HR 4807 PCS
Calendar No. 716
106th CONGRESS
2d Session
H. R. 4807
IN THE SENATE OF THE UNITED STATES
July 26, 2000
Received; read twice and placed on the calendar
AN ACT
To amend the Public Health Service Act to revise and extend programs
established under the Ryan White Comprehensive AIDS Resources Emergency Act of
1990, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
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:
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. 123. Review of administrative costs and compensation.
TITLE II--CARE GRANT PROGRAM
Subtitle A--General Grant Provisions
Sec. 201. Priority for women, infants, and children.
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. 213. Study by Institute of Medicine.
Subtitle C--Certain Partner Notification Programs
Sec. 221. Grants for compliant partner notification programs.
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. 414. Plan regarding release of prisoners with HIV disease.
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.
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
(A) in subparagraph (G), by striking `or AIDS';
(B) in subparagraph (K), by striking `and' at the end;
(C) in subparagraph (L), by striking the period and inserting the
following: `, including but not limited to providers of HIV prevention
services; and'; and
(D) 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 are not receiving HIV-related
services; and
`(ii) disparities in access and services among affected
subpopulations and historically underserved communities;';
(3) in subparagraph (C) (as so redesignated), by striking clauses (i)
through (iv) and inserting the following:
`(i) size and demographics of the population of individuals with HIV
disease (as determined under subparagraph (A)) and the needs of such
population (as determined under subparagraph (B));
`(ii) demonstrated (or probable) cost effectiveness and outcome
effectiveness of proposed strategies and interventions, to the extent
that data are reasonably available;
`(iii) priorities of the communities with HIV disease for whom the
services are intended;
`(iv) availability of other governmental and nongovernmental
resources to provide HIV-related services to individuals and families
with HIV disease, including the State plan under title XIX of the Social
Security Act (relating to the Medicaid program) and the program under
title XXI of such Act (relating to the program for State children's
health insurance); and
`(v) 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 with HIV
disease who 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 and for the prevention and
treatment of substance abuse, including programs that provide
comprehensive treatment services for such abuse; and
`(iii) is compatible with any State or local plan for the provision
of services to individuals with HIV disease;';
(5) in subparagraph (F) (as so redesignated), by striking `and' at the
end;
(6) in subparagraph (G) (as so redesignated)--
(A) by striking `public meetings,' and inserting `public meetings (in
accordance with paragraph (7)),'; and
(B) by striking the period and inserting `; and'; and
(7) by adding at the end the following subparagraph:
`(H) coordinate with Federal grantees that provide HIV-related
services within the eligible area.'.
(b) PROCESS FOR ESTABLISHING ALLOCATION PRIORITIES- Section 2602 of the
Public Health Service Act (42 U.S.C. 300ff-12) is amended by adding at the end
the following subsection:
`(d) PROCESS FOR ESTABLISHING ALLOCATION PRIORITIES- Promptly after the
date of the submission of the report required in section 501(b) of the Ryan
White CARE Act Amendments of 2000 (relating to the relationship between
epidemiological measures and health care for certain individuals with HIV
disease), the Secretary, in consultation with 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 2601(a) guidelines and
materials for training members of the planning council under paragraph (1)
regarding the duties of the council.'.
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) The meetings of the council shall be open to the public and
shall be held only after adequate notice to the public.
`(ii) The records, reports, transcripts, minutes, agenda, or other
documents which were made available to or prepared for or by the council
shall be available for public inspection and copying at a single
location.
`(iii) Detailed minutes of each meeting of the council shall be
kept. The accuracy of all minutes shall be certified to by the chair of
the council.
`(iv) This subparagraph does not apply to any disclosure of
information of a personal nature that would constitute a clearly
unwarranted invasion of personal privacy, including any disclosure of
medical information or personnel matters.'.
Subtitle B--Type and Distribution of Grants
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'.
(b) AMOUNT OF GRANT; ESTIMATE OF LIVING CASES-
(1) IN GENERAL- Section 2603(a)(3)) of the Public Health Service Act (42
U.S.C. 300ff-13(a)(3)) is amended--
(A) in subparagraph (C)(i), by inserting before the semicolon the
following: `, except that (subject to subparagraph (D)), for grants made
pursuant to this paragraph for fiscal year 2005 and subsequent fiscal
years, the cases counted for each 12-month period beginning on or after
July 1, 2004, shall be cases of HIV disease (as reported to and confirmed
by such Director) rather than cases of acquired immune deficiency
syndrome'; and
(B) in subparagraph (C), in the matter after and below clause
(ii)(X)--
(i) in the first sentence, by inserting before the period the
following: `, and shall be reported to the congressional committees of
jurisdiction'; and
(ii) by adding at the end the following sentence: `Updates shall as
applicable take into account the counting of cases of HIV disease
pursuant to clause (i).'.
