Text: S.2311 — 106th Congress (1999-2000)All Bill Information (Except Text)

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Public Law No: 106-345 (10/20/2000)




[106th Congress Public Law 345]
[From the U.S. Government Printing Office]


<DOC>
[DOCID: f:publ345.106]


[[Page 114 STAT. 1319]]

Public Law 106-345
106th Congress

                                 An Act


 
  To amend the Public Health Service Act to revise and extend programs 
established under the Ryan White Comprehensive AIDS Resources Emergency 
   Act of 1990, and for other purposes. <<NOTE: Oct. 20, 2000 -  [S. 
                                2311]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Ryan White CARE 
Act Amendments of 2000.>> 

SECTION 1. SHORT TITLE. <<NOTE: 42 USC 201 note.>> 

    This Act may be cited as the ``Ryan White CARE Act Amendments of 
2000''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

 TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

            Subtitle A--HIV Health Services Planning Councils

Sec. 101. Membership of councils.
Sec. 102. Duties of councils.
Sec. 103. Open meetings; other additional provisions.

               Subtitle B--Type and Distribution of Grants

Sec. 111. Formula grants.
Sec. 112. Supplemental grants.

                      Subtitle C--Other Provisions

Sec. 121. Use of amounts.
Sec. 122. Application.

                      TITLE II--CARE GRANT PROGRAM

                  Subtitle A--General Grant Provisions

Sec. 201. Priority for women, infants, and children.
Sec. 202. Use of grants.
Sec. 203. Grants to establish HIV care consortia.
Sec. 204. Provision of treatments.
Sec. 205. State application.
Sec. 206. Distribution of funds.
Sec. 207. Supplemental grants for certain States.

 Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission 
                                 of HIV

Sec. 211. Repeals.
Sec. 212. Grants.
Sec. 213. Study by Institute of Medicine.

            Subtitle C--Certain Partner Notification Programs

Sec. 221. Grants for compliant partner notification programs.

[[Page 114 STAT. 1320]]

                 TITLE III--EARLY INTERVENTION SERVICES

                  Subtitle A--Formula Grants for States

Sec. 301. Repeal of program.

                     Subtitle B--Categorical Grants

Sec. 311. Preferences in making grants.
Sec. 312. Planning and development grants.
Sec. 313. Authorization of appropriations.

                     Subtitle C--General Provisions

Sec. 321. Provision of certain counseling services.
Sec. 322. Additional required agreements.

                 TITLE IV--OTHER PROGRAMS AND ACTIVITIES

 Subtitle A--Certain Programs for Research, Demonstrations, or Training

Sec. 401. Grants for coordinated services and access to research for 
           women, infants, children, and youth.
Sec. 402. AIDS education and training centers.

              Subtitle B--General Provisions in Title XXVI

Sec. 411. Evaluations and reports.
Sec. 412. Data collection through Centers for Disease Control and 
           Prevention.
Sec. 413. Coordination.
Sec. 414. Plan regarding release of prisoners with HIV disease.
Sec. 415. Audits.
Sec. 416. Administrative simplification.
Sec. 417. Authorization of appropriations for parts A and B.

                       TITLE V--GENERAL PROVISIONS

Sec. 501. Studies by Institute of Medicine.
Sec. 502. Development of rapid HIV test.
Sec. 503. Technical corrections.

                        TITLE VI--EFFECTIVE DATE

Sec. 601. Effective date.

 TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

            Subtitle A--HIV Health Services Planning Councils

SEC. 101. MEMBERSHIP OF COUNCILS.

    (a) In General.--Section 2602(b) of the Public Health Service Act 
(42 U.S.C. 300ff-12(b)) is amended--
            (1) in paragraph (1), by striking ``demographics of the 
        epidemic in the eligible area involved,'' and inserting 
        ``demographics of the population of individuals with HIV disease 
        in the eligible area involved,''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (C), by inserting before the 
                semicolon the following: ``, including providers of 
                housing and homeless services'';
                    (B) in subparagraph (G), by striking ``or AIDS'';
                    (C) in subparagraph (K), by striking ``and'' at the 
                end;
                    (D) in subparagraph (L), by striking the period and 
                inserting the following: ``, including but not limited 
                to providers of HIV prevention services; and''; and

[[Page 114 STAT. 1321]]

                    (E) by adding at the end the following subparagraph:
                    ``(M) representatives of individuals who formerly 
                were Federal, State, or local prisoners, were released 
                from the custody of the penal system during the 
                preceding 3 years, and had HIV disease as of the date on 
                which the individuals were so released.''.

    (b) Conflicts of Interests.--Section 2602(b)(5) of the Public Health 
Service Act (42 U.S.C. 300ff-12(b)(5)) is amended by adding at the end 
the following subparagraph:
                    ``(C) Composition of council.--The following applies 
                regarding the membership of a planning council under 
                paragraph (1):
                          ``(i) Not less than 33 percent of the council 
                      shall be individuals who are receiving HIV-related 
                      services pursuant to a grant under section 
                      2601(a), are not officers, employees, or 
                      consultants to any entity that receives amounts 
                      from such a grant, and do not represent any such 
                      entity, and reflect the demographics of the 
                      population of individuals with HIV disease as 
                      determined under paragraph (4)(A). For purposes of 
                      the preceding sentence, an individual shall be 
                      considered to be receiving such services if the 
                      individual is a parent of, or a caregiver for, a 
                      minor child who is receiving such services.
                          ``(ii) With respect to membership on the 
                      planning council, clause (i) may not be construed 
                      as having any effect on entities that receive 
                      funds from grants under any of parts B through F 
                      but do not receive funds from grants under section 
                      2601(a), on officers or employees of such 
                      entities, or on individuals who represent such 
                      entities.''.

SEC. 102. DUTIES OF COUNCILS.

    (a) In General.--Section 2602(b)(4) of the Public Health Service Act 
(42 U.S.C. 300ff-12(b)(4)) is amended--
            (1) by redesignating subparagraphs (A) through (E) as 
        subparagraphs (C) through (G), respectively;
            (2) by inserting before subparagraph (C) (as so 
        redesignated) the following subparagraphs:
                    ``(A) determine the size and demographics of the 
                population of individuals with HIV disease;
                    ``(B) determine the needs of such population, with 
                particular attention to--
                          ``(i) individuals with HIV disease who know 
                      their HIV status and are not receiving HIV-related 
                      services; and
                          ``(ii) disparities in access and services 
                      among affected subpopulations and historically 
                      underserved communities;'';
            (3) in subparagraph (C) (as so redesignated), by striking 
        clauses (i) through (iv) and inserting the following:
                          ``(i) size and demographics of the population 
                      of individuals with HIV disease (as determined 
                      under subparagraph (A)) and the needs of such 
                      population (as determined under subparagraph (B));
                          ``(ii) demonstrated (or probable) cost 
                      effectiveness and outcome effectiveness of 
                      proposed strategies and

[[Page 114 STAT. 1322]]

                      interventions, to the extent that data are 
                      reasonably available;
                          ``(iii) priorities of the communities with HIV 
                      disease for whom the services are intended;
                          ``(iv) coordination in the provision of 
                      services to such individuals with programs for HIV 
                      prevention and for the prevention and treatment of 
                      substance abuse, including programs that provide 
                      comprehensive treatment for such abuse;
                          ``(v) availability of other governmental and 
                      non-governmental resources, including the State 
                      medicaid plan under title XIX of the Social 
                      Security Act and the State Children's Health 
                      Insurance Program under title XXI of such Act to 
                      cover health care costs of eligible individuals 
                      and families with HIV disease; and
                          ``(vi) capacity development needs resulting 
                      from disparities in the availability of HIV-
                      related services in historically underserved 
                      communities;'';
            (4) in subparagraph (D) (as so redesignated), by amending 
        the subparagraph to read as follows:
                    ``(D) develop a comprehensive plan for the 
                organization and delivery of health and support services 
                described in section 2604 that--
                          ``(i) includes a strategy for identifying 
                      individuals who know their HIV status and are not 
                      receiving such services and for informing the 
                      individuals of and enabling the individuals to 
                      utilize the services, giving particular attention 
                      to eliminating disparities in access and services 
                      among affected subpopulations and historically 
                      underserved communities, and including discrete 
                      goals, a timetable, and an appropriate allocation 
                      of funds;
                          ``(ii) includes a strategy to coordinate the 
                      provision of such services with programs for HIV 
                      prevention (including outreach and early 
                      intervention) and for the prevention and treatment 
                      of substance abuse (including programs that 
                      provide comprehensive treatment services for such 
                      abuse); and
                          ``(iii) is compatible with any State or local 
                      plan for the provision of services to individuals 
                      with HIV disease;'';
            (5) in subparagraph (F) (as so redesignated), by striking 
        ``and'' at the end;
            (6) in subparagraph (G) (as so redesignated)--
                    (A) by striking ``public meetings,'' and inserting 
                ``public meetings (in accordance with paragraph (7)),''; 
                and
                    (B) by striking the period and inserting ``; and''; 
                and
            (7) by adding at the end the following subparagraph:
                    ``(H) coordinate with Federal grantees that provide 
                HIV-related services within the eligible area.''.

    (b) Process for Establishing Allocation Priorities.--Section 2602 of 
the Public Health Service Act (42 U.S.C. 300ff-12) is amended by adding 
at the end the following subsection:
    ``(d) Process for Establishing Allocation Priorities.--Promptly 
after the date of the submission of the report required in section 
501(b) of the Ryan White CARE Act Amendments of 2000 (relating to the 
relationship between epidemiological measures

[[Page 114 STAT. 1323]]

and health care for certain individuals with HIV disease), the 
Secretary, in consultation with planning councils and entities that 
receive amounts from grants under section 2601(a) or 2611, shall develop 
epidemiologic measures--
            ``(1) for establishing the number of individuals living with 
        HIV disease who are not receiving HIV-related health services; 
        and
            ``(2) for carrying out the duties under subsection (b)(4) 
        and section 2617(b).''.

    (c) Training.--Section 2602 of the Public Health Service Act (42 
U.S.C. 300ff-12), as amended by subsection (b) of this section, is 
amended by adding at the end the following subsection:
    ``(e) Training Guidance and Materials.--The Secretary shall provide 
to each chief elected official receiving a grant under section 2601(a) 
guidelines and materials for training members of the planning council 
under paragraph (1) regarding the duties of the council.''.
    (d) <<NOTE: 42 USC 300ff-13.>>  Conforming Amendment.--Section 
2603(c) of the Public Health Service Act (42 U.S.C. 300ff-12(b)) is 
amended by striking ``section 2602(b)(3)(A)'' and inserting ``section 
2602(b)(4)(C)''.

SEC. 103. OPEN MEETINGS; OTHER ADDITIONAL PROVISIONS.

    Section 2602(b) of the Public Health Service Act (42 U.S.C. 300ff-
12(b)) is amended--
            (1) in paragraph (3), by striking subparagraph (C); and
            (2) by adding at the end the following paragraph:
            ``(7) Public deliberations.--With respect to a planning 
        council under paragraph (1), the following applies:
                    ``(A) The council may not be chaired solely by an 
                employee of the grantee under section 2601(a).
                    ``(B) In accordance with criteria established by the 
                Secretary:
                          ``(i) <<NOTE: Public notice.>>  The meetings 
                      of the council shall be open to the public and 
                      shall be held only after adequate notice to the 
                      public.
                          ``(ii) <<NOTE: Records. Reports.>>  The 
                      records, reports, transcripts, minutes, agenda, or 
                      other documents which were made available to or 
                      prepared for or by the council shall be available 
                      for public inspection and copying at a single 
                      location.
                          ``(iii) Detailed minutes of each meeting of 
                      the council shall be kept. The accuracy of all 
                      minutes shall be certified to by the chair of the 
                      council.
                          ``(iv) This subparagraph does not apply to any 
                      disclosure of information of a personal nature 
                      that would constitute a clearly unwarranted 
                      invasion of personal privacy, including any 
                      disclosure of medical information or personnel 
                      matters.''.

               Subtitle B--Type and Distribution of Grants

SEC. 111. FORMULA GRANTS.

    (a) Expedited Distribution.--Section 2603(a)(2) of the Public Health 
Service Act (42 U.S.C. 300ff-13(a)(2)) is amended in the first sentence 
by striking ``for each of the fiscal years 1996 through 2000'' and 
inserting ``for a fiscal year''.

