[106th Congress Public Law 345]
[From the U.S. Government Printing Office]
<DOC>
[DOCID: f:publ345.106]
[[Page 114 STAT. 1319]]
Public Law 106-345
106th Congress
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. <<NOTE: Oct. 20, 2000 - [S.
2311]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Ryan White CARE
Act Amendments of 2000.>>
SECTION 1. SHORT TITLE. <<NOTE: 42 USC 201 note.>>
This Act may be cited as the ``Ryan White CARE Act Amendments of
2000''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES
Subtitle A--HIV Health Services Planning Councils
Sec. 101. Membership of councils.
Sec. 102. Duties of councils.
Sec. 103. Open meetings; other additional provisions.
Subtitle B--Type and Distribution of Grants
Sec. 111. Formula grants.
Sec. 112. Supplemental grants.
Subtitle C--Other Provisions
Sec. 121. Use of amounts.
Sec. 122. Application.
TITLE II--CARE GRANT PROGRAM
Subtitle A--General Grant Provisions
Sec. 201. Priority for women, infants, and children.
Sec. 202. Use of grants.
Sec. 203. Grants to establish HIV care consortia.
Sec. 204. Provision of treatments.
Sec. 205. State application.
Sec. 206. Distribution of funds.
Sec. 207. Supplemental grants for certain States.
Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission
of HIV
Sec. 211. Repeals.
Sec. 212. Grants.
Sec. 213. Study by Institute of Medicine.
Subtitle C--Certain Partner Notification Programs
Sec. 221. Grants for compliant partner notification programs.
[[Page 114 STAT. 1320]]
TITLE III--EARLY INTERVENTION SERVICES
Subtitle A--Formula Grants for States
Sec. 301. Repeal of program.
Subtitle B--Categorical Grants
Sec. 311. Preferences in making grants.
Sec. 312. Planning and development grants.
Sec. 313. Authorization of appropriations.
Subtitle C--General Provisions
Sec. 321. Provision of certain counseling services.
Sec. 322. Additional required agreements.
TITLE IV--OTHER PROGRAMS AND ACTIVITIES
Subtitle A--Certain Programs for Research, Demonstrations, or Training
Sec. 401. Grants for coordinated services and access to research for
women, infants, children, and youth.
Sec. 402. AIDS education and training centers.
Subtitle B--General Provisions in Title XXVI
Sec. 411. Evaluations and reports.
Sec. 412. Data collection through Centers for Disease Control and
Prevention.
Sec. 413. Coordination.
Sec. 414. Plan regarding release of prisoners with HIV disease.
Sec. 415. Audits.
Sec. 416. Administrative simplification.
Sec. 417. Authorization of appropriations for parts A and B.
TITLE V--GENERAL PROVISIONS
Sec. 501. Studies by Institute of Medicine.
Sec. 502. Development of rapid HIV test.
Sec. 503. Technical corrections.
TITLE VI--EFFECTIVE DATE
Sec. 601. Effective date.
TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES
Subtitle A--HIV Health Services Planning Councils
SEC. 101. MEMBERSHIP OF COUNCILS.
(a) In General.--Section 2602(b) of the Public Health Service Act
(42 U.S.C. 300ff-12(b)) is amended--
(1) in paragraph (1), by striking ``demographics of the
epidemic in the eligible area involved,'' and inserting
``demographics of the population of individuals with HIV disease
in the eligible area involved,''; and
(2) in paragraph (2)--
(A) in subparagraph (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
[[Page 114 STAT. 1321]]
(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.''.
SEC. 102. DUTIES OF COUNCILS.
(a) In General.--Section 2602(b)(4) of the Public Health Service Act
(42 U.S.C. 300ff-12(b)(4)) is amended--
(1) by redesignating subparagraphs (A) through (E) as
subparagraphs (C) through (G), respectively;
(2) by inserting before subparagraph (C) (as so
redesignated) the following subparagraphs:
``(A) determine the size and demographics of the
population of individuals with HIV disease;
``(B) determine the needs of such population, with
particular attention to--
``(i) individuals with HIV disease who 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
[[Page 114 STAT. 1322]]
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
[[Page 114 STAT. 1323]]
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) <<NOTE: 42 USC 300ff-13.>> 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)''.
SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVISIONS.
