that was 
an eligible area under this part for fiscal year 1996 is an 
eligible area for fiscal year 1997 and each subsequent fiscal 
year.]
  (b) Continued Status as Eligible Area.--Notwithstanding any 
other provision of this section, a metropolitan area that is an 
eligible area for a fiscal year continues to be an eligible 
area until the metropolitan area fails, for three consecutive 
fiscal years--
          (1) to meet the requirements of subsection (a); and
          (2) to have a cumulative total of 3,000 or more 
        living cases of AIDS (reported to and confirmed by the 
        Director of the Centers for Disease Control and 
        Prevention) as of December 31 of the most recent 
        calendar year for which such data is available.
  (c) Boundaries.--For purposes of determining eligibility 
under this part--
          (1) with respect to a metropolitan area that received 
        funding under this part in fiscal year 2006, the 
        boundaries of such metropolitan area shall be the 
        boundaries that were in effect for such area for fiscal 
        year 1994; or
          (2) with respect to a metropolitan area that becomes 
        eligible to receive funding under this part in any 
        fiscal year after fiscal year 2006, the boundaries of 
        such metropolitan area shall be the boundaries that are 
        in effect for such area when such area initially 
        receives funding under this part.

SEC. 2602. ADMINISTRATION AND PLANNING COUNCIL.

  (a) Administration.--
          (1) In general.--Assistance made available under 
        grants awarded under [this part] this subpart shall be 
        directed to the chief elected official of the city or 
        urban county that administers the public health agency 
        that provides outpatient and ambulatory services to the 
        greatest number of individuals with AIDS, as reported 
        to and confirmed by the Centers for Disease Control and 
        Prevention, in the eligible area that is awarded such a 
        grant.

           *       *       *       *       *       *       *

  (b) Hiv Health Services Planning Council.--
          (1) Establishment.--To be eligible for assistance 
        under [this part] this subpart, 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 population of individuals with [HIV disease] 
        HIV/AIDS 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] HIV/AIDS, members of a 
                Federally recognized Indian tribe as 
                represented in the population, individuals co-
                infected with hepatitis B or C and historically 
                underserved groups and subpopulations;

           *       *       *       *       *       *       *

                  (M) representatives of individuals who 
                formerly were Federal, State, or local 
                prisoners, were released from the custody of 
                the penal system during the preceding 3 years, 
                and had [HIV disease] HIV/AIDS as of the date 
                on which the individuals were so released.

           *       *       *       *       *       *       *

          (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] HIV/AIDS;
                  (B) determine the needs of such population, 
                with particular attention to--
                          (i) individuals with [HIV disease] 
                        HIV/AIDS who know their HIV status and 
                        are not receiving HIV-related services; 
                        and

           *       *       *       *       *       *       *

                  (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) size and demographics of the 
                        population of individuals with [HIV 
                        disease] HIV/AIDS (as determined under 
                        subparagraph (A)) and the needs of such 
                        population (as determined under 
                        subparagraph (B));

           *       *       *       *       *       *       *

                          (iii) priorities of the communities 
                        with [HIV disease] HIV/AIDS for whom 
                        the services are intended;

           *       *       *       *       *       *       *

                          (v) availability of other 
                        governmental and non-governmental 
                        resources, including the State medicaid 
                        plan under title XIX of the Social 
                        Security Act and the State Children's 
                        Health Insurance Program under title 
                        XXI of such Act to cover health care 
                        costs of eligible individuals and 
                        families with [HIV disease] HIV/AIDS; 
                        and

           *       *       *       *       *       *       *

                  (D) develop a comprehensive plan for the 
                organization and delivery of health and support 
                services described in section 2604 that--
                          (i) * * *

           *       *       *       *       *       *       *

                          (iii) is compatible with any State or 
                        local plan for the provision of 
                        services to individuals with [HIV 
                        disease] HIV/AIDS;

           *       *       *       *       *       *       *

          (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] HIV/AIDS 
                        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.

           *       *       *       *       *       *       *

          (6) Grievance procedures.--A planning council under 
        paragraph (1) shall develop procedures for addressing 
        grievances with respect to funding under [this part] 
        this subpart, including procedures for submitting 
        grievances that cannot be resolved to binding 
        arbitration. Such procedures shall be described in the 
        by-laws of the planning council and be consistent with 
        the requirements of subsection (c).

           *       *       *       *       *       *       *

  (c) Grievance Procedures.--
          (1) Federal responsibility.--
                  (A) Models.--The Secretary shall, through a 
                process that includes consultations with 
                grantees under [this part] this subpart and 
                public and private experts in grievance 
                procedures, arbitration, and mediation, develop 
                model grievance procedures that may be 
                implemented by the planning council under 
                subsection (b)(1) and grantees under [this 
                part] this subpart. Such model procedures shall 
                describe the elements that must be addressed in 
                establishing local grievance procedures and 
                provide grantees with flexibility in the design 
                of such local procedures.
                  (B) Review.--The Secretary shall review 
                grievance procedures established by the 
                planning council and grantees under [this part] 
                this subpart to determine if such procedures 
                are adequate. In making such a determination, 
                the Secretary shall assess whether such 
                procedures permit legitimate grievances to be 
                filed, evaluated, and resolved at the local 
                level.
          (2) Grantees.--To be eligible to receive funds under 
        [this part] this subpart, a grantee shall develop 
        grievance procedures that are determined by the 
        Secretary to be consistent with the model procedures 
        developed under paragraph (1)(A). Such procedures shall 
        include a process for submitting grievances to binding 
        arbitration.
  (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] HIV/
AIDS), the Secretary, in consultation with planning councils 
and entities that receive amounts from grants under section 
2601(a) or 2611, shall develop epidemiologic measures--
          (1) for establishing the number of individuals living 
        with [HIV disease] HIV/AIDS who are not receiving HIV-
        related health services; and

           *       *       *       *       *       *       *


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] this subpart 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] 66\2/3\ percent 
        of the amount made available under section 2610(b) for 
        carrying out this subpart for such fiscal year through 
        grants to eligible areas under section 2601(a), in 
        accordance with [paragraph (3)] paragraphs (3) and (4). 
        [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) In general.--Subject to the extent of 
                amounts made available in appropriations Acts, 
                a grant made for purposes of this paragraph to 
                an eligible area shall be made in an amount 
                equal to the product of--
                          (i) * * *
                          (ii) the percentage constituted by 
                        the ratio of the distribution factor 
                        for the eligible area to the sum of the 
                        respective distribution factors for all 
                        eligible areas.which product shall 
                        then, as applicable, be increased under 
                        paragraph (4)[.];
                which product shall then, as applicable, be 
                increased under paragraph (4).
                  (B) Distribution factor.--For purposes of 
                subparagraph (A)(ii), the term ``distribution 
                factor'' means an amount equal to the 
                [estimated number of living cases of acquired 
                immune deficiency syndrome] living cases of 
                HIV/AIDS (reported to and confirmed by the 
                Director of the Centers for Disease Control and 
                Prevention) in the eligible area involved, as 
                determined under subparagraph (C).
                  [(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) the first year during 
                                such period, .06;
                                  [(II) the second year during 
                                such period, .06;
                                  [(III) the third year during 
                                such period, .08;
                                  [(IV) the fourth year during 
                                such period, .10;
                                  [(V) the fifth year during 
                                such period, .16;
                                  [(VI) the sixth year during 
                                such period, .16;
                                  [(VII) the seventh year 
                                during such period, .24;
                                  [(VIII) the eighth year 
                                during such period, .40;
                                  [(IX) the ninth year during 
                                such period, .57; and
                                  [(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).
                          [(ii) Effect of adverse 
                        determination.--If under clause (i) the 
                        Secretary determines that data on cases 
                        of HIV disease is not sufficiently 
                        accurate and reliable for use for 
                        purposes of subparagraph (C)(i), then 
                        notwithstanding such subparagraph, for 
                        any fiscal year prior to fiscal year 
                        2007 the references in such 
                        subparagraph to cases of HIV disease do 
                        not have any legal effect.
                          [(iii) Grants and technical 
                        assistance regarding counting of hiv 
                        cases.--Of the amounts appropriated 
                        under section 318B for a fiscal year, 
                        the Secretary shall reserve amounts to 
                        make grants and provide technical 
                        assistance to States and eligible areas 
                        with respect to obtaining data on cases 
                        of HIV disease to ensure that data on 
                        such cases is available from all States 
                        and eligible areas as soon as is 
                        practicable but not later than the 
                        beginning of fiscal year 2007.
                  [(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.]
                  (C) Living cases of HIV/AIDS.--
                          (i) Requirement of names-based 
                        reporting.--Except as provided in 
                        clause (ii), the number determined 
                        under this subparagraph for an eligible 
                        area for a fiscal year for purposes of 
                        subparagraph (B) is the number of 
                        living names-based cases of HIV/AIDS 
                        that, as of December 31 of the most 
                        recent calendar year for which such 
                        data is available, have been reported 
                        to and confirmed by the Director of the 
                        Centers for Disease Control and 
                        Prevention.
                          (ii) Transition period; exemption 
                        regarding non-aids cases.--For each of 
                        the fiscal years 2007 through 2010, an 
                        eligible area is, subject to clauses 
                        (iii) through (v), exempt from the 
                        requirement under clause (i) that 
                        living names-based non-AIDS cases of 
                        HIV be reported unless--
                                  (I) a system was in operation 
                                as of December 31, 2005, that 
                                provides sufficiently accurate 
                                and reliable names-based 
                                reporting of such cases 
                                throughout the State in which 
                                the area is located, subject to 
                                clause (viii); or
                                  (II) no later than the 
                                beginning of fiscal year 2008, 
                                2009, or 2010, the Secretary, 
                                in consultation with the chief 
                                executive of the State in which 
                                the area is located, determines 
                                that a system has become 
                                operational in the State that 
                                provides sufficiently accurate 
                                and reliable names-based 
                                reporting of such cases 
                                throughout the State.
                          (iii) Requirements for exemption for 
                        fiscal year 2007.--For fiscal year 
                        2007, an exemption under clause (ii) 
                        for an eligible area applies only if, 
                        by October 1, 2006--
                                  (I)(aa) the State in which 
                                the area is located had 
                                submitted to the Secretary a 
                                plan for making the transition 
                                to sufficiently accurate and 
                                reliable names-based reporting 
                                of living non-AIDS cases of 
                                HIV; or
                          (bb) all statutory changes necessary 
                        to provide for sufficiently accurate 
                        and reliable reporting of such cases 
                        had been made; and
                                  (II) the State had agreed 
                                that, by April 1, 2008, the 
                                State will begin accurate and 
                                reliable names-based reporting 
                                of such cases, except that such 
                                agreement is not required to 
                                provide that, as of such date, 
                                the system for such reporting 
                                be fully sufficient with 
                                respect to accuracy and 
                                reliability throughout the 
                                area.
                          (iv) Requirement for exemption as of 
                        fiscal year 2008.--For each of the 
                        fiscal years 2008 through 2010, an 
                        exemption under clause (ii) for an 
                        eligible area applies only if, as of 
                        April 1, 2008, the State in which the 
                        area is located is substantially in 
                        compliance with the agreement under 
                        clause (iii)(II).
                          (v) Progress toward names-based 
                        reporting.--For fiscal year 2009 or 
                        2010, the Secretary may terminate an 
                        exemption under clause (ii) for an 
                        eligible area if the State in which the 
                        area is located submitted a plan under 
                        clause (iii)(I)(aa) and the Secretary 
                        determines that the State is not 
                        substantially following the plan.
                          (vi) Counting of cases in areas with 
                        exemptions.--
                                  (I) In general.--With respect 
                                to an eligible area that is 
                                under a reporting system for 
                                living non-AIDS cases of HIV 
                                that is not names-based 
                                (referred to in this 
                                subparagraph as ``code-based 
                                reporting''), the Secretary 
                                shall, for purposes of this 
                                subparagraph, modify the number 
                                of such cases reported for the 
                                eligible area in order to 
                                adjust for duplicative 
                                reporting in and among systems 
                                that use code-based reporting.
                                  (II) Adjustment rate.--The 
                                adjustment rate under subclause 
                                (I) for an eligible area shall 
                                be a reduction of 5 percent in 
                                the number of living non-AIDS 
                                cases of HIV reported for the 
                                area.
                          (vii) Multiple political 
                        jurisdictions.--With respect to living 
                        non-AIDS cases of HIV, if an eligible 
                        area is not entirely within one 
                        political jurisdiction and as a result 
                        is subject to more than one reporting 
                        system for purposes of this 
                        subparagraph:
                                  (I) Names-based reporting 
                                under clause (i) applies in a 
                                jurisdictional portion of the 
                                area, or an exemption under 
                                clause (ii) applies in such 
                                portion (subject to applicable 
                                provisions of this 
                                subparagraph), according to 
                                whether names-based reporting 
                                or code-based reporting is used 
                                in such portion.
                                  (II) If under subclause (I) 
                                both names-based reporting and 
                                code-based reporting apply in 
                                the area, the number of code-
                                based cases shall be reduced 
                                under clause (vi).
                          (viii) List of eligible areas meeting 
                        standard regarding December 31, 2005.--
                                  (I) In general.--If an 
                                eligible area or portion 
                                thereof is in a State specified 
                                in subclause (II), the eligible 
                                area or portion shall be 
                                considered to meet the standard 
                                described in clause (ii)(I). No 
                                other eligible area or portion 
                                thereof may be considered to 
                                meet such standard.
                                  (II) Relevant states.--For 
                                purposes of subclause (I), the 
                                States specified in this 
                                subclause are the following: 
                                Alaska, Alabama, Arkansas, 
                                Arizona, Colorado, Florida, 
                                Indiana, Iowa, Idaho, Kansas, 
                                Louisiana, Michigan, Minnesota, 
                                Missouri, Mississippi, North 
                                Carolina, North Dakota, 
                                Nebraska, New Jersey, New 
                                Mexico, New York, Nevada, Ohio, 
                                Oklahoma, South Carolina, South 
                                Dakota, Tennessee, Texas, Utah, 
                                Virginia, Wisconsin, West 
                                Virginia, Wyoming, Guam, and 
                                the Virgin Islands.
                          (ix) Rules of construction regarding 
                        acceptance of reports.--
                                  (I) Cases of aids.--With 
                                respect to an eligible area 
                                that is subject to the 
                                requirement under clause (i) 
                                and is not in compliance with 
                                the requirement for names-based 
                                reporting of living non-AIDS 
                                cases of HIV, the Secretary 
                                shall, notwithstanding such 
                                noncompliance, accept reports 
                                of living cases of AIDS that 
                                are in accordance with such 
                                clause.
                                  (II) Applicability of 
                                exemption requirements.--The 
                                provisions of clauses (ii) 
                                through (viii) may not be 
                                construed as having any legal 
                                effect for fiscal year 2011 or 
                                any subsequent fiscal year, and 
                                accordingly, the status of a 
                                State for purposes of such 
                                clauses may not be considered 
                                after fiscal year 2010.
                          (x) Program for detecting inaccurate 
                        or fraudulent counting.--The Secretary 
                        shall carry out a program to monitor 
                        the reporting of names-based cases for 
                        purposes of this subparagraph and to 
                        detect instances of inaccurate 
                        reporting, including fraudulent 
                        reporting.
                  (D) Code-based areas; limitation on increase 
                in grant .--
                          (i) In general.--For each of the 
                        fiscal years 2007 through 2010, if 
                        code-based reporting (within the 
                        meaning of subparagraph (C)(vi)) 
                        applies in an eligible area or any 
                        portion thereof as of the beginning of 
                        the fiscal year involved, then 
                        notwithstanding any other provision of 
                        this paragraph, the amount of the grant 
                        pursuant to this paragraph for such 
                        area for such fiscal year may not--
                                  (I) for fiscal year 2007, 
                                exceed by more than 5 percent 
                                the amount of the grant for the 
                                area that would have been made 
                                pursuant to this paragraph and 
                                paragraph (4) for fiscal year 
                                2006 (as such paragraphs were 
                                in effect for such fiscal year) 
                                if paragraph (2) (as so in 
                                effect) had been applied by 
                                substituting ``66\2/3\ 
                                percent'' for ``50 percent''; 
                                and
                                  (II) for each of the fiscal 
                                years 2008 and 2009, exceed by 
                                more than 5 percent the amount 
                                of the grant pursuant to this 
                                paragraph and paragraph (4) for 
                                the area for the preceding 
                                fiscal year.
                          (ii) Use of amounts involved.--For 
                        each of the fiscal years 2007 through 
                        2010, amounts available as a result of 
                        the limitation under clause (i) shall 
                        be made available by the Secretary as 
                        additional amounts for grants pursuant 
                        to subsection (b) for the fiscal year 
                        involved, subject to paragraph (4) and 
                        section 2610(d)(2).
          [(4) Increases in grant.--
                  [(A) In general.--For each fiscal year in a 
                protection period for an eligible area, the 
                Secretary shall increase the amount of the 
                grant made pursuant to paragraph (2) for the 
                area to ensure that--
                          [(i) for the first fiscal year in the 
                        protection period, the grant is not 
                        less than 98 percent of the amount of 
                        the grant made for the eligible area 
                        pursuant to such paragraph for the base 
                        year for the protection period;
                          [(ii) for any second fiscal year in 
                        such period, the grant is not less than 
                        95 percent of the amount of such base 
                        year grant;
                          [(iii) for any third fiscal year in 
                        such period, the grant is not less than 
                        92 percent of the amount of the base 
                        year grant;
                          [(iv) for any fourth fiscal year in 
                        such period, the grant is not less than 
                        89 percent of the amount of the base 
                        year grant; and
                          [(v) for any fifth or subsequent 
                        fiscal year in such period, if, 
                        pursuant to paragraph (3)(D)(ii), the 
                        references in paragraph (3)(C)(i) to 
                        HIV disease do not have any legal 
                        effect, the grant is not less than 85 
                        percent of the amount of the base year 
                        grant.
                  [(B) Special rule.--If for fiscal year 2005, 
                pursuant to paragraph (3)(D)(ii), data on cases 
                of HIV disease are used for purposes of 
                paragraph (3)(C)(i), the Secretary shall 
                increase the amount of a grant made pursuant to 
                paragraph (2) for an eligible area to ensure 
                that the grant is not less than 98 percent of 
                the amount of the grant made for the area in 
                fiscal year 2004.
                  [(C) Base year; protection period.--With 
                respect to grants made pursuant to paragraph 
                (2) for an eligible area:
                          [(i) The base year for a protection 
                        period is the fiscal year preceding the 
                        trigger grant-reduction year.
                          [(ii) The first trigger grant-
                        reduction year is the first fiscal year 
                        (after fiscal year 2000) for which the 
                        grant for the area is less than the 
                        grant for the area for the preceding 
                        fiscal year.
                          [(iii) A protection period begins 
                        with the trigger grant-reduction year 
                        and continues until the beginning of 
                        the first fiscal year for which the 
                        amount of the grant determined pursuant 
                        to paragraph (2) for the area equals or 
                        exceeds the amount of the grant 
                        determined under subparagraph (A).
                          [(iv) Any subsequent trigger grant-
                        reduction year is the first fiscal 
                        year, after the end of the preceding 
                        protection period, for which the amount 
                        of the grant is less than the amount of 
                        the grant for the preceding fiscal 
                        year.]
          (4) Increases in grant.--
                  (A) In general.--For each eligible area that 
                received a grant pursuant to this subsection 
                for fiscal year 2006, the Secretary shall, for 
                each of the fiscal years 2007 through 2009, 
                increase the amount of the grant made pursuant 
                to paragraph (3) for the area to ensure that 
                the amount of the grant for the fiscal year 
                involved is not less than the following amount, 
                as applicable to such fiscal year:
                          (i) For fiscal year 2007, an amount 
                        equal to 95 percent of the amount of 
                        the grant that would have been made 
                        pursuant to paragraph (3) and this 
                        paragraph for fiscal year 2006 (as such 
                        paragraphs were in effect for such 
                        fiscal year) if paragraph (2) (as so in 
                        effect) had been applied by 
                        substituting ``66\2/3\ percent'' for 
                        ``50 percent''.
                          (ii) For each of the fiscal years 
                        2008 and 2009, an amount equal to 95 
                        percent of the amount of the grant made 
                        pursuant to paragraph (3) and this 
                        paragraph for the preceding fiscal 
                        year.
                  (B) Source of funds for increase.--
                          (i) In general.--From the amounts 
                        available for carrying out the single 
                        program referred to in section 
                        2609(d)(2)(C) for a fiscal year 
                        (relating to supplemental grants), the 
                        Secretary shall make available such 
                        amounts as may be necessary to comply 
                        with subparagraph (A), subject to 
                        section 2610(d)(2).
                          (ii) Pro rata reduction.--If the 
                        amounts referred to in clause (i) for a 
                        fiscal year are insufficient to fully 
                        comply with subparagraph (A) for the 
                        year, the Secretary, in order to 
                        provide the additional funds necessary 
                        for such compliance, shall reduce on a 
                        pro rata basis the amount of each grant 
                        pursuant to this subsection for the 
                        fiscal year, other than grants for 
                        eligible areas for which increases 
                        under subparagraph (A) apply. A 
                        reduction under the preceding sentence 
                        may not be made in an amount that would 
                        result in the eligible area involved 
                        becoming eligible for such an increase.
                  (C) Limitation.--This paragraph may not be 
                construed as having any applicability after 
                fiscal year 2009.
  (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] Subject to 
        subsection (a)(4)(B)(i) and section 2610(d), 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) * * *
                  (B) [demonstrates the severe need in such 
                area] demonstrates the need in such area, on an 
                objective and quantified basis, for 
                supplemental financial assistance to combat the 
                HIV epidemic;

           *       *       *       *       *       *       *

                  (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] HIV/AIDS;
                  [(F) demonstrates the inclusiveness of the 
                planning council membership, with particular 
                emphasis on affected communities and 
                individuals with HIV disease; and]
                  (F) demonstrates the inclusiveness of 
                affected communities and individuals with HIV/
                AIDS;
                  (G) demonstrates the manner in which the 
                proposed services are consistent with the local 
                needs assessment and the statewide coordinated 
                statement of need[.]; and
                  (H) demonstrates the ability of the applicant 
                to expend funds efficiently by not having had, 
                for the most recent grant year under subsection 
                (a) for which data is available, more than 2 
                percent of grant funds under such subsection 
                canceled or covered by any waivers under 
                subsection (c)(3).
          (2) 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] demonstrated need under 
                subparagraph (B) of such paragraph counting 
                one-third.
                  [(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;
                          [(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) Demonstrated need.--The factors 
                considered by the Secretary in determining 
                whether an eligible area has a demonstrated 
                need for purposes of paragraph (1)(B) may 
                include any or all of the following:
                          (i) The unmet need for such services, 
                        as determined under section 2602(b)(4) 
                        or other community input process as 
                        defined under section 2609(d)(1)(A).
                          (ii) An increasing need for HIV/AIDS-
                        related services, including relative 
                        rates of increase in the number of 
                        cases of HIV/AIDS.
                          (iii) The relative rates of increase 
                        in the number of cases of HIV/AIDS 
                        within new or emerging subpopulations.
                          (iv) The current prevalence of HIV/
                        AIDS.
                          (v) Relevant factors related to the 
                        cost and complexity of delivering 
                        health care to individuals with HIV/
                        AIDS in the eligible area.
                          (vi) The impact of co-morbid factors, 
                        including co-occurring conditions, 
                        determined relevant by the Secretary.
                          (vii) The prevalence of homelessness.
                          (viii) The prevalence of individuals 
                        described under section 2602(b)(2)(M).
                          (ix) The relevant factors that limit 
                        access to health care, including 
                        geographic variation, adequacy of 
                        health insurance coverage, and language 
                        barriers.
                          (x) The impact of a decline in the 
                        amount received pursuant to subsection 
                        (a) on services available to all 
                        individuals with HIV/AIDS identified 
                        and eligible under this title.
                  [(C) Prevalence.--In determining the impact 
                of the factors described in subparagraph (B), 
                the Secretary shall, to the extent practicable, 
                use national, quantitative incidence data that 
                are available for each eligible area. Not later 
                than 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 (B), including 
                any local prevalence data gathered and analyzed 
                by the eligible area.
                  [(D) Priority.--Subsequent to the development 
                of the quantitative mechanism described in 
                subparagraph (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.]
                  (C) Priority in making grants.--The Secretary 
                shall provide funds under this subsection to an 
                eligible area to address the decline in 
                services related to the decline in the amounts 
                received pursuant to subsection (a) consistent 
                with the grant award for the eligible area for 
                fiscal year 2006, to the extent that the factor 
                under subparagraph (B)(x) (relating to a 
                decline in funding) applies to the eligible 
                area.

           *       *       *       *       *       *       *

  (c) Timeframe for Obligation and Expenditure of Grant 
Funds.--
          (1) Obligation by end of grant year.--Effective for 
        fiscal year 2007 and subsequent fiscal years, funds 
        from a grant award made pursuant to subsection (a) or 
        (b) for a fiscal year are available for obligation by 
        the eligible area involved through the end of the one-
        year period beginning on the date in such fiscal year 
        on which funds from the award first become available to 
        the area (referred to in this subsection as the ``grant 
        year for the award''), except as provided in paragraph 
        (3)(A).
          (2) Supplemental grants; cancellation of unobligated 
        balance of grant award.--Effective for fiscal year 2007 
        and subsequent fiscal years, if a grant award made 
        pursuant to subsection (b) for an eligible area for a 
        fiscal year has an unobligated balance as of the end of 
        the grant year for the award--
                  (A) the Secretary shall cancel that 
                unobligated balance of the award, and shall 
                require the eligible area to return any amounts 
                from such balance that have been disbursed to 
                the area; and
                  (B) the funds involved shall be made 
                available by the Secretary as additional 
                amounts for grants pursuant to subsection (b) 
                for the first fiscal year beginning after the 
                fiscal year in which the Secretary obtains the 
                information necessary for determining that the 
                balance is required under subparagraph (A) to 
                be canceled, except that the availability of 
                the funds for such grants is subject to 
                subsection (a)(4) and section 2610(d)(2) as 
                applied for such year.
          (3) Formula grants; cancellation of unobligated 
        balance of grant award; waiver permitting carryover.--
                  (A) In general.--Effective for fiscal year 
                2007 and subsequent fiscal years, if a grant 
                award made pursuant to subsection (a) for an 
                eligible area for a fiscal year has an 
                unobligated balance as of the end of the grant 
                year for the award, the Secretary shall cancel 
                that unobligated balance of the award, and 
                shall require the eligible area to return any 
                amounts from such balance that have been 
                disbursed to the area, unless--
                          (i) before the end of the grant year, 
                        the chief executive officer of the area 
                        submits to the Secretary a written 
                        application for a waiver of the 
                        cancellation, which application 
                        includes a description of the purposes 
                        for which the area intends to expend 
                        the funds involved; and
                          (ii) the Secretary approves the 
                        waiver.
                  (B) Expenditure by end of carryover year.--
                With respect to a waiver under subparagraph (A) 
                that is approved for a balance that is 
                unobligated as of the end of a grant year for 
                an award:
                          (i) The unobligated funds are 
                        available for expenditure by the 
                        eligible area involved for the one-year 
                        period beginning upon the expiration of 
                        the grant year (referred to in this 
                        subsection as the ``carryover year'').
                          (ii) If the funds are not expended by 
                        the end of the carryover year, the 
                        Secretary shall cancel that unexpended 
                        balance of the award, and shall require 
                        the eligible area to return any amounts 
                        from such balance that have been 
                        disbursed to the area.
                  (C) Use of cancelled balances.--In the case 
                of any balance of a grant award that is 
                cancelled under subparagraph (A) or (B)(ii), 
                the grant funds involved shall be made 
                available by the Secretary as additional 
                amounts for grants pursuant to subsection (b) 
                for the first fiscal year beginning after the 
                fiscal year in which the Secretary obtains the 
                information necessary for determining that the 
                balance is required under such subparagraph to 
                be canceled, except that the availability of 
                the funds for such grants is subject to 
                subsection (a)(4) and section 2610(d)(2) as 
                applied for such year.
                  (D) Corresponding reduction in future 
                grant.--
                          (i) In general.--In the case of an 
                        eligible area for which a balance from 
                        a grant award under subsection (a) is 
                        unobligated as of the end of the grant 
                        year for the award--
                                  (I) the Secretary shall 
                                reduce, by the same amount as 
                                such unobligated balance, the 
                                amount of the grant under such 
                                subsection for the first fiscal 
                                year beginning after the fiscal 
                                year in which the Secretary 
                                obtains the information 
                                necessary for determining that 
                                such balance was unobligated as 
                                of the end of the grant year 
                                (which requirement for a 
                                reduction applies without 
                                regard to whether a waiver 
                                under subparagraph (A) has been 
                                approved with respect to such 
                                balance); and
                                  (II) the grant funds involved 
                                in such reduction shall be made 
                                available by the Secretary as 
                                additional funds for grants 
                                pursuant to subsection (b) for 
                                such first fiscal year, subject 
                                to subsection (a)(4) and 
                                section 2610(d)(2);
                except that this clause does not apply to the 
                eligible area if the amount of the unobligated 
                balance was 2 percent or less.
                          (ii) Relation to increases in 
                        grant.--A reduction under clause (i) 
                        for an eligible area for a fiscal year 
                        may not be taken into account in 
                        applying subsection (a)(4) with respect 
                        to the area for the subsequent fiscal 
                        year.
  [(c)] (d) Compliance With Priorities of Hiv Planning 
Council.--Notwithstanding any other provision of [this part] 
this subpart, the Secretary, in carrying out section 2601(a), 
may not make any grant under subsection (a) or (b) to an 
eligible area unless the application submitted by such area 
under section 2605 for the grant involved demonstrates that the 
grants made under subsections (a) and (b) to the area for the 
preceding fiscal year (if any) were expended in accordance with 
the priorities applicable to such year that were established, 
pursuant to section 2602(b)(4)(C), by the planning council 
serving the area.

