[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2311 Enrolled Bill (ENR)]
S.2311
One Hundred Sixth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Monday,
the twenty-fourth day of January, two thousand
An Act
To amend the Public Health Service Act to revise and extend programs
established under the Ryan White Comprehensive AIDS Resources Emergency
Act of 1990, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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

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The table of contents for this Act is as follows:

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Subtitle A--HIV Health Services Planning Councils

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Subtitle B--Type and Distribution of Grants

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TITLE I

-EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

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

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TITLE II

-CARE GRANT PROGRAM

Subtitle C--Certain Partner Notification Programs

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TITLE III

-EARLY INTERVENTION SERVICES

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

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TITLE IV

-OTHER PROGRAMS AND ACTIVITIES

Subtitle B--General Provisions in Title XXVI

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TITLE VI

-EFFECTIVE DATE

(a) In General.--Section 2602(b) of the Public Health Service Act
(42 U.S.C. 300ff-12(b)) is amended--
(1) in paragraph (1), by striking ``demographics of the
epidemic in the eligible area involved,'' and inserting
``demographics of the population of individuals with HIV disease in
the eligible area involved,''; and
(2) in paragraph (2)--
(A) in subparagraph (C), by inserting before the semicolon
the following: ``, including providers of housing and homeless
services'';
(B) in subparagraph (G), by striking ``or AIDS'';
(C) in subparagraph (K), by striking ``and'' at the end;
(D) in subparagraph (L), by striking the period and
inserting the following: ``, including but not limited to
providers of HIV prevention services; and''; and
(E) by adding at the end the following subparagraph:
``(M) representatives of individuals who formerly were
Federal, State, or local prisoners, were released from the
custody of the penal system during the preceding 3 years, and
had HIV disease as of the date on which the individuals were so
released.''.
(b) Conflicts of Interests.--Section 2602(b)(5) of the Public
Health Service Act (42 U.S.C. 300ff-12(b)(5)) is amended by adding at
the end the following subparagraph:
``(C) Composition of council.--The following applies
regarding the membership of a planning council under paragraph
(1):
``(i) Not less than 33 percent of the council shall be
individuals who are receiving HIV-related services pursuant
to a grant under section 2601(a), are not officers,
employees, or consultants to any entity that receives
amounts from such a grant, and do not represent any such
entity, and reflect the demographics of the population of
individuals with HIV disease as determined under paragraph
(4)(A). For purposes of the preceding sentence, an
individual shall be considered to be receiving such
services if the individual is a parent of, or a caregiver
for, a minor child who is receiving such services.
``(ii) With respect to membership on the planning
council, clause (i) may not be construed as having any
effect on entities that receive funds from grants under any
of parts B through F but do not receive funds from grants
under section 2601(a), on officers or employees of such
entities, or on individuals who represent such entities.''.

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(a) In General.--Section 2602(b)(4) of the Public Health Service
Act (42 U.S.C. 300ff-12(b)(4)) is amended--
(1) by redesignating subparagraphs (A) through (E) as
subparagraphs (C) through (G), respectively;
(2) by inserting before subparagraph (C) (as so redesignated)
the following subparagraphs:
``(A) determine the size and demographics of the population
of individuals with HIV disease;
``(B) determine the needs of such population, with
particular attention to--
``(i) individuals with HIV disease who know their HIV
status and are not receiving HIV-related services; and
``(ii) disparities in access and services among
affected subpopulations and historically underserved
communities;'';
(3) in subparagraph (C) (as so redesignated), by striking
clauses (i) through (iv) and inserting the following:
``(i) size and demographics of the population of
individuals with HIV disease (as determined under
subparagraph (A)) and the needs of such population (as
determined under subparagraph (B));
``(ii) demonstrated (or probable) cost effectiveness
and outcome effectiveness of proposed strategies and
interventions, to the extent that data are reasonably
available;
``(iii) priorities of the communities with HIV disease
for whom the services are intended;
``(iv) coordination in the provision of services to
such individuals with programs for HIV prevention and for
the prevention and treatment of substance abuse, including
programs that provide comprehensive treatment for such
abuse;
``(v) availability of other governmental and non-
governmental resources, including the State medicaid plan
under title XIX of the Social Security Act and the State
Children's Health Insurance Program under title XXI of such
Act to cover health care costs of eligible individuals and
families with HIV disease; and
``(vi) capacity development needs resulting from
disparities in the availability of HIV-related services in
historically underserved communities;'';
(4) in subparagraph (D) (as so redesignated), by amending the
subparagraph to read as follows:
``(D) develop a comprehensive plan for the organization and
delivery of health and support services described in section
2604 that--
``(i) includes a strategy for identifying individuals
who know their HIV status and are not receiving such
services and for informing the individuals of and enabling
the individuals to utilize the services, giving particular
attention to eliminating disparities in access and services
among affected subpopulations and historically underserved
communities, and including discrete goals, a timetable, and
an appropriate allocation of funds;
``(ii) includes a strategy to coordinate the provision
of such services with programs for HIV prevention
(including outreach and early intervention) and for the
prevention and treatment of substance abuse (including
programs that provide comprehensive treatment services for
such abuse); and
``(iii) is compatible with any State or local plan for
the provision of services to individuals with HIV
disease;'';
(5) in subparagraph (F) (as so redesignated), by striking
``and'' at the end;
(6) in subparagraph (G) (as so redesignated)--
(A) by striking ``public meetings,'' and inserting ``public
meetings (in accordance with paragraph (7)),''; and
(B) by striking the period and inserting ``; and''; and
(7) by adding at the end the following subparagraph:
``(H) coordinate with Federal grantees that provide HIV-
related services within the eligible area.''.
(b) Process for Establishing Allocation Priorities.--Section 2602
of the Public Health Service Act (42 U.S.C. 300ff-12) is amended by
adding at the end the following subsection:
``(d) Process for Establishing Allocation Priorities.--Promptly
after the date of the submission of the report required in section
501(b) of the Ryan White CARE Act Amendments of 2000 (relating to the
relationship between epidemiological measures and health care for
certain individuals with HIV disease), the Secretary, in consultation
with planning councils and entities that receive amounts from grants
under section 2601(a) or 2611, shall develop epidemiologic measures--
``(1) for establishing the number of individuals living with
HIV disease who are not receiving HIV-related health services; and
``(2) for carrying out the duties under subsection (b)(4) and
section 2617(b).''.
(c) Training.--Section 2602 of the Public Health Service Act (42
U.S.C. 300ff-12), as amended by subsection (b) of this section, is
amended by adding at the end the following subsection:
``(e) Training Guidance and Materials.--The Secretary shall provide
to each chief elected official receiving a grant under section 2601(a)
guidelines and materials for training members of the planning council
under paragraph (1) regarding the duties of the council.''.
(d) Conforming Amendment.--Section 2603(c) of the Public Health
Service Act (42 U.S.C. 300ff-12(b)) is amended by striking ``section
2602(b)(3)(A)'' and inserting ``section 2602(b)(4)(C)''.