(2) DETERMINATION OF SECRETARY REGARDING DATA ON HIV CASES- Section
2603(a)(3)) of the Public Health Service Act (42 U.S.C. 300ff-13(a)(3)) is
amended--
(A) by redesignating subparagraph (D) as subparagraph (E);
and
(B) by inserting after subparagraph (C) the following
subparagraph:
`(D) DETERMINATION OF SECRETARY REGARDING DATA ON HIV CASES-
`(i) IN GENERAL- Not later than July 1, 2004, the Secretary shall
determine whether there is data on cases of HIV disease from all
eligible areas (reported to and confirmed by the Director of the Centers
for Disease Control and Prevention) sufficiently accurate and reliable
for use for purposes of subparagraph (C)(i). In making such a
determination, the Secretary shall take into consideration the findings
of the study under section 501(b) of the Ryan White CARE Act Amendments
of 2000 (relating to the relationship between epidemiological measures
and health care for certain individuals with HIV disease), the fiscal
impact of the use of such data, the impact of the use of such data on
the organization and delivery of HIV-related services in eligible areas,
and the fiscal impact of not using such data.
`(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 2675 for a fiscal year,
the Secretary shall reserve amounts to make grants and provide technical
assistance to States and eligible areas with respect to obtaining data
on cases of HIV disease to ensure that data on such cases is available
from all States and eligible areas as soon as is practicable but not
later than the beginning of fiscal year 2007.'.
(c) INCREASES IN GRANT- Section 2603(a)(4)) of the Public Health Service
Act (42 U.S.C. 300ff-13(a)(4)) is amended to read as follows:
`(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 95.7 percent of the amount of such base year
grant;
`(iii) for any third fiscal year in such period, the grant is not
less than 91.1 percent of the amount of the base year grant;
`(iv) for any fourth fiscal year in such period, the grant is not
less than 84.2 percent of the amount of the base year grant;
and
`(v) for any fifth or subsequent fiscal year in such period, the
grant is not less than 75 percent of the amount of the base year
grant.
`(B) 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 for the area equals or exceeds the amount
of the grant for the base year for the period.
`(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.'.
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) 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); and
(2) by redesignating paragraph (5) as paragraph (4).
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--
(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, support, or
sustain the delivery, 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 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);
`(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) ADDITIONAL PURPOSES- 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);
(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) (including referrals
under subparagraph (C) of such section), subject to subparagraph (B). The
entities through which such services may be provided under the grant
include public health departments, emergency rooms, substance abuse and
mental health treatment programs, detoxification centers, detention
facilities, clinics regarding sexually transmitted diseases, homeless
shelters, HIV disease counseling and testing sites, health care points of
entry specified by States or eligible areas, federally qualified health
centers, and entities described in section 2652(a).
`(B) CONDITIONS- With respect to an entity that proposes to provide
early intervention services under subparagraph (A), such subparagraph
applies only if the entity demonstrates to the satisfaction of the chief
elected official for the eligible area involved that--
`(i) Federal, State, or local funds are otherwise inadequate for the
early intervention services the entity proposes to provide;
and
`(ii) the entity will expend funds pursuant to such subparagraph to
supplement and not supplant other funds available to the entity for the
provision of early intervention services for the fiscal year involved.';
and
(3) in paragraph (4) (as so redesignated), by inserting `youth,' after
`children,' each place such term appears;
(c) 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:
`(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.
`(2) USE OF FUNDS- From amounts received under a grant awarded under
this part for a fiscal year, the chief elected official of an eligible area
may (in addition to amounts to which subsection (f)(1) applies) use for
activities associated with the quality management program required in
paragraph (1) not more than the lesser of--
`(A) 5 percent of amounts received under the grant; or
SEC. 122. APPLICATION.
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 (4)
through (7), respectively; and
(2) by inserting after paragraph (2) the following paragraph:
`(3) that entities within the eligible area that receive funds under a
grant under section 2601(a) will maintain relationships with appropriate
entities in the area, including entities described in section
2604(b)(3);'.
SEC. 123. REVIEW OF ADMINISTRATIVE COSTS AND COMPENSATION.
Each chief elected official of an eligible area (as defined in section
2607 of the Public Health Service Act) shall ensure that, not later than 1
year after the date of the enactment of this Act, the planning council for the
eligible area--
(1) conducts a review of the existing, available data on the extent to
which entities in the area that receive amounts from a grant under section
2601(a) of the Public Health Service Act have from their overall budget
expended amounts for administrative costs (including financial compensation
and benefits), expressed as a proportion and indicating the growth in such
expenditures, including a statement of the average amount expended for such
costs per client served and the average amount expended for such costs per
client served in providing HIV-related services; and
(2) makes a determination of whether the financial compensation of any
officers or employees of such entities exceeds that of the chief elected
official of the eligible area.