[SEC. 2604. USE OF AMOUNTS.

  [(a) Requirements.--The Secretary may not make a grant under 
section 2601(a) to the chief elected official of an eligible 
area unless such political subdivision agrees that--
          [(1) subject to paragraph (2), the allocation of 
        funds and services within the eligible area will be 
        made in accordance with the priorities established, 
        pursuant to section 2602(b)(3)(A), by the HIV health 
        services planning council that serves such eligible 
        area; and
          [(2) funds provided under section 2601 will be 
        expended only for the purposes described in subsections 
        (b) and (c).
  [(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 services, as 
        follows:
                  [(A) 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.
                  [(B) Outpatient and ambulatory support 
                services (including case management), to the 
                extent that such services facilitate, enhance, 
                support, or sustain the delivery, continuity, 
                or benefits of health services for individuals 
                and families with HIV disease.
                  [(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 know 
                their HIV status and 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)(A);
                          [(ii) conducted in a manner 
                        consistent with the requirements under 
                        sections 2605(a)(3) and 2651(b)(2); and
                          [(iii) supplement, and do not 
                        supplant, such activities that are 
                        carried out with amounts appropriated 
                        under section 317.
          [(2) Appropriate entities.--
                  [(A) In general.--Subject to subparagraph 
                (B), direct financial assistance may be 
                provided under paragraph (1) to public or 
                nonprofit private entities,, or private for-
                profit entities if such entities are the only 
                available provider of quality HIV care in the 
                area, including hospitals (which may include 
                Department of Veterans Affairs facilities), 
                community-based organizations, hospices, 
                ambulatory care facilities, community health 
                centers, migrant health centers, homeless 
                health centers, substance abuse treatment 
                programs, and mental health programs.
                  [(B) Priority.--In providing direct financial 
                assistance under paragraph (1) the chief 
                elected official shall give priority to 
                entities that are currently participating in 
                Health Resources and Services Administration 
                HIV health care demonstration projects.
          [(3) Early intervention services.--
                  [(A) In general.--The purposes for which a 
                grant under section 2601 may be used include 
                providing to individuals with HIV disease early 
                intervention services described in section 
                2651(b)(2), with follow-up referral provided 
                for the purpose of facilitating the access of 
                individuals receiving the services to HIV-
                related health services. The entities through 
                which such services may be provided under the 
                grant include public health departments, 
                emergency rooms, substance abuse and mental 
                health treatment programs, detoxification 
                centers, detention facilities, clinics 
                regarding sexually transmitted diseases, 
                homeless shelters, HIV disease counseling and 
                testing sites, health care points of entry 
                specified by eligible areas, federally 
                qualified health centers, and entities 
                described in section 2652(a) that constitute a 
                point of access to services by maintaining 
                referral relationships.
                  [(B) Conditions.--With respect to an entity 
                that proposes to provide early intervention 
                services under subparagraph (A), such 
                subparagraph applies only if the entity 
                demonstrates to the satisfaction of the chief 
                elected official for the eligible area involved 
                that--
                          [(i) Federal, State, or local funds 
                        are otherwise inadequate for the early 
                        intervention services the entity 
                        proposes to provide; and
                          [(ii) the entity will expend funds 
                        pursuant to such subparagraph to 
                        supplement and not supplant other funds 
                        available to the entity for the 
                        provision of early intervention 
                        services for the fiscal year involved.
          [(4) Priority for women, infants and children.--
                  [(A) In general.--For the purpose of 
                providing health and support services to 
                infants, children, youth, and women with HIV 
                disease, including treatment measures to 
                prevent the perinatal transmission of HIV, the 
                chief elected official of an eligible area, in 
                accordance with the established priorities of 
                the planning council, shall for each of such 
                populations in the eligible area use, from the 
                grants made for the area under section 2601(a) 
                for a fiscal year, not less than the percentage 
                constituted by the ratio of the population 
                involved (infants, children, youth, or women in 
                such area) with acquired immune deficiency 
                syndrome to the general population in such area 
                of individuals with such syndrome.
                  [(B) Waiver.--With respect to the population 
                involved, the Secretary may provide to the 
                chief elected official of an eligible area a 
                waiver of the requirement of subparagraph (A) 
                if such official demonstrates to the 
                satisfaction of the Secretary that the 
                population is receiving HIV-related health 
                services through the State medicaid program 
                under title XIX of the Social Security Act, the 
                State children's health insurance program under 
                title XXI of such Act, or other Federal or 
                State programs.
  [(c) Quality Management.--
          [(1) Requirement.--The chief elected official of an 
        eligible area that receives a grant under this part 
        shall provide for the establishment of a quality 
        management program to assess the extent to which HIV 
        health services provided to patients under the grant 
        are consistent with the most recent Public Health 
        Service guidelines for the treatment of HIV disease and 
        related opportunistic infection, and as applicable, to 
        develop strategies for ensuring that such services are 
        consistent with the guidelines for improvement in the 
        access to and quality of HIV health services.
          [(2) Use of funds.--From amounts received under a 
        grant awarded under this part for a fiscal year, the 
        chief elected official of an eligible area may (in 
        addition to amounts to which subsection (f)(1) applies) 
        use for activities associated with the quality 
        management program required in paragraph (1) not more 
        than the lesser of--
                  [(A) 5 percent of amounts received under the 
                grant; or
                  [(B) $3,000,000.
  [(d) Limited Expenditures for Personnel Needs.--
          [(1) In general.--A chief elected official, in 
        accordance with paragraph (3), may use not to exceed 10 
        percent of amounts received under a grant under section 
        2601 to provide financial assistance or services, for 
        the purposes described in paragraph (2), to any public 
        or nonprofit private entity, including hospitals (which 
        may include Veterans Administration facilities), 
        nursing homes, subacute and transitional care 
        facilities, and hospices that--
                  [(A) provide HIV-related care or services to 
                a disproportionate share of low-income 
                individuals and families with HIV disease;
                  [(B) incur uncompensated costs in the 
                provision of such care or services to such 
                individuals and families;
                  [(C) have established, and agree to 
                implement, a plan to evaluate the utilization 
                of services provided in the care of individuals 
                and families with HIV disease; and
                  [(D) have established a system designed to 
                ensure that such individuals and families are 
                referred to the most medically appropriate 
                level of care as soon as such referral is 
                medically indicated.
          [(2) Use.--A chief elected official may use amounts 
        referred to in paragraph (1) to--
                  [(A) provide direct financial assistance to 
                institutions and entities of the type referred 
                to in such paragraph to assist such 
                institutions and entities in recruiting or 
                training and paying compensation to qualified 
                personnel determined, under paragraph (3), to 
                be necessary by the HIV health services 
                planning council, specifically for the care of 
                individuals with HIV disease; or
                  [(B) in lieu of providing direct financial 
                assistance, make arrangements for the provision 
                of the services of such qualified personnel to 
                such institutions and entities.
          [(3) Requirement of determination by council.--A 
        chief elected official shall not use any of the amounts 
        received under a grant under section 2601(a) to provide 
        assistance or services under paragraph (2) unless the 
        HIV health services planning council of the eligible 
        area has made a determination that, with respect to the 
        care of individuals with HIV disease--
                  [(A) a shortage of specific health, mental 
                health or support service personnel exists 
                within specific institutions or entities in the 
                eligible area;
                  [(B) the shortage of such personnel has 
                resulted in the inappropriate utilization of 
                inpatient services within the area; and
                  [(C) assistance or services provided to an 
                institution or entity under paragraph (2), will 
                not be used to supplant the existing resources 
                devoted by such institution or entity to the 
                uses described in such paragraph.
  [(e) Requirement of Status as Medicaid Provider.--
          [(1) Provision of service.--Subject to paragraph (2), 
        the Secretary may not make a grant under section 
        2601(a) for the provision of services under this 
        section in a State unless, in the case of any such 
        service that is available pursuant to the State plan 
        approved under title XIX of the Social Security Act for 
        the State--
                  [(A) the political subdivision involved will 
                provide the service directly, and the political 
                subdivision has entered into a participation 
                agreement under the State plan and is qualified 
                to receive payments under such plan; or
                  [(B) the political subdivision will enter 
                into an agreement with a public or nonprofit 
                private entity under which the entity will 
                provide the service, and the entity has entered 
                into such a participation agreement and is 
                qualified to receive such payments.
          [(2) Waiver.--
                  [(A) In general.--In the case of an entity 
                making an agreement pursuant to paragraph 
                (1)(B) regarding the provision of services, the 
                requirement established in such paragraph shall 
                be waived by the HIV health services planning 
                council for the eligible area if the entity 
                does not, in providing health care services, 
                impose a charge or accept reimbursement 
                available from any third-party payor, including 
                reimbursement under any insurance policy or 
                under any Federal or State health benefits 
                program.
                  [(B) Determination.--A determination by the 
                HIV health services planning council of whether 
                an entity referred to in subparagraph (A) meets 
                the criteria for a waiver under such 
                subparagraph shall be made without regard to 
                whether the entity accepts voluntary donations 
                for the purpose of providing services to the 
                public.
  [(f) Administration.--
          [(1) In general.--The chief executive officer of an 
        eligible area shall not use in excess of 5 percent of 
        amounts received under 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).
          [(2) Administrative activities.--For the purposes of 
        paragraph (1), amounts may be used for administrative 
        activities that include--
                  [(A) routine grant administration and 
                monitoring activities, including the 
                development of applications for part A funds, 
                the receipt and disbursal of program funds, the 
                development and establishment of reimbursement 
                and accounting systems, the preparation of 
                routine programmatic and financial reports, and 
                compliance with grant conditions and audit 
                requirements; and
                  [(B) all activities associated with the 
                grantee's contract award procedures, including 
                the development of requests for proposals, 
                contract proposal review activities, 
                negotiation and awarding of contracts, 
                monitoring of contracts through telephone 
                consultation, written documentation or onsite 
                visits, reporting on contracts, and funding 
                reallocation activities.
          [(3) Subcontractor administrative costs.--For the 
        purposes of this subsection, subcontractor 
        administrative activities include--
                  [(A) usual and recognized overhead, including 
                established indirect rates for agencies;
                  [(B) management oversight of specific 
                programs funded under this title; and
                  [(C) other types of program support such as 
                quality assurance, quality control, and related 
                activities.
  [(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. 2604. USE OF AMOUNTS.

  (a) Requirements.--The Secretary may not make a grant under 
section 2601(a) to the chief elected official of an eligible 
area unless such political subdivision agrees that--
          (1) subject to paragraph (2), the allocation of funds 
        and services within the eligible area will be made in 
        accordance with the priorities established, pursuant to 
        section 2602(b)(4)(C), by the HIV health services 
        planning council that serves such eligible area;
          (2) funds provided under section 2601 will be 
        expended only for--
                  (A) core medical services described in 
                subsection (c);
                  (B) support services described in subsection 
                (d); and
                  (C) administrative expenses described in 
                subsection (h); and
          (3) the use of such funds will comply with the 
        requirements of this section.
  (b) Direct Financial Assistance to Appropriate Entities.--
          (1) In general.--The chief elected official of an 
        eligible area shall use amounts from a grant under 
        section 2601 to provide direct financial assistance to 
        entities described in paragraph (2) for the purpose of 
        providing core medical services and support services.
          (2) Appropriate entities.--Direct financial 
        assistance may be provided under paragraph (1) to 
        public or nonprofit private entities, or private for-
        profit entities if such entities are the only available 
        provider of quality HIV care in the area.
  (c) Required Funding for Core Medical Services.--
          (1) In general.--With respect to a grant under 
        section 2601 for an eligible area for a grant year, the 
        chief elected official of the area shall, of the 
        portion of the grant remaining after reserving amounts 
        for purposes of paragraphs (1) and (5)(B)(i) of 
        subsection (h), use not less than 75 percent to provide 
        core medical services that are needed in the eligible 
        area for individuals with HIV/AIDS who are identified 
        and eligible under this title (including services 
        regarding the co-occurring conditions of the 
        individuals).
          (2) Waiver.--
                  (A) In general.--The Secretary shall waive 
                the application of paragraph (1) with respect 
                to a chief elected official for a grant year if 
                the Secretary determines that, within the 
                eligible area involved--
                          (i) there are no waiting lists for 
                        AIDS Drug Assistance Program services 
                        under section 2616; and
                          (ii) core medical services are 
                        available to all individuals with HIV/
                        AIDS identified and eligible under this 
                        title.
                  (B) Notification of waiver status.--When 
                informing the chief elected official of an 
                eligible area that a grant under section 2601 
                is being made for the area for a grant year, 
                the Secretary shall inform the official whether 
                a waiver under subparagraph (A) is in effect 
                for such year.
          (3) Core medical services.--For purposes of this 
        subsection, the term ``core medical services'', with 
        respect to an individual with HIV/AIDS (including the 
        co-occurring conditions of the individual), means the 
        following services:
                  (A) Outpatient and ambulatory health 
                services.
                  (B) AIDS Drug Assistance Program treatments 
                in accordance with section 2616.
                  (C) AIDS pharmaceutical assistance.
                  (D) Oral health care.
                  (E) Early intervention services described in 
                subsection (e).
                  (F) Health insurance premium and cost sharing 
                assistance for low-income individuals in 
                accordance with section 2615.
                  (G) Home health care.
                  (H) Medical nutrition therapy.
                  (I) Hospice services.
                  (J) Home and community-based health services 
                as defined under section 2614(c).
                  (K) Mental health services.
                  (L) Substance abuse outpatient care.
                  (M) Medical case management, including 
                treatment adherence services.
  (d) Support Services.--
          (1) In general.--For purposes of this section, the 
        term ``support services'' means services, subject to 
        the approval of the Secretary, that are needed for 
        individuals with HIV/AIDS to achieve their medical 
        outcomes (such as respite care for persons caring for 
        individuals with HIV/AIDS, outreach services, medical 
        transportation, linguistic services, and referrals for 
        health care and support services).
          (2) Medical outcomes.--In this subsection, the term 
        ``medical outcomes'' means those outcomes affecting the 
        HIV-related clinical status of an individual with HIV/
        AIDS.
  (e) Early Intervention Services.--
          (1) In general.--For purposes of this section, the 
        term ``early intervention services'' means HIV/AIDS 
        early intervention services described in section 
        2651(e), with follow-up referral provided for the 
        purpose of facilitating the access of individuals 
        receiving the services to HIV-related health services. 
        The entities through which such services may be 
        provided under the grant include public health 
        departments, emergency rooms, substance abuse and 
        mental health treatment programs, detoxification 
        centers, detention facilities, clinics regarding 
        sexually transmitted diseases, homeless shelters, HIV/
        AIDS counseling and testing sites, health care points 
        of entry specified by eligible areas, federally 
        qualified health centers, and entities described in 
        section 2652(a) that constitute a point of access to 
        services by maintaining referral relationships.
          (2) Conditions.--With respect to an entity that 
        proposes to provide early intervention services under 
        paragraph (1), such paragraph shall apply only if the 
        entity demonstrates to the satisfaction of the chief 
        elected official for the eligible area involved that--
                  (A) Federal, State, or local funds are 
                otherwise inadequate for the early intervention 
                services the entity proposes to provide; and
                  (B) the entity will expend funds pursuant to 
                such paragraph to supplement and not supplant 
                other funds available to the entity for the 
                provision of early intervention services for 
                the fiscal year involved.
  (f) Priority for Women, Infants, Children, and Youth.--
          (1) In general.--For the purpose of providing health 
        and support services to infants, children, youth, and 
        women with HIV/AIDS, including treatment measures to 
        prevent the perinatal transmission of HIV, the chief 
        elected official of an eligible area, in accordance 
        with the established priorities of the planning 
        council, shall for each of such populations in the 
        eligible area use, from the grants made for the area 
        under section 2601(a) for a fiscal year, not less than 
        the percentage constituted by the ratio of the 
        population involved (infants, children, youth, or women 
        in such area) with HIV/AIDS to the general population 
        in such area of individuals with HIV/AIDS.
          (2) Waiver.--With respect to the population involved, 
        the Secretary may provide to the chief elected official 
        of an eligible area a waiver of the requirement of 
        paragraph (1) if such official demonstrates to the 
        satisfaction of the Secretary that the population is 
        receiving HIV-related health services through the State 
        medicaid program under title XIX of the Social Security 
        Act, the State children's health insurance program 
        under title XXI of such Act, or other Federal or State 
        programs.
  (g) Requirement of Status as Medicaid Provider.--
          (1) Provision of service.--Subject to paragraph (2), 
        the Secretary may not make a grant under section 
        2601(a) for the provision of services under this 
        section in a State unless, in the case of any such 
        service that is available pursuant to the State plan 
        approved under title XIX of the Social Security Act for 
        the State--
                  (A) the political subdivision involved will 
                provide the service directly, and the political 
                subdivision has entered into a participation 
                agreement under the State plan and is qualified 
                to receive payments under such plan; or
                  (B) the political subdivision will enter into 
                an agreement with a public or nonprofit private 
                entity under which the entity will provide the 
                service, and the entity has entered into such a 
                participation agreement and is qualified to 
                receive such payments.
          (2) Waiver.--
                  (A) In general.--In the case of an entity 
                making an agreement pursuant to paragraph 
                (1)(B) regarding the provision of services, the 
                requirement established in such paragraph shall 
                be waived by the HIV health services planning 
                council for the eligible area if the entity 
                does not, in providing health care services, 
                impose a charge or accept reimbursement 
                available from any third-party payor, including 
                reimbursement under any insurance policy or 
                under any Federal or State health benefits 
                program.
                  (B) Determination.--A determination by the 
                HIV health services planning council of whether 
                an entity referred to in subparagraph (A) meets 
                the criteria for a waiver under such 
                subparagraph shall be made without regard to 
                whether the entity accepts voluntary donations 
                for the purpose of providing services to the 
                public.
  (h) Administration.--
          (1) Limitation.--The chief executive officer of an 
        eligible area shall not use in excess of 10 percent of 
        amounts received under a grant under this part for 
        administrative expenses.
          (2) Allocations by chief executive officer.--In the 
        case of entities and subcontractors to which the chief 
        executive officer of an eligible area allocates amounts 
        received by the officer under a grant under this part, 
        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).
          (3) Administrative activities.--For purposes of 
        paragraph (1), amounts may be used for administrative 
        activities that include--
                  (A) routine grant administration and 
                monitoring activities, including the 
                development of applications for part A funds, 
                the receipt and disbursal of program funds, the 
                development and establishment of reimbursement 
                and accounting systems, the development of a 
                clinical quality management program as 
                described in paragraph (5), the preparation of 
                routine programmatic and financial reports, and 
                compliance with grant conditions and audit 
                requirements; and
                  (B) all activities associated with the 
                grantee's contract award procedures, including 
                the activities carried out by the HIV health 
                services planning council as established under 
                section 2602(b), the development of requests 
                for proposals, contract proposal review 
                activities, negotiation and awarding of 
                contracts, monitoring of contracts through 
                telephone consultation, written documentation 
                or onsite visits, reporting on contracts, and 
                funding reallocation activities.
          (4) Subcontractor administrative activities.--For the 
        purposes of this subsection, subcontractor 
        administrative activities include--
                  (A) usual and recognized overhead activities, 
                including established indirect rates for 
                agencies;
                  (B) management oversight of specific programs 
                funded under this title; and
                  (C) other types of program support such as 
                quality assurance, quality control, and related 
                activities.
          (5) Clinical quality management.--
                  (A) Requirement.--The chief elected official 
                of an eligible area that receives a grant under 
                this part shall provide for the establishment 
                of a clinical quality management program to 
                assess the extent to which HIV health services 
                provided to patients under the grant are 
                consistent with the most recent Public Health 
                Service guidelines for the treatment of HIV/
                AIDS and related opportunistic infection, and 
                as applicable, to develop strategies for 
                ensuring that such services are consistent with 
                the guidelines for improvement in the access to 
                and quality of HIV health services.
                  (B) Use of funds.--
                          (i) In general.--From amounts 
                        received under a grant awarded under 
                        this subpart for a fiscal year, the 
                        chief elected official of an eligible 
                        area may use for activities associated 
                        with the clinical quality management 
                        program required in subparagraph (A) 
                        not to exceed the lesser of--
                                  (I) 5 percent of amounts 
                                received under the grant; or
                                  (II) $3,000,000.
                          (ii) Relation to limitation on 
                        administrative expenses.--The costs of 
                        a clinical quality management program 
                        under subparagraph (A) may not be 
                        considered administrative expenses for 
                        purposes of the limitation established 
                        in paragraph (1).
  (i) Construction.--A chief elected official may not use 
amounts received under a grant awarded under this part to 
purchase or improve land, or to purchase, construct, or 
permanently improve (other than minor remodeling) any building 
or other facility, or to make cash payments to intended 
recipients of services.

SEC. 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)(A) that funds received under a grant awarded 
        under [this part] this subpart will be utilized to 
        supplement not supplant State funds made available in 
        the year for which the grant is awarded to provide HIV-
        related services as described in section 2604(b)(1);

           *       *       *       *       *       *       *

  (C) that political subdivisions within the eligible area will 
not use funds received under a grant awarded under [this part] 
this subpart in maintaining the level of expenditures for HIV-
related services as required in subparagraph (B);

           *       *       *       *       *       *       *

          (3) that entities within the eligible area that 
        receive funds under a grant under [this part] this 
        subpart will maintain appropriate relationships with 
        entities in the eligible area served that constitute 
        key points of access to the health care system for 
        individuals with HIV disease (including emergency 
        rooms, substance abuse treatment programs, 
        detoxification centers, adult and juvenile detention 
        facilities, sexually transmitted disease clinics, HIV 
        counseling and testing sites, mental health programs, 
        and homeless shelters), and other entities under 
        section 2604(b)(3) and 2652(a), for the purpose of 
        facilitating early intervention for individuals newly 
        diagnosed with HIV disease and individuals 
        knowledgeable of their HIV status but not in care;

           *       *       *       *       *       *       *

          (6) that funds received under a grant awarded under 
        [this part] this subpart 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 (except for a 
                program administered by or providing the 
                services of the Indian Health Service); or

           *       *       *       *       *       *       *

          (7) to the maximum extent practicable, that--
                  (A) HIV health care and support services 
                provided with assistance made available under 
                [this part] this subpart will be provided 
                without regard--
                          (i) * * *

           *       *       *       *       *       *       *

          (8) 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; [and]
          (9) that the eligible area has procedures in place to 
        ensure that services provided with funds received under 
        this part meet the criteria specified in section 
        2604(b)(1)[.]; and
          (10) that the chief elected official will submit to 
        the lead State agency under section 2617(b)(4), audits, 
        consistent with Office of Management and Budget 
        circular A133, regarding funds expended in accordance 
        with this part every 2 years and shall include 
        necessary client-based data to compile unmet need 
        calculations and Statewide coordinated statements of 
        need process.
  (b) Application.--An eligible area that desires to receive a 
grant under section 2603(b) 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 the information required under such 
subsection and information concerning
          (1) * * *

           *       *       *       *       *       *       *

          (3) the average cost of providing each category of 
        HIV-related health services and the extent to which 
        such cost is paid by third-party payors; [and]
          (4) the aggregate amounts expended for each such 
        category of services[.];
          (5) the manner in which the expected expenditures are 
        related to the planning process for States that receive 
        funding under part B (including the planning process 
        described in section 2617(b)); and
          (6) the expected expenditures and how those 
        expenditures will improve overall client outcomes, as 
        described under the State plan under section 2617(b), 
        and through additional outcomes measures as identified 
        by the HIV health services planning council under 
        section 2602(b).

           *       *       *       *       *       *       *

  (d) Date Certain for Submission.--
          (1) * * *

           *       *       *       *       *       *       *

          (4) Redistribution.--Any amounts appropriated in any 
        fiscal year under [this part] this subpart and not 
        obligated to an eligible entity as a result of the 
        failure of such entity to submit an application shall 
        be redistributed by the Secretary to other eligible 
        entities in proportion to the original grants made to 
        such eligible areas under section 2601(a).
  (e) Requirements Regarding Imposition of Charges for 
Services.--
          (1) * * *

           *       *       *       *       *       *       *

          (2) Assessment of charge.--With respect to compliance 
        with the assurance made under paragraph (1), a grantee 
        or entity receiving assistance under [this part] this 
        subpart may, in the case of individuals subject to a 
        charge for purposes of such paragraph--
                  (A) * * *

           *       *       *       *       *       *       *


SEC. 2606. TECHNICAL ASSISTANCE.

  The Administrator of the Health Resources and Services 
Administration shall, beginning on the date of enactment of 
this title, provide technical assistance, including assistance 
from other grantees, contractors or subcontractors under this 
title to assist newly eligible metropolitan areas in the 
establishment of HIV health services planning councils and, to 
assist entities in complying with the requirements of [this 
part] this subpart in order to make such entities eligible to 
receive a grant under [this part] this subpart. The 
Administrator may make planning grants available to 
metropolitan areas, in an amount not to exceed $75,000 for any 
metropolitan area, projected to be eligible for funding under 
section 2601 in the following fiscal year. Such grant amounts 
shall be deducted from the first year formula award to eligible 
areas accepting such grants. Not to exceed 1 percent of the 
amount appropriated for a fiscal year under section 2677 for 
grants under part A may be used to carry out this section.

SEC. 2607. DEFINITIONS.

   For purposes of [this part] this subpart:
          (1) * * *
          (2) Metropolitan area.--The term ``metropolitan 
        area'' means an [area referred] area that is referred 
        to in the HIV/AIDS Surveillance Report of the Centers 
        for Disease Control and Prevention as a metropolitan 
        area, and that has a population of 50,000 or more 
        individuals.

                    Subpart II--Transitional Grants

SEC. 2609. ESTABLISHMENT OF PROGRAM.

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

                    Subpart III--General Provisions

SEC. 2610. AUTHORIZATION OF APPROPRIATIONS.