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

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(a) Expedited Distribution.--Section 2603(a)(2) of the Public
Health Service Act (42 U.S.C. 300ff-13(a)(2)) is amended in the first
sentence by striking ``for each of the fiscal years 1996 through 2000''
and inserting ``for a fiscal year''.
(b) Amount of Grant; Estimate of Living Cases.--
(1) In general.--Section 2603(a)(3) of the Public Health
Service Act (42 U.S.C. 300ff-13(a)(3)) is amended--
(A) in subparagraph (C)(i), by inserting before the
semicolon the following: ``, except that (subject to
subparagraph (D)), for grants made pursuant to this paragraph
for fiscal year 2005 and subsequent fiscal years, the cases
counted for each 12-month period beginning on or after July 1,
2004, shall be cases of HIV disease (as reported to and
confirmed by such Director) rather than cases of acquired
immune deficiency syndrome''; and
(B) in subparagraph (C), in the matter after and below
clause (ii)(X)--
(i) in the first sentence, by inserting before the
period the following: ``, and shall be reported to the
congressional committees of jurisdiction''; and
(ii) by adding at the end the following sentence:
``Updates shall as applicable take into account the
counting of cases of HIV disease pursuant to clause (i).''.
(2) Determination of secretary regarding data on hiv cases.--
Section 2603(a)(3) of the Public Health Service Act (42 U.S.C.
300ff-13(a)(3)) is amended--
(A) by redesignating subparagraph (D) as subparagraph (E);
and
(B) by inserting after subparagraph (C) the following
subparagraph:
``(D) Determination of secretary regarding data on hiv
cases.--
``(i) In general.--Not later than July 1, 2004, the
Secretary shall determine whether there is data on cases of
HIV disease from all eligible areas (reported to and
confirmed by the Director of the Centers for Disease
Control and Prevention) sufficiently accurate and reliable
for use for purposes of subparagraph (C)(i). In making such
a determination, the Secretary shall take into
consideration the findings of the study under section
501(b) of the Ryan White CARE Act Amendments of 2000
(relating to the relationship between epidemiological
measures and health care for certain individuals with HIV
disease).
``(ii) Effect of adverse determination.--If under
clause (i) the Secretary determines that data on cases of
HIV disease is not sufficiently accurate and reliable for
use for purposes of subparagraph (C)(i), then
notwithstanding such subparagraph, for any fiscal year
prior to fiscal year 2007 the references in such
subparagraph to cases of HIV disease do not have any legal
effect.
``(iii) Grants and technical assistance regarding
counting of hiv cases.--Of the amounts appropriated under
section 318B for a fiscal year, the Secretary shall reserve
amounts to make grants and provide technical assistance to
States and eligible areas with respect to obtaining data on
cases of HIV disease to ensure that data on such cases is
available from all States and eligible areas as soon as is
practicable but not later than the beginning of fiscal year
2007.''.
(c) Increases in Grant.--Section 2603(a)(4) of the Public Health
Service Act (42 U.S.C. 300ff-13(a)(4)) is amended to read as follows:
``(4) Increases in grant.--
``(A) In general.--For each fiscal year in a protection
period for an eligible area, the Secretary shall increase the
amount of the grant made pursuant to paragraph (2) for the area
to ensure that--
``(i) for the first fiscal year in the protection
period, the grant is not less than 98 percent of the amount
of the grant made for the eligible area pursuant to such
paragraph for the base year for the protection period;
``(ii) for any second fiscal year in such period, the
grant is not less than 95 percent of the amount of such
base year grant;
``(iii) for any third fiscal year in such period, the
grant is not less than 92 percent of the amount of the base
year grant;
``(iv) for any fourth fiscal year in such period, the
grant is not less than 89 percent of the amount of the base
year grant; and
``(v) for any fifth or subsequent fiscal year in such
period, if, pursuant to paragraph (3)(D)(ii), the
references in paragraph (3)(C)(i) to HIV disease do not
have any legal effect, the grant is not less than 85
percent of the amount of the base year grant.
``(B) Special rule.--If for fiscal year 2005, pursuant to
paragraph (3)(D)(ii), data on cases of HIV disease are used for
purposes of paragraph (3)(C)(i), the Secretary shall increase
the amount of a grant made pursuant to paragraph (2) for an
eligible area to ensure that the grant is not less than 98
percent of the amount of the grant made for the area in fiscal
year 2004.
``(C) Base year; protection period.--With respect to grants
made pursuant to paragraph (2) for an eligible area:
``(i) The base year for a protection period is the
fiscal year preceding the trigger grant-reduction year.
``(ii) The first trigger grant-reduction year is the
first fiscal year (after fiscal year 2000) for which the
grant for the area is less than the grant for the area for
the preceding fiscal year.
``(iii) A protection period begins with the trigger
grant-reduction year and continues until the beginning of
the first fiscal year for which the amount of the grant
determined pursuant to paragraph (2) for the area equals or
exceeds the amount of the grant determined under
subparagraph (A).
``(iv) Any subsequent trigger grant-reduction year is
the first fiscal year, after the end of the preceding
protection period, for which the amount of the grant is
less than the amount of the grant for the preceding fiscal
year.''.

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

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(a) Primary Purposes.--Section 2604(b)(1) of the Public Health
Service Act (42 U.S.C. 300ff-14(b)(1)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``HIV-related--'' and inserting ``HIV-related services, as
follows:'';
(2) in subparagraph (A)--
(A) by striking ``outpatient'' and all that follows through
``substance abuse treatment and'' and inserting the following:
``Outpatient and ambulatory health services, including
substance abuse treatment,''; and
(B) by striking ``; and'' and inserting a period;
(3) in subparagraph (B), by striking ``(B) inpatient case
management'' and inserting ``(C) Inpatient case management'';
(4) by inserting after subparagraph (A) the following
subparagraph:
``(B) Outpatient and ambulatory support services (including
case management), to the extent that such services facilitate,
enhance, support, or sustain the delivery, continuity, or
benefits of health services for individuals and families with
HIV disease.''; and
(5) by adding at the end the following:
``(D) Outreach activities that are intended to identify
individuals with HIV disease who know their HIV status and are
not receiving HIV-related services, and that are--
``(i) necessary to implement the strategy under section
2602(b)(4)(D), including activities facilitating the access
of such individuals to HIV-related primary care services at
entities described in paragraph (3)(A);
``(ii) conducted in a manner consistent with the
requirements under sections 2605(a)(3) and 2651(b)(2); and
``(iii) supplement, and do not supplant, such
activities that are carried out with amounts appropriated
under section 317.''.
(b) Early Intervention Services.--Section 2604(b) (42 U.S.C. 300ff-
14(b)) of the Public Health Service Act is amended--
(1) by redesignating paragraph (3) as paragraph (4); and
(2) by inserting after paragraph (2) the following:
``(3) Early intervention services.--
``(A) In general.--The purposes for which a grant under
section 2601 may be used include providing to individuals with
HIV disease early intervention services described in section
2651(b)(2), with follow-up referral provided for the purpose of
facilitating the access of individuals receiving the services
to HIV-related health services. The entities through which such
services may be provided under the grant include public health
departments, emergency rooms, substance abuse and mental health
treatment programs, detoxification centers, detention
facilities, clinics regarding sexually transmitted diseases,
homeless shelters, HIV disease counseling and testing sites,
health care points of entry specified by eligible areas,
federally qualified health centers, and entities described in
section 2652(a) that constitute a point of access to services
by maintaining referral relationships.
``(B) Conditions.--With respect to an entity that proposes
to provide early intervention services under subparagraph (A),
such subparagraph applies only if the entity demonstrates to
the satisfaction of the chief elected official for the eligible
area involved that--
``(i) Federal, State, or local funds are otherwise
inadequate for the early intervention services the entity
proposes to provide; and
``(ii) the entity will expend funds pursuant to such
subparagraph to supplement and not supplant other funds
available to the entity for the provision of early
intervention services for the fiscal year involved.''.
(c) Priority for Women, Infants, and Children.--Section 2604(b) (42
U.S.C. 300ff-14(b)) of the Public Health Service Act is amended in
paragraph (4) (as redesignated by subsection (b)(1) of this section) by
amending the paragraph to read as follows:
``(4) Priority for women, infants and children.--
``(A) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with
HIV disease, including treatment measures to prevent the
perinatal transmission of HIV, the chief elected official of an
eligible area, in accordance with the established priorities of
the planning council, shall for each of such populations in the
eligible area use, from the grants made for the area under
section 2601(a) for a fiscal year, not less than the percentage
constituted by the ratio of the population involved (infants,
children, youth, or women in such area) with acquired immune
deficiency syndrome to the general population in such area of
individuals with such syndrome.
``(B) Waiver.--With respect to the population involved, the
Secretary may provide to the chief elected official of an
eligible area a waiver of the requirement of subparagraph (A)
if such official demonstrates to the satisfaction of the
Secretary that the population is receiving HIV-related health
services through the State medicaid program under title XIX of
the Social Security Act, the State children's health insurance
program under title XXI of such Act, or other Federal or State
programs.''.
(d) Quality Management.--Section 2604 of the Public Health Service
Act (42 U.S.C. 300ff-14) is amended--
(1) by redesignating subsections (c) through (f) as subsections
(d) through (g), respectively; and
(2) by inserting after subsection (b) the following:
``(c) Quality Management.--
``(1) Requirement.--The chief elected official of an eligible
area that receives a grant under this part shall provide for the
establishment of a quality management program to assess the extent
to which HIV health services provided to patients under the grant
are consistent with the most recent Public Health Service
guidelines for the treatment of HIV disease and related
opportunistic infection, and as applicable, to develop strategies
for ensuring that such services are consistent with the guidelines
for improvement in the access to and quality of HIV health
services.
``(2) Use of funds.--From amounts received under a grant
awarded under this part for a fiscal year, the chief elected
official of an eligible area may (in addition to amounts to which
subsection (f)(1) applies) use for activities associated with the
quality management program required in paragraph (1) not more than
the lesser of--
``(A) 5 percent of amounts received under the grant; or
``(B) $3,000,000.''.