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 by inserting `youth,' after `children,' each place such term
appears.
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) Support services under section 2611(a) (including case management)
to the extent that such services facilitate, support, or sustain the
delivery, 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 are not receiving HIV-related services, and that are--
`(A) necessary to implement the strategy under section
2617(b)(4)(B);
`(B) conducted in a manner consistent with the requirement under
section 2617(b)(6)(G); 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) (including referrals under
subparagraph (C) of such section), subject to paragraph (2). The entities
through which such services may be provided under the grant include public
health departments, emergency rooms, substance abuse and mental health
treatment programs, detoxification centers, detention facilities, clinics
regarding sexually transmitted diseases, homeless shelters, HIV disease
counseling and testing sites, health care points of entry specified by
States or eligible areas, federally qualified health centers, and entities
described in section 2652(a).
`(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.
`(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.
`(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(c)(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
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 2617(b)(4)
and';
(2) in subsection (c)(1)--
(A) in subparagraph (D), by striking `and' after the semicolon at the
end;
(B) in subparagraph (E), by striking the period and inserting `; and';
and
(C) by adding at the end the following subparagraph:
`(F) demonstrates that adequate planning occurred to address
disparities in access and services and historically underserved
communities.'; and
(3) in subsection (c)(2)--
(A) in subparagraph (B), by striking `and' after the
semicolon;
(B) in subparagraph (C), by striking the period and inserting `; and';
and
(C) by inserting after subparagraph (C) the following
subparagraph:
`(D) entities described in section 2602(b)(2).'.
SEC. 204. PROVISION OF TREATMENTS.
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- 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.'.
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 are not receiving HIV-related
services; and
`(B) disparities in access and services among affected subpopulations
and historically underserved communities;'; and
(3) in paragraph (4) (as so redesignated)--
(A) by striking `comprehensive plan for the organization' and
inserting `comprehensive plan that describes the organization';
(B) by striking `, including--' and inserting `, and that--';
(C) by redesignating subparagraphs (A) through (C) as subparagraphs
(D) through (F), respectively;
(D) by inserting before subparagraph (C) the following
subparagraphs:
`(A) establishes priorities for the allocation of funds within the
State based on--
`(i) size and demographics of the population of individuals with HIV
disease (as determined under paragraph (2)) and the needs of such
population (as determined under paragraph (3));
`(ii) availability of other governmental and nongovernmental
resources to provide HIV-related services to 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 with HIV disease
who 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 and for the prevention and treatment of
substance abuse, including programs that provide comprehensive treatment
services for such abuse;';
(E) in subparagraph (D) (as redesignated by subparagraph (C) of this
paragraph), by inserting `describes' before `the services and
activities';
(F) in subparagraph (E) (as so redesignated), by inserting `provides'
before `a description'; and
(G) in subparagraph (F) (as so redesignated), by inserting `provides'
before `a description'.
(b) PUBLIC PARTICIPATION- Section 2617(b) of the Public Health Service
Act, as amended by subsection (a) of this section, is amended--
(1) in paragraph (5), by striking `HIV' and inserting `HIV disease';
and
(2) in paragraph (6), by amending subparagraph (A) to read as
follows:
`(A) the public health agency that is administering the grant for the
State engages in a public advisory planning process, including public
hearings, that includes the participants under paragraph (5), and entities
described in section 2602(b)(2), in developing the comprehensive plan
under paragraph (4) and commenting on the implementation of such
plan;'.
(c) HEALTH CARE RELATIONSHIPS- Section 2617(b) of the Public Health
Service Act, as amended by subsection (a) of this section, is amended in
paragraph (6)--
(1) in subparagraph (E), by striking `and' at the end;
(2) in subparagraph (F), by striking the period and inserting `; and';
and
(3) by adding at the end the following subparagraph:
`(G) entities within areas in which activities under the grant are
carried out will maintain relationships with appropriate entities in the
area, including entities described in section 2612(c);'.
SEC. 206. DISTRIBUTION OF FUNDS.
(a) MINIMUM ALLOTMENT- Section 2618(b)(1)(A)(i) of the Public Health
Service Act (42 U.S.C. 300ff-28(b)(1)(A)(i)) is amended--
(1) in subclause (I), by striking `$100,000' and inserting `$200,000';
and
(2) in subclause (II), by striking `$250,000' and inserting
`$500,000'.