  (a) In General.--For the purpose of carrying out this part, 
there are authorized to be appropriated $604,000,000 for fiscal 
year 2007, $626,300,000 for fiscal year 2008, $649,500,000 for 
fiscal year 2009, $673,600,000 for fiscal year 2010, and 
$698,500,000 for fiscal year 2011. Amounts appropriated under 
the preceding sentence for a fiscal year are available for 
obligation by the Secretary until the end of the second 
succeeding fiscal year.
  (b) Reservation of Amounts.--
          (1) Fiscal year 2007.--Of the amount appropriated 
        under subsection (a) for fiscal year 2007, the 
        Secretary shall reserve--
                  (A) $458,310,000 for grants under subpart I; 
                and
                  (B) $145,690,000 for grants under section 
                2609.
          (2) Subsequent fiscal years.--Of the amount 
        appropriated under subsection (a) for fiscal year 2008 
        and each subsequent fiscal year--
                  (A) the Secretary shall reserve an amount for 
                grants under subpart I; and
                  (B) the Secretary shall reserve an amount for 
                grants under section 2609.
  (c) Transfer of Certain Amounts; Change in Status as Eligible 
Area or Transitional Area.--Notwithstanding subsection (b):
          (1) If a metropolitan area is an eligible area under 
        subpart I for a fiscal year, but for a subsequent 
        fiscal year ceases to be an eligible area by reason of 
        section 2601(b)--
                  (A)(i) the amount reserved under paragraph 
                (1)(A) or (2)(A) of subsection (b) of this 
                section for the first such subsequent year of 
                not being an eligible area is deemed to be 
                reduced by an amount equal to the amount of the 
                grant made pursuant to section 2603(a) for the 
                metropolitan area for the preceding fiscal 
                year; and
                  (ii)(I) if the metropolitan area qualifies 
                for such first subsequent fiscal year as a 
                transitional area under 2609, the amount 
                reserved under paragraph (1)(B) or (2)(B) of 
                subsection (b) for such fiscal year is deemed 
                to be increased by an amount equal to the 
                amount of the reduction under subparagraph (A) 
                for such year; or
                  (II) if the metropolitan area does not 
                qualify for such first subsequent fiscal year 
                as a transitional area under 2609, an amount 
                equal to the amount of such reduction is, 
                notwithstanding subsection (a), transferred and 
                made available for grants pursuant to section 
                2618(a)(1), in addition to amounts available 
                for such grants under section 2623; and
                  (B) if a transfer under subparagraph 
                (A)(ii)(II) is made with respect to the 
                metropolitan area for such first subsequent 
                fiscal year, then--
                          (i) the amount reserved under 
                        paragraph (1)(A) or (2)(A) of 
                        subsection (b) of this section for such 
                        year is deemed to be reduced by an 
                        additional $500,000; and
                          (ii) an amount equal to the amount of 
                        such additional reduction is, 
                        notwithstanding subsection (a), 
                        transferred and made available for 
                        grants pursuant to section 2618(a)(1), 
                        in addition to amounts available for 
                        such grants under section 2623.
          (2) If a metropolitan area is a transitional area 
        under section 2609 for a fiscal year, but for a 
        subsequent fiscal year ceases to be a transitional area 
        by reason of section 2609(c)(2) (and does not qualify 
        for such subsequent fiscal year as an eligible area 
        under subpart I)--
                  (A) the amount reserved under subsection 
                (b)(2)(B) of this section for the first such 
                subsequent fiscal year of not being a 
                transitional area is deemed to be reduced by an 
                amount equal to the total of--
                          (i) the amount of the grant that, 
                        pursuant to section 2603(a), was made 
                        under section 2609(d)(2)(A) for the 
                        metropolitan area for the preceding 
                        fiscal year; and
                          (ii) $500,000; and
                  (B) an amount equal to the amount of the 
                reduction under subparagraph (A) for such year 
                is, notwithstanding subsection (a), transferred 
                and made available for grants pursuant to 
                section 2618(a)(1), in addition to amounts 
                available for such grants under section 2623.
          (3) If a metropolitan area is a transitional area 
        under section 2609 for a fiscal year, but for a 
        subsequent fiscal year qualifies as an eligible area 
        under subpart I--
                  (A) the amount reserved under subsection 
                (b)(2)(B) of this section for the first such 
                subsequent fiscal year of becoming an eligible 
                area is deemed to be reduced by an amount equal 
                to the amount of the grant that, pursuant to 
                section 2603(a), was made under section 
                2609(d)(2)(A) for the metropolitan area for the 
                preceding fiscal year; and
                  (B) the amount reserved under subsection 
                (b)(2)(A) for such fiscal year is deemed to be 
                increased by an amount equal to the amount of 
                the reduction under subparagraph (A) for such 
                year.
  (d) Certain Transfers; Allocations Between Programs Under 
Subpart I.--With respect to paragraphs (1)(B)(i) and (2)(A)(ii) 
of subsection (c), the Secretary shall administer any 
reductions under such paragraphs for a fiscal year in 
accordance with the following:
          (1) The reductions shall be made from amounts 
        available for the single program referred to in section 
        2609(d)(2)(C) (relating to supplemental grants).
          (2) The reductions shall be made before the amounts 
        referred to in paragraph (1) are used for purposes of 
        section 2603(a)(4).
          (3) If the amounts referred to in paragraph (1) are 
        not sufficient for making all the reductions, the 
        reductions shall be reduced until the total amount of 
        the reductions equals the total of the amounts referred 
        to in such paragraph.
  (e) Rules of Construction Regarding First Subsequent Fiscal 
Year.--Paragraphs (1) and (2) of subsection (c) apply with 
respect to each series of fiscal years during which a 
metropolitan area is an eligible area under subpart I or a 
transitional area under section 2609 for a fiscal year and then 
for a subsequent fiscal year ceases to be such an area by 
reason of section 2601(b) or 2609(c)(2), respectively, rather 
than applying to a single such series. Paragraph (3) of 
subsection (c) applies with respect to each series of fiscal 
years during which a metropolitan area is a transitional area 
under section 2609 for a fiscal year and then for a subsequent 
fiscal year becomes an eligible area under subpart I, rather 
than applying to a single such series.

                       PART B--Care Grant Program

                  Subpart I--General Grant Provisions

SEC. 2611. GRANTS.

  [(a) In General.--]The Secretary shall, subject to the 
availability of appropriations, make grants to States to enable 
such States to improve the quality, availability and 
organization of health care and support services for 
individuals and families with HIV disease. The authority of the 
Secretary to provide grants under part B is subject to section 
2626(e)(2) (relating to the decrease in perinatal transmission 
of HIV disease).
  [(b) Priority for Women, Infants and Children.--
          [(1) In general.--For the purpose of providing health 
        and support services to infants, children, youth, and 
        women with HIV disease, including treatment measures to 
        prevent the perinatal transmission of HIV, a State 
        shall for each of such populations use, of the funds 
        allocated under this part to the State for a fiscal 
        year, not less than the percentage constituted by the 
        ratio of the population involved (infants, children, 
        youth, or women in the State) with acquired immune 
        deficiency syndrome to the general population in the 
        State of individuals with such syndrome.
          [(2) Waiver.--With respect to the population 
        involved, the Secretary may provide to a State a waiver 
        of the requirement of paragraph (1) if the State 
        demonstrates to the satisfaction of the Secretary that 
        the population is receiving HIV-related health services 
        through the State medicaid program under title XIX of 
        the Social Security Act, the State children's health 
        insurance program under title XXI of such Act, or other 
        Federal or State programs.]

[SEC. 2612. GENERAL USE OF GRANTS.

  [(a) In General.--A State may use amounts provided under 
grants made under this part--
          [(1) to provide the services described in section 
        2604(b)(1) for individuals with HIV disease;
          [(2) to establish and operate HIV care consortia 
        within areas most affected by HIV disease that shall be 
        designed to provide a comprehensive continuum of care 
        to individuals and families with HIV disease in 
        accordance with section 2613;
          [(3) to provide home- and community-based care 
        services for individuals with HIV disease in accordance 
        with section 2614;
          [(4) to provide assistance to assure the continuity 
        of health insurance coverage for individuals with HIV 
        disease in accordance with section 2615; and
          [(5) to provide therapeutics to treat HIV disease to 
        individuals with HIV disease in accordance with section 
        2616.
Services described in paragraph (1) shall be delivered through 
consortia designed as described in paragraph (2), where such 
consortia exist, unless the State demonstrates to the Secretary 
that delivery of such services would be more effective when 
other delivery mechanisms are used. In making a determination 
regarding the delivery of services, the State shall consult 
with appropriate representatives of service providers and 
recipients of services who would be affected by such 
determination, and shall include in its demonstration to the 
Secretary the findings of the State regarding such 
consultation.
  [(b) Support Services; Outreach.--The purposes for which a 
grant under this part may be used include delivering or 
enhancing the following:
          [(1) Outpatient and ambulatory support services under 
        section 2611(a) (including case management) to the 
        extent that such services facilitate, enhance, support, 
        or sustain the delivery, continuity, or benefits of 
        health services for individuals and families with HIV 
        disease.
          [(2) Outreach activities that are intended to 
        identify individuals with HIV disease who know their 
        HIV status and are not receiving HIV-related services, 
        and that are--
                  [(A) necessary to implement the strategy 
                under section 2617(b)(4)(B), including 
                activities facilitating the access of such 
                individuals to HIV-related primary care 
                services at entities described in subsection 
                (c)(1);
                  [(B) conducted in a manner consistent with 
                the requirement under section 2617(b)(6)(G) and 
                2651(b)(2); and
                  [(C) supplement, and do not supplant, such 
                activities that are carried out with amounts 
                appropriated under section 317.
  [(c) Early Intervention Services.--
          [(1) In general.--The purposes for which a grant 
        under this part may be used include providing to 
        individuals with HIV disease early intervention 
        services described in section 2651(b)(2), with follow-
        up referral provided for the purpose of facilitating 
        the access of individuals receiving the services to 
        HIV-related health services. The entities through which 
        such services may be provided under the grant include 
        public health departments, emergency rooms, substance 
        abuse and mental health treatment programs, 
        detoxification centers, detention facilities, clinics 
        regarding sexually transmitted diseases, homeless 
        shelters, HIV disease counseling and testing sites, 
        health care points of entry specified by States or 
        eligible areas, federally qualified health centers, and 
        entities described in section 2652(a) that constitute a 
        point of access to services by maintaining referral 
        relationships.
          [(2) Conditions.--With respect to an entity that 
        proposes to provide early intervention services under 
        paragraph (1), such paragraph applies only if the 
        entity demonstrates to the satisfaction of the State 
        involved that--
                  [(A) Federal, State, or local funds are 
                otherwise inadequate for the early intervention 
                services the entity proposes to provide; and
                  [(B) the entity will expend funds pursuant to 
                such paragraph to supplement and not supplant 
                other funds available to the entity for the 
                provision of early intervention services for 
                the fiscal year involved.
  [(d) Quality Management.--
          [(1) Requirement.--Each State that receives a grant 
        under this part shall provide for the establishment of 
        a quality management program to assess the extent to 
        which HIV health services provided to patients under 
        the grant are consistent with the most recent Public 
        Health Service guidelines for the treatment of HIV 
        disease and related opportunistic infection, and as 
        applicable, to develop strategies for ensuring that 
        such services are consistent with the guidelines for 
        improvement in the access to and quality of HIV health 
        services.
          [(2) Use of funds.--From amounts received under a 
        grant awarded under this part for a fiscal year, the 
        State may (in addition to amounts to which section 
        2618(b)(5) applies) use for activities associated with 
        the quality management program required in paragraph 
        (1) not more than the lesser of--
                  [(A) 5 percent of amounts received under the 
                grant; or
                  [(B) $3,000,000.]

SEC. 2612. GENERAL USE OF GRANTS.

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

SEC. 2613. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

  (a) Consortia.--A State [may use] may, subject to subsection 
(f), use amounts provided under a grant awarded under [this 
part] section 2611 to provide assistance under [section 
2612(a)(1)] section 2612(a) to an entity that--
          (1) is an association of one or more public, and one 
        or more nonprofit private, (or private for-profit 
        providers or organizations if such entities are the 
        only available providers of quality HIV care in the 
        area) health care and support service providers and 
        community based organizations operating within areas 
        determined by the State to be most affected by [HIV 
        disease] HIV/AIDS; and
          (2) agrees to use such assistance for the planning, 
        development and delivery, through the direct provision 
        of services or through entering into agreements with 
        other entities for the provision of such services, of 
        comprehensive outpatient health and support services 
        for individuals with [HIV disease] HIV/AIDS, that may 
        include--
                  (A) * * *
                  (B) essential support services such as 
                transportation services, attendant care, 
                homemaker services, day or respite care, 
                benefits advocacy, advocacy services provided 
                through public and nonprofit private entities, 
                and services that are incidental to the 
                provision of health care services for 
                individuals with [HIV disease] HIV/AIDS 
                including nutrition services, housing referral 
                services, and child welfare and family services 
                (including foster care and adoption services).
An entity or entities of the type described in this subsection 
shall hereinafter be referred to in this title as a 
``consortium'' or ``consortia''.
  (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] HIV/AIDS have been identified by 
                the consortium, particularly those experiencing 
                disparities in access and services and those 
                who reside in historically underserved 
                communities;

           *       *       *       *       *       *       *

  (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) demonstrates that the consortium includes 
                agencies and community-based organizations--
                          (i) with a record of service to 
                        populations and subpopulations with 
                        [HIV disease] HIV/AIDS requiring care 
                        within the community to be served; and

           *       *       *       *       *       *       *

                  (B) demonstrates that the consortium has 
                carried out an assessment of service needs 
                within the geographic area to be served and, 
                after consultation with the entities described 
                in paragraph (2), has established a plan to 
                ensure the delivery of services to meet such 
                identified needs that shall include--
                          (i) * * *

           *       *       *       *       *       *       *

                          (iv) assurances that the assessment 
                        of service needs and the planning of 
                        the delivery of services will include 
                        participation by individuals with [HIV 
                        disease] HIV/AIDS;
                  (C) demonstrates that adequate planning has 
                occurred to meet the special needs of families 
                with [HIV disease] HIV/AIDS, including family 
                centered and youth centered care;

           *       *       *       *       *       *       *

          (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] HIV/
                AIDS;

           *       *       *       *       *       *       *

  (d) Definition.--As used in [this part] section 2611, the 
term ``family centered care'' means the system of services 
described in this section that is targeted specifically to the 
special needs of infants, children, women, and families. Family 
centered care shall be based on a partnership between parents, 
professionals, and the community designed to ensure an 
integrated, coordinated, culturally sensitive, and community-
based continuum of care for children, women, and families with 
[HIV disease] HIV/AIDS.

           *       *       *       *       *       *       *

  (f) Allocation of Funds; Treatment as Support Services.--For 
purposes of the requirement of section 2612(b)(1), expenditures 
of grants under section 2611 for or through consortia under 
this section are deemed to be support services, not core 
medical services. The preceding sentence may not be construed 
as having any legal effect on the provisions of subsection (a) 
that relate to authorized expenditures of the grant.

SEC. 2614. GRANTS FOR HOME- AND COMMUNITY-BASED CARE.

  (a) Uses.--A State may use amounts provided under a grant 
awarded under [this part] section 2611 to make grants under 
[section 2612(a)(2)] section 2612(b)(3)(J) to entities to--
          (1) provide home- and community-based health services 
        for individuals with [HIV disease] HIV/AIDS pursuant to 
        written plans of care prepared by a case management 
        team, that shall include appropriate health care 
        professionals, in such State for providing such 
        services to such individuals;
          (2) provide outreach services to individuals with 
        [HIV disease] HIV/AIDS, including those individuals in 
        rural areas; and
          (3) provide for the coordination of the provision of 
        services under this section with the provision of HIV-
        related health services, including specialty care and 
        vaccinations for hepatitis co-infection, provided by 
        public and private entities.
  (b) Priority.--In awarding grants under subsection (a), a 
State shall give priority to entities that provide assurances 
to the State that--
          (1) * * *
          (2) such entities will utilize amounts provided under 
        such grants for the provision of home- and community-
        based services to low-income individuals with [HIV 
        disease] HIV/AIDS.
  (c) Definition.--As used in [this part] section 2611, the 
term ``home- and community-based health services''--
          (1) means, with respect to an individual with [HIV 
        disease] HIV/AIDS, skilled health services furnished to 
        the individual in the individual's home pursuant to a 
        written plan of care established by a case management 
        team, that shall include appropriate health care 
        professionals, for the provision of such services and 
        items described in paragraph (2);
          (2) includes--
                  (A) * * *
                  (B) [homemaker or] home health aide services 
                and personal care services furnished in the 
                home of the individual;

           *       *       *       *       *       *       *


SEC. 2615. CONTINUUM OF HEALTH INSURANCE COVERAGE.

  (a) In General.--A State may use amounts received under a 
grant awarded under [this part] section 2611 to establish a 
program of financial assistance under section [2612(a)(3)] 
2612(b)(3)(F) to assist eligible low-income individuals with 
[HIV disease] HIV/AIDS in--
          (1) * * *

           *       *       *       *       *       *       *


SEC. 2616. PROVISION OF TREATMENTS.

  (a) In General.--A State shall use a portion of the amounts 
provided under a grant awarded under [this part] section 2611 
to establish a program under section [2612(a)(5)] 2612(b)(3)(B) 
to provide therapeutics to treat [HIV disease] HIV/AIDS or 
prevent the serious deterioration of health arising from [HIV 
disease] HIV/AIDS in eligible individuals, including measures 
for the prevention and treatment of opportunistic infections.
  (b) Eligible Individual.--To be eligible to receive 
assistance from a State under this section an individual 
shall--
          (1) have a medical diagnosis of [HIV disease] HIV/
        AIDS; and

           *       *       *       *       *       *       *

  (c) State Duties.--In carrying out this section the State 
shall--
          [(1) determine, in accordance with guidelines issued 
        by the Secretary, which treatments are eligible to be 
        included under the program established under this 
        section;]
          (1) ensure that the therapeutics included on the list 
        of classes of core antiretroviral therapeutics 
        established by the Secretary under subsection (e) are, 
        at a minimum, the treatments provided by the State 
        pursuant to this section;

           *       *       *       *       *       *       *

          (3) provide outreach to individuals with [HIV 
        disease] HIV/AIDS, and as appropriate to the families 
        of such individuals;

           *       *       *       *       *       *       *

  (e) List of Classes of Core Antiretroviral Therapeutics.--For 
purposes of subsection (c)(1), the Secretary shall develop and 
maintain a list of classes of core antiretroviral therapeutics, 
which list shall be based on the therapeutics included in the 
guidelines of the Secretary known as the Clinical Practice 
Guidelines for Use of HIV/AIDS Drugs, relating to drugs needed 
to manage symptoms associated with HIV. The preceding sentence 
does not affect the authority of the Secretary to modify such 
Guidelines.
  [(e)] (f) Use of Health Insurance and Plans.--
          (1) In general.--In carrying out subsection (a), a 
        State may expend a grant under [this part] section 2611 
        to provide the therapeutics described in such 
        subsection by paying on behalf of individuals with [HIV 
        disease] HIV/AIDS the costs of purchasing or 
        maintaining health insurance or plans whose coverage 
        includes a full range of such therapeutics and 
        appropriate primary care services.
          (2) Limitation.--The authority established in 
        paragraph (1) applies only to the extent that, for the 
        fiscal year involved, the costs of the health insurance 
        or plans to be purchased or maintained under such 
        paragraph do not exceed the costs of otherwise 
        providing therapeutics described in subsection (a).
  (g) Drug Rebate Program.--A State shall ensure that any drug 
rebates received on drugs purchased from funds provided 
pursuant to this section are applied to activities supported 
under this subpart, with priority given to activities described 
under this section.

SEC. 2617. STATE APPLICATION.

  (a) In General.--The Secretary shall not make a grant to a 
State under this part for a fiscal year unless the State 
prepares and submits, to the Secretary, an application at such 
time, in such form, and containing such agreements, assurances, 
and information as the Secretary determines to be necessary to 
carry out this part.
  (b) Description of Intended Uses and Agreements.--The 
application submitted under subsection (a) shall contain--
          (1) a detailed description of the HIV-related 
        services provided in the State to individuals and 
        families with [HIV disease] HIV/AIDS during the year 
        preceding the year for which the grant is requested, 
        and the number of individuals and families receiving 
        such services, that shall include--
                  (A) a description of the types of programs 
                operated or funded by the State for the 
                provision of HIV-related services during the 
                year preceding the year for which the grant is 
                requested and the methods utilized by the State 
                to finance such programs;
                  (B) an accounting of the amount of funds that 
                the State has expended for such services and 
                programs during the year preceding the year for 
                which the grant is requested; and
                  (C) information concerning--
                          (i) the number of individuals to be 
                        served with assistance provided under 
                        the grant;
                          (ii) demographic data on the 
                        population of the individuals to be 
                        served;
                          (iii) the average cost of providing 
                        each category of HIV-related health 
                        services and the extent to which such 
                        cost is paid by third-party payors; and
                          (iv) the aggregate amounts expended 
                        for each such category of services;
          (2) a determination of the size and demographics of 
        the population of individuals with [HIV disease] HIV/
        AIDS in the State;
          (3) a determination of the needs of such population, 
        with particular attention to--
                  (A) individuals with [HIV disease] HIV/AIDS 
                who know their HIV status and are not receiving 
                HIV-related services; and
                  (B) disparities in access and services among 
                affected subpopulations and historically 
                underserved communities;
          (4) the designation of a lead State agency that 
        shall--
                  (A) administer all assistance received under 
                this part;
                  (B) conduct the needs assessment and prepare 
                the State plan under paragraph (3);
                  (C) prepare all applications for assistance 
                under this part;
                  (D) receive notices with respect to programs 
                under this title;
                  (E) every 2 years, collect and submit to the 
                Secretary all audits, consistent with Office of 
                Management and Budget circular A133, from 
                grantees within the State, including audits 
                regarding funds expended in accordance with 
                this part; and
                  (F) carry out any other duties determined 
                appropriate by the Secretary to facilitate the 
                coordination of programs under this title.
          [(4)] (5) a comprehensive plan that describes the 
        organization and delivery of HIV health care and 
        support services to be funded with assistance received 
        under [this part] section 2611 that shall include a 
        description of the purposes for which the State intends 
        to use such assistance, 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] HIV/AIDS (as determined under 
                        paragraph (2)) and the needs of such 
                        population (as determined under 
                        paragraph (3));
                          (ii) availability of other 
                        governmental and non-governmental 
                        resources, including the State medicaid 
                        plan under title XIX of the Social 
                        Security Act and the State Children's 
                        Health Insurance Program under title 
                        XXI of such Act to cover health care 
                        costs of eligible individuals and 
                        families with [HIV disease] HIV/AIDS;
                          (iii) capacity development needs 
                        resulting from disparities in the 
                        availability of HIV-related services in 
                        historically underserved communities 
                        and rural communities; and
                          (iv) the efficiency of the 
                        administrative mechanism of the State 
                        for rapidly allocating funds to the 
                        areas of greatest need within the 
                        State;
                  (B) includes a strategy for identifying 
                individuals who know their HIV status and are 
                not receiving such services and for informing 
                the individuals of and enabling the individuals 
                to utilize the services, giving particular 
                attention to eliminating disparities in access 
                and services among affected subpopulations and 
                historically underserved communities, and 
                including discrete goals, a timetable, and an 
                appropriate allocation of funds;
                  (C) includes a strategy to coordinate the 
                provision of such services with programs for 
                HIV prevention (including outreach and early 
                intervention) and for the prevention and 
                treatment of substance abuse (including 
                programs that provide comprehensive treatment 
                services for such abuse);
                  (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] HIV/AIDS throughout the State;
                  (E) provides a description of the manner in 
                which services funded with assistance provided 
                under [this part] section 2611 will be 
                coordinated with other available related 
                services for individuals with [HIV disease] 
                HIV/AIDS; [and]
                  (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
                  (G) includes key outcomes to be measured by 
                all entities in the State receiving assistance 
                under this title; and
          [(5)] (6) an assurance that the public health agency 
        administering the grant for the State will periodically 
        convene a meeting of individuals with [HIV disease] 
        HIV/AIDS, members of a Federally recognized Indian 
        tribe as represented in the State, 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
          [(6)] (7) an assurance by the State that--
                  (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)] paragraph 
                (6), and the types of entities described in 
                section 2602(b)(2), in developing the 
                comprehensive plan under [paragraph (4)] 
                paragraph (5) and commenting on the 
                implementation of such plan;
                  (B) the State will--
                          (i) to the maximum extent 
                        practicable, ensure that HIV-related 
                        health care and support services 
                        delivered pursuant to a program 
                        established with assistance provided 
                        under [this part] section 2611 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] HIV/AIDS;
                          (ii) ensure that such services will 
                        be provided in a setting that is 
                        accessible to low-income individuals 
                        with [HIV disease] HIV/AIDS;
                          (iii) provide outreach to low-income 
                        individuals with [HIV disease] HIV/AIDS 
                        to inform such individuals of the 
                        services available under [this part] 
                        section 2611; and
                          (iv) in the case of a State that 
                        intends to use amounts provided under 
                        the grant for purposes described in 
                        2615, submit a plan to the Secretary 
                        that demonstrates that the State has 
                        established a program that assures 
                        that--
                                  (I) such amounts will be 
                                targeted to individuals who 
                                would not otherwise be able to 
                                afford health insurance 
                                coverage; and
                                  (II) income, asset, and 
                                medical expense criteria will 
                                be established and applied by 
                                the State to identify those 
                                individuals who qualify for 
                                assistance under such program, 
                                and information concerning such 
                                criteria shall be made 
                                available to the public;
                  (C) the State will provide for periodic 
                independent peer review to assess the quality 
                and appropriateness of health and support 
                services provided by entities that receive 
                funds from the State under [this part] section 
                2611;
                  (D) the State will permit and cooperate with 
                any Federal investigations undertaken regarding 
                programs conducted under [this part] section 
                2611;
                  (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] section 2611;
                  (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) under any State compensation 
                        program, under an insurance policy, or 
                        under any Federal or State health 
                        benefits program; or
                          (ii) by an entity that provides 
                        health services on a prepaid basis 
                        (except for a program administered by 
                        or providing the services of the Indian 
                        Health Service); and
                  (G) entities within areas in which activities 
                under the grant are carried out will maintain 
                appropriate relationships with entities in the 
                area served that constitute key points of 
                access to the health care system for 
                individuals with [HIV disease] HIV/AIDS 
                (including emergency rooms, substance abuse 
                treatment programs, detoxification centers, 
                adult and juvenile detention facilities, 
                sexually transmitted disease clinics, HIV 
                counseling and testing sites, mental health 
                programs, and homeless shelters), and other 
                entities under section 2612(c) and 2652(a), for 
                the purpose of facilitating early intervention 
                for individuals newly diagnosed with [HIV 
                disease] HIV/AIDS and individuals knowledgeable 
                of their HIV status but not in care.
  (c) Requirements Regarding Imposition of Charges for 
Services.--
          (1) In General.--The Secretary may not make a grant 
        under section 2611 to a State unless the State provides 
        assurances that in the provision of services with 
        assistance provided under the grant--
                  (A) in the case of individuals with an income 
                less than or equal to 100 percent of the 
                official poverty line, the provider will not 
                impose charges on any such individual for the 
                provision of services under the grant;
                  (B) in the case of individuals with an income 
                greater than 100 percent of the official 
                poverty line, the provider--
                          (i) will impose charges on each such 
                        individual for the provision of such 
                        services; and
                          (ii) will impose charges according to 
                        a schedule of charges that is made 
                        available to the public;
                  (C) in the case of individuals with an income 
                greater than 100 percent of the official 
                poverty line and not exceeding 200 percent of 
                such poverty line, the provider will not, for 
                any calendar year, impose charges in an amount 
                exceeding 5 percent of the annual gross income 
                of the individual involved;
                  (D) in the case of individuals with an income 
                greater than 200 percent of the official 
                poverty line and not exceeding 300 percent of 
                such poverty line, the provider will not, for 
                any calendar year, impose charges in an amount 
                exceeding 7 percent of the annual gross income 
                of the individual involved; and
                  (E) in the case of individuals with an income 
                greater than 300 percent of the official 
                poverty line, the provider will not, for any 
                calendar year, impose charges in an amount 
                exceeding 10 percent of the annual gross income 
                of the individual involved.
          (2) Assessment of charge.--With respect to compliance 
        with the assurance made under paragraph (1), a grantee 
        under [this part] section 2611 may, in the case of 
        individuals subject to a charge for purposes of such 
        paragraph--
                  (A) assess the amount of the charge in the 
                discretion of the grantee, including imposing 
                only a nominal charge for the provision of 
                services, subject to the provisions of such 
                paragraph regarding public schedules regarding 
                limitation on the maximum amount of charges; 
                and
                  (B) take into consideration the medical 
                expenses of individuals in assessing the amount 
                of the charge, subject to such provisions.
          (3) Applicability of limitation on amount of 
        charge.--The Secretary may not make a grant under 
        section 2611 unless the applicant of the grant agrees 
        that the limitations established in subparagraphs (C), 
        (D), and (E) of paragraph (1) regarding the imposition 
        of charges for services applies to the annual aggregate 
        of charges imposed for such services, without regard to 
        whether they are characterized as enrollment fees, 
        premiums, deductibles, cost sharing, copayments, 
        coinsurance, or other charges.
          (4) Waiver.--
                  (A) In general.--The State shall waive the 
                requirements established in paragraphs (1) 
                through (3) in the case of an entity that does 
                not, in providing health care services, impose 
                a charge or accept reimbursement from any 
                third-party payor, including reimbursement 
                under any insurance policy or under any Federal 
                or State health benefits program.
                  (B) Determination.--A determination by the 
                State of whether an entity referred to in 
                subparagraph (A) meets the criteria for a 
                waiver under such subparagraph shall be made 
                without regard to whether the entity accepts 
                voluntary donations regarding the provision of 
                services to the public.
  (d) Requirement of Matching Funds Regarding State 
Allotments.--
          (1) In general.--In the case of any State to which 
        the criterion described in paragraph (3) applies, the 
        Secretary may not make a grant under [this part] 
        section 2611 unless the State agrees that, with respect 
        to the costs to be incurred by the State in carrying 
        out the program for which the grant was awarded, 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--
                  (A) for the first fiscal year of payments 
                under the grant, not less than 16\2/3\ percent 
                of such costs ($1 for each $5 of Federal funds 
                provided in the grant);
                  (B) for any second fiscal year of such 
                payments, not less than 20 percent of such 
                costs ($1 for each $4 of Federal funds provided 
                in the grant);
                  (C) for any third fiscal year of such 
                payments, not less than 25 percent of such 
                costs ($1 for each $3 of Federal funds provided 
                in the grant);
                  (D) for any fourth fiscal year of such 
                payments, not less than 33\1/3\ percent of such 
                costs ($1 for each $2 of Federal funds provided 
                in the grant); and
                  (E) for any subsequent fiscal year of such 
                payments, not less than 33\1/3\ percent of such 
                costs ($1 for each $2 of Federal funds provided 
                in the grant).
          (2) Determination of amount of non-federal 
        contribution.--
                  (A) In general.--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 any portion of any 
                service subsidized by the Federal Government, 
                may not be included in determining the amount 
                of such non-Federal contributions.
                  (B) Inclusion of certain amounts.--
                          (i) In making a determination of the 
                        amount of non-Federal contributions 
                        made by a State for purposes of 
                        paragraph (1), the Secretary shall, 
                        subject to clause (ii), 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;
                          (ii) In making a determination for 
                        purposes of clause (i), 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 
                        [this part] section 2611) or under 
                        other provisions of law.
          (3) Applicability of requirement.--
                  (A) Number of cases.--A State referred to in 
                paragraph (1) is any State for which the number 
                of cases of [acquired immune deficiency 
                syndrome] AIDS reported to and confirmed by the 
                Director of the Centers for Disease Control and 
                Prevention for the period described in 
                subparagraph (B) constitutes in excess of 1 
                percent of the aggregate number of such cases 
                reported to and confirmed by the Director for 
                such period for the United States.
                  (B) Period of time.--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 
                subsection (a).
                  (C) Puerto Rico.--For purposes of paragraph 
                (1), the number of cases of [acquired immune 
                deficiency syndrome] AIDS reported and 
                confirmed for the Commonwealth of Puerto Rico 
                for any fiscal year shall be deemed to be less 
                than 1 percent.
          (4) Diminished state contribution.--With respect to a 
        State that does not make available the entire amount of 
        the non-Federal contribution referred to in paragraph 
        (1), the State shall continue to be eligible to receive 
        Federal funds under a grant under [this part] section 
        2611, 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. 2618. DISTRIBUTION OF FUNDS.