1238d327e5d44d212b34e4e94367b33c5fbe9144343ef6bb4f636e716476de7b

(a) In General.--Section 2605(a) of the Public Health Service Act
(42 U.S.C. 300ff-15(a)) is amended--
(1) by redesignating paragraphs (3) through (6) as paragraphs
(5) through (8), respectively; and
(2) by inserting after paragraph (2) the following paragraphs:
``(3) that entities within the eligible area that receive funds
under a grant under this part will maintain appropriate
relationships with entities in the eligible area served that
constitute key points of access to the health care system for
individuals with HIV disease (including emergency rooms, substance
abuse treatment programs, detoxification centers, adult and
juvenile detention facilities, sexually transmitted disease
clinics, HIV counseling and testing sites, mental health programs,
and homeless shelters), and other entities under section 2604(b)(3)
and 2652(a), for the purpose of facilitating early intervention for
individuals newly diagnosed with HIV disease and individuals
knowledgeable of their HIV status but not in care;
``(4) that the chief elected official of the eligible area will
satisfy all requirements under section 2604(c);''.
(b) Conforming Amendments.--Section 2605(a) (42 U.S.C. 300ff-
15(a)(1)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by striking ``services to
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''; and
(B) in subparagraph (B), by striking ``services for
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)'';
(2) in paragraph (7) (as redesignated by subsection (a)(1) of
this section), by striking ``and'' at the end;
(3) in paragraph (8) (as so redesignated), by striking the
period and inserting ``; and''; and
(4) by adding at the end the following paragraph:
``(9) that the eligible area has procedures in place to ensure
that services provided with funds received under this part meet the
criteria specified in section 2604(b)(1).''.
Subtitle A--General Grant Provisions

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Section 2611(b) of the Public Health Service Act (42 U.S.C. 300ff-
21(b)) is amended to read as follows:
``(b) Priority for Women, Infants and Children.--
``(1) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with HIV
disease, including treatment measures to prevent the perinatal
transmission of HIV, a State shall for each of such populations
use, of the funds allocated under this part to the State for a
fiscal year, not less than the percentage constituted by the ratio
of the population involved (infants, children, youth, or women in
the State) with acquired immune deficiency syndrome to the general
population in the State of individuals with such syndrome.
``(2) Waiver.--With respect to the population involved, the
Secretary may provide to a State a waiver of the requirement of
paragraph (1) if the State demonstrates to the satisfaction of the
Secretary that the population is receiving HIV-related health
services through the State medicaid program under title XIX of the
Social Security Act, the State children's health insurance program
under title XXI of such Act, or other Federal or State programs.''.

7e7a302b51e511ace28a2db03cbc53b4980a604ed372947d4d4a0d0f5c5a3818

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

e3da973d0e54167bbd99621b662b9df21bd18d6145b324e5e2fcc01f84bb1463

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

5b0723541e47a2084bb223fbd8b911795cea099ec4c95768527897ad7717b091

(a) In General.--Section 2616(c) of the Public Health Service Act
(42 U.S.C. 300ff-26(c)) is amended--
(1) in paragraph (4), by striking ``and'' after the semicolon
at the end;
(2) in paragraph (5), by striking the period and inserting ``;
and''; and
(3) by inserting after paragraph (5) the following:
``(6) encourage, support, and enhance adherence to and
compliance with treatment regimens, including related medical
monitoring.
Of the amount reserved by a State for a fiscal year for use under this
section, the State may not use more than 5 percent to carry out
services under paragraph (6), except that the percentage applicable
with respect to such paragraph is 10 percent if the State demonstrates
to the Secretary that such additional services are essential and in no
way diminish access to the therapeutics described in subsection (a).''.
(b) Health Insurance and Plans.--Section 2616 of the Public Health
Service Act (42 U.S.C. 300ff-26) is amended by adding at the end the
following subsection:
``(e) Use of Health Insurance and Plans.--
``(1) In general.--In carrying out subsection (a), a State may
expend a grant under this part to provide the therapeutics
described in such subsection by paying on behalf of individuals
with HIV disease the costs of purchasing or maintaining health
insurance or plans whose coverage includes a full range of such
therapeutics and appropriate primary care services.
``(2) Limitation.--The authority established in paragraph (1)
applies only to the extent that, for the fiscal year involved, the
costs of the health insurance or plans to be purchased or
maintained under such paragraph do not exceed the costs of
otherwise providing therapeutics described in subsection (a).''.

