[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6143 Enrolled Bill (ENR)]
H.R.6143
One Hundred Ninth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Tuesday,
the third day of January, two thousand and six
An Act
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

ca01e21ba75a4b614844d67d8b67d5b15af522c82133db7e87da3d755d3ab4ad

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

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aa688bc25139f2869e41f5f1a319604cc225194209b10dce9d53eb63921ddbca

TITLE I

-EMERGENCY RELIEF FOR ELIGIBLE AREAS

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TITLE II

-CARE GRANTS

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TITLE III

-EARLY INTERVENTION SERVICES

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

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(a) Distribution Percentages.--Section 2603(a)(2) of the Public
Health Service Act (42 U.S.C. 300ff-13(a)(2)) is amended--
(1) in the first sentence--
(A) by striking ``50 percent of the amount appropriated
under section 2677'' and inserting ``66\2/3\ percent of the
amount made available under section 2610(b) for carrying out
this subpart''; and
(B) by striking ``paragraph (3)'' and inserting
``paragraphs (3) and (4)''.
(2) by striking the last sentence.
(b) Distribution Based on Living Cases of HIV/AIDS.--Section
2603(a)(3) of the Public Health Service Act (42 U.S.C. 300ff-13(a)(3))
is amended--
(1) in subparagraph (B), by striking ``estimated living cases
of acquired immune deficiency syndrome'' and inserting ``living
cases of HIV/AIDS (reported to and confirmed by the Director of the
Centers for Disease Control and Prevention)''; and
(2) by striking subparagraphs (C) through (E) and inserting the
following:
``(C) Living cases of hiv/aids.--
``(i) Requirement of names-based reporting.--Except as
provided in clause (ii), the number determined under this
subparagraph for an eligible area for a fiscal year for
purposes of subparagraph (B) is the number of living names-
based cases of HIV/AIDS that, as of December 31 of the most
recent calendar year for which such data is available, have
been reported to and confirmed by the Director of the
Centers for Disease Control and Prevention.
``(ii) Transition period; exemption regarding non-aids
cases.--For each of the fiscal years 2007 through 2009, an
eligible area is, subject to clauses (iii) through (v),
exempt from the requirement under clause (i) that living
names-based non-AIDS cases of HIV be reported unless--
``(I) a system was in operation as of December 31,
2005, that provides sufficiently accurate and reliable
names-based reporting of such cases throughout the
State in which the area is located, subject to clause
(viii); or
``(II) no later than the beginning of fiscal year
2008 or 2009, the Secretary, in consultation with the
chief executive of the State in which the area is
located, determines that a system has become
operational in the State that provides sufficiently
accurate and reliable names-based reporting of such
cases throughout the State.
``(iii) Requirements for exemption for fiscal year
2007.--For fiscal year 2007, an exemption under clause (ii)
for an eligible area applies only if, by October 1, 2006--
``(I)(aa) the State in which the area is located
had submitted to the Secretary a plan for making the
transition to sufficiently accurate and reliable names-
based reporting of living non-AIDS cases of HIV; or
``(bb) all statutory changes necessary to provide
for sufficiently accurate and reliable reporting of
such cases had been made; and
``(II) the State had agreed that, by April 1, 2008,
the State will begin accurate and reliable names-based
reporting of such cases, except that such agreement is
not required to provide that, as of such date, the
system for such reporting be fully sufficient with
respect to accuracy and reliability throughout the
area.
``(iv) Requirement for exemption as of fiscal year
2008.--For each of the fiscal years 2008 through 2010, an
exemption under clause (ii) for an eligible area applies
only if, as of April 1, 2008, the State in which the area
is located is substantially in compliance with the
agreement under clause (iii)(II).
``(v) Progress toward names-based reporting.--For
fiscal year 2009, the Secretary may terminate an exemption
under clause (ii) for an eligible area if the State in
which the area is located submitted a plan under clause
(iii)(I)(aa) and the Secretary determines that the State is
not substantially following the plan.
``(vi) Counting of cases in areas with exemptions.--
``(I) In general.--With respect to an eligible area
that is under a reporting system for living non-AIDS
cases of HIV that is not names-based (referred to in
this subparagraph as `code-based reporting'), the
Secretary shall, for purposes of this subparagraph,
modify the number of such cases reported for the
eligible area in order to adjust for duplicative
reporting in and among systems that use code-based
reporting.
``(II) Adjustment rate.--The adjustment rate under
subclause (I) for an eligible area shall be a reduction
of 5 percent in the number of living non-AIDS cases of
HIV reported for the area.
``(vii) Multiple political jurisdictions.--With respect
to living non-AIDS cases of HIV, if an eligible area is not
entirely within one political jurisdiction and as a result
is subject to more than one reporting system for purposes
of this subparagraph:
``(I) Names-based reporting under clause (i)
applies in a jurisdictional portion of the area, or an
exemption under clause (ii) applies in such portion
(subject to applicable provisions of this
subparagraph), according to whether names-based
reporting or code-based reporting is used in such
portion.
``(II) If under subclause (I) both names-based
reporting and code-based reporting apply in the area,
the number of code-based cases shall be reduced under
clause (vi).
``(viii) List of eligible areas meeting standard
regarding December 31, 2005.--
``(I) In general.--If an eligible area or portion
thereof is in a State specified in subclause (II), the
eligible area or portion shall be considered to meet
the standard described in clause (ii)(I). No other
eligible area or portion thereof may be considered to
meet such standard.
``(II) Relevant states.--For purposes of subclause
(I), the States specified in this subclause are the
following: Alaska, Alabama, Arkansas, Arizona,
Colorado, Florida, Indiana, Iowa, Idaho, Kansas,
Louisiana, Michigan, Minnesota, Missouri, Mississippi,
North Carolina, North Dakota, Nebraska, New Jersey, New
Mexico, New York, Nevada, Ohio, Oklahoma, South
Carolina, South Dakota, Tennessee, Texas, Utah,
Virginia, Wisconsin, West Virginia, Wyoming, Guam, and
the Virgin Islands.
``(ix) Rules of construction regarding acceptance of
reports.--
``(I) Cases of aids.--With respect to an eligible
area that is subject to the requirement under clause
(i) and is not in compliance with the requirement for
names-based reporting of living non-AIDS cases of HIV,
the Secretary shall, notwithstanding such
noncompliance, accept reports of living cases of AIDS
that are in accordance with such clause.
``(II) Applicability of exemption requirements.--
The provisions of clauses (ii) through (viii) may not
be construed as having any legal effect for fiscal year
2010 or any subsequent fiscal year, and accordingly,
the status of a State for purposes of such clauses may
not be considered after fiscal year 2009.
``(x) Program for detecting inaccurate or fraudulent
counting.--The Secretary shall carry out a program to
monitor the reporting of names-based cases for purposes of
this subparagraph and to detect instances of inaccurate
reporting, including fraudulent reporting.''.
(c) Code-Based Areas; Limitation on Increase in Grant.--Section
2603(a)(3) of the Public Health Service Act (42 U.S.C. 300ff-13(a)), as
amended by subsection (b)(2) of this section, is amended by adding at
the end the following subparagraph:
``(D) Code-based areas; limitation on increase in grant .--
``(i) In general.--For each of the fiscal years 2007
through 2009, if code-based reporting (within the meaning
of subparagraph (C)(vi)) applies in an eligible area or any
portion thereof as of the beginning of the fiscal year
involved, then notwithstanding any other provision of this
paragraph, the amount of the grant pursuant to this
paragraph for such area for such fiscal year may not--
``(I) for fiscal year 2007, exceed by more than 5
percent the amount of the grant for the area that would
have been made pursuant to this paragraph and paragraph
(4) for fiscal year 2006 (as such paragraphs were in
effect for such fiscal year) if paragraph (2) (as so in
effect) had been applied by substituting `66\2/3\
percent' for `50 percent'; and
``(II) for each of the fiscal years 2008 and 2009,
exceed by more than 5 percent the amount of the grant
pursuant to this paragraph and paragraph (4) for the
area for the preceding fiscal year.
``(ii) Use of amounts involved.--For each of the fiscal
years 2007 through 2009, amounts available as a result of
the limitation under clause (i) shall be made available by
the Secretary as additional amounts for grants pursuant to
subsection (b) for the fiscal year involved, subject to
paragraph (4) and section 2610(d)(2).''.
(d) Hold Harmless.--Section 2603(a) of the Public Health Service
Act (42 U.S.C. 300ff-13(a)) is amended--
(1) in paragraph (3)(A)--
(A) in clause (ii), by striking the period at the end and
inserting a semicolon; and
(B) by inserting after and below clause (ii) the following:
``which product shall then, as applicable, be increased under
paragraph (4).''.
(2) by amending paragraph (4) to read as follows:
``(4) Increases in grant.--
``(A) In general.--For each eligible area that received a
grant pursuant to this subsection for fiscal year 2006, the
Secretary shall, for each of the fiscal years 2007 through
2009, increase the amount of the grant made pursuant to
paragraph (3) for the area to ensure that the amount of the
grant for the fiscal year involved is not less than the
following amount, as applicable to such fiscal year:
``(i) For fiscal year 2007, an amount equal to 95
percent of the amount of the grant that would have been
made pursuant to paragraph (3) and this paragraph for
fiscal year 2006 (as such paragraphs were in effect for
such fiscal year) if paragraph (2) (as so in effect) had
been applied by substituting `66\2/3\ percent' for `50
percent'.
``(ii) For each of the fiscal years 2008 and 2009, an
amount equal to 100 percent of the amount of the grant made
pursuant to paragraph (3) and this paragraph for fiscal
year 2007.
``(B) Source of funds for increase.--
``(i) In general.--From the amounts available for
carrying out the single program referred to in section
2609(d)(2)(C) for a fiscal year (relating to supplemental
grants), the Secretary shall make available such amounts as
may be necessary to comply with subparagraph (A), subject
to section 2610(d)(2).
``(ii) Pro rata reduction.--If the amounts referred to
in clause (i) for a fiscal year are insufficient to fully
comply with subparagraph (A) for the year, the Secretary,
in order to provide the additional funds necessary for such
compliance, shall reduce on a pro rata basis the amount of
each grant pursuant to this subsection for the fiscal year,
other than grants for eligible areas for which increases
under subparagraph (A) apply. A reduction under the
preceding sentence may not be made in an amount that would
result in the eligible area involved becoming eligible for
such an increase.
``(C) Limitation.--This paragraph may not be construed as
having any applicability after fiscal year 2009.''.

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Section 2603(b) of the Public Health Service Act (42 U.S.C. 300ff-
13(b)) is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by striking
``Not later than'' and all that follows through ``the Secretary
shall'' and inserting the following: ``Subject to subsection
(a)(4)(B)(i) and section 2610(d), the Secretary shall'';
(B) in subparagraph (B), by striking ``demonstrates the
severe need in such area'' and inserting ``demonstrates the
need in such area, on an objective and quantified basis,'';
(C) by striking subparagraph (F) and inserting the
following:
``(F) demonstrates the inclusiveness of affected
communities and individuals with HIV/AIDS;'';
(D) in subparagraph (G), by striking the period and
inserting ``; and''; and
(E) by adding at the end the following:
``(H) demonstrates the ability of the applicant to expend
funds efficiently by not having had, for the most recent grant
year under subsection (a) for which data is available, more
than 2 percent of grant funds under such subsection canceled or
covered by any waivers under subsection (c)(3).''; and
(2) in paragraph (2)--
(A) in subparagraph (A), by striking ``severe need'' and
inserting ``demonstrated need'';
(B) by striking subparagraph (B) and inserting the
following:
``(B) Demonstrated need.--The factors considered by the
Secretary in determining whether an eligible area has a
demonstrated need for purposes of paragraph (1)(B) may include
any or all of the following:
``(i) The unmet need for such services, as determined
under section 2602(b)(4) or other community input process
as defined under section 2609(d)(1)(A).
``(ii) An increasing need for HIV/AIDS-related
services, including relative rates of increase in the
number of cases of HIV/AIDS.
``(iii) The relative rates of increase in the number of
cases of HIV/AIDS within new or emerging subpopulations.
``(iv) The current prevalence of HIV/AIDS.
``(v) Relevant factors related to the cost and
complexity of delivering health care to individuals with
HIV/AIDS in the eligible area.
``(vi) The impact of co-morbid factors, including co-
occurring conditions, determined relevant by the Secretary.
``(vii) The prevalence of homelessness.
``(viii) The prevalence of individuals described under
section 2602(b)(2)(M).
``(ix) The relevant factors that limit access to health
care, including geographic variation, adequacy of health
insurance coverage, and language barriers.
``(x) The impact of a decline in the amount received
pursuant to subsection (a) on services available to all
individuals with HIV/AIDS identified and eligible under
this title.''; and
(C) by striking subparagraphs (C) and (D) and inserting the
following:
``(C) Priority in making grants.--The Secretary shall
provide funds under this subsection to an eligible area to
address the decline or disruption of all EMA-provided services
related to the decline in the amounts received pursuant to
subsection (a) consistent with the grant award for the eligible
area for fiscal year 2006, to the extent that the factor under
subparagraph (B)(x) (relating to a decline in funding) applies
to the eligible area.''.