Section 2602(b) of the Public Health Service Act (42 U.S.C. 300ff-
12(b)) is amended--
(1) in paragraph (3), by striking subparagraph (C); and
(2) by adding at the end the following paragraph:
``(7) Public deliberations.--With respect to a planning
council under paragraph (1), the following applies:
``(A) The council may not be chaired solely by an
employee of the grantee under section 2601(a).
``(B) In accordance with criteria established by the
Secretary:
``(i) <<NOTE: Public notice.>> The meetings
of the council shall be open to the public and
shall be held only after adequate notice to the
public.
``(ii) <<NOTE: Records. Reports.>> The
records, reports, transcripts, minutes, agenda, or
other documents which were made available to or
prepared for or by the council shall be available
for public inspection and copying at a single
location.
``(iii) Detailed minutes of each meeting of
the council shall be kept. The accuracy of all
minutes shall be certified to by the chair of the
council.
``(iv) This subparagraph does not apply to any
disclosure of information of a personal nature
that would constitute a clearly unwarranted
invasion of personal privacy, including any
disclosure of medical information or personnel
matters.''.
Subtitle B--Type and Distribution of Grants
SEC. 111. FORMULA GRANTS.
(a) Expedited Distribution.--Section 2603(a)(2) of the Public Health
Service Act (42 U.S.C. 300ff-13(a)(2)) is amended in the first sentence
by striking ``for each of the fiscal years 1996 through 2000'' and
inserting ``for a fiscal year''.
[[Page 114 STAT. 1324]]
(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) <<NOTE: Deadline.>> 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
[[Page 114 STAT. 1325]]
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.''.
[[Page 114 STAT. 1326]]
SEC. 112. SUPPLEMENTAL GRANTS.
(a) In General.--Section 2603(b)(2) of the Public Health Service Act
(42 U.S.C. 300ff-13(b)(2)) is amended--
(1) in the heading for the paragraph, by striking
``Definition'' and inserting ``Amount of grant'';
(2) by redesignating subparagraphs (A) through (C) as
subparagraphs (B) through (D), respectively;
(3) by inserting before subparagraph (B) (as so
redesignated) the following subparagraph:
``(A) In general.--The amount of each grant made for
purposes of this subsection shall be determined by the
Secretary based on a weighting of factors under
paragraph (1), with severe need under subparagraph (B)
of such paragraph counting one-third.'';
(4) in subparagraph (B) (as so redesignated)--
(A) in clause (ii), by striking ``and'' at the end;
(B) in clause (iii), by striking the period and
inserting a semicolon; and
(C) by adding at the end the following clauses:
``(iv) the current prevalence of HIV disease;
``(v) an increasing need for HIV-related
services, including relative rates of increase in
the number of cases of HIV disease; and
``(vi) unmet need for such services, as
determined under section 2602(b)(4).'';
(5) in subparagraph (C) (as so redesignated)--
(A) by striking ``subparagraph (A)'' each place such
term appears and inserting ``subparagraph (B)'';
(B) in the second sentence, by striking ``2 years
after the date of enactment of this paragraph'' and
inserting ``18 months after the date of the enactment of
the Ryan White CARE Act Amendments of 2000''; and
(C) by inserting after the second sentence the
following sentence: ``Such a mechanism shall be modified
to reflect the findings of the study under section
501(b) of the Ryan White CARE Act Amendments of 2000
(relating to the relationship between epidemiological
measures and health care for certain individuals with
HIV disease).''; and
(6) in subparagraph (D) (as so redesignated), by striking
``subparagraph (B)'' and inserting ``subparagraph (C)''.
(b) Requirements for Application.--Section 2603(b)(1)(E) of the
Public Health Service Act (42 U.S.C. 300ff-13(b)(1)(E)) is amended by
inserting ``youth,'' after ``children,''.
(c) 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
SEC. 121. USE OF AMOUNTS.
(a) Primary Purposes.--Section 2604(b)(1) of the Public Health
Service Act (42 U.S.C. 300ff-14(b)(1)) is amended--
[[Page 114 STAT. 1327]]
(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
[[Page 114 STAT. 1328]]
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
[[Page 114 STAT. 1329]]
with the quality management program required in paragraph (1)
not more than the lesser of--
``(A) 5 percent of amounts received under the grant;
or
``(B) $3,000,000.''.
SEC. 122. APPLICATION.