8c66f85c129894d5ff78fd36b3a17ecd50ff5974b1ce859a93caed1e14764f1e

(a) Determination of Size and Needs of Population; Comprehensive
Plan.--Section 2617(b) of the Public Health Service Act (42 U.S.C.
300ff-27(b)) is amended--
(1) by redesignating paragraphs (2) through (4) as paragraphs
(4) through (6), respectively;
(2) by inserting after paragraph (1) the following paragraphs:
``(2) a determination of the size and demographics of the
population of individuals with HIV disease in the State;
``(3) a determination of the needs of such population, with
particular attention to--
``(A) individuals with HIV disease who know their HIV
status and are not receiving HIV-related services; and
``(B) disparities in access and services among affected
subpopulations and historically underserved communities;''; and
(3) in paragraph (4) (as so redesignated)--
(A) by striking ``comprehensive plan for the organization''
and inserting ``comprehensive plan that describes the
organization'';
(B) by striking ``, including--'' and inserting ``, and
that--'';
(C) by redesignating subparagraphs (A) through (C) as
subparagraphs (D) through (F), respectively;
(D) by inserting before subparagraph (C) the following
subparagraphs:
``(A) establishes priorities for the allocation of funds
within the State based on--
``(i) size and demographics of the population of
individuals with HIV disease (as determined under paragraph
(2)) and the needs of such population (as determined under
paragraph (3));
``(ii) availability of other governmental and non-
governmental resources, including the State medicaid plan
under title XIX of the Social Security Act and the State
Children's Health Insurance Program under title XXI of such
Act to cover health care costs of eligible individuals and
families with HIV disease;
``(iii) capacity development needs resulting from
disparities in the availability of HIV-related services in
historically underserved communities and rural communities;
and
``(iv) the efficiency of the administrative mechanism
of the State for rapidly allocating funds to the areas of
greatest need within the State;
``(B) includes a strategy for identifying individuals who
know their HIV status and are not receiving such services and
for informing the individuals of and enabling the individuals
to utilize the services, giving particular attention to
eliminating disparities in access and services among affected
subpopulations and historically underserved communities, and
including discrete goals, a timetable, and an appropriate
allocation of funds;
``(C) includes a strategy to coordinate the provision of
such services with programs for HIV prevention (including
outreach and early intervention) and for the prevention and
treatment of substance abuse (including programs that provide
comprehensive treatment services for such abuse);'';
(E) in subparagraph (D) (as redesignated by subparagraph
(C) of this paragraph), by inserting ``describes'' before ``the
services and activities'';
(F) in subparagraph (E) (as so redesignated), by inserting
``provides'' before ``a description''; and
(G) in subparagraph (F) (as so redesignated), by inserting
``provides'' before ``a description''.
(b) Public Participation.--Section 2617(b) of the Public Health
Service Act, as amended by subsection (a) of this section, is amended--
(1) in paragraph (5), by striking ``HIV'' and inserting ``HIV
disease''; and
(2) in paragraph (6), by amending subparagraph (A) to read as
follows:
``(A) the public health agency that is administering the
grant for the State engages in a public advisory planning
process, including public hearings, that includes the
participants under paragraph (5), and the types of entities
described in section 2602(b)(2), in developing the
comprehensive plan under paragraph (4) and commenting on the
implementation of such plan;''.
(c) Health Care Relationships.--Section 2617(b) of the Public
Health Service Act, as amended by subsection (a) of this section, is
amended in paragraph (6)--
(1) in subparagraph (E), by striking ``and'' at the end;
(2) in subparagraph (F), by striking the period and inserting
``; and''; and
(3) by adding at the end the following subparagraph:
``(G) entities within areas in which activities under the
grant are carried out will maintain appropriate relationships
with entities in the area served that constitute key points of
access to the health care system for individuals with HIV
disease (including emergency rooms, substance abuse treatment
programs, detoxification centers, adult and juvenile detention
facilities, sexually transmitted disease clinics, HIV
counseling and testing sites, mental health programs, and
homeless shelters), and other entities under section 2612(c)
and 2652(a), for the purpose of facilitating early intervention
for individuals newly diagnosed with HIV disease and
individuals knowledgeable of their HIV status but not in
care.''.

2d85aedc03d5e4fa71cbae98ab78a738f0e2e894b9b696f1a278afb0c55189a0

(a) Minimum Allotment.--Section 2618 of the Public Health Service
Act (42 U.S.C. 300ff-28) is amended--
(1) by redesignating subsections (b) through (e) as subsections
(a) through (d), respectively; and
(2) in subsection (a) (as so redesignated), in paragraph
(1)(A)(i)--
(A) in subclause (I), by striking ``$100,000'' and
inserting ``$200,000''; and
(B) in subclause (II), by striking ``$250,000'' and
inserting ``$500,000''.
(b) Amount of Grant; Estimate of Living Cases.--Section 2618(a) of
the Public Health Service Act (as redesignated by subsection (a)(1) of
this section) is amended in paragraph (2)--
(1) in subparagraph (D)(i), by inserting before the semicolon
the following: ``, except that (subject to subparagraph (E)), for
grants made pursuant to this paragraph or section 2620 for fiscal
year 2005 and subsequent fiscal years, the cases counted for each
12-month period beginning on or after July 1, 2004, shall be cases
of HIV disease (as reported to and confirmed by such Director)
rather than cases of acquired immune deficiency syndrome'';
(2) by redesignating subparagraphs (E) through (H) as
subparagraphs (F) through (I), respectively; and
(3) by inserting after subparagraph (D) the following
subparagraph:
``(E) Determination of secretary regarding data on hiv
cases.--If under section 2603(a)(3)(D)(i) the Secretary
determines that data on cases of HIV disease are not
sufficiently accurate and reliable, then notwithstanding
subparagraph (D) of this paragraph, for any fiscal year prior
to fiscal year 2007 the references in such subparagraph to
cases of HIV disease do not have any legal effect.''.
(c) Increases in Formula Amount.--Section 2618(a) of the Public
Health Service Act (as redesignated by subsection (a)(1) of this
section) is amended--
(1) in paragraph (1)(A)(ii), by inserting before the semicolon
the following: ``and then, as applicable, increased under paragraph
(2)(H)''; and
(2) in paragraph (2)--
(A) in subparagraph (A)(i), by striking ``subparagraph
(H)'' and inserting ``subparagraphs (H) and (I)''; and
(B) in subparagraph (H) (as redesignated by subsection
(b)(2) of this section), by amending the subparagraph to read
as follows:
``(H) Limitation.--
``(i) In general.--The Secretary shall ensure that the
amount of a grant awarded to a State or territory under
section 2611 or subparagraph (I)(i) for a fiscal year is
not less than--
``(I) with respect to fiscal year 2001, 99 percent;
``(II) with respect to fiscal year 2002, 98
percent;
``(III) with respect to fiscal year 2003, 97
percent;
``(IV) with respect to fiscal year 2004, 96
percent; and
``(V) with respect to fiscal year 2005, 95 percent,
of the amount such State or territory received for fiscal
year 2000 under section 2611 or subparagraph (I)(i),
respectively (notwithstanding such subparagraph). In
administering this subparagraph, the Secretary shall, with
respect to States or territories that will under such
section receive grants in amounts that exceed the amounts
that such States received under such section or
subparagraph for fiscal year 2000, proportionally reduce
such amounts to ensure compliance with this subparagraph.
In making such reductions, the Secretary shall ensure that
no such State receives less than that State received for
fiscal year 2000.
``(ii) Ratable reduction.--If the amount appropriated
under section 2677 for a fiscal year and available for
grants under section 2611 or subparagraph (I)(i) is less
than the amount appropriated and available for fiscal year
2000 under section 2611 or subparagraph (I)(i),
respectively, the limitation contained in clause (i) for
the grants involved shall be reduced by a percentage equal
to the percentage of the reduction in such amounts
appropriated and available.''.
(d) Territories.--Section 2618(a) of the Public Health Service Act
(as redesignated by subsection (a)(1) of this section) is amended in
paragraph (1)(B) by inserting ``the greater of $50,000 or'' after
``shall be''.
(e) Separate Treatment Drug Grants.--Section 2618(a) of the Public
Health Service Act (as redesignated by subsection (a)(1) of this
section and amended by subsection (b)(2) of this section) is amended in
paragraph (2)(I)--
(1) by redesignating clauses (i) and (ii) as subclauses (I) and
(II), respectively;
(2) by striking ``(I) Appropriations'' and all that follows
through ``With respect to'' and inserting the following:
``(I) Appropriations for treatment drug program.--
``(i) Formula grants.--With respect to'';
(3) in subclause (I) of clause (i) (as designated by paragraphs
(1) and (2)), by inserting before the semicolon the following: ``,
less the percentage reserved under clause (ii)(V)''; and
(4) by adding at the end the following clause:
``(ii) Supplemental treatment drug grants.--
``(I) In general.--From amounts made available
under subclause (V), the Secretary shall make
supplemental grants to States described in subclause
(II) to enable such States to increase access to
therapeutics described in section 2616(a), as provided
by the State under section 2616(c)(2).
``(II) Eligible states.--For purposes of subclause
(I), a State described in this subclause is a State
that, in accordance with criteria established by the
Secretary, demonstrates a severe need for a grant under
such subclause. In developing such criteria, the
Secretary shall consider eligibility standards,
formulary composition, and the number of eligible
individuals at or below 200 percent of the official
poverty line to whom the State is unable to provide
therapeutics described in section 2616(a).
``(III) State requirements.--The Secretary may not
make a grant to a State under this clause unless the
State agrees that--
``(aa) the State will make available (directly
or through donations from public or private
entities) non-Federal contributions toward the
activities to be carried out under the grant in an
amount equal to $1 for each $4 of Federal funds
provided in the grant; and
``(bb) the State will not impose eligibility
requirements for services or scope of benefits
limitations under section 2616(a) that are more
restrictive than such requirements in effect as of
January 1, 2000.
``(IV) Use and coordination.--Amounts made
available under a grant under this clause shall
only be used by the State to provide HIV/AIDS-
related medications. The State shall coordinate the
use of such amounts with the amounts otherwise
provided under section 2616(a) in order to maximize
drug coverage.
``(V) Funding.--For the purpose of making grants
under this clause, the Secretary shall each fiscal year
reserve 3 percent of the amount referred to in clause
(i) with respect to section 2616, subject to subclause
(VI).
``(VI) Limitation.--In reserving amounts under
subclause (V) and making grants under this clause for a
fiscal year, the Secretary shall ensure for each State
that the total of the grant under section 2611 for the
State for the fiscal year and the grant under clause
(i) for the State for the fiscal year is not less than
such total for the State for the preceding fiscal
year.''.
(f) Technical Amendment.--Section 2618(a) of the Public Health
Service Act (as redesignated by subsection (a)(1) of this section) is
amended in paragraph (3)(B) by striking ``and the Republic of the
Marshall Islands'' and inserting ``the Republic of the Marshall
Islands, the Federated States of Micronesia, and the Republic of Palau,
and only for purposes of paragraph (1) the Commonwealth of Puerto
Rico''.

