RYAN WHITE CARE ACT AMENDMENTS OF 2000
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RYAN WHITE CARE ACT AMENDMENTS OF 2000
(House of Representatives - October 05, 2000)
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RYAN WHITE CARE ACT AMENDMENTS OF 2000
Mr. GOSS. Mr. Speaker, by direction of the Committee on Rules, I call
up House Resolution 611 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 611
Resolved, That upon the adoption of this resolution it
shall be in order without intervention of any point of order
to consider in the House the bill (
S. 2311) 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 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. The bill
shall be considered as read for amendment. The amendment in
the nature of a substitute printed in the Congressional
Record and numbered 1 pursuant to clause 8 of rule XVIII
shall be considered as adopted. The previous question shall
be considered as ordered on the bill, as amended, to final
passage without intervening motion except: (1) one hour of
debate on the bill, as amended, equally divided and
controlled by the chairman and ranking minority member of the
Committee on Commerce; and (2) one motion to recommit with or
without instructions.
The SPEAKER pro tempore. The gentleman from Florida (Mr. Goss) is
recognized for 1 hour.
Mr. GOSS. Mr. Speaker, for purposes of debate only, I am pleased to
yield the customary 30 minutes to my friend, the distinguished
gentleman from Ohio (Mr. Hall), pending which I yield myself such time
as I may consume. During consideration of this resolution, all time
yielded is for purposes of debate only.
Mr. Speaker, this is a fair and straightforward closed rule for a
very important piece of legislation. The rule waives all points of
order against consideration of the bill and provides that the amendment
in the nature of a substitute printed in the Congressional Record shall
be considered as adopted.
{time} 1030
This is largely a noncontroversial bill. As no members of the
minority testified differently last night at the Committee on Rules,
this rule should receive unanimous support, and I urge support.
This reauthorization of the Ryan White CARE Act recognizes the
changing demographics of the AIDS epidemic in our country in a way that
truly honors the memory of the courageous young boy for which the bill
was originally named. Today, there are between 800,000 and 900,000
persons living with HIV in the United States of America with some
40,000 new infections annually. This conference report seeks to shift
resources to the most needy areas while preserving the best features of
the current programs.
The gentleman from Virginia (Chairman Bliley) should be commended for
his leadership and attention to this critical public health issue which
is of concern to every Member of this body. I am hopeful that the
progress made on this authorization will spur funding for another
essential program for individuals afflicted with the HIV virus.
As my colleagues remember and well know, this House led the way and
adopted the Ricky Ray Authorization Act in the last Congress. It
authorized $750 million for compassion assistance and recognition to
hemophiliacs who contracted AIDS through no fault of their own because
of contaminated blood products in the 1980s.
Now, the first installment was provided last year, and this year the
gentleman from Florida (Chairman Young) of the Committee on
Appropriations should be commended for exceeding the President's
request in the House version of the Fiscal Year 2001 Labor-HHS
appropriation bill for the next installment.
As negotiations continue and we near the end of this Congress, I am
hopeful that the White House will become fully engaged on the Ricky Ray
funding problem and work with leadership and Congress to provide full
funding for these victims as soon as humanly possible. The need is
great and the time is now.
I am confident that, if the White House shows true leadership and
demonstrates that this problem is really a top priority for them, we
will be able to move further toward full funding this year. Obviously
we cannot undo the tragic events of the 1980s, but we can work to
provide assistance to these individuals before it is any later.
Mr. Speaker, this rule should engender little debate. It is a fair
rule for a good bill. I urge its adoption.
Mr. Speaker, I reserve the balance of my time.
Mr. HALL of Ohio. Mr. Speaker, I want to thank the gentleman from
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Florida (Mr. Goss) for yielding me the time.
Mr. Speaker, this is a closed rule. It will allow for the
consideration of
S. 2311, which is called the Ryan White CARE Act
Amendments of 2000. As the gentleman from Florida has described, this
rule provides for 1 hour of general debate to be equally divided and
controlled by the chairman and ranking minority member of the Committee
on Commerce. Under this closed rule, no amendments can be offered on
the House floor.
In 1990, Congress passed the Ryan White Comprehensive AIDS Resources
Emergency Act. It was known as the Ryan White CARE Act. This law
created programs to help Americans with AIDS and HIV, the virus that
causes AIDS, and to slow the spread of HIV.
These programs expired October 1. The bill we are considering will
reauthorize and strengthen the Ryan White CARE Act programs by
expanding access, improving quality, and providing additional services.
Some of the changes will help target health care services to the people
who need it the most but who can least afford it.
Women, children, infants and youth with HIV will especially benefit
from this bill as will low-income individuals and families. AIDS
possesses one of the greatest health challenges of our generation, and
there is no way to avoid its tragic grip. However, an active role by
the Federal government can, in my opinion, ease the tragedy by reducing
the number of new HIV cases and by supporting victims and their
families.
The Ryan White CARE Act has worked. The Federal funds spent under
this law have saved lives and reduced suffering. These are dollars that
could not have been better spent. For example, between 1994 and 1999,
pediatric AIDS cases declined by nearly 80 percent largely because of
these programs funded by the Federal Government under this Act.
I would like to point out to my colleague that this act offers a
framework that we should apply to tackling other tragic diseases, such
as childhood cancer. I hope that Congress will learn from the success
of this act.
This legislation extending the Ryan White CARE Act represents our
best response to dealing with AIDS and its consequences. The bill we
are considering is a compromise between the previously passed House and
Senate versions. The Senate version passed by unanimous consent. The
House version passed by a voice vote under suspension of the rules. I
am proud to be a cosponsor of this House version.
Because there is general agreement between the House and Senate,
there is no need for a formal conference committee.
I urge my colleagues to vote for the rule and for the bill.
Mr. Speaker, I reserve the balance of my time.
Mr. GOSS. Mr. Speaker, I advise that we have no speakers lined up,
and I would be prepared to yield back if the gentleman from Ohio (Mr.
Hall) has no speakers.
Mr. HALL of Ohio. Mr. Speaker, I yield back the balance of my time.
Mr. GOSS. Mr. Speaker, I yield back the balance of my time, and I
move the previous question on the resolution.
The previous question was ordered.
The resolution was agreed to.
A motion to reconsider was laid on the table.
Mr. COBURN. Mr. Speaker, pursuant to House Resolution 611, I call up
the Senate bill (
S. 2311) 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 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, and ask for its immediate
consideration.
The Clerk read the title of the Senate bill.
The SPEAKER pro tempore (Mr. Simpson). Pursuant to House Resolution
611, the Senate bill is considered read for amendment.
The text of
S. 2311 is as follows:
S. 2311
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.
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.
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.
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H8819]]
``(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.
``(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.
``(5) Coordination with other federal grantees.--The
council shall coordinate with Federal grantees providing HIV-
related services within the eligible area.
``(6) Community participation.--The council shall establish
methods for obtaining input on community needs and priorities
which may include public meetings, conducting focus groups,
and convening ad-hoc panels.
``(e) Process for Establishing Allocation Priorities.--
``(1) In general.--Not later than 24 months after the date
of enactment of the Ryan White CARE Act Amendments of 2000,
the Secretary shall--
``(A) consult with eligible metropolitan areas, affected
communities, experts, and other appropriate individuals and
entities, to develop epidemiologic measures for establishing
the number of individuals living with HIV disease who are not
receiving HIV-related health services; and
``(B) provide advice and technical assistance to planning
councils with respect to the process for establishing
priorities for the allocation of funds under subsection
(d)(1).
``(2) Exception.--Grantees under subsection (d)(1)(A) shall
not be required to establish priorities for individuals not
in care until epidemiologic measures are developed under
paragraph (1).''.
SEC. 102. QUALITY MANAGEMENT.
(a) Funds Available for Quality Management.--Section 2604
(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 medical 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 to develop
strategies for improvements in the access to and quality of
medical services.
``(2) Use of funds.--From amounts received under a grant
awarded under this part, the chief elected official of an
eligible area may use, for activities associated with its
quality management program, not more than the lesser of--
``(A) 5 percent of amounts received under the grant; or
``(B) $3,000,000.''.
(b) Quality Management Required for Eligibility for
Grants.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended--
(1) by redesignating paragraphs (3) through (6) as
paragraphs (5) through (8), respectively; and
(2) by inserting after paragraph (2) the following:
``(3) that the chief elected official of the eligible area
will satisfy all requirements under section 2604(c);''.
SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE
RELATIONSHIPS.
(a) Use of Amounts.--Section 2604(e)(1) (42 U.S.C. 300ff-
14(d)(1)) (as so redesignated by section 102(a)) is amended
by inserting ``and the State Children's Health Insurance
Program under title XXI of such Act'' after ``Social Security
Act''.
(b) Applications.--Section 2605(a) (42 U.S.C. 300ff-15(a))
is amended by inserting after paragraph (3), as added by
section 102(b), the following:
``(4) that funded entities within the eligible area that
receive funds under a grant under section 2601(a) shall
maintain appropriate relationships with entities in the area
served that constitute key points of access to the health
care system for individuals with HIV disease (including
emergency rooms, substance abuse treatment programs,
detoxification centers, adult and juvenile detention
facilities, sexually transmitted disease clinics, HIV
counseling and testing sites, and homeless shelters) and
other entities under section 2652(a) for the purpose of
facilitating early intervention for individuals newly
diagnosed with HIV disease and individuals knowledgeable of
their status but not in care;''.
SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
RELATED.
(a) In General.--Section 2604(b)(1) (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 health services.--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
services.--Inpatient case management''; and
(4) by inserting after subparagraph (A) the following:
``(B) Outpatient support services.--Outpatient and
ambulatory support services (including case management), to
the extent that such services facilitate, enhance, support,
or sustain the delivery, continuity, or benefits of health
services for individuals and families with HIV disease.''.
(b) Conforming Amendment to Application Requirements.--
Section 2605(a) (42 U.S.C. 300ff-15(a)), as amended by
section 102(b), is further amended--
(1) in paragraph (6) (as so redesignated), by striking
``and'' at the end thereof;
(2) in paragraph (7) (as so redesignated), by striking the
period and inserting ``; and''; and
(3) by adding at the end the following:
``(8) that the eligible area has procedures in place to
ensure that services provided with funds received under this
part meet the criteria specified in section 2604(b)(1).''.
SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.
(a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-
14(b)(1)), as amended by section 104(a), is further amended
by adding at the end the following:
``(D) Early intervention services.--Early intervention
services as described in section 2651(b)(2), with follow-
through referral, provided for the purpose of facilitating
the access of individuals receiving the services to HIV-
related health services, but only if the entity providing
such services--
``(i)(I) is receiving funds under subparagraph (A) or (C);
or
``(II) is an entity constituting a point of access to
services, as described in paragraph (2)(C), that maintains a
relationship with an entity described in subclause (I) and
that is serving individuals at elevated risk of HIV disease;
and
``(ii) demonstrates to the satisfaction of the chief
elected official that no other Federal, State, or local funds
are available for the early intervention services the entity
will provide with funds received under this paragraph.''.
(b) Conforming Amendments to Application Requirements.--
Section 2605(a)(1) (42 U.S.C. 300ff-15(a)(1)) is amended--
(1) in subparagraph (A), by striking ``services to
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''; and
(2) in subparagraph (B), by striking ``services for
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''.
SEC. 106. REPLACEMENT OF SPECIFIED FISCAL YEARS REGARDING THE
SUNSET ON EXPEDITED DISTRIBUTION REQUIREMENTS.
Section 2603(a)(2) (42 U.S.C. 300ff-13(a)(2)) is amended by
striking ``for each of the fiscal years 1996 through 2000''
and inserting ``for a fiscal year''.
SEC. 107. HOLD HARMLESS PROVISION.
Section 2603(a)(4) (42 U.S.C. 300ff-13(a)(4)) is amended to
read as follows:
``(4) Limitations.--
``(A) In general.--With respect to each of fiscal years
2001 through 2005, the Secretary shall ensure that the amount
of a grant made to an eligible area under paragraph (2) for
such a fiscal year is not less than an amount equal to 98
percent of the amount the eligible area received for the
fiscal year preceding the year for which the determination is
being made.
``(B) Application of provision.--Subparagraph (A) shall
only apply with respect to those eligible areas receiving a
grant under paragraph (2) for fiscal year 2000 in an amount
that has been adjusted in accordance with paragraph (4) of
this subsection (as in effect on the day before the date of
enactment of the Ryan White CARE Act Amendments of 2000).''.
SEC. 108. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.
Section 2604(b)(3) (42 U.S.C. 300ff-14(b)(3)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``established priorities''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.
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Subtitle B--Amendments to Part B (Care Grant Program)
SEC. 121. STATE REQUIREMENTS CONCERNING IDENTIFICATION OF
NEED AND ALLOCATION OF RESOURCES.
(a) General Use of Grants.--Section 2612 (42 U.S.C. 300ff-
22) is amended--
(1) by striking ``A State'' and inserting ``(a) In
General.--A State''; and
(2) in the matter following paragraph (5)--
(A) by striking ``paragraph (2)'' and inserting
``subsection (a)(2) and section 2613'';
(b) Application.--Section 2617(b) (42 U.S.C. 300ff-27(b))
is amended--
(1) in paragraph (1)(C)--
(A) by striking clause (i) and inserting the following:
``(i) the size and demographic characteristics of the
population with HIV disease to be served, except that by not
later than October 1, 2002, the State shall take into account
the needs of individuals not in care, based on epidemiologic
measures developed by the Secretary in consultation with the
State, affected communities, experts, and other appropriate
individuals (such State shall not be required to establish
priorities for individuals not in care until such
epidemiologic measures are developed);'';
(B) in clause (iii), by striking ``and'' at the end; and
(C) by adding at the end the following:
``(v) the availability of other governmental and non-
governmental resources;
``(vi) the capacity development needs resulting in gaps in
the provision of HIV services in historically underserved
low-income and rural low-income communities; and
``(vii) the efficiency of the administrative mechanism in
rapidly allocating funds to the areas of greatest need within
the State;''; and
(2) in paragraph (2)--
(A) in subparagraph (B), by striking ``and'' at the end;
(B) by redesignating subparagraph (C) as subparagraph (F);
and
(C) by inserting after subparagraph (B), the following:
``(C) an assurance that capacity development needs
resulting from gaps in the provision of services in
underserved low-income and rural low-income communities will
be addressed; and
``(D) with respect to fiscal year 2003 and subsequent
fiscal years, assurances that, in the planning and allocation
of resources, the State, through systems of HIV-related
health services provided under paragraphs (1), (2), and (3)
of section 2612(a), will make appropriate provision for the
HIV-related health and support service needs of individuals
who have been diagnosed with HIV disease but who are not
currently receiving such services, based on the epidemiologic
measures developed under paragraph (1)(C)(i);''.
SEC. 122. QUALITY MANAGEMENT.
(a) State Requirement for Quality Management.--Section
2617(b)(4) (42 U.S.C. 300ff-27(b)(4)) is amended--
(1) by striking subparagraph (C) and inserting the
following:
``(C) the State will provide for--
``(i) the establishment of a quality management program to
assess the extent to which medical 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 infections and to develop
strategies for improvements in the access to and quality of
medical services; and
``(ii) a periodic review (such as through an independent
peer review) to assess the quality and appropriateness of
HIV-related health and support services provided by entities
that receive funds from the State under this part;'';
(2) by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively;
(3) by inserting after subparagraph (D), the following:
``(E) an assurance that the State, through systems of HIV-
related health services provided under paragraphs (1), (2),
and (3) of section 2612(a), has considered strategies for
working with providers to make optimal use of financial
assistance under the State medicaid plan under title XIX of
the Social Security Act, the State Children's Health
Insurance Program under title XXI of such Act, and other
Federal grantees that provide HIV-related services, to
maximize access to quality HIV-related health and support
services;
(4) in subparagraph (F), as so redesignated, by striking
``and'' at the end; and
(5) in subparagraph (G), as so redesignated, by striking
the period and inserting ``; and''.
(b) Availability of Funds for Quality Management.--
(1) Availability of grant funds for planning and
evaluation.--Section 2618(c)(3) (42 U.S.C. 300ff-28(c)(3)) is
amended by inserting before the period ``, including not more
than $3,000,000 for all activities associated with its
quality management program''.
(2) Exception to combined ceiling on planning and
administration funds for states with small grants.--Paragraph
(6) of section 2618(c) (42 U.S.C. 300ff-28(c)(6)) is amended
to read as follows:
``(6) Exception for quality management.--Notwithstanding
paragraph (5), a State whose grant under this part for a
fiscal year does not exceed $1,500,000 may use not to exceed
20 percent of the amount of the grant for the purposes
described in paragraphs (3) and (4) if--
``(A) that portion of such amount in excess of 15 percent
of the grant is used for its quality management program; and
``(B) the State submits and the Secretary approves a plan
(in such form and containing such information as the
Secretary may prescribe) for use of funds for its quality
management program.''.
SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE
RELATIONSHIPS.
Section 2617(b)(4) (42 U.S.C. 300ff-27(b)(4)), as amended
by section 122(a), is further amended by adding at the end
the following:
``(H) that funded entities maintain appropriate
relationships with entities in the area served that
constitute key points of access to the health care system for
individuals with HIV disease (including emergency rooms,
substance abuse treatment programs, detoxification centers,
adult and juvenile detention facilities, sexually transmitted
disease clinics, HIV counseling and testing sites, and
homeless shelters), and other entities under section 2652(a),
for the purpose of facilitating early intervention for
individuals newly diagnosed with HIV disease and individuals
knowledgeable of their status but not in care.''.
SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
RELATED.
(a) Technical Amendment.--Section 3(c)(2)(A)(iii) of the
Ryan White CARE Act Amendments of 1996 (Public Law 104-146)
is amended by inserting ``before paragraph (2) as so
redesignated'' after ``inserting''.
(b) Services.--Section 2612(a)(1) (42 U.S.C. 300ff-
22(a)(1)), as so designated by section 121(a), is amended by
striking ``for individuals with HIV disease'' and inserting
``, subject to the conditions and limitations that apply
under such section''.
(c) Conforming Amendment to State Application
Requirement.--Section 2617(b)(2) (42 U.S.C. 300ff-27(b)(2)),
as amended by section 121(b), is further amended by adding at
the end the following:
``(F) an assurance that the State has procedures in place
to ensure that services provided with funds received under
this section meet the criteria specified in section
2604(b)(1)(B); and''.
SEC. 125. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.
Section 2612(a) (42 U.S.C. 300ff-22(a)), as amended by
section 121, is further amended by adding at the end the
following:
``(6) Early intervention services.--The State, through
systems of HIV-related health services provided under
paragraphs (1), (2), and (3) of section 2612(a), may provide
early intervention services, as described in section
2651(b)(2), with follow-up referral, provided for the purpose
of facilitating the access of individuals receiving the
services to HIV-related health services, but only if the
entity providing such services--
``(A)(i) is receiving funds under section 2612(a)(1); or
``(ii) is an entity constituting a point of access to
services, as described in section 2617(b)(4), that maintains
a referral relationship with an entity described in clause
(i) and that is serving individuals at elevated risk of HIV
disease; and
``(B) demonstrates to the State's satisfaction that no
other Federal, State, or local funds are available for the
early intervention services the entity will provide with
funds received under this paragraph.''.
SEC. 126. AUTHORIZATION OF APPROPRIATIONS FOR HIV-RELATED
SERVICES FOR WOMEN AND CHILDREN.
Section 2625(c)(2) (42 U.S.C. 300ff-33(c)(2)) is amended by
striking ``fiscal years 1996 through 2000'' and inserting
``fiscal years 2001 through 2005''.