(b) AMOUNT OF GRANT; ESTIMATE OF LIVING CASES- Section 2618(b)(2) of the
Public Health Service Act (42 U.S.C. 300ff-28(b)(2)) is amended--
(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 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
2603(a)(3)(D)(i) the Secretary determines that data on cases of HIV
disease is 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(b) of the Public Health
Service Act (42 U.S.C. 300ff-28(b)) 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
(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:
`(i) IN GENERAL- The Secretary shall ensure that the amount of a
grant awarded to a State or territory under section 2611 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 such section. 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 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 is
less than the amount appropriated and available under such section for
fiscal year 2000, the limitation contained in clause (i) shall be
reduced by a percentage equal to the percentage of the reduction in such
amounts appropriated and available.'.
(d) TERRITORIES- Section 2618(b)(1)(B) of the Public Health Service Act
(42 U.S.C. 300ff-28(b)(1)(B)) is amended by inserting `the greater of $50,000
or' after `shall be'.
(e) SEPARATE TREATMENT DRUG GRANTS- Section 2618(b)(2) of the Public
Health Service Act, as amended by subsection (b)(3) of this section, is
amended in subparagraph (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 striking `100 percent' and inserting `98 percent'; and
(4) by adding at the end the following clause:
`(ii) SUPPLEMENTAL TREATMENT DRUG GRANTS-
`(I) IN GENERAL- With respect to the fiscal year involved, if
under section 2677 an appropriations Act provides an amount
exclusively for carrying out section 2616, and such amount is not less
than the amount so provided for the preceding fiscal year, the
Secretary shall reserve 2 percent of such amount for making grants to
States whose population of individuals with HIV disease has, as
determined by the Secretary, a need for quantities of therapeutics
described in section 2616(a) greater than the quantities available
pursuant to clause (i). Such a grant is available for purposes of
obtaining such therapeutics. The Secretary shall carry out this clause
as a program of discretionary grants, and not as a program of formula
grants.
`(II) DISTRIBUTION OF GRANTS- The Secretary shall disburse all
amounts under grants under subclause (I) for a fiscal year not later
than 240 days after the date on which the amount referred to in such
subclause with respect to section 2616 becomes
available.
`(III) REQUIREMENT OF MATCHING FUNDS- A condition for receiving a
grant under subclause (I) is that the State agree to make available
(directly or through donations from public or private entities)
non-Federal contributions toward the costs of obtaining the
therapeutics involved in an amount that is not less than 25 percent of
such costs (determined in the same manner as under
2617(d)(2)(A)).'.
(f) TECHNICAL AMENDMENT- Section 2618(b)(3)(B) of the Public Health
Service Act (42 U.S.C. 300ff-28(b)(3)(B)) is amended 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 (42
U.S.C. 300ff-11 et seq.) is amended--
(1) by striking section 2621; and
(2) by inserting after section 2620 the following section:
`SEC. 2621. SUPPLEMENTAL GRANTS.
`(a) IN GENERAL- From amounts available pursuant to subsection (d) for a
fiscal year, the Secretary shall make grants to States that meet the
conditions to receive grants under section 2611, and that have one or more
eligible communities, for the purpose of providing in such communities
comprehensive services of the type described in section 2612(a) to supplement
the development and care activities, primary care, and support services
otherwise provided in such communities by the State under a grant under
section 2611.
`(b) ELIGIBLE COMMUNITY- For purposes of this section, the term `eligible
community' means a geographic area that--
`(1) is not within any eligible area as defined in section 2607;
and
`(2) has a severe need for supplemental financial assistance to combat
the HIV epidemic, according to criteria developed by the Secretary in
consultation with the States, including evidence of underserved or rural
areas or both.
`(c) APPLICATION- A grant under subsection (a) may be made to a State if
the State submits to the Secretary, as part of the State application submitted
under section 2617, such information as required to apply for funds under this
section as determined by the Secretary in consultation with the States.
`(1) IN GENERAL- For the purpose of making grants under subsection (a)
for a fiscal year, the Secretary shall reserve 50 percent of the amount
specified in paragraph (2).
`(2) INCREASES IN PART B FUNDING-
`(A) IN GENERAL- For purposes of paragraph (1), the amount specified
in this paragraph is the amount by which the amount appropriated under
section 2677 for the fiscal year involved and available for carrying out
part B is an increase over the amount so appropriated and available for
the preceding fiscal year, subject to subparagraphs (B) and (C).
`(B) INITIAL ALLOCATION YEAR- The allocation under paragraph (1) shall
not be made until the first fiscal year for which the amount appropriated
under section 2677 for the fiscal year involved and available for carrying
out part B is an increase of not less than $20,000,000 over the amount so
appropriated and available for fiscal year 2000, subject to subparagraph
(C).