b8b41d34755d122113468dd3bb04e83588a8bb75f242cc023c87cadecc7dc497

Subpart I of part B of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-11 et seq.) is amended--
(1) by striking section 2621; and
(2) by inserting after section 2619 the following section:
``SEC. 2620. SUPPLEMENTAL GRANTS.
``(a) In General.--The Secretary shall award supplemental grants to
States determined to be eligible under subsection (b) to enable such
States to provide comprehensive services of the type described in
section 2612(a) to supplement the services otherwise provided by the
State under a grant under this subpart in emerging communities within
the State that are not eligible to receive grants under part A.
``(b) Eligibility.--To be eligible to receive a supplemental grant
under subsection (a), a State shall--
``(1) be eligible to receive a grant under this subpart;
``(2) demonstrate the existence in the State of an emerging
community as defined in subsection (d)(1); and
``(3) submit the information described in subsection (c).
``(c) Reporting Requirements.--A State that desires a grant under
this section shall, as part of the State application submitted under
section 2617, submit a detailed description of the manner in which the
State will use amounts received under the grant and of the severity of
need. Such description shall include--
``(1) a report concerning the dissemination of supplemental
funds under this section and the plan for the utilization of such
funds in the emerging community;
``(2) a demonstration of the existing commitment of local
resources, both financial and in-kind;
``(3) a demonstration that the State will maintain HIV-related
activities at a level that is equal to not less than the level of
such activities in the State for the 1-year period preceding the
fiscal year for which the State is applying to receive a grant
under this part;
``(4) a demonstration of the ability of the State to utilize
such supplemental financial resources in a manner that is
immediately responsive and cost effective;
``(5) a demonstration that the resources will be allocated in
accordance with the local demographic incidence of AIDS including
appropriate allocations for services for infants, children, women,
and families with HIV disease;
``(6) a demonstration of the inclusiveness of the planning
process, with particular emphasis on affected communities and
individuals with HIV disease; and
``(7) a demonstration of the manner in which the proposed
services are consistent with local needs assessments and the
statewide coordinated statement of need.
``(d) Definition of Emerging Community.--In this section, the term
`emerging community' means a metropolitan area--
``(1) that is not eligible for a grant under part A; and
``(2) for which there has been reported to the Director of the
Centers for Disease Control and Prevention a cumulative total of
between 500 and 1,999 cases of acquired immune deficiency syndrome
for the most recent period of 5 calendar years for which such data
are available (except that, for fiscal year 2005 and subsequent
fiscal years, cases of HIV disease shall be counted rather than
cases of acquired immune deficiency syndrome if cases of HIV
disease are being counted for purposes of section
2618(a)(2)(D)(i)).
``(e) Funding.--
``(1) In general.--Subject to paragraph (2), with respect to
each fiscal year beginning with fiscal year 2001, the Secretary, to
carry out this section, shall utilize--
``(A) the greater of--
``(i) 25 percent of the amount appropriated under
section 2677 to carry out part B, excluding the amount
appropriated under section 2618(a)(2)(I), for such fiscal
year that is in excess of the amount appropriated to carry
out such part in the fiscal year preceding the fiscal year
involved; or
``(ii) $5,000,000,
to provide funds to States for use in emerging communities with
at least 1,000, but less than 2,000, cases of AIDS as reported
to and confirmed by the Director of the Centers for Disease
Control and Prevention for the five year period preceding the
year for which the grant is being awarded; and
``(B) the greater of--
``(i) 25 percent of the amount appropriated under
section 2677 to carry out part B, excluding the amount
appropriated under section 2618(a)(2)(I), for such fiscal
year that is in excess of the amount appropriated to carry
out such part in the fiscal year preceding the fiscal year
involved; or
``(ii) $5,000,000,
to provide funds to States for use in emerging communities with
at least 500, but less than 1,000, cases of AIDS reported to
and confirmed by the Director of the Centers for Disease
Control and Prevention for the five year period preceding the
year for which the grant is being awarded.
``(2) Trigger of funding.--This section shall be effective only
for fiscal years beginning in the first fiscal year in which the
amount appropriated under section 2677 to carry out part B,
excluding the amount appropriated under section 2618(a)(2)(I),
exceeds by at least $20,000,000 the amount appropriated under
section 2677 to carry out part B in fiscal year 2000, excluding the
amount appropriated under section 2618(a)(2)(I).
``(3) Minimum amount in future years.--Beginning with the first
fiscal year in which amounts provided for emerging communities
under paragraph (1)(A) equals $5,000,000 and under paragraph (1)(B)
equals $5,000,000, the Secretary shall ensure that amounts made
available under this section for the types of emerging communities
described in each such paragraph in subsequent fiscal years is at
least $5,000,000.
``(4) Distribution.--Grants under this section for emerging
communities shall be formula grants. There shall be two categories
of such formula grants, as follows:
``(A) One category of such grants shall be for emerging
communities for which the cumulative total of cases for
purposes of subsection (d)(2) is 999 or fewer cases. The grant
made to such an emerging community for a fiscal year shall be
the product of--
``(i) an amount equal to 50 percent of the amount
available pursuant to this subsection for the fiscal year
involved; and
``(ii) a percentage equal to the ratio constituted by
the number of cases for such emerging community for the
fiscal year over the aggregate number of such cases for
such year for all emerging communities to which this
subparagraph applies.
``(B) The other category of formula grants shall be for
emerging communities for which the cumulative total of cases
for purposes of subsection (d)(2) is 1,000 or more cases. The
grant made to such an emerging community for a fiscal year
shall be the product of--
``(i) an amount equal to 50 percent of the amount
available pursuant to this subsection for the fiscal year
involved; and
``(ii) a percentage equal to the ratio constituted by
the number of cases for such community for the fiscal year
over the aggregate number of such cases for the fiscal year
for all emerging communities to which this subparagraph
applies.''.
Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission
of HIV

255ce37c0cb6d83db76e7fc3593da23cb9b0744be870f4b782823a89c895ddbe

Subpart II of part B of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-33 et seq.) is amended--
(1) in section 2626, by striking each of subsections (d)
through (f);
(2) by striking sections 2627 and 2628; and
(3) by redesignating section 2629 as section 2627.