(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).''.
TITLE II--CARE GRANT PROGRAM
Subtitle A--General Grant Provisions
SEC. 201. PRIORITY FOR WOMEN, INFANTS, AND CHILDREN.
Section 2611(b) of the Public Health Service Act (42 U.S.C. 300ff-
21(b)) is amended 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
[[Page 114 STAT. 1330]]
perinatal transmission of HIV, a State shall for each of such
populations use, of the funds allocated under this part to the
State for a fiscal year, not less than the percentage
constituted by the ratio of the population involved (infants,
children, youth, or women in the State) with acquired immune
deficiency syndrome to the general population in the State of
individuals with such syndrome.
``(2) Waiver.--With respect to the population involved, the
Secretary may provide to a State a waiver of the requirement of
paragraph (1) if the State demonstrates to the satisfaction of
the Secretary that the population is receiving HIV-related
health services through the State medicaid program under title
XIX of the Social Security Act, the State children's health
insurance program under title XXI of such Act, or other Federal
or State programs.''.
SEC. 202. USE OF GRANTS.
Section 2612 of the Public Health Service Act (42 U.S.C. 300ff-22)
is amended--
(1) by striking ``A State may use'' and inserting ``(a) In
General.--A State may use''; and
(2) by adding at the end the following subsections:
``(b) Support Services; Outreach.--The purposes for which a grant
under this part may be used include delivering or enhancing the
following:
``(1) 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
[[Page 114 STAT. 1331]]
2652(a) that constitute a point of access to services by
maintaining referral relationships.
``(2) Conditions.--With respect to an entity that proposes
to provide early intervention services under paragraph (1), such
paragraph applies only if the entity demonstrates to the
satisfaction of the State involved that--
``(A) Federal, State, or local funds are otherwise
inadequate for the early intervention services the
entity proposes to provide; and
``(B) the entity will expend funds pursuant to such
paragraph to supplement and not supplant other funds
available to the entity for the provision of early
intervention services for the fiscal year involved.
``(d) Quality Management.--
``(1) Requirement.--Each State that receives a grant under
this part shall provide for the establishment of a quality
management program to assess the extent to which HIV health
services provided to patients under the grant are consistent
with the most recent Public Health Service guidelines for the
treatment of HIV disease and related opportunistic infection,
and as applicable, to develop strategies for ensuring that such
services are consistent with the guidelines for improvement in
the access to and quality of HIV health services.
``(2) Use of funds.--From amounts received under a grant
awarded under this part for a fiscal year, the State may (in
addition to amounts to which section 2618(b)(5) applies) use for
activities associated with the quality management program
required in paragraph (1) not more than the lesser of--
``(A) 5 percent of amounts received under the grant;
or
``(B) $3,000,000.''.
SEC. 203. GRANTS TO ESTABLISH HIV CARE CONSORTIA.
Section 2613 of the Public Health Service Act (42 U.S.C. 300ff-23)
is amended--
(1) in subsection (b)(1)--
(A) in subparagraph (A), by inserting before the
semicolon the following: ``, particularly those
experiencing disparities in access and services and
those who reside in historically underserved
communities''; and
(B) in subparagraph (B), by inserting after ``by
such consortium'' the following: ``is consistent with
the comprehensive plan under 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
[[Page 114 STAT. 1332]]
(C) by inserting after subparagraph (C) the
following subparagraph:
``(D) the types of entities described in section
2602(b)(2).''.
SEC. 204. PROVISION OF TREATMENTS.
(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).''.
SEC. 205. STATE APPLICATION.
(a) Determination of Size and Needs of Population; Comprehensive
Plan.--Section 2617(b) of the Public Health Service Act (42 U.S.C.
300ff-27(b)) is amended--
(1) by redesignating paragraphs (2) through (4) as
paragraphs (4) through (6), respectively;
(2) by inserting after paragraph (1) the following
paragraphs:
``(2) a determination of the size and demographics of the
population of individuals with HIV disease in the State;
``(3) a determination of the needs of such population, with
particular attention to--
``(A) individuals with HIV disease who 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)--
[[Page 114 STAT. 1333]]
(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, <<NOTE: 42 USC 300ff-27.>> 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:
[[Page 114 STAT. 1334]]
``(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, <<NOTE: 42 USC 300ff-27.>> 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.''.