`(C) EXCLUSION REGARDING SEPARATE TREATMENT DRUG GRANTS- Each
determination under subparagraph (A) or (B) of the amount appropriated
under section 2677 for a fiscal year and available for carrying out part B
shall be made without regard to any amount to which section
2618(b)(2)(I)(i) 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) in section 2626, by striking each of subsections (d) through (f);
and
(2) by striking 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--
(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:
`(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, the Secretary shall reserve
the applicable percentage under clause (ii) for making grants under
paragraph (1) to 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; 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.
`(ii) APPLICABLE PERCENTAGE- For purposes of clause (i), the
applicable amount for a fiscal year is as follows:
`(I) For fiscal year 2001, 25 percent.
`(II) For fiscal year 2002, 50 percent.
`(III) For fiscal year 2003, 50 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.'; and
(3) by adding at the end the following paragraph:
`(4) MAINTENANCE OF EFFORT- A condition for the receipt of a grant under
paragraph (1) is that the State involved agree that the grant will be used
to supplement and not supplant other funds available to the State to carry
out the purposes of the grant.'.
(b) Special Funding Rule for Fiscal Year 2001-
(1) IN GENERAL- If for fiscal year 2001 the amount appropriated under
paragraph (2)(A) of section 2625(c) of the Public Health Service Act is less
than $14,000,000--
(A) the Secretary of Health and Human Services shall, for the purpose
of making grants under paragraph (1) of such section, reserve from the
amount specified in paragraph (2) of this subsection an amount equal to
the difference between $14,000,000 and the amount appropriated under
paragraph (2)(A) of such section for such fiscal year;
(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)(ii)(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 (42
U.S.C. 300ff-33 et seq.) is amended by adding at the end the following
section:
`SEC. 2630. RECOMMENDATIONS FOR REDUCING INCIDENCE OF PERINATAL
TRANSMISSION.
`(a) STUDY BY INSTITUTE OF MEDICINE-
`(1) IN GENERAL- The Secretary shall request the Institute of Medicine
to enter into an agreement with the Secretary under which such Institute
conducts a study to provide the following:
`(A) For the most recent fiscal year for which the information is
available, a determination of the number of newborn infants with HIV born
in the United States with respect to whom the attending obstetrician for
the birth did not know the HIV status of the mother.
`(B) A determination for each State of any barriers, including legal
barriers, that prevent or discourage an obstetrician from making it a
routine practice to offer pregnant women an HIV test and a routine
practice to test newborn infants for HIV disease in circumstances in which
the obstetrician does not know the HIV status of the mother of the
infant.
`(C) Recommendations for each State for reducing the incidence of
cases of the perinatal transmission of HIV, including recommendations on
removing the barriers identified under subparagraph (B).
If such Institute declines to conduct the study, the Secretary shall
enter into an agreement with another appropriate public or nonprofit private
entity to conduct the study.
`(2) REPORT- The Secretary shall ensure that, not later than 18 months
after the effective date of this section, the study required in paragraph
(1) is completed and a report describing the findings made in the study is
submitted to the appropriate committees of the Congress, the Secretary, and
the chief public health official of each of the States.
`(b) PROGRESS TOWARD RECOMMENDATIONS- Each State shall comply with the
following (as applicable to the fiscal year involved):
`(1) For fiscal year 2004, the State shall submit to the Secretary a
report describing the actions taken by the State toward meeting the
recommendations specified for the State under subsection (a)(1)(C).
`(2) For fiscal year 2005 and each subsequent fiscal year--
`(A) the State shall make reasonable progress toward meeting such
recommendations; or
`(B) if the State has not made such progress--
`(i) the State shall cooperate with the Director of the Centers for
Disease Control and Prevention in carrying out activities toward meeting
the recommendations; and
`(ii) the State shall submit to the Secretary a report containing a
description of any barriers identified under subsection (a)(1)(B) that
continue to exist in the State; as applicable, the factors underlying
the continued existence of such barriers; and a description of how the
State intends to reduce the incidence of cases of the perinatal
transmission of HIV.
`(c) SUBMISSION OF REPORTS TO CONGRESS- The Secretary shall submit to the
appropriate committees of the Congress each report received by the Secretary
under subsection (b)(2)(B)(ii).'.
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. GRANTS FOR PARTNER NOTIFICATION PROGRAMS.
`(a) IN GENERAL- In the case of States whose laws or regulations are in
accordance with subsection (b), the Secretary, subject to subsection (c)(2),
may make grants to the States for carrying out programs to provide partner
counseling and referral services.
