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quandary, and allow
[Page: S1885] GPO's PDF
Specifically, this legislation, supported by the Administration, would do the following:
For willful violations of the law, this legislation would allow the Treasury Department to suspend or revoke a dealer's license, or to assess a fine of up to $10,000 per violation;
Those same penalties would be available for any dealer who willfully transfers armor piercing ammunition;
The legislation allows the Treasury Department to negotiate a compromise with a dealer at any time;
And the legislation outlines some clear, procedural protections for dealers--
A right to notice and opportunity for a hearing before any action is taken, so that the dealer may be made aware of the charges and seek to avert the action;
A right to written notice of any action taken, including the grounds upon which the action was based;
A right to a prompt hearing after a penalty is assessed, during which time the dealer can contest the outcome. This hearing must even be held at a location convenient to the dealer;
If the second hearing is not fruitful, the dealer has an additional right to appeal the decision of the Department to federal court, during which time any action is stayed.
Mr. President, these procedural safeguards prevent an aggressive agent from pursuing unfair penalties. There are at least three clear opportunities for an aggrieved dealer to make his or her case, including the right to appeal any decision to federal court.
As a result, I believe that this bill gives law abiding firearms dealers every opportunity necessary to protect themselves against unwarranted claims.
At the same time, this bill provides law enforcement with the variety of sanctions necessary to force true compliance with the laws already on the books. No more will rogue dealers flout the law knowing that no viable recourse is available to law enforcement.
Once this legislation passes, the punishment will finally fit the crime.
Mr. President, again I challenge the NRA and my colleagues to join me in moving this bill forward. We cannot continue to allow miscreant gun dealers to ignore the laws passed by this Congress.
By Mr. JEFFORDS (for himself, Mr. KENNEDY, Mr. FRIST, Mr. HATCH, Mr. DODD, Mr. ENZI, Mr. HARKIN, Ms. MIKULSKI, Mr. BINGAMAN, Mr. WELLSTONE, Mr. REED and Mr. BIDEN):
S. 2311. A bill to revise and extend the Ryan White CARE Act programs under title XXVI of the Public Health Service Act, to improve access to health care and the quality of health care under such programs, and to provide for the development of increased capacity to provide health care and related support services to individuals and families with HIV disease, and for other purposes; to the Committee on Health, Education, Labor, and Pensions.
RYAN WHITE CARE ACT AMENDMENTS OF 2000
Mr. JEFFORDS.
Mr. President, it gives me great pleasure to join my colleagues today in introducing the Ryan White Comprehensive AIDS Resources and Emergency Act Amendments of 2000; a measure that will reauthorize a national program of providing primary health care services for people living with HIV and AIDS. I especially want to commend Senators HATCH and KENNEDY for the leadership they have provided since the inauguration of the legislation establishing the Ryan White programs over a decade ago. I also want to commend Senator FRIST whose medical expertise played a critical role in key provisions of the bill and continues to be an invaluable resource to our efforts on the range of health issues that come before the Senate. Finally, I want to acknowledge Senator ENZI's recognition of the growing burden that AIDS and HIV is having on rural communities throughout the country and the need to address those gaps in services.
Since its inception in 1990, the Ryan White program has enjoyed broad bipartisan support. When I looked back to the last time the Ryan White CARE Act was reauthorized in 1996, I was heartened to see that the measure had garnered a vote of 97 to 3 on its final passage. I urge my colleagues to examine this bill we are introducing today and to join me in working toward its passage.
With this reauthorization, we mark the ten years through which the Ryan White CARE Act has provided needed health care and support services to HIV positive people around the country. Titles I and II have provided much needed relief to cities and states hardest hit by this disease, while Titles III and IV have had a direct role in providing healthcare services to underserved communities. Ryan White program dollars provide the foundation of care so necessary in fighting this epidemic.
Fortunately, we have experienced significant success over the last decade, and especially over the last five years. The General Accounting Office recently released a report that found that CARE Act funds are reaching the infected groups that have generally been found to be underserved, including the poor, the uninsured, women, and ethnic minorities. In fact, these groups form a majority of CARE Act clients and are being served by the CARE Act in higher proportions than their representation in the AIDS population. The GAO also found that CARE Act funds support a wide array of primary care and support services, including the provision of powerful therapeutic regimens for people with HIV/AIDS that have dramatically reduced AIDS diagnoses and deaths.