SEC. 206. DISTRIBUTION OF FUNDS.
(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
[[Page 114 STAT. 1335]]
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 <<NOTE: 42 USC 300ff-28.>> (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)
[[Page 114 STAT. 1336]]
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) <<NOTE: Effective
date.>> 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
[[Page 114 STAT. 1337]]
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 <<NOTE: 42 USC 300ff-28.>> (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''.
SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.
Subpart I of part B of title XXVI of the Public Health Service
Act <<NOTE: 42 USC 300ff-31.>> (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. <<NOTE: 42 USC 300ff-30.>> 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) <<NOTE: Reports.>> 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
[[Page 114 STAT. 1338]]
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) <<NOTE: Effective date.>> 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
[[Page 114 STAT. 1339]]
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
SEC. 211. REPEALS.
Subpart II of part B of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-33 et seq.) is amended--
(1) <<NOTE: 42 USC 300ff-34.>> in section 2626, by striking
each of subsections (d) through (f);
(2) <<NOTE: 42 USC 300ff-35, 300ff-36.>> by striking
sections 2627 and 2628; and
(3) <<NOTE: 42 USC 300ff-37.>> by redesignating section
2629 as section 2627.
SEC. 212. GRANTS.
(a) In General.--Section 2625(c) of the Public Health Service Act
(42 U.S.C. 300ff-33) is amended--
[[Page 114 STAT. 1340]]
(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
[[Page 114 STAT. 1341]]
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.--
[[Page 114 STAT. 1342]]
(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.
SEC. 213. STUDY BY INSTITUTE OF MEDICINE.
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. <<NOTE: 42 USC 300ff-37a.>> 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) <<NOTE: Deadline.>> 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
[[Page 114 STAT. 1343]]
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
SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICATION PROGRAMS.
Part B of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-21 et seq.) is amended by adding at the end the following subpart:
``Subpart III--Certain Partner Notification Programs
``SEC. 2631. <<NOTE: 42 USC 300ff-38.>> 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.
[[Page 114 STAT. 1344]]
``(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.''.
[[Page 114 STAT. 1345]]
TITLE III--EARLY INTERVENTION SERVICES
Subtitle A--Formula Grants for States
SEC. 301. REPEAL OF PROGRAM.
(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) <<NOTE: 42 USC 300ff-61.>> 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) <<NOTE: 42 USC 300ff-64.>> 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
SEC. 311. PREFERENCES IN MAKING GRANTS.
Section 2653 of the Public Health Service Act (42 U.S.C. 300ff-53)
is amended by adding at the end the following subsection:
``(d) 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.''.
SEC. 312. PLANNING AND DEVELOPMENT GRANTS.
(a) In General.--Section 2654(c)(1) of the Public Health Service Act
(42 U.S.C. 300ff-54(c)(1)) is amended by striking ``planning grants''
and all that follows and inserting the following: ``planning grants to
public and nonprofit private entities for purposes of--
``(A) enabling such entities to provide HIV early
intervention services; and
``(B) assisting the entities in expanding their
capacity to provide HIV-related health services,
including early intervention services, in low-income
communities and affected subpopulations that are
underserved with respect to such services (subject to
the condition that a grant pursuant to this subparagraph
may not be expended to purchase or improve land, or to
purchase, construct, or permanently improve, other than
minor remodeling, any building or other facility).''.
(b) Amount; Duration.--Section 2654(c) of the Public Health Service
Act (42 U.S.C. 300ff-54(c)) is further amended--
(1) by redesignating paragraph (4) as paragraph (5); and
(2) by inserting after paragraph (3) the following:
``(4) Amount and duration of grants.--
[[Page 114 STAT. 1346]]
``(A) Early intervention services.--A grant under
paragraph (1)(A) may be made in an amount not to exceed
$50,000.
``(B) Capacity development.--
``(i) Amount.--A grant under paragraph (1)(B)
may be made in an amount not to exceed $150,000.
``(ii) Duration.--The total duration of a
grant under paragraph (1)(B), including any
renewal, may not exceed 3 years.''.
(c) Increase in Limitation.--Section 2654(c)(5) of the Public Health
Service Act (42 U.S.C. 300ff-54(c)(5)), as redesignated by subsection
(b), is amended by striking ``1 percent'' and inserting ``5 percent''.
SEC. 313. AUTHORIZATION OF APPROPRIATIONS.