SEC. 127. REPEAL OF REQUIREMENT FOR COMPLETED INSTITUTE OF
MEDICINE REPORT.
Section 2628 (42 U.S.C. 300ff-36) is repealed.
SEC. 128. SUPPLEMENT 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 by adding
at the end the following:
``SEC. 2622. SUPPLEMENTAL GRANTS.
``(a) In General.--The Secretary shall award supplemental
grants to States determined to be eligible under subsection
(b) to enable such States to provide comprehensive services
of the type described in section 2612(a) to supplement the
services otherwise provided by the State under a grant under
this subpart in areas within the State that are not eligible
to receive grants under part A.
``(b) Eligibility.--To be eligible to receive a
supplemental grant under subsection (a) a State shall--
``(1) be eligible to receive a grant under this subpart;
and
``(2) demonstrate to the Secretary that there is severe
need (as defined for purposes of section 2603(b)(2)(A) for
supplemental financial assistance in areas in the State that
are not served through grants under part A.
``(c) Application.--A State that desires a grant under this
section shall, as part of the State application submitted
under section 2617, submit a detailed description of the
manner in which the State will use amounts received under the
grant and of the severity of need. Such description shall
include--
``(1) a report concerning the dissemination of supplemental
funds under this section and the plan for the utilization of
such funds;
``(2) a demonstration of the existing commitment of local
resources, both financial and in-kind;
``(3) a demonstration that the State will maintain HIV-
related activities at a level
[[Page
H8821]]
that is equal to not less than the level of such activities
in the State for the 1-year period preceding the fiscal year
for which the State is applying to receive a grant under this
part;
``(4) a demonstration of the ability of the State to
utilize such supplemental financial resources in a manner
that is immediately responsive and cost effective;
``(5) a demonstration that the resources will be allocated
in accordance with the local demographic incidence of AIDS
including appropriate allocations for services for infants,
children, women, and families with HIV disease;
``(6) a demonstration of the inclusiveness of the planning
process, with particular emphasis on affected communities and
individuals with HIV disease; and
``(7) a demonstration of the manner in which the proposed
services are consistent with local needs assessments and the
statewide coordinated statement of need.
``(d) Amount Reserved for Emerging Communities.--
``(1) In general.--For awarding grants under this section
for each fiscal year, the Secretary shall reserve the greater
of 50 percent of the amount to be utilized under subsection
(e) for such fiscal year or $5,000,000, to be provided to
States that contain emerging communities for use in such
communities.
``(2) Definition.--In paragraph (1), the term `emerging
community' means a metropolitan area--
``(A) that is not eligible for a grant under part A; and
``(B) for which there has been reported to the Director of
the Centers for Disease Control and Prevention a cumulative
total of between 1000 and 1999 cases of acquired immune
deficiency syndrome for the most recent period of 5 calendar
years for which such data are available.
``(e) Appropriations.--With respect to each fiscal year
beginning with fiscal year 2001, the Secretary, to carry out
this section, shall utilize 50 percent of the amount
appropriated under section 2677 to carry out part B for such
fiscal year that is in excess of the amount appropriated to
carry out such part in fiscal year preceding the fiscal year
involved.
SEC. 129. USE OF TREATMENT FUNDS.
(a) State Duties.--Section 2616(c) (42 U.S.C. 300ff-26(c))
is amended--
(1) in the matter preceding paragraph (1), by striking
``shall--'' and inserting ``shall use funds made available
under this section to--'';
(2) by redesignating paragraphs (1) through (5) as
subparagraphs (A) through (E), respectively and realigning
the margins of such subparagraphs appropriately;
(3) in subparagraph (D) (as so redesignated), by striking
``and'' at the end;
(4) in subparagraph (E) (as so redesignated), by striking
the period and ``; and''; and
(5) by adding at the end the following:
``(F) encourage, support, and enhance adherence to and
compliance with treatment regimens, including related medical
monitoring.'';
(6) by striking ``In carrying'' and inserting the
following:
``(1) In general.--In carrying''; and
(7) by adding at the end the following:
``(2) Limitations.--
``(A) In general.--No State shall use funds under paragraph
(1)(F) unless the limitations on access to HIV/AIDS
therapeutic regimens as defined in subsection (e)(2) are
eliminated.
``(B) Amount of funding.--No State shall use in excess of
10 percent of the amount set-aside for use under this section
in any fiscal year to carry out activities under paragraph
(1)(F) unless the State demonstrates to the Secretary that
such additional services are essential and in no way diminish
access to therapeutics.''.
(b) Supplement Grants.--Section 2616 (42 U.S.C. 300ff-
26(c)) is amended by adding at the end the following:
``(e) Supplemental Grants for the Provision of
Treatments.--
``(1) In general.--From amounts made available under
paragraph (5), the Secretary shall award supplemental grants
to States determined to be eligible under paragraph (2) to
enable such States to provide access to therapeutics to treat
HIV disease as provided by the State under subsection
(c)(1)(B) for individuals at or below 200 percent of the
Federal poverty line.
``(2) Criteria.--The Secretary shall develop criteria for
the awarding of grants under paragraph (1) to States that
demonstrate a severe need. In determining the criteria for
demonstrating State severity of need (as defined for purposes
of section 2603(b)(2)(A)), the Secretary shall consider
whether limitation to access exist such that--
``(A) the State programs under this section are unable to
provide HIV/AIDS therapeutic regimens to all eligible
individuals living at or below 200 percent of the Federal
poverty line; and
``(B) the State programs under this section are unable to
provide to all eligible individuals appropriate HIV/AIDS
therapeutic regimens as recommended in the most recent
Federal treatment guidelines.
``(3) State requirement.--The Secretary may not make a
grant to a State under this subsection unless the State
agrees that--
``(A) the State will make available (directly or through
donations from public or private entities) non-Federal
contributions toward the activities to be carried out under
the grant in an amount equal to $1 for each $4 of Federal
funds provided in the grant; and
``(B) the State will not impose eligibility requirements
for services or scope of benefits limitations under
subsection (a) that are more restrictive than such
requirements in effect as of January 1, 2000.
``(4) Use and coordination.--Amounts made available under a
grant under this subsection shall only be used by the State
to provide AIDS/HIV-related medications. The State shall
coordinate the use of such amounts with the amounts otherwise
provided under this section in order to maximize drug
coverage.
``(5) Funding.--
``(A) Reservation of amount.--The Secretary may reserve not
to exceed 4 percent, but not less than 2 percent, of any
amount referred to in section 2618(b)(2)(H) that is
appropriated for a fiscal year, to carry out this subsection.
``(B) Minimum amount.--In providing grants under this
subsection, the Secretary shall ensure that the amount of a
grant to a State under this part is not less than the amount
the State received under this part in the previous fiscal
year, as a result of grants provided under this
subsection.''.
(c) Supplement and not Supplant.--Section 2616 (42 U.S.C.
300ff-26(c)), as amended by subsection (b), is further
amended by adding at the end the following:
``(f) Supplement not Supplant.--Notwithstanding any other
provision of law, amounts made available under this section
shall be used to supplement and not supplant other funding
available to provide treatments of the type that may be
provided under this section.''.
SEC. 130. INCREASE IN MINIMUM ALLOTMENT.
(a) In General.--Section 2618(b)(1)(A)(i) (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) Technical Amendment.--Section 2618(b)(3)(B) (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''.
SEC. 131. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.
Section 2611(b) (42 U.S.C. 300ff-21(b)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``State shall use''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.
Subtitle C--Amendments to Part C (Early Intervention Services)
SEC. 141. AMENDMENT OF HEADING; REPEAL OF FORMULA GRANT
PROGRAM.
(a) Amendment of Heading.--The heading of part C of title
XXVI is amended to read as follows:
``Part C--Early Intervention and Primary Care Services''.
(b) Repeal.--Part C of title XXVI (42 U.S.C. 300ff-41 et
seq.) is amended--
(1) by repealing subpart I; and
(2) by redesignating subparts II and III as subparts I and
II.
(c) Conforming Amendments.--
(1) Information regarding receipt of services.--Section
2661(a) (42 U.S.C. 300ff-61(a)) is amended by striking
``unless--'' and all that follows through ``(2) in the case
of'' and inserting ``unless, in the case of''.
(2) Additional agreements.--Section 2664 (42 U.S.C. 300ff-
64) is amended--
(A) in subsection (e)(5), by striking ``2642(b) or'';
(B) in subsection (f)(2), by striking ``2642(b) or''; and
(C) by striking subsection (h).
SEC. 142. PLANNING AND DEVELOPMENT GRANTS.
(a) Allowing Planning and Development Grant To Expand
Ability To Provide Primary Care Services.--Section 2654(c)
(42 U.S.C. 300ff-54(c)) is amended--
(1) in paragraph (1), to read as follows:
``(1) In general.--The Secretary may provide planning and
development grants to public and nonprofit private entities
for the purpose of--
``(A) enabling such entities to provide HIV early
intervention services; or
``(B) assisting such entities to expand the capacity,
preparedness, and expertise to deliver primary care services
to individuals with HIV disease in underserved low-income
communities on the condition that the funds are not used to
purchase or improve land or to purchase, construct, or
permanently improve (other than minor remodeling) any
building or other facility.''; and
(2) in paragraphs (2) and (3) by striking ``paragraph (1)''
each place that such appears and inserting ``paragraph
(1)(A)''.
(b) Amount; Duration.--Section 2654(c) (42 U.S.C. 300ff-
54(c)), as amended by subsection (a), 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.
[[Page
H8822]]
``(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) (42 U.S.C.
300ff-54(c)(5)), as so redesignated by subsection (b), is
amended by striking ``1 percent'' and inserting ``5
percent''.
SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CATEGORICAL
GRANTS.
Section 2655 (42 U.S.C. 300ff-55) is amended by striking
``1996'' and all that follows through ``2000'' and inserting
``2001 through 2005''.
SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY MANAGEMENT
PROGRAM.
Section 2664(g) (42 U.S.C. 300ff-64(g)) is amended--
(1) in paragraph (3), to read as follows:
``(3) the applicant will not expend more than 10 percent of
the grant for costs of administrative activities with respect
to the grant;'';
(2) in paragraph (4), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(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.''.
SEC. 145. PREFERENCE FOR CERTAIN AREAS.
Section 2651 (42 U.S.C. 300ff-51) is amended by adding at
the end the following:
``(d) Preference in Awarding Grants.--Beginning in fiscal
year 2001, in awarding new grants under this section, the
Secretary shall give preference to applicants that will use
amounts received under the grant to serve areas that are
otherwise not eligible to receive assistance under part A.''.
Subtitle D--Amendments to Part D (General Provisions)
SEC. 151. RESEARCH INVOLVING WOMEN, INFANTS, CHILDREN, AND
YOUTH.
(a) Elimination of Requirement To Enroll Significant
Numbers of Women and Children.--Section 2671(b) (42 U.S.C.
300ff-71(b)) is amended--
(1) in paragraph (1), by striking subparagraphs (C) and
(D); and
(2) by striking paragraphs (3) and (4).
(b) Information and Education.--Section 2671(d) (42 U.S.C.
300ff-71(d)) is amended by adding at the end the following:
``(4) The applicant will provide individuals with
information and education on opportunities to participate in
HIV/AIDS-related clinical research.''.
(c) Quality Management; Administrative Expenses Ceiling.--
Section 2671(f) (42 U.S.C. 300ff-71(f)) is amended--
(1) by striking the subsection heading and designation and
inserting the following:
``(f) Administration.--
``(1) Application.--''; and
(2) by adding at the end the following:
``(2) Quality management program.--A grantee under this
section shall implement a quality management program.''.
(d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g))
is amended by adding at the end the following: ``The
Secretary acting through the Director of NIH, shall examine
the distribution and availability of ongoing and appropriate
HIV/AIDS-related research projects to existing sites under
this section for purposes of enhancing and expanding
voluntary access to HIV-related research, especially within
communities that are not reasonably served by such
projects.''.
(e) Authorization of Appropriations.--Section 2671(j) (42
U.S.C. 300ff-71(j)) is amended by striking ``fiscal years
1996 through 2000'' and inserting ``fiscal years 2001 through
2005''.
SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.
Section 2671 (42 U.S.C. 300ff-71) is amended--
(1) by redesignating subsections (i) and (j), as
subsections (j) and (k), respectively; and
(2) by inserting after subsection (h), the following:
``(i) Limitation on Administrative Expenses.--
``(1) Determination by secretary.--Not later than 12 months
after the date of enactment of the Ryan White Care Act
Amendments of 2000, the Secretary, in consultation with
grantees under this part, shall conduct a review of the
administrative, program support, and direct service-related
activities that are carried out under this part to ensure
that eligible individuals have access to quality, HIV-related
health and support services and research opportunities under
this part, and to support the provision of such services.
``(2) Requirements.--
``(A) In general.--Not later than 180 days after the
expiration of the 12-month period referred to in paragraph
(1) the Secretary, in consultation with grantees under this
part, shall determine the relationship between the costs of
the activities referred to in paragraph (1) and the access of
eligible individuals to the services and research
opportunities described in such paragraph.
``(B) Limitation.--After a final determination under
subparagraph (A), the Secretary may not make a grant under
this part unless the grantee complies with such requirements
as may be included in such determination.''.
SEC. 153. EVALUATIONS AND REPORTS.
Section 2674(c) (42 U.S.C. 399ff-74(c)) is amended by
striking ``1991 through 1995'' and inserting ``2001 through
2005''.
SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR GRANTS UNDER
PARTS A AND B.
Section 2677 (42 U.S.C. 300ff-77) is amended to read as
follows:
``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated--
``(1) such sums as may be necessary to carry out part A for
each of the fiscal years 2001 through 2005; and
``(2) such sums as may be necessary to carry out part B for
each of the fiscal years 2001 through 2005.''.
Subtitle E--Amendments to Part F (Demonstration and Training)
SEC. 161. AUTHORIZATION OF APPROPRIATIONS.
(a) Schools; Centers.--Section 2692(c)(1) (42 U.S.C. 300ff-
111(c)(1)) is amended by striking ``fiscal years 1996 through
2000'' and inserting ``fiscal years 2001 through 2005''.
(b) Dental Schools.--Section 2692(c)(2) (42 U.S.C. 300ff-
111(c)(2)) is amended by striking ``fiscal years 1996 through
2000'' and inserting ``fiscal years 2001 through 2005''.
TITLE II--MISCELLANEOUS PROVISIONS
SEC. 201. INSTITUTE OF MEDICINE STUDY.
(a) In General.--Not later than 120 days after the date of
enactment of this Act, the Secretary of Health and Human
Services shall enter into a contract with the Institute of
Medicine for the conduct of 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.
(b) Requirements.--
(1) Completion.--The study under subsection (a) shall be
completed not later than 21 months after the date on which
the contract referred to in such subsection is entered into.
(2) Issues to be considered.--The study conducted under
subsection (a) shall consider--
(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;
(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;
and
(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) Report.--Not later than 90 days after the date on which
the study is completed under subsection (a), the Secretary of
Health and Human Services shall prepare and submit to the
appropriate committees of Congress a report describing the
manner in which the conclusions and recommendations of the
Institute of Medicine can be addressed and implemented.
The SPEAKER pro tempore. Pursuant to House Resolution 611, the
amendment in the nature of a substitute printed in the Congressional
Record and numbered 1 is considered adopted.
The text of
S. 2311, as amended pursuant to House Resolution 611, is
as follows:
Strike all after the enacting clause and insert the
following:
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. 122. Application.
TITLE II--CARE GRANT PROGRAM
Subtitle A--General Grant Provisions
Sec. 201. Priority for women, infants, and children.
Sec. 202. Use of grants.
Sec. 203. Grants to establish HIV care consortia.
Sec. 204. Provision of treatments.
Sec. 205. State application.
Sec. 206. Distribution of funds.
Sec. 207. Supplemental grants for certain States.
Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission
of HIV
Sec. 211. Repeals.
Sec. 212. Grants.
Sec. 213. Study by Institute of Medicine.
[[Page
H8823]]
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. 413. Coordination.
Sec. 414. Plan regarding release of prisoners with HIV disease.
Sec. 415. Audits.
Sec. 416. Administrative simplification.
Sec. 417. Authorization of appropriations for parts A and B.
TITLE V--GENERAL PROVISIONS
Sec. 501. Studies by Institute of Medicine.
Sec. 502. Development of rapid HIV test.
Sec. 503. Technical corrections.
TITLE VI--EFFECTIVE DATE
Sec. 601. Effective date.
TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES
Subtitle A--HIV Health Services Planning Councils
SEC. 101. MEMBERSHIP OF COUNCILS.
(a) In General.--Section 2602(b) of the Public Health
Service Act (42 U.S.C. 300ff-12(b)) is amended--
(1) in paragraph (1), by striking ``demographics of the
epidemic in the eligible area involved,'' and inserting
``demographics of the population of individuals with HIV
disease in the eligible area involved,''; and
(2) in paragraph (2)--
(A) in subparagraph (C), by inserting before the semicolon
the following: ``, including providers of housing and
homeless services'';
(B) in subparagraph (G), by striking ``or AIDS'';
(C) in subparagraph (K), by striking ``and'' at the end;
(D) in subparagraph (L), by striking the period and
inserting the following: ``, including but not limited to
providers of HIV prevention services; and''; and
(E) by adding at the end the following subparagraph:
``(M) representatives of individuals who formerly were
Federal, State, or local prisoners, were released from the
custody of the penal system during the preceding 3 years, and
had HIV disease as of the date on which the individuals were
so released.''.
(b) Conflicts of Interests.--Section 2602(b)(5) of the
Public Health Service Act (42 U.S.C. 300ff-12(b)(5)) is
amended by adding at the end the following subparagraph:
``(C) Composition of council.--The following applies
regarding the membership of a planning council under
paragraph (1):
``(i) Not less than 33 percent of the council shall be
individuals who are receiving HIV-related services pursuant
to a grant under section 2601(a), are not officers,
employees, or consultants to any entity that receives amounts
from such a grant, and do not represent any such entity, and
reflect the demographics of the population of individuals
with HIV disease as determined under paragraph (4)(A). For
purposes of the preceding sentence, an individual shall be
considered to be receiving such services if the individual is
a parent of, or a caregiver for, a minor child who is
receiving such services.
``(ii) With respect to membership on the planning council,
clause (i) may not be construed as having any effect on
entities that receive funds from grants under any of parts B
through F but do not receive funds from grants under section
2601(a), on officers or employees of such entities, or on
individuals who represent such entities.''.
SEC. 102. DUTIES OF COUNCILS.
(a) In General.--Section 2602(b)(4) of the Public Health
Service Act (42 U.S.C. 300ff-12(b)(4)) is amended--
(1) by redesignating subparagraphs (A) through (E) as
subparagraphs (C) through (G), respectively;
(2) by inserting before subparagraph (C) (as so
redesignated) the following subparagraphs:
``(A) determine the size and demographics of the population
of individuals with HIV disease;
``(B) determine the needs of such population, with
particular attention to--
``(i) individuals with HIV disease who know their HIV
status and are not receiving HIV-related services; and
``(ii) disparities in access and services among affected
subpopulations and historically underserved communities;'';
(3) in subparagraph (C) (as so redesignated), by striking
clauses (i) through (iv) and inserting the following:
``(i) size and demographics of the population of
individuals with HIV disease (as determined under
subparagraph (A)) and the needs of such population (as
determined under subparagraph (B));
``(ii) demonstrated (or probable) cost effectiveness and
outcome effectiven
Major Actions:
All articles in House section
RYAN WHITE CARE ACT AMENDMENTS OF 2000
(House of Representatives - October 05, 2000)
Text of this article available as:
TXT
PDF
[Pages
H8817-H8847]
RYAN WHITE CARE ACT AMENDMENTS OF 2000
Mr. GOSS. Mr. Speaker, by direction of the Committee on Rules, I call
up House Resolution 611 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 611
Resolved, That upon the adoption of this resolution it
shall be in order without intervention of any point of order
to consider in the House the bill (
S. 2311) 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 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. The bill
shall be considered as read for amendment. The amendment in
the nature of a substitute printed in the Congressional
Record and numbered 1 pursuant to clause 8 of rule XVIII
shall be considered as adopted. The previous question shall
be considered as ordered on the bill, as amended, to final
passage without intervening motion except: (1) one hour of
debate on the bill, as amended, equally divided and
controlled by the chairman and ranking minority member of the
Committee on Commerce; and (2) one motion to recommit with or
without instructions.