Mr. President, there have also been successes in the reduction of HIV/AIDS among women, infants and children. During the last reauthorization, Congressman COBURN and our colleague, Senator FRIST, focused our attention on the needs of women living with HIV/AIDS and the problems associated with perinatal transmission of HIV. Since then, the CARE Act has helped to dramatically reduce mother-to-child transmission through more effective outreach, counseling, and voluntary
testing of mothers at risk for HIV infection. Between 1993 and 1998, perinatal-acquired AIDS cases declined 74% in the U.S. In this bill, I have continued to support efforts to reach women in need of care for their HIV disease and have included provisions to ensure that women, infants and children receive resources in accordance with the prevalence of the infection among them.
Another key success has been the AIDS Drug Assistance Program. New therapies and improved systems of care have led to impressive reductions in the AIDS death rate and the number of new AIDS cases. From 1996 to 1998, deaths from AIDS dropped 54% while new AIDS cases have been reduced by 27%. However, these treatments are very expensive, do not provide a cure, and do not work for everyone.
Much has occurred to change the course of the AIDS epidemic since the last reauthorization. A whole new class of therapeutic drugs called anti-retrovirals have been developed and people are living longer and the rate of increase of the number of new AIDS cases has begun to level off. AIDS, HIV, the people it infects and families that it has affected are not in the news today as often as they have been in the past. But for too many of us, this lack of bad news has created a false sense of complacency. The epidemic of HIV continues to grow, to infect whole new groups of people, and to expand both within our urban areas and beyond to our rural communities.
While the rate of decline in new AIDS cases and AIDS deaths is leveling off, HIV infection rates continue to rise in many areas; becoming increasingly prevalent in rural and underserved urban areas; and also among women, youth, and minority communities. Local and state healthcare systems face an increasing burden of disease, despite our success in treating and caring for people living with HIV and AIDS. Unfortunately, rural and underserved urban areas are often unable to address the complex medical and support services needs of people with HIV infection.
The bill being introduced today was developed on a bipartisan basis, working with other Committee Members, community stakeholders and elected officials at the state and local levels from whom we sought input to ensure that we addressed the most important
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To address these challenges, we have developed a bill that will improve access to care in underserved urban and rural areas. My bill will double the minimum base funding available to states through the CARE Act to assist them in developing systems of care for people struggling with HIV and AIDS. The bill also includes a new supplemental state grant that will target assistance to rural and underserved areas to help them address the increasing number of people with HIV/AIDS living outside of urban areas that receive assistance under Title I of the Act. Furthermore, these areas will be given preference for direct care grants and we have strengthened the AIDS Drug Assistance Program to supplement those states struggling to provide lifesaving drugs to their HIV/AIDS patients.
We have not changed the unique flexibility of CARE Act programs; it remains primarily a system of grants to State and local jurisdictions. States and EMAs will still decide how to best prioritize and address the healthcare needs of their HIV-positive citizens.
Today, there are few people who can say they have not been touched by this epidemic. Recently, I had the opportunity to visit with Jeanne White. We talked about the impact of this disease; about the loved ones it has taken, and the damage to the lives of those it has left behind--about the infected, and about the affected. We talked about her son Ryan, and about my good friend David Curtis of Burlington, Vermont, who testified before my committee in 1995, but who passed away just last year. As an advocate of the program and as a person living with AIDS, David helped me to understand the terrible impact of this disease. Ryan White and David and countless others, worked long and hard to ensure that all people affected by AIDS could receive both the care and compassion they deserve.
The AIDS epidemic, despite our success in developing treatments and providing systems of care, is still ravaging communities in this country. This program remains as vital to the public health of this nation as it was in 1990 and in 1996. As the AIDS epidemic reaches into rural areas and into underserved urban communities across the country, this legislation being introduced today will allow us to adapt our care systems to meet the most urgent needs in the communities hardest hit by the epidemic.
I intend to see this bill become law this year so that the people struggling to overcome the challenges of HIV and AIDS continue to benefit from high quality medical care and access to lifesaving drugs. We have made incredible progress in the fight against HIV/AIDS and I want to be sure that every person in America that needs our assistance, benefits from our tremendous advances.
Mr. President I ask unanimous consent that the text of this measure be printed in the RECORD.
There being no objection, the bill was ordered to be printed in the RECORD, as follows:
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. REFERENCES; TABLE OF CONTENTS.
