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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:

`(4) INCREASES IN GRANT-

`(A) IN GENERAL- For each fiscal year in a protection period for an eligible area, the Secretary shall increase the amount of the grant made pursuant to paragraph (2) for the area to ensure that--

`(i) for the first fiscal year in the protection period, the grant is not less than 98 percent of the amount of the grant made for the eligible area pursuant to such paragraph for the base year for the protection period;

`(ii) for any second fiscal year in such period, the grant is not less than 95.7 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:

`(c) QUALITY MANAGEMENT-

`(1) REQUIREMENT- The chief elected official of an eligible area that receives a grant under this part shall provide for the establishment of a quality management program to assess the extent to which HIV health services provided to patients under the grant are consistent with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic infection, and as applicable, to develop strategies for ensuring that such services are consistent with the guidelines.

`(2) USE OF FUNDS- From amounts received under a grant awarded under this part for a fiscal year, the chief elected official of an eligible area may (in addition to amounts to which subsection (f)(1) applies) use for activities associated with the quality management program required in paragraph (1) not more than the lesser of--

`(A) 5 percent of amounts received under the grant; or

`(B) $3,000,000.'.

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).

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