[House Report 111-305]
[From the U.S. Government Publishing Office]


111th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    111-305

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



 
          RYAN WHITE HIV/AIDS TREATMENT EXTENSION ACT OF 2009

                                _______
                                

October 20, 2009.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Waxman, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3792) 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
Amendment........................................................     2
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Legislative History..............................................     2
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings and Recommendations.................     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Statement of General Performance Goals and Objectives............     3
Constitutional Authority Statement...............................     3
Earmarks and Tax and Tariff Benefits.............................     4
Advisory Committee Statement.....................................     4
Applicability of Law to Legislative Branch.......................     4
Federal Mandates Statement.......................................     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Section-by-Section Analysis of the Legislation...................     5
Changes in Existing Law Made by the Bill, as Reported............    10

                               Amendment

    There were no amendments to H.R. 3792 offered or adopted 
during Committee consideration of the bill.

                          Purpose and Summary

    H.R. 3792, the ``Ryan White HIV/AIDS Treatment Extension 
Act of 2009'', is a bill to reauthorize programs providing 
comprehensive care, treatment, and support services for 
Americans living with HIV/AIDS.

                  Background and Need for Legislation

    Since 1981, when the first cases of AIDS were reported to 
the Centers for Disease Control and Prevention (CDC), the 
epidemic has continued to expand and, as a result, it is one of 
the largest public health challenges in this country. According 
to the most recent surveillance report released by the CDC, a 
cumulative total of 1,030,832 AIDS cases were reported in the 
United States from the beginning of the epidemic through 2007. 
The CDC estimates that 583,298 people died of HIV/AIDS over the 
same time period. For 2006, the most recent year that data are 
available, CDC estimated that approximately 56,300 people were 
newly infected with HIV. More than half (57%) of these new 
infections occurred in gay and bisexual men. In addition, the 
incidence rate for African American men and women was estimated 
to be 7 times as high as the incidence rate among whites. It is 
clear from these statistics that despite the significant 
advances in testing, treatment and prevention, the impact of 
HIV/AIDS on people in the United States has been and continues 
to be substantial.
    The Ryan White HIV/AIDS Program was established by Congress 
in 1990 (P.L. 101-381) to provide assistance in health care and 
support services for individuals and families affected by HIV/
AIDS. The Ryan White program has been reauthorized and amended 
by Congress three times: in 1996 (P.L. 104-146), 2000 (P.L. 
106-345), and 2006 (P.L. 109-415). The 2006 reauthorization 
contained a ``sunset'' provision that would have eliminated the 
entire title, but a provision in the October 1, 2009, 
Continuing Resolution (P.L. 111-68) extended the program 
through the end of October 2009.

                          Legislative History

    H.R. 3792 was introduced on October 13, 2009, by 
Subcommittee Chairman Pallone, Ranking Member Deal, Committee 
Chairman Waxman, and Ranking Member Barton. The bill was 
referred to the Committee on Energy and Commerce, and 
subsequently to the Subcommittee on Health.
    Prior to the bill's introduction, the Subcommittee on 
Health held a legislative hearing entitled ```Ryan White CARE 
Act Amendments of 2009' Discussion Draft Legislation'' on 
September 9, 2009. The hearing examined a discussion draft of 
legislation to extend the Ryan White program for three 
additional years. The Subcommittee received testimony from Mary 
Wakefield, Ph.D., R.N., Administrator, Health Resources and 
Services Administration; Marcia Crosse, Ph.D., Healthcare 
Director, Government Accountability Office; Julie Scofield, 
Executive Director, National Alliance of State and Territorial 
AIDS Directors; and Donna Elaine Sweet, M.D., M.A.C.P., 
A.A.H.I.V.S., Professor, Department of Internal Medicine, 
University of Kentucky, School of Medicine, and Board Chair, 
American Academy of HIV Medicine.
    The language reported by the Committee was developed in 
bipartisan negotiations with the Senate.

                        Committee Consideration

    H.R. 3792 was considered in open markup session by the 
Subcommittee on Health on Wednesday, October 14, 2009, and was 
forwarded favorably to the full Committee without amendment. On 
Thursday, October 15, 2009, the full Committee met in open 
markup session and considered H.R 3792, as approved by the 
Subcommittee on Health. Subsequently, the Committee ordered 
H.R. 3792 favorably reported to the House, without amendment, 
by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. A 
motion by Mr. Pallone to order H.R. 3792 favorably reported to 
the House, without amendment, was adopted by a voice vote. 
There were no amendments offered to H.R. 3792 during the 
Committee's consideration and no recorded votes were requested 
on the bill.

            Committee Oversight Findings and Recommendations

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the findings and 
recommendations of the Committee are reflected in the 
descriptive portions of this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to clause 3(c)(2) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that H.R. 3792 
would result in no new budget authority, entitlement authority, 
or tax expenditures or revenues.

         Statement of General Performance Goals and Objectives

    The goal of H.R. 3792, the Ryan White HIV/AIDS Treatment 
Extension Act of 2009, is to provide HIV-related health 
services to address unmet needs.

                   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 H.R. 3792 is provided in Article 
I, section 8, clauses 1, 3, and 18.

                  Earmarks and Tax and Tariff Benefits

    H.R. 3792 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9 of rule XXI of the Rules of the House of 
Representatives.

                      Advisory Committee Statement

    No advisory committees were created by H.R. 3792 within the 
meaning of section 5 U.S.C. App., 5(b) of the Federal Advisory 
Committee Act.

             Applicability of Law to the Legislative Branch

    The Committee finds that H.R. 3792 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 of 1985.

                       Federal Mandates Statement

    The Committee adopts as its own the estimates of federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandate Reform 
Act.

                        Committee Cost Estimate

    Pursuant to clause 3(d) of rule XIII of the Rules of the 
House of Representatives, the Committee will adopt as its own 
the cost estimate on H.R. 3792 prepared by the Director of the 
Congressional Budget Office (CBO) pursuant to section 402 of 
the Congressional Budget Act.

                  Congressional Budget Office Estimate

    With respect to the requirement of clause 3(c)(3) of rule 
XIII of the Rules of the House of Representatives, a complete 
cost estimate on H.R. 3792 by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 1974 
was not available when the Committee filed this report. CBO 
has, however, determined that the bill would not impact direct 
spending, as discussed in the letter that follows:

                                     U.S. Congress,
                               Congressional Budget Office,
                                  Washington, DC, October 19, 2009.
Hon. Henry A. Waxman,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
reviewed H.R. 3792, the Ryan White HIV/AIDS Treatment Extension 
Act of 2009, as ordered reported by the Committee on Energy and 
Commerce on October 15, 2009, and determined that the bill 
would have no impact on direct spending or revenues. The bill 
would reauthorize the Ryan White program in title XXVI of the 
Public Health Service Act and would authorize appropriations 
for purposes specified in the bill. CBO has not completed an 
estimate of the legislation's impact on spending subject to 
appropriation.
    H.R. 3792 would impose intergovernmental and private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
because it would require public and private medical facilities 
to comply with new procedures for notifying emergency response 
employees of possible exposures to an infectious disease. CBO 
estimates that the costs of the mandates would fall below the 
annual thresholds established in UMRA for both 
intergovernmental and private-sector mandates ($69 million and 
$139 million in 2009, respectively, adjusted annually for 
inflation). In general, funds authorized in the bill would 
benefit state, local, and tribal governments that participate 
in medical and other support programs for individuals with HIV/
AIDS.
    If you wish further details, we will be pleased to provide 
them. The CBO staff contact is Lisa Ramirez-Branum.
            Sincerely,
                                      Douglas W. Elmendorf,
                                                          Director.
    Enclosure.