(a) REFERENCES.--Except as otherwise expressly provided, whenever in this Act an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act (42 U.S.C. 201 et seq.).
(b) TABLE OF CONTENTS.--The table of contents of this Act is as follows:
Sec..1..Short title.
Sec..2..References; table of contents.
TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM
Subtitle A--Purpose; Amendments to Part A (Emergency Relief Grants)
Sec..101..Duties of planning council, funding priorities, quality assessment.
Sec..102..Quality management.
Sec..103..Funded entities required to have health care relationships.
Sec..104..Support services required to be health care-related.
Sec..105..Use of grant funds for early intervention services.
Sec..106..Replacement of specified fiscal years regarding the sunset on expedited distribution requirement.
Sec..107..Hold harmless provision.
Sec..108..Set-aside for infants, children, and women.
Subtitle B--Amendments to Part B (Care Grant Program)
Sec..121..State requirements concerning identification of need and allocation of resources.
Sec..122..Quality management.
Sec..123..Funded entities required to have health care referral relationships.
Sec..124..Support services required to be health care-related.
Sec..125..Use of grant funds for early intervention services.
Sec..126..Authorization of appropriations for HIV-related services for women and children.
Sec..127..Repeal of requirement for completed Institute of Medicine report.
Sec..130..Supplement grants for certain States.
Sec..131..Use of treatment funds.
Sec..132..Increase in minimum allotment.
Sec..133..Set-aside for infants, children, and women.
Subtitle C--Amendments to Part C (Early Intervention Services)
Sec..141..Amendment of heading; repeal of formula grant program.
Sec..142..Planning and development grants.
Sec..143..Authorization of appropriations for categorical grants.
Sec..144..Administrative expenses ceiling; quality management program.
Sec..145..Preference for certain areas.
Subtitle D--Amendments to Part D (General Provisions)
Sec..151..Research involving women, infants, children, and youth.
Sec..152..Limitation on administrative expenses.
Sec..153..Evaluations and reports.
Sec..154..Authorization of appropriations for grants under parts A and B.
Subtitle E--Amendments to Part F (Demonstration and Training)
Sec..161..Authorization of appropriations.
TITLE II--MISCELLANEOUS PROVISIONS
Sec..201..Institute of Medicine study.
SEC. 101. DUTIES OF PLANNING COUNCIL, FUNDING PRIORITIES, QUALITY ASSESSMENT.
Section 2602 (42 U.S.C. 300ff-12) is amended--
(1) in subsection (b)--
(A) in paragraph (2)(C), by inserting before the semicolon the following: ``, including providers of housing and homeless services''; and
(B) in paragraph (4), by striking ``shall--'' and all that follows and inserting ``shall have the responsibilities specified in subsection (d).''; and
(2) by adding at the end the following:
``(d) DUTIES OF PLANNING COUNCIL.--The planning council established under subsection (b) shall have the following duties:
``(1) PRIORITIES FOR ALLOCATION OF FUNDS.--The council shall establish priorities for the allocation of funds within the eligible area, including how best to meet each such priority and additional factors that a grantee should consider in allocating funds under a grant, based on the following factors:
``(A) The size and demographic characteristics of the population with HIV disease to be served, including, subject to subsection (e), the needs of individuals living with HIV infection who are not receiving HIV-related health services.
``(B) The documented needs of the population with HIV disease with particular attention being given to disparities in health services among affected subgroups within the eligible area.
``(C) The demonstrated or probable cost and outcome effectiveness of proposed strategies and interventions, to the extent that data are reasonably available.
``(D) Priorities of the communities with HIV disease for whom the services are intended.
``(E) The 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.
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``(F) Capacity development needs resulting from gaps in the availability of HIV services in historically underserved low-income communities.
``(2) COMPREHENSIVE SERVICE DELIVERY PLAN.--The council shall develop a comprehensive plan for the organization and delivery of health and support services described in section 2604. Such plan shall be compatible with any existing State or local plans regarding the provision of such services to individuals with HIV disease.
``(3) ASSESSMENT OF FUND ALLOCATION EFFICIENCY.--The council shall assess the efficiency of the administrative mechanism in rapidly allocating funds to the areas of greatest need within the eligible area.
``(4) STATEWIDE STATEMENT OF NEED.--The council shall participate in the development of the Statewide coordinated statement of need as initiated by the State public health agency responsible for administering grants under part B.
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