[[Page 114 STAT. 1324]]

    (b) Amount of Grant; Estimate of Living Cases.--
            (1) In general.--Section 2603(a)(3) of the Public Health 
        Service Act (42 U.S.C. 300ff-13(a)(3)) is amended--
                    (A) in subparagraph (C)(i), by inserting before the 
                semicolon the following: ``, except that (subject to 
                subparagraph (D)), for grants made pursuant to this 
                paragraph for fiscal year 2005 and subsequent fiscal 
                years, the cases counted for each 12-month period 
                beginning on or after July 1, 2004, shall be cases of 
                HIV disease (as reported to and confirmed by such 
                Director) rather than cases of acquired immune 
                deficiency syndrome''; and
                    (B) in subparagraph (C), in the matter after and 
                below clause (ii)(X)--
                          (i) in the first sentence, by inserting before 
                      the period the following: ``, and shall be 
                      reported to the congressional committees of 
                      jurisdiction''; and
                          (ii) by adding at the end the following 
                      sentence: ``Updates shall as applicable take into 
                      account the counting of cases of HIV disease 
                      pursuant to clause (i).''.
            (2) Determination of secretary regarding data on hiv 
        cases.--Section 2603(a)(3) of the Public Health Service Act (42 
        U.S.C. 300ff-13(a)(3)) is amended--
                    (A) by redesignating subparagraph (D) as 
                subparagraph (E); and
                    (B) by inserting after subparagraph (C) the 
                following subparagraph:
                    ``(D) Determination of secretary regarding data on 
                hiv cases.--
                          ``(i) <<NOTE: Deadline.>>  In general.--Not 
                      later than July 1, 2004, the Secretary shall 
                      determine whether there is data on cases of HIV 
                      disease from all eligible areas (reported to and 
                      confirmed by the Director of the Centers for 
                      Disease Control and Prevention) sufficiently 
                      accurate and reliable for use for purposes of 
                      subparagraph (C)(i). In making such a 
                      determination, the Secretary shall take into 
                      consideration the findings of the study under 
                      section 501(b) of the Ryan White CARE Act 
                      Amendments of 2000 (relating to the relationship 
                      between epidemiological measures and health care 
                      for certain individuals with HIV disease).
                          ``(ii) Effect of adverse determination.--If 
                      under clause (i) the Secretary determines that 
                      data on cases of HIV disease is not sufficiently 
                      accurate and reliable for use for purposes of 
                      subparagraph (C)(i), then notwithstanding such 
                      subparagraph, for any fiscal year prior to fiscal 
                      year 2007 the references in such subparagraph to 
                      cases of HIV disease do not have any legal effect.
                          ``(iii) Grants and technical assistance 
                      regarding counting of hiv cases.--Of the amounts 
                      appropriated under section 318B for a fiscal year, 
                      the Secretary shall reserve amounts to make grants 
                      and provide technical assistance to States and 
                      eligible areas with respect to obtaining data on 
                      cases of HIV disease to ensure that data on such 
                      cases is available from

[[Page 114 STAT. 1325]]

                      all States and eligible areas as soon as is 
                      practicable but not later than the beginning of 
                      fiscal year 2007.''.

    (c) Increases in Grant.--Section 2603(a)(4) of the Public Health 
Service Act (42 U.S.C. 300ff-13(a)(4)) is amended to read as follows:
            ``(4) Increases in grant.--
                    ``(A) In general.--For each fiscal year in a 
                protection period for an eligible area, the Secretary 
                shall increase the amount of the grant made pursuant to 
                paragraph (2) for the area to ensure that--
                          ``(i) for the first fiscal year in the 
                      protection period, the grant is not less than 98 
                      percent of the amount of the grant made for the 
                      eligible area pursuant to such paragraph for the 
                      base year for the protection period;
                          ``(ii) for any second fiscal year in such 
                      period, the grant is not less than 95 percent of 
                      the amount of such base year grant;
                          ``(iii) for any third fiscal year in such 
                      period, the grant is not less than 92 percent of 
                      the amount of the base year grant;
                          ``(iv) for any fourth fiscal year in such 
                      period, the grant is not less than 89 percent of 
                      the amount of the base year grant; and
                          ``(v) for any fifth or subsequent fiscal year 
                      in such period, if, pursuant to paragraph 
                      (3)(D)(ii), the references in paragraph (3)(C)(i) 
                      to HIV disease do not have any legal effect, the 
                      grant is not less than 85 percent of the amount of 
                      the base year grant.
                    ``(B) Special rule.--If for fiscal year 2005, 
                pursuant to paragraph (3)(D)(ii), data on cases of HIV 
                disease are used for purposes of paragraph (3)(C)(i), 
                the Secretary shall increase the amount of a grant made 
                pursuant to paragraph (2) for an eligible area to ensure 
                that the grant is not less than 98 percent of the amount 
                of the grant made for the area in fiscal year 2004.
                    ``(C) Base year; protection period.--With respect to 
                grants made pursuant to paragraph (2) for an eligible 
                area:
                          ``(i) The base year for a protection period is 
                      the fiscal year preceding the trigger grant-
                      reduction year.
                          ``(ii) The first trigger grant-reduction year 
                      is the first fiscal year (after fiscal year 2000) 
                      for which the grant for the area is less than the 
                      grant for the area for the preceding fiscal year.
                          ``(iii) A protection period begins with the 
                      trigger grant-reduction year and continues until 
                      the beginning of the first fiscal year for which 
                      the amount of the grant determined pursuant to 
                      paragraph (2) for the area equals or exceeds the 
                      amount of the grant determined under subparagraph 
                      (A).
                          ``(iv) Any subsequent trigger grant-reduction 
                      year is the first fiscal year, after the end of 
                      the preceding protection period, for which the 
                      amount of the grant is less than the amount of the 
                      grant for the preceding fiscal year.''.

[[Page 114 STAT. 1326]]

SEC. 112. SUPPLEMENTAL GRANTS.

    (a) In General.--Section 2603(b)(2) of the Public Health Service Act 
(42 U.S.C. 300ff-13(b)(2)) is amended--
            (1) in the heading for the paragraph, by striking 
        ``Definition'' and inserting ``Amount of grant'';
            (2) by redesignating subparagraphs (A) through (C) as 
        subparagraphs (B) through (D), respectively;
            (3) by inserting before subparagraph (B) (as so 
        redesignated) the following subparagraph:
                    ``(A) In general.--The amount of each grant made for 
                purposes of this subsection shall be determined by the 
                Secretary based on a weighting of factors under 
                paragraph (1), with severe need under subparagraph (B) 
                of such paragraph counting one-third.'';
            (4) in subparagraph (B) (as so redesignated)--
                    (A) in clause (ii), by striking ``and'' at the end;
                    (B) in clause (iii), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following clauses:
                          ``(iv) the current prevalence of HIV disease;
                          ``(v) an increasing need for HIV-related 
                      services, including relative rates of increase in 
                      the number of cases of HIV disease; and
                          ``(vi) unmet need for such services, as 
                      determined under section 2602(b)(4).'';
            (5) in subparagraph (C) (as so redesignated)--
                    (A) by striking ``subparagraph (A)'' each place such 
                term appears and inserting ``subparagraph (B)'';
                    (B) in the second sentence, by striking ``2 years 
                after the date of enactment of this paragraph'' and 
                inserting ``18 months after the date of the enactment of 
                the Ryan White CARE Act Amendments of 2000''; and
                    (C) by inserting after the second sentence the 
                following sentence: ``Such a mechanism shall be modified 
                to reflect the findings of the study under section 
                501(b) of the Ryan White CARE Act Amendments of 2000 
                (relating to the relationship between epidemiological 
                measures and health care for certain individuals with 
                HIV disease).''; and
            (6) in subparagraph (D) (as so redesignated), by striking 
        ``subparagraph (B)'' and inserting ``subparagraph (C)''.

    (b) Requirements for Application.--Section 2603(b)(1)(E) of the 
Public Health Service Act (42 U.S.C. 300ff-13(b)(1)(E)) is amended by 
inserting ``youth,'' after ``children,''.
    (c) Technical and Conforming Amendment.--Section 2603(b) of the 
Public Health Service Act (42 U.S.C. 300ff-13(b)) is amended--
            (1) by striking paragraph (4);
            (2) by redesignating paragraph (5) as paragraph (4); and
            (3) in paragraph (4) (as so redesignated), in subparagraph 
        (B), by striking ``grants'' and inserting ``grant''.

                      Subtitle C--Other Provisions

SEC. 121. USE OF AMOUNTS.

    (a) Primary Purposes.--Section 2604(b)(1) of the Public Health 
Service Act (42 U.S.C. 300ff-14(b)(1)) is amended--

[[Page 114 STAT. 1327]]

            (1) in the matter preceding subparagraph (A), by striking 
        ``HIV-related--'' and inserting ``HIV-related services, as 
        follows:'';
            (2) in subparagraph (A)--
                    (A) by striking ``outpatient'' and all that follows 
                through ``substance abuse treatment and'' and inserting 
                the following: ``Outpatient and ambulatory health 
                services, including substance abuse treatment,''; and
                    (B) by striking ``; and'' and inserting a period;
            (3) in subparagraph (B), by striking ``(B) inpatient case 
        management'' and inserting ``(C) Inpatient case management'';
            (4) by inserting after subparagraph (A) the following 
        subparagraph:
                    ``(B) Outpatient and ambulatory support services 
                (including case management), to the extent that such 
                services facilitate, enhance, support, or sustain the 
                delivery, continuity, or benefits of health services for 
                individuals and families with HIV disease.''; and
            (5) by adding at the end the following:
                    ``(D) Outreach activities that are intended to 
                identify individuals with HIV disease who know their HIV 
                status and are not receiving HIV-related services, and 
                that are--
                          ``(i) necessary to implement the strategy 
                      under section 2602(b)(4)(D), including activities 
                      facilitating the access of such individuals to 
                      HIV-related primary care services at entities 
                      described in paragraph (3)(A);
                          ``(ii) conducted in a manner consistent with 
                      the requirements under sections 2605(a)(3) and 
                      2651(b)(2); and
                          ``(iii) supplement, and do not supplant, such 
                      activities that are carried out with amounts 
                      appropriated under section 317.''.

    (b) Early Intervention Services.--Section 2604(b) (42 U.S.C. 300ff-
14(b)) of the Public Health Service Act is amended--
            (1) by redesignating paragraph (3) as paragraph (4); and
            (2) by inserting after paragraph (2) the following:
            ``(3) Early intervention services.--
                    ``(A) In general.--The purposes for which a grant 
                under section 2601 may be used include providing to 
                individuals with HIV disease early intervention services 
                described in section 2651(b)(2), with follow-up referral 
                provided for the purpose of facilitating the access of 
                individuals receiving the services to HIV-related health 
                services. The entities through which such services may 
                be provided under the grant include public health 
                departments, emergency rooms, substance abuse and mental 
                health treatment programs, detoxification centers, 
                detention facilities, clinics regarding sexually 
                transmitted diseases, homeless shelters, HIV disease 
                counseling and testing sites, health care points of 
                entry specified by eligible areas, federally qualified 
                health centers, and entities described in section 
                2652(a) that constitute a point of access to services by 
                maintaining referral relationships.
                    ``(B) Conditions.--With respect to an entity that 
                proposes to provide early intervention services under 
                subparagraph (A), such subparagraph applies only if the 
                entity

[[Page 114 STAT. 1328]]

                demonstrates to the satisfaction of the chief elected 
                official for the eligible area involved that--
                          ``(i) Federal, State, or local funds are 
                      otherwise inadequate for the early intervention 
                      services the entity proposes to provide; and
                          ``(ii) the entity will expend funds pursuant 
                      to such subparagraph to supplement and not 
                      supplant other funds available to the entity for 
                      the provision of early intervention services for 
                      the fiscal year involved.''.