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Section 2603 of the Public Health Service Act (42 U.S.C. 300ff-13)
is amended--
(1) by redesignating subsection (c) as subsection (d);
(2) by inserting after subsection (b) the following:
``(c) Timeframe for Obligation and Expenditure of Grant Funds.--
``(1) Obligation by end of grant year.--Effective for fiscal
year 2007 and subsequent fiscal years, funds from a grant award
made pursuant to subsection (a) or (b) for a fiscal year are
available for obligation by the eligible area involved through the
end of the one-year period beginning on the date in such fiscal
year on which funds from the award first become available to the
area (referred to in this subsection as the `grant year for the
award'), except as provided in paragraph (3)(A).
``(2) Supplemental grants; cancellation of unobligated balance
of grant award.--Effective for fiscal year 2007 and subsequent
fiscal years, if a grant award made pursuant to subsection (b) for
an eligible area for a fiscal year has an unobligated balance as of
the end of the grant year for the award--
``(A) the Secretary shall cancel that unobligated balance
of the award, and shall require the eligible area to return any
amounts from such balance that have been disbursed to the area;
and
``(B) the funds involved shall be made available by the
Secretary as additional amounts for grants pursuant to
subsection (b) for the first fiscal year beginning after the
fiscal year in which the Secretary obtains the information
necessary for determining that the balance is required under
subparagraph (A) to be canceled, except that the availability
of the funds for such grants is subject to subsection (a)(4)
and section 2610(d)(2) as applied for such year.
``(3) Formula grants; cancellation of unobligated balance of
grant award; waiver permitting carryover.--
``(A) In general.--Effective for fiscal year 2007 and
subsequent fiscal years, if a grant award made pursuant to
subsection (a) for an eligible area for a fiscal year has an
unobligated balance as of the end of the grant year for the
award, the Secretary shall cancel that unobligated balance of
the award, and shall require the eligible area to return any
amounts from such balance that have been disbursed to the area,
unless--
``(i) before the end of the grant year, the chief
elected official of the area submits to the Secretary a
written application for a waiver of the cancellation, which
application includes a description of the purposes for
which the area intends to expend the funds involved; and
``(ii) the Secretary approves the waiver.
``(B) Expenditure by end of carryover year.--With respect
to a waiver under subparagraph (A) that is approved for a
balance that is unobligated as of the end of a grant year for
an award:
``(i) The unobligated funds are available for
expenditure by the eligible area involved for the one-year
period beginning upon the expiration of the grant year
(referred to in this subsection as the `carryover year').
``(ii) If the funds are not expended by the end of the
carryover year, the Secretary shall cancel that unexpended
balance of the award, and shall require the eligible area
to return any amounts from such balance that have been
disbursed to the area.
``(C) Use of cancelled balances.--In the case of any
balance of a grant award that is cancelled under subparagraph
(A) or (B)(ii), the grant funds involved shall be made
available by the Secretary as additional amounts for grants
pursuant to subsection (b) for the first fiscal year beginning
after the fiscal year in which the Secretary obtains the
information necessary for determining that the balance is
required under such subparagraph to be canceled, except that
the availability of the funds for such grants is subject to
subsection (a)(4) and section 2610(d)(2) as applied for such
year.
``(D) Corresponding reduction in future grant.--
``(i) In general.--In the case of an eligible area for
which a balance from a grant award under subsection (a) is
unobligated as of the end of the grant year for the award--
``(I) the Secretary shall reduce, by the same
amount as such unobligated balance, the amount of the
grant under such subsection for the first fiscal year
beginning after the fiscal year in which the Secretary
obtains the information necessary for determining that
such balance was unobligated as of the end of the grant
year (which requirement for a reduction applies without
regard to whether a waiver under subparagraph (A) has
been approved with respect to such balance); and
``(II) the grant funds involved in such reduction
shall be made available by the Secretary as additional
funds for grants pursuant to subsection (b) for such
first fiscal year, subject to subsection (a)(4) and
section 2610(d)(2);
except that this clause does not apply to the eligible area
if the amount of the unobligated balance was 2 percent or
less.
``(ii) Relation to increases in grant.--A reduction
under clause (i) for an eligible area for a fiscal year may
not be taken into account in applying subsection (a)(4)
with respect to the area for the subsequent fiscal year.'';
and
(3) by adding at the end the following:
``(e) Report on the Awarding of Supplemental Funds.--Not later than
45 days after the awarding of supplemental funds under this section,
the Secretary shall submit to Congress a report concerning such funds.
Such report shall include information detailing--
``(1) the total amount of supplemental funds available under
this section for the year involved;
``(2) the amount of supplemental funds used in accordance with
the hold harmless provisions of subsection (a)(4);
``(3) the amount of supplemental funds disbursed pursuant to
subsection (b)(2)(C);
``(4) the disbursement of the remainder of the supplemental
funds after taking into account the uses described in paragraphs
(2) and (3); and
``(5) the rationale used for the amount of funds disbursed as
described under paragraphs (2), (3), and (4).''.

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Section 2604 of the Public Health Service Act (42 U.S.C. 300ff-14)
is amended to read as follows:
``SEC. 2604. USE OF AMOUNTS.
``(a) Requirements.--The Secretary may not make a grant under
section 2601(a) to the chief elected official of an eligible area
unless such political subdivision agrees that--
``(1) subject to paragraph (2), the allocation of funds and
services within the eligible area will be made in accordance with
the priorities established, pursuant to section 2602(b)(4)(C), by
the HIV health services planning council that serves such eligible
area;
``(2) funds provided under section 2601 will be expended only
for--
``(A) core medical services described in subsection (c);
``(B) support services described in subsection (d); and
``(C) administrative expenses described in subsection (h);
and
``(3) the use of such funds will comply with the requirements
of this section.
``(b) Direct Financial Assistance to Appropriate Entities.--
``(1) In general.--The chief elected official of an eligible
area shall use amounts from a grant under section 2601 to provide
direct financial assistance to entities described in paragraph (2)
for the purpose of providing core medical services and support
services.
``(2) Appropriate entities.--Direct financial assistance may be
provided under paragraph (1) to public or nonprofit private
entities, or private for-profit entities if such entities are the
only available provider of quality HIV care in the area.
``(c) Required Funding for Core Medical Services.--
``(1) In general.--With respect to a grant under section 2601
for an eligible area for a grant year, the chief elected official
of the area shall, of the portion of the grant remaining after
reserving amounts for purposes of paragraphs (1) and (5)(B)(i) of
subsection (h), use not less than 75 percent to provide core
medical services that are needed in the eligible area for
individuals with HIV/AIDS who are identified and eligible under
this title (including services regarding the co-occurring
conditions of the individuals).
``(2) Waiver.--
``(A) In general.--The Secretary shall waive the
application of paragraph (1) with respect to a chief elected
official for a grant year if the Secretary determines that,
within the eligible area involved--
``(i) there are no waiting lists for AIDS Drug
Assistance Program services under section 2616; and
``(ii) core medical services are available to all
individuals with HIV/AIDS identified and eligible under
this title.
``(B) Notification of waiver status.--When informing the
chief elected official of an eligible area that a grant under
section 2601 is being made for the area for a grant year, the
Secretary shall inform the official whether a waiver under
subparagraph (A) is in effect for such year.
``(3) Core medical services.--For purposes of this subsection,
the term `core medical services', with respect to an individual
with HIV/AIDS (including the co-occurring conditions of the
individual), means the following services:
``(A) Outpatient and ambulatory health services.
``(B) AIDS Drug Assistance Program treatments in accordance
with section 2616.
``(C) AIDS pharmaceutical assistance.
``(D) Oral health care.
``(E) Early intervention services described in subsection
(e).
``(F) Health insurance premium and cost sharing assistance
for low-income individuals in accordance with section 2615.
``(G) Home health care.
``(H) Medical nutrition therapy.
``(I) Hospice services.
``(J) Home and community-based health services as defined
under section 2614(c).
``(K) Mental health services.
``(L) Substance abuse outpatient care.
``(M) Medical case management, including treatment
adherence services.
``(d) Support Services.--
``(1) In general.--For purposes of this section, the term
`support services' means services, subject to the approval of the
Secretary, that are needed for individuals with HIV/AIDS to achieve
their medical outcomes (such as respite care for persons caring for
individuals with HIV/AIDS, outreach services, medical
transportation, linguistic services, and referrals for health care
and support services).
``(2) Medical outcomes.--In this subsection, the term `medical
outcomes' means those outcomes affecting the HIV-related clinical
status of an individual with HIV/AIDS.
``(e) Early Intervention Services.--
``(1) In general.--For purposes of this section, the term
`early intervention services' means HIV/AIDS early intervention
services described in section 2651(e), with follow-up referral
provided for the purpose of facilitating the access of individuals
receiving the services to HIV-related health services. The entities
through which such services may be provided under the grant include
public health departments, emergency rooms, substance abuse and
mental health treatment programs, detoxification centers, detention
facilities, clinics regarding sexually transmitted diseases,
homeless shelters, HIV/AIDS counseling and testing sites, health
care points of entry specified by eligible areas, federally
qualified health centers, and entities described in section 2652(a)
that constitute a point of access to services by maintaining
referral relationships.
``(2) Conditions.--With respect to an entity that proposes to
provide early intervention services under paragraph (1), such
paragraph shall apply only if the entity demonstrates to the
satisfaction of the chief elected official for the eligible area
involved that--
``(A) Federal, State, or local funds are otherwise
inadequate for the early intervention services the entity
proposes to provide; and
``(B) the entity will expend funds pursuant to such
paragraph to supplement and not supplant other funds available
to the entity for the provision of early intervention services
for the fiscal year involved.
``(f) Priority for Women, Infants, Children, and Youth.--
``(1) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with HIV/
AIDS, including treatment measures to prevent the perinatal
transmission of HIV, the chief elected official of an eligible
area, in accordance with the established priorities of the planning
council, shall for each of such populations in the eligible area
use, from the grants made for the area under section 2601(a) for a
fiscal year, not less than the percentage constituted by the ratio
of the population involved (infants, children, youth, or women in
such area) with HIV/AIDS to the general population in such area of
individuals with HIV/AIDS.
``(2) Waiver.--With respect to the population involved, the
Secretary may provide to the chief elected official of an eligible
area a waiver of the requirement of paragraph (1) if such official
demonstrates to the satisfaction of the Secretary that the
population is receiving HIV-related health services through the
State medicaid program under title XIX of the Social Security Act,
the State children's health insurance program under title XXI of
such Act, or other Federal or State programs.
``(g) Requirement of Status as Medicaid Provider.--
``(1) Provision of service.--Subject to paragraph (2), the
Secretary may not make a grant under section 2601(a) for the
provision of services under this section in a State unless, in the
case of any such service that is available pursuant to the State
plan approved under title XIX of the Social Security Act for the
State--
``(A) the political subdivision involved will provide the
service directly, and the political subdivision has entered
into a participation agreement under the State plan and is
qualified to receive payments under such plan; or
``(B) the political subdivision will enter into an
agreement with a public or nonprofit private entity under which
the entity will provide the service, and the entity has entered
into such a participation agreement and is qualified to receive
such payments.
``(2) Waiver.--
``(A) In general.--In the case of an entity making an
agreement pursuant to paragraph (1)(B) regarding the provision
of services, the requirement established in such paragraph
shall be waived by the HIV health services planning council for
the eligible area if the entity does not, in providing health
care services, impose a charge or accept reimbursement
available from any third-party payor, including reimbursement
under any insurance policy or under any Federal or State health
benefits program.
``(B) Determination.--A determination by the HIV health
services planning council of whether an entity referred to in
subparagraph (A) meets the criteria for a waiver under such
subparagraph shall be made without regard to whether the entity
accepts voluntary donations for the purpose of providing
services to the public.
``(h) Administration.--
``(1) Limitation.--The chief elected official of an eligible
area shall not use in excess of 10 percent of amounts received
under a grant under this part for administrative expenses.
``(2) Allocations by chief elected official.--In the case of
entities and subcontractors to which the chief elected official of
an eligible area allocates amounts received by the official under a
grant under this part, the official shall ensure that, of the
aggregate amount so allocated, the total of the expenditures by
such entities for administrative expenses does not exceed 10
percent (without regard to whether particular entities expend more
than 10 percent for such expenses).
``(3) Administrative activities.--For purposes of paragraph
(1), amounts may be used for administrative activities that
include--
``(A) routine grant administration and monitoring
activities, including the development of applications for part
A funds, the receipt and disbursal of program funds, the
development and establishment of reimbursement and accounting
systems, the development of a clinical quality management
program as described in paragraph (5), the preparation of
routine programmatic and financial reports, and compliance with
grant conditions and audit requirements; and
``(B) all activities associated with the grantee's contract
award procedures, including the activities carried out by the
HIV health services planning council as established under
section 2602(b), the development of requests for proposals,
contract proposal review activities, negotiation and awarding
of contracts, monitoring of contracts through telephone
consultation, written documentation or onsite visits, reporting
on contracts, and funding reallocation activities.
``(4) Subcontractor administrative activities.--For the
purposes of this subsection, subcontractor administrative
activities include--
``(A) usual and recognized overhead activities, including
established indirect rates for agencies;
``(B) management oversight of specific programs funded
under this title; and
``(C) other types of program support such as quality
assurance, quality control, and related activities.
``(5) Clinical quality management.--
``(A) Requirement.--The chief elected official of an
eligible area that receives a grant under this part shall
provide for the establishment of a clinical quality management
program to assess the extent to which HIV health services
provided to patients under the grant are consistent with the
most recent Public Health Service guidelines for the treatment
of HIV/AIDS and related opportunistic infection, and as
applicable, to develop strategies for ensuring that such
services are consistent with the guidelines for improvement in
the access to and quality of HIV health services.
``(B) Use of funds.--
``(i) In general.--From amounts received under a grant
awarded under this subpart for a fiscal year, the chief
elected official of an eligible area may use for activities
associated with the clinical quality management program
required in subparagraph (A) not to exceed the lesser of--
``(I) 5 percent of amounts received under the
grant; or
``(II) $3,000,000.
``(ii) Relation to limitation on administrative
expenses.--The costs of a clinical quality management
program under subparagraph (A) may not be considered
administrative expenses for purposes of the limitation
established in paragraph (1).
``(i) Construction.--A chief elected official may not use amounts
received under a grant awarded under this part to purchase or improve
land, or to purchase, construct, or permanently improve (other than
minor remodeling) any building or other facility, or to make cash
payments to intended recipients of services.''.