             Section-by-Section Analysis of the Legislation


Section 1. Short title; references

    Section 1 establishes the short title of the Act as the 
``Ryan White HIV/AIDS Treatment Extension Act of 2009''.

Section 2. Reauthorization of HIV health care services program

    Section 2 re-establishes the provisions of the Act, 
retroactive to September 30, 2009, and repeals all prior sunset 
provisions. It provides a 5% increase over fiscal year 2009 
authorization levels across Parts A through D and Part F for 
each of fiscal years 2010 through 2013.
    Section 2 contains several provisions that pertain to the 
Minority AIDS Initiative (MAI), which addresses HIV/AIDS among 
racial and ethnic minorities, who as a whole, face 
disproportionate incidence and prevalence rates of the disease, 
as well as heightened barriers to care and treatment. It 
synchronizes the MAI application schedules across Ryan White 
Parts A through D and Part F to streamline the MAI application 
process.
    Section 2 also reverts competitive funding under MAI Parts 
A and Part B to formula funding. Prior to the 2006 Ryan White 
HIV/AIDS Treatment Modernization Act (RWHATMA), Part A and Part 
B MAI funding was allocated to cities and states based on their 
share of total AIDS cases among racial and ethnic minorities. 
RWHATMA shifted MAI funding to a competitive process. According 
to the Government Accountability Office (GAO), this created a 
large administrative burden, and resulted in a number of 
jurisdictions receiving no funding; no improvements in program 
performance were reported. Therefore, this section shifts MAI 
funding for Part A and Part B to a formula basis. It is the 
Committee's intent that the Secretary distribute MAI funding 
for Part A and Part B based on the distribution of HIV/AIDS 
cases among racial and ethnic minorities.
    In addition, the section requires the GAO to report on MAI 
activities across the Department of Health and Human Services 
(HHS) departmental agencies, including a description of best 
practices in capacity-building, particularly for minority 
community-based organizations. The section also requires the 
Secretary of HHS to prepare a plan for the use of MAI funds for 
capacity-building, taking into consideration the findings of 
the GAO report.
    The legislation retains the existing requirement that 75% 
of funding be spent on ``core medical services''. The Committee 
encourages grantees and subgrantees to maximize flexibility in 
the use of support services in support of medical outcomes, 
including finding methods of reducing costs. Grantees may seek 
to adopt systems that reasonably ensure the ability of clients 
to attain support services that minimize cost or accounting 
burden wherever possible. Examples that have come to the 
Committee's attention include the use of monthly bus or subway 
passes and weekly or monthly gas cards or vouchers that may 
allow incidental non-Ryan White Program travel but are cheaper 
overall than individual bus passes or taxi vouchers.
    The Committee is concerned about the prevalence of HIV in 
the nation's prison system. Disparities in the epidemic are 
exacerbated by the lack of access to adequate health and 
support services for inmates while incarcerated and upon their 
return to the community. The Committee notes that the Health 
Research and Services Administration (HRSA) has developed 
guidance on the permitted use of Ryan White dollars for pre- 
and post-release programs for HIV-positive inmates being 
released back to the community, and believes that HRSA should 
encourage Part B grantees to develop and implement such 
programs as appropriate.
    More than 30% of HIV-infected persons in the United States 
are chronically infected with the hepatitis C virus (HCV). Ryan 
White grantees require additional assistance in addressing the 
complex needs of co-infected clients, particularly in large 
urban areas where the majority of HIV/HCV co-infected patients 
live and receive services. The Committee encourages the HRSA to 
increase the capacity of Ryan White grantees to deliver medical 
management, treatment, and support services for clients co-
infected with HIV and HCV by implementing training and 
technical assistance initiatives, so that Ryan White funded 
programs are able to increase HCV education, testing, medical 
management, case management, and treatment services to meet the 
needs of their respective communities. While not all co-
infected patients are appropriate candidates for treatment, the 
low uptake in hepatitis treatment despite availability of 
medications on ADAP formularies is troubling. The Committee 
encourages HRSA to address this concern through the creation of 
best practices from successful efforts in the field, increased 
provider education, case manager capacity building and creation 
of educational materials for clients.
    Numerous studies and reports, including the National 
Healthcare Disparities Report and Unequal Treatment, the 2002 
Institute of Medicine Report, document extensive health 
disparities across the country. These studies have found that, 
on average, racial and ethnic minorities are disproportionately 
afflicted with chronic and acute conditions--such as cancer, 
diabetes, and hypertension--as well as communicable diseases 
likes HIV/AIDS, and suffer worse health outcomes, worse health 
status, and higher mortality rates than the general population.
    The Ryan White Act provides the best opportunity for 
individuals affected by HIV/AIDS to access health care. 
Comorbidities such as hepatitis C have a substantial impact on 
health-related quality for patients with HIV/AIDS. By ensuring 
patients with comorbidities have access to care, the Ryan White 
Act is taking a small but necessary step in reducing the 
serious health disparities that disproportionately affect 
racial and ethnic minorities.
    Most low-income HIV-positive individuals co-infected with 
HBV or HCV can obtain services through the Ryan White Program, 
but coverage for HBV and HCV treatment and viral load testing, 
which is crucial for diagnosis and monitoring response to 
treatment, is limited. Unfortunately, coverage for diagnostics, 
monitoring, treatment and vaccination against viral hepatitis 
is not uniformly available through state AIDS Drug Assistance 
Programs (ADAPs), due to funding shortfalls. The Committee 
believes resources under the Ryan White Program are urgently 
needed for care, treatment, diagnostics, hepatitis vaccine, 
case management, and support services for patients undergoing 
hepatitis treatment, as well as to improve provider education 
on HBV and HCV medical management and treatment.
    The Committee recognizes that despite the progress made to 
treat individuals with HIV/AIDS, including through the Ryan 
White Act, that there is still significant progress that needs 
to be made to prevent HIV transmission. From 2004 to 2007, the 
estimated number of newly diagnosed HIV/AIDS cases increased 
among all races and ethnicities, and increased 18% among males 
and 8% among females during that time period. In recognition of 
this trend, the Committee supports the development of an HIV 
vaccine as a solution for ending the HIV pandemic. Of the more 
than 80 HIV/AIDS vaccine candidates that have undergone Phase I 
clinical trials, 2 have entered phase III trials. The 
development and testing of HIV vaccines should be encouraged by 
the public and private sector, along with other promising 
science that seeks to eradicate HIV/AIDS in the United States.

Section 3. Extended exemption period for names-based reporting

    Section 3 maintains the code-based protections established 
under the 2006 reauthorization for states and jurisdictions 
with maturing names-based HIV case data during the first three 
years of the reauthorization period. For the first two years, 
jurisdictions that report code-based data to HRSA will continue 
to incur a 5% penalty against their count of living cases of 
HIV and will still be subject to a 5% cap on increases in the 
HIV case count. In 2012, the penalty will be increased to 6%. 
Beginning in fiscal year 2013, code-based protections will be 
eliminated and all states will be required to report cases 
using a names-based system.

Section 4. Extension of transitional grant area status

    Section 4 extends current rules for transitional grant area 
(TGA) status. It adds a provision that if a metropolitan area 
receiving Part A funding has between 1400 and 1500 cumulative 
living AIDS cases and did not have more than 5% of its total 
grants unobligated at the end of the grant period for the prior 
fiscal year, it will be treated as having met the criteria for 
continued eligibility as a TGA.
    Section 4 also modifies the transfer of amounts from TGAs 
that lose their eligibility during the reauthorization period. 
Under current law, when a TGA loses its status, $500,000 is 
transferred to the overall Part B pool for states, along with 
the state's most recent formula grant award. Section 4 provides 
transitional funding as the clients of a former TGA are 
absorbed by the overall state program. In the first year after 
a TGA loses eligibility for Part A funding, the state in which 
the TGA is located will retain 75% of the TGA formula funding. 
The amount will decline to 50% in the second year and 25% in 
the third. By the fourth year, all of the former TGAs funding 
will be part of the overall Part B pool.