    (c) Priority for Women, Infants, and Children.--Section 2604(b) (42 
U.S.C. 300ff-14(b)) of the Public Health Service Act is amended in 
paragraph (4) (as redesignated by subsection (b)(1) of this section) by 
amending the paragraph to read as follows:
            ``(4) Priority for women, infants and children.--
                    ``(A) In general.--For the purpose of providing 
                health and support services to infants, children, youth, 
                and women with HIV disease, including treatment measures 
                to prevent the perinatal transmission of HIV, the chief 
                elected official of an eligible area, in accordance with 
                the established priorities of the planning council, 
                shall for each of such populations in the eligible area 
                use, from the grants made for the area under section 
                2601(a) for a fiscal year, not less than the percentage 
                constituted by the ratio of the population involved 
                (infants, children, youth, or women in such area) with 
                acquired immune deficiency syndrome to the general 
                population in such area of individuals with such 
                syndrome.
                    ``(B) Waiver.--With respect to the population 
                involved, the Secretary may provide to the chief elected 
                official of an eligible area a waiver of the requirement 
                of subparagraph (A) if such official demonstrates to the 
                satisfaction of the Secretary that the population is 
                receiving HIV-related health services through the State 
                medicaid program under title XIX of the Social Security 
                Act, the State children's health insurance program under 
                title XXI of such Act, or other Federal or State 
                programs.''.

    (d) Quality Management.--Section 2604 of the Public Health Service 
Act (42 U.S.C. 300ff-14) is amended--
            (1) by redesignating subsections (c) through (f) as 
        subsections (d) through (g), respectively; and
            (2) by inserting after subsection (b) the following:

    ``(c) Quality Management.--
            ``(1) Requirement.--The chief elected official of an 
        eligible area that receives a grant under this part shall 
        provide for the establishment of a quality management program to 
        assess the extent to which HIV health services provided to 
        patients under the grant are consistent with the most recent 
        Public Health Service guidelines for the treatment of HIV 
        disease and related opportunistic infection, and as applicable, 
        to develop strategies for ensuring that such services are 
        consistent with the guidelines for improvement in the access to 
        and quality of HIV health services.
            ``(2) Use of funds.--From amounts received under a grant 
        awarded under this part for a fiscal year, the chief elected 
        official of an eligible area may (in addition to amounts to 
        which subsection (f)(1) applies) use for activities associated

[[Page 114 STAT. 1329]]

        with the quality management program required in paragraph (1) 
        not more than the lesser of--
                    ``(A) 5 percent of amounts received under the grant; 
                or
                    ``(B) $3,000,000.''.

SEC. 122. APPLICATION.

    (a) In General.--Section 2605(a) of the Public Health Service Act 
(42 U.S.C. 300ff-15(a)) is amended--
            (1) by redesignating paragraphs (3) through (6) as 
        paragraphs (5) through (8), respectively; and
            (2) by inserting after paragraph (2) the following 
        paragraphs:
            ``(3) that entities within the eligible area that receive 
        funds under a grant under this part will maintain appropriate 
        relationships with entities in the eligible area served that 
        constitute key points of access to the health care system for 
        individuals with HIV disease (including emergency rooms, 
        substance abuse treatment programs, detoxification centers, 
        adult and juvenile detention facilities, sexually transmitted 
        disease clinics, HIV counseling and testing sites, mental health 
        programs, and homeless shelters), and other entities under 
        section 2604(b)(3) and 2652(a), for the purpose of facilitating 
        early intervention for individuals newly diagnosed with HIV 
        disease and individuals knowledgeable of their HIV status but 
        not in care;
            ``(4) that the chief elected official of the eligible area 
        will satisfy all requirements under section 2604(c);''.

    (b) Conforming Amendments.--Section 2605(a) (42 U.S.C. 300ff-
15(a)(1)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A), by striking ``services to 
                individuals with HIV disease'' and inserting ``services 
                as described in section 2604(b)(1)''; and
                    (B) in subparagraph (B), by striking ``services for 
                individuals with HIV disease'' and inserting ``services 
                as described in section 2604(b)(1)'';
            (2) in paragraph (7) (as redesignated by subsection (a)(1) 
        of this section), by striking ``and'' at the end;
            (3) in paragraph (8) (as so redesignated), by striking the 
        period and inserting ``; and''; and
            (4) by adding at the end the following paragraph:
            ``(9) that the eligible area has procedures in place to 
        ensure that services provided with funds received under this 
        part meet the criteria specified in section 2604(b)(1).''.

                      TITLE II--CARE GRANT PROGRAM

                  Subtitle A--General Grant Provisions

SEC. 201. PRIORITY FOR WOMEN, INFANTS, AND CHILDREN.

    Section 2611(b) of the Public Health Service Act (42 U.S.C. 300ff-
21(b)) is amended to read as follows:
    ``(b) Priority for Women, Infants and Children.--
            ``(1) In general.--For the purpose of providing health and 
        support services to infants, children, youth, and women with HIV 
        disease, including treatment measures to prevent the

[[Page 114 STAT. 1330]]

        perinatal transmission of HIV, a State shall for each of such 
        populations use, of the funds allocated under this part to the 
        State for a fiscal year, not less than the percentage 
        constituted by the ratio of the population involved (infants, 
        children, youth, or women in the State) with acquired immune 
        deficiency syndrome to the general population in the State of 
        individuals with such syndrome.
            ``(2) Waiver.--With respect to the population involved, the 
        Secretary may provide to a State a waiver of the requirement of 
        paragraph (1) if the State demonstrates to the satisfaction of 
        the Secretary that the population is receiving HIV-related 
        health services through the State medicaid program under title 
        XIX of the Social Security Act, the State children's health 
        insurance program under title XXI of such Act, or other Federal 
        or State programs.''.

SEC. 202. USE OF GRANTS.

    Section 2612 of the Public Health Service Act (42 U.S.C. 300ff-22) 
is amended--
            (1) by striking ``A State may use'' and inserting ``(a) In 
        General.--A State may use''; and
            (2) by adding at the end the following subsections:

    ``(b) Support Services; Outreach.--The purposes for which a grant 
under this part may be used include delivering or enhancing the 
following:
            ``(1) Outpatient and ambulatory support services under 
        section 2611(a) (including case management) to the extent that 
        such services facilitate, enhance, support, or sustain the 
        delivery, continuity, or benefits of health services for 
        individuals and families with HIV disease.
            ``(2) Outreach activities that are intended to identify 
        individuals with HIV disease who know their HIV status and are 
        not receiving HIV-related services, and that are--
                    ``(A) necessary to implement the strategy under 
                section 2617(b)(4)(B), including activities facilitating 
                the access of such individuals to HIV-related primary 
                care services at entities described in subsection 
                (c)(1);
                    ``(B) conducted in a manner consistent with the 
                requirement under section 2617(b)(6)(G) and 2651(b)(2); 
                and
                    ``(C) supplement, and do not supplant, such 
                activities that are carried out with amounts 
                appropriated under section 317.

    ``(c) Early Intervention Services.--
            ``(1) In general.--The purposes for which a grant under this 
        part may be used include providing to individuals with HIV 
        disease early intervention services described in section 
        2651(b)(2), with follow-up referral provided for the purpose of 
        facilitating the access of individuals receiving the services to 
        HIV-related health services. The entities through which such 
        services may be provided under the grant include public health 
        departments, emergency rooms, substance abuse and mental health 
        treatment programs, detoxification centers, detention 
        facilities, clinics regarding sexually transmitted diseases, 
        homeless shelters, HIV disease counseling and testing sites, 
        health care points of entry specified by States or eligible 
        areas, federally qualified health centers, and entities 
        described in section

[[Page 114 STAT. 1331]]

        2652(a) that constitute a point of access to services by 
        maintaining referral relationships.
            ``(2) Conditions.--With respect to an entity that proposes 
        to provide early intervention services under paragraph (1), such 
        paragraph applies only if the entity demonstrates to the 
        satisfaction of the State involved that--
                    ``(A) Federal, State, or local funds are otherwise 
                inadequate for the early intervention services the 
                entity proposes to provide; and
                    ``(B) the entity will expend funds pursuant to such 
                paragraph to supplement and not supplant other funds 
                available to the entity for the provision of early 
                intervention services for the fiscal year involved.

    ``(d) Quality Management.--
            ``(1) Requirement.--Each State that receives a grant under 
        this part shall provide for the establishment of a quality 
        management program to assess the extent to which HIV health 
        services provided to patients under the grant are consistent 
        with the most recent Public Health Service guidelines for the 
        treatment of HIV disease and related opportunistic infection, 
        and as applicable, to develop strategies for ensuring that such 
        services are consistent with the guidelines for improvement in 
        the access to and quality of HIV health services.
            ``(2) Use of funds.--From amounts received under a grant 
        awarded under this part for a fiscal year, the State may (in 
        addition to amounts to which section 2618(b)(5) applies) use for 
        activities associated with the quality management program 
        required in paragraph (1) not more than the lesser of--
                    ``(A) 5 percent of amounts received under the grant; 
                or
                    ``(B) $3,000,000.''.

SEC. 203. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

    Section 2613 of the Public Health Service Act (42 U.S.C. 300ff-23) 
is amended--
            (1) in subsection (b)(1)--
                    (A) in subparagraph (A), by inserting before the 
                semicolon the following: ``, particularly those 
                experiencing disparities in access and services and 
                those who reside in historically underserved 
                communities''; and
                    (B) in subparagraph (B), by inserting after ``by 
                such consortium'' the following: ``is consistent with 
                the comprehensive plan under section 2617(b)(4) and'';
            (2) in subsection (c)(1)--
                    (A) in subparagraph (D), by striking ``and'' after 
                the semicolon at the end;
                    (B) in subparagraph (E), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following subparagraph:
                    ``(F) demonstrates that adequate planning occurred 
                to address disparities in access and services and 
                historically underserved communities.''; and
            (3) in subsection (c)(2)--
                    (A) in subparagraph (B), by striking ``and'' after 
                the semicolon;
                    (B) in subparagraph (C), by striking the period and 
                inserting ``; and''; and

[[Page 114 STAT. 1332]]

                    (C) by inserting after subparagraph (C) the 
                following subparagraph:
                    ``(D) the types of entities described in section 
                2602(b)(2).''.

SEC. 204. PROVISION OF TREATMENTS.

    (a) In General.--Section 2616(c) of the Public Health Service Act 
(42 U.S.C. 300ff-26(c)) is amended--
            (1) in paragraph (4), by striking ``and'' after the 
        semicolon at the end;
            (2) in paragraph (5), by striking the period and inserting 
        ``; and''; and
            (3) by inserting after paragraph (5) the following:
            ``(6) encourage, support, and enhance adherence to and 
        compliance with treatment regimens, including related medical 
        monitoring.

Of the amount reserved by a State for a fiscal year for use under this 
section, the State may not use more than 5 percent to carry out services 
under paragraph (6), except that the percentage applicable with respect 
to such paragraph is 10 percent if the State demonstrates to the 
Secretary that such additional services are essential and in no way 
diminish access to the therapeutics described in subsection (a).''.
    (b) Health Insurance and Plans.--Section 2616 of the Public Health 
Service Act (42 U.S.C. 300ff-26) is amended by adding at the end the 
following subsection:
    ``(e) Use of Health Insurance and Plans.--
            ``(1) In general.--In carrying out subsection (a), a State 
        may expend a grant under this part to provide the therapeutics 
        described in such subsection by paying on behalf of individuals 
        with HIV disease the costs of purchasing or maintaining health 
        insurance or plans whose coverage includes a full range of such 
        therapeutics and appropriate primary care services.
            ``(2) Limitation.--The authority established in paragraph 
        (1) applies only to the extent that, for the fiscal year 
        involved, the costs of the health insurance or plans to be 
        purchased or maintained under such paragraph do not exceed the 
        costs of otherwise providing therapeutics described in 
        subsection (a).''.

SEC. 205. STATE APPLICATION.

    (a) Determination of Size and Needs of Population; Comprehensive 
Plan.--Section 2617(b) of the Public Health Service Act (42 U.S.C. 
300ff-27(b)) is amended--
            (1) by redesignating paragraphs (2) through (4) as 
        paragraphs (4) through (6), respectively;
            (2) by inserting after paragraph (1) the following 
        paragraphs:
            ``(2) a determination of the size and demographics of the 
        population of individuals with HIV disease in the State;
            ``(3) a determination of the needs of such population, with 
        particular attention to--
                    ``(A) individuals with HIV disease who know their 
                HIV status and are not receiving HIV-related services; 
                and
                    ``(B) disparities in access and services among 
                affected subpopulations and historically underserved 
                communities;''; and
            (3) in paragraph (4) (as so redesignated)--

[[Page 114 STAT. 1333]]

                    (A) by striking ``comprehensive plan for the 
                organization'' and inserting ``comprehensive plan that 
                describes the organization'';
                    (B) by striking ``, including--'' and inserting ``, 
                and that--'';
                    (C) by redesignating subparagraphs (A) through (C) 
                as subparagraphs (D) through (F), respectively;
                    (D) by inserting before subparagraph (C) the 
                following subparagraphs:
                    ``(A) establishes priorities for the allocation of 
                funds within the State based on--
                          ``(i) size and demographics of the population 
                      of individuals with HIV disease (as determined 
                      under paragraph (2)) and the needs of such 
                      population (as determined under paragraph (3));
                          ``(ii) availability of other governmental and 
                      non-governmental resources, including the State 
                      medicaid plan under title XIX of the Social 
                      Security Act and the State Children's Health 
                      Insurance Program under title XXI of such Act to 
                      cover health care costs of eligible individuals 
                      and families with HIV disease;
                          ``(iii) capacity development needs resulting 
                      from disparities in the availability of HIV-
                      related services in historically underserved 
                      communities and rural communities; and
                          ``(iv) the efficiency of the administrative 
                      mechanism of the State for rapidly allocating 
                      funds to the areas of greatest need within the 
                      State;
                    ``(B) includes a strategy for identifying 
                individuals who know their HIV status and are not 
                receiving such services and for informing the 
                individuals of and enabling the individuals to utilize 
                the services, giving particular attention to eliminating 
                disparities in access and services among affected 
                subpopulations and historically underserved communities, 
                and including discrete goals, a timetable, and an 
                appropriate allocation of funds;
                    ``(C) includes a strategy to coordinate the 
                provision of such services with programs for HIV 
                prevention (including outreach and early intervention) 
                and for the prevention and treatment of substance abuse 
                (including programs that provide comprehensive treatment 
                services for such abuse);'';
                    (E) in subparagraph (D) (as redesignated by 
                subparagraph (C) of this paragraph), by inserting 
                ``describes'' before ``the services and activities'';
                    (F) in subparagraph (E) (as so redesignated), by 
                inserting ``provides'' before ``a description''; and
                    (G) in subparagraph (F) (as so redesignated), by 
                inserting ``provides'' before ``a description''.

    (b) Public Participation.--Section 2617(b) of the Public Health 
Service Act, <<NOTE: 42 USC 300ff-27.>>  as amended by subsection (a) of 
this section, is amended--
            (1) in paragraph (5), by striking ``HIV'' and inserting 
        ``HIV disease''; and
            (2) in paragraph (6), by amending subparagraph (A) to read 
        as follows:

[[Page 114 STAT. 1334]]

                    ``(A) the public health agency that is administering 
                the grant for the State engages in a public advisory 
                planning process, including public hearings, that 
                includes the participants under paragraph (5), and the 
                types of entities described in section 2602(b)(2), in 
                developing the comprehensive plan under paragraph (4) 
                and commenting on the implementation of such plan;''.

    (c) Health Care Relationships.--Section 2617(b) of the Public Health 
Service Act, <<NOTE: 42 USC 300ff-27.>>  as amended by subsection (a) of 
this section, is amended in paragraph (6)--
            (1) in subparagraph (E), by striking ``and'' at the end;
            (2) in subparagraph (F), by striking the period and 
        inserting ``; and''; and
            (3) by adding at the end the following subparagraph:
                    ``(G) entities within areas in which activities 
                under the grant are carried out will maintain 
                appropriate relationships with entities in the area 
                served that constitute key points of access to the 
                health care system for individuals with HIV disease 
                (including emergency rooms, substance abuse treatment 
                programs, detoxification centers, adult and juvenile 
                detention facilities, sexually transmitted disease 
                clinics, HIV counseling and testing sites, mental health 
                programs, and homeless shelters), and other entities 
                under section 2612(c) and 2652(a), for the purpose of 
                facilitating early intervention for individuals newly 
                diagnosed with HIV disease and individuals knowledgeable 
                of their HIV status but not in care.''.

SEC. 206. DISTRIBUTION OF FUNDS.

    (a) Minimum Allotment.--Section 2618 of the Public Health Service 
Act (42 U.S.C. 300ff-28) is amended--
            (1) by redesignating subsections (b) through (e) as 
        subsections (a) through (d), respectively; and
            (2) in subsection (a) (as so redesignated), in paragraph 
        (1)(A)(i)--
                    (A) in subclause (I), by striking ``$100,000'' and 
                inserting ``$200,000''; and
                    (B) in subclause (II), by striking ``$250,000'' and 
                inserting ``$500,000''.

    (b) Amount of Grant; Estimate of Living Cases.--Section 2618(a) of 
the Public Health Service Act (as redesignated by subsection (a)(1) of 
this section) is amended in paragraph (2)--
            (1) in subparagraph (D)(i), by inserting before the 
        semicolon the following: ``, except that (subject to 
        subparagraph (E)), for grants made pursuant to this paragraph or 
        section 2620 for fiscal year 2005 and subsequent fiscal years, 
        the cases counted for each 12-month period beginning on or after 
        July 1, 2004, shall be cases of HIV disease (as reported to and 
        confirmed by such Director) rather than cases of acquired immune 
        deficiency syndrome'';
            (2) by redesignating subparagraphs (E) through (H) as 
        subparagraphs (F) through (I), respectively; and
            (3) by inserting after subparagraph (D) the following 
        subparagraph:
                    ``(E) Determination of secretary regarding data on 
                hiv cases.--If under section 2603(a)(3)(D)(i) the 
                Secretary determines that data on cases of HIV disease 
                are

[[Page 114 STAT. 1335]]

                not sufficiently accurate and reliable, then 
                notwithstanding subparagraph (D) of this paragraph, for 
                any fiscal year prior to fiscal year 2007 the references 
                in such subparagraph to cases of HIV disease do not have 
                any legal effect.''.

    (c) Increases in Formula Amount.--Section 2618(a) of the Public 
Health Service Act <<NOTE: 42 USC 300ff-28.>>  (as redesignated by 
subsection (a)(1) of this section) is amended--
            (1) in paragraph (1)(A)(ii), by inserting before the 
        semicolon the following: ``and then, as applicable, increased 
        under paragraph (2)(H)''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (A)(i), by striking 
                ``subparagraph (H)'' and inserting ``subparagraphs (H) 
                and (I)''; and
                    (B) in subparagraph (H) (as redesignated by 
                subsection (b)(2) of this section), by amending the 
                subparagraph to read as follows:
                    ``(H) Limitation.--
                          ``(i) In general.--The Secretary shall ensure 
                      that the amount of a grant awarded to a State or 
                      territory under section 2611 or subparagraph 
                      (I)(i) for a fiscal year is not less than--
                                    ``(I) with respect to fiscal year 
                                2001, 99 percent;
                                    ``(II) with respect to fiscal year 
                                2002, 98 percent;
                                    ``(III) with respect to fiscal year 
                                2003, 97 percent;
                                    ``(IV) with respect to fiscal year 
                                2004, 96 percent; and
                                    ``(V) with respect to fiscal year 
                                2005, 95 percent,
                      of the amount such State or territory received for 
                      fiscal year 2000 under section 2611 or 
                      subparagraph (I)(i), respectively (notwithstanding 
                      such subparagraph). In administering this 
                      subparagraph, the Secretary shall, with respect to 
                      States or territories that will under such section 
                      receive grants in amounts that exceed the amounts 
                      that such States received under such section or 
                      subparagraph for fiscal year 2000, proportionally 
                      reduce such amounts to ensure compliance with this 
                      subparagraph. In making such reductions, the 
                      Secretary shall ensure that no such State receives 
                      less than that State received for fiscal year 
                      2000.
                          ``(ii) Ratable reduction.--If the amount 
                      appropriated under section 2677 for a fiscal year 
                      and available for grants under section 2611 or 
                      subparagraph (I)(i) is less than the amount 
                      appropriated and available for fiscal year 2000 
                      under section 2611 or subparagraph (I)(i), 
                      respectively, the limitation contained in clause 
                      (i) for the grants involved shall be reduced by a 
                      percentage equal to the percentage of the 
                      reduction in such amounts appropriated and 
                      available.''.

    (d) Territories.--Section 2618(a) of the Public Health Service Act 
(as redesignated by subsection (a)(1) of this section) is amended in 
paragraph (1)(B) by inserting ``the greater of $50,000 or'' after 
``shall be''.
    (e) Separate Treatment Drug Grants.--Section 2618(a) of the Public 
Health Service Act (as redesignated by subsection (a)(1)

[[Page 114 STAT. 1336]]

of this section and amended by subsection (b)(2) of this section) is 
amended in paragraph (2)(I)--
            (1) by redesignating clauses (i) and (ii) as subclauses (I) 
        and (II), respectively;
            (2) by striking ``(I) Appropriations'' and all that follows 
        through ``With respect to'' and inserting the following:
                    ``(I) Appropriations for treatment drug program.--
                          ``(i) Formula grants.--With respect to'';
            (3) in subclause (I) of clause (i) (as designated by 
        paragraphs (1) and (2)), by inserting before the semicolon the 
        following: ``, less the percentage reserved under clause 
        (ii)(V)''; and
            (4) by adding at the end the following clause:
                          ``(ii) Supplemental treatment drug grants.--
                                    ``(I) In general.--From amounts made 
                                available under subclause (V), the 
                                Secretary shall make supplemental grants 
                                to States described in subclause (II) to 
                                enable such States to increase access to 
                                therapeutics described in section 
                                2616(a), as provided by the State under 
                                section 2616(c)(2).
                                    ``(II) Eligible states.--For 
                                purposes of subclause (I), a State 
                                described in this subclause is a State 
                                that, in accordance with criteria 
                                established by the Secretary, 
                                demonstrates a severe need for a grant 
                                under such subclause. In developing such 
                                criteria, the Secretary shall consider 
                                eligibility standards, formulary 
                                composition, and the number of eligible 
                                individuals at or below 200 percent of 
                                the official poverty line to whom the 
                                State is unable to provide therapeutics 
                                described in section 2616(a).
                                    ``(III) State requirements.--The 
                                Secretary may not make a grant to a 
                                State under this clause unless the State 
                                agrees that--
                                            ``(aa) the State will make 
                                        available (directly or through 
                                        donations from public or private 
                                        entities) non-Federal 
                                        contributions toward the 
                                        activities to be carried out 
                                        under the grant in an amount 
                                        equal to $1 for each $4 of 
                                        Federal funds provided in the 
                                        grant; and
                                            ``(bb) <<NOTE: Effective 
                                        date.>>  the State will not 
                                        impose eligibility requirements 
                                        for services or scope of 
                                        benefits limitations under 
                                        section 2616(a) that are more 
                                        restrictive than such 
                                        requirements in effect as of 
                                        January 1, 2000.
                                            ``(IV) Use and 
                                        coordination.--Amounts made 
                                        available under a grant under 
                                        this clause shall only be used 
                                        by the State to provide HIV/
                                        AIDS-related medications. The 
                                        State shall coordinate the use 
                                        of such amounts with the amounts 
                                        otherwise provided under section 
                                        2616(a) in order to maximize 
                                        drug coverage.
                                    ``(V) Funding.--For the purpose of 
                                making grants under this clause, the 
                                Secretary shall each fiscal year reserve 
                                3 percent of the amount referred

[[Page 114 STAT. 1337]]

                                to in clause (i) with respect to section 
                                2616, subject to subclause (VI).
                                    ``(VI) Limitation.--In reserving 
                                amounts under subclause (V) and making 
                                grants under this clause for a fiscal 
                                year, the Secretary shall ensure for 
                                each State that the total of the grant 
                                under section 2611 for the State for the 
                                fiscal year and the grant under clause 
                                (i) for the State for the fiscal year is 
                                not less than such total for the State 
                                for the preceding fiscal year.''.

    (f) Technical Amendment.--Section 2618(a) of the Public Health 
Service Act <<NOTE: 42 USC 300ff-28.>>  (as redesignated by subsection 
(a)(1) of this section) is amended in paragraph (3)(B) by striking ``and 
the Republic of the Marshall Islands'' and inserting ``the Republic of 
the Marshall Islands, the Federated States of Micronesia, and the 
Republic of Palau, and only for purposes of paragraph (1) the 
Commonwealth of Puerto Rico''.

SEC. 207. SUPPLEMENTAL GRANTS FOR CERTAIN STATES.

    Subpart I of part B of title XXVI of the Public Health Service 
Act <<NOTE: 42 USC 300ff-31.>>  (42 U.S.C. 300ff-11 et seq.) is 
amended--
            (1) by striking section 2621; and
            (2) by inserting after section 2619 the following section:

``SEC. 2620. <<NOTE: 42 USC 300ff-30.>>  SUPPLEMENTAL GRANTS.

    ``(a) In General.--The Secretary shall award supplemental grants to 
States determined to be eligible under subsection (b) to enable such 
States to provide comprehensive services of the type described in 
section 2612(a) to supplement the services otherwise provided by the 
State under a grant under this subpart in emerging communities within 
the State that are not eligible to receive grants under part A.
    ``(b) Eligibility.--To be eligible to receive a supplemental grant 
under subsection (a), a State shall--
            ``(1) be eligible to receive a grant under this subpart;
            ``(2) demonstrate the existence in the State of an emerging 
        community as defined in subsection (d)(1); and
            ``(3) submit the information described in subsection (c).

    ``(c) Reporting Requirements.--A State that desires a grant under 
this section shall, as part of the State application submitted under 
section 2617, submit a detailed description of the manner in which the 
State will use amounts received under the grant and of the severity of 
need. Such description shall include--
            ``(1) <<NOTE: Reports.>>  a report concerning the 
        dissemination of supplemental funds under this section and the 
        plan for the utilization of such funds in the emerging 
        community;
            ``(2) a demonstration of the existing commitment of local 
        resources, both financial and in-kind;
            ``(3) a demonstration that the State will maintain HIV-
        related activities at a level that is equal to not less than the 
        level of such activities in the State for the 1-year period 
        preceding the fiscal year for which the State is applying to 
        receive a grant under this part;
            ``(4) a demonstration of the ability of the State to utilize 
        such supplemental financial resources in a manner that is 
        immediately responsive and cost effective;
            ``(5) a demonstration that the resources will be allocated 
        in accordance with the local demographic incidence of AIDS

[[Page 114 STAT. 1338]]

        including appropriate allocations for services for infants, 
        children, women, and families with HIV disease;
            ``(6) a demonstration of the inclusiveness of the planning 
        process, with particular emphasis on affected communities and 
        individuals with HIV disease; and
            ``(7) a demonstration of the manner in which the proposed 
        services are consistent with local needs assessments and the 
        statewide coordinated statement of need.

    ``(d) Definition of Emerging Community.--In this section, the term 
`emerging community' means a metropolitan area--
            ``(1) that is not eligible for a grant under part A; and
            ``(2) for which there has been reported to the Director of 
        the Centers for Disease Control and Prevention a cumulative 
        total of between 500 and 1,999 cases of acquired immune 
        deficiency syndrome for the most recent period of 5 calendar 
        years for which such data are available (except that, for fiscal 
        year 2005 and subsequent fiscal years, cases of HIV disease 
        shall be counted rather than cases of acquired immune deficiency 
        syndrome if cases of HIV disease are being counted for purposes 
        of section 2618(a)(2)(D)(i)).

    ``(e) Funding.--
            ``(1) In general.--Subject to paragraph (2), with respect to 
        each fiscal year beginning with fiscal year 2001, the Secretary, 
        to carry out this section, shall utilize--
                    ``(A) the greater of--
                          ``(i) 25 percent of the amount appropriated 
                      under section 2677 to carry out part B, excluding 
                      the amount appropriated under section 
                      2618(a)(2)(I), for such fiscal year that is in 
                      excess of the amount appropriated to carry out 
                      such part in the fiscal year preceding the fiscal 
                      year involved; or
                          ``(ii) $5,000,000,
                to provide funds to States for use in emerging 
                communities with at least 1,000, but less than 2,000, 
                cases of AIDS as reported to and confirmed by the 
                Director of the Centers for Disease Control and 
                Prevention for the five year period preceding the year 
                for which the grant is being awarded; and
                    ``(B) the greater of--
                          ``(i) 25 percent of the amount appropriated 
                      under section 2677 to carry out part B, excluding 
                      the amount appropriated under section 
                      2618(a)(2)(I), for such fiscal year that is in 
                      excess of the amount appropriated to carry out 
                      such part in the fiscal year preceding the fiscal 
                      year involved; or
                          ``(ii) $5,000,000,
                to provide funds to States for use in emerging 
                communities with at least 500, but less than 1,000, 
                cases of AIDS reported to and confirmed by the Director 
                of the Centers for Disease Control and Prevention for 
                the five year period preceding the year for which the 
                grant is being awarded.
            ``(2) <<NOTE: Effective date.>>  Trigger of funding.--This 
        section shall be effective only for fiscal years beginning in 
        the first fiscal year in which the amount appropriated under 
        section 2677 to carry out part B, excluding the amount 
        appropriated under section 2618(a)(2)(I), exceeds by at least 
        $20,000,000 the amount appropriated under section 2677 to carry 
        out part B in fiscal year

[[Page 114 STAT. 1339]]

        2000, excluding the amount appropriated under section 
        2618(a)(2)(I).
            ``(3) Minimum amount in future years.--Beginning with the 
        first fiscal year in which amounts provided for emerging 
        communities under paragraph (1)(A) equals $5,000,000 and under 
        paragraph (1)(B) equals $5,000,000, the Secretary shall ensure 
        that amounts made available under this section for the types of 
        emerging communities described in each such paragraph in 
        subsequent fiscal years is at least $5,000,000.
            ``(4) Distribution.--Grants under this section for emerging 
        communities shall be formula grants. There shall be two 
        categories of such formula grants, as follows:
                    ``(A) One category of such grants shall be for 
                emerging communities for which the cumulative total of 
                cases for purposes of subsection (d)(2) is 999 or fewer 
                cases. The grant made to such an emerging community for 
                a fiscal year shall be the product of--
                          ``(i) an amount equal to 50 percent of the 
                      amount available pursuant to this subsection for 
                      the fiscal year involved; and
                          ``(ii) a percentage equal to the ratio 
                      constituted by the number of cases for such 
                      emerging community for the fiscal year over the 
                      aggregate number of such cases for such year for 
                      all emerging communities to which this 
                      subparagraph applies.
                    ``(B) The other category of formula grants shall be 
                for emerging communities for which the cumulative total 
                of cases for purposes of subsection (d)(2) is 1,000 or 
                more cases. The grant made to such an emerging community 
                for a fiscal year shall be the product of--
                          ``(i) an amount equal to 50 percent of the 
                      amount available pursuant to this subsection for 
                      the fiscal year involved; and
                          ``(ii) a percentage equal to the ratio 
                      constituted by the number of cases for such 
                      community for the fiscal year over the aggregate 
                      number of such cases for the fiscal year for all 
                      emerging communities to which this subparagraph 
                      applies.''.

 Subtitle B--Provisions Concerning Pregnancy and Perinatal Transmission 
                                 of HIV

SEC. 211. REPEALS.

    Subpart II of part B of title XXVI of the Public Health Service Act 
(42 U.S.C. 300ff-33 et seq.) is amended--
            (1) <<NOTE: 42 USC 300ff-34.>>  in section 2626, by striking 
        each of subsections (d) through (f);
            (2) <<NOTE: 42 USC 300ff-35, 300ff-36.>>  by striking 
        sections 2627 and 2628; and
            (3) <<NOTE: 42 USC 300ff-37.>>  by redesignating section 
        2629 as section 2627.

SEC. 212. GRANTS.

    (a) In General.--Section 2625(c) of the Public Health Service Act 
(42 U.S.C. 300ff-33) is amended--

[[Page 114 STAT. 1340]]

            (1) in paragraph (1), by inserting at the end the following 
        subparagraph:
                    ``(F) Making available to pregnant women with HIV 
                disease, and to the infants of women with such disease, 
                treatment services for such disease in accordance with 
                applicable recommendations of the Secretary.'';
            (2) by amending paragraph (2) to read as follows:
            ``(2) Funding.--
                    ``(A) Authorization of appropriations.--For the 
                purpose of carrying out this subsection, there are 
                authorized to be appropriated $30,000,000 for each of 
                the fiscal years 2001 through 2005. Amounts made 
                available under section 2677 for carrying out this part 
                are not available for carrying out this section unless 
                otherwise authorized.
                    ``(B) Allocations for certain states.--
                          ``(i) In general.--Of the amounts appropriated 
                      under subparagraph (A) for a fiscal year in excess 
                      of $10,000,000--
                                    ``(I) the Secretary shall reserve 
                                the applicable percentage under clause 
                                (iv) for making grants under paragraph 
                                (1) both to States described in clause 
                                (ii) and States described in clause 
                                (iii); and
                                    ``(II) the Secretary shall reserve 
                                the remaining amounts for other States, 
                                taking into consideration the factors 
                                described in subparagraph (C)(iii), 
                                except that this subclause does not 
                                apply to any State that for the fiscal 
                                year involved is receiving amounts 
                                pursuant to subclause (I).
                          ``(ii) Required testing of newborns.--For 
                      purposes of clause (i)(I), the States described in 
                      this clause are States that under law (including 
                      under regulations or the discretion of State 
                      officials) have--
                                    ``(I) a requirement that all newborn 
                                infants born in the State be tested for 
                                HIV disease and that the biological 
                                mother of each such infant, and the 
                                legal guardian of the infant (if other 
                                than the biological mother), be informed 
                                of the results of the testing; or
                                    ``(II) a requirement that newborn 
                                infants born in the State be tested for 
                                HIV disease in circumstances in which 
                                the attending obstetrician for the birth 
                                does not know the HIV status of the 
                                mother of the infant, and that the 
                                biological mother of each such infant, 
                                and the legal guardian of the infant (if 
                                other than the biological mother), be 
                                informed of the results of the testing.
                          ``(iii) Most significant reduction in cases of 
                      perinatal transmission.--For purposes of clause 
                      (i)(I), the States described in this clause are 
                      the following (exclusive of States described in 
                      clause (ii)), as applicable:
                                    ``(I) For fiscal years 2001 and 
                                2002, the two States that, relative to 
                                other States, have the most significant 
                                reduction in the rate of new cases of 
                                the perinatal transmission of HIV (as 
                                indicated by the number of such cases 
                                reported to the Director of the Centers 
                                for Disease Control and

[[Page 114 STAT. 1341]]

                                Prevention for the most recent periods 
                                for which the data are available).
                                    ``(II) For fiscal years 2003 and 
                                2004, the three States that have the 
                                most significant such reduction.
                                    ``(III) For fiscal year 2005, the 
                                four States that have the most 
                                significant such reduction.
                          ``(iv) Applicable percentage.--For purposes of 
                      clause (i), the applicable amount for a fiscal 
                      year is as follows:
                                    ``(I) For fiscal year 2001, 33 
                                percent.
                                    ``(II) For fiscal year 2002, 50 
                                percent.
                                    ``(III) For fiscal year 2003, 67 
                                percent.
                                    ``(IV) For fiscal year 2004, 75 
                                percent.
                                    ``(V) For fiscal year 2005, 75 
                                percent.
                    ``(C) Certain provisions.--With respect to grants 
                under paragraph (1) that are made with amounts reserved 
                under subparagraph (B) of this paragraph:
                          ``(i) Such a grant may not be made in an 
                      amount exceeding $4,000,000.
                          ``(ii) If pursuant to clause (i) or pursuant 
                      to an insufficient number of qualifying 
                      applications for such grants (or both), the full 
                      amount reserved under subparagraph (B) for a 
                      fiscal year is not obligated, the requirement 
                      under such subparagraph to reserve amounts ceases 
                      to apply.
                          ``(iii) In the case of a State that meets the 
                      conditions to receive amounts reserved under 
                      subparagraph (B)(i)(II), the Secretary shall in 
                      making grants consider the following factors:
                                    ``(I) The extent of the reduction in 
                                the rate of new cases of the perinatal 
                                transmission of HIV.
                                    ``(II) The extent of the reduction 
                                in the rate of new cases of perinatal 
                                cases of acquired immune deficiency 
                                syndrome.
                                    ``(III) The overall incidence of 
                                cases of infection with HIV among women 
                                of childbearing age.
                                    ``(IV) The overall incidence of 
                                cases of acquired immune deficiency 
                                syndrome among women of childbearing 
                                age.
                                    ``(V) The higher acceptance rate of 
                                HIV testing of pregnant women.
                                    ``(VI) The extent to which women and 
                                children with HIV disease are receiving 
                                HIV-related health services.
                                    ``(VII) The extent to which HIV-
                                exposed children are receiving health 
                                services appropriate to such 
                                exposure.''; and
            (3) by adding at the end the following paragraph:
            ``(4) Maintenance of effort.--A condition for the receipt of 
        a grant under paragraph (1) is that the State involved agree 
        that the grant will be used to supplement and not supplant other 
        funds available to the State to carry out the purposes of the 
        grant.''.