The SPEAKER pro tempore. The gentleman from Florida (Mr. Goss) is
recognized for 1 hour.
Mr. GOSS. Mr. Speaker, for purposes of debate only, I am pleased to
yield the customary 30 minutes to my friend, the distinguished
gentleman from Ohio (Mr. Hall), pending which I yield myself such time
as I may consume. During consideration of this resolution, all time
yielded is for purposes of debate only.
Mr. Speaker, this is a fair and straightforward closed rule for a
very important piece of legislation. The rule waives all points of
order against consideration of the bill and provides that the amendment
in the nature of a substitute printed in the Congressional Record shall
be considered as adopted.
{time} 1030
This is largely a noncontroversial bill. As no members of the
minority testified differently last night at the Committee on Rules,
this rule should receive unanimous support, and I urge support.
This reauthorization of the Ryan White CARE Act recognizes the
changing demographics of the AIDS epidemic in our country in a way that
truly honors the memory of the courageous young boy for which the bill
was originally named. Today, there are between 800,000 and 900,000
persons living with HIV in the United States of America with some
40,000 new infections annually. This conference report seeks to shift
resources to the most needy areas while preserving the best features of
the current programs.
The gentleman from Virginia (Chairman Bliley) should be commended for
his leadership and attention to this critical public health issue which
is of concern to every Member of this body. I am hopeful that the
progress made on this authorization will spur funding for another
essential program for individuals afflicted with the HIV virus.
As my colleagues remember and well know, this House led the way and
adopted the Ricky Ray Authorization Act in the last Congress. It
authorized $750 million for compassion assistance and recognition to
hemophiliacs who contracted AIDS through no fault of their own because
of contaminated blood products in the 1980s.
Now, the first installment was provided last year, and this year the
gentleman from Florida (Chairman Young) of the Committee on
Appropriations should be commended for exceeding the President's
request in the House version of the Fiscal Year 2001 Labor-HHS
appropriation bill for the next installment.
As negotiations continue and we near the end of this Congress, I am
hopeful that the White House will become fully engaged on the Ricky Ray
funding problem and work with leadership and Congress to provide full
funding for these victims as soon as humanly possible. The need is
great and the time is now.
I am confident that, if the White House shows true leadership and
demonstrates that this problem is really a top priority for them, we
will be able to move further toward full funding this year. Obviously
we cannot undo the tragic events of the 1980s, but we can work to
provide assistance to these individuals before it is any later.
Mr. Speaker, this rule should engender little debate. It is a fair
rule for a good bill. I urge its adoption.
Mr. Speaker, I reserve the balance of my time.
Mr. HALL of Ohio. Mr. Speaker, I want to thank the gentleman from
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Florida (Mr. Goss) for yielding me the time.
Mr. Speaker, this is a closed rule. It will allow for the
consideration of
S. 2311, which is called the Ryan White CARE Act
Amendments of 2000. As the gentleman from Florida has described, this
rule provides for 1 hour of general debate to be equally divided and
controlled by the chairman and ranking minority member of the Committee
on Commerce. Under this closed rule, no amendments can be offered on
the House floor.
In 1990, Congress passed the Ryan White Comprehensive AIDS Resources
Emergency Act. It was known as the Ryan White CARE Act. This law
created programs to help Americans with AIDS and HIV, the virus that
causes AIDS, and to slow the spread of HIV.
These programs expired October 1. The bill we are considering will
reauthorize and strengthen the Ryan White CARE Act programs by
expanding access, improving quality, and providing additional services.
Some of the changes will help target health care services to the people
who need it the most but who can least afford it.
Women, children, infants and youth with HIV will especially benefit
from this bill as will low-income individuals and families. AIDS
possesses one of the greatest health challenges of our generation, and
there is no way to avoid its tragic grip. However, an active role by
the Federal government can, in my opinion, ease the tragedy by reducing
the number of new HIV cases and by supporting victims and their
families.
The Ryan White CARE Act has worked. The Federal funds spent under
this law have saved lives and reduced suffering. These are dollars that
could not have been better spent. For example, between 1994 and 1999,
pediatric AIDS cases declined by nearly 80 percent largely because of
these programs funded by the Federal Government under this Act.
I would like to point out to my colleague that this act offers a
framework that we should apply to tackling other tragic diseases, such
as childhood cancer. I hope that Congress will learn from the success
of this act.
This legislation extending the Ryan White CARE Act represents our
best response to dealing with AIDS and its consequences. The bill we
are considering is a compromise between the previously passed House and
Senate versions. The Senate version passed by unanimous consent. The
House version passed by a voice vote under suspension of the rules. I
am proud to be a cosponsor of this House version.
Because there is general agreement between the House and Senate,
there is no need for a formal conference committee.
I urge my colleagues to vote for the rule and for the bill.
Mr. Speaker, I reserve the balance of my time.
Mr. GOSS. Mr. Speaker, I advise that we have no speakers lined up,
and I would be prepared to yield back if the gentleman from Ohio (Mr.
Hall) has no speakers.
Mr. HALL of Ohio. Mr. Speaker, I yield back the balance of my time.
Mr. GOSS. Mr. Speaker, I yield back the balance of my time, and I
move the previous question on the resolution.
The previous question was ordered.
The resolution was agreed to.
A motion to reconsider was laid on the table.
Mr. COBURN. Mr. Speaker, pursuant to House Resolution 611, I call up
the Senate bill (
S. 2311) 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 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, and ask for its immediate
consideration.
The Clerk read the title of the Senate bill.
The SPEAKER pro tempore (Mr. Simpson). Pursuant to House Resolution
611, the Senate bill is considered read for amendment.
The text of
S. 2311 is as follows:
S. 2311
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.
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.
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.
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``(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.
``(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.
``(5) Coordination with other federal grantees.--The
council shall coordinate with Federal grantees providing HIV-
related services within the eligible area.
``(6) Community participation.--The council shall establish
methods for obtaining input on community needs and priorities
which may include public meetings, conducting focus groups,
and convening ad-hoc panels.
``(e) Process for Establishing Allocation Priorities.--
``(1) In general.--Not later than 24 months after the date
of enactment of the Ryan White CARE Act Amendments of 2000,
the Secretary shall--
``(A) consult with eligible metropolitan areas, affected
communities, experts, and other appropriate individuals and
entities, to develop epidemiologic measures for establishing
the number of individuals living with HIV disease who are not
receiving HIV-related health services; and
``(B) provide advice and technical assistance to planning
councils with respect to the process for establishing
priorities for the allocation of funds under subsection
(d)(1).
``(2) Exception.--Grantees under subsection (d)(1)(A) shall
not be required to establish priorities for individuals not
in care until epidemiologic measures are developed under
paragraph (1).''.
SEC. 102. QUALITY MANAGEMENT.
(a) Funds Available for Quality Management.--Section 2604
(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 medical 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 to develop
strategies for improvements in the access to and quality of
medical services.
``(2) Use of funds.--From amounts received under a grant
awarded under this part, the chief elected official of an
eligible area may use, for activities associated with its
quality management program, not more than the lesser of--
``(A) 5 percent of amounts received under the grant; or
``(B) $3,000,000.''.
(b) Quality Management Required for Eligibility for
Grants.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended--
(1) by redesignating paragraphs (3) through (6) as
paragraphs (5) through (8), respectively; and
(2) by inserting after paragraph (2) the following:
``(3) that the chief elected official of the eligible area
will satisfy all requirements under section 2604(c);''.
SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE
RELATIONSHIPS.
(a) Use of Amounts.--Section 2604(e)(1) (42 U.S.C. 300ff-
14(d)(1)) (as so redesignated by section 102(a)) is amended
by inserting ``and the State Children's Health Insurance
Program under title XXI of such Act'' after ``Social Security
Act''.
(b) Applications.--Section 2605(a) (42 U.S.C. 300ff-15(a))
is amended by inserting after paragraph (3), as added by
section 102(b), the following:
``(4) that funded entities within the eligible area that
receive funds under a grant under section 2601(a) shall
maintain appropriate relationships with entities in the area
served that constitute key points of access to the health
care system for individuals with HIV disease (including
emergency rooms, substance abuse treatment programs,
detoxification centers, adult and juvenile detention
facilities, sexually transmitted disease clinics, HIV
counseling and testing sites, and homeless shelters) and
other entities under section 2652(a) for the purpose of
facilitating early intervention for individuals newly
diagnosed with HIV disease and individuals knowledgeable of
their status but not in care;''.
SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
RELATED.
(a) In General.--Section 2604(b)(1) (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 health services.--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
services.--Inpatient case management''; and
(4) by inserting after subparagraph (A) the following:
``(B) Outpatient support services.--Outpatient and
ambulatory support services (including case management), to
the extent that such services facilitate, enhance, support,
or sustain the delivery, continuity, or benefits of health
services for individuals and families with HIV disease.''.
(b) Conforming Amendment to Application Requirements.--
Section 2605(a) (42 U.S.C. 300ff-15(a)), as amended by
section 102(b), is further amended--
(1) in paragraph (6) (as so redesignated), by striking
``and'' at the end thereof;
(2) in paragraph (7) (as so redesignated), by striking the
period and inserting ``; and''; and
(3) by adding at the end the following:
``(8) that the eligible area has procedures in place to
ensure that services provided with funds received under this
part meet the criteria specified in section 2604(b)(1).''.
SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.
(a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-
14(b)(1)), as amended by section 104(a), is further amended
by adding at the end the following:
``(D) Early intervention services.--Early intervention
services as described in section 2651(b)(2), with follow-
through referral, provided for the purpose of facilitating
the access of individuals receiving the services to HIV-
related health services, but only if the entity providing
such services--
``(i)(I) is receiving funds under subparagraph (A) or (C);
or
``(II) is an entity constituting a point of access to
services, as described in paragraph (2)(C), that maintains a
relationship with an entity described in subclause (I) and
that is serving individuals at elevated risk of HIV disease;
and
``(ii) demonstrates to the satisfaction of the chief
elected official that no other Federal, State, or local funds
are available for the early intervention services the entity
will provide with funds received under this paragraph.''.
(b) Conforming Amendments to Application Requirements.--
Section 2605(a)(1) (42 U.S.C. 300ff-15(a)(1)) is amended--
(1) in subparagraph (A), by striking ``services to
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''; and
(2) in subparagraph (B), by striking ``services for
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''.
SEC. 106. REPLACEMENT OF SPECIFIED FISCAL YEARS REGARDING THE
SUNSET ON EXPEDITED DISTRIBUTION REQUIREMENTS.
Section 2603(a)(2) (42 U.S.C. 300ff-13(a)(2)) is amended by
striking ``for each of the fiscal years 1996 through 2000''
and inserting ``for a fiscal year''.
SEC. 107. HOLD HARMLESS PROVISION.
Section 2603(a)(4) (42 U.S.C. 300ff-13(a)(4)) is amended to
read as follows:
``(4) Limitations.--
``(A) In general.--With respect to each of fiscal years
2001 through 2005, the Secretary shall ensure that the amount
of a grant made to an eligible area under paragraph (2) for
such a fiscal year is not less than an amount equal to 98
percent of the amount the eligible area received for the
fiscal year preceding the year for which the determination is
being made.
``(B) Application of provision.--Subparagraph (A) shall
only apply with respect to those eligible areas receiving a
grant under paragraph (2) for fiscal year 2000 in an amount
that has been adjusted in accordance with paragraph (4) of
this subsection (as in effect on the day before the date of
enactment of the Ryan White CARE Act Amendments of 2000).''.
SEC. 108. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.
Section 2604(b)(3) (42 U.S.C. 300ff-14(b)(3)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``established priorities''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.
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Subtitle B--Amendments to Part B (Care Grant Program)
SEC. 121. STATE REQUIREMENTS CONCERNING IDENTIFICATION OF
NEED AND ALLOCATION OF RESOURCES.
(a) General Use of Grants.--Section 2612 (42 U.S.C. 300ff-
22) is amended--
(1) by striking ``A State'' and inserting ``(a) In
General.--A State''; and
(2) in the matter following paragraph (5)--
(A) by striking ``paragraph (2)'' and inserting
``subsection (a)(2) and section 2613'';
(b) Application.--Section 2617(b) (42 U.S.C. 300ff-27(b))
is amended--
(1) in paragraph (1)(C)--
(A) by striking clause (i) and inserting the following:
``(i) the size and demographic characteristics of the
population with HIV disease to be served, except that by not
later than October 1, 2002, the State shall take into account
the needs of individuals not in care, based on epidemiologic
measures developed by the Secretary in consultation with the
State, affected communities, experts, and other appropriate
individuals (such State shall not be required to establish
priorities for individuals not in care until such
epidemiologic measures are developed);'';
(B) in clause (iii), by striking ``and'' at the end; and
(C) by adding at the end the following:
``(v) the availability of other governmental and non-
governmental resources;
``(vi) the capacity development needs resulting in gaps in
the provision of HIV services in historically underserved
low-income and rural low-income communities; and
``(vii) the efficiency of the administrative mechanism in
rapidly allocating funds to the areas of greatest need within
the State;''; and
(2) in paragraph (2)--
(A) in subparagraph (B), by striking ``and'' at the end;
(B) by redesignating subparagraph (C) as subparagraph (F);
and
(C) by inserting after subparagraph (B), the following:
``(C) an assurance that capacity development needs
resulting from gaps in the provision of services in
underserved low-income and rural low-income communities will
be addressed; and
``(D) with respect to fiscal year 2003 and subsequent
fiscal years, assurances that, in the planning and allocation
of resources, the State, through systems of HIV-related
health services provided under paragraphs (1), (2), and (3)
of section 2612(a), will make appropriate provision for the
HIV-related health and support service needs of individuals
who have been diagnosed with HIV disease but who are not
currently receiving such services, based on the epidemiologic
measures developed under paragraph (1)(C)(i);''.
SEC. 122. QUALITY MANAGEMENT.
(a) State Requirement for Quality Management.--Section
2617(b)(4) (42 U.S.C. 300ff-27(b)(4)) is amended--
(1) by striking subparagraph (C) and inserting the
following:
``(C) the State will provide for--
``(i) the establishment of a quality management program to
assess the extent to which medical 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 infections and to develop
strategies for improvements in the access to and quality of
medical services; and
``(ii) a periodic review (such as through an independent
peer review) to assess the quality and appropriateness of
HIV-related health and support services provided by entities
that receive funds from the State under this part;'';
(2) by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively;
(3) by inserting after subparagraph (D), the following:
``(E) an assurance that the State, through systems of HIV-
related health services provided under paragraphs (1), (2),
and (3) of section 2612(a), has considered strategies for
working with providers to make optimal use of financial
assistance under the State medicaid plan under title XIX of
the Social Security Act, the State Children's Health
Insurance Program under title XXI of such Act, and other
Federal grantees that provide HIV-related services, to
maximize access to quality HIV-related health and support
services;
(4) in subparagraph (F), as so redesignated, by striking
``and'' at the end; and
(5) in subparagraph (G), as so redesignated, by striking
the period and inserting ``; and''.
(b) Availability of Funds for Quality Management.--
(1) Availability of grant funds for planning and
evaluation.--Section 2618(c)(3) (42 U.S.C. 300ff-28(c)(3)) is
amended by inserting before the period ``, including not more
than $3,000,000 for all activities associated with its
quality management program''.
(2) Exception to combined ceiling on planning and
administration funds for states with small grants.--Paragraph
(6) of section 2618(c) (42 U.S.C. 300ff-28(c)(6)) is amended
to read as follows:
``(6) Exception for quality management.--Notwithstanding
paragraph (5), a State whose grant under this part for a
fiscal year does not exceed $1,500,000 may use not to exceed
20 percent of the amount of the grant for the purposes
described in paragraphs (3) and (4) if--
``(A) that portion of such amount in excess of 15 percent
of the grant is used for its quality management program; and
``(B) the State submits and the Secretary approves a plan
(in such form and containing such information as the
Secretary may prescribe) for use of funds for its quality
management program.''.
SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE
RELATIONSHIPS.
Section 2617(b)(4) (42 U.S.C. 300ff-27(b)(4)), as amended
by section 122(a), is further amended by adding at the end
the following:
``(H) that funded entities maintain appropriate
relationships with entities in the area served that
constitute key points of access to the health care system for
individuals with HIV disease (including emergency rooms,
substance abuse treatment programs, detoxification centers,
adult and juvenile detention facilities, sexually transmitted
disease clinics, HIV counseling and testing sites, and
homeless shelters), and other entities under section 2652(a),
for the purpose of facilitating early intervention for
individuals newly diagnosed with HIV disease and individuals
knowledgeable of their status but not in care.''.
SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
RELATED.
(a) Technical Amendment.--Section 3(c)(2)(A)(iii) of the
Ryan White CARE Act Amendments of 1996 (Public Law 104-146)
is amended by inserting ``before paragraph (2) as so
redesignated'' after ``inserting''.
(b) Services.--Section 2612(a)(1) (42 U.S.C. 300ff-
22(a)(1)), as so designated by section 121(a), is amended by
striking ``for individuals with HIV disease'' and inserting
``, subject to the conditions and limitations that apply
under such section''.
(c) Conforming Amendment to State Application
Requirement.--Section 2617(b)(2) (42 U.S.C. 300ff-27(b)(2)),
as amended by section 121(b), is further amended by adding at
the end the following:
``(F) an assurance that the State has procedures in place
to ensure that services provided with funds received under
this section meet the criteria specified in section
2604(b)(1)(B); and''.
SEC. 125. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.
Section 2612(a) (42 U.S.C. 300ff-22(a)), as amended by
section 121, is further amended by adding at the end the
following:
``(6) Early intervention services.--The State, through
systems of HIV-related health services provided under
paragraphs (1), (2), and (3) of section 2612(a), may provide
early intervention services, as described in section
2651(b)(2), with follow-up referral, provided for the purpose
of facilitating the access of individuals receiving the
services to HIV-related health services, but only if the
entity providing such services--
``(A)(i) is receiving funds under section 2612(a)(1); or
``(ii) is an entity constituting a point of access to
services, as described in section 2617(b)(4), that maintains
a referral relationship with an entity described in clause
(i) and that is serving individuals at elevated risk of HIV
disease; and
``(B) demonstrates to the State's satisfaction that no
other Federal, State, or local funds are available for the
early intervention services the entity will provide with
funds received under this paragraph.''.
SEC. 126. AUTHORIZATION OF APPROPRIATIONS FOR HIV-RELATED
SERVICES FOR WOMEN AND CHILDREN.
Section 2625(c)(2) (42 U.S.C. 300ff-33(c)(2)) is amended by
striking ``fiscal years 1996 through 2000'' and inserting
``fiscal years 2001 through 2005''.
SEC. 127. REPEAL OF REQUIREMENT FOR COMPLETED INSTITUTE OF
MEDICINE REPORT.
Section 2628 (42 U.S.C. 300ff-36) is repealed.