Section 5. Hold harmless

    Section 5 continues the hold harmless pattern established 
in 2006 for the first three years of the reauthorization 
period. States and EMAs will receive no less than 95% of fiscal 
year 2009 formula award amounts in 2010 and 100% of fiscal year 
2010 formula award amounts for each of the fiscal years 2011 
and 2012. For fiscal year 2013, states and EMAs may not receive 
less than 92.5% of the previous fiscal year's grant.

Section 6. Amendments to the general grant provisions

    Section 6 encourages early identification of individuals 
infected with HIV. It requires the planning councils for Part A 
grant recipients to develop a strategy, in coordination with 
other appropriate community strategies or activities, to 
identify and diagnose individuals with HIV/AIDS who are unaware 
of their status and link them with the appropriate care and 
treatment.
    For the purposes of allocating competitive Part A 
supplemental grants, one-third of the criteria on which 
allocations are made will be based on demonstrated success in 
identifying undiagnosed individuals with HIV/AIDS, making them 
aware of their status, and linking them to appropriate care.

Section 7. Increase in adjustment for names-based reporting

    Section 7 adds an adjustment for Part A and B jurisdictions 
that switched to names-based reporting early in 2007 and 
received a decrease in total funding of at least 30% from year 
2006 as a result of determinations based on the new reporting 
system. For those jurisdictions, the Secretary shall base 
awards on living HIV/AIDS cases plus an adjustment of 3%.

Section 8. Treatment of unobligated funds

    Under current law, if a Part A or Part B grantee has 
unobligated formula funding at the end of the grant year, it 
can request a waiver to carry over the funding. If the waiver 
is not granted or if the funds remain unspent by the end of the 
carryover year, the funds return to the Secretary and become 
available for supplemental grants.
    If the unobligated formula balance is 2% or more of the 
total award, certain penalties apply, whether or not the 
jurisdiction receives a carryover waiver. For formula funds, 
future formula funding will be reduced by the amount of the 
unobligated balance, beginning in the year following the 
report. In addition, the jurisdiction will not be eligible for 
supplemental funding in the year following the report.
    Because of multiple factors (such as statewide budget 
problems and hiring freezes) it has at times been difficult for 
all Part A and Part B grantees to obligate 98% of their funds 
by the end of the year. Nine states experienced a reduction in 
their fiscal year 2009 grants due to unobligated balances in 
fiscal year 2007.
    Section 7 increases the unobligated penalty threshold from 
2% of the total award to 5%. It retains the provision that a 
jurisdiction with more than 5% of its funds unobligated will be 
ineligible for supplemental funding in the following year. For 
formula funds, if the unobligated amount is more than the 5% 
threshold, the next year's formula funding will be reduced by 
the amount of unobligated balance, but the reduction amount 
will not include any unobligated balance that was approved for 
carryover by HRSA.

Section 9. Application by States

    Section 9 requires states, as part of their planning 
process for Ryan White funding, to establish a comprehensive 
strategy to identify and diagnose individuals with HIV/AIDS who 
are unaware of their status and link them with the appropriate 
care and treatment.

Section 10. ADAP rebate funds

    The unobligated balances requirement addressed in section 8 
intersects with the treatment of rebate dollars under the AIDS 
Drug Assistance Program (ADAP). Under current law, many states 
purchase ADAP drugs directly from the manufacturer and receive 
substantial rebates in return. These rebates must be put back 
into the program and, as a general requirement, states must 
spend rebate dollars before grant dollars. The amount and 
timing of rebate dollars, however, is unpredictable. For 
example, a state may receive a significant rebate late in the 
award year. Since rebates must be spent before program funds, 
the state could end the year with more than the permitted 
threshold of unobligated program funds.
    Section 10 of the bill provides that if an expenditure of 
ADAP rebate funds would trigger a penalty or a higher penalty 
than would otherwise have applied, the Secretary shall deem the 
state's unobligated balance to be reduced by the amount of 
rebate funds in the proposed expenditure.
    Section 10 also specifies that any unobligated ADAP grant 
amounts that are returned to the Secretary shall go to the 
state ADAP program, if the Secretary deems appropriate, or to 
Part B supplemental fund.

Section 11. Application to primary care services

    Part D of Ryan White provides grants to entities serving 
women, infants, children, and youths living with HIV/AIDS. 
Programs provide for outpatient medical care and offer case 
management, referrals, and other services to enable 
participation in the program, including outreach efforts to 
youth with HIV.
    Section 11 clarifies that Part D should be the payer of 
last resort and specifies memoranda of understanding as 
vehicles for Part D providers to ensure access to primary care.

Section 12. National HIV/AIDS testing goal

    Section 12 requires the Secretary to establish a national 
HIV/AIDS testing goal of 5 million HIV tests provided through 
all federally-supported HIV/AIDS programs.
     Also, Section 12 requires the Secretary to report to 
Congress each year on the progress made toward achieving the 
goal. The Secretary is required to review each domestic HIV/
AIDS prevention program to determine its effectiveness based on 
the program's stated purposes and on its contributions toward 
the testing goal.

Section 13. Notification of possible exposure to infectious diseases

    Section 13 establishes requirements to ensure that 
emergency responders are notified if exposed to potentially 
life-threatening infectious diseases, while preserving 
confidentiality requirements. A nearly identical section was in 
statute prior to the 2006 reauthorization. The legislation 
makes minor changes to the original language, including 
permitting the Secretary to suspend the requirements in a 
federal public health emergency. Because states and many 
localities have their own requirements for infectious disease 
surveillance, prevention, investigation, and control, the 
Committee expects that in developing the disease list under 
this section, the Secretary will consult as appropriate with 
state and local governmental public health authorities, and 
work to optimize efficiency and coordination with state and 
local procedures.

         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):

RYAN WHITE HIV/AIDS TREATMENT MODERNIZATION ACT OF 2006

           *       *       *       *       *       *       *



TITLE VII--MISCELLANEOUS PROVISIONS

           *       *       *       *       *       *       *


[SEC. 703. REPEAL.

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


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. 2602. ADMINISTRATION AND PLANNING COUNCIL.

  (a) * * *
  (b) HIV Health Services Planning Council.--
          (1) * * *

           *       *       *       *       *       *       *

          (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/AIDS, as 
                well as the size and demographics of the 
                estimated population of individuals with HIV/
                AIDS who are unaware of their HIV status;
                  (B) determine the needs of such population, 
                with particular attention to--
                          (i) individuals with HIV/AIDS who 
                        know their HIV status and are not 
                        receiving HIV-related services; [and]
                          (ii) disparities in access and 
                        services among affected subpopulations 
                        and historically underserved 
                        communities; and
                          (iii) individuals with HIV/AIDS who 
                        do not know their HIV status;

           *       *       *       *       *       *       *

                  (D) develop a comprehensive plan for the 
                organization and delivery of health and support 
                services described in section 2604 that--
                          (i) * * *
                          (ii) includes a strategy to 
                        coordinate the provision of such 
                        services with programs for HIV 
                        prevention (including outreach and 
                        early intervention) and for the 
                        prevention and treatment of substance 
                        abuse (including programs that provide 
                        comprehensive treatment services for 
                        such abuse); [and]
                          (iii) is compatible with any State or 
                        local plan for the provision of 
                        services to individuals with HIV/AIDS; 
                        and
                          (iv) includes a strategy, coordinated 
                        as appropriate with other community 
                        strategies and efforts, including 
                        discrete goals, a timetable, and 
                        appropriate funding, for identifying 
                        individuals with HIV/AIDS who do not 
                        know their HIV status, making such 
                        individuals aware of such status, and 
                        enabling such individuals to use the 
                        health and support services described 
                        in section 2604, with particular 
                        attention to reducing barriers to 
                        routine testing and disparities in 
                        access and services among affected 
                        subpopulations and historically 
                        underserved communities;

           *       *       *       *       *       *       *


SEC. 2603. TYPE AND DISTRIBUTION OF GRANTS.