cdbb8676c148dfc56de228a593793a6b8f2467e50ef95c305061b8283d65f076

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

31410f01efa56d0c04d5b4ebfc156a37bf30c62e02b2fbd0d6df00f5b2e2c619

INELIGIBLE UNDER SECTION 2601.
(a) In General.--Part A of title XXVI of the Public Health Service
Act (42 U.S.C. 300ff-11) is amended--
(1) by inserting after the part heading the following:
``Subpart I--General Grant Provisions''; and
(2) by adding at the end the following:
``Subpart II--Transitional Grants
``SEC. 2609. ESTABLISHMENT OF PROGRAM.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall make grants
for the purpose of providing services described in section 2604 in
transitional areas, subject to the same provisions regarding the
allocation of grant funds as apply under subsection (c) of such
section.
``(b) Transitional Areas.--For purposes of this section, the term
`transitional area' means, subject to subsection (c), a metropolitan
area for which there has been reported to and confirmed by the Director
of the Centers for Disease Control and Prevention a cumulative total of
at least 1,000, but fewer than 2,000, cases of AIDS during the most
recent period of 5 calendar years for which such data are available.
``(c) Certain Eligibility Rules.--
``(1) Fiscal year 2007.--With respect to grants under
subsection (a) for fiscal year 2007, a metropolitan area that
received funding under subpart I for fiscal year 2006 but does not
for fiscal year 2007 qualify under such subpart as an eligible area
and does not qualify under subsection (b) as a transitional area
shall, notwithstanding subsection (b), be considered a transitional
area.
``(2) Continued status as transitional area.--
``(A) In general.--Notwithstanding subsection (b), a
metropolitan area that is a transitional area for a fiscal year
continues, except as provided in subparagraph (B), to be a
transitional area until the metropolitan area fails, for three
consecutive fiscal years--
``(i) to qualify under such subsection as a
transitional area; and
``(ii) to have a cumulative total of 1,500 or more
living cases of AIDS (reported to and confirmed by the
Director of the Centers for Disease Control and Prevention)
as of December 31 of the most recent calendar year for
which such data is available.
``(B) Exception regarding status as eligible area.--
Subparagraph (A) does not apply for a fiscal year if the
metropolitan area involved qualifies under subpart I as an
eligible area.
``(d) Application of Certain Provisions of Subpart I.--
``(1) Administration; planning council.--
``(A) In general.--The provisions of section 2602 apply
with respect to a grant under subsection (a) for a transitional
area to the same extent and in the same manner as such
provisions apply with respect to a grant under subpart I for an
eligible area, except that, subject to subparagraph (B), the
chief elected official of the transitional area may elect not
to comply with the provisions of section 2602(b) if the
official provides documentation to the Secretary that details
the process used to obtain community input (particularly from
those with HIV) in the transitional area for formulating the
overall plan for priority setting and allocating funds from the
grant under subsection (a).
``(B) Exception.--For each of the fiscal years 2007 through
2009, the exception described in subparagraph (A) does not
apply if the transitional area involved received funding under
subpart I for fiscal year 2006.
``(2) Type and distribution of grants; timeframe for obligation
and expenditure of grant funds.--
``(A) Formula grants; supplemental grants.--The provisions
of section 2603 apply with respect to grants under subsection
(a) to the same extent and in the same manner as such
provisions apply with respect to grants under subpart I,
subject to subparagraphs (B) and (C).
``(B) Formula grants; increase in grant.--For purposes of
subparagraph (A), section 2603(a)(4) does not apply.
``(C) Supplemental grants; single program with subpart i
program.--With respect to section 2603(b) as applied for
purposes of subparagraph (A):
``(i) The Secretary shall combine amounts available
pursuant to such subparagraph with amounts available for
carrying out section 2603(b) and shall administer the two
programs as a single program.
``(ii) In the single program, the Secretary has
discretion in allocating amounts between eligible areas
under subpart I and transitional areas under this section,
subject to the eligibility criteria that apply under such
section, and subject to section 2603(b)(2)(C) (relating to
priority in making grants).
``(iii) Pursuant to section 2603(b)(1), amounts for the
single program are subject to use under sections 2603(a)(4)
and 2610(d)(1).
``(3) Application; technical assistance; definitions.--The
provisions of sections 2605, 2606, and 2607 apply with respect to
grants under subsection (a) to the same extent and in the same
manner as such provisions apply with respect to grants under
subpart I.''.
(b) Conforming Amendments.--Subpart I of part A of title XXVI of
the Public Health Service Act, as designated by subsection (a)(1) of
this section, is amended by striking ``this part'' each place such term
appears and inserting ``this subpart''.

c916b100d4556f93e181c08f893fa3b1c0b1af7eaf5483bead76f07b67afaad4

Part A of title XXVI of the Public Health Service Act, as amended
by section 106(a), is amended by adding at the end the following:
``Subpart III--General Provisions
``SEC. 2610. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--For the purpose of carrying out this part, there
are authorized to be appropriated $604,000,000 for fiscal year 2007,
$626,300,000 for fiscal year 2008, and $649,500,000 for fiscal year
2009. Amounts appropriated under the preceding sentence for a fiscal
year are available for obligation by the Secretary until the end of the
second succeeding fiscal year.
``(b) Reservation of Amounts.--
``(1) Fiscal year 2007.--Of the amount appropriated under
subsection (a) for fiscal year 2007, the Secretary shall reserve--
``(A) $458,310,000 for grants under subpart I; and
``(B) $145,690,000 for grants under section 2609.
``(2) Subsequent fiscal years.--Of the amount appropriated
under subsection (a) for fiscal year 2008 and each subsequent
fiscal year--
``(A) the Secretary shall reserve an amount for grants
under subpart I; and
``(B) the Secretary shall reserve an amount for grants
under section 2609.
``(c) Transfer of Certain Amounts; Change in Status as Eligible
Area or Transitional Area.--Notwithstanding subsection (b):
``(1) If a metropolitan area is an eligible area under subpart
I for a fiscal year, but for a subsequent fiscal year ceases to be
an eligible area by reason of section 2601(b)--
``(A)(i) the amount reserved under paragraph (1)(A) or
(2)(A) of subsection (b) of this section for the first such
subsequent year of not being an eligible area is deemed to be
reduced by an amount equal to the amount of the grant made
pursuant to section 2603(a) for the metropolitan area for the
preceding fiscal year; and
``(ii)(I) if the metropolitan area qualifies for such first
subsequent fiscal year as a transitional area under 2609, the
amount reserved under paragraph (1)(B) or (2)(B) of subsection
(b) for such fiscal year is deemed to be increased by an amount
equal to the amount of the reduction under subparagraph (A) for
such year; or
``(II) if the metropolitan area does not qualify for such
first subsequent fiscal year as a transitional area under 2609,
an amount equal to the amount of such reduction is,
notwithstanding subsection (a), transferred and made available
for grants pursuant to section 2618(a)(1), in addition to
amounts available for such grants under section 2623; and
``(B) if a transfer under subparagraph (A)(ii)(II) is made
with respect to the metropolitan area for such first subsequent
fiscal year, then--
``(i) the amount reserved under paragraph (1)(A) or
(2)(A) of subsection (b) of this section for such year is
deemed to be reduced by an additional $500,000; and
``(ii) an amount equal to the amount of such additional
reduction is, notwithstanding subsection (a), transferred
and made available for grants pursuant to section
2618(a)(1), in addition to amounts available for such
grants under section 2623.
``(2) If a metropolitan area is a transitional area under
section 2609 for a fiscal year, but for a subsequent fiscal year
ceases to be a transitional area by reason of section 2609(c)(2)
(and does not qualify for such subsequent fiscal year as an
eligible area under subpart I)--
``(A) the amount reserved under subsection (b)(2)(B) of
this section for the first such subsequent fiscal year of not
being a transitional area is deemed to be reduced by an amount
equal to the total of--
``(i) the amount of the grant that, pursuant to section
2603(a), was made under section 2609(d)(2)(A) for the
metropolitan area for the preceding fiscal year; and
``(ii) $500,000; and
``(B) an amount equal to the amount of the reduction under
subparagraph (A) for such year is, notwithstanding subsection
(a), transferred and made available for grants pursuant to
section 2618(a)(1), in addition to amounts available for such
grants under section 2623.
``(3) If a metropolitan area is a transitional area under
section 2609 for a fiscal year, but for a subsequent fiscal year
qualifies as an eligible area under subpart I--
``(A) the amount reserved under subsection (b)(2)(B) of
this section for the first such subsequent fiscal year of
becoming an eligible area is deemed to be reduced by an amount
equal to the amount of the grant that, pursuant to section
2603(a), was made under section 2609(d)(2)(A) for the
metropolitan area for the preceding fiscal year; and
``(B) the amount reserved under subsection (b)(2)(A) for
such fiscal year is deemed to be increased by an amount equal
to the amount of the reduction under subparagraph (A) for such
year.
``(d) Certain Transfers; Allocations Between Programs Under Subpart
I.--With respect to paragraphs (1)(B)(i) and (2)(A)(ii) of subsection
(c), the Secretary shall administer any reductions under such
paragraphs for a fiscal year in accordance with the following:
``(1) The reductions shall be made from amounts available for
the single program referred to in section 2609(d)(2)(C) (relating
to supplemental grants).
``(2) The reductions shall be made before the amounts referred
to in paragraph (1) are used for purposes of section 2603(a)(4).
``(3) If the amounts referred to in paragraph (1) are not
sufficient for making all the reductions, the reductions shall be
reduced until the total amount of the reductions equals the total
of the amounts referred to in such paragraph.
``(e) Rules of Construction Regarding First Subsequent Fiscal
Year.--Paragraphs (1) and (2) of subsection (c) apply with respect to
each series of fiscal years during which a metropolitan area is an
eligible area under subpart I or a transitional area under section 2609
for a fiscal year and then for a subsequent fiscal year ceases to be
such an area by reason of section 2601(b) or 2609(c)(2), respectively,
rather than applying to a single such series. Paragraph (3) of
subsection (c) applies with respect to each series of fiscal years
during which a metropolitan area is a transitional area under section
2609 for a fiscal year and then for a subsequent fiscal year becomes an
eligible area under subpart I, rather than applying to a single such
series.''.

8062df3922ba8dcddd52600d4aa116aa3fa95d16917b1ff28b9f33fcc5b2084c

(a) In General.--Section 2612 of the Public Health Service Act (42
U.S.C. 300ff-22) is amended to read as follows:
``SEC. 2612. GENERAL USE OF GRANTS.
``(a) In General.--A State may use amounts provided under grants
made under section 2611 for--
``(1) core medical services described in subsection (b);
``(2) support services described in subsection (c); and
``(3) administrative expenses described in section 2618(b)(3).
``(b) Required Funding for Core Medical Services.--
``(1) In general.--With respect to a grant under section 2611
for a State for a grant year, the State shall, of the portion of
the grant remaining after reserving amounts for purposes of
subparagraphs (A) and (E)(ii)(I) of section 2618(b)(3), use not
less than 75 percent to provide core medical services that are
needed in the State for individuals with HIV/AIDS who are
identified and eligible under this title (including services
regarding the co-occurring conditions of the individuals).
``(2) Waiver.--
``(A) In general.--The Secretary shall waive the
application of paragraph (1) with respect to a State for a
grant year if the Secretary determines that, within the State--
``(i) there are no waiting lists for AIDS Drug
Assistance Program services under section 2616; and
``(ii) core medical services are available to all
individuals with HIV/AIDS identified and eligible under
this title.
``(B) Notification of waiver status.--When informing a
State that a grant under section 2611 is being made to the
State for a fiscal year, the Secretary shall inform the State
whether a waiver under subparagraph (A) is in effect for the
fiscal year.
``(3) Core medical services.--For purposes of this subsection,
the term `core medical services', with respect to an individual
infected with HIV/AIDS (including the co-occurring conditions of
the individual) means the following services:
``(A) Outpatient and ambulatory health services.
``(B) AIDS Drug Assistance Program treatments in accordance
with section 2616.
``(C) AIDS pharmaceutical assistance.
``(D) Oral health care.
``(E) Early intervention services described in subsection
(d).
``(F) Health insurance premium and cost sharing assistance
for low-income individuals in accordance with section 2615.
``(G) Home health care.
``(H) Medical nutrition therapy.
``(I) Hospice services.
``(J) Home and community-based health services as defined
under section 2614(c).
``(K) Mental health services.
``(L) Substance abuse outpatient care.
``(M) Medical case management, including treatment
adherence services.
``(c) Support Services.--
``(1) In general.--For purposes of this subsection, the term
`support services' means services, subject to the approval of the
Secretary, that are needed for individuals with HIV/AIDS to achieve
their medical outcomes (such as respite care for persons caring for
individuals with HIV/AIDS, outreach services, medical
transportation, linguistic services, and referrals for health care
and support services).
``(2) Definition of medical outcomes.--In this subsection, the
term `medical outcomes' means those outcomes affecting the HIV-
related clinical status of an individual with HIV/AIDS.
``(d) Early Intervention Services.--
``(1) In general.--For purposes of this section, the term
`early intervention services' means HIV/AIDS early intervention
services described in section 2651(e), with follow-up referral
provided for the purpose of facilitating the access of individuals
receiving the services to HIV-related health services. The entities
through which such services may be provided under the grant include
public health departments, emergency rooms, substance abuse and
mental health treatment programs, detoxification centers, detention
facilities, clinics regarding sexually transmitted diseases,
homeless shelters, HIV/AIDS counseling and testing sites, health
care points of entry specified by States, federally qualified
health centers, and entities described in section 2652(a) that
constitute a point of access to services by maintaining referral
relationships.
``(2) Conditions.--With respect to an entity that proposes to
provide early intervention services under paragraph (1), such
paragraph shall apply only if the entity demonstrates to the
satisfaction of the chief elected official for the State involved
that--
``(A) Federal, State, or local funds are otherwise
inadequate for the early intervention services the entity
proposes to provide; and
``(B) the entity will expend funds pursuant to such
subparagraph to supplement and not supplant other funds
available to the entity for the provision of early intervention
services for the fiscal year involved.
``(e) Priority for Women, Infants, Children, and Youth.--
``(1) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with HIV/
AIDS, including treatment measures to prevent the perinatal
transmission of HIV, a State shall for each of such populations in
the eligible area use, from the grants made for the area under
section 2601(a) for a fiscal year, not less than the percentage
constituted by the ratio of the population involved (infants,
children, youth, or women in such area) with HIV/AIDS to the
general population in such area of individuals with HIV/AIDS.
``(2) Waiver.--With respect to the population involved, the
Secretary may provide to a State a waiver of the requirement of
paragraph (1) if such State demonstrates to the satisfaction of the
Secretary that the population is receiving HIV-related health
services through the State medicaid program under title XIX of the
Social Security Act, the State children's health insurance program
under title XXI of such Act, or other Federal or State programs.
``(f) Construction.--A State may not use amounts received under a
grant awarded under section 2611 to purchase or improve land, or to
purchase, construct, or permanently improve (other than minor
remodeling) any building or other facility, or to make cash payments to
intended recipients of services.''.
(b) HIV Care Consortia.--Section 2613 of the Public Health Service
Act (42 U.S.C. 300ff-23) is amended--
(1) in subsection (a), in the matter preceding paragraph (1)--
(A) by striking ``may use'' and inserting ``may, subject to
subsection (f), use''; and
(B) by striking ``section 2612(a)(1)'' and inserting
``section 2612(a)''; and
(2) by adding at the end the following subsection:
``(f) Allocation of Funds; Treatment as Support Services.--For
purposes of the requirement of section 2612(b)(1), expenditures of
grants under section 2611 for or through consortia under this section
are deemed to be support services, not core medical services. The
preceding sentence may not be construed as having any legal effect on
the provisions of subsection (a) that relate to authorized expenditures
of the grant.''.
(c) Technical Amendments.--Part B of title XXVI of the Public
Health Service Act (42 U.S.C. 300ff-21 et seq.) is amended--
(1) in section 2611--
(A) in subsection (a), by striking the subsection
designation and heading; and
(B) by striking subsection (b);
(2) in section 2614--
(A) in subsection (a), in the matter preceding paragraph
(1), by striking ``section 2612(a)(2)'' and inserting ``section
2612(b)(3)(J)''; and
(B) in subsection (c)(2)(B), by striking ``homemaker or'';
(3) in section 2615(a) by striking ``section 2612(a)(3)'' and
inserting ``section 2612(b)(3)(F)''; and
(4) in section 2616(a) by striking ``section 2612(a)(5)'' and
inserting ``section 2612(b)(3)(B)''.