ae8bd6175a14693a3bb9e42007d88b37f2bb3b1653676e2de089c58a5a31f0b6

(a) In General.--Section 2625(c) of the Public Health Service Act
(42 U.S.C. 300ff-33) is amended--
(1) in paragraph (1), by inserting at the end the following
subparagraph:
``(F) Making available to pregnant women with HIV disease,
and to the infants of women with such disease, treatment
services for such disease in accordance with applicable
recommendations of the Secretary.'';
(2) by amending paragraph (2) to read as follows:
``(2) Funding.--
``(A) Authorization of appropriations.--For the purpose of
carrying out this subsection, there are authorized to be
appropriated $30,000,000 for each of the fiscal years 2001
through 2005. Amounts made available under section 2677 for
carrying out this part are not available for carrying out this
section unless otherwise authorized.
``(B) Allocations for certain states.--
``(i) In general.--Of the amounts appropriated under
subparagraph (A) for a fiscal year in excess of
$10,000,000--
``(I) the Secretary shall reserve the applicable
percentage under clause (iv) for making grants under
paragraph (1) both to States described in clause (ii)
and States described in clause (iii); and
``(II) the Secretary shall reserve the remaining
amounts for other States, taking into consideration the
factors described in subparagraph (C)(iii), except that
this subclause does not apply to any State that for the
fiscal year involved is receiving amounts pursuant to
subclause (I).
``(ii) Required testing of newborns.--For purposes of
clause (i)(I), the States described in this clause are
States that under law (including under regulations or the
discretion of State officials) have--
``(I) a requirement that all newborn infants born
in the State be tested for HIV disease and that the
biological mother of each such infant, and the legal
guardian of the infant (if other than the biological
mother), be informed of the results of the testing; or
``(II) a requirement that newborn infants born in
the State be tested for HIV disease in circumstances in
which the attending obstetrician for the birth does not
know the HIV status of the mother of the infant, and
that the biological mother of each such infant, and the
legal guardian of the infant (if other than the
biological mother), be informed of the results of the
testing.
``(iii) Most significant reduction in cases of
perinatal transmission.--For purposes of clause (i)(I), the
States described in this clause are the following
(exclusive of States described in clause (ii)), as
applicable:
``(I) For fiscal years 2001 and 2002, the two
States that, relative to other States, have the most
significant reduction in the rate of new cases of the
perinatal transmission of HIV (as indicated by the
number of such cases reported to the Director of the
Centers for Disease Control and Prevention for the most
recent periods for which the data are available).
``(II) For fiscal years 2003 and 2004, the three
States that have the most significant such reduction.
``(III) For fiscal year 2005, the four States that
have the most significant such reduction.
``(iv) Applicable percentage.--For purposes of clause
(i), the applicable amount for a fiscal year is as follows:
``(I) For fiscal year 2001, 33 percent.
``(II) For fiscal year 2002, 50 percent.
``(III) For fiscal year 2003, 67 percent.
``(IV) For fiscal year 2004, 75 percent.
``(V) For fiscal year 2005, 75 percent.
``(C) Certain provisions.--With respect to grants under
paragraph (1) that are made with amounts reserved under
subparagraph (B) of this paragraph:
``(i) Such a grant may not be made in an amount
exceeding $4,000,000.
``(ii) If pursuant to clause (i) or pursuant to an
insufficient number of qualifying applications for such
grants (or both), the full amount reserved under
subparagraph (B) for a fiscal year is not obligated, the
requirement under such subparagraph to reserve amounts
ceases to apply.
``(iii) In the case of a State that meets the
conditions to receive amounts reserved under subparagraph
(B)(i)(II), the Secretary shall in making grants consider
the following factors:
``(I) The extent of the reduction in the rate of
new cases of the perinatal transmission of HIV.
``(II) The extent of the reduction in the rate of
new cases of perinatal cases of acquired immune
deficiency syndrome.
``(III) The overall incidence of cases of infection
with HIV among women of childbearing age.
``(IV) The overall incidence of cases of acquired
immune deficiency syndrome among women of childbearing
age.
``(V) The higher acceptance rate of HIV testing of
pregnant women.
``(VI) The extent to which women and children with
HIV disease are receiving HIV-related health services.
``(VII) The extent to which HIV-exposed children
are receiving health services appropriate to such
exposure.''; and
(3) by adding at the end the following paragraph:
``(4) Maintenance of effort.--A condition for the receipt of a
grant under paragraph (1) is that the State involved agree that the
grant will be used to supplement and not supplant other funds
available to the State to carry out the purposes of the grant.''.
(b) Special Funding Rule for Fiscal Year 2001.--
(1) In general.--If for fiscal year 2001 the amount
appropriated under paragraph (2)(A) of section 2625(c) of the
Public Health Service Act is less than $14,000,000--
(A) the Secretary of Health and Human Services shall, for
the purpose of making grants under paragraph (1) of such
section, reserve from the amount specified in paragraph (2) of
this subsection an amount equal to the difference between
$14,000,000 and the amount appropriated under paragraph (2)(A)
of such section for such fiscal year (notwithstanding any other
provision of this Act or the amendments made by this Act);
(B) the amount so reserved shall, for purposes of paragraph
(2)(B)(i) of such section, be considered to have been
appropriated under paragraph (2)(A) of such section; and
(C) the percentage specified in paragraph (2)(B)(iv)(I) of
such section is deemed to be 50 percent.
(2) Allocation from increases in funding for part b.--For
purposes of paragraph (1), the amount specified in this paragraph
is the amount by which the amount appropriated under section 2677
of the Public Health Service Act for fiscal year 2001 and available
for grants under section 2611 of such Act is an increase over the
amount so appropriated and available for fiscal year 2000.

5baad10795b1638621b1e05e48bc34f768bc7f9451aa14f67d96660bb7e55827

Subpart II of part B of title XXVI of the Public Health Service
Act, as amended by section 211(3), is amended by adding at the end the
following section:
``SEC. 2628. RECOMMENDATIONS FOR REDUCING INCIDENCE OF PERINATAL
TRANSMISSION.
``(a) Study by Institute of Medicine.--
``(1) In general.--The Secretary shall request the Institute of
Medicine to enter into an agreement with the Secretary under which
such Institute conducts a study to provide the following:
``(A) For the most recent fiscal year for which the
information is available, a determination of the number of
newborn infants with HIV born in the United States with respect
to whom the attending obstetrician for the birth did not know
the HIV status of the mother.
``(B) A determination for each State of any barriers,
including legal barriers, that prevent or discourage an
obstetrician from making it a routine practice to offer
pregnant women an HIV test and a routine practice to test
newborn infants for HIV disease in circumstances in which the
obstetrician does not know the HIV status of the mother of the
infant.
``(C) Recommendations for each State for reducing the
incidence of cases of the perinatal transmission of HIV,
including recommendations on removing the barriers identified
under subparagraph (B).
If such Institute declines to conduct the study, the Secretary
shall enter into an agreement with another appropriate public or
nonprofit private entity to conduct the study.
``(2) Report.--The Secretary shall ensure that, not later than
18 months after the effective date of this section, the study
required in paragraph (1) is completed and a report describing the
findings made in the study is submitted to the appropriate
committees of the Congress, the Secretary, and the chief public
health official of each of the States.
``(b) Progress Toward Recommendations.--In fiscal year 2004, the
Secretary shall collect information from the States describing the
actions taken by the States toward meeting the recommendations
specified for the States under subsection (a)(1)(C).
``(c) Submission of Reports to Congress.--The Secretary shall
submit to the appropriate committees of the Congress reports describing
the information collected under subsection (b).''.
Subtitle C--Certain Partner Notification Programs