  (a) Grants Based on Relative Need of Area.--
          (1) * * *

           *       *       *       *       *       *       *

          (3) Amount of grant.--
                  (A) * * *

           *       *       *       *       *       *       *

                  (C) Living cases of hiv/aids.--
                          (i) * * *
                          (ii) Transition period; exemption 
                        regarding non-aids cases.--For each of 
                        the fiscal years 2007 through [2009] 
                        2012, 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) * * *
                                  (II) no later than the 
                                beginning of fiscal year 2008 
                                [or 2009] or a subsequent 
                                fiscal year through fiscal year 
                                2012, 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.

           *       *       *       *       *       *       *

                          (iv) Requirement for exemption as of 
                        fiscal year 2008.--For each of the 
                        fiscal years 2008 through [2010] 2012, 
                        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 a 
                        subsequent fiscal year, 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) * * *
                                  (II) Adjustment rate.--The 
                                adjustment rate under subclause 
                                (I) for an eligible area shall 
                                be a reduction of 5 percent for 
                                fiscal years before fiscal year 
                                2012 (and 6 percent for fiscal 
                                year 2012) in the number of 
                                living non-AIDS cases of HIV 
                                reported for the area.
                                  (III) Increased adjustment 
                                for certain areas previously 
                                using code-based reporting.--
                                For purposes of this 
                                subparagraph for each of fiscal 
                                years 2010 through 2012, the 
                                Secretary shall deem the 
                                applicable number of living 
                                cases of HIV/AIDS in an area 
                                that were reported to and 
                                confirmed by the Centers for 
                                Disease Control and Prevention 
                                to be 3 percent higher than the 
                                actual number if--
                                          (aa) for fiscal year 
                                        2007, such area was a 
                                        transitional area;
                                          (bb) fiscal year 2007 
                                        was the first year in 
                                        which the count of 
                                        living non-AIDS cases 
                                        of HIV in such area, 
                                        for purposes of this 
                                        section, was based on a 
                                        names-based reporting 
                                        system; and
                                          (cc) the amount of 
                                        funding that such area 
                                        received under this 
                                        part for fiscal year 
                                        2007 was less than 70 
                                        percent of the amount 
                                        of funding (exclusive 
                                        of funds that were 
                                        identified as being for 
                                        purposes of the 
                                        Minority AIDS 
                                        Initiative) that such 
                                        area received under 
                                        such part for fiscal 
                                        year 2006.

           *       *       *       *       *       *       *

                          (ix) Rules of construction regarding 
                        acceptance of reports.--
                                  (I) * * *
                                  (II) Applicability of 
                                exemption requirements.--The 
                                provisions of clauses (ii) 
                                through (viii) may not be 
                                construed as having any legal 
                                effect for fiscal year [2010] 
                                2013 or any subsequent fiscal 
                                year, and accordingly, the 
                                status of a State for purposes 
                                of such clauses may not be 
                                considered after fiscal year 
                                [2009] 2012.

           *       *       *       *       *       *       *

                          (xi) Future fiscal years.--For fiscal 
                        years beginning with fiscal year 2013, 
                        determinations under this paragraph 
                        shall be based only on living names-
                        based cases of HIV/AIDS with respect to 
                        the area involved.
                  (D) Code-based areas; limitation on increase 
                in grant.--
                          (i) In general.--For each of the 
                        fiscal years 2007 through [2009] 2012, 
                        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) * * *
                                  (II) for each of the fiscal 
                                years 2008 [and 2009] through 
                                2012, exceed by more than 5 
                                percent the amount of the grant 
                                pursuant to this paragraph and 
                                paragraph (4) for the area for 
                                the preceding fiscal year.
                          (ii) Use of amounts involved.--For 
                        each of the fiscal years 2007 through 
                        [2009] 2012, 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 eligible area that 
                received a grant pursuant to this subsection 
                for fiscal year [2006] 2009, the Secretary 
                shall, for each of the fiscal years [2007 
                through 2009] 2010 through 2013, 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 2009 (as such 
                        paragraphs were in effect for such 
                        fiscal year) if paragraph (2) (as so in 
                        effect) had been applied by 
                        substituting ``66\2/3\ percent'' for 
                        ``50 percent''.
                          [(ii) For each of the fiscal years 
                        2008 and 2009, an amount equal to 100 
                        percent of the amount of the grant made 
                        pursuant to paragraph (3) and this 
                        paragraph for fiscal year 2007.]
                          (i) For fiscal year 2010, an amount 
                        equal to 95 percent of the sum of the 
                        amount of the grant made pursuant to 
                        paragraph (3) and this paragraph for 
                        fiscal year 2009.
                          (ii) For each of the fiscal years 
                        2011 and 2012, an amount equal to 100 
                        percent of the amount of the grant made 
                        pursuant to paragraph (3) and this 
                        paragraph for fiscal year 2010.
                          (iii) For fiscal year 2013, an amount 
                        equal to 92.5 percent of the amount of 
                        the grant made pursuant to paragraph 
                        (3) and this paragraph for fiscal year 
                        2012.

           *       *       *       *       *       *       *

                  (C) Limitation.--This paragraph may not be 
                construed as having any applicability after 
                fiscal year [2009] 2013.
  (b) Supplemental Grants.--
          (1) In general.--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) * * *

           *       *       *       *       *       *       *

                  (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] 5 percent of grant funds under such 
                subsection [canceled] canceled, offset under 
                subsection (c)(4), or covered by any waivers 
                under subsection (c)(3)[.]; and
                  (I) demonstrates success in identifying 
                individuals with HIV/AIDS as described in 
                clauses (i) through (iii) of paragraph (2)(A).
          (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 
                demonstrated need under subparagraph (B) of 
                such paragraph counting one-third[.], and 
                demonstrated success in identifying individuals 
                with HIV/AIDS who do not know their HIV status 
                and making them aware of such status counting 
                one-third. In making such determination, the 
                Secretary shall consider--
                          (i) the number of individuals who 
                        have been tested for HIV/AIDS;
                          (ii) of those individuals described 
                        in clause (i), the number of 
                        individuals who tested for HIV/AIDS who 
                        are made aware of their status, 
                        including the number who test positive; 
                        and
                          (iii) of those individuals described 
                        in clause (ii), the number who have 
                        been referred to appropriate treatment 
                        and care.

           *       *       *       *       *       *       *

                  (D) Increased adjustment for certain areas 
                previously using code-based reporting.--For 
                purposes of this subsection for each of fiscal 
                years 2010 through 2012, the Secretary shall 
                deem the applicable number of living cases of 
                HIV/AIDS in an area that were reported to and 
                confirmed by the Centers for Disease Control 
                and Prevention to be 3 percent higher than the 
                actual number if the conditions described in 
                items (aa) through (cc) of subsection 
                (a)(3)(C)(vi)(III) are all satisfied.