SEC. 128. SUPPLEMENT 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 by adding
at the end the following:
``SEC. 2622. SUPPLEMENTAL GRANTS.
``(a) In General.--The Secretary shall award supplemental
grants to States determined to be eligible under subsection
(b) to enable such States to provide comprehensive services
of the type described in section 2612(a) to supplement the
services otherwise provided by the State under a grant under
this subpart in areas within the State that are not eligible
to receive grants under part A.
``(b) Eligibility.--To be eligible to receive a
supplemental grant under subsection (a) a State shall--
``(1) be eligible to receive a grant under this subpart;
and
``(2) demonstrate to the Secretary that there is severe
need (as defined for purposes of section 2603(b)(2)(A) for
supplemental financial assistance in areas in the State that
are not served through grants under part A.
``(c) Application.--A State that desires a grant under this
section shall, as part of the State application submitted
under section 2617, submit a detailed description of the
manner in which the State will use amounts received under the
grant and of the severity of need. Such description shall
include--
``(1) a report concerning the dissemination of supplemental
funds under this section and the plan for the utilization of
such funds;
``(2) a demonstration of the existing commitment of local
resources, both financial and in-kind;
``(3) a demonstration that the State will maintain HIV-
related activities at a level
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that is equal to not less than the level of such activities
in the State for the 1-year period preceding the fiscal year
for which the State is applying to receive a grant under this
part;
``(4) a demonstration of the ability of the State to
utilize such supplemental financial resources in a manner
that is immediately responsive and cost effective;
``(5) a demonstration that the resources will be allocated
in accordance with the local demographic incidence of AIDS
including appropriate allocations for services for infants,
children, women, and families with HIV disease;
``(6) a demonstration of the inclusiveness of the planning
process, with particular emphasis on affected communities and
individuals with HIV disease; and
``(7) a demonstration of the manner in which the proposed
services are consistent with local needs assessments and the
statewide coordinated statement of need.
``(d) Amount Reserved for Emerging Communities.--
``(1) In general.--For awarding grants under this section
for each fiscal year, the Secretary shall reserve the greater
of 50 percent of the amount to be utilized under subsection
(e) for such fiscal year or $5,000,000, to be provided to
States that contain emerging communities for use in such
communities.
``(2) Definition.--In paragraph (1), the term `emerging
community' means a metropolitan area--
``(A) that is not eligible for a grant under part A; and
``(B) for which there has been reported to the Director of
the Centers for Disease Control and Prevention a cumulative
total of between 1000 and 1999 cases of acquired immune
deficiency syndrome for the most recent period of 5 calendar
years for which such data are available.
``(e) Appropriations.--With respect to each fiscal year
beginning with fiscal year 2001, the Secretary, to carry out
this section, shall utilize 50 percent of the amount
appropriated under section 2677 to carry out part B for such
fiscal year that is in excess of the amount appropriated to
carry out such part in fiscal year preceding the fiscal year
involved.
SEC. 129. USE OF TREATMENT FUNDS.
(a) State Duties.--Section 2616(c) (42 U.S.C. 300ff-26(c))
is amended--
(1) in the matter preceding paragraph (1), by striking
``shall--'' and inserting ``shall use funds made available
under this section to--'';
(2) by redesignating paragraphs (1) through (5) as
subparagraphs (A) through (E), respectively and realigning
the margins of such subparagraphs appropriately;
(3) in subparagraph (D) (as so redesignated), by striking
``and'' at the end;
(4) in subparagraph (E) (as so redesignated), by striking
the period and ``; and''; and
(5) by adding at the end the following:
``(F) encourage, support, and enhance adherence to and
compliance with treatment regimens, including related medical
monitoring.'';
(6) by striking ``In carrying'' and inserting the
following:
``(1) In general.--In carrying''; and
(7) by adding at the end the following:
``(2) Limitations.--
``(A) In general.--No State shall use funds under paragraph
(1)(F) unless the limitations on access to HIV/AIDS
therapeutic regimens as defined in subsection (e)(2) are
eliminated.
``(B) Amount of funding.--No State shall use in excess of
10 percent of the amount set-aside for use under this section
in any fiscal year to carry out activities under paragraph
(1)(F) unless the State demonstrates to the Secretary that
such additional services are essential and in no way diminish
access to therapeutics.''.
(b) Supplement Grants.--Section 2616 (42 U.S.C. 300ff-
26(c)) is amended by adding at the end the following:
``(e) Supplemental Grants for the Provision of
Treatments.--
``(1) In general.--From amounts made available under
paragraph (5), the Secretary shall award supplemental grants
to States determined to be eligible under paragraph (2) to
enable such States to provide access to therapeutics to treat
HIV disease as provided by the State under subsection
(c)(1)(B) for individuals at or below 200 percent of the
Federal poverty line.
``(2) Criteria.--The Secretary shall develop criteria for
the awarding of grants under paragraph (1) to States that
demonstrate a severe need. In determining the criteria for
demonstrating State severity of need (as defined for purposes
of section 2603(b)(2)(A)), the Secretary shall consider
whether limitation to access exist such that--
``(A) the State programs under this section are unable to
provide HIV/AIDS therapeutic regimens to all eligible
individuals living at or below 200 percent of the Federal
poverty line; and
``(B) the State programs under this section are unable to
provide to all eligible individuals appropriate HIV/AIDS
therapeutic regimens as recommended in the most recent
Federal treatment guidelines.
``(3) State requirement.--The Secretary may not make a
grant to a State under this subsection unless the State
agrees that--
``(A) the State will make available (directly or through
donations from public or private entities) non-Federal
contributions toward the activities to be carried out under
the grant in an amount equal to $1 for each $4 of Federal
funds provided in the grant; and
``(B) the State will not impose eligibility requirements
for services or scope of benefits limitations under
subsection (a) that are more restrictive than such
requirements in effect as of January 1, 2000.
``(4) Use and coordination.--Amounts made available under a
grant under this subsection shall only be used by the State
to provide AIDS/HIV-related medications. The State shall
coordinate the use of such amounts with the amounts otherwise
provided under this section in order to maximize drug
coverage.
``(5) Funding.--
``(A) Reservation of amount.--The Secretary may reserve not
to exceed 4 percent, but not less than 2 percent, of any
amount referred to in section 2618(b)(2)(H) that is
appropriated for a fiscal year, to carry out this subsection.
``(B) Minimum amount.--In providing grants under this
subsection, the Secretary shall ensure that the amount of a
grant to a State under this part is not less than the amount
the State received under this part in the previous fiscal
year, as a result of grants provided under this
subsection.''.
(c) Supplement and not Supplant.--Section 2616 (42 U.S.C.
300ff-26(c)), as amended by subsection (b), is further
amended by adding at the end the following:
``(f) Supplement not Supplant.--Notwithstanding any other
provision of law, amounts made available under this section
shall be used to supplement and not supplant other funding
available to provide treatments of the type that may be
provided under this section.''.
SEC. 130. INCREASE IN MINIMUM ALLOTMENT.
(a) In General.--Section 2618(b)(1)(A)(i) (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) Technical Amendment.--Section 2618(b)(3)(B) (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''.
SEC. 131. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.
Section 2611(b) (42 U.S.C. 300ff-21(b)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``State shall use''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.
Subtitle C--Amendments to Part C (Early Intervention Services)
SEC. 141. AMENDMENT OF HEADING; REPEAL OF FORMULA GRANT
PROGRAM.
(a) Amendment of Heading.--The heading of part C of title
XXVI is amended to read as follows:
``Part C--Early Intervention and Primary Care Services''.
(b) Repeal.--Part C of title XXVI (42 U.S.C. 300ff-41 et
seq.) is amended--
(1) by repealing subpart I; and
(2) by redesignating subparts II and III as subparts I and
II.
(c) Conforming Amendments.--
(1) Information regarding receipt of services.--Section
2661(a) (42 U.S.C. 300ff-61(a)) is amended by striking
``unless--'' and all that follows through ``(2) in the case
of'' and inserting ``unless, in the case of''.
(2) Additional agreements.--Section 2664 (42 U.S.C. 300ff-
64) is amended--
(A) in subsection (e)(5), by striking ``2642(b) or'';
(B) in subsection (f)(2), by striking ``2642(b) or''; and
(C) by striking subsection (h).
SEC. 142. PLANNING AND DEVELOPMENT GRANTS.
(a) Allowing Planning and Development Grant To Expand
Ability To Provide Primary Care Services.--Section 2654(c)
(42 U.S.C. 300ff-54(c)) is amended--
(1) in paragraph (1), to read as follows:
``(1) In general.--The Secretary may provide planning and
development grants to public and nonprofit private entities
for the purpose of--
``(A) enabling such entities to provide HIV early
intervention services; or
``(B) assisting such entities to expand the capacity,
preparedness, and expertise to deliver primary care services
to individuals with HIV disease in underserved low-income
communities on the condition that the funds are not used to
purchase or improve land or to purchase, construct, or
permanently improve (other than minor remodeling) any
building or other facility.''; and
(2) in paragraphs (2) and (3) by striking ``paragraph (1)''
each place that such appears and inserting ``paragraph
(1)(A)''.
(b) Amount; Duration.--Section 2654(c) (42 U.S.C. 300ff-
54(c)), as amended by subsection (a), 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.
[[Page
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``(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) (42 U.S.C.
300ff-54(c)(5)), as so redesignated by subsection (b), is
amended by striking ``1 percent'' and inserting ``5
percent''.
SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CATEGORICAL
GRANTS.
Section 2655 (42 U.S.C. 300ff-55) is amended by striking
``1996'' and all that follows through ``2000'' and inserting
``2001 through 2005''.
SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY MANAGEMENT
PROGRAM.
Section 2664(g) (42 U.S.C. 300ff-64(g)) is amended--
(1) in paragraph (3), to read as follows:
``(3) the applicant will not expend more than 10 percent of
the grant for costs of administrative activities with respect
to the grant;'';
(2) in paragraph (4), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(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.''.
SEC. 145. PREFERENCE FOR CERTAIN AREAS.
Section 2651 (42 U.S.C. 300ff-51) is amended by adding at
the end the following:
``(d) Preference in Awarding Grants.--Beginning in fiscal
year 2001, in awarding new grants under this section, the
Secretary shall give preference to applicants that will use
amounts received under the grant to serve areas that are
otherwise not eligible to receive assistance under part A.''.
Subtitle D--Amendments to Part D (General Provisions)
SEC. 151. RESEARCH INVOLVING WOMEN, INFANTS, CHILDREN, AND
YOUTH.
(a) Elimination of Requirement To Enroll Significant
Numbers of Women and Children.--Section 2671(b) (42 U.S.C.
300ff-71(b)) is amended--
(1) in paragraph (1), by striking subparagraphs (C) and
(D); and
(2) by striking paragraphs (3) and (4).
(b) Information and Education.--Section 2671(d) (42 U.S.C.
300ff-71(d)) is amended by adding at the end the following:
``(4) The applicant will provide individuals with
information and education on opportunities to participate in
HIV/AIDS-related clinical research.''.
(c) Quality Management; Administrative Expenses Ceiling.--
Section 2671(f) (42 U.S.C. 300ff-71(f)) is amended--
(1) by striking the subsection heading and designation and
inserting the following:
``(f) Administration.--
``(1) Application.--''; and
(2) by adding at the end the following:
``(2) Quality management program.--A grantee under this
section shall implement a quality management program.''.
(d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g))
is amended by adding at the end the following: ``The
Secretary acting through the Director of NIH, shall examine
the distribution and availability of ongoing and appropriate
HIV/AIDS-related research projects to existing sites under
this section for purposes of enhancing and expanding
voluntary access to HIV-related research, especially within
communities that are not reasonably served by such
projects.''.
(e) Authorization of Appropriations.--Section 2671(j) (42
U.S.C. 300ff-71(j)) is amended by striking ``fiscal years
1996 through 2000'' and inserting ``fiscal years 2001 through
2005''.
SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.
Section 2671 (42 U.S.C. 300ff-71) is amended--
(1) by redesignating subsections (i) and (j), as
subsections (j) and (k), respectively; and
(2) by inserting after subsection (h), the following:
``(i) Limitation on Administrative Expenses.--
``(1) Determination by secretary.--Not later than 12 months
after the date of enactment of the Ryan White Care Act
Amendments of 2000, the Secretary, in consultation with
grantees under this part, shall conduct a review of the
administrative, program support, and direct service-related
activities that are carried out under this part to ensure
that eligible individuals have access to quality, HIV-related
health and support services and research opportunities under
this part, and to support the provision of such services.
``(2) Requirements.--
``(A) In general.--Not later than 180 days after the
expiration of the 12-month period referred to in paragraph
(1) the Secretary, in consultation with grantees under this
part, shall determine the relationship between the costs of
the activities referred to in paragraph (1) and the access of
eligible individuals to the services and research
opportunities described in such paragraph.
``(B) Limitation.--After a final determination under
subparagraph (A), the Secretary may not make a grant under
this part unless the grantee complies with such requirements
as may be included in such determination.''.
SEC. 153. EVALUATIONS AND REPORTS.
Section 2674(c) (42 U.S.C. 399ff-74(c)) is amended by
striking ``1991 through 1995'' and inserting ``2001 through
2005''.
SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR GRANTS UNDER
PARTS A AND B.
Section 2677 (42 U.S.C. 300ff-77) is amended to read as
follows:
``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated--
``(1) such sums as may be necessary to carry out part A for
each of the fiscal years 2001 through 2005; and
``(2) such sums as may be necessary to carry out part B for
each of the fiscal years 2001 through 2005.''.
Subtitle E--Amendments to Part F (Demonstration and Training)
SEC. 161. AUTHORIZATION OF APPROPRIATIONS.
(a) Schools; Centers.--Section 2692(c)(1) (42 U.S.C. 300ff-
111(c)(1)) is amended by striking ``fiscal years 1996 through
2000'' and inserting ``fiscal years 2001 through 2005''.
(b) Dental Schools.--Section 2692(c)(2) (42 U.S.C. 300ff-
111(c)(2)) is amended by striking ``fiscal years 1996 through
2000'' and inserting ``fiscal years 2001 through 2005''.
TITLE II--MISCELLANEOUS PROVISIONS
SEC. 201. INSTITUTE OF MEDICINE STUDY.
(a) In General.--Not later than 120 days after the date of
enactment of this Act, the Secretary of Health and Human
Services shall enter into a contract with the Institute of
Medicine for the conduct of 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.
(b) Requirements.--
(1) Completion.--The study under subsection (a) shall be
completed not later than 21 months after the date on which
the contract referred to in such subsection is entered into.
(2) Issues to be considered.--The study conducted under
subsection (a) shall consider--
(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;
(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;
and
(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) Report.--Not later than 90 days after the date on which
the study is completed under subsection (a), the Secretary of
Health and Human Services shall prepare and submit to the
appropriate committees of Congress a report describing the
manner in which the conclusions and recommendations of the
Institute of Medicine can be addressed and implemented.
The SPEAKER pro tempore. Pursuant to House Resolution 611, the
amendment in the nature of a substitute printed in the Congressional
Record and numbered 1 is considered adopted.
The text of
S. 2311, as amended pursuant to House Resolution 611, is
as follows:
Strike all after the enacting clause and insert the
following:
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. 122. Application.
TITLE II--CARE GRANT PROGRAM
Subtitle A--General Grant Provisions
Sec. 201. Priority for women, infants, and children.
Sec. 202. Use of grants.
Sec. 203. Grants to establish HIV care consortia.
Sec. 204. Provision of treatments.
Sec. 205. State application.
Sec. 206. Distribution of funds.
Sec. 207. Supplemental grants for certain States.
Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission
of HIV
Sec. 211. Repeals.
Sec. 212. Grants.
Sec. 213. Study by Institute of Medicine.
[[Page
H8823]]
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. 413. Coordination.
Sec. 414. Plan regarding release of prisoners with HIV disease.
Sec. 415. Audits.
Sec. 416. Administrative simplification.
Sec. 417. Authorization of appropriations for parts A and B.
TITLE V--GENERAL PROVISIONS
Sec. 501. Studies by Institute of Medicine.
Sec. 502. Development of rapid HIV test.
Sec. 503. Technical corrections.
TITLE VI--EFFECTIVE DATE
Sec. 601. Effective date.
TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES
Subtitle A--HIV Health Services Planning Councils
SEC. 101. MEMBERSHIP OF COUNCILS.
(a) In General.--Section 2602(b) of the Public Health
Service Act (42 U.S.C. 300ff-12(b)) is amended--
(1) in paragraph (1), by striking ``demographics of the
epidemic in the eligible area involved,'' and inserting
``demographics of the population of individuals with HIV
disease in the eligible area involved,''; and
(2) in paragraph (2)--
(A) in subparagraph (C), by inserting before the semicolon
the following: ``, including providers of housing and
homeless services'';
(B) in subparagraph (G), by striking ``or AIDS'';
(C) in subparagraph (K), by striking ``and'' at the end;
(D) in subparagraph (L), by striking the period and
inserting the following: ``, including but not limited to
providers of HIV prevention services; and''; and
(E) by adding at the end the following subparagraph:
``(M) representatives of individuals who formerly were
Federal, State, or local prisoners, were released from the
custody of the penal system during the preceding 3 years, and
had HIV disease as of the date on which the individuals were
so released.''.
(b) Conflicts of Interests.--Section 2602(b)(5) of the
Public Health Service Act (42 U.S.C. 300ff-12(b)(5)) is
amended by adding at the end the following subparagraph:
``(C) Composition of council.--The following applies
regarding the membership of a planning council under
paragraph (1):
``(i) Not less than 33 percent of the council shall be
individuals who are receiving HIV-related services pursuant
to a grant under section 2601(a), are not officers,
employees, or consultants to any entity that receives amounts
from such a grant, and do not represent any such entity, and
reflect the demographics of the population of individuals
with HIV disease as determined under paragraph (4)(A). For
purposes of the preceding sentence, an individual shall be
considered to be receiving such services if the individual is
a parent of, or a caregiver for, a minor child who is
receiving such services.
``(ii) With respect to membership on the planning council,
clause (i) may not be construed as having any effect on
entities that receive funds from grants under any of parts B
through F but do not receive funds from grants under section
2601(a), on officers or employees of such entities, or on
individuals who represent such entities.''.
SEC. 102. DUTIES OF COUNCILS.
(a) In General.--Section 2602(b)(4) of the Public Health
Service Act (42 U.S.C. 300ff-12(b)(4)) is amended--
(1) by redesignating subparagraphs (A) through (E) as
subparagraphs (C) through (G), respectively;
(2) by inserting before subparagraph (C) (as so
redesignated) the following subparagraphs:
``(A) determine the size and demographics of the population
of individuals with HIV disease;
``(B) determine the needs of such population, with
particular attention to--
``(i) individuals with HIV disease who know their HIV
status and are not receiving HIV-related services; and
``(ii) disparities in access and services among affected
subpopulations and historically underserved communities;'';
(3) in subparagraph (C) (as so redesignated), by striking
clauses (i) through (iv) and inserting the following:
``(i) size and demographics of the population of
individuals with HIV disease (as determined under
subparagraph (A)) and the needs of such population (as
determined under subparagraph (B));
``(ii) demonstrated (or probable) cost effectiveness and
outcome
Amendments:
Cosponsors:
RYAN WHITE CARE ACT AMENDMENTS OF 2000
Sponsor:
Summary:
All articles in House section
RYAN WHITE CARE ACT AMENDMENTS OF 2000
(House of Representatives - October 05, 2000)
Text of this article available as:
TXT
PDF
[Pages
H8817-H8847]
RYAN WHITE CARE ACT AMENDMENTS OF 2000
Mr. GOSS. Mr. Speaker, by direction of the Committee on Rules, I call
up House Resolution 611 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 611
Resolved, That upon the adoption of this resolution it
shall be in order without intervention of any point of order
to consider in the House the bill (
S. 2311) 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 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. The bill
shall be considered as read for amendment. The amendment in
the nature of a substitute printed in the Congressional
Record and numbered 1 pursuant to clause 8 of rule XVIII
shall be considered as adopted. The previous question shall
be considered as ordered on the bill, as amended, to final
passage without intervening motion except: (1) one hour of
debate on the bill, as amended, equally divided and
controlled by the chairman and ranking minority member of the
Committee on Commerce; and (2) one motion to recommit with or
without instructions.