`(b) DESCRIPTION OF COMPLIANT STATE PROGRAMS- For purposes of subsection
(a), the laws or regulations of a State are in accordance with this subsection
if under such laws or regulations (including programs carried out pursuant to
the discretion of State officials) the following policies are in effect:
`(1) The State requires that the public health officer of the State
carry out a program of partner notification to inform partners of
individuals with HIV disease that the partners may have been exposed to the
disease.
`(2)(A) In the case of a health entity that provides for the performance
on an individual of a test for HIV disease, or that treats the individual
for the disease, the State requires, subject to subparagraph (B), that the
entity confidentially report the positive test results to the State public
health officer in a manner recommended and approved by the Director of the
Centers for Disease Control and Prevention, together with such additional
information as may be necessary for carrying out such program.
`(B) The State may provide that the requirement of subparagraph (A) does
not apply to the testing of an individual for HIV disease if the individual
underwent the testing through a program designed to perform the test and
provide the results to the individual without the individual disclosing his
or her identity to the program. This subparagraph may not be construed as
affecting the requirement of subparagraph (A) with respect to a health
entity that treats an individual for HIV disease.
`(3) The program under paragraph (1) is carried out in accordance with
the following:
`(A) Partners are provided with an appropriate opportunity to learn
that the partners have been exposed to HIV disease, subject to
subparagraph (B).
`(B) The State does not inform partners of the identity of the
infected individuals involved.
`(C) Counseling and testing for HIV disease are made available to the
partners and to infected individuals, and such counseling includes
information on modes of transmission for the disease, including
information on prenatal and perinatal transmission and preventing
transmission.
`(D) Counseling of infected individuals and their partners includes
the provision of information regarding therapeutic measures for preventing
and treating the deterioration of the immune system and conditions arising
from the disease, and the provision of other prevention-related
information.
`(E) Referrals for appropriate services are provided to partners and
infected individuals, including referrals for support services and legal
aid.
`(F) Notifications under subparagraph (A) are provided in person,
unless doing so is an unreasonable burden on the State.
`(G) There is no criminal or civil penalty on, or civil liability for,
an infected individual if the individual chooses not to identify the
partners of the individual, or the individual does not otherwise cooperate
with such program.
`(H) The failure of the State to notify partners is not a basis for
the civil liability of any health entity who under the program reported to
the State the identity of the infected individual involved.
`(I) The State provides that the provisions of the program may not be
construed as prohibiting the State from providing a notification under
subparagraph (A) without the consent of the infected individual
involved.
`(4) The State annually reports to the Director of the Centers for
Disease Control and Prevention the number of individuals from whom the names
of partners have been sought under the program under paragraph (1), the
number of such individuals who provided the names of partners, and the
number of partners so named who were notified under the program.
`(5) The State cooperates with such Director in carrying out a national
program of partner notification, including the sharing of information
between the public health officers of the States.
`(c) REPORTING SYSTEM FOR CASES OF HIV DISEASE-
`(1) PREFERENCE IN MAKING GRANTS THROUGH FISCAL YEAR 2003- In making
grants under subsection (a) for each of the fiscal years 2001 through 2003,
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(b)(2)(D)(i).
`(2) ELIGIBILITY CONDITION AFTER FISCAL YEAR 2003- For fiscal year 2004
and subsequent fiscal years, a State may not receive a grant under
subsection (a) unless the reporting system of the State for cases of HIV
disease produces data on such cases that is sufficiently accurate and
reliable for purposes of section 2618(b)(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.'.
TITLE III--EARLY INTERVENTION SERVICES
Subtitle A--Formula Grants for States
SEC. 301. REPEAL OF PROGRAM.
Subpart I of part C of title XXVI of the Public Health Service Act (42
U.S.C. 300ff-41 et seq.) is repealed.
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) UNDERSERVED AND RURAL AREAS- Of the applicants who qualify for
preference under this section, 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 or in 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-
`(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--
(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 to assess the extent to which medical services funded
under this title that are provided to patients are consistent with the most
recent Public Health Service guidelines for the treatment of HIV disease and
related opportunistic infections and that improvements in the access to and
quality of medical 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.
Section 2671 of the Public Health Service Act (42 U.S.C. 300ff-71) is
amended--
(A) 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
(B) by striking paragraphs (3) and (4);
(2) in subsection (g), by adding at the end the following: `In addition,
the Secretary, in coordination with the Director of such Institutes, shall
examine the distribution and availability of appropriate HIV-related
research projects with respect to grantees under subsection (a) for purposes
of enhancing and expanding HIV-related research, especially within
communities that are underrepresented with respect to such projects.';
(A) by striking the subsection heading and designation and inserting
the following:
(B) by adding at the end the following paragraph:
`(2) QUALITY MANAGEMENT PROGRAM- A grantee under this section shall
implement a quality management program.'; and
(4) in subsection (j), by striking `1996 through 2000' and inserting
`2001 through 2005'.