    (b) Special Funding Rule for Fiscal Year 2001.--

[[Page 114 STAT. 1342]]

            (1) In general.--If for fiscal year 2001 the amount 
        appropriated under paragraph (2)(A) of section 2625(c) of the 
        Public Health Service Act is less than $14,000,000--
                    (A) the Secretary of Health and Human Services 
                shall, for the purpose of making grants under paragraph 
                (1) of such section, reserve from the amount specified 
                in paragraph (2) of this subsection an amount equal to 
                the difference between $14,000,000 and the amount 
                appropriated under paragraph (2)(A) of such section for 
                such fiscal year (notwithstanding any other provision of 
                this Act or the amendments made by this Act);
                    (B) the amount so reserved shall, for purposes of 
                paragraph (2)(B)(i) of such section, be considered to 
                have been appropriated under paragraph (2)(A) of such 
                section; and
                    (C) the percentage specified in paragraph 
                (2)(B)(iv)(I) of such section is deemed to be 50 
                percent.
            (2) Allocation from increases in funding for part b.--For 
        purposes of paragraph (1), the amount specified in this 
        paragraph is the amount by which the amount appropriated under 
        section 2677 of the Public Health Service Act for fiscal year 
        2001 and available for grants under section 2611 of such Act is 
        an increase over the amount so appropriated and available for 
        fiscal year 2000.

SEC. 213. STUDY BY INSTITUTE OF MEDICINE.

    Subpart II of part B of title XXVI of the Public Health Service Act, 
as amended by section 211(3), is amended by adding at the end the 
following section:
``SEC. 2628.  <<NOTE: 42 USC 300ff-37a.>> RECOMMENDATIONS FOR 
                            REDUCING INCIDENCE OF PERINATAL 
                            TRANSMISSION.

    ``(a) Study by Institute of Medicine.--
            ``(1) In general.--The Secretary shall request the Institute 
        of Medicine to enter into an agreement with the Secretary under 
        which such Institute conducts a study to provide the following:
                    ``(A) For the most recent fiscal year for which the 
                information is available, a determination of the number 
                of newborn infants with HIV born in the United States 
                with respect to whom the attending obstetrician for the 
                birth did not know the HIV status of the mother.
                    ``(B) A determination for each State of any 
                barriers, including legal barriers, that prevent or 
                discourage an obstetrician from making it a routine 
                practice to offer pregnant women an HIV test and a 
                routine practice to test newborn infants for HIV disease 
                in circumstances in which the obstetrician does not know 
                the HIV status of the mother of the infant.
                    ``(C) Recommendations for each State for reducing 
                the incidence of cases of the perinatal transmission of 
                HIV, including recommendations on removing the barriers 
                identified under subparagraph (B).
        If such Institute declines to conduct the study, the Secretary 
        shall enter into an agreement with another appropriate public or 
        nonprofit private entity to conduct the study.
            ``(2) <<NOTE: Deadline.>>  Report.--The Secretary shall 
        ensure that, not later than 18 months after the effective date 
        of this section, the study required in paragraph (1) is 
        completed and a report

[[Page 114 STAT. 1343]]

        describing the findings made in the study is submitted to the 
        appropriate committees of the Congress, the Secretary, and the 
        chief public health official of each of the States.

    ``(b) Progress Toward Recommendations.--In fiscal year 2004, the 
Secretary shall collect information from the States describing the 
actions taken by the States toward meeting the recommendations specified 
for the States under subsection (a)(1)(C).
    ``(c) Submission of Reports to Congress.--The Secretary shall submit 
to the appropriate committees of the Congress reports describing the 
information collected under subsection (b).''.

            Subtitle C--Certain Partner Notification Programs

SEC. 221. GRANTS FOR COMPLIANT PARTNER NOTIFICATION PROGRAMS.

    Part B of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff-21 et seq.) is amended by adding at the end the following subpart:

          ``Subpart III--Certain Partner Notification Programs

``SEC. 2631. <<NOTE: 42 USC 300ff-38.>>  GRANTS FOR PARTNER NOTIFICATION 
            PROGRAMS.

    ``(a) In General.--In the case of States whose laws or regulations 
are in accordance with subsection (b), the Secretary, subject to 
subsection (c)(2), may make grants to the States for carrying out 
programs to provide partner counseling and referral services.
    ``(b) Description of Compliant State Programs.--For purposes of 
subsection (a), the laws or regulations of a State are in accordance 
with this subsection if under such laws or regulations (including 
programs carried out pursuant to the discretion of State officials) the 
following policies are in effect:
            ``(1) The State requires that the public health officer of 
        the State carry out a program of partner notification to inform 
        partners of individuals with HIV disease that the partners may 
        have been exposed to the disease.
            ``(2)(A) In the case of a health entity that provides for 
        the performance on an individual of a test for HIV disease, or 
        that treats the individual for the disease, the State requires, 
        subject to subparagraph (B), that the entity confidentially 
        report the positive test results to the State public health 
        officer in a manner recommended and approved by the Director of 
        the Centers for Disease Control and Prevention, together with 
        such additional information as may be necessary for carrying out 
        such program.
            ``(B) The State may provide that the requirement of 
        subparagraph (A) does not apply to the testing of an individual 
        for HIV disease if the individual underwent the testing through 
        a program designed to perform the test and provide the results 
        to the individual without the individual disclosing his or her 
        identity to the program. This subparagraph may not be construed 
        as affecting the requirement of subparagraph (A) with respect to 
        a health entity that treats an individual for HIV disease.

[[Page 114 STAT. 1344]]

            ``(3) The program under paragraph (1) is carried out in 
        accordance with the following:
                    ``(A) Partners are provided with an appropriate 
                opportunity to learn that the partners have been exposed 
                to HIV disease, subject to subparagraph (B).
                    ``(B) The State does not inform partners of the 
                identity of the infected individuals involved.
                    ``(C) Counseling and testing for HIV disease are 
                made available to the partners and to infected 
                individuals, and such counseling includes information on 
                modes of transmission for the disease, including 
                information on prenatal and perinatal transmission and 
                preventing transmission.
                    ``(D) Counseling of infected individuals and their 
                partners includes the provision of information regarding 
                therapeutic measures for preventing and treating the 
                deterioration of the immune system and conditions 
                arising from the disease, and the provision of other 
                prevention-related information.
                    ``(E) Referrals for appropriate services are 
                provided to partners and infected individuals, including 
                referrals for support services and legal aid.
                    ``(F) Notifications under subparagraph (A) are 
                provided in person, unless doing so is an unreasonable 
                burden on the State.
                    ``(G) There is no criminal or civil penalty on, or 
                civil liability for, an infected individual if the 
                individual chooses not to identify the partners of the 
                individual, or the individual does not otherwise 
                cooperate with such program.
                    ``(H) The failure of the State to notify partners is 
                not a basis for the civil liability of any health entity 
                who under the program reported to the State the identity 
                of the infected individual involved.
                    ``(I) The State provides that the provisions of the 
                program may not be construed as prohibiting the State 
                from providing a notification under subparagraph (A) 
                without the consent of the infected individual involved.
            ``(4) The State annually reports to the Director of the 
        Centers for Disease Control and Prevention the number of 
        individuals from whom the names of partners have been sought 
        under the program under paragraph (1), the number of such 
        individuals who provided the names of partners, and the number 
        of partners so named who were notified under the program.
            ``(5) The State cooperates with such Director in carrying 
        out a national program of partner notification, including the 
        sharing of information between the public health officers of the 
        States.

    ``(c) Reporting System for Cases of HIV Disease; Preference in 
Making Grants.--In making grants under subsection (a), the Secretary 
shall give preference to States whose reporting systems for cases of HIV 
disease produce data on such cases that is sufficiently accurate and 
reliable for use for purposes of section 2618(a)(2)(D)(i).
    ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $30,000,000 
for fiscal year 2001, and such sums as may be necessary for each of the 
fiscal years 2002 through 2005.''.

[[Page 114 STAT. 1345]]

                 TITLE III--EARLY INTERVENTION SERVICES

                  Subtitle A--Formula Grants for States

SEC. 301. REPEAL OF PROGRAM.

    (a) Repeal.--Subpart I of part C of title XXVI of the Public Health 
Service Act (42 U.S.C. 300ff-41 et seq.) is repealed.
    (b) Conforming Amendments.--Part C of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff-41 et seq.), as amended by 
subsection (a) of this section, is amended--
            (1) by redesignating subparts II and III as subparts I and 
        II, respectively;
            (2) <<NOTE: 42 USC 300ff-61.>>  in section 2661(a), by 
        striking ``unless--'' and all that follows through ``(2) in the 
        case of'' and inserting ``unless, in the case of''; and
            (3) <<NOTE: 42 USC 300ff-64.>>  in section 2664--
                    (A) in subsection (e)(5), by striking ``2642(b) 
                or'';
                    (B) in subsection (f)(2), by striking ``2642(b) 
                or''; and
                    (C) by striking subsection (h).

                     Subtitle B--Categorical Grants

SEC. 311. PREFERENCES IN MAKING GRANTS.

    Section 2653 of the Public Health Service Act (42 U.S.C. 300ff-53) 
is amended by adding at the end the following subsection:
    ``(d) Certain Areas.--Of the applicants who qualify for preference 
under this section--
            ``(1) the Secretary shall give preference to applicants that 
        will expend the grant under section 2651 to provide early 
        intervention under such section in rural areas; and
            ``(2) the Secretary shall give special consideration to 
        areas that are underserved with respect to such services.''.

SEC. 312. PLANNING AND DEVELOPMENT GRANTS.

    (a) In General.--Section 2654(c)(1) of the Public Health Service Act 
(42 U.S.C. 300ff-54(c)(1)) is amended by striking ``planning grants'' 
and all that follows and inserting the following: ``planning grants to 
public and nonprofit private entities for purposes of--
                    ``(A) enabling such entities to provide HIV early 
                intervention services; and
                    ``(B) assisting the entities in expanding their 
                capacity to provide HIV-related health services, 
                including early intervention services, in low-income 
                communities and affected subpopulations that are 
                underserved with respect to such services (subject to 
                the condition that a grant pursuant to this subparagraph 
                may not be expended to purchase or improve land, or to 
                purchase, construct, or permanently improve, other than 
                minor remodeling, any building or other facility).''.

    (b) Amount; Duration.--Section 2654(c) of the Public Health Service 
Act (42 U.S.C. 300ff-54(c)) is further amended--
            (1) by redesignating paragraph (4) as paragraph (5); and
            (2) by inserting after paragraph (3) the following:
            ``(4) Amount and duration of grants.--

[[Page 114 STAT. 1346]]

                    ``(A) Early intervention services.--A grant under 
                paragraph (1)(A) may be made in an amount not to exceed 
                $50,000.
                    ``(B) Capacity development.--
                          ``(i) Amount.--A grant under paragraph (1)(B) 
                      may be made in an amount not to exceed $150,000.
                          ``(ii) Duration.--The total duration of a 
                      grant under paragraph (1)(B), including any 
                      renewal, may not exceed 3 years.''.

    (c) Increase in Limitation.--Section 2654(c)(5) of the Public Health 
Service Act (42 U.S.C. 300ff-54(c)(5)), as redesignated by subsection 
(b), is amended by striking ``1 percent'' and inserting ``5 percent''.

SEC. 313. AUTHORIZATION OF APPROPRIATIONS.

    Section 2655 of the Public Health Service Act (42 U.S.C. 300ff-55) 
is amended by striking ``in each of'' and all that follows and inserting 
``for each of the fiscal years 2001 through 2005.''.

                     Subtitle C--General Provisions

SEC. 321. PROVISION OF CERTAIN COUNSELING SERVICES.