The SPEAKER pro tempore. The gentleman from Florida (Mr. Goss) is
recognized for 1 hour.
Mr. GOSS. Mr. Speaker, for purposes of debate only, I am pleased to
yield the customary 30 minutes to my friend, the distinguished
gentleman from Ohio (Mr. Hall), pending which I yield myself such time
as I may consume. During consideration of this resolution, all time
yielded is for purposes of debate only.
Mr. Speaker, this is a fair and straightforward closed rule for a
very important piece of legislation. The rule waives all points of
order against consideration of the bill and provides that the amendment
in the nature of a substitute printed in the Congressional Record shall
be considered as adopted.
{time} 1030
This is largely a noncontroversial bill. As no members of the
minority testified differently last night at the Committee on Rules,
this rule should receive unanimous support, and I urge support.
This reauthorization of the Ryan White CARE Act recognizes the
changing demographics of the AIDS epidemic in our country in a way that
truly honors the memory of the courageous young boy for which the bill
was originally named. Today, there are between 800,000 and 900,000
persons living with HIV in the United States of America with some
40,000 new infections annually. This conference report seeks to shift
resources to the most needy areas while preserving the best features of
the current programs.
The gentleman from Virginia (Chairman Bliley) should be commended for
his leadership and attention to this critical public health issue which
is of concern to every Member of this body. I am hopeful that the
progress made on this authorization will spur funding for another
essential program for individuals afflicted with the HIV virus.
As my colleagues remember and well know, this House led the way and
adopted the Ricky Ray Authorization Act in the last Congress. It
authorized $750 million for compassion assistance and recognition to
hemophiliacs who contracted AIDS through no fault of their own because
of contaminated blood products in the 1980s.
Now, the first installment was provided last year, and this year the
gentleman from Florida (Chairman Young) of the Committee on
Appropriations should be commended for exceeding the President's
request in the House version of the Fiscal Year 2001 Labor-HHS
appropriation bill for the next installment.
As negotiations continue and we near the end of this Congress, I am
hopeful that the White House will become fully engaged on the Ricky Ray
funding problem and work with leadership and Congress to provide full
funding for these victims as soon as humanly possible. The need is
great and the time is now.
I am confident that, if the White House shows true leadership and
demonstrates that this problem is really a top priority for them, we
will be able to move further toward full funding this year. Obviously
we cannot undo the tragic events of the 1980s, but we can work to
provide assistance to these individuals before it is any later.
Mr. Speaker, this rule should engender little debate. It is a fair
rule for a good bill. I urge its adoption.
Mr. Speaker, I reserve the balance of my time.
Mr. HALL of Ohio. Mr. Speaker, I want to thank the gentleman from
[[Page
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Florida (Mr. Goss) for yielding me the time.
Mr. Speaker, this is a closed rule. It will allow for the
consideration of
S. 2311, which is called the Ryan White CARE Act
Amendments of 2000. As the gentleman from Florida has described, this
rule provides for 1 hour of general debate to be equally divided and
controlled by the chairman and ranking minority member of the Committee
on Commerce. Under this closed rule, no amendments can be offered on
the House floor.
In 1990, Congress passed the Ryan White Comprehensive AIDS Resources
Emergency Act. It was known as the Ryan White CARE Act. This law
created programs to help Americans with AIDS and HIV, the virus that
causes AIDS, and to slow the spread of HIV.
These programs expired October 1. The bill we are considering will
reauthorize and strengthen the Ryan White CARE Act programs by
expanding access, improving quality, and providing additional services.
Some of the changes will help target health care services to the people
who need it the most but who can least afford it.
Women, children, infants and youth with HIV will especially benefit
from this bill as will low-income individuals and families. AIDS
possesses one of the greatest health challenges of our generation, and
there is no way to avoid its tragic grip. However, an active role by
the Federal government can, in my opinion, ease the tragedy by reducing
the number of new HIV cases and by supporting victims and their
families.
The Ryan White CARE Act has worked. The Federal funds spent under
this law have saved lives and reduced suffering. These are dollars that
could not have been better spent. For example, between 1994 and 1999,
pediatric AIDS cases declined by nearly 80 percent largely because of
these programs funded by the Federal Government under this Act.
I would like to point out to my colleague that this act offers a
framework that we should apply to tackling other tragic diseases, such
as childhood cancer. I hope that Congress will learn from the success
of this act.
This legislation extending the Ryan White CARE Act represents our
best response to dealing with AIDS and its consequences. The bill we
are considering is a compromise between the previously passed House and
Senate versions. The Senate version passed by unanimous consent. The
House version passed by a voice vote under suspension of the rules. I
am proud to be a cosponsor of this House version.
Because there is general agreement between the House and Senate,
there is no need for a formal conference committee.
I urge my colleagues to vote for the rule and for the bill.
Mr. Speaker, I reserve the balance of my time.
Mr. GOSS. Mr. Speaker, I advise that we have no speakers lined up,
and I would be prepared to yield back if the gentleman from Ohio (Mr.
Hall) has no speakers.
Mr. HALL of Ohio. Mr. Speaker, I yield back the balance of my time.
Mr. GOSS. Mr. Speaker, I yield back the balance of my time, and I
move the previous question on the resolution.
The previous question was ordered.
The resolution was agreed to.
A motion to reconsider was laid on the table.
Mr. COBURN. Mr. Speaker, pursuant to House Resolution 611, I call up
the Senate bill (
S. 2311) 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 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, and ask for its immediate
consideration.
The Clerk read the title of the Senate bill.
The SPEAKER pro tempore (Mr. Simpson). Pursuant to House Resolution
611, the Senate bill is considered read for amendment.
The text of
S. 2311 is as follows:
S. 2311
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.
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.
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.
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``(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.
``(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.
``(5) Coordination with other federal grantees.--The
council shall coordinate with Federal grantees providing HIV-
related services within the eligible area.
``(6) Community participation.--The council shall establish
methods for obtaining input on community needs and priorities
which may include public meetings, conducting focus groups,
and convening ad-hoc panels.
``(e) Process for Establishing Allocation Priorities.--
``(1) In general.--Not later than 24 months after the date
of enactment of the Ryan White CARE Act Amendments of 2000,
the Secretary shall--
``(A) consult with eligible metropolitan areas, affected
communities, experts, and other appropriate individuals and
entities, to develop epidemiologic measures for establishing
the number of individuals living with HIV disease who are not
receiving HIV-related health services; and
``(B) provide advice and technical assistance to planning
councils with respect to the process for establishing
priorities for the allocation of funds under subsection
(d)(1).
``(2) Exception.--Grantees under subsection (d)(1)(A) shall
not be required to establish priorities for individuals not
in care until epidemiologic measures are developed under
paragraph (1).''.
SEC. 102. QUALITY MANAGEMENT.
(a) Funds Available for Quality Management.--Section 2604
(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 medical 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 to develop
strategies for improvements in the access to and quality of
medical services.
``(2) Use of funds.--From amounts received under a grant
awarded under this part, the chief elected official of an
eligible area may use, for activities associated with its
quality management program, not more than the lesser of--
``(A) 5 percent of amounts received under the grant; or
``(B) $3,000,000.''.
(b) Quality Management Required for Eligibility for
Grants.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended--
(1) by redesignating paragraphs (3) through (6) as
paragraphs (5) through (8), respectively; and
(2) by inserting after paragraph (2) the following:
``(3) that the chief elected official of the eligible area
will satisfy all requirements under section 2604(c);''.
SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE
RELATIONSHIPS.
(a) Use of Amounts.--Section 2604(e)(1) (42 U.S.C. 300ff-
14(d)(1)) (as so redesignated by section 102(a)) is amended
by inserting ``and the State Children's Health Insurance
Program under title XXI of such Act'' after ``Social Security
Act''.
(b) Applications.--Section 2605(a) (42 U.S.C. 300ff-15(a))
is amended by inserting after paragraph (3), as added by
section 102(b), the following:
``(4) that funded entities within the eligible area that
receive funds under a grant under section 2601(a) shall
maintain appropriate relationships with entities in the area
served that constitute key points of access to the health
care system for individuals with HIV disease (including
emergency rooms, substance abuse treatment programs,
detoxification centers, adult and juvenile detention
facilities, sexually transmitted disease clinics, HIV
counseling and testing sites, and homeless shelters) and
other entities under section 2652(a) for the purpose of
facilitating early intervention for individuals newly
diagnosed with HIV disease and individuals knowledgeable of
their status but not in care;''.
SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
RELATED.
(a) In General.--Section 2604(b)(1) (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 health services.--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
services.--Inpatient case management''; and
(4) by inserting after subparagraph (A) the following:
``(B) Outpatient support services.--Outpatient and
ambulatory support services (including case management), to
the extent that such services facilitate, enhance, support,
or sustain the delivery, continuity, or benefits of health
services for individuals and families with HIV disease.''.
(b) Conforming Amendment to Application Requirements.--
Section 2605(a) (42 U.S.C. 300ff-15(a)), as amended by
section 102(b), is further amended--
(1) in paragraph (6) (as so redesignated), by striking
``and'' at the end thereof;
(2) in paragraph (7) (as so redesignated), by striking the
period and inserting ``; and''; and
(3) by adding at the end the following:
``(8) that the eligible area has procedures in place to
ensure that services provided with funds received under this
part meet the criteria specified in section 2604(b)(1).''.
SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.
(a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-
14(b)(1)), as amended by section 104(a), is further amended
by adding at the end the following:
``(D) Early intervention services.--Early intervention
services as described in section 2651(b)(2), with follow-
through referral, provided for the purpose of facilitating
the access of individuals receiving the services to HIV-
related health services, but only if the entity providing
such services--
``(i)(I) is receiving funds under subparagraph (A) or (C);
or
``(II) is an entity constituting a point of access to
services, as described in paragraph (2)(C), that maintains a
relationship with an entity described in subclause (I) and
that is serving individuals at elevated risk of HIV disease;
and
``(ii) demonstrates to the satisfaction of the chief
elected official that no other Federal, State, or local funds
are available for the early intervention services the entity
will provide with funds received under this paragraph.''.
(b) Conforming Amendments to Application Requirements.--
Section 2605(a)(1) (42 U.S.C. 300ff-15(a)(1)) is amended--
(1) in subparagraph (A), by striking ``services to
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''; and
(2) in subparagraph (B), by striking ``services for
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''.
SEC. 106. REPLACEMENT OF SPECIFIED FISCAL YEARS REGARDING THE
SUNSET ON EXPEDITED DISTRIBUTION REQUIREMENTS.
Section 2603(a)(2) (42 U.S.C. 300ff-13(a)(2)) is amended by
striking ``for each of the fiscal years 1996 through 2000''
and inserting ``for a fiscal year''.
SEC. 107. HOLD HARMLESS PROVISION.
Section 2603(a)(4) (42 U.S.C. 300ff-13(a)(4)) is amended to
read as follows:
``(4) Limitations.--
``(A) In general.--With respect to each of fiscal years
2001 through 2005, the Secretary shall ensure that the amount
of a grant made to an eligible area under paragraph (2) for
such a fiscal year is not less than an amount equal to 98
percent of the amount the eligible area received for the
fiscal year preceding the year for which the determination is
being made.
``(B) Application of provision.--Subparagraph (A) shall
only apply with respect to those eligible areas receiving a
grant under paragraph (2) for fiscal year 2000 in an amount
that has been adjusted in accordance with paragraph (4) of
this subsection (as in effect on the day before the date of
enactment of the Ryan White CARE Act Amendments of 2000).''.
SEC. 108. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.
Section 2604(b)(3) (42 U.S.C. 300ff-14(b)(3)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``established priorities''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.
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Subtitle B--Amendments to Part B (Care Grant Program)
SEC. 121. STATE REQUIREMENTS CONCERNING IDENTIFICATION OF
NEED AND ALLOCATION OF RESOURCES.
(a) General Use of Grants.--Section 2612 (42 U.S.C. 300ff-
22) is amended--
(1) by striking ``A State'' and inserting ``(a) In
General.--A State''; and
(2) in the matter following paragraph (5)--
(A) by striking ``paragraph (2)'' and inserting
``subsection (a)(2) and section 2613'';
(b) Application.--Section 2617(b) (42 U.S.C. 300ff-27(b))
is amended--
(1) in paragraph (1)(C)--
(A) by striking clause (i) and inserting the following:
``(i) the size and demographic characteristics of the
population with HIV disease to be served, except that by not
later than October 1, 2002, the State shall take into account
the needs of individuals not in care, based on epidemiologic
measures developed by the Secretary in consultation with the
State, affected communities, experts, and other appropriate
individuals (such State shall not be required to establish
priorities for individuals not in care until such
epidemiologic measures are developed);'';
(B) in clause (iii), by striking ``and'' at the end; and
(C) by adding at the end the following:
``(v) the availability of other governmental and non-
governmental resources;
``(vi) the capacity development needs resulting in gaps in
the provision of HIV services in historically underserved
low-income and rural low-income communities; and
``(vii) the efficiency of the administrative mechanism in
rapidly allocating funds to the areas of greatest need within
the State;''; and
(2) in paragraph (2)--
(A) in subparagraph (B), by striking ``and'' at the end;
(B) by redesignating subparagraph (C) as subparagraph (F);
and
(C) by inserting after subparagraph (B), the following:
``(C) an assurance that capacity development needs
resulting from gaps in the provision of services in
underserved low-income and rural low-income communities will
be addressed; and
``(D) with respect to fiscal year 2003 and subsequent
fiscal years, assurances that, in the planning and allocation
of resources, the State, through systems of HIV-related
health services provided under paragraphs (1), (2), and (3)
of section 2612(a), will make appropriate provision for the
HIV-related health and support service needs of individuals
who have been diagnosed with HIV disease but who are not
currently receiving such services, based on the epidemiologic
measures developed under paragraph (1)(C)(i);''.
SEC. 122. QUALITY MANAGEMENT.
(a) State Requirement for Quality Management.--Section
2617(b)(4) (42 U.S.C. 300ff-27(b)(4)) is amended--
(1) by striking subparagraph (C) and inserting the
following:
``(C) the State will provide for--
``(i) the establishment of a quality management program to
assess the extent to which medical 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 infections and to develop
strategies for improvements in the access to and quality of
medical services; and
``(ii) a periodic review (such as through an independent
peer review) to assess the quality and appropriateness of
HIV-related health and support services provided by entities
that receive funds from the State under this part;'';
(2) by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively;
(3) by inserting after subparagraph (D), the following:
``(E) an assurance that the State, through systems of HIV-
related health services provided under paragraphs (1), (2),
and (3) of section 2612(a), has considered strategies for
working with providers to make optimal use of financial
assistance under the State medicaid plan under title XIX of
the Social Security Act, the State Children's Health
Insurance Program under title XXI of such Act, and other
Federal grantees that provide HIV-related services, to
maximize access to quality HIV-related health and support
services;
(4) in subparagraph (F), as so redesignated, by striking
``and'' at the end; and
(5) in subparagraph (G), as so redesignated, by striking
the period and inserting ``; and''.
(b) Availability of Funds for Quality Management.--
(1) Availability of grant funds for planning and
evaluation.--Section 2618(c)(3) (42 U.S.C. 300ff-28(c)(3)) is
amended by inserting before the period ``, including not more
than $3,000,000 for all activities associated with its
quality management program''.
(2) Exception to combined ceiling on planning and
administration funds for states with small grants.--Paragraph
(6) of section 2618(c) (42 U.S.C. 300ff-28(c)(6)) is amended
to read as follows:
``(6) Exception for quality management.--Notwithstanding
paragraph (5), a State whose grant under this part for a
fiscal year does not exceed $1,500,000 may use not to exceed
20 percent of the amount of the grant for the purposes
described in paragraphs (3) and (4) if--
``(A) that portion of such amount in excess of 15 percent
of the grant is used for its quality management program; and
``(B) the State submits and the Secretary approves a plan
(in such form and containing such information as the
Secretary may prescribe) for use of funds for its quality
management program.''.
SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE
RELATIONSHIPS.
Section 2617(b)(4) (42 U.S.C. 300ff-27(b)(4)), as amended
by section 122(a), is further amended by adding at the end
the following:
``(H) that funded entities maintain appropriate
relationships with entities in the area served that
constitute key points of access to the health care system for
individuals with HIV disease (including emergency rooms,
substance abuse treatment programs, detoxification centers,
adult and juvenile detention facilities, sexually transmitted
disease clinics, HIV counseling and testing sites, and
homeless shelters), and other entities under section 2652(a),
for the purpose of facilitating early intervention for
individuals newly diagnosed with HIV disease and individuals
knowledgeable of their status but not in care.''.
SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
RELATED.
(a) Technical Amendment.--Section 3(c)(2)(A)(iii) of the
Ryan White CARE Act Amendments of 1996 (Public Law 104-146)
is amended by inserting ``before paragraph (2) as so
redesignated'' after ``inserting''.
(b) Services.--Section 2612(a)(1) (42 U.S.C. 300ff-
22(a)(1)), as so designated by section 121(a), is amended by
striking ``for individuals with HIV disease'' and inserting
``, subject to the conditions and limitations that apply
under such section''.
(c) Conforming Amendment to State Application
Requirement.--Section 2617(b)(2) (42 U.S.C. 300ff-27(b)(2)),
as amended by section 121(b), is further amended by adding at
the end the following:
``(F) an assurance that the State has procedures in place
to ensure that services provided with funds received under
this section meet the criteria specified in section
2604(b)(1)(B); and''.
SEC. 125. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.
Section 2612(a) (42 U.S.C. 300ff-22(a)), as amended by
section 121, is further amended by adding at the end the
following:
``(6) Early intervention services.--The State, through
systems of HIV-related health services provided under
paragraphs (1), (2), and (3) of section 2612(a), may provide
early intervention services, as described in section
2651(b)(2), with follow-up referral, provided for the purpose
of facilitating the access of individuals receiving the
services to HIV-related health services, but only if the
entity providing such services--
``(A)(i) is receiving funds under section 2612(a)(1); or
``(ii) is an entity constituting a point of access to
services, as described in section 2617(b)(4), that maintains
a referral relationship with an entity described in clause
(i) and that is serving individuals at elevated risk of HIV
disease; and
``(B) demonstrates to the State's satisfaction that no
other Federal, State, or local funds are available for the
early intervention services the entity will provide with
funds received under this paragraph.''.
SEC. 126. AUTHORIZATION OF APPROPRIATIONS FOR HIV-RELATED
SERVICES FOR WOMEN AND CHILDREN.
Section 2625(c)(2) (42 U.S.C. 300ff-33(c)(2)) is amended by
striking ``fiscal years 1996 through 2000'' and inserting
``fiscal years 2001 through 2005''.
SEC. 127. REPEAL OF REQUIREMENT FOR COMPLETED INSTITUTE OF
MEDICINE REPORT.
Section 2628 (42 U.S.C. 300ff-36) is repealed.