  (a) Amount of Grant to State.--
          (1) Minimum allotment.--Subject to the extent of 
        amounts made available under [section 2677] section 
        2623, the amount of a grant to be made under [this 
        part] section 2611 for--
                  (A) [each of the several States and the 
                District of Columbia] each of the 50 States, 
                the District of Columbia, Guam, and the Virgin 
                Islands (referred to in this paragraph as a 
                ``covered State'') for a fiscal year shall be 
                the greater of--
                          (i)(I) with respect to a [State or 
                        District] covered State that has less 
                        than 90 living cases of [acquired 
                        immune deficiency syndrome] AIDS, as 
                        determined under paragraph (2)(D), 
                        $200,000; or
                  (II) with respect to a [State or District] 
                covered State that has 90 or more living cases 
                of [acquired immune deficiency syndrome] AIDS, 
                as determined under paragraph (2)(D), $500,000; 
                and

           *       *       *       *       *       *       *

                  (B) [each territory of the United States, as 
                defined in paragraph (3),] each territory other 
                than Guam and the Virgin Islands 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 subparagraphs (H) 
                        and (I); and] For purposes of paragraph 
                        (1), the amount referred to in this 
                        paragraph for a State (including a 
                        territory) for a fiscal year is, 
                        subject to subparagraphs (E) and (F)--
                          (i) an amount equal to the amount 
                        made available under section 2623 for 
                        the fiscal year involved for grants 
                        pursuant to paragraph (1), subject to 
                        subparagraph (G); and
                          (ii) the percentage constituted by 
                        the sum of--
                                  (I) the product of [.80] .75 
                                and the ratio of the State 
                                distribution factor for the 
                                State or territory (as 
                                determined under subsection 
                                (B)) to the sum of the 
                                respective State distribution 
                                factors for all States or 
                                territories; [and]
                                  (II) the product of .20 and 
                                the ratio of the non-EMA 
                                distribution factor for the 
                                State or territory (as 
                                determined under subparagraph 
                                (C)) to the sum of the 
                                respective non-EMA distribution 
                                factors for all States or 
                                territories[.]; and
                                  (III) if the State does not 
                                for such fiscal year contain 
                                any area that is an eligible 
                                area under subpart I of part A 
                                or any area that is a 
                                transitional area under section 
                                2609 (referred to in this 
                                subclause as a ``no-EMA 
                                State''), the product of 0.05 
                                and the ratio of the number of 
                                cases that applies for the 
                                State under subparagraph (D) to 
                                the sum of the respective 
                                numbers of cases that so apply 
                                for all no-EMA States.
                  (B) State distribution factor.--For purposes 
                of subparagraph (A)(ii)(I), the term ``State 
                distribution factor'' means an amount equal to 
                the [estimated number of living cases of 
                acquired immune deficiency syndrome in the 
                eligible area involved] number of living cases 
                of HIV/AIDS in the State involved, as 
                determined under subparagraph (D).
                  (C) Non-ema distribution factor.--For 
                purposes of subparagraph (A)(ii)(II), the term 
                ``non-ema distribution factor'' means an amount 
                equal to the sum of--
                          (i) the [estimated number of living 
                        cases of acquired immune deficiency 
                        syndrome] number of living cases of 
                        HIV/AIDS in the State [or territory] 
                        involved, as determined under 
                        subparagraph (D); less
                          [(ii) the estimated number of living 
                        cases of acquired immune deficiency 
                        syndrome in such State or territory 
                        that are within an eligible area (as 
                        determined under part A).]
                          (ii) a number equal to the sum of--
                                  (I) the total number of 
                                living cases of HIV/AIDS that 
                                are within areas in such State 
                                that are eligible areas under 
                                subpart I of part A for the 
                                fiscal year involved, which 
                                individual number for an area 
                                is the number that applies 
                                under section 2601 for the area 
                                for such fiscal year; and
                                  (II) the total number of such 
                                cases that are within areas in 
                                such State that are 
                                transitional areas under 
                                section 2609 for such fiscal 
                                year, which individual number 
                                for an area is the number that 
                                applies under such section for 
                                the fiscal year.
                  [(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 or section 
                        2620 for fiscal year 2005 and 
                        subsequent fiscal years, the cases 
                        counted for each 12-month period 
                        beginning on or after July 1, 2004, 
                        shall be cases of HIV disease (as 
                        reported to and confirmed by such 
                        Director) rather than cases of acquired 
                        immune deficiency syndrome; and
                          [(ii) with respect to each of the 
                        first through the tenth year during 
                        such period, the amount referred to in 
                        section 2603(a)(3)(C)(ii).
                  [(E) Determination of secretary regarding 
                data on hiv cases.--If under section 
                2603(a)(3)(D)(i) the Secretary determines that 
                data on cases of HIV disease are not 
                sufficiently accurate and reliable, then 
                notwithstanding subparagraph (D) of this 
                paragraph, for any fiscal year prior to fiscal 
                year 2007 the references in such subparagraph 
                to cases of HIV disease do not have any legal 
                effect.
                  [(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.
                  [(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.
                  [(H) Limitation.--
                          [(i) In general.--The Secretary shall 
                        ensure that the amount of a grant 
                        awarded to a State or territory under 
                        section 2611 or subparagraph (I)(i) for 
                        a fiscal year is not less than--
                                  [(I) with respect to fiscal 
                                year 2001, 99 percent;
                                  [(II) with respect to fiscal 
                                year 2002, 98 percent;
                                  [(III) with respect to fiscal 
                                year 2003, 97 percent;
                                  [(IV) with respect to fiscal 
                                year 2004, 96 percent; and
                                  [(V) with respect to fiscal 
                                year 2005, 95 percent,
                        of the amount such State or territory 
                        received for fiscal year 2000 under 
                        section 2611 or subparagraph (I)(i), 
                        respectively (notwithstanding such 
                        subparagraph). In administering this 
                        subparagraph, the Secretary shall, with 
                        respect to States or territories that 
                        will under such section receive grants 
                        in amounts that exceed the amounts that 
                        such States received under such section 
                        or subparagraph for fiscal year 2000, 
                        proportionally reduce such amounts to 
                        ensure compliance with this 
                        subparagraph. In making such 
                        reductions, the Secretary shall ensure 
                        that no such State receives less than 
                        that State received for fiscal year 
                        2000.
                          [(ii) Ratable reduction.--If the 
                        amount appropriated under section 2677 
                        for a fiscal year and available for 
                        grants under section 2611 or 
                        subparagraph (I)(i) is less than the 
                        amount appropriated and available for 
                        fiscal year 2000 under section 2611 or 
                        subparagraph (I)(i), respectively, the 
                        limitation contained in clause (i) for 
                        the grants involved shall be reduced by 
                        a percentage equal to the percentage of 
                        the reduction in such amounts 
                        appropriated and available.]
                  (D) Living cases of hiv/aids.--
                          (i) Requirement of names-based 
                        reporting.--Except as provided in 
                        clause (ii), the number determined 
                        under this subparagraph for a State for 
                        a fiscal year for purposes of 
                        subparagraph (B) is the number of 
                        living names-based cases of HIV/AIDS in 
                        the State that, as of December 31 of 
                        the most recent calendar year for which 
                        such data is available, have been 
                        reported to and confirmed by the 
                        Director of the Centers for Disease 
                        Control and Prevention.
                          (ii) Transition period; exemption 
                        regarding non-aids cases.--For each of 
                        the fiscal years 2007 through 2010, a 
                        State is, subject to clauses (iii) 
                        through (v), exempt from the 
                        requirement under clause (i) that 
                        living non-AIDS names-based cases of 
                        HIV be reported unless--
                                  (I) a system was in operation 
                                as of December 31, 2005, that 
                                provides sufficiently accurate 
                                and reliable names-based 
                                reporting of such cases 
                                throughout the State, subject 
                                to clause (vii); or
                                  (II) no later than the 
                                beginning of fiscal year 2008, 
                                2009, or 2010, the Secretary, 
                                after consultation with the 
                                chief executive of the State, 
                                determines that a system has 
                                become operational in the State 
                                that provides sufficiently 
                                accurate and reliable names-
                                based reporting of such cases 
                                throughout the State.
                          (iii) Requirements for exemption for 
                        fiscal year 2007.--For fiscal year 
                        2007, an exemption under clause (ii) 
                        for a State applies only if, by October 
                        1, 2006--
                                  (I)(aa) the State had 
                                submitted to the Secretary a 
                                plan for making the transition 
                                to sufficiently accurate and 
                                reliable names-based reporting 
                                of living non-AIDS cases of 
                                HIV; or
                                  (bb) all statutory changes 
                                necessary to provide for 
                                sufficiently accurate and 
                                reliable reporting of such 
                                cases had been made; and
                                  (II) the State had agreed 
                                that, by April 1, 2008, the 
                                State will begin accurate and 
                                reliable names-based reporting 
                                of such cases, except that such 
                                agreement is not required to 
                                provide that, as of such date, 
                                the system for such reporting 
                                be fully sufficient with 
                                respect to accuracy and 
                                reliability throughout the 
                                area.
                          (iv) Requirement for exemption as of 
                        fiscal year 2008.--For each of the 
                        fiscal years 2008 through 2010, an 
                        exemption under clause (ii) for a State 
                        applies only if, as of April 1, 2008, 
                        the State is substantially in 
                        compliance with the agreement under 
                        clause (iii)(II).
                          (v) Progress toward names-based 
                        reporting.--For fiscal year 2009 or 
                        2010, the Secretary may terminate an 
                        exemption under clause (ii) for a State 
                        if the State submitted a plan under 
                        clause (iii)(I)(aa) and the Secretary 
                        determines that the State is not 
                        substantially following the plan.
                          (vi) Counting of cases in areas with 
                        exemptions.--
                                  (I) In general.--With respect 
                                to a State that is under a 
                                reporting system for living 
                                non-AIDS cases of HIV that is 
                                not names-based (referred to in 
                                this subparagraph as ``code-
                                based reporting''), the 
                                Secretary shall, for purposes 
                                of this subparagraph, modify 
                                the number of such cases 
                                reported for the State in order 
                                to adjust for duplicative 
                                reporting in and among systems 
                                that use code-based reporting.
                                  (II) Adjustment rate.--The 
                                adjustment rate under subclause 
                                (I) for a State shall be a 
                                reduction of 5 percent in the 
                                number of living non-AIDS cases 
                                of HIV reported for the State.
                          (vii) List of states meeting standard 
                        regarding december 31, 2005.--
                                  (I) In general.--If a State 
                                is specified in subclause (II), 
                                the State shall be considered 
                                to meet the standard described 
                                in clause (ii)(I). No other 
                                State may be considered to meet 
                                such standard.
                                  (II) Relevant states.--For 
                                purposes of subclause (I), the 
                                States specified in this 
                                subclause are the following: 
                                Alaska, Alabama, Arkansas, 
                                Arizona, Colorado, Florida, 
                                Indiana, Iowa, Idaho, Kansas, 
                                Louisiana, Michigan, Minnesota, 
                                Missouri, Mississippi, North 
                                Carolina, North Dakota, 
                                Nebraska, New Jersey, New 
                                Mexico, New York, Nevada, Ohio, 
                                Oklahoma, South Carolina, South 
                                Dakota, Tennessee, Texas, Utah, 
                                Virginia, Wisconsin, West 
                                Virginia, Wyoming, Guam, and 
                                the Virgin Islands.
                          (viii) Rules of construction 
                        regarding acceptance of reports.--
                                  (I) Cases of aids.--With 
                                respect to a State that is 
                                subject to the requirement 
                                under clause (i) and is not in 
                                compliance with the requirement 
                                for names-based reporting of 
                                living non-AIDS cases of HIV, 
                                the Secretary shall, 
                                notwithstanding such 
                                noncompliance, accept reports 
                                of living cases of AIDS that 
                                are in accordance with such 
                                clause.
                                  (II) Applicability of 
                                exemption requirements.--The 
                                provisions of clauses (ii) 
                                through (vii) may not be 
                                construed as having any legal 
                                effect for fiscal year 2011 or 
                                any subsequent fiscal year, and 
                                accordingly, the status of a 
                                State for purposes of such 
                                clauses may not be considered 
                                after fiscal year 2010.
                          (ix) Program for detecting inaccurate 
                        or fraudulent counting.--The Secretary 
                        shall carry out a program to monitor 
                        the reporting of names-based cases for 
                        purposes of this subparagraph and to 
                        detect instances of inaccurate 
                        reporting, including fraudulent 
                        reporting.
                  (E) Code-based states; limitation on increase 
                in grant.--
                          (i) In general.--For each of the 
                        fiscal years 2007 through 2010, if 
                        code-based reporting (within the 
                        meaning of subparagraph (D)(vi)) 
                        applies in a State as of the beginning 
                        of the fiscal year involved, then 
                        notwithstanding any other provision of 
                        this paragraph, the amount of the grant 
                        pursuant to paragraph (1) for the State 
                        may not for the fiscal year involved 
                        exceed by more than 5 percent the 
                        amount of the grant pursuant to this 
                        paragraph for the State for the 
                        preceding fiscal year, except that the 
                        limitation under this clause may not 
                        result in a grant pursuant to paragraph 
                        (1) for a fiscal year that is less than 
                        the minimum amount that applies to the 
                        State under such paragraph for such 
                        fiscal year.
                          (ii) Use of amounts involved.--For 
                        each of the fiscal years 2007 through 
                        2010, amounts available as a result of 
                        the limitation under clause (i) shall 
                        be made available by the Secretary as 
                        additional amounts for grants pursuant 
                        to section 2620, subject to 
                        subparagraph (H).
                  (F) Severity of need.--
                          (i) Fiscal years beginning with 
                        2011.--If, by January 1, 2010, the 
                        Secretary notifies the appropriate 
                        committees of Congress that the 
                        Secretary has developed a severity of 
                        need index in accordance with clause 
                        (v), the provisions of subparagraphs 
                        (A) through (E) shall not apply for 
                        fiscal year 2011 or any fiscal year 
                        thereafter, and the Secretary shall use 
                        the severity of need index (as defined 
                        in clause (iv)) for the determination 
                        of the formula allocations, subject to 
                        the Congressional Review Act.
                          (ii) Subsequent fiscal years.--If, on 
                        or before any January 1 that is 
                        subsequent to the date referred to in 
                        clause (i), the Secretary notifies the 
                        appropriate committees of Congress that 
                        the Secretary has developed a severity 
                        of need index, in accordance with 
                        clause (v), for each succeeding fiscal 
                        year, the provisions of subparagraphs 
                        (A) through (D) shall not apply for the 
                        subsequent fiscal year or any fiscal 
                        year thereafter, and the Secretary 
                        shall use the severity of need index 
                        (as defined in clause (iv)) for the 
                        determination of the formula 
                        allocations, subject to the 
                        Congressional Review Act.
                          (iii) Fiscal year 2013.--The 
                        Secretary shall notify the appropriate 
                        committees of Congress that the 
                        Secretary has developed a severity of 
                        need index by January 1, 2012, in 
                        accordance with clause (v), and the 
                        provisions of subparagraphs (A) through 
                        (D) shall not apply for fiscal year 
                        2013 or any fiscal year thereafter, and 
                        the Secretary shall use the severity of 
                        need index (as defined in clause (iv)) 
                        for the determination of the formula 
                        allocations, subject to the 
                        Congressional Review Act.
                          (iv) Definition of severity of need 
                        index.--In this subparagraph, the term 
                        ``severity of need index'' means the 
                        index of the relative needs of 
                        individuals within the State, as 
                        identified by a variety of different 
                        factors, and is a factor that is 
                        multiplied by the number of living HIV/
                        AIDS cases in the State, providing 
                        different weights to those cases based 
                        on their needs.
                          (v) Requirements for secretarial 
                        notification.--When the Secretary 
                        notifies the appropriate committees of 
                        Congress that the Secretary has 
                        developed a severity of need index, the 
                        Secretary shall provide the following:
                                  (I) Methodology for and 
                                rationale behind developing the 
                                severity of need index, 
                                including information related 
                                to the field testing of the 
                                severity of need index.
                                  (II) An independent 
                                contractor analysis of 
                                activities carried out under 
                                subclause (I).
                                  (III) Expected changes in 
                                funding allocations, given the 
                                application of the severity of 
                                need index and the elimination 
                                of the provisions of 
                                subparagraphs (A) through (D).
                                  (IV) Information regarding 
                                the process by which the 
                                Secretary received community 
                                input regarding the application 
                                and development of the severity 
                                of need index.
                                  (V) Timeline and process for 
                                the implementation of the 
                                severity of need index to 
                                ensure that it is applied in 
                                the following fiscal year.
                          (vi) Annual reports.--Not later than 
                        1 year after the date of enactment of 
                        the Ryan White HIV/AIDS Treatment 
                        Modernization Act of 2006, and annually 
                        thereafter until the Secretary notifies 
                        Congress that the Secretary has 
                        developed a severity of need index in 
                        accordance with this subparagraph, the 
                        Secretary shall prepare and submit to 
                        the appropriate committees of Congress 
                        a report--
                                  (I) that updates progress 
                                toward having client level 
                                data;
                                  (II) that updates the 
                                progress toward having a 
                                severity of need index, 
                                including information related 
                                to the methodology and process 
                                for obtaining community input; 
                                and
                                  (III) that, as applicable, 
                                states whether the Secretary 
                                could develop a severity of 
                                need index before fiscal year 
                                2010.
                  [(I)] (G) Appropriations for treatment drug 
                program.--
                          (i) Formula grants.--With respect to 
                        the fiscal year involved, if under 
                        [section 2677] section 2623 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) 100 percent of such amount, less 
                        the percentage reserved under clause 
                        (ii)(V); and
                          (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[.];
                        which product shall then, as 
                        applicable, be increased under 
                        subparagraph (H).
                          (ii) Supplemental treatment drug 
                        grants.--
                                  [(I) In general.--From 
                                amounts made available under 
                                subclause (V), the Secretary 
                                shall make supplemental grants 
                                to States described in 
                                subclause (II) to enable such 
                                States to increase access to 
                                therapeutics described in 
                                section 2616(a), as provided by 
                                the State under section 
                                2616(c)(2).
                                  [(II) Eligible states.--For 
                                purposes of subclause (I), a 
                                State described in this 
                                subclause is a State that, in 
                                accordance with criteria 
                                established by the Secretary, 
                                demonstrates a severe need for 
                                a grant under such subclause. 
                                In developing such criteria, 
                                the Secretary shall consider 
                                eligibility standards, 
                                formulary composition, and the 
                                number of eligible individuals 
                                at or below 200 percent of the 
                                official poverty line to whom 
                                the State is unable to provide 
                                therapeutics described in 
                                section 2616(a).
                                  [(III) State requirements.--
                                The Secretary may not make a 
                                grant to a State under this 
                                clause unless the State agrees 
                                that--
                                          [(aa) the State will 
                                        make available 
                                        (directly or through 
                                        donations from public 
                                        or private entities) 
                                        non-Federal 
                                        contributions toward 
                                        the activities to be 
                                        carried out under the 
                                        grant in an amount 
                                        equal to $1 for each $4 
                                        of Federal funds 
                                        provided in the grant; 
                                        and
                                          [(bb) the State will 
                                        not impose eligibility 
                                        requirements for 
                                        services or scope of 
                                        benefits limitations 
                                        under section 2616(a) 
                                        that are more 
                                        restrictive than such 
                                        requirements in effect 
                                        as of January 1, 2000.]
                                  (I) In general.--From amounts 
                                made available under subclause 
                                (V), the Secretary shall award 
                                supplemental grants to States 
                                described in subclause (II) to 
                                enable such States to purchase 
                                and distribute to eligible 
                                individuals under section 
                                2616(b) pharmaceutical 
                                therapeutics described under 
                                subsections (c)(2) and (e) of 
                                such section.
                                  (II) Eligible states.--For 
                                purposes of subclause (I), a 
                                State shall be an eligible 
                                State if the State did not have 
                                unobligated funds subject to 
                                reallocation under section 
                                2618(d) in the previous fiscal 
                                year and, in accordance with 
                                criteria established by the 
                                Secretary, demonstrates a 
                                severe need for a grant under 
                                this clause. For purposes of 
                                determining severe need, the 
                                Secretary shall consider 
                                eligibility standards, 
                                formulary composition, the 
                                number of eligible individuals 
                                to whom a State is unable to 
                                provide therapeutics described 
                                in section 2616(a), and an 
                                unanticipated increase of 
                                eligible individuals with HIV/
                                AIDS.
                                  (III) State requirements.--
                                The Secretary may not make a 
                                grant to a State under this 
                                clause unless the State agrees 
                                that the State will make 
                                available (directly or through 
                                donations of public or private 
                                entities) non-Federal 
                                contributions toward the 
                                activities to be carried out 
                                under the grant in an amount 
                                equal to $1 for each $4 of 
                                Federal funds provided in the 
                                grant, except that the 
                                Secretary may waive this 
                                subclause if the State has 
                                otherwise fully complied with 
                                section 2617(d) with respect to 
                                the grant year involved. The 
                                provisions of this subclause 
                                shall apply to States that are 
                                not required to comply with 
                                such section 2617(d).
                                  (IV) Use and coordination.--
                                Amounts made available under a 
                                grant under this clause shall 
                                only be used by the State to 
                                provide HIV/AIDS-related 
                                medications. The State shall 
                                coordinate the use of such 
                                amounts with the amounts 
                                otherwise provided under 
                                section 2616(a) in order to 
                                maximize drug coverage.
                                  (V) Funding.--For the purpose 
                                of making grants under this 
                                clause, the Secretary shall 
                                each fiscal year reserve [3 
                                percent] 5 percent of the 
                                amount referred to in clause 
                                (i) with respect to section 
                                2616, subject to subclause 
                                (VI).
                                  [(VI) Limitation.--In 
                                reserving amounts under 
                                subclause (V) and making grants 
                                under this clause for a fiscal 
                                year, the Secretary shall 
                                ensure for each State that the 
                                total of the grant under 
                                section 2611 for the State for 
                                the fiscal year and the grant 
                                under clause (i) for the State 
                                for the fiscal year is not less 
                                than such total for the State 
                                for the preceding fiscal year.]
                          (iii) Code-based states; limitation 
                        on increase in formula grant.--The 
                        limitation under subparagraph (E)(i) 
                        applies to grants pursuant to clause 
                        (i) of this subparagraph to the same 
                        extent and in the same manner as such 
                        limitation applies to grants pursuant 
                        to paragraph (1), except that the 
                        reference to minimum grants does not 
                        apply for purposes of this clause. 
                        Amounts available as a result of the 
                        limitation under the preceding sentence 
                        shall be made available by the 
                        Secretary as additional amounts for 
                        grants under clause (ii) of this 
                        subparagraph.
                  (H) Increase in formula grants.--
                          (i) In general.--For each of the 
                        fiscal years 2007 through 2009, the 
                        Secretary shall ensure, subject to 
                        clauses (ii) through (iv), that the 
                        total for a State of the grant pursuant 
                        to paragraph (1) and the grant pursuant 
                        to subparagraph (G) is not less than 95 
                        percent of such total for the State for 
                        the preceding fiscal year, except that 
                        any increase under this clause--
                                  (I) may not result in a grant 
                                pursuant to paragraph (1) that 
                                is more than 95 percent of the 
                                amount of such grant for the 
                                preceding fiscal year; and
                                  (II) may not result in a 
                                grant pursuant to subparagraph 
                                (G) that is more than 95 
                                percent of the amount of such 
                                grant for such preceding fiscal 
                                year.
                          (ii) Fiscal year 2007.--For purposes 
                        of clause (i) as applied for fiscal 
                        year 2007, the references in such 
                        clause to subparagraph (G) are deemed 
                        to be references to subparagraph (I) as 
                        such subparagraph was in effect for 
                        fiscal year 2006.
                          (iii) Source of funds for increase.--
                                  (I) In general.--From the 
                                amount reserved under section 
                                2623(b)(2) for a fiscal year, 
                                and from amounts available for 
                                such section pursuant to 
                                subsection (d) of this section, 
                                the Secretary shall make 
                                available such amounts as may 
                                be necessary to comply with 
                                clause (i).
                                  (II) Pro rata reduction.--If 
                                the amounts referred to in 
                                subclause (I) for a fiscal year 
                                are insufficient to fully 
                                comply with clause (i) for the 
                                year, the Secretary, in order 
                                to provide the additional funds 
                                necessary for such compliance, 
                                shall reduce on a pro rata 
                                basis the amount of each grant 
                                pursuant to paragraph (1) for 
                                the fiscal year, other than 
                                grants for States for which 
                                increases under clause (i) 
                                apply and other than States 
                                described in paragraph 
                                (1)(A)(i)(I). A reduction under 
                                the preceding sentence may not 
                                be made in an amount that would 
                                result in the State involved 
                                becoming eligible for such an 
                                increase.
                          (iv) Applicability.--This paragraph 
                        may not be construed as having any 
                        applicability after fiscal year 2009.
          [(3) Definitions.--As used in this subsection--
                  [(A) the term ``State'' means each of the 50 
                States, the District of Columbia, the 
                Commonwealth of Puerto Rico, the Virgin 
                Islands, and Guam; and
                  [(B) the term ``territory of the United 
                States'' means, American Samoa, the 
                Commonwealth of the Northern Mariana 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.]
  (b) Allocation of Assistance by States.--
          [(2)] (1) Allowances.--Prior to allocating assistance 
        under this subsection, a State shall consider the unmet 
        needs of those areas that have not received financial 
        assistance under part A.
          [(3)] (2) Planning and evaluations.--Subject to 
        [paragraph (5)] paragraph (4) and except as provided in 
        [paragraph (6)] paragraph (5), a State may not use more 
        than 10 percent of amounts received under a grant 
        awarded under [this part] section 2611 for planning and 
        evaluation activities.
          [(4)] (3) Administration.--
                  [(A) In general.--Subject to paragraph (5) 
                and except as provided in paragraph (6), a 
                State may not use more than 10 percent of 
                amounts received under a grant awarded under 
                this part for administration. In the case of 
                entities and subcontractors to which the State 
                allocates amounts received by the State under 
                the grant (including consortia under section 
                2613), the State shall ensure that, of the 
                aggregate amount so allocated, the total of the 
                expenditures by such entities for 
                administrative expenses does not exceed 10 
                percent (without regard to whether particular 
                entities expend more than 10 percent for such 
                expenses).]
                  (A) In general.--Subject to paragraph (4,) 
                and except as provided in paragraph (5), a 
                State may not use more than 10 percent of 
                amounts received under a grant awarded under 
                section 2611 for administration.
                  (B) Allocations.--In the case of entities and 
                subcontractors to which a State allocates 
                amounts received by the State under a grant 
                under section 2611, the State shall ensure 
                that, of the aggregate amount so allocated, the 
                total of the expenditures by such entities for 
                administrative expenses does not exceed 10 
                percent (without regard to whether particular 
                entities expend more than 10 percent for such 
                expenses).
                  [(B)] (C) Administrative activities.--For the 
                purposes of subparagraph (A), amounts may be 
                used for administrative activities that include 
                routine grant administration and monitoring 
                activities, including a clinical quality 
                management program under subparagraph (E).
                  [(C)] (D) Subcontractor administrative 
                costs.--For the purposes of this paragraph, 
                subcontractor administrative activities 
                include--
                          (i) usual and recognized overhead, 
                        including established indirect rates 
                        for agencies;
                          (ii) management oversight of specific 
                        programs funded under this title; and
                          (iii) other types of program support 
                        such as quality assurance, quality 
                        control, and related activities.
                  (E) Clinical quality management.--
                          (i) Requirement.--Each State that 
                        receives a grant under section 2611 
                        shall provide for the establishment of 
                        a clinical quality management program 
                        to assess the extent to which HIV 
                        health services provided to patients 
                        under the grant are consistent with the 
                        most recent Public Health Service 
                        guidelines for the treatment of HIV/
                        AIDS and related opportunistic 
                        infection, and as applicable, to 
                        develop strategies for ensuring that 
                        such services are consistent with the 
                        guidelines for improvement in the 
                        access to and quality of HIV health 
                        services.
                          (ii) Use of funds.--
                                  (I) In general.--From amounts 
                                received under a grant awarded 
                                under section 2611 for a fiscal 
                                year, a State may use for 
                                activities associated with the 
                                clinical quality management 
                                program required in clause (i) 
                                not to exceed the lesser of--
                                          (aa) 5 percent of 
                                        amounts received under 
                                        the grant; or
                                          (bb) $3,000,000.
                                  (II) Relation to limitation 
                                on administrative expenses.--
                                The costs of a clinical quality 
                                management program under clause 
                                (i) may not be considered 
                                administrative expenses for 
                                purposes of the limitation 
                                established in subparagraph 
                                (A).
          [(5)] (4) Limitation on use of funds.--Except as 
        provided in [paragraph (6)] paragraph (5), a State may 
        not use more than a total of 15 percent of amounts 
        received under a grant awarded under [this part] 
        section 2611 for the purposes described in [paragraphs 
        (3) and (4)] paragraphs (2) and (3).
          [(6)] (5) Exception.--With respect to a State that 
        receives the minimum allotment under subsection (a)(1) 
        for a fiscal year, such State, from the amounts 
        received under a grant awarded under [this part] 
        section 2611 for such fiscal year for the activities 
        described in [paragraphs (3) and (4), may, 
        notwithstanding paragraphs (3), (4), and (5),] 
        paragraphs (2) and (3), may, notwithstanding paragraphs 
        (2) through (4), use not more than that amount required 
        to support one full-time-equivalent employee.
          [(7)] (6) Construction.--A State may not use amounts 
        received under a grant awarded under [this part] 
        section 2611 to purchase or improve land, or to 
        purchase, construct, or permanently improve (other than 
        minor remodeling) any building or other facility, or to 
        make cash payments to intended recipients of services.
  (c) Expedited Distribution.--
          (1) In general.--Not less than 75 percent of the 
        amounts received under a grant awarded to a State under 
        [this part] section 2611 shall be obligated to specific 
        programs and projects and made available for 
        expenditure not later than--
                  (A) * * *

           *       *       *       *       *       *       *

  [(d) Reallocation.--Any amounts appropriated in any fiscal 
year and made available to a State under this part that have 
not been obligated as described in subsection (d) shall be 
repaid to the Secretary and reallotted to other States in 
proportion to the original grants made to such States.]
  (d) Reallocation.--Any portion of a grant made to a State 
under section 2611 for a fiscal year that has not been 
obligated as described in subsection (c) ceases to be available 
to the State and shall be made available by the Secretary for 
grants under section 2620, in addition to amounts made 
available for such grants under section 2623(b)(2).

           *       *       *       *       *       *       *


SEC. 2620. SUPPLEMENTAL GRANTS.

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

SEC. [2620] 2621. [SUPPLEMENTAL GRANTS] EMERGING COMMUNITIES.

  (a) * * *
  (b) Eligibility.--To be eligible to receive a supplemental 
grant under subsection (a), a State shall--
          (1) * * *
          (2) demonstrate the existence in the State of an 
        emerging community as defined in subsection (d)(1); 
        [and]
          (3) agree that the grant will be used to provide 
        funds directly to emerging communities in the State, 
        separately from other funds under this title that are 
        provided by the State to such communities; and
          [(3)] (4) submit the information described in 
        subsection (c).

           *       *       *       *       *       *       *

  [(d) Definition of Emerging Community.--In this section, the 
term ``emerging community'' means a metropolitan area--
          [(1) that is not eligible for a grant under part A; 
        and
          [(2) for which there has been reported to the 
        Director of the Centers for Disease Control and 
        Prevention a cumulative total of between 500 and 1,999 
        cases of acquired immune deficiency syndrome for the 
        most recent period of 5 calendar years for which such 
        data are available (except that, for fiscal year 2005 
        and subsequent fiscal years, cases of HIV disease shall 
        be counted rather than cases of acquired immune 
        deficiency syndrome if cases of HIV disease are being 
        counted for purposes of section 2618(a)(2)(D)(i)).
  [(e) Funding.--
          [(1) In general.--Subject to paragraph (2), with 
        respect to each fiscal year beginning with fiscal year 
        2001, the Secretary, to carry out this section, shall 
        utilize--
                  [(A) the greater of--
                          [(i) 25 percent of the amount 
                        appropriated under section 2677 to 
                        carry out part B, excluding the amount 
                        appropriated under section 
                        2618(a)(2)(I), for such fiscal year 
                        that is in excess of the amount 
                        appropriated to carry out such part in 
                        the fiscal year preceding the fiscal 
                        year involved; or
                          [(ii) $5,000,000,
                to provide funds to States for use in emerging 
                communities with at least 1,000, but less than 
                2,000, cases of AIDS as reported to and 
                confirmed by the Director of the Centers for 
                Disease Control and Prevention for the five 
                year period preceding the year for which the 
                grant is being awarded; and
                  [(B) the greater of--
                          [(i) 25 percent of the amount 
                        appropriated under section 2677 to 
                        carry out part B, excluding the amount 
                        appropriated under section 
                        2618(a)(2)(I), for such fiscal year 
                        that is in excess of the amount 
                        appropriated to carry out such part in 
                        the fiscal year preceding the fiscal 
                        year involved; or
                          [(ii) $5,000,000,
                to provide funds to States for use in emerging 
                communities with at least 500, but less than 
                1,000, cases of AIDS reported to and confirmed 
                by the Director of the Centers for Disease 
                Control and Prevention for the five year period 
                preceding the year for which the grant is being 
                awarded.
          [(2) Trigger of funding.--This section shall be 
        effective only for fiscal years beginning in the first 
        fiscal year in which the amount appropriated under 
        section 2677 to carry out part B, excluding the amount 
        appropriated under section 2618(a)(2)(I), exceeds by at 
        least $20,000,000 the amount appropriated under section 
        2677 to carry out part B in fiscal year 2000, excluding 
        the amount appropriated under section 2618(a)(2)(I).
          [(3) Minimum amount in future years.--Beginning with 
        the first fiscal year in which amounts provided for 
        emerging communities under paragraph (1)(A) equals 
        $5,000,000 and under paragraph (1)(B) equals 
        $5,000,000, the Secretary shall ensure that amounts 
        made available under this section for the types of 
        emerging communities described in each such paragraph 
        in subsequent fiscal years is at least $5,000,000.
          [(4) Distribution.--Grants under this section for 
        emerging communities shall be formula grants. There 
        shall be two categories of such formula grants, as 
        follows:
                  [(A) One category of such grants shall be for 
                emerging communities for which the cumulative 
                total of cases for purposes of subsection 
                (d)(2) is 999 or fewer cases. The grant made to 
                such an emerging community for a fiscal year 
                shall be the product of--
                          [(i) an amount equal to 50 percent of 
                        the amount available pursuant to this 
                        subsection for the fiscal year 
                        involved; and
                          [(ii) a percentage equal to the ratio 
                        constituted by the number of cases for 
                        such emerging community for the fiscal 
                        year over the aggregate number of such 
                        cases for such year for all emerging 
                        communities to which this subparagraph 
                        applies.
                  [(B) The other category of formula grants 
                shall be for emerging communities for which the 
                cumulative total of cases for purposes of 
                subsection (d)(2) is 1,000 or more cases. The 
                grant made to such an emerging community for a 
                fiscal year shall be the product of--
                          [(i) an amount equal to 50 percent of 
                        the amount available pursuant to this 
                        subsection for the fiscal year 
                        involved; and
                          [(ii) a percentage equal to the ratio 
                        constituted by the number of cases for 
                        such community for the fiscal year over 
                        the aggregate number of such cases for 
                        the fiscal year for all emerging 
                        communities to which this subparagraph 
                        applies.]
  (d) Definitions of Emerging Community.--For purposes of this 
section, the term ``emerging community'' means a metropolitan 
area (as defined in section 2607) for which there has been 
reported to and confirmed by the Director of the Centers for 
Disease Control and Prevention a cumulative total of at least 
500, but fewer than 1,000, cases of AIDS during the most recent 
period of 5 calendar years for which such data are available.
  (e) Continued Status as Emerging Community.--Notwithstanding 
any other provision of this section, a metropolitan area that 
is an emerging community for a fiscal year continues to be an 
emerging community until the metropolitan area fails, for three 
consecutive fiscal years--
          (1) to meet the requirements of subsection (d); and
          (2) to have a cumulative total of 750 or more living 
        cases of AIDS (reported to and confirmed by the 
        Director of the Centers for Disease Control and 
        Prevention) as of December 31 of the most recent 
        calendar year for which such data is available.
  (f) Distribution.--The amount of a grant under subsection (a) 
for a State for a fiscal year shall be an amount equal to the 
product of--
          (1) the amount available under section 2623(b)(1) for 
        the fiscal year; and
          (2) a percentage equal to the ratio constituted by 
        the number of living cases of HIV/AIDS in emerging 
        communities in the State to the sum of the respective 
        numbers of such cases in such communities for all 
        States.

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

  (a) Obligation by End of Grant Year.--Effective for fiscal 
year 2007 and subsequent fiscal years, funds from a grant award 
made to a State for a fiscal year pursuant to section 
2618(a)(1) or 2618(a)(2)(G), or under section 2620 or 2621, are 
available for obligation by the State through the end of the 
one-year period beginning on the date in such fiscal year on 
which funds from the award first become available to the State 
(referred to in this section as the ``grant year for the 
award''), except as provided in subsection (c)(1).
  (b) Supplemental Grants; Cancellation of Unobligated Balance 
of Grant Award.--Effective for fiscal year 2007 and subsequent 
fiscal years, if a grant award made to a State for a fiscal 
year pursuant to section 2618(a)(2)(G)(ii), or under section 
2620 or 2621, has an unobligated balance as of the end of the 
grant year for the award--
          (1) the Secretary shall cancel that unobligated 
        balance of the award, and shall require the State to 
        return any amounts from such balance that have been 
        disbursed to the State; and
          (2) the funds involved shall be made available by the 
        Secretary as additional amounts for grants pursuant to 
        section 2620 for the first fiscal year beginning after 
        the fiscal year in which the Secretary obtains the 
        information necessary for determining that the balance 
        is required under paragraph (1) to be canceled, except 
        that the availability of the funds for such grants is 
        subject to section 2618(a)(2)(H) as applied for such 
        year.
  (c) Formula Grants; Cancellation of Unobligated Balance of 
Grant Award; Waiver Permitting Carryover.--
          (1) In general.--Effective for fiscal year 2007 and 
        subsequent fiscal years, if a grant award made to a 
        State for a fiscal year pursuant to section 2618(a)(1) 
        or 2618(a)(2)(G)(i) has an unobligated balance as of 
        the end of the grant year for the award, the Secretary 
        shall cancel that unobligated balance of the award, and 
        shall require the State to return any amounts from such 
        balance that have been disbursed to the State, unless--
                  (A) before the end of the grant year, the 
                State submits to the Secretary a written 
                application for a waiver of the cancellation, 
                which application includes a description of the 
                purposes for which the State intends to expend 
                the funds involved; and
                  (B) the Secretary approves the waiver.
          (2) Expenditure by end of carryover year.--With 
        respect to a waiver under paragraph (1) that is 
        approved for a balance that is unobligated as of the 
        end of a grant year for an award:
                  (A) The unobligated funds are available for 
                expenditure by the State involved for the one-
                year period beginning upon the expiration of 
                the grant year (referred to in this section as 
                the ``carryover year'').
                  (B) If the funds are not expended by the end 
                of the carryover year, the Secretary shall 
                cancel that unexpended balance of the award, 
                and shall require the State to return any 
                amounts from such balance that have been 
                disbursed to the State.
          (3) Use of cancelled balances.--In the case of any 
        balance of a grant award that is cancelled under 
        paragraph (1) or (2)(B), the grant funds involved shall 
        be made available by the Secretary as additional 
        amounts for grants under section 2620 for the first 
        fiscal year beginning after the fiscal year in which 
        the Secretary obtains the information necessary for 
        determining that the balance is required under such 
        paragraph to be canceled, except that the availability 
        of the funds for such grants is subject to section 
        2618(a)(2)(H) as applied for such year.
          (4) Corresponding reduction in future grant.--
                  (A) In general.--In the case of a State for 
                which a balance from a grant award made 
                pursuant to section 2618(a)(1) or 
                2618(a)(2)(G)(i) is unobligated as of the end 
                of the grant year for the award--
                          (i) the Secretary shall reduce, by 
                        the same amount as such unobligated 
                        balance, the amount of the grant under 
                        such section for the first fiscal year 
                        beginning after the fiscal year in 
                        which the Secretary obtains the 
                        information necessary for determining 
                        that such balance was unobligated as of 
                        the end of the grant year (which 
                        requirement for a reduction applies 
                        without regard to whether a waiver 
                        under paragraph (1) has been approved 
                        with respect to such balance); and
                          (ii) the grant funds involved in such 
                        reduction shall be made available by 
                        the Secretary as additional funds for 
                        grants under section 2620 for such 
                        first fiscal year, subject to section 
                        2618(a)(2)(H);
                except that this subparagraph does not apply to 
                the State if the amount of the unobligated 
                balance was 2 percent or less.
                  (B) Relation to increases in grant.--A 
                reduction under subparagraph (A) for a State 
                for a fiscal year may not be taken into account 
                in applying section 2618(a)(2)(H) with respect 
                to the State for the subsequent fiscal year.
  (d) Treatment of Drug Rebates.--For purposes of this section, 
funds that are drug rebates referred to in section 2616(g) may 
not be considered part of any grant award referred to in 
subsection (a).

SEC. 2623. AUTHORIZATION OF APPROPRIATIONS.

  (a) In General.--For the purpose of carrying out this 
subpart, there are authorized to be appropriated $1,195,500,000 
for fiscal year 2007, $1,239,500,000 for fiscal year 2008, 
$1,285,200,000 for fiscal year 2009, $1,332,600,000 for fiscal 
year 2010, and $1,381,700,000 for fiscal year 2011. Amounts 
appropriated under the preceding sentence for a fiscal year are 
available for obligation by the Secretary until the end of the 
second succeeding fiscal year.
  (b) Reservation of Amounts.--
          (1) Emerging communities.--Of the amount appropriated 
        under subsection (a) for a fiscal year, the Secretary 
        shall reserve $5,000,000 for grants under section 2621.
          (2) Supplemental grants.--
                  (A) In general.--Of the amount appropriated 
                under subsection (a) for a fiscal year in 
                excess of the 2006 adjusted amount, the 
                Secretary shall reserve \1/3\ for grants under 
                section 2620, except that the availability of 
                the reserved funds for such grants is subject 
                to section 2618(a)(2)(H) as applied for such 
                year, and except that any amount appropriated 
                exclusively for carrying out section 2616 (and, 
                accordingly, distributed under section 
                2618(a)(2)(G)) is not subject to this 
                subparagraph.
                  (B) 2006 adjusted amount.--For purposes of 
                subparagraph (A), the term ``2006 adjusted 
                amount'' means the amount appropriated for 
                fiscal year 2006 under section 2677(b) (as such 
                section was in effect for such fiscal year), 
                excluding any amount appropriated for such year 
                exclusively for carrying out section 2616 (and, 
                accordingly, distributed under section 
                2618(a)(2)(I), as so in effect).

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

[SEC. 2625. CDC GUIDELINES FOR PREGNANT WOMEN.

  [(a) Requirement.--Notwithstanding any other provision of 
law, a State shall, not later than 120 days after the date of 
enactment of this subpart, certify to the Secretary that such 
State has in effect regulations or measures to adopt the 
guidelines issued by the Centers for Disease Control and 
Prevention concerning recommendations for human 
immunodeficiency virus counseling and voluntary testing for 
pregnant women.
  [(b) Noncompliance.--If a State does not provide the 
certification required under subsection (a) within the 120-day 
period described in such subsection, such State shall not be 
eligible to receive assistance for HIV counseling and testing 
under this section until such certification is provided.
  [(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) Making available to pregnant women 
                appropriate counseling on HIV disease.
                  [(B) Making available outreach efforts to 
                pregnant women at high risk of HIV who are not 
                currently receiving prenatal care.
                  [(C) Making available to such women voluntary 
                HIV testing for such disease.
                  [(D) Offsetting other State costs associated 
                with the implementation of this section and 
                subsections (a) and (b) of section 2626.
                  [(E) Offsetting State costs associated with 
                the implementation of mandatory newborn testing 
                in accordance with this title or at an earlier 
                date than is required by this title.
                  [(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.--
                  [(A) Authorization of appropriations.--For 
                the purpose of carrying out this subsection, 
                there are authorized to be appropriated 
                $30,000,000 for each of the fiscal years 2001 
                through 2005. Amounts made available under 
                section 2677 for carrying out this part are not 
                available for carrying out this section unless 
                otherwise authorized.
                  [(B) Allocations for certain states.--
                          [(i) In general.--Of the amounts 
                        appropriated under subparagraph (A) for 
                        a fiscal year in excess of 
                        $10,000,000--
                                  [(I) the Secretary shall 
                                reserve the applicable 
                                percentage under clause (iv) 
                                for making grants under 
                                paragraph (1) both to States 
                                described in clause (ii) and 
                                States described in clause 
                                (iii); and
                                  [(II) the Secretary shall 
                                reserve the remaining amounts 
                                for other States, taking into 
                                consideration the factors 
                                described in subparagraph 
                                (C)(iii), except that this 
                                subclause does not apply to any 
                                State that for the fiscal year 
                                involved is receiving amounts 
                                pursuant to subclause (I).
                          [(ii) Required testing of newborns.--
                        For purposes of clause (i)(I), the 
                        States described in this clause are 
                        States that under law (including under 
                        regulations or the discretion of State 
                        officials) have--
                                  [(I) a requirement that all 
                                newborn infants born in the 
                                State be tested for HIV disease 
                                and that the biological mother 
                                of each such infant, and the 
                                legal guardian of the infant 
                                (if other than the biological 
                                mother), be informed of the 
                                results of the testing; or
                                  [(II) a requirement that 
                                newborn infants born in the 
                                State be tested for HIV disease 
                                in circumstances in which the 
                                attending obstetrician for the 
                                birth does not know the HIV 
                                status of the mother of the 
                                infant, and that the biological 
                                mother of each such infant, and 
                                the legal guardian of the 
                                infant (if other than the 
                                biological mother), be informed 
                                of the results of the testing.
                          [(iii) Most significant reduction in 
                        cases of perinatal transmission.--For 
                        purposes of clause (i)(I), the States 
                        described in this clause are the 
                        following (exclusive of States 
                        described in clause (ii)), as 
                        applicable:
                                  [(I) For fiscal years 2001 
                                and 2002, the two States that, 
                                relative to other States, have 
                                the most significant reduction 
                                in the rate of new cases of the 
                                perinatal transmission of HIV 
                                (as indicated by the number of 
                                such cases reported to the 
                                Director of the Centers for 
                                Disease Control and Prevention 
                                for the most recent periods for 
                                which the data are available).
                                  [(II) For fiscal years 2003 
                                and 2004, the three States that 
                                have the most significant such 
                                reduction.
                                  [(III) For fiscal year 2005, 
                                the four States that have the 
                                most significant such 
                                reduction.
                          [(iv) Applicable percentage.--For 
                        purposes of clause (i), the applicable 
                        amount for a fiscal year is as follows:
                                  [(I) For fiscal year 2001, 33 
                                percent.
                                  [(II) For fiscal year 2002, 
                                50 percent.
                                  [(III) For fiscal year 2003, 
                                67 percent.
                                  [(IV) For fiscal year 2004, 
                                75 percent.
                                  [(V) For fiscal year 2005, 75 
                                percent.
                  [(C) Certain provisions.--With respect to 
                grants under paragraph (1) that are made with 
                amounts reserved under subparagraph (B) of this 
                paragraph:
                          [(i) Such a grant may not be made in 
                        an amount exceeding $4,000,000.
                          [(ii) If pursuant to clause (i) or 
                        pursuant to an insufficient number of 
                        qualifying applications for such grants 
                        (or both), the full amount reserved 
                        under subparagraph (B) for a fiscal 
                        year is not obligated, the requirement 
                        under such subparagraph to reserve 
                        amounts ceases to apply.
                          [(iii) In the case of a State that 
                        meets the conditions to receive amounts 
                        reserved under subparagraph (B)(i)(II), 
                        the Secretary shall in making grants 
                        consider the following factors:
                                  [(I) The extent of the 
                                reduction in the rate of new 
                                cases of the perinatal 
                                transmission of HIV.
                                  [(II) The extent of the 
                                reduction in the rate of new 
                                cases of perinatal cases of 
                                acquired immune deficiency 
                                syndrome.
                                  [(III) The overall incidence 
                                of cases of infection with HIV 
                                among women of childbearing 
                                age.
                                  [(IV) The overall incidence 
                                of cases of acquired immune 
                                deficiency syndrome among women 
                                of childbearing age.
                                  [(V) The higher acceptance 
                                rate of HIV testing of pregnant 
                                women.
                                  [(VI) The extent to which 
                                women and children with HIV 
                                disease are receiving HIV-
                                related health services.
                                  [(VII) The extent to which 
                                HIV-exposed children are 
                                receiving health services 
                                appropriate to such exposure.
          [(3) Priority.--In awarding grants under this 
        subsection the Secretary shall give priority to States 
        that have the greatest proportion of HIV seroprevalance 
        among child bearing women using the most recent data 
        available as determined by the Centers for Disease 
        Control and Prevention.
          [(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. 2625. EARLY DIAGNOSIS GRANT PROGRAM.

  (a) In General.--In the case of States whose laws or 
regulations are in accordance with subsection (b), the 
Secretary, acting through the Centers for Disease Control and 
Prevention, shall make grants to such States for the purposes 
described in subsection (c).
  (b) Description of Compliant States.--For purposes of 
subsection (a), the laws or regulations of a State are in 
accordance with this subsection if, under such laws or 
regulations (including programs carried out pursuant to the 
discretion of State officials), both of the policies described 
in paragraph (1) are in effect, or both of the policies 
described in paragraph (2) are in effect, as follows:
          (1)(A) Voluntary opt-out testing of pregnant women.
  (B) Universal testing of newborns.
          (2)(A) Voluntary opt-out testing of clients at 
        sexually transmitted disease clinics.
  (B) Voluntary opt-out testing of clients at substance abuse 
treatment centers.
The Secretary shall periodically ensure that the applicable 
policies are being carried out and recertify compliance.
  (c) Use of Funds.--A State may use funds provided under 
subsection (a) for HIV/AIDS testing (including rapid testing), 
prevention counseling, treatment of newborns exposed to HIV/
AIDS, treatment of mothers infected with HIV/AIDS, and costs 
associated with linking those diagnosed with HIV/AIDS to care 
and treatment for HIV/AIDS.
  (d) Application.--A State that is eligible for the grant 
under subsection (a) shall submit an application to the 
Secretary, in such form, in such manner, and containing such 
information as the Secretary may require.
  (e) Limitation on Amount of Grant.--A grant under subsection 
(a) to a State for a fiscal year may not be made in an amount 
exceeding $10,000,000.
  (f) Rule of Construction.--Nothing in this section shall be 
construed to pre-empt State laws regarding HIV/AIDS counseling 
and testing.
  (g) Definitions.--In this section:
          (1) The term ``voluntary opt-out testing'' means HIV/
        AIDS testing--
                  (A) that is administered to an individual 
                seeking other health care services; and
                  (B) in which--
                          (i) pre-test counseling is not 
                        required but the individual is informed 
                        that the individual will receive an 
                        HIV/AIDS test and the individual may 
                        opt out of such testing; and
                          (ii) for those individuals with a 
                        positive test result, post-test 
                        counseling (including referrals for 
                        care) is provided and confidentiality 
                        is protected.
          (2) The term ``universal testing of newborns'' means 
        HIV/AIDS testing that is administered within 48 hours 
        of delivery to--
                  (A) all infants born in the State; or
                  (B) all infants born in the State whose 
                mother's HIV/AIDS status is unknown at the time 
                of delivery.
  (h) Authorization of Appropriations.--Of the funds 
appropriated annually to the Centers for Disease Control and 
Prevention for HIV/AIDS prevention activities, $30,000,000 
shall be made available for each of the fiscal years 2007 
through 2011 for grants under subsection (a), of which 
$20,000,000 shall be made available for grants to States with 
the policies described in subsection (b)(1), and $10,000,000 
shall be made available for grants to States with the policies 
described in subsection (b)(2). Funds provided under this 
section are available until expended.