Section 2655 of the Public Health Service Act (42 U.S.C. 300ff-55)
is amended by striking ``in each of'' and all that follows and inserting
``for each of the fiscal years 2001 through 2005.''.
Subtitle C--General Provisions
SEC. 321. PROVISION OF CERTAIN COUNSELING SERVICES.
Section 2662(c)(3) of the Public Health Service Act (42 U.S.C.
300ff-62(c)(3)) is amended--
(1) in the matter preceding subparagraph (A), by striking
``counseling on--'' and inserting ``counseling--'';
(2) in each of subparagraphs (A), (B), and (D), by inserting
``on'' after the subparagraph designation; and
(3) in subparagraph (C)--
(A) by striking ``(C) the benefits'' and inserting
``(C)(i) that explains the benefits''; and
(B) by inserting after clause (i) (as designated by
subparagraph (A) of this paragraph) the following
clause:
``(ii) that emphasizes it is the duty of infected
individuals to disclose their infected status to their
sexual partners and their partners in the sharing of
hypodermic needles; that provides advice to infected
individuals on the manner in which such disclosures can
be made; and that emphasizes that it is the continuing
duty of the individuals to avoid any behaviors that will
expose others to HIV.''.
SEC. 322. ADDITIONAL REQUIRED AGREEMENTS.
Section 2664(g) of the Public Health Service Act (42 U.S.C. 300ff-
64(g)) is amended--
(1) in paragraph (3)--
(A) by striking ``7.5 percent'' and inserting ``10
percent''; and
(B) by striking ``and'' after the semicolon at the
end;
(2) in paragraph (4), by striking the period and inserting
``; and''; and
(3) by adding at the end the following paragraph:
``(5) the applicant will provide for the establishment of a
quality management program--
``(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
[[Page 114 STAT. 1347]]
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.''.
TITLE IV--OTHER PROGRAMS AND ACTIVITIES
Subtitle A--Certain Programs for Research, Demonstrations, or Training
SEC. 401. GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH
FOR WOMEN, INFANTS, CHILDREN, AND YOUTH.
(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. <<NOTE: Deadline. Reports.>> 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
[[Page 114 STAT. 1348]]
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) <<NOTE: Deadlines.>> 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''.
SEC. 402. AIDS EDUCATION AND TRAINING CENTERS.
(a) Schools; Centers.--
(1) In general.--Section 2692(a)(1) of the Public Health
Service Act (42 U.S.C. 300ff-111(a)(1)) is amended--
(A) in subparagraph (A)--
(i) by striking ``training'' and inserting
``to train'';
(ii) by striking ``and including'' and
inserting ``, including''; and
(iii) by inserting before the semicolon the
following: ``, and including (as applicable to the
type of health professional involved), prenatal
and other gynecological care for women with HIV
disease'';
(B) in subparagraph (B), by striking ``and'' after
the semicolon at the end;
(C) in subparagraph (C), by striking the period and
inserting ``; and''; and
(D) by adding at the end the following:
``(D) to develop protocols for the medical care of
women with HIV disease, including prenatal and other
gynecological care for such women.''.
[[Page 114 STAT. 1349]]
(2) <<NOTE: 42 USC 300ff-111 note. Deadline.>>
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.''.
[[Page 114 STAT. 1350]]
Subtitle B--General Provisions in Title XXVI
SEC. 411. EVALUATIONS AND REPORTS.
Section 2674(c) of the Public Health Service Act (42 U.S.C. 300ff-
74(c)) is amended by striking ``1991 through 1995'' and inserting ``2001
through 2005''.
SEC. 412. DATA COLLECTION THROUGH CENTERS FOR DISEASE CONTROL AND
PREVENTION.
Part 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. <<NOTE: 42 USC 247c-2.>> 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.''.
SEC. 413. COORDINATION.
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.
[[Page 114 STAT. 1351]]
SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH HIV DISEASE.
Section 2675 of the Public Health Service Act, as amended by section
413(2) <<NOTE: 42 USC 300ff-75.>> 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. <<NOTE: Deadline.>>
The Secretary shall submit the plan to the Congress not later than 2
years after the date of the enactment of the Ryan White CARE Act
Amendments of 2000.''.
SEC. 415. AUDITS.
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. <<NOTE: 42 USC 300ff-75a.>> AUDITS.