SEC. 128. SUPPLEMENT 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 by adding
at the end the following:
``SEC. 2622. SUPPLEMENTAL GRANTS.
``(a) In General.--The Secretary shall award supplemental
grants to States determined to be eligible under subsection
(b) to enable such States to provide comprehensive services
of the type described in section 2612(a) to supplement the
services otherwise provided by the State under a grant under
this subpart in areas within the State that are not eligible
to receive grants under part A.
``(b) Eligibility.--To be eligible to receive a
supplemental grant under subsection (a) a State shall--
``(1) be eligible to receive a grant under this subpart;
and
``(2) demonstrate to the Secretary that there is severe
need (as defined for purposes of section 2603(b)(2)(A) for
supplemental financial assistance in areas in the State that
are not served through grants under part A.
``(c) Application.--A State that desires a grant under this
section shall, as part of the State application submitted
under section 2617, submit a detailed description of the
manner in which the State will use amounts received under the
grant and of the severity of need. Such description shall
include--
``(1) a report concerning the dissemination of supplemental
funds under this section and the plan for the utilization of
such funds;
``(2) a demonstration of the existing commitment of local
resources, both financial and in-kind;
``(3) a demonstration that the State will maintain HIV-
related activities at a level
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that is equal to not less than the level of such activities
in the State for the 1-year period preceding the fiscal year
for which the State is applying to receive a grant under this
part;
``(4) a demonstration of the ability of the State to
utilize such supplemental financial resources in a manner
that is immediately responsive and cost effective;
``(5) a demonstration that the resources will be allocated
in accordance with the local demographic incidence of AIDS
including appropriate allocations for services for infants,
children, women, and families with HIV disease;
``(6) a demonstration of the inclusiveness of the planning
process, with particular emphasis on affected communities and
individuals with HIV disease; and
``(7) a demonstration of the manner in which the proposed
services are consistent with local needs assessments and the
statewide coordinated statement of need.
``(d) Amount Reserved for Emerging Communities.--
``(1) In general.--For awarding grants under this section
for each fiscal year, the Secretary shall reserve the greater
of 50 percent of the amount to be utilized under subsection
(e) for such fiscal year or $5,000,000, to be provided to
States that contain emerging communities for use in such
communities.
``(2) Definition.--In paragraph (1), the term `emerging
community' means a metropolitan area--
``(A) that is not eligible for a grant under part A; and
``(B) for which there has been reported to the Director of
the Centers for Disease Control and Prevention a cumulative
total of between 1000 and 1999 cases of acquired immune
deficiency syndrome for the most recent period of 5 calendar
years for which such data are available.
``(e) Appropriations.--With respect to each fiscal year
beginning with fiscal year 2001, the Secretary, to carry out
this section, shall utilize 50 percent of the amount
appropriated under section 2677 to carry out part B for such
fiscal year that is in excess of the amount appropriated to
carry out such part in fiscal year preceding the fiscal year
involved.
SEC. 129. USE OF TREATMENT FUNDS.
(a) State Duties.--Section 2616(c) (42 U.S.C. 300ff-26(c))
is amended--
(1) in the matter preceding paragraph (1), by striking
``shall--'' and inserting ``shall use funds made available
under this section to--'';
(2) by redesignating paragraphs (1) through (5) as
subparagraphs (A) through (E), respectively and realigning
the margins of such subparagraphs appropriately;
(3) in subparagraph (D) (as so redesignated), by striking
``and'' at the end;
(4) in subparagraph (E) (as so redesignated), by striking
the period and ``; and''; and
(5) by adding at the end the following:
``(F) encourage, support, and enhance adherence to and
compliance with treatment regimens, including related medical
monitoring.'';
(6) by striking ``In carrying'' and inserting the
following:
``(1) In general.--In carrying''; and
(7) by adding at the end the following:
``(2) Limitations.--
``(A) In general.--No State shall use funds under paragraph
(1)(F) unless the limitations on access to HIV/AIDS
therapeutic regimens as defined in subsection (e)(2) are
eliminated.
``(B) Amount of funding.--No State shall use in excess of
10 percent of the amount set-aside for use under this section
in any fiscal year to carry out activities under paragraph
(1)(F) unless the State demonstrates to the Secretary that
such additional services are essential and in no way diminish
access to therapeutics.''.
(b) Supplement Grants.--Section 2616 (42 U.S.C. 300ff-
26(c)) is amended by adding at the end the following:
``(e) Supplemental Grants for the Provision of
Treatments.--
``(1) In general.--From amounts made available under
paragraph (5), the Secretary shall award supplemental grants
to States determined to be eligible under paragraph (2) to
enable such States to provide access to therapeutics to treat
HIV disease as provided by the State under subsection
(c)(1)(B) for individuals at or below 200 percent of the
Federal poverty line.
``(2) Criteria.--The Secretary shall develop criteria for
the awarding of grants under paragraph (1) to States that
demonstrate a severe need. In determining the criteria for
demonstrating State severity of need (as defined for purposes
of section 2603(b)(2)(A)), the Secretary shall consider
whether limitation to access exist such that--
``(A) the State programs under this section are unable to
provide HIV/AIDS therapeutic regimens to all eligible
individuals living at or below 200 percent of the Federal
poverty line; and
``(B) the State programs under this section are unable to
provide to all eligible individuals appropriate HIV/AIDS
therapeutic regimens as recommended in the most recent
Federal treatment guidelines.
``(3) State requirement.--The Secretary may not make a
grant to a State under this subsection unless the State
agrees that--
``(A) the State will make available (directly or through
donations from public or private entities) non-Federal
contributions toward the activities to be carried out under
the grant in an amount equal to $1 for each $4 of Federal
funds provided in the grant; and
``(B) the State will not impose eligibility requirements
for services or scope of benefits limitations under
subsection (a) that are more restrictive than such
requirements in effect as of January 1, 2000.
``(4) Use and coordination.--Amounts made available under a
grant under this subsection shall only be used by the State
to provide AIDS/HIV-related medications. The State shall
coordinate the use of such amounts with the amounts otherwise
provided under this section in order to maximize drug
coverage.
``(5) Funding.--
``(A) Reservation of amount.--The Secretary may reserve not
to exceed 4 percent, but not less than 2 percent, of any
amount referred to in section 2618(b)(2)(H) that is
appropriated for a fiscal year, to carry out this subsection.
``(B) Minimum amount.--In providing grants under this
subsection, the Secretary shall ensure that the amount of a
grant to a State under this part is not less than the amount
the State received under this part in the previous fiscal
year, as a result of grants provided under this
subsection.''.
(c) Supplement and not Supplant.--Section 2616 (42 U.S.C.
300ff-26(c)), as amended by subsection (b), is further
amended by adding at the end the following:
``(f) Supplement not Supplant.--Notwithstanding any other
provision of law, amounts made available under this section
shall be used to supplement and not supplant other funding
available to provide treatments of the type that may be
provided under this section.''.
SEC. 130. INCREASE IN MINIMUM ALLOTMENT.
(a) In General.--Section 2618(b)(1)(A)(i) (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) Technical Amendment.--Section 2618(b)(3)(B) (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''.
SEC. 131. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.
Section 2611(b) (42 U.S.C. 300ff-21(b)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``State shall use''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.
Subtitle C--Amendments to Part C (Early Intervention Services)
SEC. 141. AMENDMENT OF HEADING; REPEAL OF FORMULA GRANT
PROGRAM.
(a) Amendment of Heading.--The heading of part C of title
XXVI is amended to read as follows:
``Part C--Early Intervention and Primary Care Services''.
(b) Repeal.--Part C of title XXVI (42 U.S.C. 300ff-41 et
seq.) is amended--
(1) by repealing subpart I; and
(2) by redesignating subparts II and III as subparts I and
II.
(c) Conforming Amendments.--
(1) Information regarding receipt of services.--Section
2661(a) (42 U.S.C. 300ff-61(a)) is amended by striking
``unless--'' and all that follows through ``(2) in the case
of'' and inserting ``unless, in the case of''.
(2) Additional agreements.--Section 2664 (42 U.S.C. 300ff-
64) is amended--
(A) in subsection (e)(5), by striking ``2642(b) or'';
(B) in subsection (f)(2), by striking ``2642(b) or''; and
(C) by striking subsection (h).
SEC. 142. PLANNING AND DEVELOPMENT GRANTS.
(a) Allowing Planning and Development Grant To Expand
Ability To Provide Primary Care Services.--Section 2654(c)
(42 U.S.C. 300ff-54(c)) is amended--
(1) in paragraph (1), to read as follows:
``(1) In general.--The Secretary may provide planning and
development grants to public and nonprofit private entities
for the purpose of--
``(A) enabling such entities to provide HIV early
intervention services; or
``(B) assisting such entities to expand the capacity,
preparedness, and expertise to deliver primary care services
to individuals with HIV disease in underserved low-income
communities on the condition that the funds are not used to
purchase or improve land or to purchase, construct, or
permanently improve (other than minor remodeling) any
building or other facility.''; and
(2) in paragraphs (2) and (3) by striking ``paragraph (1)''
each place that such appears and inserting ``paragraph
(1)(A)''.
(b) Amount; Duration.--Section 2654(c) (42 U.S.C. 300ff-
54(c)), as amended by subsection (a), 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.
[[Page
H8822]]
``(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) (42 U.S.C.
300ff-54(c)(5)), as so redesignated by subsection (b), is
amended by striking ``1 percent'' and inserting ``5
percent''.
SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CATEGORICAL
GRANTS.
Section 2655 (42 U.S.C. 300ff-55) is amended by striking
``1996'' and all that follows through ``2000'' and inserting
``2001 through 2005''.
SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY MANAGEMENT
PROGRAM.
Section 2664(g) (42 U.S.C. 300ff-64(g)) is amended--
(1) in paragraph (3), to read as follows:
``(3) the applicant will not expend more than 10 percent of
the grant for costs of administrative activities with respect
to the grant;'';
(2) in paragraph (4), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(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.''.
SEC. 145. PREFERENCE FOR CERTAIN AREAS.
Section 2651 (42 U.S.C. 300ff-51) is amended by adding at
the end the following:
``(d) Preference in Awarding Grants.--Beginning in fiscal
year 2001, in awarding new grants under this section, the
Secretary shall give preference to applicants that will use
amounts received under the grant to serve areas that are
otherwise not eligible to receive assistance under part A.''.
Subtitle D--Amendments to Part D (General Provisions)
SEC. 151. RESEARCH INVOLVING WOMEN, INFANTS, CHILDREN, AND
YOUTH.
(a) Elimination of Requirement To Enroll Significant
Numbers of Women and Children.--Section 2671(b) (42 U.S.C.
300ff-71(b)) is amended--
(1) in paragraph (1), by striking subparagraphs (C) and
(D); and
(2) by striking paragraphs (3) and (4).
(b) Information and Education.--Section 2671(d) (42 U.S.C.
300ff-71(d)) is amended by adding at the end the following:
``(4) The applicant will provide individuals with
information and education on opportunities to participate in
HIV/AIDS-related clinical research.''.
(c) Quality Management; Administrative Expenses Ceiling.--
Section 2671(f) (42 U.S.C. 300ff-71(f)) is amended--
(1) by striking the subsection heading and designation and
inserting the following:
``(f) Administration.--
``(1) Application.--''; and
(2) by adding at the end the following:
``(2) Quality management program.--A grantee under this
section shall implement a quality management program.''.
(d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g))
is amended by adding at the end the following: ``The
Secretary acting through the Director of NIH, shall examine
the distribution and availability of ongoing and appropriate
HIV/AIDS-related research projects to existing sites under
this section for purposes of enhancing and expanding
voluntary access to HIV-related research, especially within
communities that are not reasonably served by such
projects.''.
(e) Authorization of Appropriations.--Section 2671(j) (42
U.S.C. 300ff-71(j)) is amended by striking ``fiscal years
1996 through 2000'' and inserting ``fiscal years 2001 through
2005''.
SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.
Section 2671 (42 U.S.C. 300ff-71) is amended--
(1) by redesignating subsections (i) and (j), as
subsections (j) and (k), respectively; and
(2) by inserting after subsection (h), the following:
``(i) Limitation on Administrative Expenses.--
``(1) Determination by secretary.--Not later than 12 months
after the date of enactment of the Ryan White Care Act
Amendments of 2000, the Secretary, in consultation with
grantees under this part, shall conduct a review of the
administrative, program support, and direct service-related
activities that are carried out under this part to ensure
that eligible individuals have access to quality, HIV-related
health and support services and research opportunities under
this part, and to support the provision of such services.
``(2) Requirements.--
``(A) In general.--Not later than 180 days after the
expiration of the 12-month period referred to in paragraph
(1) the Secretary, in consultation with grantees under this
part, shall determine the relationship between the costs of
the activities referred to in paragraph (1) and the access of
eligible individuals to the services and research
opportunities described in such paragraph.
``(B) Limitation.--After a final determination under
subparagraph (A), the Secretary may not make a grant under
this part unless the grantee complies with such requirements
as may be included in such determination.''.
SEC. 153. EVALUATIONS AND REPORTS.
Section 2674(c) (42 U.S.C. 399ff-74(c)) is amended by
striking ``1991 through 1995'' and inserting ``2001 through
2005''.
SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR GRANTS UNDER
PARTS A AND B.
Section 2677 (42 U.S.C. 300ff-77) is amended to read as
follows:
``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated--
``(1) such sums as may be necessary to carry out part A for
each of the fiscal years 2001 through 2005; and
``(2) such sums as may be necessary to carry out part B for
each of the fiscal years 2001 through 2005.''.
Subtitle E--Amendments to Part F (Demonstration and Training)
SEC. 161. AUTHORIZATION OF APPROPRIATIONS.
(a) Schools; Centers.--Section 2692(c)(1) (42 U.S.C. 300ff-
111(c)(1)) is amended by striking ``fiscal years 1996 through
2000'' and inserting ``fiscal years 2001 through 2005''.
(b) Dental Schools.--Section 2692(c)(2) (42 U.S.C. 300ff-
111(c)(2)) is amended by striking ``fiscal years 1996 through
2000'' and inserting ``fiscal years 2001 through 2005''.
TITLE II--MISCELLANEOUS PROVISIONS
SEC. 201. INSTITUTE OF MEDICINE STUDY.
(a) In General.--Not later than 120 days after the date of
enactment of this Act, the Secretary of Health and Human
Services shall enter into a contract with the Institute of
Medicine for the conduct of 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.
(b) Requirements.--
(1) Completion.--The study under subsection (a) shall be
completed not later than 21 months after the date on which
the contract referred to in such subsection is entered into.
(2) Issues to be considered.--The study conducted under
subsection (a) shall consider--
(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;
(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;
and
(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) Report.--Not later than 90 days after the date on which
the study is completed under subsection (a), the Secretary of
Health and Human Services shall prepare and submit to the
appropriate committees of Congress a report describing the
manner in which the conclusions and recommendations of the
Institute of Medicine can be addressed and implemented.
The SPEAKER pro tempore. Pursuant to House Resolution 611, the
amendment in the nature of a substitute printed in the Congressional
Record and numbered 1 is considered adopted.
The text of
S. 2311, as amended pursuant to House Resolution 611, is
as follows:
Strike all after the enacting clause and insert the
following:
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. 122. Application.
TITLE II--CARE GRANT PROGRAM
Subtitle A--General Grant Provisions
Sec. 201. Priority for women, infants, and children.
Sec. 202. Use of grants.
Sec. 203. Grants to establish HIV care consortia.
Sec. 204. Provision of treatments.
Sec. 205. State application.
Sec. 206. Distribution of funds.
Sec. 207. Supplemental grants for certain States.
Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission
of HIV
Sec. 211. Repeals.
Sec. 212. Grants.
Sec. 213. Study by Institute of Medicine.
[[Page
H8823]]
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. 413. Coordination.
Sec. 414. Plan regarding release of prisoners with HIV disease.
Sec. 415. Audits.
Sec. 416. Administrative simplification.
Sec. 417. Authorization of appropriations for parts A and B.
TITLE V--GENERAL PROVISIONS
Sec. 501. Studies by Institute of Medicine.
Sec. 502. Development of rapid HIV test.
Sec. 503. Technical corrections.
TITLE VI--EFFECTIVE DATE
Sec. 601. Effective date.
TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES
Subtitle A--HIV Health Services Planning Councils
SEC. 101. MEMBERSHIP OF COUNCILS.
(a) In General.--Section 2602(b) of the Public Health
Service Act (42 U.S.C. 300ff-12(b)) is amended--
(1) in paragraph (1), by striking ``demographics of the
epidemic in the eligible area involved,'' and inserting
``demographics of the population of individuals with HIV
disease in the eligible area involved,''; and
(2) in paragraph (2)--
(A) in subparagraph (C), by inserting before the semicolon
the following: ``, including providers of housing and
homeless services'';
(B) in subparagraph (G), by striking ``or AIDS'';
(C) in subparagraph (K), by striking ``and'' at the end;
(D) in subparagraph (L), by striking the period and
inserting the following: ``, including but not limited to
providers of HIV prevention services; and''; and
(E) by adding at the end the following subparagraph:
``(M) representatives of individuals who formerly were
Federal, State, or local prisoners, were released from the
custody of the penal system during the preceding 3 years, and
had HIV disease as of the date on which the individuals were
so released.''.
(b) Conflicts of Interests.--Section 2602(b)(5) of the
Public Health Service Act (42 U.S.C. 300ff-12(b)(5)) is
amended by adding at the end the following subparagraph:
``(C) Composition of council.--The following applies
regarding the membership of a planning council under
paragraph (1):
``(i) Not less than 33 percent of the council shall be
individuals who are receiving HIV-related services pursuant
to a grant under section 2601(a), are not officers,
employees, or consultants to any entity that receives amounts
from such a grant, and do not represent any such entity, and
reflect the demographics of the population of individuals
with HIV disease as determined under paragraph (4)(A). For
purposes of the preceding sentence, an individual shall be
considered to be receiving such services if the individual is
a parent of, or a caregiver for, a minor child who is
receiving such services.
``(ii) With respect to membership on the planning council,
clause (i) may not be construed as having any effect on
entities that receive funds from grants under any of parts B
through F but do not receive funds from grants under section
2601(a), on officers or employees of such entities, or on
individuals who represent such entities.''.
SEC. 102. DUTIES OF COUNCILS.
(a) In General.--Section 2602(b)(4) of the Public Health
Service Act (42 U.S.C. 300ff-12(b)(4)) is amended--
(1) by redesignating subparagraphs (A) through (E) as
subparagraphs (C) through (G), respectively;
(2) by inserting before subparagraph (C) (as so
redesignated) the following subparagraphs:
``(A) determine the size and demographics of the population
of individuals with HIV disease;
``(B) determine the needs of such population, with
particular attention to--
``(i) individuals with HIV disease who know their HIV
status and are not receiving HIV-related services; and
``(ii) disparities in access and services among affected
subpopulations and historically underserved communities;'';
(3) in subparagraph (C) (as so redesignated), by striking
clauses (i) through (iv) and inserting the following:
``(i) size and demographics of the population of
individuals with HIV disease (as determined under
subparagraph (A)) and the needs of such population (as
determined under subparagraph (B));
``(ii) demonstrated (or probable) cost effectiveness and
outcome effectiven
Major Actions:
All articles in House section
RYAN WHITE CARE ACT AMENDMENTS OF 2000
(House of Representatives - October 05, 2000)
Text of this article available as:
TXT
PDF
[Pages
H8817-H8847]
RYAN WHITE CARE ACT AMENDMENTS OF 2000
Mr. GOSS. Mr. Speaker, by direction of the Committee on Rules, I call
up House Resolution 611 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 611
Resolved, That upon the adoption of this resolution it
shall be in order without intervention of any point of order
to consider in the House the bill (
S. 2311) 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 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. The bill
shall be considered as read for amendment. The amendment in
the nature of a substitute printed in the Congressional
Record and numbered 1 pursuant to clause 8 of rule XVIII
shall be considered as adopted. The previous question shall
be considered as ordered on the bill, as amended, to final
passage without intervening motion except: (1) one hour of
debate on the bill, as amended, equally divided and
controlled by the chairman and ranking minority member of the
Committee on Commerce; and (2) one motion to recommit with or
without instructions.