    Section 2662(c)(3) of the Public Health Service Act (42 U.S.C. 
300ff-62(c)(3)) is amended--
            (1) in the matter preceding subparagraph (A), by striking 
        ``counseling on--'' and inserting ``counseling--'';
            (2) in each of subparagraphs (A), (B), and (D), by inserting 
        ``on'' after the subparagraph designation; and
            (3) in subparagraph (C)--
                    (A) by striking ``(C) the benefits'' and inserting 
                ``(C)(i) that explains the benefits''; and
                    (B) by inserting after clause (i) (as designated by 
                subparagraph (A) of this paragraph) the following 
                clause:
                    ``(ii) that emphasizes it is the duty of infected 
                individuals to disclose their infected status to their 
                sexual partners and their partners in the sharing of 
                hypodermic needles; that provides advice to infected 
                individuals on the manner in which such disclosures can 
                be made; and that emphasizes that it is the continuing 
                duty of the individuals to avoid any behaviors that will 
                expose others to HIV.''.

SEC. 322. ADDITIONAL REQUIRED AGREEMENTS.

    Section 2664(g) of the Public Health Service Act (42 U.S.C. 300ff-
64(g)) is amended--
            (1) in paragraph (3)--
                    (A) by striking ``7.5 percent'' and inserting ``10 
                percent''; and
                    (B) by striking ``and'' after the semicolon at the 
                end;
            (2) in paragraph (4), by striking the period and inserting 
        ``; and''; and
            (3) by adding at the end the following paragraph:
            ``(5) the applicant will provide for the establishment of a 
        quality management program--
                    ``(A) to assess the extent to which medical services 
                funded under this title that are provided to patients 
                are consistent with the most recent Public Health 
                Service guidelines for the treatment of HIV disease and 
                related

[[Page 114 STAT. 1347]]

                opportunistic infections, and as applicable, to develop 
                strategies for ensuring that such services are 
                consistent with the guidelines; and
                    ``(B) to ensure that improvements in the access to 
                and quality of HIV health services are addressed.''.

                 TITLE IV--OTHER PROGRAMS AND ACTIVITIES

 Subtitle A--Certain Programs for Research, Demonstrations, or Training

SEC. 401. GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH 
                        FOR WOMEN, INFANTS, CHILDREN, AND YOUTH.

    (a) Elimination of Requirement To Enroll Significant Numbers of 
Women and Children.--Section 2671(b) (42 U.S.C. 300ff-71(b)) is 
amended--
            (1) in paragraph (1), by striking subparagraphs (C) and (D) 
        and inserting the following:
                    ``(C) The applicant will demonstrate linkages to 
                research and how access to such research is being 
                offered to patients.''; and
            (2) by striking paragraphs (3) and (4).

    (b) Information and Education.--Section 2671(d) (42 U.S.C. 300ff-
71(d)) is amended by adding at the end the following:
            ``(4) The applicant will provide individuals with 
        information and education on opportunities to participate in 
        HIV/AIDS-related clinical research.''.

    (c) Quality Management; Administrative Expenses Ceiling.--Section 
2671(f) (42 U.S.C. 300ff-71(f)) is amended--
            (1) by striking the subsection heading and designation and 
        inserting the following:

    ``(f) Administration.--
            ``(1) Application.--''; and
            (2) by adding at the end the following:
            ``(2) Quality management program.--A grantee under this 
        section shall implement a quality management program to assess 
        the extent to which HIV health services provided to patients 
        under the grant are consistent with the most recent Public 
        Health Service guidelines for the treatment of HIV disease and 
        related opportunistic infection, and as applicable, to develop 
        strategies for ensuring that such services are consistent with 
        the guidelines for improvement in the access to and quality of 
        HIV health services.''.

    (d) Coordination.--Section 2671(g) (42 U.S.C. 300ff-71(g)) is 
amended by adding at the end the following: ``The Secretary acting 
through the Director of NIH, shall examine the distribution and 
availability of ongoing and appropriate HIV/AIDS-related research 
projects to existing sites under this section for purposes of enhancing 
and expanding voluntary access to HIV-related research, especially 
within communities that are not reasonably served by such 
projects. <<NOTE: Deadline. Reports.>>  Not later than 12 months after 
the date of the enactment of the Ryan White CARE Act Amendments of 2000, 
the Secretary shall prepare and submit to the appropriate committees of 
Congress a report that describes the findings made by

[[Page 114 STAT. 1348]]

the Director and the manner in which the conclusions based on those 
findings can be addressed.''.

    (e) Administrative Expenses.--Section 2671 of the Public Health 
Service Act (42 U.S.C. 300ff-71) is amended--
            (1) by redesignating subsections (i) and (j) as subsections 
        (j) and (k), respectively; and
            (2) by inserting after subsection (h) the following 
        subsection:

    ``(i) <<NOTE: Deadlines.>>  Limitation on Administrative Expenses.--
            ``(1) Determination by secretary.--Not later than 12 months 
        after the date of the enactment of the Ryan White CARE Act 
        Amendments of 2000, the Secretary, in consultation with grantees 
        under this part, shall conduct a review of the administrative, 
        program support, and direct service-related activities that are 
        carried out under this part to ensure that eligible individuals 
        have access to quality, HIV-related health and support services 
        and research opportunities under this part, and to support the 
        provision of such services.
            ``(2) Requirements.--
                    ``(A) In general.--Not later than 180 days after the 
                expiration of the 12-month period referred to in 
                paragraph (1) the Secretary, in consultation with 
                grantees under this part, shall determine the 
                relationship between the costs of the activities 
                referred to in paragraph (1) and the access of eligible 
                individuals to the services and research opportunities 
                described in such paragraph.
                    ``(B) Limitation.--After a final determination under 
                subparagraph (A), the Secretary may not make a grant 
                under this part unless the grantee complies with such 
                requirements as may be included in such 
                determination.''.

    (f) Authorization of Appropriations.--Section 2671 of the Public 
Health Service Act (42 U.S.C. 300ff-71) is amended in subsection (j) (as 
redesignated by subsection (e)(1) of this section) by striking ``fiscal 
years 1996 through 2000'' and inserting ``fiscal years 2001 through 
2005''.

SEC. 402. AIDS EDUCATION AND TRAINING CENTERS.

    (a) Schools; Centers.--
            (1) In general.--Section 2692(a)(1) of the Public Health 
        Service Act (42 U.S.C. 300ff-111(a)(1)) is amended--
                    (A) in subparagraph (A)--
                          (i) by striking ``training'' and inserting 
                      ``to train'';
                          (ii) by striking ``and including'' and 
                      inserting ``, including''; and
                          (iii) by inserting before the semicolon the 
                      following: ``, and including (as applicable to the 
                      type of health professional involved), prenatal 
                      and other gynecological care for women with HIV 
                      disease'';
                    (B) in subparagraph (B), by striking ``and'' after 
                the semicolon at the end;
                    (C) in subparagraph (C), by striking the period and 
                inserting ``; and''; and
                    (D) by adding at the end the following:
                    ``(D) to develop protocols for the medical care of 
                women with HIV disease, including prenatal and other 
                gynecological care for such women.''.

[[Page 114 STAT. 1349]]

            (2) <<NOTE: 42 USC 300ff-111 note. Deadline.>>  
        Dissemination of treatment guidelines; medical consultation 
        activities.--Not later than 90 days after the date of the 
        enactment of this Act, the Secretary of Health and Human 
        Services shall issue and begin implementation of a strategy for 
        the dissemination of HIV treatment information to health care 
        providers and patients.

    (b) Dental Schools.--Section 2692(b) of the Public Health Service 
Act (42 U.S.C. 300ff-111(b)) is amended--
            (1) by amending paragraph (1) to read as follows:
            ``(1) In general.--
                    ``(A) Grants.--The Secretary may make grants to 
                dental schools and programs described in subparagraph 
                (B) to assist such schools and programs with respect to 
                oral health care to patients with HIV disease.
                    ``(B) Eligible applicants.--For purposes of this 
                subsection, the dental schools and programs referred to 
                in this subparagraph are dental schools and programs 
                that were described in section 777(b)(4)(B) as such 
                section was in effect on the day before the date of the 
                enactment of the Health Professions Education 
                Partnerships Act of 1998 (Public Law 105-392) and in 
                addition dental hygiene programs that are accredited by 
                the Commission on Dental Accreditation.'';
            (2) in paragraph (2), by striking ``777(b)(4)(B)'' and 
        inserting ``the section referred to in paragraph (1)(B)''; and
            (3) by inserting after paragraph (4) the following 
        paragraph:
            ``(5) Community-based care.--The Secretary may make grants 
        to dental schools and programs described in paragraph (1)(B) 
        that partner with community-based dentists to provide oral 
        health care to patients with HIV disease in unserved areas. Such 
        partnerships shall permit the training of dental students and 
        residents and the participation of community dentists as adjunct 
        faculty.''.

    (c) Authorization of Appropriations.--
            (1) Schools; centers.--Section 2692(c)(1) of the Public 
        Health Service Act (42 U.S.C. 300ff-111(c)(1)) is amended by 
        striking ``fiscal years 1996 through 2000'' and inserting 
        ``fiscal years 2001 through 2005''.
            (2) Dental schools.--Section 2692(c)(2) of the Public Health 
        Service Act (42 U.S.C. 300ff-111(c)(2)) is amended to read as 
        follows:
            ``(2) Dental schools.--
                    ``(A) In general.--For the purpose of grants under 
                paragraphs (1) through (4) of subsection (b), there are 
                authorized to be appropriated such sums as may be 
                necessary for each of the fiscal years 2001 through 
                2005.
                    ``(B) Community-based care.--For the purpose of 
                grants under subsection (b)(5), there are authorized to 
                be appropriated such sums as may be necessary for each 
                of the fiscal years 2001 through 2005.''.

[[Page 114 STAT. 1350]]

              Subtitle B--General Provisions in Title XXVI

SEC. 411. EVALUATIONS AND REPORTS.

    Section 2674(c) of the Public Health Service Act (42 U.S.C. 300ff-
74(c)) is amended by striking ``1991 through 1995'' and inserting ``2001 
through 2005''.
SEC. 412. DATA COLLECTION THROUGH CENTERS FOR DISEASE CONTROL AND 
                        PREVENTION.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after section 318A the following 
section:

          ``data collection regarding programs under title xxvi

    ``Sec. 318B. <<NOTE: 42 USC 247c-2.>>  For the purpose of collecting 
and providing data for program planning and evaluation activities under 
title XXVI, there are authorized to be appropriated to the Secretary 
(acting through the Director of the Centers for Disease Control and 
Prevention) such sums as may be necessary for each of the fiscal years 
2001 through 2005. Such authorization of appropriations is in addition 
to other authorizations of appropriations that are available for such 
purpose.''.

SEC. 413. COORDINATION.

    Section 2675 of the Public Health Service Act (42 U.S.C. 300ff-75) 
is amended--
            (1) by amending subsection (a) to read as follows:

    ``(a) Requirement.--The Secretary shall ensure that the Health 
Resources and Services Administration, the Centers for Disease Control 
and Prevention, the Substance Abuse and Mental Health Services 
Administration, and the Health Care Financing Administration coordinate 
the planning, funding, and implementation of Federal HIV programs to 
enhance the continuity of care and prevention services for individuals 
with HIV disease or those at risk of such disease. The Secretary shall 
consult with other Federal agencies, including the Department of 
Veterans Affairs, as needed and utilize planning information submitted 
to such agencies by the States and entities eligible for support.'';
            (2) by redesignating subsections (b) and (c) as subsections 
        (c) and (d), respectively;
            (3) by inserting after subsection (b) the following 
        subsection:

    ``(b) Report.--The Secretary shall biennially prepare and submit to 
the appropriate committees of the Congress a report concerning the 
coordination efforts at the Federal, State, and local levels described 
in this section, including a description of Federal barriers to HIV 
program integration and a strategy for eliminating such barriers and 
enhancing the continuity of care and prevention services for individuals 
with HIV disease or those at risk of such disease.''; and
            (4) in each of subsections (c) and (d) (as redesignated by 
        paragraph (2) of this section), by inserting ``and prevention 
        services'' after ``continuity of care'' each place such term 
        appears.

[[Page 114 STAT. 1351]]

SEC. 414. PLAN REGARDING RELEASE OF PRISONERS WITH HIV DISEASE.