           *       *       *       *       *       *       *

  (c) Timeframe for Obligation and Expenditure of Grant 
Funds.--
          (1) * * *

           *       *       *       *       *       *       *

          (3) Formula grants; cancellation of unobligated 
        balance of grant award; waiver permitting carryover.--
                  (A) * * *

           *       *       *       *       *       *       *

                  (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 (less 
                                any amount of such balance that 
                                is the subject of a waiver of 
                                cancellation under subparagraph 
                                (A)), 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

           *       *       *       *       *       *       *

                        except that this clause does not apply 
                        to the eligible area if the amount of 
                        the unobligated balance was [2 percent] 
                        5 percent or less.

           *       *       *       *       *       *       *

          (4) Authority regarding administration of 
        provisions.--In administering paragraphs (2) and (3) 
        with respect to the unobligated balance of an eligible 
        area, the Secretary may elect to reduce the amount of 
        future grants to the area under subsection (a) or (b), 
        as applicable, by the amount of any such unobligated 
        balance in lieu of cancelling such amount as provided 
        for in paragraph (2) or (3)(A). In such case, the 
        Secretary may permit the area to use such unobligated 
        balance for purposes of any such future grant. An 
        amount equal to such reduction shall be available for 
        use as additional amounts for grants pursuant to 
        subsection (b), subject to subsection (a)(4) and 
        section 2610(d)(2). Nothing in this paragraph shall be 
        construed to affect the authority of the Secretary 
        under paragraphs (2) and (3), including the authority 
        to grant waivers under paragraph (3)(A). The reduction 
        in future grants authorized under this paragraph shall 
        be notwithstanding the penalty required under paragraph 
        (3)(D) with respect to unobligated funds.

           *       *       *       *       *       *       *


SEC. 2605. APPLICATION.

  (a) * * *
  (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) the number of individuals to be served within the 
        eligible area with assistance provided under the grant, 
        including the identification of individuals with HIV/
        AIDS as described in clauses (i) through (iii) of 
        section 2603(b)(2)(A);

           *       *       *       *       *       *       *


                    Subpart II--Transitional Grants

SEC. 2609. ESTABLISHMENT OF PROGRAM.

  (a) * * *

           *       *       *       *       *       *       *

  (c) Certain Eligibility Rules.--
          (1) Fiscal year [2007] 2011.--With respect to grants 
        under subsection (a) for fiscal year [2007] 2011, a 
        metropolitan area that received funding under subpart I 
        for fiscal year [2006] 2010 but does not for fiscal 
        year [2007] 2011 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) * * *
                          (ii) [to have a] subject to 
                        subparagraphs (B) and (C), 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) Permitting margin of error applicable to 
                certain metropolitan areas.--In applying 
                subparagraph (A)(ii) for a fiscal year after 
                fiscal year 2008, in the case of a metropolitan 
                area that has a cumulative total of at least 
                1,400 (and fewer than 1,500) living cases of 
                AIDS as of December 31 of the most recent 
                calendar year for which such data is available, 
                such area shall be treated as having met the 
                criteria of such subparagraph if not more than 
                5 percent of the total grants awarded to such 
                area under this part is unobligated as of the 
                end of the most recent fiscal year for which 
                such data is available.
                  [(B)] (C) Exception regarding status as 
                eligible area.--[Subparagraph (A) does not 
                apply] Subparagraphs (A) and (B) do 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) * * *
                  (B) Exception.--For each of the fiscal years 
                2007 through [2009] 2013, the exception 
                described in subparagraph (A) does not apply if 
                the transitional area involved received funding 
                under subpart I for fiscal year 2006.

           *       *       *       *       *       *       *


                    Subpart III--General Provisions

SEC. 2610. AUTHORIZATION OF APPROPRIATIONS.

  (a) In General.--For the purpose of carrying out this part, 
there are authorized to be appropriated $604,000,000 for fiscal 
year 2007, $626,300,000 for fiscal year 2008, [and $649,500,000 
for fiscal year 2009] $649,500,000 for fiscal year 2009, 
$681,975,000 for fiscal year 2010, $716,074,000 for fiscal year 
2011, $751,877,000 for fiscal year 2012, and $789,471,000 for 
fiscal year 2013. 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.

           *       *       *       *       *       *       *

  (c) Transfer of Certain Amounts; Change in Status as Eligible 
Area or Transitional Area.--Notwithstanding subsection (b):
          (1) * * *
          (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) * * *
                  (B)(i) subject to clause (ii), 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[.]; and
                  (ii) for each of fiscal years 2010 through 
                2013, notwithstanding subsection (a)--
                          (I) there shall be transferred to the 
                        State containing the metropolitan area, 
                        for purposes described in section 
                        2612(a), an amount (which shall not be 
                        taken into account in applying section 
                        2618(a)(2)(H)) equal to--
                                  (aa) for the first fiscal 
                                year of the metropolitan area 
                                not being a transitional area, 
                                75 percent of the amount 
                                described in subparagraph 
                                (A)(i) for such area;
                                  (bb) for the second fiscal 
                                year of the metropolitan area 
                                not being a transitional area, 
                                50 percent of such amount; and
                                  (cc) for the third fiscal 
                                year of the metropolitan area 
                                not being a transitional area, 
                                25 percent of such amount; and
                          (II) there shall be transferred and 
                        made available for grants pursuant to 
                        section 2618(a)(1) for the fiscal year, 
                        in addition to amounts available for 
                        such grants under section 2623, an 
                        amount equal to the total amount of the 
                        reduction for such fiscal year under 
                        subparagraph (A), less the amount 
                        transferred for such fiscal year under 
                        subclause (I).

           *       *       *       *       *       *       *


                       Part B--Care Grant Program

Subpart I--General Grant Provisions

           *       *       *       *       *       *       *


SEC. 2617. STATE APPLICATION.

  (a) * * *
  (b) Description of Intended Uses and Agreements.--The 
application submitted under subsection (a) shall contain--
          (1) * * *

           *       *       *       *       *       *       *

          (6) an assurance that the public health agency 
        administering the grant for the State will periodically 
        convene a meeting of individuals with 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]
          (7) an assurance by the State that--
                  (A) * * *

           *       *       *       *       *       *       *

                  (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/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/AIDS and individuals 
                knowledgeable of their HIV status but not in 
                care[.]; and
          (8) a comprehensive plan--
                  (A) containing an identification of 
                individuals with HIV/AIDS as described in 
                clauses (i) through (iii) of section 
                2603(b)(2)(A) and the strategy required under 
                section 2602(b)(4)(D)(iv);
                  (B) describing the estimated number of 
                individuals within the State with HIV/AIDS who 
                do not know their status;
                  (C) describing activities undertaken by the 
                State to find the individuals described in 
                subparagraph (A) and to make such individuals 
                aware of their status;
                  (D) describing the manner in which the State 
                will provide undiagnosed individuals who are 
                made aware of their status with access to 
                medical treatment for their HIV/AIDS; and
                  (E) describing efforts to remove legal 
                barriers, including State laws and regulations, 
                to routine testing.

           *       *       *       *       *       *       *


SEC. 2618. DISTRIBUTION OF FUNDS.

  (a) Amount of Grant to State.--
          (1) * * *
          (2) Determination.--
                  (A) Formula.--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)] subparagraph (F); 
                        and

           *       *       *       *       *       *       *

                  (D) Living cases of hiv/aids.--
                          (i) * * *
                          (ii) Transition period; exemption 
                        regarding non-aids cases.--For each of 
                        the fiscal years 2007 through [2009] 
                        2012, 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) * * *
                                  (II) no later than the 
                                beginning of fiscal year 2008 
                                [or 2009] or a subsequent 
                                fiscal year through fiscal year 
                                2012, 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.