75eda16ebd1d1538e35eac8b3da2d0941a5c5aae0171ed19756222b40993538a

Part B of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-21 et seq.) is amended by adding at the end the following
subpart:
``Subpart III--Certain Partner Notification Programs
``SEC. 2631. GRANTS FOR PARTNER NOTIFICATION PROGRAMS.
``(a) In General.--In the case of States whose laws or regulations
are in accordance with subsection (b), the Secretary, subject to
subsection (c)(2), may make grants to the States for carrying out
programs to provide partner counseling and referral services.
``(b) Description of Compliant State Programs.--For purposes of
subsection (a), the laws or regulations of a State are in accordance
with this subsection if under such laws or regulations (including
programs carried out pursuant to the discretion of State officials) the
following policies are in effect:
``(1) The State requires that the public health officer of the
State carry out a program of partner notification to inform
partners of individuals with HIV disease that the partners may have
been exposed to the disease.
``(2)(A) In the case of a health entity that provides for the
performance on an individual of a test for HIV disease, or that
treats the individual for the disease, the State requires, subject
to subparagraph (B), that the entity confidentially report the
positive test results to the State public health officer in a
manner recommended and approved by the Director of the Centers for
Disease Control and Prevention, together with such additional
information as may be necessary for carrying out such program.
``(B) The State may provide that the requirement of
subparagraph (A) does not apply to the testing of an individual for
HIV disease if the individual underwent the testing through a
program designed to perform the test and provide the results to the
individual without the individual disclosing his or her identity to
the program. This subparagraph may not be construed as affecting
the requirement of subparagraph (A) with respect to a health entity
that treats an individual for HIV disease.
``(3) The program under paragraph (1) is carried out in
accordance with the following:
``(A) Partners are provided with an appropriate opportunity
to learn that the partners have been exposed to HIV disease,
subject to subparagraph (B).
``(B) The State does not inform partners of the identity of
the infected individuals involved.
``(C) Counseling and testing for HIV disease are made
available to the partners and to infected individuals, and such
counseling includes information on modes of transmission for
the disease, including information on prenatal and perinatal
transmission and preventing transmission.
``(D) Counseling of infected individuals and their partners
includes the provision of information regarding therapeutic
measures for preventing and treating the deterioration of the
immune system and conditions arising from the disease, and the
provision of other prevention-related information.
``(E) Referrals for appropriate services are provided to
partners and infected individuals, including referrals for
support services and legal aid.
``(F) Notifications under subparagraph (A) are provided in
person, unless doing so is an unreasonable burden on the State.
``(G) There is no criminal or civil penalty on, or civil
liability for, an infected individual if the individual chooses
not to identify the partners of the individual, or the
individual does not otherwise cooperate with such program.
``(H) The failure of the State to notify partners is not a
basis for the civil liability of any health entity who under
the program reported to the State the identity of the infected
individual involved.
``(I) The State provides that the provisions of the program
may not be construed as prohibiting the State from providing a
notification under subparagraph (A) without the consent of the
infected individual involved.
``(4) The State annually reports to the Director of the Centers
for Disease Control and Prevention the number of individuals from
whom the names of partners have been sought under the program under
paragraph (1), the number of such individuals who provided the
names of partners, and the number of partners so named who were
notified under the program.
``(5) The State cooperates with such Director in carrying out a
national program of partner notification, including the sharing of
information between the public health officers of the States.
``(c) Reporting System for Cases of HIV Disease; Preference in
Making Grants.--In making grants under subsection (a), the Secretary
shall give preference to States whose reporting systems for cases of
HIV disease produce data on such cases that is sufficiently accurate
and reliable for use for purposes of section 2618(a)(2)(D)(i).
``(d) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $30,000,000
for fiscal year 2001, and such sums as may be necessary for each of the
fiscal years 2002 through 2005.''.
Subtitle A--Formula Grants for States

21c5415b0c3ecb3b60d08f8ea3650c5b86ad0a5127e861e0f89eb7908879f789

(a) Repeal.--Subpart I of part C of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-41 et seq.) is repealed.
(b) Conforming Amendments.--Part C of title XXVI of the Public
Health Service Act (42 U.S.C. 300ff-41 et seq.), as amended by
subsection (a) of this section, is amended--
(1) by redesignating subparts II and III as subparts I and II,
respectively;
(2) in section 2661(a), by striking ``unless--'' and all that
follows through ``(2) in the case of'' and inserting ``unless, in
the case of''; and
(3) in section 2664--
(A) in subsection (e)(5), by striking ``2642(b) or'';
(B) in subsection (f)(2), by striking ``2642(b) or''; and
(C) by striking subsection (h).
Subtitle B--Categorical Grants

2e651ba1c2e59e08abb14ac61d54dfc5da348786c1b56ba42cc3db9d41d3533a

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

3db36d37257114412370fb7da1a28a71f47a91901cf5fafec56eaee16ed63fca

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

ac021905cb7e1bd02e7513c390c75a770f134b42fd85bff03e2ffb248b93f624

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

81cb0bac0d112d79fa2a21ab3ae7369f53e3fdf4b9ff253aa066302ebbbaf4ed

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

80b0205bb643f8770991af70f8bd97550b08ffccb12ae2e91f8476fc163077bb

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

97aa48d0b7be2514fdf8433034b29fea1daf47afae061b4f4b68845b2decc7d5

FOR WOMEN, INFANTS, CHILDREN, AND YOUTH.
(a) Elimination of Requirement To Enroll Significant Numbers of
Women and Children.--Section 2671(b) (42 U.S.C. 300ff-71(b)) is
amended--
(1) in paragraph (1), by striking subparagraphs (C) and (D) and
inserting the following:
``(C) The applicant will demonstrate linkages to research
and how access to such research is being offered to
patients.''; and
(2) by striking paragraphs (3) and (4).
(b) Information and Education.--Section 2671(d) (42 U.S.C. 300ff-
71(d)) is amended by adding at the end the following:
``(4) The applicant will provide individuals with information
and education on opportunities to participate in HIV/AIDS-related
clinical research.''.
(c) Quality Management; Administrative Expenses Ceiling.--Section
2671(f) (42 U.S.C. 300ff-71(f)) is amended--
(1) by striking the subsection heading and designation and
inserting the following:
``(f) Administration.--
``(1) Application.--''; and
(2) by adding at the end the following:
``(2) Quality management program.--A grantee under this section
shall implement a quality management program to assess the extent
to which HIV health services provided to patients under the grant
are consistent with the most recent Public Health Service
guidelines for the treatment of HIV disease and related
opportunistic infection, and as applicable, to develop strategies
for ensuring that such services are consistent with the guidelines
for improvement in the access to and quality of HIV health
services.''.
(d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g)) is
amended by adding at the end the following: ``The Secretary acting
through the Director of NIH, shall examine the distribution and
availability of ongoing and appropriate HIV/AIDS-related research
projects to existing sites under this section for purposes of enhancing
and expanding voluntary access to HIV-related research, especially
within communities that are not reasonably served by such projects. Not
later than 12 months after the date of the enactment of the Ryan White
CARE Act Amendments of 2000, the Secretary shall prepare and submit to
the appropriate committees of Congress a report that describes the
findings made by the Director and the manner in which the conclusions
based on those findings can be addressed.''.
(e) Administrative Expenses.--Section 2671 of the Public Health
Service Act (42 U.S.C. 300ff-71) is amended--
(1) by redesignating subsections (i) and (j) as subsections (j)
and (k), respectively; and
(2) by inserting after subsection (h) the following subsection:
``(i) Limitation on Administrative Expenses.--
``(1) Determination by secretary.--Not later than 12 months
after the date of the enactment of the Ryan White CARE Act
Amendments of 2000, the Secretary, in consultation with grantees
under this part, shall conduct a review of the administrative,
program support, and direct service-related activities that are
carried out under this part to ensure that eligible individuals
have access to quality, HIV-related health and support services and
research opportunities under this part, and to support the
provision of such services.
``(2) Requirements.--
``(A) In general.--Not later than 180 days after the
expiration of the 12-month period referred to in paragraph (1)
the Secretary, in consultation with grantees under this part,
shall determine the relationship between the costs of the
activities referred to in paragraph (1) and the access of
eligible individuals to the services and research opportunities
described in such paragraph.
``(B) Limitation.--After a final determination under
subparagraph (A), the Secretary may not make a grant under this
part unless the grantee complies with such requirements as may
be included in such determination.''.
(f) Authorization of Appropriations.--Section 2671 of the Public
Health Service Act (42 U.S.C. 300ff-71) is amended in subsection (j)
(as redesignated by subsection (e)(1) of this section) by striking
``fiscal years 1996 through 2000'' and inserting ``fiscal years 2001
through 2005''.