``For fiscal year 2002 and subsequent fiscal years, the Secretary
may reduce the amounts of grants under this title to a State or
political subdivision of a State for a fiscal year if, with respect to
such grants for the second preceding fiscal year, the State or
subdivision fails to prepare audits in accordance with the procedures of
section 7502 of title 31, United States Code. The Secretary shall
annually select representative samples of such audits, prepare summaries
of the selected audits, and submit the summaries to the Congress.''.
SEC. 416. ADMINISTRATIVE SIMPLIFICATION.
Part D of title XXVI of the Public Health Service Act, as amended by
section 415 of this Act, is amended by inserting after section 2675A the
following section:
``SEC. 2675B. <<NOTE: 42 USC 300ff-75b.>> 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. <<NOTE: Deadline.>> 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
[[Page 114 STAT. 1352]]
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. <<NOTE: Deadline.>> 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. <<NOTE: Deadline.>> The Secretary shall submit the plan to the
Congress not later than 18 months after the date of the enactment of the
Ryan White CARE Act Amendments of 2000. Not later than 2 years after the
date on which the plan is so submitted, the Secretary shall complete the
implementation of the plan, notwithstanding any provision of this title
that is inconsistent with the plan.''.
SEC. 417. AUTHORIZATION OF APPROPRIATIONS FOR PARTS A
AND B.
Section 2677 of the Public Health Service Act (42 U.S.C. 300ff-77)
is amended to read as follows:
``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.
``(a) Part A.--For the purpose of carrying out part A, there are
authorized to be appropriated such sums as may be necessary for each of
the fiscal years 2001 through 2005.
``(b) Part B.--For the purpose of carrying out part B, there are
authorized to be appropriated such sums as may be necessary for each of
the fiscal years 2001 through 2005.''.
TITLE V--GENERAL PROVISIONS
SEC. 501. <<NOTE: 42 USC 300ff-11 note.>> STUDIES BY INSTITUTE OF
MEDICINE.
(a) State Surveillance Systems on Prevalence of HIV.--The Secretary
of Health and Human Services (referred to in this section as the
``Secretary'') shall request the Institute of Medicine to enter into an
agreement with the Secretary under which such Institute conducts a study
to provide the following:
(1) A determination of whether the surveillance system of
each of the States regarding the human immunodeficiency virus
provides for the reporting of 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.--
[[Page 114 STAT. 1353]]
(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) <<NOTE: Deadline.>> 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.
SEC. 502. <<NOTE: 42 USC 300cc note.>> DEVELOPMENT OF RAPID HIV TEST.
(a) Expansion, Intensification, and Coordination of Research and
Other Activities.--
(1) In general.--The Director of NIH shall expand,
intensify, and coordinate research and other activities of the
National Institutes of Health with respect to the development of
reliable and affordable tests for HIV disease that can rapidly
be administered and whose results can rapidly be obtained (in
this section referred to as ``rapid HIV test'').
[[Page 114 STAT. 1354]]
(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 <<NOTE: Deadline.>> 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.
SEC. 503. TECHNICAL CORRECTIONS.
(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) <<NOTE: 42 USC 300ff-15.>> --
(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) <<NOTE: 42 USC 300ff-73.>> in section 2673(a), in the
matter preceding paragraph (1), by striking ``the Agency for
Health Care Policy and
[[Page 114 STAT. 1355]]
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) <<NOTE: 42 USC 300ff-22.>> 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''.
TITLE VI--EFFECTIVE DATE
SEC. 601. <<NOTE: 42 USC 300ff-12 note.>> EFFECTIVE DATE.
This Act and the amendments made by this Act take effect October 1,
2000, or upon the date of the enactment of this Act, whichever occurs
later.
Approved October 20, 2000.
LEGISLATIVE HISTORY--S. 2311 (H.R. 4807):
---------------------------------------------------------------------------
HOUSE REPORTS: No. 106-788 accompanying H.R. 4807 (Comm. on Commerce).
SENATE REPORTS: No. 106-294 (Comm. on Health, Education, Labor, and
Pensions).
CONGRESSIONAL RECORD, Vol. 146 (2000):
June 6, considered and passed Senate.
Oct. 5, considered and passed House, amended. Senate
concurred in House amendments.
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 36 (2000):
Oct. 20, Presidential statement.
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