           *       *       *       *       *       *       *

                          (iv) Requirement for exemption as of 
                        fiscal year 2008.--For each of the 
                        fiscal years 2008 through [2010] 2012, 
                        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 a 
                        subsequent fiscal year, 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) * * *
                                  (II) Adjustment rate.--The 
                                adjustment rate under subclause 
                                (I) for a State shall be a 
                                reduction of 5 percent for 
                                fiscal years before fiscal year 
                                2012 (and 6 percent for fiscal 
                                year 2012) in the number of 
                                living non-AIDS cases of HIV 
                                reported for the State.
                                  (III) Increased adjustment 
                                for certain states previously 
                                using code-based reporting.--
                                For purposes of this 
                                subparagraph for each of fiscal 
                                years 2010 through 2012, the 
                                Secretary shall deem the 
                                applicable number of living 
                                cases of HIV/AIDS in a State 
                                that were reported to and 
                                confirmed by the Centers for 
                                Disease Control and Prevention 
                                to be 3 percent higher than the 
                                actual number if--
                                          (aa) there is an area 
                                        in such State that 
                                        satisfies all of the 
                                        conditions described in 
                                        items (aa) through (cc) 
                                        of section 
                                        2603(a)(3)(C)(vi)(III); 
                                        or
                                          (bb)(AA) fiscal year 
                                        2007 was the first year 
                                        in which the count of 
                                        living non-AIDS cases 
                                        of HIV in such area, 
                                        for purposes of this 
                                        part, was based on a 
                                        names-based reporting 
                                        system; and
                                          (BB) the amount of 
                                        funding that such State 
                                        received under this 
                                        part for fiscal year 
                                        2007 was less than 70 
                                        percent of the amount 
                                        of funding that such 
                                        State received under 
                                        such part for fiscal 
                                        year 2006.

           *       *       *       *       *       *       *

                          (viii) Rules of construction 
                        regarding acceptance of reports.--
                                  (I) * * *
                                  (II) Applicability of 
                                exemption requirements.--The 
                                provisions of clauses (ii) 
                                through (vii) may not be 
                                construed as having any legal 
                                effect for fiscal year [2010] 
                                2013 or any subsequent fiscal 
                                year, and accordingly, the 
                                status of a State for purposes 
                                of such clauses may not be 
                                considered after fiscal year 
                                [2009] 2012.

           *       *       *       *       *       *       *

                          (x) Future fiscal years.--For fiscal 
                        years beginning with fiscal year 2013, 
                        determinations under this paragraph 
                        shall be based only on living names-
                        based cases of HIV/AIDS with respect to 
                        the State involved.
                  (E) Code-based states; limitation on increase 
                in grant.--
                          (i) In general.--For each of the 
                        fiscal years 2007 through [2009] 2012, 
                        if code-based reporting (within the 
                        meaning of subparagraph (D)(vi)) 
                        applies in a State as of the beginning 
                        of the fiscal year involved, then 
                        notwithstanding any other provision of 
                        this paragraph, the amount of the grant 
                        pursuant to paragraph (1) for the State 
                        may not for the fiscal year involved 
                        exceed by more than 5 percent the 
                        amount of the grant pursuant to this 
                        paragraph for the State for the 
                        preceding fiscal year, except that the 
                        limitation under this clause may not 
                        result in a grant pursuant to paragraph 
                        (1) for a fiscal year that is less than 
                        the minimum amount that applies to the 
                        State under such paragraph for such 
                        fiscal year.
                          (ii) Use of amounts involved.--For 
                        each of the fiscal years 2007 through 
                        [2009] 2012, 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) Appropriations for treatment drug 
                program.--
                          (i) * * *
                          (ii) Supplemental treatment drug 
                        grants.--
                                  (I) * * *

           *       *       *       *       *       *       *

                                  (V) Funding.--For the purpose 
                                of making grants under this 
                                clause, the Secretary shall 
                                each fiscal year reserve 5 
                                percent of the amount referred 
                                to in clause (i) with respect 
                                to section 2616[, subject to 
                                subclause (VI)].

           *       *       *       *       *       *       *

                  (H) Increase in formula grants.--
                          (i) Assurance of amount.--
                                  (I) General rule.--For fiscal 
                                year [2007] 2010, 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)] subparagraph 
                                (F) is not less than 95 percent 
                                of such total for the State for 
                                fiscal year [2006] 2009.
                                  (II) Rule of construction.--
                                With respect to the application 
                                of subclause (I), the 95 
                                percent requirement under such 
                                subclause shall apply with 
                                respect to each grant awarded 
                                under paragraph (1) and with 
                                respect to each grant awarded 
                                under [subparagraph (G)] 
                                subparagraph (F).
                          [(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)] (ii) Fiscal years [2008 and 
                        2009] 2011 and 2012.--For each of the 
                        fiscal years [2008 and 2009] 2011 and 
                        2012, the Secretary shall ensure that 
                        the total for a State of the grant 
                        pursuant to paragraph (1) and the grant 
                        pursuant to [subparagraph (G)] 
                        subparagraph (F) is not less than 100 
                        percent of such total for the State for 
                        fiscal year [2007] 2010.
                          (iii) Fiscal year 2013.--For fiscal 
                        year 2013, the Secretary shall ensure 
                        that the total for a State of the grant 
                        pursuant to paragraph (1) and the grant 
                        pursuant to subparagraph (F) is not 
                        less than 92.5 percent of such total 
                        for the State for fiscal year 2012.

           *       *       *       *       *       *       *

                          (v) Applicability.--This paragraph 
                        may not be construed as having any 
                        applicability after fiscal year [2009] 
                        2013.

           *       *       *       *       *       *       *


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) * * *
          (2) that did not, for the most recent grant year 
        pursuant to section 2618(a)(1) or [2618(a)(2)(G)(i)] 
        2618(a)(2)(F)(i) for which data is available, have more 
        than [2 percent] 5 percent of grant funds under such 
        sections [canceled] canceled, offset under section 
        2622(e), or covered by any waivers under section 
        2622(c).

           *       *       *       *       *       *       *


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)] 2618(a)(2)(F), 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)] 2618(a)(2)(F)(ii), 
or under section 2620 or 2621, has an unobligated balance as of 
the end of the grant year for the award--
          (1) * * *

           *       *       *       *       *       *       *

  (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)] 2618(a)(2)(F)(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) * * *

           *       *       *       *       *       *       *

          (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)] 2618(a)(2)(F)(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 (less any amount of such 
                        balance that is the subject of a waiver 
                        of cancellation under paragraph (1)), 
                        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

           *       *       *       *       *       *       *

                except that this subparagraph does not apply to 
                the State if the amount of the unobligated 
                balance was [2] 5 percent or less.

           *       *       *       *       *       *       *

  (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). If an expenditure of ADAP rebate funds would 
trigger a penalty under this section or a higher penalty than 
would otherwise have applied, the State may request that for 
purposes of this section, the Secretary deem the State's 
unobligated balance to be reduced by the amount of rebate funds 
in the proposed expenditure. Notwithstanding 2618(a)(2)(F), any 
unobligated amount under section 2618(a)(2)(F)(ii)(V) that is 
returned to the Secretary for reallocation shall be used by the 
Secretary for--
          (1) the ADAP supplemental program if the Secretary 
        determines appropriate; or
          (2) for additional amounts for grants pursuant to 
        section 2620.
  (e) Authority Regarding Administration of Provisions.--In 
administering subsections (b) and (c) with respect to the 
unobligated balance of a State, the Secretary may elect to 
reduce the amount of future grants to the State under section 
2618, 2620, or 2621, as applicable, by the amount of any such 
unobligated balance in lieu of cancelling such amount as 
provided for in subsection (b) or (c)(1). In such case, the 
Secretary may permit the State to use such unobligated balance 
for purposes of any such future grant. An amount equal to such 
reduction shall be available for use as additional amounts for 
grants pursuant to section 2620, subject to section 
2618(a)(2)(H). Nothing in this paragraph shall be construed to 
affect the authority of the Secretary under subsections (b) and 
(c), including the authority to grant waivers under subsection 
(c)(1). The reduction in future grants authorized under this 
subsection shall be notwithstanding the penalty required under 
subsection (c)(4) with respect to unobligated funds.

SEC. 2623. AUTHORIZATION OF APPROPRIATIONS.

  (a) In General.--For the purpose of carrying out this 
subpart, there are authorized to be appropriated $1,195,500,000 
for fiscal year 2007, $1,239,500,000 for fiscal year 2008, [and 
$1,285,200,000 for fiscal year 2009] $1,285,200,000 for fiscal 
year 2009, $1,349,460,000 for fiscal year 2010, $1,416,933,000 
for fiscal year 2011, $1,487,780,000 for fiscal year 2012, and 
$1,562,169,000 for fiscal year 2013. 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) * * *
          (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)] 2618(a)(2)(F)) is not subject 
                to this subparagraph.

           *       *       *       *       *       *       *


                  Part C--Early Intervention Services

Subpart I--Categorical Grants

           *       *       *       *       *       *       *


SEC. 2655. AUTHORIZATION OF APPROPRIATIONS.

  For the purpose of making grants under section 2651, there 
are authorized to be appropriated, $218,600,000 for fiscal year 
2007, $226,700,000 for fiscal year 2008, [and $235,100,000 for 
fiscal year 2009] $235,100,000 for fiscal year 2009, 
$246,855,000 for fiscal year 2010, $259,198,000 for fiscal year 
2011, $272,158,000 for fiscal year 2012, and $285,766,000 for 
fiscal year 2013.

           *       *       *       *       *       *       *


              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)] (directly 
or through contracts or memoranda of understanding) for women, 
infants, children, and youth with HIV/AIDS.

           *       *       *       *       *       *       *

  (g) Training and Technical Assistance.--From the amounts 
appropriated under [subsection (i)] subsection (j) 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.

           *       *       *       *       *       *       *

  (i) Application to Primary Care Services.--Nothing in this 
part shall be construed as requiring funds under this part to 
be used for primary care services when payments are available 
for such services from other sources (including under titles 
XVIII, XIX, and XXI of the Social Security Act).
  [(i)] (j) Authorization of Appropriations.--For the purpose 
of carrying out this section, there are authorized to be 
appropriated, $71,800,000 for each of the fiscal years 2007 
through 2009, $75,390,000 for fiscal year 2010, $79,160,000 for 
fiscal year 2011, $83,117,000 for fiscal year 2012, and 
$87,273,000 for fiscal year 2013.

PART E--GENERAL PROVISIONS

           *       *       *       *       *       *       *


[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. 2686. GAO REPORT.

  The Comptroller General of the Government Accountability 
Office shall, not less than 1 year after the date of enactment 
of the Ryan White HIV/AIDS Treatment Extension Act of 2009, 
submit to the appropriate committees of Congress a report 
describing Minority AIDS Initiative activities across the 
Department of Health and Human Services, including programs 
under this title and programs at the Centers for Disease 
Control and Prevention, the Substance Abuse and Mental Health 
Services Administration, and other departmental agencies. Such 
report shall include a history of program activities within 
each relevant agency and a description of activities conducted, 
people served and types of grantees funded, and shall collect 
and describe best practices in community outreach and capacity-
building of community based organizations serving the 
communities that are disproportionately affected by HIV/AIDS.

           *       *       *       *       *       *       *


SEC. 2688. NATIONAL HIV/AIDS TESTING GOAL.

  (a) In General.--Not later than January 1, 2010, the 
Secretary shall establish a national HIV/AIDS testing goal of 
5,000,000 tests for HIV/AIDS annually through federally 
supported HIV/AIDS prevention, treatment, and care programs, 
including programs under this title and other programs 
administered by the Centers for Disease Control and Prevention.
  (b) Annual Report.--Not later than January 1, 2011, and 
annually thereafter, the Secretary, acting through the Director 
of the Centers for Disease Control and Prevention, shall submit 
to Congress a report describing, with regard to the preceding 
12-month reporting period--
          (1) whether the testing goal described in subsection 
        (a) has been met;
          (2) the total number of individuals tested through 
        federally supported and other HIV/AIDS prevention, 
        treatment, and care programs in each State;
          (3) the number of individuals who--
                  (A) prior to such 12-month period, were 
                unaware of their HIV status; and
                  (B) through federally supported and other 
                HIV/AIDS prevention, treatment, and care 
                programs, were diagnosed and referred into 
                treatment and care during such period;
          (4) any barriers, including State laws and 
        regulations, that the Secretary determines to be a 
        barrier to meeting the testing goal described in 
        subsection (a);
          (5) the amount of funding the Secretary determines 
        necessary to meet the annual testing goal in the 
        following 12 months and the amount of Federal funding 
        expended to meet the testing goal in the prior 12-month 
        period; and
          (6) the most cost-effective strategies for 
        identifying and diagnosing individuals who were unaware 
        of their HIV status, including voluntary testing with 
        pre-test counseling, routine screening including opt-
        out testing, partner counseling and referral services, 
        and mass media campaigns.
  (c) Review of Program Effectiveness.--Not later than 1 year 
after the date of enactment of this section, the Secretary, in 
consultation with the Director of the Centers for Disease 
Control and Prevention, shall submit a report to Congress based 
on a comprehensive review of each of the programs and 
activities conducted by the Centers for Disease Control and 
Prevention as part of the Domestic HIV/AIDS Prevention 
Activities, including the following:
          (1) The amount of funding provided for each program 
        or activity.
          (2) The primary purpose of each program or activity.
          (3) The annual goals for each program or activity.
          (4) The relative effectiveness of each program or 
        activity with relation to the other programs and 
        activities conducted by the Centers for Disease Control 
        and Prevention, based on the--
                  (A) number of previously undiagnosed 
                individuals with HIV/AIDS made aware of their 
                status and referred into the appropriate 
                treatment;
                  (B) amount of funding provided for each 
                program or activity compared to the number of 
                undiagnosed individuals with HIV/AIDS made 
                aware of their status;
                  (C) program's contribution to the National 
                HIV/AIDS testing goal; and
                  (D) progress made toward the goals described 
                in paragraph (3).
          (5) Recommendations if any to Congress on ways to 
        allocate funding for domestic HIV/AIDS prevention 
        activities and programs in order to achieve the 
        National HIV/AIDS testing goal.
  (d) Coordination With Other Federal Activities.--In pursuing 
the National HIV/AIDS testing goal, the Secretary, where 
appropriate, shall consider and coordinate with other national 
strategies conducted by the Federal Government to address HIV/
AIDS.

SEC. [2688.] 2689. DEFINITIONS.