1691c243a9b01e50749c4a7a3f129437570d7307a3370e5a0c6ce3e8f515e83d

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

de833420d7a10860cd4c17a09da3e6edcf1f2f5c59362f806c0542fdf712063c

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

6c715cb420613cd34b6a2558f3fbd46443b63c652565bc85c2c9590d1b3c8e62

PREVENTION.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 318A the following
section:
``data collection regarding programs under title xxvi
``Sec. 318B. For the purpose of collecting and providing data for
program planning and evaluation activities under title XXVI, there are
authorized to be appropriated to the Secretary (acting through the
Director of the Centers for Disease Control and Prevention) such sums
as may be necessary for each of the fiscal years 2001 through 2005.
Such authorization of appropriations is in addition to other
authorizations of appropriations that are available for such
purpose.''.

9cdf6bd7eae483d701caea0197a6e0a4e13047acbc86e405c2f143a80a03057b

Section 2675 of the Public Health Service Act (42 U.S.C. 300ff-75)
is amended--
(1) by amending subsection (a) to read as follows:
``(a) Requirement.--The Secretary shall ensure that the Health
Resources and Services Administration, the Centers for Disease Control
and Prevention, the Substance Abuse and Mental Health Services
Administration, and the Health Care Financing Administration coordinate
the planning, funding, and implementation of Federal HIV programs to
enhance the continuity of care and prevention services for individuals
with HIV disease or those at risk of such disease. The Secretary shall
consult with other Federal agencies, including the Department of
Veterans Affairs, as needed and utilize planning information submitted
to such agencies by the States and entities eligible for support.'';
(2) by redesignating subsections (b) and (c) as subsections (c)
and (d), respectively;
(3) by inserting after subsection (b) the following subsection:
``(b) Report.--The Secretary shall biennially prepare and submit to
the appropriate committees of the Congress a report concerning the
coordination efforts at the Federal, State, and local levels described
in this section, including a description of Federal barriers to HIV
program integration and a strategy for eliminating such barriers and
enhancing the continuity of care and prevention services for
individuals with HIV disease or those at risk of such disease.''; and
(4) in each of subsections (c) and (d) (as redesignated by
paragraph (2) of this section), by inserting ``and prevention
services'' after ``continuity of care'' each place such term
appears.

8088c3cc0541e1b12aba912ed7333647e9c3e8dca2adabd9f12373123a00c623

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

746f734bd8af93780bf74da39876480f3e760ff317a775431cd23b634cfeb3b8

Part D of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-71 et seq.) is amended by inserting after section 2675 the
following section:
``SEC. 2675A. AUDITS.
``For fiscal year 2002 and subsequent fiscal years, the Secretary
may reduce the amounts of grants under this title to a State or
political subdivision of a State for a fiscal year if, with respect to
such grants for the second preceding fiscal year, the State or
subdivision fails to prepare audits in accordance with the procedures
of section 7502 of title 31, United States Code. The Secretary shall
annually select representative samples of such audits, prepare
summaries of the selected audits, and submit the summaries to the
Congress.''.

7a2d6ecdf49de6a87d3b0736bc1264b14c51f21801a3c1e9b7a6dfcfe7376b64

Part D of title XXVI of the Public Health Service Act, as amended
by section 415 of this Act, is amended by inserting after section 2675A
the following section:
``SEC. 2675B. ADMINISTRATIVE SIMPLIFICATION REGARDING PARTS A AND B.
``(a) Coordinated Disbursement.--After consultation with the
States, with eligible areas under part A, and with entities that
receive amounts from grants under part A or B, the Secretary shall
develop a plan for coordinating the disbursement of appropriations for
grants under part A with the disbursement of appropriations for grants
under part B in order to assist grantees and other recipients of
amounts from such grants in complying with the requirements of such
parts. The Secretary shall submit the plan to the Congress not later
than 18 months after the date of the enactment of the Ryan White CARE
Act Amendments of 2000. Not later than 2 years after the date on which
the plan is so submitted, the Secretary shall complete the
implementation of the plan, notwithstanding any provision of this title
that is inconsistent with the plan.
``(b) Biennial Applications.--After consultation with the States,
with eligible areas under part A, and with entities that receive
amounts from grants under part A or B, the Secretary shall make a
determination of whether the administration of parts A and B by the
Secretary, and the efficiency of grantees under such parts in complying
with the requirements of such parts, would be improved by requiring
that applications for grants under such parts be submitted biennially
rather than annually. The Secretary shall submit such determination to
the Congress not later than 2 years after the date of the enactment of
the Ryan White CARE Act Amendments of 2000.
``(c) Application Simplification.--After consultation with the
States, with eligible areas under part A, and with entities that
receive amounts from grants under part A or B, the Secretary shall
develop a plan for simplifying the process for applications under parts
A and B. The Secretary shall submit the plan to the Congress not later
than 18 months after the date of the enactment of the Ryan White CARE
Act Amendments of 2000. Not later than 2 years after the date on which
the plan is so submitted, the Secretary shall complete the
implementation of the plan, notwithstanding any provision of this title
that is inconsistent with the plan.''.

043dc22643ecb91e3b1bfe7004365b4f37d8bf62cd9b06818bb485b15f1956a0

AND B.
Section 2677 of the Public Health Service Act (42 U.S.C. 300ff-77)
is amended to read as follows:
``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.
``(a) Part A.--For the purpose of carrying out part A, there are
authorized to be appropriated such sums as may be necessary for each of
the fiscal years 2001 through 2005.
``(b) Part B.--For the purpose of carrying out part B, there are
authorized to be appropriated such sums as may be necessary for each of
the fiscal years 2001 through 2005.''.

46312f7d2657ce2e7cce1c85b2dcccea25e43fc13cb45d560e9bbf080954c96b

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

819bc430fe70a4a3bc7c9599710662b7359473814652065f509b3423ef1fca52

TITLE V

-GENERAL PROVISIONS

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

61d79b81c9f92a0d0619944ef1e13e4e5833fb4f49e69079514386286596459e

(a) Public Health Service Act.--Title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-11 et seq.) is amended--
(1) in section 2605(d)--
(A) in paragraph (1), by striking ``section 2608'' and
inserting ``section 2677''; and
(B) in paragraph (4), by inserting ``section'' before
``2601(a)''; and
(2) in section 2673(a), in the matter preceding paragraph (1),
by striking ``the Agency for Health Care Policy and Research'' and
inserting ``the Director of the Agency for Healthcare Research and
Quality''.
(b) Related Act.--The first paragraph (2) of section 3(c) of the
Ryan White CARE Act Amendments of 1996 (Public Law 104-146; 110 Stat.
1354) is amended in subparagraph (A)(iii) by striking ``by inserting
the following new paragraph:'' and inserting ``by inserting before
paragraph (2) (as so redesignated) the following new paragraph''.

0e4431e752bfeafed9b0aff9e2d176980089f0f881df0c49e789cff3d0f551c3

This Act and the amendments made by this Act take effect October 1,
2000, or upon the date of the enactment of this Act, whichever occurs
later.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.

9e08eed4e104e36e327c8569c682063f82672463a3806449e32b74a64dffe653

Ryan White CARE Act Programs Authorization bill — S. 2311

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