           *       *       *       *       *       *       *


           Subpart III--Certain Partner Notification Programs

SEC. 2631. GRANTS FOR PARTNER NOTIFICATION PROGRAMS.

  (a) * * *

           *       *       *       *       *       *       *

  (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] HIV/AIDS 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] HIV/AIDS, 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] HIV/AIDS 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] HIV/AIDS.
          (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] HIV/AIDS, 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] 
                HIV/AIDS 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.

           *       *       *       *       *       *       *

  (c) Reporting System for Cases of [HIV Disease] HIV/AIDS; 
Preference in Making Grants.--In making grants under subsection 
(a), the Secretary shall give preference to States whose 
reporting systems for cases of [HIV disease] HIV/AIDS produce 
data on such cases that is sufficiently accurate and reliable 
for use for purposes of section 2618(a)(2)(D)(i).
  (d) Authorization of Appropriations.--For the purpose of 
carrying out this section, [there are authorized to be 
appropriated $30,000,000 for fiscal year 2001, and such sums as 
may be necessary for each of the fiscal years 2002 through 
2005.] there is authorized to be appropriated $10,000,000 for 
each of the fiscal years 2007 through 2011.

           *       *       *       *       *       *       *


PART C--Early Intervention Services

           *       *       *       *       *       *       *


                     Subpart I--Categorical Grants

[SEC. 2651. ESTABLISHMENT OF PROGRAM.

  [(a) In General.--For the purposes described in subsection 
(b), the Secretary, acting through the Administrator of the 
Health Resources and Services Administration, may make grants 
to public and nonprofit private entities specified in section 
2652(a).
  [(b) Purposes of Grants.--
          [(1) In general.--The Secretary may not make a grant 
        under subsection (a) unless the applicant for the grant 
        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, and unless the applicant agrees 
        to expend not less than 50 percent of the grant for 
        such services that are specified in subparagraphs (B) 
        through (E) of such paragraph for individuals with 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 
                regarding HIV disease, and periodic medical 
                evaluations of individuals with the disease;
                  [(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 a pregnant woman.
          [(4) Requirement of availability of all early 
        intervention services through each grantee.--
                  [(A) In general.--The Secretary may not make 
                a grant under subsection (a) unless the 
                applicant for the grant agrees that each of the 
                early intervention services specified in 
                paragraph (2) will be available through the 
                grantee. With respect to compliance with such 
                agreement, such a grantee may expend the grant 
                to provide the early intervention services 
                directly, and may expend the grant to enter 
                into agreements with public or nonprofit 
                private entities, or private for-profit 
                entities if such entities are the only 
                available provider of quality HIV care in the 
                area, under which the entities provide the 
                services.
                  [(B) Other requirements.--Grantees described 
                in--
                          [(i) paragraphs (1), (2), (5), and 
                        (6) of section 2652(a) shall use not 
                        less than 50 percent of the amount of 
                        such a grant to provide the services 
                        described in subparagraphs (A), (B), 
                        (D), and (E) of section 2651(b)(2) 
                        directly and on-site or at sites where 
                        other primary care services are 
                        rendered; and
                          [(ii) paragraphs (3) and (4) of 
                        section 2652(a) shall ensure the 
                        availability of early intervention 
                        services through a system of linkages 
                        to community-based primary care 
                        providers, and to establish mechanisms 
                        for the referrals described in section 
                        2651(b)(2)(C), and for follow-up 
                        concerning such referrals.
          [(5) Optional services.--A grantee under subsection 
        (a)--
                  [(A) 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
                  [(B) 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.
  [(c) Participation in Certain Consortium.--The Secretary may 
not make a grant under subsection (a) unless the applicant for 
the grant agrees to make reasonable efforts to participate in a 
consortium established with a grant under section 2612(a)(1) 
regarding comprehensive services to individuals with HIV 
disease, if such a consortium exists in the geographic area 
with respect to which the applicant is applying to receive such 
a grant.]

SEC. 2651. ESTABLISHMENT OF A PROGRAM.

  (a) In General.--For the purposes described in subsection 
(b), the Secretary, acting through the Administrator of the 
Health Resources and Services Administration, may make grants 
to public and nonprofit private entities specified in section 
2652(a).
  (b) Requirements.--
          (1) In general.--The Secretary may not make a grant 
        under subsection (a) unless the applicant for the grant 
        agrees to expend the grant only for--
                  (A) core medical services described in 
                subsection (c);
                  (B) support services described in subsection 
                (d); and
                  (C) administrative expenses as described in 
                section 2664(g)(3).
          (2) Early intervention services.--An applicant for a 
        grant under subsection (a) shall expend not less than 
        50 percent of the amount received under the grant for 
        the services described in subparagraphs (B) through (E) 
        of subsection (e)(1) for individuals with HIV/AIDS.
  (c) Required Funding for Core Medical Services.--
          (1) In general.--With respect to a grant under 
        subsection (a) to an applicant for a fiscal year, the 
        applicant shall, of the portion of the grant remaining 
        after reserving amounts for purposes of paragraphs (3) 
        and (5) of section 2664(g), use not less than 75 
        percent to provide core medical services that are 
        needed in the area involved for individuals with HIV/
        AIDS who are identified and eligible under this title 
        (including services regarding the co-occurring 
        conditions of the individuals).
          (2) Waiver.--
                  (A) The Secretary shall waive the application 
                of paragraph (1) with respect to an applicant 
                for a grant if the Secretary determines that, 
                within the service area of the applicant--
                          (i) there are no waiting lists for 
                        AIDS Drug Assistance Program services 
                        under section 2616; and
                          (ii) core medical services are 
                        available to all individuals with HIV/
                        AIDS identified and eligible under this 
                        title.
                  (B) Notification of waiver status.--When 
                informing an applicant that a grant under 
                subsection (a) is being made for a fiscal year, 
                the Secretary shall inform the applicant 
                whether a waiver under subparagraph (A) is in 
                effect for the fiscal year.
          (3) Core medical services.--For purposes of this 
        subsection, the term ``core medical services'', with 
        respect to an individual with HIV/AIDS (including the 
        co-occurring conditions of the individual) means the 
        following services:
                  (A) Outpatient and ambulatory health 
                services.
                  (B) AIDS Drug Assistance Program treatments 
                under section 2616.
                  (C) AIDS pharmaceutical assistance.
                  (D) Oral health care.
                  (E) Early intervention services described in 
                subsection (e).
                  (F) Health insurance premium and cost sharing 
                assistance for low-income individuals in 
                accordance with section 2615.
                  (G) Home health care.
                  (H) Medical nutrition therapy.
                  (I) Hospice services.
                  (J) Home and community-based health services 
                as defined under section 2614(c).
                  (K) Mental health services.
                  (L) Substance abuse outpatient care.
                  (M) Medical case management, including 
                treatment adherence services.
  (d) Support Services.--
          (1) In general.--For purposes of this section, the 
        term ``support services'' means services, subject to 
        the approval of the Secretary, that are needed for 
        individuals with HIV/AIDS to achieve their medical 
        outcomes (such as respite care for persons caring for 
        individuals with HIV/AIDS, outreach services, medical 
        transportation, linguistic services, and referrals for 
        health care and support services).
          (2) Definition of medical outcomes.--In this section, 
        the term ``medical outcomes'' means those outcomes 
        affecting the HIV-related clinical status of an 
        individual with HIV/AIDS.
  (e) Specification of Early Intervention Services.--
          (1) In general.--The early intervention services 
        referred to in this section are--
                  (A) counseling individuals with respect to 
                HIV/AIDS in accordance with section 2662;
                  (B) testing individuals with respect to HIV/
                AIDS, including tests to confirm the presence 
                of the disease, tests to diagnose the extent of 
                the deficiency in the immune system, and tests 
                to provide information on appropriate 
                therapeutic measures for preventing and 
                treating the deterioration of the immune system 
                and for preventing and treating conditions 
                arising from HIV/AIDS;
                  (C) referrals described in paragraph (2);
                  (D) other clinical and diagnostic services 
                regarding HIV/AIDS, and periodic medical 
                evaluations of individuals with HIV/AIDS; and
                  (E) providing the therapeutic measures 
                described in subparagraph (B).
          (2) Referrals.--The services referred to in paragraph 
        (1)(C) are referrals of individuals with HIV/AIDS to 
        appropriate providers of health and support services, 
        including, as appropriate--
                  (A) to entities receiving amounts under part 
                A or B for the provision of such services;
                  (B) to biomedical research facilities of 
                institutions of higher education that offer 
                experimental treatment for such disease, or to 
                community-based organizations or other entities 
                that provide such treatment; or
                  (C) to grantees under section 2671, in the 
                case of a pregnant woman.
          (3) Requirement of availability of all early 
        intervention services through each grantee.--
                  (A) In general.--The Secretary may not make a 
                grant under subsection (a) unless the applicant 
                for the grant agrees that each of the early 
                intervention services specified in paragraph 
                (2) will be available through the grantee. With 
                respect to compliance with such agreement, such 
                a grantee may expend the grant to provide the 
                early intervention services directly, and may 
                expend the grant to enter into agreements with 
                public or nonprofit private entities, or 
                private for-profit entities if such entities 
                are the only available provider of quality HIV 
                care in the area, under which the entities 
                provide the services.
                  (B) Other requirements.--Grantees described 
                in--
                          (i) subparagraphs (A), (D), (E), and 
                        (F) of section 2652(a)(1) shall use not 
                        less than 50 percent of the amount of 
                        such a grant to provide the services 
                        described in subparagraphs (A), (B), 
                        (D), and (E) of paragraph (1) directly 
                        and on-site or at sites where other 
                        primary care services are rendered; and
                          (ii) subparagraphs (B) and (C) of 
                        section 2652(a)(1) shall ensure the 
                        availability of early intervention 
                        services through a system of linkages 
                        to community-based primary care 
                        providers, and to establish mechanisms 
                        for the referrals described in 
                        paragraph (1)(C), and for follow-up 
                        concerning such referrals.

SEC. 2652. MINIMUM QUALIFICATIONS OF GRANTEES.

  [(a) In General.--The entities referred to in section 2651(a) 
are public entities and nonprofit private entities that are--
          [(1) migrant health centers under section 329 or 
        community health centers under section 330;
          [(2) grantees under section 330(h) (regarding health 
        services for the homeless);
          [(3) grantees under section 1001 (regarding family 
        planning) other than States;
          [(4) comprehensive hemophilia diagnostic and 
        treatment centers;
          [(5) Federally-qualified health centers under section 
        1905(l)(2)(B) of the Social Security Act; or
          [(6) nonprofit private entities that provide 
        comprehensive primary care services to populations at 
        risk of HIV disease.]
  (a) Eligible Entities.--
          (1) In general.--The entities referred to in section 
        2651(a) are public entities and nonprofit private 
        entities that are--
                  (A) federally-qualified health centers under 
                section 1905(l)(2)(B) of the Social Security 
                Act;
                  (B) grantees under section 1001 (regarding 
                family planning) other than States;
                  (C) comprehensive hemophilia diagnostic and 
                treatment centers;
                  (D) rural health clinics;
                  (E) health facilities operated by or pursuant 
                to a contract with the Indian Health Service;
                  (F) community-based organizations, clinics, 
                hospitals and other health facilities that 
                provide early intervention services to those 
                persons infected with HIV/AIDS through 
                intravenous drug use; or
                  (G) nonprofit private entities that provide 
                comprehensive primary care services to 
                populations at risk of HIV/AIDS, including 
                faith-based and community-based organizations.
          (2) Underserved populations.--Entities described in 
        paragraph (1) shall serve underserved populations which 
        may include minority populations and Native American 
        populations, ex-offenders, individuals with 
        comorbidities including hepatitis B or C, mental 
        illness, or substance abuse, low-income populations, 
        inner city populations, and rural populations.

           *       *       *       *       *       *       *


SEC. 2653. PREFERENCES IN MAKING GRANTS.

  (a) In General.--In making grants under section 2651, the 
Secretary shall give preference to any qualified applicant 
experiencing an increase in the burden of providing services 
regarding [HIV disease] HIV/AIDS, as indicated by the factors 
specified in subsection (b).
  (b) Specification of Factors.--
          (1) In general.--In the case of the geographic area 
        with respect to which the entity involved is applying 
        for a grant under section 2651, the factors referred to 
        in subsection (a), as determined for the period 
        specified in paragraph (2), are--
                  (A) the number of cases of [acquired immune 
                deficiency syndrome] AIDS;

           *       *       *       *       *       *       *

                  (D) the number of other cases of sexually 
                transmitted diseases, and the number of cases 
                of tuberculosis and of drug abuse and the 
                number of cases of individuals co-infected with 
                HIV/AIDS and hepatitis B or C;

           *       *       *       *       *       *       *

  (d) Certain Areas.--Of the applicants who qualify for 
preference under this section--
          (1) * * *
          (2) the Secretary shall give [special consideration] 
        preference to 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 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] HIV/AIDS-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).

           *       *       *       *       *       *       *

          (3) Preference.--In awarding grants under paragraph 
        (1), the Secretary shall give preference to entities 
        that provide primary care services in rural [or 
        underserved communities] areas or to underserved 
        populations.

           *       *       *       *       *       *       *


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 for each of the fiscal years 2001 through 2005], 
$218,600,000 for fiscal year 2007, $226,700,000 for fiscal year 
2008, $235,100,000 for fiscal year 2009, $243,800,000 for 
fiscal year 2010, and $252,800,000 for fiscal year 2011.

           *       *       *       *       *       *       *


                     Subpart II--General Provisions

[SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT.

  [(a) Confidentiality.--The Secretary may not make a grant 
under this part unless, in the case of any entity applying for 
a grant under section 2651, the entity agrees to ensure that 
information regarding the receipt of early intervention 
services pursuant to the grant is maintained confidentially in 
a manner not inconsistent with applicable law.
  [(b) Informed Consent.--
          [(1) In general.--The Secretary may not make a grant 
        under this part unless the applicant for the grant 
        agrees that, in testing an individual for HIV disease, 
        the applicant will test an individual only after 
        obtaining from the individual a statement, made in 
        writing and signed by the individual, declaring that 
        the individual has undergone the counseling described 
        in section 2662(a) and that the decision of the 
        individual with respect to undergoing such testing is 
        voluntarily made.
          [(2) Provisions regarding anonymous testing.--
                  [(A) If, pursuant to section 2664(b), an 
                individual will undergo testing pursuant to 
                this part through the use of a pseudonym, a 
                grantee under such section shall be considered 
                to be in compliance with the agreement made 
                under paragraph (1) if the individual signs the 
                statement described in such subsection using 
                the pseudonym.
                  [(B) If, pursuant to section 2664(b), an 
                individual will undergo testing pursuant to 
                this part without providing any information 
                relating to the identity of the individual, a 
                grantee under such section shall be considered 
                to be in compliance with the agreement made 
                under paragraph (1) if the individual orally 
                provides the declaration described in such 
                paragraph.

[SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.

  [(a) Counseling Before Testing.--The Secretary may not make a 
grant under this part unless the applicant for the grant agrees 
that, before testing an individual for HIV disease, the 
applicant will provide to the individual appropriate counseling 
regarding the disease (based on the most recently available 
scientific data), including counseling on--
          [(1) measures for the prevention of exposure to, and 
        the transmission of, HIV;
          [(2) the accuracy and reliability of the results of 
        testing for HIV disease;
          [(3) the significance of the results of such testing, 
        including the potential for developing acquired immune 
        deficiency syndrome;
          [(4) encouraging the individual, as appropriate, to 
        undergo such testing;
          [(5) the benefits of such testing, including the 
        medical benefits of diagnosing HIV disease in the early 
        stages and the medical benefits of receiving early 
        intervention services during such stages;
          [(6) provisions of law relating to the 
        confidentiality of the process of receiving such 
        services, including information regarding any 
        disclosures that may be authorized under applicable law 
        and information regarding the availability of anonymous 
        counseling and testing pursuant to section 2664(b); and
          [(7) provisions of applicable law relating to 
        discrimination against individuals with HIV disease.
  [(b) Counseling of Individuals With Negative Test Results.--
The Secretary may not make a grant under this part unless the 
applicant for the grant agrees that, if the results of testing 
conducted for HIV disease indicate that an individual does not 
have the disease, the applicant will review for the individual 
the information provided pursuant to subsection (a), 
including--
          [(1) the information described in paragraphs (1) 
        through (3) of such subsection; and
          [(2) the appropriateness of further counseling, 
        testing, and education of the individual regarding such 
        disease.
  [(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) reviewing the information described in 
        paragraphs (1) through (3) of subsection (a);
          [(2) reviewing the appropriateness of further 
        counseling, testing, and education of the individual 
        regarding such disease; and
          [(3) providing counseling--
                  [(A) on the availability, through the 
                applicant, of early intervention services;
                  [(B) on the availability in the geographic 
                area of appropriate health care, mental health 
                care, and social and support services, 
                including providing referrals for such 
                services, as appropriate;
                  [(C)(i) that explains the benefits of 
                locating and counseling any individual by whom 
                the infected individual may have been exposed 
                to HIV 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).
  [(d) Additional Requirements Regarding Appropriate 
Counseling.--The Secretary may not make a grant under this part 
unless the applicant for the grant agrees that, in counseling 
individuals with respect to HIV disease, the applicant will 
ensure that the counseling is provided under conditions 
appropriate to the needs of the individuals.
  [(e) Counseling of Emergency Response Employees.--The 
Secretary may not make a grant under this part to a State 
unless the State agrees that, in counseling individuals with 
respect to HIV disease, the State will ensure that, in the case 
of emergency response employees, the counseling is provided to 
such employees under conditions appropriate to the needs of the 
employees regarding the counseling.
  [(f) Rule of Construction Regarding Counseling Without 
Testing.--Agreements made pursuant to this section may not be 
construed to prohibit any grantee under this part from 
expending the grant for the purpose of providing counseling 
services described in this section to an individual who does 
not undergo testing for HIV disease as a result of the grantee 
or the individual determining that such testing of the 
individual is not appropriate.

SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT.

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

SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.

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

SEC. 2663. APPLICABILITY OF REQUIREMENTS REGARDING CONFIDENTIALITY, 
                    INFORMED CONSENT, AND COUNSELING.

  The Secretary may not make a grant under this part unless the 
applicant for the grant agrees that, with respect to testing 
for [HIV disease] HIV/AIDS, any such testing carried out by the 
applicant [will, without regard to whether such testing is 
carried out with Federal funds, be carried] with funds 
appropriated through this Act will be carried out in accordance 
with conditions described in sections 2661 and 2662.

SEC. 2664. ADDITIONAL REQUIRED AGREEMENTS.

  (a) Reports to Secretary.--The Secretary may not make a grant 
under this part unless--
          (1) the applicant submits to the Secretary--
                  (A) a specification of the expenditures made 
                by the applicant for early intervention 
                services for the fiscal year preceding the 
                fiscal year for which the applicant is applying 
                to receive the grant; [and]
                  (B) an estimate of the number of individuals 
                to whom the applicant has provided such 
                services for such fiscal year; [and]
                  (C) information regarding how the expected 
                expenditures of the grant are related to the 
                planning process for localities funded under 
                part A (including the planning process 
                described in section 2602) and for States 
                funded under part B (including the planning 
                process described in section 2617(b)); and
                  (D) a specification of the expected 
                expenditures and how those expenditures will 
                improve overall client outcomes, as described 
                in the State plan under section 2617(b);
          (2) the applicant agrees to submit to the Secretary a 
        report providing--
                  (A) * * *

           *       *       *       *       *       *       *

                  (E) the aggregate amounts expended for each 
                such category[.];
          (3) the applicant agrees to provide additional 
        documentation to the Secretary regarding the process 
        used to obtain community input into the design and 
        implementation of activities related to such grant; and
          (4) the applicant agrees to submit, every 2 years, to 
        the lead State agency under section 2617(b)(4) audits, 
        consistent with Office of Management and Budget 
        circular A133, regarding funds expended in accordance 
        with this title and shall include necessary client 
        level data to complete unmet need calculations and 
        Statewide coordinated statements of need process.

           *       *       *       *       *       *       *

  (b) Provision of Opportunities for Anonymous Counseling and 
Testing.--The Secretary may not make a grant under this part 
unless the applicant for the grant agrees that, to the extent 
permitted under State law, regulation or rule, the applicant 
will offer substantial opportunities for an individual--
          (1) to undergo counseling and testing regarding [HIV 
        disease] HIV/AIDS without being required to provide any 
        information relating to the identity of the individual; 
        and

           *       *       *       *       *       *       *

  (f) Relationship to Items and Services Under Other 
Programs.--
          (1) In general.--The Secretary may not make a grant 
        under this part unless the applicant for the grant 
        agrees that, subject to paragraph (2), the grant will 
        not be expended by the applicant, or by any entity 
        receiving amounts from the applicant for the provision 
        of early intervention services, to make payment for any 
        such service to the extent that payment has been made, 
        or can reasonably be expected to be made, with respect 
        to such service--
                  (A) under any State compensation program, 
                under an insurance policy, or under any Federal 
                or State health benefits program (except for a 
                program administered by or providing the 
                services of the Indian Health Service); or

           *       *       *       *       *       *       *

  (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 10 
        percent including planning and evaluation of the grant 
        for administrative expenses with respect to the grant;]
          (3) the applicant will not expend more than 10 
        percent of the grant for administrative expenses with 
        respect to the grant, including planning and 
        evaluation, except that the costs of a clinical quality 
        management program under paragraph (5) may not be 
        considered administrative expenses for purposes of such 
        limitation;

           *       *       *       *       *       *       *

          (5) the applicant will provide for the establishment 
        of a clinical quality management program--
                  (A) to assess the extent to which medical 
                services funded under this title that are 
                provided to patients are consistent with the 
                most recent Public Health Service guidelines 
                for the treatment of [HIV disease] HIV/AIDS and 
                related opportunistic infections, and as 
                applicable, to develop strategies for ensuring 
                that such services are consistent with the 
                guidelines; and

           *       *       *       *       *       *       *


SEC. 2667. USE OF FUNDS.

   Counseling programs carried out under this part--
          (1) shall not be designed to promote or encourage, 
        directly, intravenous drug abuse or sexual activity, 
        homosexual or heterosexual;
          (2) shall be designed to reduce exposure to and 
        transmission of [HIV disease] HIV/AIDS by providing 
        accurate information; [and]
          (3) shall provide information on the health risks of 
        promiscuous sexual activity and intravenous drug 
        abuse[.]; and
          (4) shall provide information on the transmission and 
        prevention of hepatitis A, B, and C, including 
        education about the availability of hepatitis A and B 
        vaccines and assisting patients in identifying 
        vaccination sites.

           *       *       *       *       *       *       *


                      [PART D--General Provisions

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

  [(a) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration and in consultation with the Director of the 
National Institutes of Health, shall make grants to public and 
nonprofit private entities that provide primary care (directly 
or through contracts) for the following purposes:
          [(1) Providing through such entities, in accordance 
        with this section, opportunities for women, infants, 
        children, and youth to be voluntary participants in 
        research of potential clinical benefit to individuals 
        with HIV disease.
          [(2) In the case of women, infants, children, and 
        youth with HIV disease, and the families of such 
        individuals, providing to such individuals--
                  [(A) health care on an outpatient basis; and
                  [(B) additional services in accordance with 
                subsection (d).
  [(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) The applicant agrees to make reasonable 
                efforts--
                          [(i) to identify which of the 
                        patients of the applicant are women, 
                        infants, children, and youth who would 
                        be appropriate participants in the 
                        projects;
                          [(ii) to carry out clause (i) through 
                        the use of criteria provided for such 
                        purpose by the entities that will be 
                        conducting the projects of research; 
                        and
                          [(iii) to offer women, infants, 
                        children, and youth the opportunity to 
                        participate in the projects (as 
                        appropriate), including the provision 
                        of services under subsection (d)(3).
                  [(B) The applicant agrees that, in the case 
                of the research-related functions to be carried 
                out by the applicant pursuant to subsection 
                (a)(1), the applicant will comply with accepted 
                standards that are applicable to such functions 
                (including accepted standards regarding 
                informed consent and other protections for 
                human subjects).
                  [(C) The applicant will demonstrate linkages 
                to research and how access to such research is 
                being offered to patients.
          [(2) Prohibition.--Receipt of services by a patient 
        shall not be conditioned upon the consent of the 
        patient to participate in research.
  [(c) Provisions Regarding Conduct of Research.--
          [(1) In general.--With respect to eligibility for a 
        grant under subsection (a):
                  [(A) A project of research for which subjects 
                are sought pursuant to such subsection may be 
                conducted by the applicant for the grant, or by 
                an entity with which the applicant has made 
                arrangements for purposes of the grant. The 
                grant may not be expended for the conduct of 
                any project of research, except for such 
                research-related functions as are appropriate 
                for providing opportunities under subsection 
                (a)(1) (including the functions specified in 
                subsection (b)(1)).
                  [(B) The grant may be made only if the 
                Secretary makes the following determinations:
                          [(i) The applicant or other entity 
                        (as the case may be under subparagraph 
                        (A)) is appropriately qualified to 
                        conduct the project of research. An 
                        entity shall be considered to be so 
                        qualified if any research protocol of 
                        the entity has been recommended for 
                        funding under this Act pursuant to 
                        technical and scientific peer review 
                        through the National Institutes of 
                        Health.
                          [(ii) The project of research is 
                        being conducted in accordance with a 
                        research protocol to which the 
                        Secretary gives priority regarding the 
                        prevention or treatment of HIV disease 
                        in women, infants, children, or youth, 
                        subject to paragraph (2).
          [(2) List of research protocols.--
                  [(A) In general.--From among the research 
                protocols described in paragraph (1)(B)(ii), 
                the Secretary shall establish a list of 
                research protocols that are appropriate for 
                purposes of subsection (a)(1). Such list shall 
                be established only after consultation with 
                public and private entities that conduct such 
                research, and with providers of services under 
                subsection (a) and recipients of such services.
                  [(B) Discretion of secretary.--The Secretary 
                may authorize the use, for purposes of 
                subsection (a)(1), of a research protocol that 
                is not included on the list under subparagraph 
                (A). The Secretary may waive the requirement 
                specified in paragraph (1)(B)(ii) in such 
                circumstances as the Secretary determines to be 
                appropriate.
  [(d) Additional Services for Patients and Families.--A grant 
under subsection (a) may be made only if the applicant for the 
grant agrees as follows:
          [(1) The applicant will provide for the case 
        management of the patient involved and the family of 
        the patient.
          [(2) The applicant will provide for the patient and 
        the family of the patient--
                  [(A) referrals for inpatient hospital 
                services, treatment for substance abuse, and 
                mental health services; and
                  [(B) referrals for other social and support 
                services, as appropriate.
          [(3) The applicant will provide the patient and the 
        family of the patient with such transportation, child 
        care, and other incidental services as may be necessary 
        to enable the patient and the family to participate in 
        the program established by the applicant pursuant to 
        such subsection.
          [(4) The applicant will provide individuals with 
        information and education on opportunities to 
        participate in HIV/AIDS-related clinical research.
  [(e) Coordination With Other Entities.--A grant under 
subsection (a) may be made only if the applicant for the grant 
agrees as follows:
          [(1) The applicant will coordinate activities under 
        the grant with other providers of health care services 
        under this Act, and under title V of the Social 
        Security Act.
          [(2) The applicant will participate in the statewide 
        coordinated statement of need under part B (where it 
        has been initiated by the public health agency 
        responsible for administering grants under part B) and 
        in revisions of such statement.
  [(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 to assess the extent to which HIV health 
        services provided to patients under the grant are 
        consistent with the most recent Public Health Service 
        guidelines for the treatment of HIV disease and related 
        opportunistic infection, and as applicable, to develop 
        strategies for ensuring that such services are 
        consistent with the guidelines for improvement in the 
        access to and quality of HIV health services.
  [(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 grantee under such 
subsection of the needs of the project for the participation of 
women, infants, children, and youth. The Secretary acting 
through the Director of NIH, shall examine the distribution and 
availability of ongoing and appropriate HIV/AIDS-related 
research projects to existing sites under this section for 
purposes of enhancing and expanding voluntary access to HIV-
related research, especially within communities that are not 
reasonably served by such projects. Not later than 12 months 
after the date of the enactment of the Ryan White CARE Act 
Amendments of 2000, the Secretary shall prepare and submit to 
the appropriate committees of Congress a report that describes 
the findings made by the Director and the manner in which the 
conclusions based on those findings can be addressed.
  [(h) Annual Review of Programs; Evaluations.--
          [(1) Review regarding access to and participation in 
        programs.--With respect to a grant under subsection (a) 
        for an entity for a fiscal year, the Secretary shall, 
        not later than 180 days after the end of the fiscal 
        year, provide for the conduct and completion of a 
        review of the operation during the year of the program 
        carried out under such subsection by the entity. The 
        purpose of such review shall be the development of 
        recommendations, as appropriate, for improvements in 
        the following:
                  [(A) Procedures used by the entity to 
                allocate opportunities and services under 
                subsection (a) among patients of the entity who 
                are women, infants, children, or youth.
                  [(B) Other procedures or policies of the 
                entity regarding the participation of such 
                individuals in such program.
          [(2) Evaluations.--The Secretary shall, directly or 
        through contracts with public and private entities, 
        provide for evaluations of programs carried out 
        pursuant to subsection (a).
  [(i) Limitation on Administrative Expenses.--
          [(1) Determination by secretary.--Not later than 12 
        months after the date of the enactment of the Ryan 
        White CARE Act Amendments of 2000, the Secretary, in 
        consultation with grantees under this part, shall 
        conduct a review of the administrative, program 
        support, and direct service-related activities that are 
        carried out under this part to ensure that eligible 
        individuals have access to quality, HIV-related health 
        and support services and research opportunities under 
        this part, and to support the provision of such 
        services.
          [(2) Requirements.--
                  [(A) In general.--Not later than 180 days 
                after the expiration of the 12-month period 
                referred to in paragraph (1) the Secretary, in 
                consultation with grantees under this part, 
                shall determine the relationship between the 
                costs of the activities referred to in 
                paragraph (1) and the access of eligible 
                individuals to the services and research 
                opportunities described in such paragraph.
                  [(B) Limitation.--After a final determination 
                under subparagraph (A), the Secretary may not 
                make a grant under this part unless the grantee 
                complies with such requirements as may be 
                included in such determination.
  [(j) Training and Technical Assistance.--Of the amounts 
appropriated under subsection (j) for a fiscal year, the 
Secretary may use not more than five percent to provide, 
directly or through contracts with public and private entities 
(which may include grantees under subsection (a)), training and 
technical assistance to assist applicants and grantees under 
subsection (a) in complying with the requirements of this 
section.
  [(k) 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.