54fc9399e09d73eb1f88846ea8511613c191cc31b5b7dc10450e924545ea7cce

(a) Requirement of Minimum Drug List.--Section 2616 of the Public
Health Service Act (42 U.S.C. 300ff-26) is amended--
(1) in subsection (c), by striking paragraph (1) and inserting
the following:
``(1) ensure that the therapeutics included on the list of
classes of core antiretroviral therapeutics established by the
Secretary under subsection (e) are, at a minimum, the treatments
provided by the State pursuant to this section;'';
(2) by redesignating subsection (e) as subsection (f); and
(3) by inserting after subsection (d) the following:
``(e) List of Classes of Core Antiretroviral Therapeutics.--For
purposes of subsection (c)(1), the Secretary shall develop and maintain
a list of classes of core antiretroviral therapeutics, which list shall
be based on the therapeutics included in the guidelines of the
Secretary known as the Clinical Practice Guidelines for Use of HIV/AIDS
Drugs, relating to drugs needed to manage symptoms associated with HIV.
The preceding sentence does not affect the authority of the Secretary
to modify such Guidelines.''.
(b) Drug Rebate Program.--Section 2616 of the Public Health Service
Act, as amended by subsection (a)(2) of this section, is amended by
adding at the end the following:
``(g) Drug Rebate Program.--A State shall ensure that any drug
rebates received on drugs purchased from funds provided pursuant to
this section are applied to activities supported under this subpart,
with priority given to activities described under this section.''.

dee506ebaabbc7e9b64ff06ff1b493b8cf5a8db8ac16215d3433a0a6d49ce7db

(a) Distribution Based on Living Cases of HIV/AIDS.--
(1) State distribution factor.--Section 2618(a)(2) of the
Public Health Service Act (42 U.S.C. 300ff-28(a)(2)) is amended--
(A) in subparagraph (B), by striking ``estimated number of
living cases of acquired immune deficiency syndrome in the
eligible area involved'' and inserting ``number of living cases
of HIV/AIDS in the State involved''; and
(B) by amending subparagraph (D) to read as follows:
``(D) Living cases of hiv/aids.--
``(i) Requirement of names-based reporting.--Except as
provided in clause (ii), the number determined under this
subparagraph for a State for a fiscal year for purposes of
subparagraph (B) is the number of living names-based cases
of HIV/AIDS in the State that, as of December 31 of the
most recent calendar year for which such data is available,
have been reported to and confirmed by the Director of the
Centers for Disease Control and Prevention.
``(ii) Transition period; exemption regarding non-aids
cases.--For each of the fiscal years 2007 through 2009, a
State is, subject to clauses (iii) through (v), exempt from
the requirement under clause (i) that living non-AIDS
names-based cases of HIV be reported unless--
``(I) a system was in operation as of December 31,
2005, that provides sufficiently accurate and reliable
names-based reporting of such cases throughout the
State, subject to clause (vii); or
``(II) no later than the beginning of fiscal year
2008 or 2009, the Secretary, after consultation with
the chief executive of the State, determines that a
system has become operational in the State that
provides sufficiently accurate and reliable names-based
reporting of such cases throughout the State.
``(iii) Requirements for exemption for fiscal year
2007.--For fiscal year 2007, an exemption under clause (ii)
for a State applies only if, by October 1, 2006--
``(I)(aa) the State had submitted to the Secretary
a plan for making the transition to sufficiently
accurate and reliable names-based reporting of living
non-AIDS cases of HIV; or
``(bb) all statutory changes necessary to provide
for sufficiently accurate and reliable reporting of
such cases had been made; and
``(II) the State had agreed that, by April 1, 2008,
the State will begin accurate and reliable names-based
reporting of such cases, except that such agreement is
not required to provide that, as of such date, the
system for such reporting be fully sufficient with
respect to accuracy and reliability throughout the
area.
``(iv) Requirement for exemption as of fiscal year
2008.--For each of the fiscal years 2008 through 2010, an
exemption under clause (ii) for a State applies only if, as
of April 1, 2008, the State is substantially in compliance
with the agreement under clause (iii)(II).
``(v) Progress toward names-based reporting.--For
fiscal year 2009, the Secretary may terminate an exemption
under clause (ii) for a State if the State submitted a plan
under clause (iii)(I)(aa) and the Secretary determines that
the State is not substantially following the plan.
``(vi) Counting of cases in areas with exemptions.--
``(I) In general.--With respect to a State that is
under a reporting system for living non-AIDS cases of
HIV that is not names-based (referred to in this
subparagraph as `code-based reporting'), the Secretary
shall, for purposes of this subparagraph, modify the
number of such cases reported for the State in order to
adjust for duplicative reporting in and among systems
that use code-based reporting.
``(II) Adjustment rate.--The adjustment rate under
subclause (I) for a State shall be a reduction of 5
percent in the number of living non-AIDS cases of HIV
reported for the State.
``(vii) List of states meeting standard regarding
december 31, 2005.--
``(I) In general.--If a State is specified in
subclause (II), the State shall be considered to meet
the standard described in clause (ii)(I). No other
State may be considered to meet such standard.
``(II) Relevant states.--For purposes of subclause
(I), the States specified in this subclause are the
following: Alaska, Alabama, Arkansas, Arizona,
Colorado, Florida, Indiana, Iowa, Idaho, Kansas,
Louisiana, Michigan, Minnesota, Missouri, Mississippi,
North Carolina, North Dakota, Nebraska, New Jersey, New
Mexico, New York, Nevada, Ohio, Oklahoma, South
Carolina, South Dakota, Tennessee, Texas, Utah,
Virginia, Wisconsin, West Virginia, Wyoming, Guam, and
the Virgin Islands.
``(viii) Rules of construction regarding acceptance of
reports.--
``(I) Cases of aids.--With respect to a State that
is subject to the requirement under clause (i) and is
not in compliance with the requirement for names-based
reporting of living non-AIDS cases of HIV, the
Secretary shall, notwithstanding such noncompliance,
accept reports of living cases of AIDS that are in
accordance with such clause.
``(II) Applicability of exemption requirements.--
The provisions of clauses (ii) through (vii) may not be
construed as having any legal effect for fiscal year
2010 or any subsequent fiscal year, and accordingly,
the status of a State for purposes of such clauses may
not be considered after fiscal year 2009.
``(ix) Program for detecting inaccurate or fraudulent
counting.--The Secretary shall carry out a program to
monitor the reporting of names-based cases for purposes of
this subparagraph and to detect instances of inaccurate
reporting, including fraudulent reporting.''.
(2) Non-ema distribution factor.--Section 2618(a)(2)(C) of the
Public Health Service Act (42 U.S.C. 300ff-28(a)(2)(C)) is
amended--
(A) in clause (i), by striking ``estimated number of living
cases of acquired immune deficiency syndrome'' each place such
term appears and inserting ``number of living cases of HIV/
AIDS''; and
(B) in clause (ii), by amending such clause to read as
follows:
``(ii) a number equal to the sum of--
``(I) the total number of living cases of HIV/AIDS
that are within areas in such State that are eligible
areas under subpart I of part A for the fiscal year
involved, which individual number for an area is the
number that applies under section 2601 for the area for
such fiscal year; and
``(II) the total number of such cases that are
within areas in such State that are transitional areas
under section 2609 for such fiscal year, which
individual number for an area is the number that
applies under such section for the fiscal year.''.
(b) Formula Amendments Generally.--Section 2618(a)(2) of the Public
Health Service Act (42 U.S.C. 300ff-28(a)(2)) is amended--
(1) in subparagraph (A)--
(A) by striking ``The amount referred to'' in the matter
preceding clause (i) and all that follows through the end of
clause (i) and inserting the following: ``For purposes of
paragraph (1), the amount referred to in this paragraph for a
State (including a territory) for a fiscal year is, subject to
subparagraphs (E) and (F)--
``(i) an amount equal to the amount made available
under section 2623 for the fiscal year involved for grants
pursuant to paragraph (1), subject to subparagraph (G);
and''; and
(B) in clause (ii)--
(i) in subclause (I)--
(I) by striking ``.80'' and inserting ``0.75''; and
(II) by striking ``and'' at the end;
(ii) in subclause (II)--
(I) by inserting ``non-EMA'' after ``respective'';
and
(II) by striking the period and inserting ``;
and''; and
(iii) by adding at the end the following:
``(III) if the State does not for such fiscal year
contain any area that is an eligible area under subpart
I of part A or any area that is a transitional area
under section 2609 (referred to in this subclause as a
`no-EMA State'), the product of 0.05 and the ratio of
the number of cases that applies for the State under
subparagraph (D) to the sum of the respective numbers
of cases that so apply for all no-EMA States.'';
(2) by striking subparagraphs (E) through (H);
(3) by inserting after subparagraph (D) the following
subparagraphs:
``(E) Code-based states; limitation on increase in grant.--
``(i) In general.--For each of the fiscal years 2007
through 2009, if code-based reporting (within the meaning
of subparagraph (D)(vi)) applies in a State as of the
beginning of the fiscal year involved, then notwithstanding
any other provision of this paragraph, the amount of the
grant pursuant to paragraph (1) for the State may not for
the fiscal year involved exceed by more than 5 percent the
amount of the grant pursuant to this paragraph for the
State for the preceding fiscal year, except that the
limitation under this clause may not result in a grant
pursuant to paragraph (1) for a fiscal year that is less
than the minimum amount that applies to the State under
such paragraph for such fiscal year.
``(ii) Use of amounts involved.--For each of the fiscal
years 2007 through 2009, amounts available as a result of
the limitation under clause (i) shall be made available by
the Secretary as additional amounts for grants pursuant to
section 2620, subject to subparagraph (H).''; and
(4) by redesignating subparagraph (I) as subparagraph (F).
(c) Separate ADAP Grants.--Section 2618(a)(2)(G) of the Public
Health Service Act (42 U.S.C. 300ff-28(a)(2)(G)), as redesignated by
subsection (b)(4) of this section, is amended--
(1) in clause (i)--
(A) in the matter preceding subclause (I), by striking
``section 2677'' and inserting ``section 2623'';
(B) in subclause (II), by striking the period at the end
and inserting a semicolon; and
(C) by adding after and below subclause (II) the following:
``which product shall then, as applicable, be increased
under subparagraph (H).'';
(2) in clause (ii)--
(A) by striking subclauses (I) through (III) and inserting
the following:
``(I) In general.--From amounts made available
under subclause (V), the Secretary shall award
supplemental grants to States described in subclause
(II) to enable such States to purchase and distribute
to eligible individuals under section 2616(b)
pharmaceutical therapeutics described under subsections
(c)(2) and (e) of such section.
``(II) Eligible states.--For purposes of subclause
(I), a State shall be an eligible State if the State
did not have unobligated funds subject to reallocation
under section 2618(d) in the previous fiscal year and,
in accordance with criteria established by the
Secretary, demonstrates a severe need for a grant under
this clause. For purposes of determining severe need,
the Secretary shall consider eligibility standards,
formulary composition, the number of eligible
individuals to whom a State is unable to provide
therapeutics described in section 2616(a), and an
unanticipated increase of eligible individuals with
HIV/AIDS.
``(III) State requirements.--The Secretary may not
make a grant to a State under this clause unless the
State agrees that the State will make available
(directly or through donations of public or private
entities) non-Federal contributions toward the
activities to be carried out under the grant in an
amount equal to $1 for each $4 of Federal funds
provided in the grant, except that the Secretary may
waive this subclause if the State has otherwise fully
complied with section 2617(d) with respect to the grant
year involved. The provisions of this subclause shall
apply to States that are not required to comply with
such section 2617(d).''.
(B) in subclause (IV), by moving the subclause two ems to
the left;
(C) in subclause (V), by striking ``3 percent'' and
inserting ``5 percent''; and
(D) by striking subclause (VI); and
(3) by adding at the end the following clause:
``(iii) Code-based states; limitation on increase in
formula grant.--The limitation under subparagraph (E)(i)
applies to grants pursuant to clause (i) of this
subparagraph to the same extent and in the same manner as
such limitation applies to grants pursuant to paragraph
(1), except that the reference to minimum grants does not
apply for purposes of this clause. Amounts available as a
result of the limitation under the preceding sentence shall
be made available by the Secretary as additional amounts
for grants under clause (ii) of this subparagraph.''.
(d) Hold Harmless.--Section 2618(a)(2) of the Public Health Service
Act (42 U.S.C. 300ff-28(a)(2)), as amended by subsection (b)(4) of this
section, is amended by adding at the end the following subparagraph:
``(H) Increase in formula grants.--
``(i) Assurance of amount.--
``(I) General rule.--For fiscal year 2007, the
Secretary shall ensure, subject to clauses (ii) through
(iv), that the total for a State of the grant pursuant
to paragraph (1) and the grant pursuant to subparagraph
(G) is not less than 95 percent of such total for the
State for fiscal year 2006.
``(II) Rule of construction.--With respect to the
application of subclause (I), the 95 percent
requirement under such subclause shall apply with
respect to each grant awarded under paragraph (1) and
with respect to each grant awarded under subparagraph
(G).
``(ii) Fiscal year 2007.--For purposes of clause (i) as
applied for fiscal year 2007, the references in such clause
to subparagraph (G) are deemed to be references to
subparagraph (I) as such subparagraph was in effect for
fiscal year 2006.
``(iii) Fiscal years 2008 and 2009.--For each of the
fiscal years 2008 and 2009, the Secretary shall ensure that
the total for a State of the grant pursuant to paragraph
(1) and the grant pursuant to subparagraph (G) is not less
than 100 percent of such total for the State for fiscal
year 2007.
``(iv) Source of funds for increase.--
``(I) In general.--From the amount reserved under
section 2623(b)(2) for a fiscal year, and from amounts
available for such section pursuant to subsection (d)
of this section, the Secretary shall make available
such amounts as may be necessary to comply with clause
(i).
``(II) Pro rata reduction.--If the amounts referred
to in subclause (I) for a fiscal year are insufficient
to fully comply with clause (i) for the year, the
Secretary, in order to provide the additional funds
necessary for such compliance, shall reduce on a pro
rata basis the amount of each grant pursuant to
paragraph (1) for the fiscal year, other than grants
for States for which increases under clause (i) apply
and other than States described in paragraph
(1)(A)(i)(I). A reduction under the preceding sentence
may not be made in an amount that would result in the
State involved becoming eligible for such an increase.
``(v) Applicability.--This paragraph may not be
construed as having any applicability after fiscal year
2009.''.
(e) Administrative Expenses; Clinical Quality Management.--Section
2618(b) of the Public Health Service Act (42 U.S.C. 300ff-28(b)) is
amended--
(1) by redesignating paragraphs (2) through (7) as paragraphs
(1) through (6);
(2) in paragraph (2) (as so redesignated)--
(A) by striking ``paragraph (5)'' and inserting ``paragraph
(4)''; and
(B) by striking ``paragraph (6)'' and inserting ``paragraph
(5)'';
(3) in paragraph (3) (as so redesignated)--
(A) by amending subparagraph (A) to read as follows:
``(A) In general.--Subject to paragraph (4), and except as
provided in paragraph (5), a State may not use more than 10
percent of amounts received under a grant awarded under section
2611 for administration.'';
(B) by redesignating subparagraphs (B) and (C) as
subparagraphs (C) and (D), respectively;
(C) by inserting after subparagraph (A) the following:
``(B) Allocations.--In the case of entities and
subcontractors to which a State allocates amounts received by
the State under a grant under section 2611, the State shall
ensure that, of the aggregate amount so allocated, the total of
the expenditures by such entities for administrative expenses
does not exceed 10 percent (without regard to whether
particular entities expend more than 10 percent for such
expenses).'';
(D) in subparagraph (C) (as so redesignated), by inserting
before the period the following: ``, including a clinical
quality management program under subparagraph (E)''; and
(E) by adding at the end the following:
``(E) Clinical quality management.--
``(i) Requirement.--Each State that receives a grant
under section 2611 shall provide for the establishment of a
clinical quality management program to assess the extent to
which HIV health services provided to patients under the
grant are consistent with the most recent Public Health
Service guidelines for the treatment of HIV/AIDS and
related opportunistic infection, and as applicable, to
develop strategies for ensuring that such services are
consistent with the guidelines for improvement in the
access to and quality of HIV health services.
``(ii) Use of funds.--
``(I) In general.--From amounts received under a
grant awarded under section 2611 for a fiscal year, a
State may use for activities associated with the
clinical quality management program required in clause
(i) not to exceed the lesser of--
``(aa) 5 percent of amounts received under the
grant; or
``(bb) $3,000,000.
``(II) Relation to limitation on administrative
expenses.--The costs of a clinical quality management
program under clause (i) may not be considered
administrative expenses for purposes of the limitation
established in subparagraph (A).'';
(4) in paragraph (4) (as so redesignated)--
(A) by striking ``paragraph (6)'' and inserting ``paragraph
(5)''; and
(B) by striking ``paragraphs (3) and (4)'' and inserting
``paragraphs (2) and (3)''; and
(5) in paragraph (5) (as so redesignated), by striking
``paragraphs (3)'' and all that follows through ``(5),'' and
inserting the following: ``paragraphs (2) and (3), may,
notwithstanding paragraphs (2) through (4),''.
(f) Reallocation for Supplemental Grants.--Section 2618(d) of the
Public Health Service Act (42 U.S.C. 300ff-28(d)) is amended to read as
follows:
``(d) Reallocation.--Any portion of a grant made to a State under
section 2611 for a fiscal year that has not been obligated as described
in subsection (c) ceases to be available to the State and shall be made
available by the Secretary for grants under section 2620, in addition
to amounts made available for such grants under section 2623(b)(2).''.
(g) Definitions; Other Technical Amendments.--Section 2618(a) of
the Public Health Service Act (42 U.S.C. 300ff-28(a)) is amended--
(1) in paragraph (1), in the matter preceding subparagraph (A),
by striking ``section 2677'' and inserting ``section 2623'';
(2) in paragraph (1)(A)--
(A) in the matter preceding clause (i), by striking ``each
of the several States and the District of Columbia'' and
inserting ``each of the 50 States, the District of Columbia,
Guam, and the Virgin Islands (referred to in this paragraph as
a `covered State')''; and
(B) in clause (i)--
(i) in subclause (I), by striking ``State or District''
and inserting ``covered State''; and
(ii) in subclause (II)--
(I) by striking ``State or District'' and inserting
``covered State''; and
(II) by inserting ``and'' after the semicolon; and
(3) in paragraph (1)(B), by striking ``each territory of the
United States, as defined in paragraph (3),'' and inserting ``each
territory other than Guam and the Virgin Islands'';
(4) in paragraph (2)(C)(i), by striking ``or territory''; and
(5) by striking paragraph (3).