    Section 2675 of the Public Health Service Act, as amended by section 
413(2) <<NOTE: 42 USC 300ff-75.>>  of this Act, is amended by adding at 
the end the following subsection:

    ``(e) Recommendations Regarding Release of Prisoners.--After 
consultation with the Attorney General and the Director of the Bureau of 
Prisons, with States, with eligible areas under part A, and with 
entities that receive amounts from grants under part A or B, the 
Secretary, consistent with the coordination required in subsection (a), 
shall develop a plan for the medical case management of and the 
provision of support services to individuals who were Federal or State 
prisoners and had HIV disease as of the date on which the individuals 
were released from the custody of the penal system. <<NOTE: Deadline.>>  
The Secretary shall submit the plan to the Congress not later than 2 
years after the date of the enactment of the Ryan White CARE Act 
Amendments of 2000.''.

SEC. 415. AUDITS.

    Part D of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff-71 et seq.) is amended by inserting after section 2675 the 
following section:

``SEC. 2675A. <<NOTE: 42 USC 300ff-75a.>>  AUDITS.

    ``For fiscal year 2002 and subsequent fiscal years, the Secretary 
may reduce the amounts of grants under this title to a State or 
political subdivision of a State for a fiscal year if, with respect to 
such grants for the second preceding fiscal year, the State or 
subdivision fails to prepare audits in accordance with the procedures of 
section 7502 of title 31, United States Code. The Secretary shall 
annually select representative samples of such audits, prepare summaries 
of the selected audits, and submit the summaries to the Congress.''.

SEC. 416. ADMINISTRATIVE SIMPLIFICATION.

    Part D of title XXVI of the Public Health Service Act, as amended by 
section 415 of this Act, is amended by inserting after section 2675A the 
following section:
``SEC. 2675B.  <<NOTE: 42 USC 300ff-75b.>> ADMINISTRATIVE 
                              SIMPLIFICATION REGARDING PARTS A AND 
                              B.

    ``(a) Coordinated Disbursement.--After consultation with the States, 
with eligible areas under part A, and with entities that receive amounts 
from grants under part A or B, the Secretary shall develop a plan for 
coordinating the disbursement of appropriations for grants under part A 
with the disbursement of appropriations for grants under part B in order 
to assist grantees and other recipients of amounts from such grants in 
complying with the requirements of such parts. <<NOTE: Deadline.>>  The 
Secretary shall submit the plan to the Congress not later than 18 months 
after the date of the enactment of the Ryan White CARE Act Amendments of 
2000. Not later than 2 years after the date on which the plan is so 
submitted, the Secretary shall complete the implementation of the plan, 
notwithstanding any provision of this title that is inconsistent with 
the plan.

    ``(b) Biennial Applications.--After consultation with the States, 
with eligible areas under part A, and with entities that receive amounts 
from grants under part A or B, the Secretary

[[Page 114 STAT. 1352]]

shall make a determination of whether the administration of parts A and 
B by the Secretary, and the efficiency of grantees under such parts in 
complying with the requirements of such parts, would be improved by 
requiring that applications for grants under such parts be submitted 
biennially rather than annually. <<NOTE: Deadline.>>  The Secretary 
shall submit such determination to the Congress not later than 2 years 
after the date of the enactment of the Ryan White CARE Act Amendments of 
2000.

    ``(c) Application Simplification.--After consultation with the 
States, with eligible areas under part A, and with entities that receive 
amounts from grants under part A or B, the Secretary shall develop a 
plan for simplifying the process for applications under parts A and 
B. <<NOTE: Deadline.>>  The Secretary shall submit the plan to the 
Congress not later than 18 months after the date of the enactment of the 
Ryan White CARE Act Amendments of 2000. Not later than 2 years after the 
date on which the plan is so submitted, the Secretary shall complete the 
implementation of the plan, notwithstanding any provision of this title 
that is inconsistent with the plan.''.
SEC. 417. AUTHORIZATION OF APPROPRIATIONS FOR PARTS A 
                        AND B.

    Section 2677 of the Public Health Service Act (42 U.S.C. 300ff-77) 
is amended to read as follows:

``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) Part A.--For the purpose of carrying out part A, there are 
authorized to be appropriated such sums as may be necessary for each of 
the fiscal years 2001 through 2005.
    ``(b) Part B.--For the purpose of carrying out part B, there are 
authorized to be appropriated such sums as may be necessary for each of 
the fiscal years 2001 through 2005.''.

                       TITLE V--GENERAL PROVISIONS

SEC. 501. <<NOTE: 42 USC 300ff-11 note.>>  STUDIES BY INSTITUTE OF 
            MEDICINE.

    (a) State Surveillance Systems on Prevalence of HIV.--The Secretary 
of Health and Human Services (referred to in this section as the 
``Secretary'') shall request the Institute of Medicine to enter into an 
agreement with the Secretary under which such Institute conducts a study 
to provide the following:
            (1) A determination of whether the surveillance system of 
        each of the States regarding the human immunodeficiency virus 
        provides for the reporting of cases of infection with the virus 
        in a manner that is sufficient to provide adequate and reliable 
        information on the number of such cases and the demographic 
        characteristics of such cases, both for the State in general and 
        for specific geographic areas in the State.
            (2) A determination of whether such information is 
        sufficiently accurate for purposes of formula grants under parts 
        A and B of title XXVI of the Public Health Service Act.
            (3) With respect to any State whose surveillance system does 
        not provide adequate and reliable information on cases of 
        infection with the virus, recommendations regarding the manner 
        in which the State can improve the system.

    (b) Relationship Between Epidemiological Measures and Health Care 
for Certain Individuals With HIV Disease.--

[[Page 114 STAT. 1353]]

            (1) In general.--The Secretary shall request the Institute 
        of Medicine to enter into an agreement with the Secretary under 
        which such Institute conducts a study concerning the appropriate 
        epidemiological measures and their relationship to the financing 
        and delivery of primary care and health-related support services 
        for low-income, uninsured, and under-insured individuals with 
        HIV disease.
            (2) Issues to be considered.--The Secretary shall ensure 
        that the study under paragraph (1) considers the following:
                    (A) The availability and utility of health outcomes 
                measures and data for HIV primary care and support 
                services and the extent to which those measures and data 
                could be used to measure the quality of such funded 
                services.
                    (B) The effectiveness and efficiency of service 
                delivery (including the quality of services, health 
                outcomes, and resource use) within the context of a 
                changing health care and therapeutic environment, as 
                well as the changing epidemiology of the epidemic, 
                including determining the actual costs, potential 
                savings, and overall financial impact of modifying the 
                program under title XIX of the Social Security Act to 
                establish eligibility for medical assistance under such 
                title on the basis of infection with the human 
                immunodeficiency virus rather than providing such 
                assistance only if the infection has progressed to 
                acquired immune deficiency syndrome.
                    (C) Existing and needed epidemiological data and 
                other analytic tools for resource planning and 
                allocation decisions, specifically for estimating 
                severity of need of a community and the relationship to 
                the allocations process.
                    (D) Other factors determined to be relevant to 
                assessing an individual's or community's ability to gain 
                and sustain access to quality HIV services.

    (c) Other Entities.--If the Institute of Medicine declines to 
conduct a study under this section, the Secretary shall enter into an 
agreement with another appropriate public or nonprofit private entity to 
conduct the study.
    (d) Report.--The Secretary shall ensure that--
            (1) <<NOTE: Deadline.>>  not later than 3 years after the 
        date of the enactment of this Act, the study required in 
        subsection (a) is completed and a report describing the findings 
        made in the study is submitted to the appropriate committees of 
        the Congress; and
            (2) not later than 2 years after the date of the enactment 
        of this Act, the study required in subsection (b) is completed 
        and a report describing the findings made in the study is 
        submitted to such committees.

SEC. 502. <<NOTE: 42 USC 300cc note.>>  DEVELOPMENT OF RAPID HIV TEST.

    (a) Expansion, Intensification, and Coordination of Research and 
Other Activities.--
            (1) In general.--The Director of NIH shall expand, 
        intensify, and coordinate research and other activities of the 
        National Institutes of Health with respect to the development of 
        reliable and affordable tests for HIV disease that can rapidly 
        be administered and whose results can rapidly be obtained (in 
        this section referred to as ``rapid HIV test'').

[[Page 114 STAT. 1354]]

            (2) Report to congress.--The Director of NIH shall 
        periodically submit to the appropriate committees of Congress a 
        report describing the research and other activities conducted or 
        supported under paragraph (1).
            (3) Authorization of appropriations.--For the purpose of 
        carrying out this subsection, there are authorized to be 
        appropriated such sums as may be necessary for each of the 
        fiscal years 2001 through 2005.

    (b) Premarket Review of Rapid HIV Tests.--
            (1) In <<NOTE: Deadline.>> general.--Not later than 90 days 
        after the date of the enactment of this Act, the Secretary, in 
        consultation with the Director of the Centers for Disease 
        Control and Prevention and the Commissioner of Food and Drugs, 
        shall submit to the appropriate committees of the Congress a 
        report describing the progress made towards, and barriers to, 
        the premarket review and commercial distribution of rapid HIV 
        tests. The report shall--
                    (A) assess the public health need for and public 
                health benefits of rapid HIV tests, including the 
                minimization of false positive results through the 
                availability of multiple rapid HIV tests;
                    (B) make recommendations regarding the need for the 
                expedited review of rapid HIV test applications 
                submitted to the Center for Biologics Evaluation and 
                Research and, if such recommendations are favorable, 
                specify criteria and procedures for such expedited 
                review; and
                    (C) specify whether the barriers to the premarket 
                review of rapid HIV tests include the unnecessary 
                application of requirements--
                          (i) necessary to ensure the efficacy of 
                      devices for donor screening to rapid HIV tests 
                      intended for use in other screening situations; or
                          (ii) for identifying antibodies to HIV 
                      subtypes of rare incidence in the United States to 
                      rapid HIV tests intended for use in screening 
                      situations other than donor screening.

    (c) Guidelines of Centers for Disease Control and Prevention.--
Promptly after commercial distribution of a rapid HIV test begins, the 
Secretary, acting through the Director of the Centers for Disease 
Control and Prevention, shall establish or update guidelines that 
include recommendations for States, hospitals, and other appropriate 
entities regarding the ready availability of such tests for 
administration to pregnant women who are in labor or in the late stage 
of pregnancy and whose HIV status is not known to the attending 
obstetrician.

SEC. 503. TECHNICAL CORRECTIONS.

    (a) Public Health Service Act.--Title XXVI of the Public Health 
Service Act (42 U.S.C. 300ff-11 et seq.) is amended--
            (1) in section 2605(d) <<NOTE: 42 USC 300ff-15.>> --
                    (A) in paragraph (1), by striking ``section 2608'' 
                and inserting ``section 2677''; and
                    (B) in paragraph (4), by inserting ``section'' 
                before ``2601(a)''; and
            (2) <<NOTE: 42 USC 300ff-73.>>  in section 2673(a), in the 
        matter preceding paragraph (1), by striking ``the Agency for 
        Health Care Policy and

[[Page 114 STAT. 1355]]

        Research'' and inserting ``the Director of the Agency for 
        Healthcare Research and Quality''.

    (b) Related Act.--The first paragraph (2) of section 3(c) of the 
Ryan White CARE Act Amendments of 1996 (Public Law 104-146; 110 Stat. 
1354) <<NOTE: 42 USC 300ff-22.>>  is amended in subparagraph (A)(iii) by 
striking ``by inserting the following new paragraph:'' and inserting 
``by inserting before paragraph (2) (as so redesignated) the following 
new paragraph''.

                        TITLE VI--EFFECTIVE DATE

SEC. 601. <<NOTE: 42 USC 300ff-12 note.>>  EFFECTIVE DATE.

    This Act and the amendments made by this Act take effect October 1, 
2000, or upon the date of the enactment of this Act, whichever occurs 
later.

    Approved October 20, 2000.

LEGISLATIVE HISTORY--S. 2311 (H.R. 4807):
---------------------------------------------------------------------------

HOUSE REPORTS: No. 106-788 accompanying H.R. 4807 (Comm. on Commerce).
SENATE REPORTS: No. 106-294 (Comm. on Health, Education, Labor, and 
Pensions).
CONGRESSIONAL RECORD, Vol. 146 (2000):
            June 6, considered and passed Senate.
            Oct. 5, considered and passed House, amended. Senate 
                concurred in House amendments.
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 36 (2000):
            Oct. 20, Presidential statement.

                                  <all>