[SEC. 2672. PROVISIONS RELATING TO BLOOD BANKS.

  [(a) Informational and Training Programs.--The Secretary 
shall--
          [(1) develop and make available to technical and 
        supervisory personnel employed at blood banks and 
        facilities that produce blood products, materials and 
        information concerning measures that may be implemented 
        to protect the safety of the blood supply with respect 
        to the activities of such personnel, including--
                  [(A) state-of-the-art diagnostic and testing 
                procedures relating to pathogens in the blood 
                supply; and
                  [(B) quality assurance procedures relating to 
                the safety of the blood supply and of blood 
                products; and
          [(2) develop and implement a training program that is 
        designed to increase the number of employees of the 
        Department of Health and Human Services who are 
        qualified to conduct inspections of blood banks and 
        facilities that produce blood products.
  [(b) Updates.--The Secretary shall periodically review and 
update the materials and information made available under 
informational or training programs conducted under subsection 
(a).
  [(c) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section, $1,500,000 for 
fiscal year 1991, and such sums as may be necessary in each of 
the fiscal years 1992 through 1995.

[SEC. 2673. RESEARCH, EVALUATION, AND ASSESSMENT PROGRAM.

  [(a) Establishment.--The Secretary, acting through the 
Director of the Agency for Healthcare Research and Quality, 
shall establish a program to enable independent research to be 
conducted by individuals and organizations with appropriate 
expertise in the fields of health, health policy, and economics 
(particularly health care economics) to develop--
          [(1) a comparative assessment of the impact and cost-
        effectiveness of major models for organizing and 
        delivering HIV-related health care, mental health care, 
        early intervention, and support services, that shall 
        include a report concerning patient outcomes, 
        satisfaction, perceived quality of care, and total 
        cumulative cost, and a review of the appropriateness of 
        such models for the delivery of health and support 
        services to infants, children, women, and families with 
        HIV disease;
          [(2) through a review of private sector financing 
        mechanisms for the delivery of HIV-related health and 
        support services, an assessment of strategies for 
        maintaining private health benefits for individuals 
        with HIV disease and an assessment of specific business 
        practices or regulatory barriers that could serve to 
        reduce access to private sector benefit programs;
          [(3) an assessment of the manner in which different 
        points-of-entry to the health care system affect the 
        cost, quality, and outcome of the care and treatment of 
        individuals and families with HIV disease; and
          [(4) a summary report concerning the major and 
        continuing unmet needs in health care, mental health 
        care, early intervention, and support services for 
        individuals and families with HIV disease in urban and 
        rural areas.
  [(b) Report.--Not later than 2 years after the date of 
enactment of this title, and periodically thereafter, the 
Secretary shall prepare and submit, to the Committee on Energy 
and Commerce of the House of Representatives and the Committee 
on Labor and Human Resources of the Senate, a progress report 
that contains the findings and assessments developed under 
subsection (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.

[SEC. 2674. EVALUATIONS AND REPORTS.

  [(a) Evaluations.--The Secretary shall, directly or through 
grants and contracts, evaluate programs carried out under this 
title.
  [(b) Report to Congress.--The Secretary shall, not later than 
October 1, 1996, and annually thereafter, prepare and submit to 
the appropriate Committees of Congress a report--
          [(1) evaluating the programs carried out under this 
        title; and
          [(2) making such recommendations for administrative 
        and legislative initiatives with respect to this title 
        as the Secretary determines to be appropriate.
  [(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 2001 through 2005.
  [(d) Allocation of Funds.--The Secretary shall carry out this 
section with amounts available under section 241. Such amounts 
are in addition to any other amounts that are available to the 
Secretary for such purpose.

[SEC. 2675. COORDINATION.

  [(a) Requirement.--The Secretary shall ensure that the Health 
Resources and Services Administration, the Centers for Disease 
Control and Prevention, the Substance Abuse and Mental Health 
Services Administration, and the Centers for Medicare & 
Medicaid Services coordinate the planning, funding, and 
implementation of Federal HIV programs 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.
  [(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.
  [(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 2 years 
after the date of the enactment of the Ryan White CARE Act 
Amendments of 2000.

[SEC. 2675A. AUDITS.

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

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

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

[SEC. 2676. DEFINITIONS.

  [ For purposes of this title:
          [(1) Counseling.--The term ``counseling'' means such 
        counseling provided by an individual trained to provide 
        such counseling.
          [(2) Designated officer of emergency response 
        employees.--The term ``designated officer of emergency 
        response employees'' means an individual designated 
        under section 2686 by the public health officer of the 
        State involved.
          [(3) Emergency.--The term ``emergency'' means an 
        emergency involving injury or illness.
          [(4) Emergency response employee.--The term 
        ``emergency response employees'' means firefighters, 
        law enforcement officers, paramedics, emergency medical 
        technicians, funeral-service practitioners, and other 
        individuals (including employees of legally organized 
        and recognized volunteer organizations, without regard 
        to whether such employees receive nominal compensation) 
        who, in the course of professional duties, respond to 
        emergencies in the geographic area involved.
          [(5) Employer of emergency response employees.--The 
        term ``employer of emergency response employees'' means 
        an organization that, in the course of professional 
        duties, responds to emergencies in the geographic area 
        involved.
          [(6) Exposed.--The term ``exposed'', with respect to 
        HIV disease or any other infectious disease, means to 
        be in circumstances in which there is a significant 
        risk of becoming infected with the etiologic agent for 
        the disease involved.
          [(7) Families with hiv disease.--The term ``families 
        with HIV disease'' means families in which one or more 
        members have HIV disease.
          [(8) HIV.--The term ``HIV'' means infection with the 
        etiologic agent for acquired immune deficiency 
        syndrome.
          [(9) HIV disease.--The term ``HIV disease'' means 
        infection with the etiologic agent for acquired immune 
        deficiency syndrome, and includes any condition arising 
        from such syndrome.
          [(10) Official poverty line.--The term ``official 
        poverty line'' means the poverty line established by 
        the Director of the Office of Management and Budget and 
        revised by the Secretary in accordance with section 
        673(2) of the Omnibus Budget Reconciliation Act of 
        1981.
          [(11) Person.--The term ``person'' includes one or 
        more individuals, governments (including the Federal 
        Government and the governments of the States), 
        governmental agencies, political subdivisions, labor 
        unions, partnerships, associations, corporations, legal 
        representatives, mutual companies, joint-stock 
        companies, trusts, unincorporated organizations, 
        receivers, trustees, and trustees in cases under title 
        11, United States Code.
          [(12) State.--The term ``State'', except as otherwise 
        specifically provided, means each of the 50 States, the 
        District of Columbia, the Virgin Islands, Guam, 
        American Samoa, the Commonwealth of the Northern 
        Mariana Islands, Puerto Rico, and the Republic of the 
        Marshall Islands.

[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.

[SEC. 2678. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

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

                 [Part E--Emergency Response Employees

              [Subpart I--Guidelines and Model Curriculum

[SEC. 2680. GRANTS FOR IMPLEMENTATION.

  [(a) In General.--With respect to the recommendations 
contained in the guidelines and the model curriculum developed 
under section 253 of Public Law 100-607, the Secretary shall 
make grants to States and political subdivisions of States for 
the purpose of assisting grantees regarding the initial 
implementation of such portions of the recommendations as are 
applicable to emergency response employees.
  [(b) 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.
  [(c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $5,000,000 for each of the fiscal years 1991 
through 1995.

 [Subpart II--Notifications of Possible Exposure to Infectious Diseases

[SEC. 2681. INFECTIOUS DISEASES AND CIRCUMSTANCES RELEVANT TO 
                    NOTIFICATION REQUIREMENTS.

  [(a) In General.--Not later than 180 days after the date of 
the enactment of the Ryan White Comprehensive AIDS Resources 
Emergency Act of 1990, the Secretary shall complete the 
development of--
          [(1) a list of potentially life-threatening 
        infectious diseases to which emergency response 
        employees may be exposed in responding to emergencies;
          [(2) guidelines describing the circumstances in which 
        such employees may be exposed to such diseases, taking 
        into account the conditions under which emergency 
        response is provided; and
          [(3) guidelines describing the manner in which 
        medical facilities should make determinations for 
        purposes of section 2683(d).
  [(b) Specification of Airborne Infectious Diseases.--The list 
developed by the Secretary under subsection (a)(1) shall 
include a specification of those infectious diseases on the 
list that are routinely transmitted through airborne or 
aerosolized means.
  [(c) Dissemination.--The Secretary shall--
          [(1) transmit to State public health officers copies 
        of the list and guidelines developed by the Secretary 
        under subsection (a) with the request that the officers 
        disseminate such copies as appropriate throughout the 
        States; and
          [(2) make such copies available to the public.

[SEC. 2682. ROUTINE NOTIFICATIONS WITH RESPECT TO AIRBORNE INFECTIOUS 
                    DISEASES IN VICTIMS ASSISTED.

  [(a) Routine Notification of Designated Officer.--
          [(1) Determination by treating facility.--If a victim 
        of an emergency is transported by emergency response 
        employees to a medical facility and the medical 
        facility makes a determination that the victim has an 
        airborne infectious disease, the medical facility shall 
        notify the designated officer of the emergency response 
        employees who transported the victim to the medical 
        facility of the determination.
          [(2) Determination by facility ascertaining cause of 
        death.--If a victim of an emergency is transported by 
        emergency response employees to a medical facility and 
        the victim dies at or before reaching the medical 
        facility, the medical facility ascertaining the cause 
        of death shall notify the designated officer of the 
        emergency response employees who transported the victim 
        to the initial medical facility of any determination by 
        the medical facility that the victim had an airborne 
        infectious disease.
  [(b) Requirement of Prompt Notification.--With respect to a 
determination described in paragraph (1) or (2), the 
notification required in each of such paragraphs shall be made 
as soon as is practicable, but not later than 48 hours after 
the determination is made.

[SEC. 2683. REQUEST FOR NOTIFICATIONS WITH RESPECT TO VICTIMS ASSISTED.

  [(a) Initiation of Process by Employee.--If an emergency 
response employee believes that the employee may have been 
exposed to an infectious disease by a victim of an emergency 
who was transported to a medical facility as a result of the 
emergency, and if the employee attended, treated, assisted, or 
transported the victim pursuant to the emergency, then the 
designated officer of the employee shall, upon the request of 
the employee, carry out the duties described in subsection (b) 
regarding a determination of whether the employee may have been 
exposed to an infectious disease by the victim.
  [(b) Initial Determination by Designated Officer.--The duties 
referred to in subsection (a) are that--
          [(1) the designated officer involved collect the 
        facts relating to the circumstances under which, for 
        purposes of subsection (a), the employee involved may 
        have been exposed to an infectious disease; and
          [(2) the designated officer evaluate such facts and 
        make a determination of whether, if the victim involved 
        had any infectious disease included on the list issued 
        under paragraph (1) of section 2681(a), the employee 
        would have been exposed to the disease under such 
        facts, as indicated by the guidelines issued under 
        paragraph (2) of such section.
  [(c) Submission of Request to Medical Facility.--
          [(1) In general.--If a designated officer makes a 
        determination under subsection (b)(2) that an emergency 
        response employee may have been exposed to an 
        infectious disease, the designated officer shall submit 
        to the medical facility to which the victim involved 
        was transported a request for a response under 
        subsection (d) regarding the victim of the emergency 
        involved.
          [(2) Form of request.--A request under paragraph (1) 
        shall be in writing and be signed by the designated 
        officer involved, and shall contain a statement of the 
        facts collected pursuant to subsection (b)(1).
  [(d) Evaluation and Response Regarding Request to Medical 
Facility.--
          [(1) In general.--If a medical facility receives a 
        request under subsection (c), the medical facility 
        shall evaluate the facts submitted in the request and 
        make a determination of whether, on the basis of the 
        medical information possessed by the facility regarding 
        the victim involved, the emergency response employee 
        was exposed to an infectious disease included on the 
        list issued under paragraph (1) of section 2681(a), as 
        indicated by the guidelines issued under paragraph (2) 
        of such section.
          [(2) Notification of exposure.--If a medical facility 
        makes a determination under paragraph (1) that the 
        emergency response employee involved has been exposed 
        to an infectious disease, the medical facility shall, 
        in writing, notify the designated officer who submitted 
        the request under subsection (c) of the determination.
          [(3) Finding of no exposure.--If a medical facility 
        makes a determination under paragraph (1) that the 
        emergency response employee involved has not been 
        exposed to an infectious disease, the medical facility 
        shall, in writing, inform the designated officer who 
        submitted the request under subsection (c) of the 
        determination.
          [(4) Insufficient information.--
                  [(A) If a medical facility finds in 
                evaluating facts for purposes of paragraph (1) 
                that the facts are insufficient to make the 
                determination described in such paragraph, the 
                medical facility shall, in writing, inform the 
                designated officer who submitted the request 
                under subsection (c) of the insufficiency of 
                the facts.
                  [(B)(i) If a medical facility finds in making 
                a determination under paragraph (1) that the 
                facility possesses no information on whether 
                the victim involved has an infectious disease 
                included on the list under section 2681(a), the 
                medical facility shall, in writing, inform the 
                designated officer who submitted the request 
                under subsection (c) of the insufficiency of 
                such medical information.
                  [(ii) If after making a response under clause 
                (i) a medical facility determines that the 
                victim involved has an infectious disease, the 
                medical facility shall make the determination 
                described in paragraph (1) and provide the 
                applicable response specified in this 
                subsection.
  [(e) Time for Making Response.--After receiving a request 
under subsection (c) (including any such request resubmitted 
under subsection (g)(2)), a medical facility shall make the 
applicable response specified in subsection (d) as soon as is 
practicable, but not later than 48 hours after receiving the 
request.
  [(f) Death of Victim of Emergency.--
          [(1) Facility ascertaining cause of death.--If a 
        victim described in subsection (a) dies at or before 
        reaching the medical facility involved, and the medical 
        facility receives a request under subsection (c), the 
        medical facility shall provide a copy of the request to 
        the medical facility ascertaining the cause of death of 
        the victim, if such facility is a different medical 
        facility than the facility that received the original 
        request.
          [(2) Responsibility of facility.--Upon the receipt of 
        a copy of a request for purposes of paragraph (1), the 
        duties otherwise established in this subpart regarding 
        medical facilities shall apply to the medical facility 
        ascertaining the cause of death of the victim in the 
        same manner and to the same extent as such duties apply 
        to the medical facility originally receiving the 
        request.
  [(g) Assistance of Public Health Officer.--
          [(1) Evaluation of response of medical facility 
        regarding insufficient facts.--
                  [(A) In the case of a request under 
                subsection (c) to which a medical facility has 
                made the response specified in subsection 
                (d)(4)(A) regarding the insufficiency of facts, 
                the public health officer for the community in 
                which the medical facility is located shall 
                evaluate the request and the response, if the 
                designated officer involved submits such 
                documents to the officer with the request that 
                the officer make such an evaluation.
                  [(B) As soon as is practicable after a public 
                health officer receives a request under 
                paragraph (1), but not later than 48 hours 
                after receipt of the request, the public health 
                officer shall complete the evaluation required 
                in such paragraph and inform the designated 
                officer of the results of the evaluation.
          [(2) Findings of evaluation.--
                  [(A) If an evaluation under paragraph (1)(A) 
                indicates that the facts provided to the 
                medical facility pursuant to subsection (c) 
                were sufficient for purposes of determinations 
                under subsection (d)(1)--
                          [(i) the public health officer shall, 
                        on behalf of the designated officer 
                        involved, resubmit the request to the 
                        medical facility; and
                          [(ii) the medical facility shall 
                        provide to the designated officer the 
                        applicable response specified in 
                        subsection (d).
                  [(B) If an evaluation under paragraph (1)(A) 
                indicates that the facts provided in the 
                request to the medical facility were 
                insufficient for purposes of determinations 
                specified in subsection (c)--
                          [(i) the public health officer shall 
                        provide advice to the designated 
                        officer regarding the collection and 
                        description of appropriate facts; and
                          [(ii) if sufficient facts are 
                        obtained by the designated officer--
                                  [(I) the public health 
                                officer shall, on behalf of the 
                                designated officer involved, 
                                resubmit the request to the 
                                medical facility; and
                                  [(II) the medical facility 
                                shall provide to the designated 
                                officer the appropriate 
                                response under subsection (c).

[SEC. 2684. PROCEDURES FOR NOTIFICATION OF EXPOSURE.

  [(a) Contents of Notification to Officer.--In making a 
notification required under section 2682 or section 2683(d)(2), 
a medical facility shall provide--
          [(1) the name of the infectious disease involved; and
          [(2) the date on which the victim of the emergency 
        involved was transported by emergency response 
        employees to the medical facility involved.
  [(b) Manner of Notification.--If a notification under section 
2682 or section 2683(d)(2) is mailed or otherwise indirectly 
made--
          [(1) the medical facility sending the notification 
        shall, upon sending the notification, inform the 
        designated officer to whom the notification is sent of 
        the fact that the notification has been sent; and
          [(2) such designated officer shall, not later than 10 
        days after being informed by the medical facility that 
        the notification has been sent, inform such medical 
        facility whether the designated officer has received 
        the notification.

[SEC. 2685. NOTIFICATION OF EMPLOYEE.

  [(a) In General.--After receiving a notification for purposes 
of section 2682 or 2683(d)(2), a designated officer of 
emergency response employees shall, to the extent practicable, 
immediately notify each of such employees who--
          [(1) responded to the emergency involved; and
          [(2) as indicated by guidelines developed by the 
        Secretary, may have been exposed to an infectious 
        disease.
  [(b) Certain Contents of Notification to Employee.--A 
notification under this subsection to an emergency response 
employee shall inform the employee of--
          [(1) the fact that the employee may have been exposed 
        to an infectious disease and the name of the disease 
        involved;
          [(2) any action by the employee that, as indicated by 
        guidelines developed by the Secretary, is medically 
        appropriate; and
          [(3) if medically appropriate under such criteria, 
        the date of such emergency.
  [(c) Responses Other Than Notification of Exposure.--After 
receiving a response under paragraph (3) or (4) of subsection 
(d) of section 2683, or a response under subsection (g)(1) of 
such section, the designated officer for the employee shall, to 
the extent practicable, immediately inform the employee of the 
response.

[SEC. 2686. SELECTION OF DESIGNATED OFFICERS.

  [(a) In General.--For the purposes of receiving notifications 
and responses and making requests under this subpart on behalf 
of emergency response employees, the public health officer of 
each State shall designate 1 official or officer of each 
employer of emergency response employees in the State.
  [(b) Preference in Making Designations.--In making the 
designations required in subsection (a), a public health 
officer shall give preference to individuals who are trained in 
the provision of health care or in the control of infectious 
diseases.

[SEC. 2687. LIMITATIONS WITH RESPECT TO DUTIES OF MEDICAL FACILITIES.

  [The duties established in this subpart for a medical 
facility--
          [(1) shall apply only to medical information 
        possessed by the facility during the period in which 
        the facility is treating the victim for conditions 
        arising from the emergency, or during the 60-day period 
        beginning on the date on which the victim is 
        transported by emergency response employees to the 
        facility, whichever period expires first; and
          [(2) shall not apply to any extent after the 
        expiration of the 30-day period beginning on the 
        expiration of the applicable period referred to in 
        paragraph (1), except that such duties shall apply with 
        respect to any request under section 2683(c) received 
        by a medical facility before the expiration of such 30-
        day period.

[SEC. 2688. RULES OF CONSTRUCTION.

  [(a) Liability of Medical Facilities and Designated 
Officers.--This subpart may not be construed to authorize any 
cause of action for damages or any civil penalty against any 
medical facility, or any designated officer, for failure to 
comply with the duties established in this subpart.
  [(b) Testing.--This subpart may not, with respect to victims 
of emergencies, be construed to authorize or require a medical 
facility to test any such victim for any infectious disease.
  [(c) Confidentiality.--This subpart may not be construed to 
authorize or require any medical facility, any designated 
officer of emergency response employees, or any such employee, 
to disclose identifying information with respect to a victim of 
an emergency or with respect to an emergency response employee.
  [(d) Failure to Provide Emergency Services.--This subpart may 
not be construed to authorize any emergency response employee 
to fail to respond, or to deny services, to any victim of an 
emergency.

[SEC. 2689. INJUNCTIONS REGARDING VIOLATION OF PROHIBITION.

  [(a) In General.--The Secretary may, in any court of 
competent jurisdiction, commence a civil action for the purpose 
of obtaining temporary or permanent injunctive relief with 
respect to any violation of this subpart.
  [(b) Facilitation of Information on Violations.--The 
Secretary shall establish an administrative process for 
encouraging emergency response employees to provide information 
to the Secretary regarding violations of this subpart. As 
appropriate, the Secretary shall investigate alleged such 
violations and seek appropriate injunctive relief.

[SEC. 2690. APPLICABILITY OF SUBPART.

  This subpart shall not apply in a State if the chief 
executive officer of the State certifies to the Secretary that 
the law of the State is in substantial compliance with this 
subpart.

              PART D--Women, infants, children, and youth

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

  (a) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, shall award grants to public and nonprofit 
private entities (including a health facility operated by or 
pursuant to a contract with the Indian Health Service) for the 
purpose of providing family-centered care involving outpatient 
or ambulatory care (directly or through contracts) for women, 
infants, children, and youth with HIV/AIDS.
  (b) Additional Services for Patients and Families.--Funds 
provided under grants awarded under subsection (a) may be used 
for the following support services:
          (1) Family-centered care including case management.
          (2) Referrals for additional services including--
                  (A) referrals for inpatient hospital 
                services, treatment for substance abuse, and 
                mental health services; and
                  (B) referrals for other social and support 
                services, as appropriate.
          (3) Additional services necessary to enable the 
        patient and the family to participate in the program 
        established by the applicant pursuant to such 
        subsection including services designed to recruit and 
        retain youth with HIV.
          (4) The provision of information and education on 
        opportunities to participate in HIV/AIDS-related 
        clinical research.
  (c) Coordination with Other Entities.--A grant awarded under 
subsection (a) may be made only if the applicant provides an 
agreement that includes the following:
          (1) The applicant will coordinate activities under 
        the grant with other providers of health care services 
        under this Act, and under title V of the Social 
        Security Act, including programs promoting the 
        reduction and elimination of risk of HIV/AIDS for 
        youth.
          (2) The applicant will participate in the statewide 
        coordinated statement of need under part B (where it 
        has been initiated by the public health agency 
        responsible for administering grants under part B) and 
        in revisions of such statement.
          (3) The applicant will every 2 years submit to the 
        lead State agency under section 2617(b)(4) audits 
        regarding funds expended in accordance with this title 
        and shall include necessary client-level data to 
        complete unmet need calculations and Statewide 
        coordinated statements of need process.
  (d) Administration; Application.--A grant may only be awarded 
to an entity under subsection (a) if an application for the 
grant is submitted to the Secretary and the application is in 
such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary 
determines to be necessary to carry out this section. Such 
application shall include the following:
          (1) Information regarding how the expected 
        expenditures of the grant are related to the planning 
        process for localities funded under part A (including 
        the planning process outlined in section 2602) and for 
        States funded under part B (including the planning 
        process outlined in section 2617(b)).
          (2) A specification of the expected expenditures and 
        how those expenditures will improve overall patient 
        outcomes, as outlined as part of the State plan (under 
        section 2617(b)) or through additional outcome 
        measures.
  (e) Annual Review of Programs; Evaluations.--
          (1) Review regarding access to and participation in 
        programs.--With respect to a grant under subsection (a) 
        for an entity for a fiscal year, the Secretary shall, 
        not later than 180 days after the end of the fiscal 
        year, provide for the conduct and completion of a 
        review of the operation during the year of the program 
        carried out under such subsection by the entity. The 
        purpose of such review shall be the development of 
        recommendations, as appropriate, for improvements in 
        the following:
                  (A) Procedures used by the entity to allocate 
                opportunities and services under subsection (a) 
                among patients of the entity who are women, 
                infants, children, or youth.
                  (B) Other procedures or policies of the 
                entity regarding the participation of such 
                individuals in such program.
          (2) Evaluations.--The Secretary shall, directly or 
        through contracts with public and private entities, 
        provide for evaluations of programs carried out 
        pursuant to subsection (a).
  (f) Administrative Expenses.--
          (1) Limitation.--A grantee may not use more than 10 
        percent of amounts received under a grant awarded under 
        this section for administrative expenses.
          (2) Clinical quality management program.--A grantee 
        under this section shall implement a clinical quality 
        management program to assess the extent to which HIV 
        health services provided to patients under the grant 
        are consistent with the most recent Public Health 
        Service guidelines for the treatment of HIV/AIDS and 
        related opportunistic infection, and as applicable, to 
        develop strategies for ensuring that such services are 
        consistent with the guidelines for improvement in the 
        access to and quality of HIV health services.
  (g) Training and Technical Assistance.--From the amounts 
appropriated under subsection (i) for a fiscal year, the 
Secretary may use not more than 5 percent to provide, directly 
or through contracts with public and private entities (which 
may include grantees under subsection (a)), training and 
technical assistance to assist applicants and grantees under 
subsection (a) in complying with the requirements of this 
section.
  (h) Definitions.--In this section:
          (1) Administrative expenses.--The term 
        ``administrative expenses'' means funds that are to be 
        used by grantees for grant management and monitoring 
        activities, including costs related to any staff or 
        activity unrelated to services or indirect costs.
          (2) Indirect costs.--The term ``indirect costs'' 
        means costs included in a Federally negotiated indirect 
        rate.
          (3) Services.--The term ``services'' means--
                  (A) services that are provided to clients to 
                meet the goals and objectives of the program 
                under this section, including the provision of 
                professional, diagnostic, and therapeutic 
                services by a primary care provider or a 
                referral to and provision of specialty care; 
                and
                  (B) services that sustain program activity 
                and contribute to or help improve services 
                under subparagraph (A).
  (i) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated, $71,800,000 for each of the fiscal years 2007 
through 2011.