SEC. 402. AIDS EDUCATION AND TRAINING CENTERS.
(1) IN GENERAL- Section 2692(a)(1) of the Public Health Service Act (42
U.S.C. 300ff-111(a)(1)) is amended--
(A) in subparagraph (A)--
(i) by striking `training' and inserting `to train';
(ii) by striking `and including' and inserting `, including';
and
(iii) by inserting before the semicolon the following: `, and
including (as applicable to the type of health professional involved),
prenatal and other gynecological care for women with HIV
disease';
(B) in subparagraph (B), by striking `and' after the semicolon at the
end;
(C) in subparagraph (C), by striking the period and inserting `; and';
and
(D) by adding at the end the following:
`(D) to develop protocols for the medical care of women with HIV
disease, including prenatal and other gynecological care for such
women.'.
(2) DISSEMINATION OF TREATMENT GUIDELINES; MEDICAL CONSULTATION
ACTIVITIES- Not later than 90 days after the date of the enactment of this
Act, the Secretary of Health and Human Services shall issue and begin
implementation of a strategy for the dissemination of HIV treatment
information to health care providers and patients.
(b) DENTAL SCHOOLS- Section 2692(b) of the Public Health Service Act (42
U.S.C. 300ff-111(b)) is amended--
(1) by amending paragraph (1) to read as follows:
`(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:
`(A) IN GENERAL- For the purpose of grants under paragraphs (1)
through (4) of subsection (b), there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001 through
2005.
`(B) COMMUNITY-BASED CARE- For the purpose of grants under subsection
(b)(5), there are authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2001 through 2005.'.
Subtitle B--General Provisions in Title XXVI
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 D of title XXVI of the Public Health Service Act (42 U.S.C. 300ff-71
et seq.) is amended--
(1) by redesignating section 2675 as section 2675A; and
(2) by inserting after section 2674 the following section:
`SEC. 2675. DATA COLLECTION.
`For the purpose of collecting and providing data for program planning and
evaluation activities under this title, 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 2675A of the Public Health Service Act, as redesignated by section
412 of this Act, 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.
SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH HIV DISEASE.
Section 2675A of the Public Health Service Act, as amended by section
413(2) of this Act, is amended by adding at the end the following
subsection:
`(e) RECOMMENDATIONS REGARDING RELEASE OF PRISONERS- After consultation
with the Attorney General and the Director of the Bureau of Prisons, with
States, with eligible areas under part A, and with entities that receive
amounts from grants under part A or B, the Secretary, consistent with the
coordination required in subsection (a), shall develop a plan for the medical
case management of and the provision of support services to individuals who
were Federal or State prisoners and had HIV disease as of the date on which
the individuals were released from the custody of the penal system. The
Secretary shall submit the plan to the Congress not later than 2 years after
the date of the enactment of the Ryan White CARE Act Amendments of 2000.'.
SEC. 415. AUDITS.
Part D of title XXVI of the Public Health Service Act, as amended by
section 412 of this Act, is amended by inserting after section 2675A the
following section:
`SEC. 2675B. 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 2675B the
following section:
`SEC. 2675C. ADMINISTRATIVE SIMPLIFICATION REGARDING PARTS A AND B.
`(a) COORDINATED DISBURSEMENT- After consultation with the States, with
eligible areas under part A, and with entities that receive amounts from
grants under part A or B, the Secretary shall develop a plan for coordinating
the disbursement of appropriations for grants under part A with the
disbursement of appropriations for grants under part B in order to assist
grantees and other recipients of amounts from such grants in complying with
the requirements of such parts. The Secretary shall submit the plan to the
Congress not later than 18 months after the date of the enactment of the Ryan
White CARE Act Amendments of 2000. Not later than 2 years after the date on
which the plan is so submitted, the Secretary shall complete the
implementation of the plan, notwithstanding any provision of this title that
is inconsistent with the plan.
`(b) BIENNIAL APPLICATIONS- After consultation with the States, with
eligible areas under part A, and with entities that receive amounts from
grants under part A or B, the Secretary shall make a determination of whether
the administration of parts A and B by the Secretary, and the efficiency of
grantees under such parts in complying with the requirements of such parts,
would be improved by requiring that applications for grants under such parts
be submitted biennially rather than annually. The Secretary shall submit such
determination to the Congress not later than 2 years after the date of the
enactment of the Ryan White CARE Act Amendments of 2000.