0918821d8a9d3e7ae5386779e8d20438c4109695717cc083dbc59f79dd889889

(a) References to Part B.--Subpart I of part B of title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-21 et seq.) is amended by
striking ``this part'' each place such term appears and inserting
``section 2611''.
(b) Hepatitis.--Section 2614(a)(3) of the Public Health Service Act
(42 U.S.C. 300ff-24(a)(3)) is amended by inserting ``, including
specialty care and vaccinations for hepatitis co-infection,'' after
``health services''.
(c) Application for Grant.--
(1) Coordination.--Section 2617(b) of the Public Health Service
Act (42 U.S.C. 300ff-27(b)) is amended--
(A) by redesignating paragraphs (4) through (6) as
paragraphs (5) through (7), respectively;
(B) by inserting after paragraph (3), the following:
``(4) the designation of a lead State agency that shall--
``(A) administer all assistance received under this part;
``(B) conduct the needs assessment and prepare the State
plan under paragraph (3);
``(C) prepare all applications for assistance under this
part;
``(D) receive notices with respect to programs under this
title;
``(E) every 2 years, collect and submit to the Secretary
all audits, consistent with Office of Management and Budget
circular A133, from grantees within the State, including audits
regarding funds expended in accordance with this part; and
``(F) carry out any other duties determined appropriate by
the Secretary to facilitate the coordination of programs under
this title.'';
(C) in paragraph (5) (as so redesignated)--
(i) in subparagraph (E), by striking ``and'' at the
end; and
(ii) by inserting after subparagraph (F) the following:
``(G) includes key outcomes to be measured by all entities
in the State receiving assistance under this title; and''; and
(D) in paragraph (7) (as so redesignated), in subparagraph
(A)--
(i) by striking ``paragraph (5)'' and inserting
``paragraph (6)''; and
(ii) by striking ``paragraph (4)'' and inserting
``paragraph (5)''.
(2) Native american representation.--Section 2617(b)(6) of the
Public Health Service Act, as redesignated by paragraph (1)(A) of
this subsection, is amended by inserting before ``representatives
of grantees'' the following: ``members of a Federally recognized
Indian tribe as represented in the State,''.
(3) Payer of last resort.--Section 2617(b)(7)(F)(ii) of the
Public Health Service Act, as redesignated by paragraph (1)(A) of
this subsection, is amended by inserting before the semicolon the
following: ``(except for a program administered by or providing the
services of the Indian Health Service)''.
(d) Matching Funds; Applicability of Requirement.--Section
2617(d)(3) of the Public Health Service Act (42 U.S.C. 300ff-27(d)(3))
is amended--
(1) in subparagraph (A), by striking ``acquired immune
deficiency syndrome'' and inserting ``HIV/AIDS''; and
(2) in subparagraph (C), by striking ``acquired immune
deficiency syndrome'' and inserting ``HIV/AIDS''.

c1547aeb07b985bf31c5b4a9f041a1a5ea0b42fb8ff1c7b23588b87d81ddc2ad

Subpart I of part B of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-21 et seq.) is amended--
(1) by redesignating section 2620 as section 2621; and
(2) by inserting after section 2619 the following:
``SEC. 2620. SUPPLEMENTAL GRANTS.
``(a) In General.--For the purpose of providing services described
in section 2612(a), the Secretary shall make grants to States--
``(1) whose applications under section 2617 have demonstrated
the need in the State, on an objective and quantified basis, for
supplemental financial assistance to provide such services; and
``(2) that did not, for the most recent grant year pursuant to
section 2618(a)(1) or 2618(a)(2)(G)(i) for which data is available,
have more than 2 percent of grant funds under such sections
canceled or covered by any waivers under section 2622(c).
``(b) Demonstrated Need.--The factors considered by the Secretary
in determining whether an eligible area has a demonstrated need for
purposes of subsection (a)(1) may include any or all of the following:
``(1) The unmet need for such services, as determined under
section 2617(b).
``(2) An increasing need for HIV/AIDS-related services,
including relative rates of increase in the number of cases of HIV/
AIDS.
``(3) The relative rates of increase in the number of cases of
HIV/AIDS within new or emerging subpopulations.
``(4) The current prevalence of HIV/AIDS.
``(5) Relevant factors related to the cost and complexity of
delivering health care to individuals with HIV/AIDS in the eligible
area.
``(6) The impact of co-morbid factors, including co-occurring
conditions, determined relevant by the Secretary.
``(7) The prevalence of homelessness.
``(8) The prevalence of individuals described under section
2602(b)(2)(M).
``(9) The relevant factors that limit access to health care,
including geographic variation, adequacy of health insurance
coverage, and language barriers.
``(10) The impact of a decline in the amount received pursuant
to section 2618 on services available to all individuals with HIV/
AIDS identified and eligible under this title.
``(c) Priority in Making Grants.--The Secretary shall provide funds
under this section to a State to address the decline in services
related to the decline in the amounts received pursuant to section 2618
consistent with the grant award to the State for fiscal year 2006, to
the extent that the factor under subsection (b)(10) (relating to a
decline in funding) applies to the State.
``(d) Report on the Awarding of Supplemental Funds.--Not later than
45 days after the awarding of supplemental funds under this section,
the Secretary shall submit to Congress a report concerning such funds.
Such report shall include information detailing--
``(1) the total amount of supplemental funds available under
this section for the year involved;
``(2) the amount of supplemental funds used in accordance with
the hold harmless provisions of section 2618(a)(2);
``(3) the amount of supplemental funds disbursed pursuant to
subsection (c);
``(4) the disbursement of the remainder of the supplemental
funds after taking into account the uses described in paragraphs
(2) and (3); and
``(5) the rationale used for the amount of funds disbursed as
described under paragraphs (2), (3), and (4).
``(e) Core Medical Services.--The provisions of section 2612(b)
apply with respect to a grant under this section to the same extent and
in the same manner as such provisions apply with respect to a grant
made pursuant to section 2618(a)(1).
``(f) Applicability of Grant Authority.--The authority to make
grants under this section applies beginning with the first fiscal year
for which amounts are made available for such grants under section
2623(b)(1).''.