                       PART E--General Provisions

SEC. 2681. COORDINATION.

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

SEC. 2682. AUDITS.

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

SEC. 2683. PUBLIC HEALTH EMERGENCY.

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

SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

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

SEC. 2685. PRIVACY PROTECTIONS.

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

SEC. 2686. GAO REPORT.

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

SEC. 2687. DEFINITIONS.

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

PART F--DEMONSTRATION AND TRAINING

           *       *       *       *       *       *       *


         [Subpart I--Special Projects of National Significance

[SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

  [(a) In General.--Of the amount appropriated under each of 
parts A, B, C, and D of this title for each fiscal year, the 
Secretary shall use the greater of $20,000,000 or 3 percent of 
such amount appropriated under each such part, but not to 
exceed $25,000,000, to administer a special projects of 
national significance program to award direct grants to public 
and nonprofit private entities including community-based 
organizations to fund special programs for the care and 
treatment of individuals with HIV disease.
  [(b) Grants.--The Secretary shall award grants under 
subsection (a) based on--
          [(1) the need to assess the effectiveness of a 
        particular model for the care and treatment of 
        individuals with HIV disease;
          [(2) the innovative nature of the proposed activity; 
        and
          [(3) the potential replicability of the proposed 
        activity in other similar localities or nationally.
  [(c) Special Projects.--Special projects of national 
significance shall include the development and assessment of 
innovative service delivery models that are designed to--
          [(1) address the needs of special populations;
          [(2) assist in the development of essential 
        community-based service delivery infrastructure; and
          [(3) ensure the ongoing availability of services for 
        Native American communities to enable such communities 
        to care for Native Americans with HIV disease.
  [(d) Special Populations.--Special projects of national 
significance may include the delivery of HIV health care and 
support services to traditionally underserved populations 
including--
          [(1) individuals and families with HIV disease living 
        in rural communities;
          [(2) adolescents with HIV disease;
          [(3) Indian individuals and families with HIV 
        disease;
          [(4) homeless individuals and families with HIV 
        disease;
          [(5) hemophiliacs with HIV disease; and
          [(6) incarcerated individuals with HIV disease.
  [(e) Service Development Grants.--Special projects of 
national significance may include the development of model 
approaches to delivering HIV care and support services 
including--
          [(1) programs that support family-based care networks 
        and programs that build organizational capacity 
        critical to the delivery of care in minority 
        communities;
          [(2) programs designed to prepare AIDS service 
        organizations and grantees under this title for 
        operation within the changing health care environment; 
        and
          [(3) programs designed to integrate the delivery of 
        mental health and substance abuse treatment with HIV 
        services.
  [(f) Coordination.--The Secretary may not make a grant under 
this section unless the applicant submits evidence that the 
proposed program is consistent with the statewide coordinated 
statement of need, and the applicant agrees to participate in 
the ongoing revision process of such statement of need.
  [(g) Replication.--The Secretary shall make information 
concerning successful models developed under this part 
available to grantees under this title for the purpose of 
coordination, replication, and integration. To facilitate 
efforts under this subsection, the Secretary may provide for 
peer-based technical assistance from grantees funded under this 
part.]

          Subpart I--Special projects of national significance

SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

  (a) In General.--Of the amount appropriated under each of 
parts A, B, C, and D for each fiscal year, the Secretary shall 
use the greater of $20,000,000 or an amount equal to 3 percent 
of such amount appropriated under each such part, but not to 
exceed $25,000,000, to administer special projects of national 
significance to--
          (1) quickly respond to emerging needs of individuals 
        receiving assistance under this title; and
          (2) to fund special programs to develop a standard 
        electronic client information data system to improve 
        the ability of grantees under this title to report 
        client-level data to the Secretary.
  (b) Grants.--The Secretary shall award grants under 
subsection (a) to entities eligible for funding under parts A, 
B, C, and D based on--
  (1) whether the funding will promote obtaining client level 
data as it relates to the creation of a severity of need index 
under section 2618(a)(2)(E), including funds to facilitate the 
purchase and enhance the utilization of qualified health 
information technology systems;
  (2) demonstrated ability to create and maintain a qualified 
health information technology system;
  (3) the potential replicability of the proposed activity in 
other similar localities or nationally;
  (4) the demonstrated reliability of the proposed qualified 
health information technology system across a variety of 
providers, geographic regions, and clients; and
  (5) the demonstrated ability to maintain a safe and secure 
qualified health information system; or
  (6) newly emerging needs of individuals receiving assistance 
under this title.
  (c) Coordination.--The Secretary may not make a grant under 
this section unless the applicant submits evidence that the 
proposed program is consistent with the statewide coordinated 
statement of need, and the applicant agrees to participate in 
the ongoing revision process of such statement of need.
  (d) Privacy Protection.--The Secretary may not make a grant 
under this section for the development of a qualified health 
information technology system unless the applicant provides 
assurances to the Secretary that the system will, at a minimum, 
comply with the privacy regulations promulgated under section 
264(c) of the Health Insurance Portability and Accountability 
Act of 1996.
  (e) Replication.--The Secretary shall make information 
concerning successful models or programs developed under this 
part available to grantees under this title for the purpose of 
coordination, replication, and integration. To facilitate 
efforts under this subsection, the Secretary may provide for 
peer-based technical assistance for grantees funded under this 
part.

           *       *       *       *       *       *       *


            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) 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, 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;

           *       *       *       *       *       *       *

                  (D) to develop protocols for the medical care 
                of women with HIV disease, including prenatal 
                and other gynecological care for such women.
          (2) Preference in making grants.--In making grants 
        under paragraph (1), the Secretary shall give 
        preference to qualified projects which will--
                  (A) train, or result in the training of, 
                health professionals who will provide treatment 
                for minority individuals and Native Americans 
                with HIV disease and other individuals who are 
                at high risk of contracting such disease;
                  (B) train, or result in the training of, 
                minority health professionals and minority 
                allied health professionals to provide 
                treatment for individuals with such disease; 
                andK
                  (C) train or result in the training of health 
                professionals and allied health professionals 
                to provide treatment for hepatitis B or C co-
                infected individuals.

           *       *       *       *       *       *       *

  (b) Dental Schools.--
          (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] HIV/AIDS.

           *       *       *       *       *       *       *

          (2) Application.--Each dental school or program 
        described in section 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] HIV/AIDS by 
        that school or hospital during the prior year.
          (3) Distribution.--The Secretary shall distribute the 
        available funds among all eligible applicants, taking 
        into account the number of patients with [HIV disease] 
        HIV/AIDS served and the unreimbursed oral health care 
        costs incurred by each institution as compared with the 
        total number of patients served and costs incurred by 
        all eligible applicants.

           *       *       *       *       *       *       *

          (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] HIV/AIDS 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 2001 through 2005.
          [(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.]
  (c) Authorization of Appropriations.--
          (1) Schools; centers.--For the purpose of awarding 
        grants under subsection (a), there is authorized to be 
        appropriated $34,700,000 for each of the fiscal years 
        2007 through 2011.
          (2) Dental schools.--For the purpose of awarding 
        grants under subsection (b), there is authorized to be 
        appropriated $13,000,000 for each of the fiscal years 
        2007 through 2011.

           *       *       *       *       *       *       *


                 Subpart III--Minority AIDS Initiative

SEC. 2693. MINORITY AIDS INITIATIVE.

  (a) In General.--For the purpose of carrying out activities 
under this section to evaluate and address the disproportionate 
impact of HIV/AIDS on, and the disparities in access, 
treatment, care, and outcomes for, racial and ethnic minorities 
(including African Americans, Alaska Natives, Latinos, American 
Indians, Asian Americans, Native Hawaiians, and Pacific 
Islanders), there are authorized to be appropriated 
$131,200,000 for fiscal year 2007, $135,100,000 for fiscal year 
2008, $139,100,000 for fiscal year 2009, $143,200,000 for 
fiscal year 2010, and $147,500,000 for fiscal year 2011.
  (b) Certain Activities.--
          (1) In general.--In carrying out the purpose 
        described in subsection (a), the Secretary shall 
        provide for--
                  (A) emergency assistance under part A;
                  (B) care grants under part B;
                  (C) early intervention services under part C;
                  (D) services through projects for HIV-related 
                care under part D; and
                  (E) activities through education and training 
                centers under section 2692.
          (2) Allocations among activities.--Activities under 
        paragraph (1) shall be carried out by the Secretary in 
        accordance with the following:
                  (A) For competitive, supplemental grants to 
                improve HIV-related health outcomes to reduce 
                existing racial and ethnic health disparities, 
                the Secretary shall, of the amount appropriated 
                under subsection (a) for a fiscal year, reserve 
                the following, as applicable:
                          (i) For fiscal year 2007, 
                        $43,800,000.
                          (ii) For fiscal year 2008, 
                        $45,400,000.
                          (iii) For fiscal year 2009, 
                        $47,100,000.
                          (iv) For fiscal year 2010, 
                        $48,800,000.
                          (v) For fiscal year 2011, 
                        $50,700,000.
                  (B) For competitive grants used for 
                supplemental support education and outreach 
                services to increase the number of eligible 
                racial and ethnic minorities who have access to 
                treatment through the program under section 
                2616 for therapeutics, the Secretary shall, of 
                the amount appropriated for a fiscal year under 
                subsection (a), reserve the following, as 
                applicable:
                          (i) For fiscal year 2007, $7,000,000.
                          (ii) For fiscal year 2008, 
                        $7,300,000.
                          (iii) For fiscal year 2009, 
                        $7,500,000.
                          (iv) For fiscal year 2010, 
                        $7,800,000.
                          (v) For fiscal year 2011, $8,100,000.
                  (C) For planning grants, capacity-building 
                grants, and services grants to health care 
                providers who have a history of providing 
                culturally and linguistically appropriate care 
                and services to racial and ethnic minorities, 
                the Secretary shall, of the amount appropriated 
                for a fiscal year under subsection (a), reserve 
                the following, as applicable:
                          (i) For fiscal year 2007, 
                        $53,400,000.
                          (ii) For fiscal year 2008, 
                        $55,400,000.
                          (iii) For fiscal year 2009, 
                        $57,400,000.
                          (iv) For fiscal year 2010, 
                        $59,500,000.
                          (v) For fiscal year 2011, 
                        $61,800,000.
                  (D) For eliminating racial and ethnic 
                disparities in the delivery of comprehensive, 
                culturally and linguistically appropriate care 
                services for HIV disease for women, infants, 
                children, and youth, the Secretary shall, of 
                the amount appropriated under subsection (a), 
                reserve $18,500,000 for each of the fiscal 
                years 2007 through 2011.
                  (E) For increasing the training capacity of 
                centers to expand the number of health care 
                professionals with treatment expertise and 
                knowledge about the most appropriate standards 
                of HIV disease-related treatments and medical 
                care for racial and ethnic minority adults, 
                adolescents, and children with HIV disease, the 
                Secretary shall, of the amount appropriated 
                under subsection (a), reserve $8,500,000 for 
                each of the fiscal years 2007 through 2011.
  (c) Consistency with Prior Program.--With respect to the 
purpose described in subsection (a), the Secretary shall carry 
out this section consistent with the activities carried out 
under this title by the Secretary pursuant to the Departments 
of Labor, Health and Human Services, and Education, and Related 
Agencies Appropriations Act, 2002 (Public Law 107-116).

 DISSENTING VIEWS OF REPRESENTATIVES HENRY A. WAXMAN, LOIS CAPPS, ANNA 
                      G. ESHOO, AND HILDA L. SOLIS

    We reluctantly opposed the Ryan White HIV/AIDS Treatment 
Modernization Act of 2006 as reported by the House Committee on 
Energy and Commerce on September 20, 2006. This legislation has 
far-reaching implications for the stability of HIV/AIDS funding 
in our State and cities. The programs funded by the Ryan White 
Care Act have literally been life-savers for people who live 
with HIV/AIDS. The Act has provided critical support to the 
cities that have been the center of the epidemic, and to our 
State funding critical drug and support programs to treat the 
disease.
    In prior reauthorizations of the Ryan White Care Act, the 
changes that have been made were made at the margins in order 
to deal with emerging problems and developments. These changes 
did not, however, disrupt the overall program that was working 
effectively. Unfortunately, unlike those past reauthorizations, 
this Committee-reported bill would have a drastic destabilizing 
effect on many of the hardest-hit areas of the country, 
including California.
    Had this Administration and the Republican-controlled 
Congress prioritized the Ryan White program in making its 
budget allocations over the past several years, we would not be 
writing these dissenting views. The Committee-reported bill 
seeks to apportion an inadequate amount of money that is simply 
not enough to meet the current demand for HIV/AIDS care in the 
United States. The Towns/Eshoo/Engel/Capps Amendment offered at 
the markup would have addressed this concern to some extent by 
injecting much-needed additional dollars into the program. That 
amendment was regrettably voted down largely along party lines.
    The Pallone amendment also would have been a productive 
step. That amendment would have maintained the status quo for 
one year and removed the threat of damaging massive shifts in 
funds, thereby allowing the negotiation process to continue. 
Again, this amendment was voted down largely along party lines.
    There are several other problems with the way in which the 
bill seeks to allocate Ryan White funds that are of significant 
concern to our State. The first relates to incorporating data 
on HIV cases into the funding formula. The 2000 reauthorization 
of the Act included a requirement that HIV cases be 
incorporated into the funding distribution by no later than 
2007. At that time, HIV reporting systems were in various 
stages of development across the country; although some states 
and cities had been reporting HIV cases by name since 1985, 
others had yet to implement an HIV-reporting system at all. 
Given this landscape, the drafters understood the need to 
provide sufficient time to allow states and cities to begin 
collecting HIV cases. At the time, they believed seven years to 
be adequate for such a transition. As it turns out, it was not.
    As HIV reporting systems were developed, variations among 
these systems across jurisdictions emerged. Some areas reported 
HIV by the individual's name along with other identifying 
information. California and many other states, as a means of 
protecting the individual's confidentiality, opted not to 
report the person's name at all, and instead included only a 
unique code identifying the individual. The 2000 
reauthorization of the Ryan White Act did not specify which 
type of reporting system jurisdictions were required to use and 
nothing in the law prohibited this kind of variation. So long 
as the Secretary found that the data on HIV cases was 
``sufficiently accurate and reliable,'' jurisdictions were free 
to report cases by name or by code. Thus, whether an area began 
collecting HIV by name or by code, they were on equally solid 
ground under the law.
    It was not until December 2005, that CDC first gave a 
definitive indication that it would deem only cases reported by 
name to be ``sufficiently accurate and reliable.'' In a letter 
to all code-based states, CDC set forth its strong 
recommendation that those states convert to a names-based 
system--it did not, however, establish any sort of legal 
requirement. At that point, 13 states used some form of a code-
based reporting system. In response to CDC's announcement, 
almost all code-based states began the process of moving to 
names-based systems.
    The reported bill would rely exclusively on names-based HIV 
and AIDS cases in making funding allocations starting in fiscal 
year 2011. In order to meet this deadline, and have all of 
their names-based HIV cases counted for funding purposes, code-
based jurisdictions will be required to have completely 
converted to names-based systems in less than three years.
    For large and diverse code-based states with several very 
large cities, such as California, this is simply not enough 
time to make this change. California essentially has to start 
from scratch. In its code-based system, California currently 
has approximately 40,000 cases of HIV (non-AIDS). Under 
California law, these cases cannot simply be re-tallied under 
the new names-based system. In order to incorporate these cases 
into the new system, the State must contact each of these 
40,000 individuals, and ask them to come in to a testing site 
to be re-tested. Some of these individuals are homeless. Some 
are drug-abusers. Many don't speak English. Given that 
personnel and resources are already strained, California will 
simply not be able to get all of these individuals entered into 
the names-based system in three years.
    The experience of other large code-based systems provides a 
sense of the difficulty of this task. New York, for example, 
converted to a names-based system in 2000 and is now considered 
by CDC to be mature. However, it is widely acknowledged that 
New York's current names-based HIV count severely undercounts 
the true burden of HIV in the State. New York simply has not 
had enough time to find and report all of its HIV cases.
    We cannot support legislation that would disadvantage our 
State and take large amounts of dollars away simply because the 
data system is incomplete. The number of persons with HIV and 
with need for services remains. They should not lose needed 
services because of an unrealistic data requirement.
    Because HIV reporting systems across the country remain in 
a state of flux, it is critical that this reauthorization 
protect against severe losses in funding if it seeks to base 
the funding on HIV cases. The most effective way to accomplish 
this protection is to incorporate a hold-harmless provision for 
the entire life of the bill. Unfortunately, the current bill 
protects a jurisdiction's funding for only the first three 
years. This is not enough.
    Under the bill, California faces the most drastic cuts at 
the very time the hold harmless comes to an end. By 
California's estimates, the State stands to lose nearly 25 
percent of its total RWCA funding during the fifth year of the 
bill alone. Our State simply cannot sustain these kinds of 
losses.
    The bill's so-called ``priority language'' is also not a 
solution. The bill includes language within the Title I and 
Title II supplement grants that would permit--but not require--
the Secretary to allocate supplement dollars to areas that 
successfully prove they suffered a decline in funding that 
negatively impacts their provision of Ryan White services. The 
discretionary nature of this provision is concerning; there is 
no guarantee that the Secretary would agree that a given state 
has adequately demonstrated a decrease in its ability to 
provide services. However, perhaps more concerning, it is 
unclear whether funds will be available to make these grants 
even if the Secretary decided an area had shown that it met the 
criteria. Despite the fact that there are several changes 
scheduled to occur mid-way through the life of the bill, i.e., 
the shift to names-based data and the termination of the hold-
harmless protection, the data runs provided by GAO were limited 
to one year only. Thus the overall funding picture is entirely 
unknown and we cannot assume that the dollars needed to fund 
these so-called priority grants would be available.
    The bill also unfairly penalizes code-based jurisdictions 
by applying a 5 percent gain cap only to those areas--and not 
to other names-based jurisdictions. It is unacceptable to 
punish a code-based state because they adopted their system in 
good faith and collected HIV data that they thought would be in 
compliance with the requirements of the law. However, this cap 
has another important and negative effect: by failing to cap 
the gains across the board, it further depletes the funds 
necessary to make ``priority grants.'' Further, the very same 
states that had limits on any increases in funds during the 
early years of this reauthorization are denied protection 
against massive losses in the later years.
    We also cannot support the bill's inclusion of the so-
called ``severity of need index'' (SONI). The bill requires the 
Secretary to develop a SONI to measure the relative needs of 
individuals living with HIV/AIDS. But the bill fails to specify 
the factors that should be incorporated into this index, 
leaving this determination entirely up to the Secretary. 
Further, the bill then permits the Secretary to completely 
discard the current funding formula and distribute funding on 
the basis of this SONI beginning as early as FY 2011 without 
Congressional action. This is unacceptable. Congress--not the 
Administration--should be solely responsible for making such a 
drastic shift in the way funds are distributed under the Act.
    A basic goal of this reauthorization must be ensuring that 
the actions we take do not destabilize systems already in place 
serving this population. Unfortunately, the Committee-reported 
bill fails to meet this goal and jeopardizes the critical 
funding of areas throughout the country in general, and the 
State and cities of California in particular.
    For all of these reasons, we oppose the Ryan White HIV/AIDS 
Treatment Modernization Act of 2006 as reported by the House 
Committee on Energy and Commerce on September 20, 2006.

                                   Henry A. Waxman.
                                   Lois Capps.
                                   Anna G. Eshoo.
                                   Hilda L. Solis.

DISSENTING VIEWS OF REPRESENTATIVES FRANK PALLONE, JR., ELIOT L. ENGEL, 
HENRY A. WAXMAN, EDWARD J. MARKEY, EDOLPHUS TOWNS, ANNA G. ESHOO, LOIS 
                       CAPPS, AND HILDA L. SOLIS

THIS LEGISLATION FAILS TO PROVIDE ADEQUATE FUNDING TO PROVIDE TREATMENT 
                          TO HIV/AIDS PATIENTS

    The ``Ryan White HIV/AIDS Treatment Modernization Act of 
2006'', as reported out by the Committee, fails to provide 
states, metropolitan areas, and other grantees with the 
resources necessary to meet the growing need of their HIV/AIDS 
populations.
    This reauthorization will destabilize established systems 
of care and will have a devastating effect on the ability of 
high-prevalence communities to address need. While the HIV/AIDS 
epidemic has expanded, more than \1/2\ of all people living 
with AIDS in the United States reside in just five states: New 
York, California, Florida, Texas and New Jersey. Under H.R. 
6143, three of the five highest prevalence states (NY, FL, NJ) 
will suffer devastating funding losses, which will compromise 
their ability to provide comprehensive medical care and 
services to their HIV/AIDS population.
    As thousands of new infections are diagnosed annually, and 
people continue to live longer thanks to new life-saving drug 
therapies, the demand for treatment and support services funded 
by the Ryan White CARE Act are increasing rapidly. 
Unfortunately, as the demand for services continue to grow 
Republicans have flat funded the CARE Act for the past five 
fiscal years, thereby limiting the ability of grantees to 
provide necessary care. According to the AIDS Institute, there 
are presently over 230,000 people in the United States who are 
not receiving antiretroviral treatment who should be, and there 
is a growing unmet need for HIV/AIDS health care services.
    In spite of these facts, the bill reported out of the 
Committee would authorize flat funding for fiscal year 2007, 
and only increase authorizations of appropriations by 3.7% 
through fiscal year 2011 to account for inflation. As a result, 
this bill will still do very little to actually help alleviate 
the growing unmet need for HIV/AIDS treatment services in our 
communities.

                   TOWNS/ESHOO/ENGEL/CAPPS AMENDMENT

    We support increasing authorization levels above inflation 
in order to help our communities improve access to care for 
those persons and families affected by HIV/AIDS. Accordingly, 
Representatives Towns and Engel of New York and Representatives 
Eshoo and Capps of California offered a joint amendment that 
would have significantly increased authorizations above 
inflation for the life of the authorization period. Title I 
Formula and Title I Supplemental funding would have been 
increased by $120,320,405 total over five years and Title II 
Base, Title II Supplemental and ADAP funding would have been 
increased by $312,322,900 total over five years.
    In addition, the amendment would have extended the hold 
harmless of 95% of the previous fiscal year funding for all 
five years of the reauthorization. The current bill fails to 
provide states with funding certainty by ending the hold 
harmless after three years.
    Unfortunately, the Towns/Eshoo/Engel/Capps amendment was 
defeated largely along party lines.

                      PALLONE SUBSTITUTE AMENDMENT

    Representative Pallone of New Jersey offered an amendment 
in the nature of a substitute to reauthorize the Ryan White 
CARE Act through fiscal year 2007. Furthermore, the substitute 
amendment would have increased authorization levels by 3.7% to 
account for inflationary increases and prevents any unspent 
funds from reverting back to the treasury; a one time emergency 
authorization of $30 million in Title II for areas that have 
unmet need and receive no funding under Title I of the Act; and 
a one year extension of the names based reporting requirement.
    We believe that the bill taken up and ultimately reported 
out of Committee is substantially flawed. First, as outlined 
above, the bill is woefully under funded. Second, the funding 
problem is exacerbated by the fact that the bill would add HIV 
to the formula used to allocate money for the first time. We 
are not opposed to counting HIV cases for the purposes of 
distributing money. However, the impact of counting these cases 
should not result in the loss of funding for those cities and/
or states that have a disproportionate share of AIDS cases, 
such as New York and New Jersey, which have consistently been 
the hardest hit in this epidemic's history.
    We remain concerned that states' differing HIV surveillance 
systems will prevent funding from accurately following the 
epidemic. Within the bill, the dual track reporting system 
mandates separate standards for HIV reporting for states with 
code-based reporting systems versus those who report by name. 
The 33 ``name-based'' states are currently held to rigorous CDC 
validation requirements and restrictions while those who are 
code-based will eventually report to a system that is not yet 
developed. Further, the proposed arbitrary five-percent 
duplication penalty is problematic in light of the fact that 
duplication varies widely from state to state, with some states 
showing a duplication rate that exceeds five percent and some 
states below five percent. Since ``code-based'' states are also 
subject to a five percent gain cap in funding until their HIV 
surveillance systems are deemed mature, it is clear that 
regardless of code or name status, many states will not receive 
appropriate funding for their HIV populations.
    Finally, it is troubling that the committee has been given 
only one year of data that is questionable at best to evaluate 
the impact of this five year reauthorization and thus the full 
impact of this legislation is unknown. The Pallone amendment 
would provide further opportunity to clarify the real impact of 
the legislation by using data that actually would be used to 
determine formula distribution.
    Given all of these concerns, we feel that it is appropriate 
to delay the implementation of a funding formula that includes 
HIV data and postpone further action on the bill so that all 
parties can continue negotiations and reach an agreement that 
addresses our concerns and keeps all of our systems of care 
intact.
    Unfortunately, the Pallone substitute amendment was 
defeated largely along party lines.

                 CONCERNS ABOUT SEVERITY OF NEED INDEX

    We remain concerned that implementing the Severity of Need 
Index (SONI) may further exacerbate funding shifts and 
uncertainty. H.R. 6143 calls for the SONI to be used to 
allocate Title II formula funding as early as FY11 and no later 
than FY13 without Congressional action, despite the fact that 
the structure and impact of such an index cannot be determined. 
We are concerned that the SONI may consider the generosity of a 
state Medicaid program or other available state or local 
resources when determining Ryan White funding allocations. 
Factoring the contribution of state and local dollars into the 
formula essentially punishes jurisdictions taking 
responsibility upon themselves to care for their HIV/AIDS 
population, creating a powerful disincentive for state and 
local action.
    Mandating an index that has yet to be developed and tested 
is premature--particularly in light of the fact that national 
data on HIV cases are not expected to be mature and universally 
available for several years. We strongly believe that the 
Severity of Need Index should not be used to allocate federal 
funding until the next Ryan White CARE Act reauthorization.

                 CONCERNS ABOUT PRIORITY GRANT LANGUAGE

    The language related to priority grants for jurisdictions 
that experience losses is not consistent with the commitment 
that was made to address reductions in resources. The 
bicameral, bipartisan staff of Senators Enzi and Kennedy and 
Congressmen Barton and Dingell met with Governors' 
representatives on September 12, 2006, to brief them on the 
bill and to obtain feedback. During the meeting, a commitment 
was made by the staff to ``make states whole'' relative to FY06 
funding. Governors' representatives were informed that there 
are sufficient funds in the bill to address the following in 
priority order: (1) hold harmless provisions; (2) priority 
grants to ensure that jurisdictions are made whole; and (3) 
grants for demonstrated need. The priority grants were 
described as a stopgap measure. Despite efforts to negotiate 
priority grant language that was consistent with the commitment 
made to the Governors and to Members of the House Energy and 
Commerce Committee and Senate Committee on Health, Education, 
Labor, and Pensions Committee, a compromise that was acceptable 
to all could not be reached. The language in the bill does not 
represent a commitment to make jurisdictions whole; rather, the 
language calls for competitive grants and leaves to the 
discretion of the secretary whether to make a priority grant to 
a jurisdiction that has experienced a reduction as well as the 
level of priority funding.
    Finally, despite assurances that there is enough funding in 
the bill to achieve the goal to make states and Title I 
jurisdictions whole to FY06 funding, due to the numerous 
changes being made to the bill and the lack of data 
demonstrating the impact of the bill in each year of the 
authorization period, we are unconvinced that states and Title 
I jurisdictions will receive funding restoration.

                                   Frank Pallone, Jr.
                                   Henry A. Waxman.
                                   Edolphus Towns.
                                   Lois Capps.
                                   Eliot L. Engel.
                                   Edward J. Markey.
                                   Anna Eshoo.
                                   Hilda L. Solis.

                                  
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