  For purposes of this title:
          (1) * * *

           *       *       *       *       *       *       *


PART F--DEMONSTRATION AND TRAINING

           *       *       *       *       *       *       *


            Subpart II--AIDS Education and Training Centers

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

  (a) * * *

           *       *       *       *       *       *       *

  (c) Authorization of Appropriations.--
          (1) Schools; centers.--For the purpose of awarding 
        grants under subsection (a), there [is authorized] are 
        authorized to be appropriated $34,700,000 for each of 
        the fiscal years 2007 through 2009, $36,535,000 for 
        fiscal year 2010, $38,257,000 for fiscal year 2011, 
        $40,170,000 for fiscal year 2012, and $42,178,000 for 
        fiscal year 2013.
          (2) Dental schools.--For the purpose of awarding 
        grants under subsection (b), there [is authorized] are 
        authorized to be appropriated $13,000,000 for each of 
        the fiscal years 2007 through 2009, $13,650,000 for 
        fiscal year 2010, $14,333,000 for fiscal year 2011, 
        $15,049,000 for fiscal year 2012, and $15,802,000 for 
        fiscal year 2013.

                 Subpart III--Minority AIDS Initiative

SEC. 2693. MINORITY AIDS INITIATIVE.

  (a) In General.--For the purpose of carrying out activities 
under this section to evaluate and address the disproportionate 
impact of HIV/AIDS on, and the disparities in access, 
treatment, care, and outcomes for, racial and ethnic minorities 
(including African Americans, Alaska Natives, Latinos, American 
Indians, Asian Americans, Native Hawaiians, and Pacific 
Islanders), there are authorized to be appropriated 
$131,200,000 for fiscal year 2007, $135,100,000 for fiscal year 
2008, [and $139,100,000 for fiscal year 2009.] $139,100,000 for 
fiscal year 2009, $146,055,000 for fiscal year 2010, 
$153,358,000 for fiscal year 2011, $161,026,000 for fiscal year 
2012, and $169,077,000 for fiscal year 2013. The Secretary 
shall develop a formula for the awarding of grants under 
subsections (b)(1)(A) and (b)(1)(B) that ensures that funding 
is provided based on the distribution of populations 
disproportionately impacted by HIV/AIDS.
  (b) Certain Activities.--
          (1) * * *
          (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) * * *

           *       *       *       *       *       *       *

                          (iv) For fiscal year 2010, 
                        $46,738,000.
                          (v) For fiscal year 2011, 
                        $49,075,000.
                          (vi) For fiscal year 2012, 
                        $51,528,000.
                          (vii) For fiscal year 2013, 
                        $54,105,000.
                  (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) * * *

           *       *       *       *       *       *       *

                          (iv) For fiscal year 2010, 
                        $8,763,000.
                          (v) For fiscal year 2011, $9,202,000.
                          (vi) For fiscal year 2012, 
                        $9,662,000.
                          (vii) For fiscal year 2013, 
                        $10,145,000.
                  (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) * * *

           *       *       *       *       *       *       *

                          (iv) For fiscal year 2010, 
                        $61,343,000.
                          (v) For fiscal year 2011, 
                        $64,410,000.
                          (vi) For fiscal year 2012, 
                        $67,631,000.
                          (vii) For fiscal year 2013, 
                        $71,012,000.
                  (D) For eliminating racial and ethnic 
                disparities in the delivery of comprehensive, 
                culturally and linguistically appropriate care 
                services for HIV disease for women, infants, 
                children, and youth, the Secretary shall, of 
                the amount appropriated under subsection (a), 
                reserve [$18,500,000 for each of the fiscal 
                years 2007 through 2009.] the following, as 
                applicable:
                          (i) For fiscal year 2010, 
                        $20,448,000.
                          (ii) For fiscal year 2011, 
                        $21,470,000.
                          (iii) For fiscal year 2012, 
                        $22,543,000.
                          (iv) For fiscal year 2013, 
                        $23,671,000.
                  (E) For increasing the training capacity of 
                centers to expand the number of health care 
                professionals with treatment expertise and 
                knowledge about the most appropriate standards 
                of HIV disease-related treatments and medical 
                care for racial and ethnic minority adults, 
                adolescents, and children with HIV disease, the 
                Secretary shall, of the amount appropriated 
                under subsection (a), reserve [$8,500,000 for 
                each of the fiscal years 2007 through 2009.] 
                the following, as applicable:
                          (i) For fiscal year 2010, $8,763,000.
                          (ii) For fiscal year 2011, 
                        $9,201,000.
                          (iii) For fiscal year 2012, 
                        $9,662,000.
                          (iv) For fiscal year 2013, 
                        $10,144,000.

           *       *       *       *       *       *       *

  (g) Synchronization of Minority AIDS Initiative.--For fiscal 
year 2010 and each subsequent fiscal year, the Secretary shall 
incorporate and synchronize the schedule of application 
submissions and funding availability under this section with 
the schedule of application submissions and funding 
availability under the corresponding provisions of this title 
XXVI as follows:
          (1) The schedule for carrying out subsection 
        (b)(1)(A) shall be the same as the schedule applicable 
        to emergency assistance under part A.
          (2) The schedule for carrying out subsection 
        (b)(1)(B) shall be the same as the schedule applicable 
        to care grants under part B.
          (3) The schedule for carrying out subsection 
        (b)(1)(C) shall be the same as the schedule applicable 
        to grants for early intervention services under part C.
          (4) The schedule for carrying out subsection 
        (b)(1)(D) shall be the same as the schedule applicable 
        to grants for services through projects for HIV-related 
        care under part D.
          (5) The schedule for carrying out subsection 
        (b)(1)(E) shall be the same as the schedule applicable 
        to grants and contracts for activities through 
        education and training centers under section 2692.

           *       *       *       *       *       *       *


    PART G--NOTIFICATION OF POSSIBLE EXPOSURE TO INFECTIOUS DISEASES

SEC. 2695. INFECTIOUS DISEASES AND CIRCUMSTANCES RELEVANT TO 
                    NOTIFICATION REQUIREMENTS.

  (a) In General.--Not later than 180 days after the date of 
the enactment of this part, the Secretary shall complete the 
development of--
          (1) a list of potentially life-threatening infectious 
        diseases, including emerging 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 2695B(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. 2695A. 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) of subsection 
(a), 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. 2695B. REQUEST FOR NOTIFICATION 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 2695(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 2695(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 2695(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 
                subparagraph (A), 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. 2695C. PROCEDURES FOR NOTIFICATION OF EXPOSURE.

  (a) Contents of Notification to Officer.--In making a 
notification required under section 2695A or section 
2695B(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 
2695A or section 2695B(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. 2695D. NOTIFICATION OF EMPLOYEE.

  (a) In General.--After receiving a notification for purposes 
of section 2695A or 2695B(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 2695B, 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. 2695E. 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. 2695F. LIMITATION 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 2695B(c) received 
        by a medical facility before the expiration of such 30-
        day period.

SEC. 2695G. MISCELLANEOUS PROVISIONS.

  (a) Liability of Medical Facilities, Designated Officers, and 
Public Health Officers.--This subpart may not be construed to 
authorize any cause of action for damages or any civil penalty 
against any medical facility, any designated officer, or any 
other public health 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.
  (e) Notification and Reporting Deadlines.--In any case in 
which the Secretary determines that, wholly or partially as a 
result of a public health emergency that has been determined 
pursuant to section 319(a), individuals or public or private 
entities are unable to comply with the requirements of this 
part, the Secretary may, notwithstanding any other provision of 
law, temporarily suspend, in whole or in part, the requirements 
of this part as the circumstances reasonably require. Before or 
promptly after such a suspension, the Secretary shall notify 
the Congress of such action and publish in the Federal Register 
a notice of the suspension.
  (f) Continued Application of State and Local Law.--Nothing in 
this part shall be construed to limit the application of State 
or local laws that require the provision of data to public 
health authorities.

SEC. 2695H. 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. 2695I. 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 substantially consistent with this 
subpart.

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