3e0a6b74ed67e646d2a5d70a742e22e4c753d9adafce13603982c624b930d94f

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

f118bed644a4c3790f9cc363b5e511a3cf4d53b5400fc87e01ee3249776b5c89

Subpart I of part B of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-21 et seq.), as amended by section 205, is further
amended by adding at the end the following:
``SEC. 2622. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT FUNDS.
``(a) Obligation by end of Grant Year.--Effective for fiscal year
2007 and subsequent fiscal years, funds from a grant award made to a
State for a fiscal year pursuant to section 2618(a)(1) or
2618(a)(2)(G), or under section 2620 or 2621, are available for
obligation by the State through the end of the one-year period
beginning on the date in such fiscal year on which funds from the award
first become available to the State (referred to in this section as the
`grant year for the award'), except as provided in subsection (c)(1).
``(b) Supplemental Grants; Cancellation of Unobligated Balance of
Grant Award.--Effective for fiscal year 2007 and subsequent fiscal
years, if a grant award made to a State for a fiscal year pursuant to
section 2618(a)(2)(G)(ii), or under section 2620 or 2621, has an
unobligated balance as of the end of the grant year for the award--
``(1) the Secretary shall cancel that unobligated balance of
the award, and shall require the State to return any amounts from
such balance that have been disbursed to the State; and
``(2) the funds involved shall be made available by the
Secretary as additional amounts for grants pursuant to section 2620
for the first fiscal year beginning after the fiscal year in which
the Secretary obtains the information necessary for determining
that the balance is required under paragraph (1) to be canceled,
except that the availability of the funds for such grants is
subject to section 2618(a)(2)(H) as applied for such year.
``(c) Formula Grants; Cancellation of Unobligated Balance of Grant
Award; Waiver Permitting Carryover.--
``(1) In general.--Effective for fiscal year 2007 and
subsequent fiscal years, if a grant award made to a State for a
fiscal year pursuant to section 2618(a)(1) or 2618(a)(2)(G)(i) has
an unobligated balance as of the end of the grant year for the
award, the Secretary shall cancel that unobligated balance of the
award, and shall require the State to return any amounts from such
balance that have been disbursed to the State, unless--
``(A) before the end of the grant year, the State submits
to the Secretary a written application for a waiver of the
cancellation, which application includes a description of the
purposes for which the State intends to expend the funds
involved; and
``(B) the Secretary approves the waiver.
``(2) Expenditure by end of carryover year.--With respect to a
waiver under paragraph (1) that is approved for a balance that is
unobligated as of the end of a grant year for an award:
``(A) The unobligated funds are available for expenditure
by the State involved for the one-year period beginning upon
the expiration of the grant year (referred to in this section
as the `carryover year').
``(B) If the funds are not expended by the end of the
carryover year, the Secretary shall cancel that unexpended
balance of the award, and shall require the State to return any
amounts from such balance that have been disbursed to the
State.
``(3) Use of cancelled balances.--In the case of any balance of
a grant award that is cancelled under paragraph (1) or (2)(B), the
grant funds involved shall be made available by the Secretary as
additional amounts for grants under section 2620 for the first
fiscal year beginning after the fiscal year in which the Secretary
obtains the information necessary for determining that the balance
is required under such paragraph to be canceled, except that the
availability of the funds for such grants is subject to section
2618(a)(2)(H) as applied for such year.
``(4) Corresponding reduction in future grant.--
``(A) In general.--In the case of a State for which a
balance from a grant award made pursuant to section 2618(a)(1)
or 2618(a)(2)(G)(i) is unobligated as of the end of the grant
year for the award--
``(i) the Secretary shall reduce, by the same amount as
such unobligated balance, the amount of the grant under
such section for the first fiscal year beginning after the
fiscal year in which the Secretary obtains the information
necessary for determining that such balance was unobligated
as of the end of the grant year (which requirement for a
reduction applies without regard to whether a waiver under
paragraph (1) has been approved with respect to such
balance); and
``(ii) the grant funds involved in such reduction shall
be made available by the Secretary as additional funds for
grants under section 2620 for such first fiscal year,
subject to section 2618(a)(2)(H);
except that this subparagraph does not apply to the State if
the amount of the unobligated balance was 2 percent or less.
``(B) Relation to increases in grant.--A reduction under
subparagraph (A) for a State for a fiscal year may not be taken
into account in applying section 2618(a)(2)(H) with respect to
the State for the subsequent fiscal year.
``(d) Treatment of Drug Rebates.--For purposes of this section,
funds that are drug rebates referred to in section 2616(g) may not be
considered part of any grant award referred to in subsection (a).''.

2bf137602058cac642e53d9459ee970d78a986a61a5273fa3167b8ed28cc23f7

Subpart I of part B of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-21 et seq.), as amended by section 207, is further
amended by adding at the end the following:
``SEC. 2623. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--For the purpose of carrying out this subpart,
there are authorized to be appropriated $1,195,500,000 for fiscal year
2007, $1,239,500,000 for fiscal year 2008, and $1,285,200,000 for
fiscal year 2009. Amounts appropriated under the preceding sentence for
a fiscal year are available for obligation by the Secretary until the
end of the second succeeding fiscal year.
``(b) Reservation of Amounts.--
``(1) Emerging communities.--Of the amount appropriated under
subsection (a) for a fiscal year, the Secretary shall reserve
$5,000,000 for grants under section 2621.
``(2) Supplemental grants.--
``(A) In general.--Of the amount appropriated under
subsection (a) for a fiscal year in excess of the 2006 adjusted
amount, the Secretary shall reserve \1/3\ for grants under
section 2620, except that the availability of the reserved
funds for such grants is subject to section 2618(a)(2)(H) as
applied for such year, and except that any amount appropriated
exclusively for carrying out section 2616 (and, accordingly,
distributed under section 2618(a)(2)(G)) is not subject to this
subparagraph.
``(B) 2006 adjusted amount.--For purposes of subparagraph
(A), the term `2006 adjusted amount' means the amount
appropriated for fiscal year 2006 under section 2677(b) (as
such section was in effect for such fiscal year), excluding any
amount appropriated for such year exclusively for carrying out
section 2616 (and, accordingly, distributed under section
2618(a)(2)(I), as so in effect).''.

bed3e45b27b182d2c9ecd511d3a71b56fbff1c3340973f4c3ba88984e6ea3c26

Section 2625 of the Public Health Service Act (42 U.S.C. 300ff-33)
is amended to read as follows:
``SEC. 2625. EARLY DIAGNOSIS GRANT PROGRAM.
``(a) In General.--In the case of States whose laws or regulations
are in accordance with subsection (b), the Secretary, acting through
the Centers for Disease Control and Prevention, shall make grants to
such States for the purposes described in subsection (c).
``(b) Description of Compliant States.--For purposes of subsection
(a), the laws or regulations of a State are in accordance with this
subsection if, under such laws or regulations (including programs
carried out pursuant to the discretion of State officials), both of the
policies described in paragraph (1) are in effect, or both of the
policies described in paragraph (2) are in effect, as follows:
``(1)(A) Voluntary opt-out testing of pregnant women.
``(B) Universal testing of newborns.
``(2)(A) Voluntary opt-out testing of clients at sexually
transmitted disease clinics.
``(B) Voluntary opt-out testing of clients at substance abuse
treatment centers.
The Secretary shall periodically ensure that the applicable policies
are being carried out and recertify compliance.
``(c) Use of Funds.--A State may use funds provided under
subsection (a) for HIV/AIDS testing (including rapid testing),
prevention counseling, treatment of newborns exposed to HIV/AIDS,
treatment of mothers infected with HIV/AIDS, and costs associated with
linking those diagnosed with HIV/AIDS to care and treatment for HIV/
AIDS.
``(d) Application.--A State that is eligible for the grant under
subsection (a) shall submit an application to the Secretary, in such
form, in such manner, and containing such information as the Secretary
may require.
``(e) Limitation on Amount of Grant.--A grant under subsection (a)
to a State for a fiscal year may not be made in an amount exceeding
$10,000,000.
``(f) Rule of Construction.--Nothing in this section shall be
construed to pre-empt State laws regarding HIV/AIDS counseling and
testing.
``(g) Definitions.--In this section:
``(1) The term `voluntary opt-out testing' means HIV/AIDS
testing--
``(A) that is administered to an individual seeking other
health care services; and
``(B) in which--
``(i) pre-test counseling is not required but the
individual is informed that the individual will receive an
HIV/AIDS test and the individual may opt out of such
testing; and
``(ii) for those individuals with a positive test
result, post-test counseling (including referrals for care)
is provided and confidentiality is protected.
``(2) The term `universal testing of newborns' means HIV/AIDS
testing that is administered within 48 hours of delivery to--
``(A) all infants born in the State; or
``(B) all infants born in the State whose mother's HIV/AIDS
status is unknown at the time of delivery.
``(h) Authorization of Appropriations.--Of the funds appropriated
annually to the Centers for Disease Control and Prevention for HIV/AIDS
prevention activities, $30,000,000 shall be made available for each of
the fiscal years 2007 through 2009 for grants under subsection (a), of
which $20,000,000 shall be made available for grants to States with the
policies described in subsection (b)(1), and $10,000,000 shall be made
available for grants to States with the policies described in
subsection (b)(2). Funds provided under this section are available
until expended.''.

7612350c75dc646183218336c3946631d7e9e0330585d8aea3a7f8de71fc2d6c

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

e1c8af296e54acacc7113326b8e59ecb1d0a3fc9bd8af09150b8d605cf44a381

(a) In General.--Section 2651 of the Public Health Service Act (42
U.S.C. 300ff-51) is amended to read as follows:
``SEC. 2651. ESTABLISHMENT OF A PROGRAM.
``(a) In General.--For the purposes described in subsection (b),
the Secretary, acting through the Administrator of the Health Resources
and Services Administration, may make grants to public and nonprofit
private entities specified in section 2652(a).
``(b) Requirements.--
``(1) In general.--The Secretary may not make a grant under
subsection (a) unless the applicant for the grant agrees to expend
the grant only for--
``(A) core medical services described in subsection (c);
``(B) support services described in subsection (d); and
``(C) administrative expenses as described in section
2664(g)(3).
``(2) Early intervention services.--An applicant for a grant
under subsection (a) shall expend not less than 50 percent of the
amount received under the grant for the services described in
subparagraphs (B) through (E) of subsection (e)(1) for individuals
with HIV/AIDS.
``(c) Required Funding for Core Medical Services.--
``(1) In general.--With respect to a grant under subsection (a)
to an applicant for a fiscal year, the applicant shall, of the
portion of the grant remaining after reserving amounts for purposes
of paragraphs (3) and (5) of section 2664(g), use not less than 75
percent to provide core medical services that are needed in the
area involved for individuals with HIV/AIDS who are identified and
eligible under this title (including services regarding the co-
occurring conditions of the individuals).
``(2) Waiver.--
``(A) The Secretary shall waive the application of
paragraph (1) with respect to an applicant for a grant if the
Secretary determines that, within the service area of the
applicant--
``(i) there are no waiting lists for AIDS Drug
Assistance Program services under section 2616; and
``(ii) core medical services are available to all
individuals with HIV/AIDS identified and eligible under
this title.
``(B) Notification of waiver status.--When informing an
applicant that a grant under subsection (a) is being made for a
fiscal year, the Secretary shall inform the applicant whether a
waiver under subparagraph (A) is in effect for the fiscal year.
``(3) Core medical services.--For purposes of this subsection,
the term `core medical services', with respect to an individual
with HIV/AIDS (including the co-occurring conditions of the
individual) means the following services:
``(A) Outpatient and ambulatory health services.
``(B) AIDS Drug Assistance Program treatments under section
2616.
``(C) AIDS pharmaceutical assistance.
``(D) Oral health care.
``(E) Early intervention services described in subsection
(e).
``(F) Health insurance premium and cost sharing assistance
for low-income individuals in accordance with section 2615.
``(G) Home health care.
``(H) Medical nutrition therapy.
``(I) Hospice services.
``(J) Home and community-based health services as defined
under section 2614(c).
``(K) Mental health services.
``(L) Substance abuse outpatient care.
``(M) Medical case management, including treatment
adherence services.
``(d) Support Services.--
``(1) In general.--For purposes of this section, the term
`support services' means services, subject to the approval of the
Secretary, that are needed for individuals with HIV/AIDS to achieve
their medical outcomes (such as respite care for persons caring for
individuals with HIV/AIDS, outreach services, medical
transportation, linguistic services, and referrals for health care
and support services).
``(2) Definition of medical outcomes.--In this section, the
term `medical outcomes' means those outcomes affecting the HIV-
related clinical status of an individual with HIV/AIDS.
``(e) Specification of Early Intervention Services.--
``(1) In general.--The early intervention services referred to
in this section are--
``(A) counseling individuals with respect to HIV/AIDS in
accordance with section 2662;
``(B) testing individuals with respect to HIV/AIDS,
including tests to confirm the presence of the disease, tests
to diagnose the extent of the deficiency in the immune system,
and tests to provide information on appropriate therapeutic
measures for preventing and treating the deterioration of the
immune system and for preventing and treating conditions
arising from HIV/AIDS;
``(C) referrals described in paragraph (2);
``(D) other clinical and diagnostic services regarding HIV/
AIDS, and periodic medical evaluations of individuals with HIV/
AIDS; and
``(E) providing the therapeutic measures described in
subparagraph (B).
``(2) Referrals.--The services referred to in paragraph (1)(C)
are referrals of individuals with HIV/AIDS to appropriate providers
of health and support services, including, as appropriate--
``(A) to entities receiving amounts under part A or B for
the provision of such services;
``(B) to biomedical research facilities of institutions of
higher education that offer experimental treatment for such
disease, or to community-based organizations or other entities
that provide such treatment; or
``(C) to grantees under section 2671, in the case of a
pregnant woman.
``(3) Requirement of availability of all early intervention
services through each grantee.--
``(A) In general.--The Secretary may not make a grant under
subsection (a) unless the applicant for the grant agrees that
each of the early intervention services specified in paragraph
(2) will be available through the grantee. With respect to
compliance with such agreement, such a grantee may expend the
grant to provide the early intervention services directly, and
may expend the grant to enter into agreements with public or
nonprofit private entities, or private for-profit entities if
such entities are the only available provider of quality HIV
care in the area, under which the entities provide the
services.
``(B) Other requirements.--Grantees described in--
``(i) subparagraphs (A), (D), (E), and (F) of section
2652(a)(1) shall use not less than 50 percent of the amount
of such a grant to provide the services described in
subparagraphs (A), (B), (D), and (E) of paragraph (1)
directly and on-site or at sites where other primary care
services are rendered; and
``(ii) subparagraphs (B) and (C) of section 2652(a)(1)
shall ensure the availability of early intervention
services through a system of linkages to community-based
primary care providers, and to establish mechanisms for the
referrals described in paragraph (1)(C), and for follow-up
concerning such referrals.''.
(b) Administrative Expenses; Clinical Quality Management Program.--
Section 2664(g) of the Public Health Service Act (42 U.S.C. 300ff-
64(g)) is amended--
(1) in paragraph (3), by amending the paragraph to read as
follows:
``(3) the applicant will not expend more than 10 percent of the
grant for administrative expenses with respect to the grant,
including planning and evaluation, except that the costs of a
clinical quality management program under paragraph (5) may not be
considered administrative expenses for purposes of such
limitation;''; and
(2) in paragraph (5), by inserting ``clinical'' before
``quality management''.