`(c) APPLICATION SIMPLIFICATION- After consultation with the States, with
eligible areas under part A, and with entities that receive amounts from
grants under part A or B, the Secretary shall develop a plan for simplifying
the process for applications under parts A and B. The Secretary shall submit
the plan to the Congress not later than 18 months after the date of the
enactment of the Ryan White CARE Act Amendments of 2000. Not later than 2
years after the date on which the plan is so submitted, the Secretary shall
complete the implementation of the plan, notwithstanding any provision of this
title that is inconsistent with the plan.'.
SEC. 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. 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-
(1) IN GENERAL- The Secretary shall request the Institute of Medicine to
enter into an agreement with the Secretary under which such Institute
conducts a study concerning the appropriate epidemiological measures and
their relationship to the financing and delivery of primary care and
health-related support services for low-income, uninsured, and under-insured
individuals with HIV disease.
(2) ISSUES TO BE CONSIDERED- The Secretary shall ensure that the study
under paragraph (1) considers the following:
(A) The availability and utility of health outcomes measures and data
for HIV primary care and support services and the extent to which those
measures and data could be used to measure the quality of such funded
services.
(B) The effectiveness and efficiency of service delivery (including
the quality of services, health outcomes, and resource use) within the
context of a changing health care and therapeutic environment, as well as
the changing epidemiology of the epidemic, including determining the
actual costs, potential savings, and overall financial impact of modifying
the program under title XIX of the Social Security Act to establish
eligibility for medical assistance under such title on the basis of
infection with the human immunodeficiency virus rather than providing such
assistance only if the infection has progressed to acquired immune
deficiency syndrome.
(C) Existing and needed epidemiological data and other analytic tools
for resource planning and allocation decisions, specifically for
estimating severity of need of a community and the relationship to the
allocations process.
(D) Other factors determined to be relevant to assessing an
individual's or community's ability to gain and sustain access to quality
HIV services.
(c) OTHER ENTITIES- If the Institute of Medicine declines to conduct a
study under this section, the Secretary shall enter into an agreement with
another appropriate public or nonprofit private entity to conduct the
study.
(d) REPORT- The Secretary shall ensure that--
(1) not later than 3 years after the date of the enactment of this Act,
the study required in subsection (a) is completed and a report describing
the findings made in the study is submitted to the appropriate committees of
the Congress; and
(2) not later than 2 years after the date of the enactment of this Act,
the study required in subsection (b) is completed and a report describing
the findings made in the study is submitted to such committees.
SEC. 502. 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 a `rapid HIV test').
(2) REPORT TO CONGRESS- The Director of NIH shall periodically submit to
the appropriate committees of Congress a report describing the research and
other activities conducted or supported under paragraph (1).
(3) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out
this subsection, there are authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2001 through 2005.
(b) PREMARKET REVIEW OF RAPID HIV TESTS-
(1) IN GENERAL- Not later than 90 days after the date of the enactment
of this Act, the Secretary, in consultation with the Director of the Centers
for Disease Control and Prevention and the Commissioner of Food and Drugs,
shall submit to the appropriate committees of the Congress a report
describing the progress made towards, and barriers to, the premarket review
and commercial distribution of rapid HIV tests. The report shall--
(A) assess the public health need for and public health benefits of
rapid HIV tests, including the minimization of false positive results
through the availability of multiple rapid HIV tests;
(B) make recommendations regarding the need for the expedited review
of rapid HIV test applications submitted to the Center for Biologics
Evaluation and Research and, if such recommendations are favorable,
specify criteria and procedures for such expedited review; and
(C) specify whether the barriers to the premarket review of rapid HIV
tests include the unnecessary application of requirements--
(i) necessary to ensure the efficacy of devices for donor screening
to rapid HIV tests intended for use in other screening situations;
or
(ii) for identifying antibodies to HIV subtypes of rare incidence in
the United States to rapid HIV tests intended for use in screening
situations other than donor screening.
(c) GUIDELINES OF CENTERS FOR DISEASE CONTROL AND PREVENTION- Promptly
after commercial distribution of a rapid HIV test begins, the Secretary,
acting through the Director of the Centers for Disease Control and Prevention,
shall establish or update guidelines that include recommendations for States,
hospitals, and other appropriate entities regarding the ready availability of
such tests for administration to pregnant women who are in labor or in the
late stage of pregnancy and whose HIV status is not known to the attending
obstetrician.
TITLE VI--EFFECTIVE DATE
SEC. 601. 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.
Passed the House of Representatives July 26 (legislative day, July 25), 2000.
Attest:
JEFF TRANDAHL,
Clerk.
Calendar No. 716
106th CONGRESS
2d Session
H. R. 4807
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.
July 26, 2000
Received; read twice and placed on the calendar
END