The SPEAKER pro tempore. The gentleman from Florida (Mr. Goss) is
recognized for 1 hour.
Mr. GOSS. Mr. Speaker, for purposes of debate only, I am pleased to
yield the customary 30 minutes to my friend, the distinguished
gentleman from Ohio (Mr. Hall), pending which I yield myself such time
as I may consume. During consideration of this resolution, all time
yielded is for purposes of debate only.
Mr. Speaker, this is a fair and straightforward closed rule for a
very important piece of legislation. The rule waives all points of
order against consideration of the bill and provides that the amendment
in the nature of a substitute printed in the Congressional Record shall
be considered as adopted.
{time} 1030
This is largely a noncontroversial bill. As no members of the
minority testified differently last night at the Committee on Rules,
this rule should receive unanimous support, and I urge support.
This reauthorization of the Ryan White CARE Act recognizes the
changing demographics of the AIDS epidemic in our country in a way that
truly honors the memory of the courageous young boy for which the bill
was originally named. Today, there are between 800,000 and 900,000
persons living with HIV in the United States of America with some
40,000 new infections annually. This conference report seeks to shift
resources to the most needy areas while preserving the best features of
the current programs.
The gentleman from Virginia (Chairman Bliley) should be commended for
his leadership and attention to this critical public health issue which
is of concern to every Member of this body. I am hopeful that the
progress made on this authorization will spur funding for another
essential program for individuals afflicted with the HIV virus.
As my colleagues remember and well know, this House led the way and
adopted the Ricky Ray Authorization Act in the last Congress. It
authorized $750 million for compassion assistance and recognition to
hemophiliacs who contracted AIDS through no fault of their own because
of contaminated blood products in the 1980s.
Now, the first installment was provided last year, and this year the
gentleman from Florida (Chairman Young) of the Committee on
Appropriations should be commended for exceeding the President's
request in the House version of the Fiscal Year 2001 Labor-HHS
appropriation bill for the next installment.
As negotiations continue and we near the end of this Congress, I am
hopeful that the White House will become fully engaged on the Ricky Ray
funding problem and work with leadership and Congress to provide full
funding for these victims as soon as humanly possible. The need is
great and the time is now.
I am confident that, if the White House shows true leadership and
demonstrates that this problem is really a top priority for them, we
will be able to move further toward full funding this year. Obviously
we cannot undo the tragic events of the 1980s, but we can work to
provide assistance to these individuals before it is any later.
Mr. Speaker, this rule should engender little debate. It is a fair
rule for a good bill. I urge its adoption.
Mr. Speaker, I reserve the balance of my time.
Mr. HALL of Ohio. Mr. Speaker, I want to thank the gentleman from
[[Page
H8818]]
Florida (Mr. Goss) for yielding me the time.
Mr. Speaker, this is a closed rule. It will allow for the
consideration of
S. 2311, which is called the Ryan White CARE Act
Amendments of 2000. As the gentleman from Florida has described, this
rule provides for 1 hour of general debate to be equally divided and
controlled by the chairman and ranking minority member of the Committee
on Commerce. Under this closed rule, no amendments can be offered on
the House floor.
In 1990, Congress passed the Ryan White Comprehensive AIDS Resources
Emergency Act. It was known as the Ryan White CARE Act. This law
created programs to help Americans with AIDS and HIV, the virus that
causes AIDS, and to slow the spread of HIV.
These programs expired October 1. The bill we are considering will
reauthorize and strengthen the Ryan White CARE Act programs by
expanding access, improving quality, and providing additional services.
Some of the changes will help target health care services to the people
who need it the most but who can least afford it.
Women, children, infants and youth with HIV will especially benefit
from this bill as will low-income individuals and families. AIDS
possesses one of the greatest health challenges of our generation, and
there is no way to avoid its tragic grip. However, an active role by
the Federal government can, in my opinion, ease the tragedy by reducing
the number of new HIV cases and by supporting victims and their
families.
The Ryan White CARE Act has worked. The Federal funds spent under
this law have saved lives and reduced suffering. These are dollars that
could not have been better spent. For example, between 1994 and 1999,
pediatric AIDS cases declined by nearly 80 percent largely because of
these programs funded by the Federal Government under this Act.
I would like to point out to my colleague that this act offers a
framework that we should apply to tackling other tragic diseases, such
as childhood cancer. I hope that Congress will learn from the success
of this act.
This legislation extending the Ryan White CARE Act represents our
best response to dealing with AIDS and its consequences. The bill we
are considering is a compromise between the previously passed House and
Senate versions. The Senate version passed by unanimous consent. The
House version passed by a voice vote under suspension of the rules. I
am proud to be a cosponsor of this House version.
Because there is general agreement between the House and Senate,
there is no need for a formal conference committee.
I urge my colleagues to vote for the rule and for the bill.
Mr. Speaker, I reserve the balance of my time.
Mr. GOSS. Mr. Speaker, I advise that we have no speakers lined up,
and I would be prepared to yield back if the gentleman from Ohio (Mr.
Hall) has no speakers.
Mr. HALL of Ohio. Mr. Speaker, I yield back the balance of my time.
Mr. GOSS. Mr. Speaker, I yield back the balance of my time, and I
move the previous question on the resolution.
The previous question was ordered.
The resolution was agreed to.
A motion to reconsider was laid on the table.
Mr. COBURN. Mr. Speaker, pursuant to House Resolution 611, I call up
the Senate bill (
S. 2311) 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 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, and ask for its immediate
consideration.
The Clerk read the title of the Senate bill.
The SPEAKER pro tempore (Mr. Simpson). Pursuant to House Resolution
611, the Senate bill is considered read for amendment.
The text of
S. 2311 is as follows:
S. 2311
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.
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.
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.
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``(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.
``(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.
``(5) Coordination with other federal grantees.--The
council shall coordinate with Federal grantees providing HIV-
related services within the eligible area.
``(6) Community participation.--The council shall establish
methods for obtaining input on community needs and priorities
which may include public meetings, conducting focus groups,
and convening ad-hoc panels.
``(e) Process for Establishing Allocation Priorities.--
``(1) In general.--Not later than 24 months after the date
of enactment of the Ryan White CARE Act Amendments of 2000,
the Secretary shall--
``(A) consult with eligible metropolitan areas, affected
communities, experts, and other appropriate individuals and
entities, to develop epidemiologic measures for establishing
the number of individuals living with HIV disease who are not
receiving HIV-related health services; and
``(B) provide advice and technical assistance to planning
councils with respect to the process for establishing
priorities for the allocation of funds under subsection
(d)(1).
``(2) Exception.--Grantees under subsection (d)(1)(A) shall
not be required to establish priorities for individuals not
in care until epidemiologic measures are developed under
paragraph (1).''.
SEC. 102. QUALITY MANAGEMENT.
(a) Funds Available for Quality Management.--Section 2604
(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 medical 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 to develop
strategies for improvements in the access to and quality of
medical services.
``(2) Use of funds.--From amounts received under a grant
awarded under this part, the chief elected official of an
eligible area may use, for activities associated with its
quality management program, not more than the lesser of--
``(A) 5 percent of amounts received under the grant; or
``(B) $3,000,000.''.
(b) Quality Management Required for Eligibility for
Grants.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended--
(1) by redesignating paragraphs (3) through (6) as
paragraphs (5) through (8), respectively; and
(2) by inserting after paragraph (2) the following:
``(3) that the chief elected official of the eligible area
will satisfy all requirements under section 2604(c);''.
SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE
RELATIONSHIPS.
(a) Use of Amounts.--Section 2604(e)(1) (42 U.S.C. 300ff-
14(d)(1)) (as so redesignated by section 102(a)) is amended
by inserting ``and the State Children's Health Insurance
Program under title XXI of such Act'' after ``Social Security
Act''.
(b) Applications.--Section 2605(a) (42 U.S.C. 300ff-15(a))
is amended by inserting after paragraph (3), as added by
section 102(b), the following:
``(4) that funded entities within the eligible area that
receive funds under a grant under section 2601(a) shall
maintain appropriate relationships with entities in the area
served that constitute key points of access to the health
care system for individuals with HIV disease (including
emergency rooms, substance abuse treatment programs,
detoxification centers, adult and juvenile detention
facilities, sexually transmitted disease clinics, HIV
counseling and testing sites, and homeless shelters) and
other entities under section 2652(a) for the purpose of
facilitating early intervention for individuals newly
diagnosed with HIV disease and individuals knowledgeable of
their status but not in care;''.
SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
RELATED.
(a) In General.--Section 2604(b)(1) (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 health services.--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
services.--Inpatient case management''; and
(4) by inserting after subparagraph (A) the following:
``(B) Outpatient support services.--Outpatient and
ambulatory support services (including case management), to
the extent that such services facilitate, enhance, support,
or sustain the delivery, continuity, or benefits of health
services for individuals and families with HIV disease.''.
(b) Conforming Amendment to Application Requirements.--
Section 2605(a) (42 U.S.C. 300ff-15(a)), as amended by
section 102(b), is further amended--
(1) in paragraph (6) (as so redesignated), by striking
``and'' at the end thereof;
(2) in paragraph (7) (as so redesignated), by striking the
period and inserting ``; and''; and
(3) by adding at the end the following:
``(8) that the eligible area has procedures in place to
ensure that services provided with funds received under this
part meet the criteria specified in section 2604(b)(1).''.
SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.
(a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-
14(b)(1)), as amended by section 104(a), is further amended
by adding at the end the following:
``(D) Early intervention services.--Early intervention
services as described in section 2651(b)(2), with follow-
through referral, provided for the purpose of facilitating
the access of individuals receiving the services to HIV-
related health services, but only if the entity providing
such services--
``(i)(I) is receiving funds under subparagraph (A) or (C);
or
``(II) is an entity constituting a point of access to
services, as described in paragraph (2)(C), that maintains a
relationship with an entity described in subclause (I) and
that is serving individuals at elevated risk of HIV disease;
and
``(ii) demonstrates to the satisfaction of the chief
elected official that no other Federal, State, or local funds
are available for the early intervention services the entity
will provide with funds received under this paragraph.''.
(b) Conforming Amendments to Application Requirements.--
Section 2605(a)(1) (42 U.S.C. 300ff-15(a)(1)) is amended--
(1) in subparagraph (A), by striking ``services to
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''; and
(2) in subparagraph (B), by striking ``services for
individuals with HIV disease'' and inserting ``services as
described in section 2604(b)(1)''.
SEC. 106. REPLACEMENT OF SPECIFIED FISCAL YEARS REGARDING THE
SUNSET ON EXPEDITED DISTRIBUTION REQUIREMENTS.
Section 2603(a)(2) (42 U.S.C. 300ff-13(a)(2)) is amended by
striking ``for each of the fiscal years 1996 through 2000''
and inserting ``for a fiscal year''.
SEC. 107. HOLD HARMLESS PROVISION.
Section 2603(a)(4) (42 U.S.C. 300ff-13(a)(4)) is amended to
read as follows:
``(4) Limitations.--
``(A) In general.--With respect to each of fiscal years
2001 through 2005, the Secretary shall ensure that the amount
of a grant made to an eligible area under paragraph (2) for
such a fiscal year is not less than an amount equal to 98
percent of the amount the eligible area received for the
fiscal year preceding the year for which the determination is
being made.
``(B) Application of provision.--Subparagraph (A) shall
only apply with respect to those eligible areas receiving a
grant under paragraph (2) for fiscal year 2000 in an amount
that has been adjusted in accordance with paragraph (4) of
this subsection (as in effect on the day before the date of
enactment of the Ryan White CARE Act Amendments of 2000).''.
SEC. 108. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.
Section 2604(b)(3) (42 U.S.C. 300ff-14(b)(3)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``established priorities''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.
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Subtitle B--Amendments to Part B (Care Grant Program)
SEC. 121. STATE REQUIREMENTS CONCERNING IDENTIFICATION OF
NEED AND ALLOCATION OF RESOURCES.
(a) General Use of Grants.--Section 2612 (42 U.S.C. 300ff-
22) is amended--
(1) by striking ``A State'' and inserting ``(a) In
General.--A State''; and
(2) in the matter following paragraph (5)--
(A) by striking ``paragraph (2)'' and inserting
``subsection (a)(2) and section 2613'';
(b) Application.--Section 2617(b) (42 U.S.C. 300ff-27(b))
is amended--
(1) in paragraph (1)(C)--
(A) by striking clause (i) and inserting the following:
``(i) the size and demographic characteristics of the
population with HIV disease to be served, except that by not
later than October 1, 2002, the State shall take into account
the needs of individuals not in care, based on epidemiologic
measures developed by the Secretary in consultation with the
State, affected communities, experts, and other appropriate
individuals (such State shall not be required to establish
priorities for individuals not in care until such
epidemiologic measures are developed);'';
(B) in clause (iii), by striking ``and'' at the end; and
(C) by adding at the end the following:
``(v) the availability of other governmental and non-
governmental resources;
``(vi) the capacity development needs resulting in gaps in
the provision of HIV services in historically underserved
low-income and rural low-income communities; and
``(vii) the efficiency of the administrative mechanism in
rapidly allocating funds to the areas of greatest need within
the State;''; and
(2) in paragraph (2)--
(A) in subparagraph (B), by striking ``and'' at the end;
(B) by redesignating subparagraph (C) as subparagraph (F);
and
(C) by inserting after subparagraph (B), the following:
``(C) an assurance that capacity development needs
resulting from gaps in the provision of services in
underserved low-income and rural low-income communities will
be addressed; and
``(D) with respect to fiscal year 2003 and subsequent
fiscal years, assurances that, in the planning and allocation
of resources, the State, through systems of HIV-related
health services provided under paragraphs (1), (2), and (3)
of section 2612(a), will make appropriate provision for the
HIV-related health and support service needs of individuals
who have been diagnosed with HIV disease but who are not
currently receiving such services, based on the epidemiologic
measures developed under paragraph (1)(C)(i);''.
SEC. 122. QUALITY MANAGEMENT.
(a) State Requirement for Quality Management.--Section
2617(b)(4) (42 U.S.C. 300ff-27(b)(4)) is amended--
(1) by striking subparagraph (C) and inserting the
following:
``(C) the State will provide for--
``(i) the establishment of a quality management program to
assess the extent to which medical 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 infections and to develop
strategies for improvements in the access to and quality of
medical services; and
``(ii) a periodic review (such as through an independent
peer review) to assess the quality and appropriateness of
HIV-related health and support services provided by entities
that receive funds from the State under this part;'';
(2) by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively;
(3) by inserting after subparagraph (D), the following:
``(E) an assurance that the State, through systems of HIV-
related health services provided under paragraphs (1), (2),
and (3) of section 2612(a), has considered strategies for
working with providers to make optimal use of financial
assistance under the State medicaid plan under title XIX of
the Social Security Act, the State Children's Health
Insurance Program under title XXI of such Act, and other
Federal grantees that provide HIV-related services, to
maximize access to quality HIV-related health and support
services;
(4) in subparagraph (F), as so redesignated, by striking
``and'' at the end; and
(5) in subparagraph (G), as so redesignated, by striking
the period and inserting ``; and''.
(b) Availability of Funds for Quality Management.--
(1) Availability of grant funds for planning and
evaluation.--Section 2618(c)(3) (42 U.S.C. 300ff-28(c)(3)) is
amended by inserting before the period ``, including not more
than $3,000,000 for all activities associated with its
quality management program''.
(2) Exception to combined ceiling on planning and
administration funds for states with small grants.--Paragraph
(6) of section 2618(c) (42 U.S.C. 300ff-28(c)(6)) is amended
to read as follows:
``(6) Exception for quality management.--Notwithstanding
paragraph (5), a State whose grant under this part for a
fiscal year does not exceed $1,500,000 may use not to exceed
20 percent of the amount of the grant for the purposes
described in paragraphs (3) and (4) if--
``(A) that portion of such amount in excess of 15 percent
of the grant is used for its quality management program; and
``(B) the State submits and the Secretary approves a plan
(in such form and containing such information as the
Secretary may prescribe) for use of funds for its quality
management program.''.
SEC. 123. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE
RELATIONSHIPS.
Section 2617(b)(4) (42 U.S.C. 300ff-27(b)(4)), as amended
by section 122(a), is further amended by adding at the end
the following:
``(H) that funded entities maintain appropriate
relationships with entities in the area served that
constitute key points of access to the health care system for
individuals with HIV disease (including emergency rooms,
substance abuse treatment programs, detoxification centers,
adult and juvenile detention facilities, sexually transmitted
disease clinics, HIV counseling and testing sites, and
homeless shelters), and other entities under section 2652(a),
for the purpose of facilitating early intervention for
individuals newly diagnosed with HIV disease and individuals
knowledgeable of their status but not in care.''.
SEC. 124. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
RELATED.
(a) Technical Amendment.--Section 3(c)(2)(A)(iii) of the
Ryan White CARE Act Amendments of 1996 (Public Law 104-146)
is amended by inserting ``before paragraph (2) as so
redesignated'' after ``inserting''.
(b) Services.--Section 2612(a)(1) (42 U.S.C. 300ff-
22(a)(1)), as so designated by section 121(a), is amended by
striking ``for individuals with HIV disease'' and inserting
``, subject to the conditions and limitations that apply
under such section''.
(c) Conforming Amendment to State Application
Requirement.--Section 2617(b)(2) (42 U.S.C. 300ff-27(b)(2)),
as amended by section 121(b), is further amended by adding at
the end the following:
``(F) an assurance that the State has procedures in place
to ensure that services provided with funds received under
this section meet the criteria specified in section
2604(b)(1)(B); and''.
SEC. 125. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES.
Section 2612(a) (42 U.S.C. 300ff-22(a)), as amended by
section 121, is further amended by adding at the end the
following:
``(6) Early intervention services.--The State, through
systems of HIV-related health services provided under
paragraphs (1), (2), and (3) of section 2612(a), may provide
early intervention services, as described in section
2651(b)(2), with follow-up referral, provided for the purpose
of facilitating the access of individuals receiving the
services to HIV-related health services, but only if the
entity providing such services--
``(A)(i) is receiving funds under section 2612(a)(1); or
``(ii) is an entity constituting a point of access to
services, as described in section 2617(b)(4), that maintains
a referral relationship with an entity described in clause
(i) and that is serving individuals at elevated risk of HIV
disease; and
``(B) demonstrates to the State's satisfaction that no
other Federal, State, or local funds are available for the
early intervention services the entity will provide with
funds received under this paragraph.''.
SEC. 126. AUTHORIZATION OF APPROPRIATIONS FOR HIV-RELATED
SERVICES FOR WOMEN AND CHILDREN.
Section 2625(c)(2) (42 U.S.C. 300ff-33(c)(2)) is amended by
striking ``fiscal years 1996 through 2000'' and inserting
``fiscal years 2001 through 2005''.
SEC. 127. REPEAL OF REQUIREMENT FOR COMPLETED INSTITUTE OF
MEDICINE REPORT.
Section 2628 (42 U.S.C. 300ff-36) is repealed.
SEC. 128. SUPPLEMENT 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 by adding
at the end the following:
``SEC. 2622. SUPPLEMENTAL GRANTS.