7e3ea9e8f419a1eeac055cd39ed65356f69b8345a6121f9b1f1423f2b45b6030

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

5c61f43f8fd9231bfc867625e18b0670a602822b5defd0593c6bd3dd087e4f08

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

a6068d445716c61a65f51adfab71aa38ba92ae8f922dccc3f4773ea6399c3e37

Section 2661 of the Public Health Service Act (42 U.S.C. 300ff-61)
is amended to read as follows:
``SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT.
``(a) Confidentiality.--The Secretary may not make a grant under
this part unless, in the case of any entity applying for a grant under
section 2651, the entity agrees to ensure that information regarding
the receipt of early intervention services pursuant to the grant is
maintained confidentially in a manner not inconsistent with applicable
law.
``(b) Informed Consent.--The Secretary may not make a grant under
this part unless the applicant for the grant agrees that, in testing an
individual for HIV/AIDS, the applicant will test an individual only
after the individual confirms that the decision of the individual with
respect to undergoing such testing is voluntarily made.''.

e0c073451b8f736e826634f24bb08e197d092587a5b821b0e4d5cfaf1eff7a79

Section 2662 of the Public Health Service Act (42 U.S.C. 300ff-62)
is amended to read as follows:
``SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.
``(a) Counseling of Individuals With Negative Test Results.--The
Secretary may not make a grant under this part unless the applicant for
the grant agrees that, if the results of testing conducted for HIV/AIDS
indicate that an individual does not have such condition, the applicant
will provide the individual information, including--
``(1) measures for prevention of, exposure to, and transmission
of HIV/AIDS, hepatitis B, hepatitis C, and other sexually
transmitted diseases;
``(2) the accuracy and reliability of results of testing for
HIV/AIDS, hepatitis B, and hepatitis C;
``(3) the significance of the results of such testing,
including the potential for developing AIDS, hepatitis B, or
hepatitis C;
``(4) the appropriateness of further counseling, testing, and
education of the individual regarding HIV/AIDS and other sexually
transmitted diseases;
``(5) if diagnosed with chronic hepatitis B or hepatitis C co-
infection, the potential of developing hepatitis-related liver
disease and its impact on HIV/AIDS; and
``(6) information regarding the availability of hepatitis B
vaccine and information about hepatitis treatments.
``(b) Counseling of Individuals With Positive Test Results.--The
Secretary may not make a grant under this part unless the applicant for
the grant agrees that, if the results of testing for HIV/AIDS indicate
that the individual has such condition, the applicant will provide to
the individual appropriate counseling regarding the condition,
including--
``(1) information regarding--
``(A) measures for prevention of, exposure to, and
transmission of HIV/AIDS, hepatitis B, and hepatitis C;
``(B) the accuracy and reliability of results of testing
for HIV/AIDS, hepatitis B, and hepatitis C; and
``(C) the significance of the results of such testing,
including the potential for developing AIDS, hepatitis B, or
hepatitis C;
``(2) reviewing the appropriateness of further counseling,
testing, and education of the individual regarding HIV/AIDS and
other sexually transmitted diseases; and
``(3) providing counseling--
``(A) on the availability, through the applicant, of early
intervention services;
``(B) on the availability in the geographic area of
appropriate health care, mental health care, and social and
support services, including providing referrals for such
services, as appropriate;
``(C)(i) that explains the benefits of locating and
counseling any individual by whom the infected individual may
have been exposed to HIV/AIDS, hepatitis B, or hepatitis C and
any individual whom the infected individual may have exposed to
HIV/AIDS, hepatitis B, or hepatitis C; and
``(ii) that emphasizes it is the duty of infected
individuals to disclose their infected status to their sexual
partners and their partners in the sharing of hypodermic
needles; that provides advice to infected individuals on the
manner in which such disclosures can be made; and that
emphasizes that it is the continuing duty of the individuals to
avoid any behaviors that will expose others to HIV/AIDS,
hepatitis B, or hepatitis C; and
``(D) on the availability of the services of public health
authorities with respect to locating and counseling any
individual described in subparagraph (C);
``(4) if diagnosed with chronic hepatitis B or hepatitis C co-
infection, the potential of developing hepatitis-related liver
disease and its impact on HIV/AIDS; and
``(5) information regarding the availability of hepatitis B
vaccine.
``(c) Additional Requirements Regarding Appropriate Counseling.--
The Secretary may not make a grant under this part unless the applicant
for the grant agrees that, in counseling individuals with respect to
HIV/AIDS, the applicant will ensure that the counseling is provided
under conditions appropriate to the needs of the individuals.
``(d) Counseling of Emergency Response Employees.--The Secretary
may not make a grant under this part to a State unless the State agrees
that, in counseling individuals with respect to HIV/AIDS, the State
will ensure that, in the case of emergency response employees, the
counseling is provided to such employees under conditions appropriate
to the needs of the employees regarding the counseling.
``(e) Rule of Construction Regarding Counseling Without Testing.--
Agreements made pursuant to this section may not be construed to
prohibit any grantee under this part from expending the grant for the
purpose of providing counseling services described in this section to
an individual who does not undergo testing for HIV/AIDS as a result of
the grantee or the individual determining that such testing of the
individual is not appropriate.''.

c8e3194d21a77ee068774c702d426cb79bf80137f732e67614d4319a1a5fe116

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

8a1b5bbab622ee7ba4cdc7b8966d7e48eae4d88987865326ce3e00aeab5a212d

Part D of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-71 et seq.) is amended to read as follows:
``PART D--WOMEN, INFANTS, CHILDREN, AND YOUTH
``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR
WOMEN, INFANTS, CHILDREN, AND YOUTH.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall award grants
to public and nonprofit private entities (including a health facility
operated by or pursuant to a contract with the Indian Health Service)
for the purpose of providing family-centered care involving outpatient
or ambulatory care (directly or through contracts) for women, infants,
children, and youth with HIV/AIDS.
``(b) Additional Services for Patients and Families.--Funds
provided under grants awarded under subsection (a) may be used for the
following support services:
``(1) Family-centered care including case management.
``(2) Referrals for additional services including--
``(A) referrals for inpatient hospital services, treatment
for substance abuse, and mental health services; and
``(B) referrals for other social and support services, as
appropriate.
``(3) Additional services necessary to enable the patient and
the family to participate in the program established by the
applicant pursuant to such subsection including services designed
to recruit and retain youth with HIV.
``(4) The provision of information and education on
opportunities to participate in HIV/AIDS-related clinical research.
``(c) Coordination With Other Entities.--A grant awarded under
subsection (a) may be made only if the applicant provides an agreement
that includes the following:
``(1) The applicant will coordinate activities under the grant
with other providers of health care services under this Act, and
under title V of the Social Security Act, including programs
promoting the reduction and elimination of risk of HIV/AIDS for
youth.
``(2) The applicant will participate in the statewide
coordinated statement of need under part B (where it has been
initiated by the public health agency responsible for administering
grants under part B) and in revisions of such statement.
``(3) The applicant will every 2 years submit to the lead State
agency under section 2617(b)(4) audits regarding funds expended in
accordance with this title and shall include necessary client-level
data to complete unmet need calculations and Statewide coordinated
statements of need process.
``(d) Administration; Application.--A grant may only be awarded to
an entity under subsection (a) if an application for the grant is
submitted to the Secretary and the application is in such form, is made
in such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to carry out
this section. Such application shall include the following:
``(1) Information regarding how the expected expenditures of
the grant are related to the planning process for localities funded
under part A (including the planning process outlined in section
2602) and for States funded under part B (including the planning
process outlined in section 2617(b)).
``(2) A specification of the expected expenditures and how
those expenditures will improve overall patient outcomes, as
outlined as part of the State plan (under section 2617(b)) or
through additional outcome measures.
``(e) Annual Review of Programs; Evaluations.--
``(1) Review regarding access to and participation in
programs.--With respect to a grant under subsection (a) for an
entity for a fiscal year, the Secretary shall, not later than 180
days after the end of the fiscal year, provide for the conduct and
completion of a review of the operation during the year of the
program carried out under such subsection by the entity. The
purpose of such review shall be the development of recommendations,
as appropriate, for improvements in the following:
``(A) Procedures used by the entity to allocate
opportunities and services under subsection (a) among patients
of the entity who are women, infants, children, or youth.
``(B) Other procedures or policies of the entity regarding
the participation of such individuals in such program.
``(2) Evaluations.----The Secretary shall, directly or through
contracts with public and private entities, provide for evaluations
of programs carried out pursuant to subsection (a).
``(f) Administrative Expenses.--
``(1) Limitation.--A grantee may not use more than 10 percent
of amounts received under a grant awarded under this section for
administrative expenses.
``(2) Clinical quality management program.--A grantee under
this section shall implement a clinical quality management program
to assess the extent to which HIV health services provided to
patients under the grant are consistent with the most recent Public
Health Service guidelines for the treatment of HIV/AIDS and related
opportunistic infection, and as applicable, to develop strategies
for ensuring that such services are consistent with the guidelines
for improvement in the access to and quality of HIV health
services.
``(g) Training and Technical Assistance.--From the amounts
appropriated under subsection (i) for a fiscal year, the Secretary may
use not more than 5 percent to provide, directly or through contracts
with public and private entities (which may include grantees under
subsection (a)), training and technical assistance to assist applicants
and grantees under subsection (a) in complying with the requirements of
this section.
``(h) Definitions.--In this section:
``(1) Administrative expenses.--The term `administrative
expenses' means funds that are to be used by grantees for grant
management and monitoring activities, including costs related to
any staff or activity unrelated to services or indirect costs.
``(2) Indirect costs.--The term `indirect costs' means costs
included in a Federally negotiated indirect rate.
``(3) Services.--The term `services' means--
``(A) services that are provided to clients to meet the
goals and objectives of the program under this section,
including the provision of professional, diagnostic, and
therapeutic services by a primary care provider or a referral
to and provision of specialty care; and
``(B) services that sustain program activity and contribute
to or help improve services under subparagraph (A).
``(i) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated, $71,800,000
for each of the fiscal years 2007 through 2009.''.

4221611bf098b04655f59e55ca19f991eeed503b7f1f66dc91b9143dde90e240

TITLE IV

-WOMEN, INFANTS, CHILDREN, AND YOUTH

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

1fea11395fd1a2f756743df8ca8f4d7a8bbd3e2c3a6b001e345420bb3cec576f

Part E of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-80 et seq.) is amended to read as follows:
``PART E--GENERAL PROVISIONS
``SEC. 2681. COORDINATION.
``(a) Requirement.--The Secretary shall ensure that the Health
Resources and Services Administration, the Centers for Disease Control
and Prevention, the Substance Abuse and Mental Health Services
Administration, and the Centers for Medicare & Medicaid Services
coordinate the planning, funding, and implementation of Federal HIV
programs (including all minority AIDS initiatives of the Public Health
Service, including under section 2693) to enhance the continuity of
care and prevention services for individuals with HIV/AIDS or those at
risk of such disease. The Secretary shall consult with other Federal
agencies, including the Department of Veterans Affairs, as needed and
utilize planning information submitted to such agencies by the States
and entities eligible for assistance under this title.
``(b) Report.--The Secretary shall biennially prepare and submit to
the appropriate committees of the Congress a report concerning the
coordination efforts at the Federal, State, and local levels described
in this section, including a description of Federal barriers to HIV
program integration and a strategy for eliminating such barriers and
enhancing the continuity of care and prevention services for
individuals with HIV/AIDS or those at risk of such disease.
``(c) Integration by State.--As a condition of receipt of funds
under this title, a State shall provide assurances to the Secretary
that health support services funded under this title will be integrated
with other such services, that programs will be coordinated with other
available programs (including Medicaid), and that the continuity of
care and prevention services of individuals with HIV/AIDS is enhanced.
``(d) Integration by Local or Private Entities.--As a condition of
receipt of funds under this title, a local government or private
nonprofit entity shall provide assurances to the Secretary that
services funded under this title will be integrated with other such
services, that programs will be coordinated with other available
programs (including Medicaid), and that the continuity of care and
prevention services of individuals with HIV is enhanced.
``SEC. 2682. AUDITS.
``(a) In General.--For fiscal year 2009, and each subsequent fiscal
year, the Secretary may reduce the amounts of grants under this title
to a State or political subdivision of a State for a fiscal year if,
with respect to such grants for the second preceding fiscal year, the
State or subdivision fails to prepare audits in accordance with the
procedures of section 7502 of title 31, United States Code. The
Secretary shall annually select representative samples of such audits,
prepare summaries of the selected audits, and submit the summaries to
the Congress.
``(b) Posting on the Internet.--All audits that the Secretary
receives from the State lead agency under section 2617(b)(4) shall be
posted, in their entirety, on the Internet website of the Health
Resources and Services Administration.
``SEC. 2683. PUBLIC HEALTH EMERGENCY.
``(a) In General.--In an emergency area and during an emergency
period, the Secretary shall have the authority to waive such
requirements of this title to improve the health and safety of those
receiving care under this title and the general public, except that the
Secretary may not expend more than 5 percent of the funds allocated
under this title for sections 2620 and section 2603(b).
``(b) Emergency Area and Emergency Period.--In this section:
``(1) Emergency area.--The term `emergency area' means a
geographic area in which there exists--
``(A) an emergency or disaster declared by the President
pursuant to the National Emergencies Act or the Robert T.
Stafford Disaster Relief and Emergency Assistance Act; or
``(B) a public health emergency declared by the Secretary
pursuant to section 319.
``(2) Emergency period.--The term `emergency period' means the
period in which there exists--
``(A) an emergency or disaster declared by the President
pursuant to the National Emergencies Act or the Robert T.
Stafford Disaster Relief and Emergency Assistance Act; or
``(B) a public health emergency declared by the Secretary
pursuant to section 319.
``(c) Unobligated Funds.--If funds under a grant under this section
are not expended for an emergency in the fiscal year in which the
emergency is declared, such funds shall be returned to the Secretary
for reallocation under sections 2603(b) and 2620.
``SEC. 2684. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.
``None of the funds appropriated under this title shall be used to
fund AIDS programs, or to develop materials, designed to promote or
encourage, directly, intravenous drug use or sexual activity, whether
homosexual or heterosexual. Funds authorized under this title may be
used to provide medical treatment and support services for individuals
with HIV.
``SEC. 2685. PRIVACY PROTECTIONS.
``(a) In General.--The Secretary shall ensure that any information
submitted to, or collected by, the Secretary under this title excludes
any personally identifiable information.
``(b) Definition.--In this section, the term `personally
identifiable information' has the meaning given such term under the
regulations promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996.
``SEC. 2686. GAO REPORT.
``The Comptroller General of the Government Accountability Office
shall biennially submit to the appropriate committees of Congress a
report that includes a description of Federal, State, and local
barriers to HIV program integration, particularly for racial and ethnic
minorities, including activities carried out under subpart III of part
F, and recommendations for enhancing the continuity of care and the
provision of prevention services for individuals with HIV/AIDS or those
at risk for such disease. Such report shall include a demonstration of
the manner in which funds under this subpart are being expended and to
what extent the services provided with such funds increase access to
prevention and care services for individuals with HIV/AIDS and build
stronger community linkages to address HIV prevention and care for
racial and ethnic minority communities.
``SEC. 2687. SEVERITY OF NEED INDEX.
``(a) Development of Index.--Not later than September 30, 2008, the
Secretary shall develop and submit to the appropriate committees of
Congress a severity of need index in accordance with subsection (c).
``(b) Definition of Severity of Need Index.--In this section, the
term `severity of need index' means the index of the relative needs of
individuals within a State or area, as identified by a number of
different factors, and is a factor or set of factors that is multiplied
by the number of living HIV/AIDS cases in a State or area, providing
different weights to those cases based on needs. Such factors or set of
factors may be different for different components of the provisions
under this title.
``(c) Requirements for Secretarial Submission.--When the Secretary
submits to the appropriate committees of Congress the severity of need
index under subsection (a), the Secretary shall provide the following:
``(1) Methodology for and rationale behind developing the
severity of need index, including information related to the field
testing of the severity of need index.
``(2) An independent contractor analysis of activities carried
out under paragraph (1).
``(3) Information regarding the process by which the Secretary
received community input regarding the application and development
of the severity of need index.
``(d) Annual Reports.--If the Secretary fails to submit the
severity of need index under subsection (a) in either of fiscal years
2007 or 2008, the Secretary shall prepare and submit to the appropriate
committees of Congress a report for such fiscal year--
``(1) that updates progress toward having client level data;
``(2) that updates the progress toward having a severity of
need index, including information related to the methodology and
process for obtaining community input; and
``(3) that, as applicable, states whether the Secretary could
develop a severity of need index before fiscal year 2009.
``SEC. 2688. DEFINITIONS.
``For purposes of this title:
``(1) AIDS.--The term `AIDS' means acquired immune deficiency
syndrome.
``(2) Co-occurring conditions.--The term `co-occurring
conditions' means one or more adverse health conditions in an
individual with HIV/AIDS, without regard to whether the individual
has AIDS and without regard to whether the conditions arise from
HIV.
``(3) Counseling.--The term `counseling' means such counseling
provided by an individual trained to provide such counseling.
``(4) Family-centered care.--The term `family-centered care'
means the system of services described in this title that is
targeted specifically to the special needs of infants, children,
women and families. Family-centered care shall be based on a
partnership between parents, professionals, and the community
designed to ensure an integrated, coordinated, culturally
sensitive, and community-based continuum of care for children,
women, and families with HIV/AIDS.
``(5) Families with hiv/aids.--The term `families with HIV/
AIDS' means families in which one or more members have HIV/AIDS.
``(6)  HIV.--The term `HIV' means infection with the human
immunodeficiency virus.
``(7) HIV/AIDS.--
``(A) In general.--The term `HIV/AIDS' means HIV, and
includes AIDS and any condition arising from AIDS.
``(B) Counting of cases.--The term `living cases of HIV/
AIDS', with respect to the counting of cases in a geographic
area during a period of time, means the sum of--
``(i) the number of living non-AIDS cases of HIV in the
area; and
``(ii) the number of living cases of AIDS in the area.
``(C) Non-aids cases.--The term `non-AIDS', with respect to
a case of HIV, means that the individual involved has HIV but
does not have AIDS.
``(8) Human immunodeficiency virus.--The term `human
immunodeficiency virus' means the etiologic agent for AIDS.
``(9) Official poverty line.--The term `official poverty line'
means the poverty line established by the Director of the Office of
Management and Budget and revised by the Secretary in accordance
with section 673(2) of the Omnibus Budget Reconciliation Act of
1981.
``(10) Person.--The term `person' includes one or more
individuals, governments (including the Federal Government and the
governments of the States), governmental agencies, political
subdivisions, labor unions, partnerships, associations,
corporations, legal representatives, mutual companies, joint-stock
companies, trusts, unincorporated organizations, receivers,
trustees, and trustees in cases under title 11, United States Code.
``(11) State.--
``(A) In general.--The term `State' means each of the 50
States, the District of Columbia, and each of the territories.
``(B) Territories.--The term `territory' means each of
American Samoa, Guam, the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Mariana Islands, the Virgin
Islands, the Republic of the Marshall Islands, the Federated
States of Micronesia, and Palau.
``(12) Youth with hiv.--The term `youth with HIV' means
individuals who are 13 through 24 years old and who have HIV/
AIDS.''.

8d86994095fccd0ca125dd8edfa94633870a13d3f2ec4146dfc5882bb986c425

TITLE V

-GENERAL PROVISIONS

Subpart I of part F of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-101 et seq.) is amended to read as follows:
``Subpart I--Special Projects of National Significance
``SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.
``(a) In General.--Of the amount appropriated under each of parts
A, B, C, and D for each fiscal year, the Secretary shall use the
greater of $20,000,000 or an amount equal to 3 percent of such amount
appropriated under each such part, but not to exceed $25,000,000, to
administer special projects of national significance to--
``(1) quickly respond to emerging needs of individuals
receiving assistance under this title; and
``(2) to fund special programs to develop a standard electronic
client information data system to improve the ability of grantees
under this title to report client-level data to the Secretary.
``(b) Grants.--The Secretary shall award grants under subsection
(a) to entities eligible for funding under parts A, B, C, and D based
on--
``(1) whether the funding will promote obtaining client level
data as it relates to the creation of a severity of need index,
including funds to facilitate the purchase and enhance the
utilization of qualified health information technology systems;
``(2) demonstrated ability to create and maintain a qualified
health information technology system;
``(3) the potential replicability of the proposed activity in
other similar localities or nationally;
``(4) the demonstrated reliability of the proposed qualified
health information technology system across a variety of providers,
geographic regions, and clients; and
``(5) the demonstrated ability to maintain a safe and secure
qualified health information system; or
``(6) newly emerging needs of individuals receiving assistance
under this title.
``(c) Coordination.--The Secretary may not make a grant under this
section unless the applicant submits evidence that the proposed program
is consistent with the statewide coordinated statement of need, and the
applicant agrees to participate in the ongoing revision process of such
statement of need.
``(d) Privacy Protection.--The Secretary may not make a grant under
this section for the development of a qualified health information
technology system unless the applicant provides assurances to the
Secretary that the system will, at a minimum, comply with the privacy
regulations promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996.
``(e) Replication.--The Secretary shall make information concerning
successful models or programs developed under this part available to
grantees under this title for the purpose of coordination, replication,
and integration. To facilitate efforts under this subsection, the
Secretary may provide for peer-based technical assistance for grantees
funded under this part.''.

0b24e65ee9fb778b0eefcf1e18cd793894210a6035e23a5cca2982ef66d9e225

TITLE VI

-DEMONSTRATION AND TRAINING

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

4839304484de8ced3c0f248056759a136116710afe40ca41cdaff857c9c12ac1

Part F of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-101 et seq.) is amended by adding at the end the following:
``Subpart III--Minority AIDS Initiative
``SEC. 2693. MINORITY AIDS INITIATIVE.
``(a) In General.--For the purpose of carrying out activities under
this section to evaluate and address the disproportionate impact of
HIV/AIDS on, and the disparities in access, treatment, care, and
outcomes for, racial and ethnic minorities (including African
Americans, Alaska Natives, Latinos, American Indians, Asian Americans,
Native Hawaiians, and Pacific Islanders), there are authorized to be
appropriated $131,200,000 for fiscal year 2007, $135,100,000 for fiscal
year 2008, and $139,100,000 for fiscal year 2009.
``(b) Certain Activities.--
``(1) In general.--In carrying out the purpose described in
subsection (a), the Secretary shall provide for--
``(A) emergency assistance under part A;
``(B) care grants under part B;
``(C) early intervention services under part C;
``(D) services through projects for HIV-related care under
part D; and
``(E) activities through education and training centers
under section 2692.
``(2) Allocations among activities.--Activities under paragraph
(1) shall be carried out by the Secretary in accordance with the
following:
``(A) For competitive, supplemental grants to improve HIV-
related health outcomes to reduce existing racial and ethnic
health disparities, the Secretary shall, of the amount
appropriated under subsection (a) for a fiscal year, reserve
the following, as applicable:
``(i) For fiscal year 2007, $43,800,000.
``(ii) For fiscal year 2008, $45,400,000.
``(iii) For fiscal year 2009, $47,100,000.
``(B) For competitive grants used for supplemental support
education and outreach services to increase the number of
eligible racial and ethnic minorities who have access to
treatment through the program under section 2616 for
therapeutics, the Secretary shall, of the amount appropriated
for a fiscal year under subsection (a), reserve the following,
as applicable:
``(i) For fiscal year 2007, $7,000,000.
``(ii) For fiscal year 2008, $7,300,000.
``(iii) For fiscal year 2009, $7,500,000.
``(C) For planning grants, capacity-building grants, and
services grants to health care providers who have a history of
providing culturally and linguistically appropriate care and
services to racial and ethnic minorities, the Secretary shall,
of the amount appropriated for a fiscal year under subsection
(a), reserve the following, as applicable:
``(i) For fiscal year 2007, $53,400,000.
``(ii) For fiscal year 2008, $55,400,000.
``(iii) For fiscal year 2009, $57,400,000.
``(D) For eliminating racial and ethnic disparities in the
delivery of comprehensive, culturally and linguistically
appropriate care services for HIV disease for women, infants,
children, and youth, the Secretary shall, of the amount
appropriated under subsection (a), reserve $18,500,000 for each
of the fiscal years 2007 through 2009.
``(E) For increasing the training capacity of centers to
expand the number of health care professionals with treatment
expertise and knowledge about the most appropriate standards of
HIV disease-related treatments and medical care for racial and
ethnic minority adults, adolescents, and children with HIV
disease, the Secretary shall, of the amount appropriated under
subsection (a), reserve $8,500,000 for each of the fiscal years
2007 through 2009.
``(c) Consistency With Prior Program.--With respect to the purpose
described in subsection (a), the Secretary shall carry out this section
consistent with the activities carried out under this title by the
Secretary pursuant to the Departments of Labor, Health and Human
Services, and Education, and Related Agencies Appropriations Act, 2002
(Public Law 107-116).''.

f4e71679b10f6bf33e5cc99f9c9c7aebb51715cca6a276cc07007a417ab3d906

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

d967d51ab8061388d120e397e4dcd5d966191cd7abc525078829459d813ab3ee

TITLE VII

-MISCELLANEOUS PROVISIONS

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

5b4b572031711f3d1fd9f0985c3ef849f38a385cfa0a59ea9619c50f289ea772

Effective on October 1, 2009, title XXVI of the Public Health
Service Act (42 U.S.C. 300ff et seq.) is repealed.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.

ddf3679645b521b57e27937206896b7b130732060e5b5609a55fb593b27fe264

Ryan White HIV/AIDS Treatment Modernization Act of 2006

Other Sections