``(a) In General.--The Secretary shall award supplemental
grants to States determined to be eligible under subsection
(b) to enable such States to provide comprehensive services
of the type described in section 2612(a) to supplement the
services otherwise provided by the State under a grant under
this subpart in areas within the State that are not eligible
to receive grants under part A.
``(b) Eligibility.--To be eligible to receive a
supplemental grant under subsection (a) a State shall--
``(1) be eligible to receive a grant under this subpart;
and
``(2) demonstrate to the Secretary that there is severe
need (as defined for purposes of section 2603(b)(2)(A) for
supplemental financial assistance in areas in the State that
are not served through grants under part A.
``(c) Application.--A State that desires a grant under this
section shall, as part of the State application submitted
under section 2617, submit a detailed description of the
manner in which the State will use amounts received under the
grant and of the severity of need. Such description shall
include--
``(1) a report concerning the dissemination of supplemental
funds under this section and the plan for the utilization of
such funds;
``(2) a demonstration of the existing commitment of local
resources, both financial and in-kind;
``(3) a demonstration that the State will maintain HIV-
related activities at a level
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that is equal to not less than the level of such activities
in the State for the 1-year period preceding the fiscal year
for which the State is applying to receive a grant under this
part;
``(4) a demonstration of the ability of the State to
utilize such supplemental financial resources in a manner
that is immediately responsive and cost effective;
``(5) a demonstration that the resources will be allocated
in accordance with the local demographic incidence of AIDS
including appropriate allocations for services for infants,
children, women, and families with HIV disease;
``(6) a demonstration of the inclusiveness of the planning
process, with particular emphasis on affected communities and
individuals with HIV disease; and
``(7) a demonstration of the manner in which the proposed
services are consistent with local needs assessments and the
statewide coordinated statement of need.
``(d) Amount Reserved for Emerging Communities.--
``(1) In general.--For awarding grants under this section
for each fiscal year, the Secretary shall reserve the greater
of 50 percent of the amount to be utilized under subsection
(e) for such fiscal year or $5,000,000, to be provided to
States that contain emerging communities for use in such
communities.
``(2) Definition.--In paragraph (1), the term `emerging
community' means a metropolitan area--
``(A) that is not eligible for a grant under part A; and
``(B) for which there has been reported to the Director of
the Centers for Disease Control and Prevention a cumulative
total of between 1000 and 1999 cases of acquired immune
deficiency syndrome for the most recent period of 5 calendar
years for which such data are available.
``(e) Appropriations.--With respect to each fiscal year
beginning with fiscal year 2001, the Secretary, to carry out
this section, shall utilize 50 percent of the amount
appropriated under section 2677 to carry out part B for such
fiscal year that is in excess of the amount appropriated to
carry out such part in fiscal year preceding the fiscal year
involved.
SEC. 129. USE OF TREATMENT FUNDS.
(a) State Duties.--Section 2616(c) (42 U.S.C. 300ff-26(c))
is amended--
(1) in the matter preceding paragraph (1), by striking
``shall--'' and inserting ``shall use funds made available
under this section to--'';
(2) by redesignating paragraphs (1) through (5) as
subparagraphs (A) through (E), respectively and realigning
the margins of such subparagraphs appropriately;
(3) in subparagraph (D) (as so redesignated), by striking
``and'' at the end;
(4) in subparagraph (E) (as so redesignated), by striking
the period and ``; and''; and
(5) by adding at the end the following:
``(F) encourage, support, and enhance adherence to and
compliance with treatment regimens, including related medical
monitoring.'';
(6) by striking ``In carrying'' and inserting the
following:
``(1) In general.--In carrying''; and
(7) by adding at the end the following:
``(2) Limitations.--
``(A) In general.--No State shall use funds under paragraph
(1)(F) unless the limitations on access to HIV/AIDS
therapeutic regimens as defined in subsection (e)(2) are
eliminated.
``(B) Amount of funding.--No State shall use in excess of
10 percent of the amount set-aside for use under this section
in any fiscal year to carry out activities under paragraph
(1)(F) unless the State demonstrates to the Secretary that
such additional services are essential and in no way diminish
access to therapeutics.''.
(b) Supplement Grants.--Section 2616 (42 U.S.C. 300ff-
26(c)) is amended by adding at the end the following:
``(e) Supplemental Grants for the Provision of
Treatments.--
``(1) In general.--From amounts made available under
paragraph (5), the Secretary shall award supplemental grants
to States determined to be eligible under paragraph (2) to
enable such States to provide access to therapeutics to treat
HIV disease as provided by the State under subsection
(c)(1)(B) for individuals at or below 200 percent of the
Federal poverty line.
``(2) Criteria.--The Secretary shall develop criteria for
the awarding of grants under paragraph (1) to States that
demonstrate a severe need. In determining the criteria for
demonstrating State severity of need (as defined for purposes
of section 2603(b)(2)(A)), the Secretary shall consider
whether limitation to access exist such that--
``(A) the State programs under this section are unable to
provide HIV/AIDS therapeutic regimens to all eligible
individuals living at or below 200 percent of the Federal
poverty line; and
``(B) the State programs under this section are unable to
provide to all eligible individuals appropriate HIV/AIDS
therapeutic regimens as recommended in the most recent
Federal treatment guidelines.
``(3) State requirement.--The Secretary may not make a
grant to a State under this subsection unless the State
agrees that--
``(A) the State will make available (directly or through
donations from public or private entities) non-Federal
contributions toward the activities to be carried out under
the grant in an amount equal to $1 for each $4 of Federal
funds provided in the grant; and
``(B) the State will not impose eligibility requirements
for services or scope of benefits limitations under
subsection (a) that are more restrictive than such
requirements in effect as of January 1, 2000.
``(4) Use and coordination.--Amounts made available under a
grant under this subsection shall only be used by the State
to provide AIDS/HIV-related medications. The State shall
coordinate the use of such amounts with the amounts otherwise
provided under this section in order to maximize drug
coverage.
``(5) Funding.--
``(A) Reservation of amount.--The Secretary may reserve not
to exceed 4 percent, but not less than 2 percent, of any
amount referred to in section 2618(b)(2)(H) that is
appropriated for a fiscal year, to carry out this subsection.
``(B) Minimum amount.--In providing grants under this
subsection, the Secretary shall ensure that the amount of a
grant to a State under this part is not less than the amount
the State received under this part in the previous fiscal
year, as a result of grants provided under this
subsection.''.
(c) Supplement and not Supplant.--Section 2616 (42 U.S.C.
300ff-26(c)), as amended by subsection (b), is further
amended by adding at the end the following:
``(f) Supplement not Supplant.--Notwithstanding any other
provision of law, amounts made available under this section
shall be used to supplement and not supplant other funding
available to provide treatments of the type that may be
provided under this section.''.
SEC. 130. INCREASE IN MINIMUM ALLOTMENT.
(a) In General.--Section 2618(b)(1)(A)(i) (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) Technical Amendment.--Section 2618(b)(3)(B) (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''.
SEC. 131. SET-ASIDE FOR INFANTS, CHILDREN, AND WOMEN.
Section 2611(b) (42 U.S.C. 300ff-21(b)) is amended--
(1) by inserting ``for each population under this
subsection'' after ``State shall use''; and
(2) by striking ``ratio of the'' and inserting ``ratio of
each''.
Subtitle C--Amendments to Part C (Early Intervention Services)
SEC. 141. AMENDMENT OF HEADING; REPEAL OF FORMULA GRANT
PROGRAM.
(a) Amendment of Heading.--The heading of part C of title
XXVI is amended to read as follows:
``Part C--Early Intervention and Primary Care Services''.
(b) Repeal.--Part C of title XXVI (42 U.S.C. 300ff-41 et
seq.) is amended--
(1) by repealing subpart I; and
(2) by redesignating subparts II and III as subparts I and
II.
(c) Conforming Amendments.--
(1) Information regarding receipt of services.--Section
2661(a) (42 U.S.C. 300ff-61(a)) is amended by striking
``unless--'' and all that follows through ``(2) in the case
of'' and inserting ``unless, in the case of''.
(2) Additional agreements.--Section 2664 (42 U.S.C. 300ff-
64) is amended--
(A) in subsection (e)(5), by striking ``2642(b) or'';
(B) in subsection (f)(2), by striking ``2642(b) or''; and
(C) by striking subsection (h).
SEC. 142. PLANNING AND DEVELOPMENT GRANTS.
(a) Allowing Planning and Development Grant To Expand
Ability To Provide Primary Care Services.--Section 2654(c)
(42 U.S.C. 300ff-54(c)) is amended--
(1) in paragraph (1), to read as follows:
``(1) In general.--The Secretary may provide planning and
development grants to public and nonprofit private entities
for the purpose of--
``(A) enabling such entities to provide HIV early
intervention services; or
``(B) assisting such entities to expand the capacity,
preparedness, and expertise to deliver primary care services
to individuals with HIV disease in underserved low-income
communities on the condition that the funds are not used to
purchase or improve land or to purchase, construct, or
permanently improve (other than minor remodeling) any
building or other facility.''; and
(2) in paragraphs (2) and (3) by striking ``paragraph (1)''
each place that such appears and inserting ``paragraph
(1)(A)''.
(b) Amount; Duration.--Section 2654(c) (42 U.S.C. 300ff-
54(c)), as amended by subsection (a), 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.
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``(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) (42 U.S.C.
300ff-54(c)(5)), as so redesignated by subsection (b), is
amended by striking ``1 percent'' and inserting ``5
percent''.
SEC. 143. AUTHORIZATION OF APPROPRIATIONS FOR CATEGORICAL
GRANTS.
Section 2655 (42 U.S.C. 300ff-55) is amended by striking
``1996'' and all that follows through ``2000'' and inserting
``2001 through 2005''.
SEC. 144. ADMINISTRATIVE EXPENSES CEILING; QUALITY MANAGEMENT
PROGRAM.
Section 2664(g) (42 U.S.C. 300ff-64(g)) is amended--
(1) in paragraph (3), to read as follows:
``(3) the applicant will not expend more than 10 percent of
the grant for costs of administrative activities with respect
to the grant;'';
(2) in paragraph (4), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(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.''.
SEC. 145. PREFERENCE FOR CERTAIN AREAS.
Section 2651 (42 U.S.C. 300ff-51) is amended by adding at
the end the following:
``(d) Preference in Awarding Grants.--Beginning in fiscal
year 2001, in awarding new grants under this section, the
Secretary shall give preference to applicants that will use
amounts received under the grant to serve areas that are
otherwise not eligible to receive assistance under part A.''.
Subtitle D--Amendments to Part D (General Provisions)
SEC. 151. RESEARCH INVOLVING WOMEN, INFANTS, CHILDREN, AND
YOUTH.
(a) Elimination of Requirement To Enroll Significant
Numbers of Women and Children.--Section 2671(b) (42 U.S.C.
300ff-71(b)) is amended--
(1) in paragraph (1), by striking subparagraphs (C) and
(D); and
(2) by striking paragraphs (3) and (4).
(b) Information and Education.--Section 2671(d) (42 U.S.C.
300ff-71(d)) is amended by adding at the end the following:
``(4) The applicant will provide individuals with
information and education on opportunities to participate in
HIV/AIDS-related clinical research.''.
(c) Quality Management; Administrative Expenses Ceiling.--
Section 2671(f) (42 U.S.C. 300ff-71(f)) is amended--
(1) by striking the subsection heading and designation and
inserting the following:
``(f) Administration.--
``(1) Application.--''; and
(2) by adding at the end the following:
``(2) Quality management program.--A grantee under this
section shall implement a quality management program.''.
(d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g))
is amended by adding at the end the following: ``The
Secretary acting through the Director of NIH, shall examine
the distribution and availability of ongoing and appropriate
HIV/AIDS-related research projects to existing sites under
this section for purposes of enhancing and expanding
voluntary access to HIV-related research, especially within
communities that are not reasonably served by such
projects.''.
(e) Authorization of Appropriations.--Section 2671(j) (42
U.S.C. 300ff-71(j)) is amended by striking ``fiscal years
1996 through 2000'' and inserting ``fiscal years 2001 through
2005''.
SEC. 152. LIMITATION ON ADMINISTRATIVE EXPENSES.
Section 2671 (42 U.S.C. 300ff-71) is amended--
(1) by redesignating subsections (i) and (j), as
subsections (j) and (k), respectively; and
(2) by inserting after subsection (h), the following:
``(i) Limitation on Administrative Expenses.--
``(1) Determination by secretary.--Not later than 12 months
after the date of enactment of the Ryan White Care Act
Amendments of 2000, the Secretary, in consultation with
grantees under this part, shall conduct a review of the
administrative, program support, and direct service-related
activities that are carried out under this part to ensure
that eligible individuals have access to quality, HIV-related
health and support services and research opportunities under
this part, and to support the provision of such services.
``(2) Requirements.--
``(A) In general.--Not later than 180 days after the
expiration of the 12-month period referred to in paragraph
(1) the Secretary, in consultation with grantees under this
part, shall determine the relationship between the costs of
the activities referred to in paragraph (1) and the access of
eligible individuals to the services and research
opportunities described in such paragraph.
``(B) Limitation.--After a final determination under
subparagraph (A), the Secretary may not make a grant under
this part unless the grantee complies with such requirements
as may be included in such determination.''.
SEC. 153. EVALUATIONS AND REPORTS.
Section 2674(c) (42 U.S.C. 399ff-74(c)) is amended by
striking ``1991 through 1995'' and inserting ``2001 through
2005''.
SEC. 154. AUTHORIZATION OF APPROPRIATIONS FOR GRANTS UNDER
PARTS A AND B.
Section 2677 (42 U.S.C. 300ff-77) is amended to read as
follows:
``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated--
``(1) such sums as may be necessary to carry out part A for
each of the fiscal years 2001 through 2005; and
``(2) such sums as may be necessary to carry out part B for
each of the fiscal years 2001 through 2005.''.
Subtitle E--Amendments to Part F (Demonstration and Training)
SEC. 161. AUTHORIZATION OF APPROPRIATIONS.
(a) Schools; Centers.--Section 2692(c)(1) (42 U.S.C. 300ff-
111(c)(1)) is amended by striking ``fiscal years 1996 through
2000'' and inserting ``fiscal years 2001 through 2005''.
(b) Dental Schools.--Section 2692(c)(2) (42 U.S.C. 300ff-
111(c)(2)) is amended by striking ``fiscal years 1996 through
2000'' and inserting ``fiscal years 2001 through 2005''.
TITLE II--MISCELLANEOUS PROVISIONS
SEC. 201. INSTITUTE OF MEDICINE STUDY.
(a) In General.--Not later than 120 days after the date of
enactment of this Act, the Secretary of Health and Human
Services shall enter into a contract with the Institute of
Medicine for the conduct of 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.
(b) Requirements.--
(1) Completion.--The study under subsection (a) shall be
completed not later than 21 months after the date on which
the contract referred to in such subsection is entered into.
(2) Issues to be considered.--The study conducted under
subsection (a) shall consider--
(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;
(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;
and
(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) Report.--Not later than 90 days after the date on which
the study is completed under subsection (a), the Secretary of
Health and Human Services shall prepare and submit to the
appropriate committees of Congress a report describing the
manner in which the conclusions and recommendations of the
Institute of Medicine can be addressed and implemented.
The SPEAKER pro tempore. Pursuant to House Resolution 611, the
amendment in the nature of a substitute printed in the Congressional
Record and numbered 1 is considered adopted.
The text of
S. 2311, as amended pursuant to House Resolution 611, is
as follows:
Strike all after the enacting clause and insert the
following:
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. 122. Application.
TITLE II--CARE GRANT PROGRAM
Subtitle A--General Grant Provisions
Sec. 201. Priority for women, infants, and children.
Sec. 202. Use of grants.
Sec. 203. Grants to establish HIV care consortia.
Sec. 204. Provision of treatments.
Sec. 205. State application.
Sec. 206. Distribution of funds.
Sec. 207. Supplemental grants for certain States.
Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission
of HIV
Sec. 211. Repeals.
Sec. 212. Grants.
Sec. 213. Study by Institute of Medicine.
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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. 413. Coordination.
Sec. 414. Plan regarding release of prisoners with HIV disease.
Sec. 415. Audits.
Sec. 416. Administrative simplification.
Sec. 417. Authorization of appropriations for parts A and B.
TITLE V--GENERAL PROVISIONS
Sec. 501. Studies by Institute of Medicine.
Sec. 502. Development of rapid HIV test.
Sec. 503. Technical corrections.
TITLE VI--EFFECTIVE DATE
Sec. 601. Effective date.
TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES
Subtitle A--HIV Health Services Planning Councils
SEC. 101. MEMBERSHIP OF COUNCILS.
(a) In General.--Section 2602(b) of the Public Health
Service Act (42 U.S.C. 300ff-12(b)) is amended--
(1) in paragraph (1), by striking ``demographics of the
epidemic in the eligible area involved,'' and inserting
``demographics of the population of individuals with HIV
disease in the eligible area involved,''; and
(2) in paragraph (2)--
(A) in subparagraph (C), by inserting before the semicolon
the following: ``, including providers of housing and
homeless services'';
(B) in subparagraph (G), by striking ``or AIDS'';
(C) in subparagraph (K), by striking ``and'' at the end;
(D) in subparagraph (L), by striking the period and
inserting the following: ``, including but not limited to
providers of HIV prevention services; and''; and
(E) by adding at the end the following subparagraph:
``(M) representatives of individuals who formerly were
Federal, State, or local prisoners, were released from the
custody of the penal system during the preceding 3 years, and
had HIV disease as of the date on which the individuals were
so released.''.
(b) Conflicts of Interests.--Section 2602(b)(5) of the
Public Health Service Act (42 U.S.C. 300ff-12(b)(5)) is
amended by adding at the end the following subparagraph:
``(C) Composition of council.--The following applies
regarding the membership of a planning council under
paragraph (1):
``(i) Not less than 33 percent of the council shall be
individuals who are receiving HIV-related services pursuant
to a grant under section 2601(a), are not officers,
employees, or consultants to any entity that receives amounts
from such a grant, and do not represent any such entity, and
reflect the demographics of the population of individuals
with HIV disease as determined under paragraph (4)(A). For
purposes of the preceding sentence, an individual shall be
considered to be receiving such services if the individual is
a parent of, or a caregiver for, a minor child who is
receiving such services.
``(ii) With respect to membership on the planning council,
clause (i) may not be construed as having any effect on
entities that receive funds from grants under any of parts B
through F but do not receive funds from grants under section
2601(a), on officers or employees of such entities, or on
individuals who represent such entities.''.
SEC. 102. DUTIES OF COUNCILS.
(a) In General.--Section 2602(b)(4) of the Public Health
Service Act (42 U.S.C. 300ff-12(b)(4)) is amended--
(1) by redesignating subparagraphs (A) through (E) as
subparagraphs (C) through (G), respectively;
(2) by inserting before subparagraph (C) (as so
redesignated) the following subparagraphs:
``(A) determine the size and demographics of the population
of individuals with HIV disease;
``(B) determine the needs of such population, with
particular attention to--
``(i) individuals with HIV disease who know their HIV
status and are not receiving HIV-related services; and
``(ii) disparities in access and services among affected
subpopulations and historically underserved communities;'';
(3) in subparagraph (C) (as so redesignated), by striking
clauses (i) through (iv) and inserting the following:
``(i) size and demographics of the population of
individuals with HIV disease (as determined under
subparagraph (A)) and the needs of such population (as
determined under subparagraph (B));
``(ii) demonstrated (or probable) cost effectiveness and
outcome
Amendments:
Cosponsors: