(This measure has not been amended since it was passed by the Senate on December 6, 2006. The summary of that version is repeated here.)
Ryan White HIV/AIDS Treatment Modernization Act of 2006 - Title I: Emergency Relief for Eligible Areas - (Sec. 101) Amends provisions of title XXVI of the Public Health Service Act (popularly known as the Ryan White Care Act [RWCA]) concerning emergency relief grants for metropolitan areas to assist in delivering and enhancing HIV-related services. Continues an eligible metropolitan area's (EMA) eligibility to receive such a grant until such area does not, for three consecutive years, have: (1) 2,000 cases of reported and confirmed cases of AIDS during the most recent period of 5 calendar years for which such data is available; and (2) a cumulative total of 3,000 or more living cases of AIDS as of December 31 of the most recent calendar year. Sets as the boundaries for an EMA as either: (1) the boundaries that were in effect for FY1994; or (2) the boundaries that are in effect when such area initially receives funding. Amends the definition of "metropolitan area" to require a population of 50,000 or more individuals.
(Sec. 102) Requires the Secretary of Health and Human Services to disburse 66 2/3% (currently, 50%) of the amount made available for emergency relief grants based on the number of reported and confirmed living names-based cases of HIV/AIDS. Provides for: (1) a transition for reporting living names-based non-AIDS cases of HIV; and (2) exemptions for states that have a plan for making such a transition. Requires the Secretary to modify the number of cases reported for states using code-based reporting to adjust for duplicative reporting in and among systems.
Requires the Secretary to carry out a program to monitor names-based reporting. Limits the increase in grants for EMAs using code-based reporting. Requires the Secretary to increase the amount of the grant for EMAs using code-based reporting to ensure that the amount of the grants for FY2007-FY2009 do not decrease by more than a certain percentage for such fiscal years.
(Sec. 103) Requires the Secretary to disburse supplemental grants on the basis of demonstrated need (currently, severe need). Sets forth the factors the Secretary may consider in determining demonstrated need, including the unmet need for services and relevant factors that limit access to health care. Requires the Secretary to provide such supplemental grants to an eligible area to address the decline or disruption of all EMA-provided services related to the decline in the amounts received for emergency relief grants consistent with the FY2006 grant award.
(Sec. 104) Makes emergency relief grants and supplemental grants available for obligation by the EMA for one year. Directs the Secretary to: (1) cancel any unobligated balance of an award for a supplemental grant and require the return of any balance; (2) make such amounts available for supplemental grants; (3) cancel any unobligated balance of an award for an emergency relief grant and require the return of any balance, unless the chief elected official of the area submits, and the Secretary approves, a waiver; and (4) reduce the amount of an emergency relief grant by the same amount as the unobligated balance, with exceptions. Requires the Secretary to report to Congress on the amount of supplemental funds available and how such funds are disbursed.
(Sec. 105) Prohibits the Secretary from making an emergency relief grant to an eligible area unless the funds provided are only used for core medical services, support services, and administrative expenses. Requires the chief elected official to: (1) provide direct financial assistance to entities for the provision of core medical services and support services; and (2) use not less than 75% of the grant for core medical services that are needed in the eligible area for individuals with HIV/AIDS who are identified and eligible under RWCA. Requires the Secretary to waive such requirement if: (1) there is no waiting list for AIDS Drug Assistance Program (ADAP) services; and (2) core medical services are available to all eligible individuals.
Defines core medical services, support services, and early intervention services.
Requires the chief elected official to use not less than the percentage constituted by the ratio of the population of women, infants, children, and youth with HIV/AIDS to the general population of individuals with HIV/AIDS for providing health and support services to infants, children, youth and women with HIV/AIDS.
(Sec. 106) Requires the HIV health services planning council representatives to include members of a federally recognized Indian tribe and individuals co-infected with hepatitis B or C.
Excludes a program administered by or providing the services of the Indian Health Service from requirements that prohibit the use of grant funds to make payments for any item or service paid for by another program or insurance policy. Requires the chief elected official to submit to the lead state agency audits regarding funds expended under emergency relief grants every two years and include necessary client-based data to compile unmet need calculations and statewide coordinated statements of need process. Requires an EMA's application for a grant to include: (1) the manner in which the expected expenditures are related to the planning process for states that receive funding; and (2) the expected expenditures and how those expenditures will improve overall client outcomes.
(Sec. 107) Requires the Secretary, acting through the Administrator of the Health Resources and Services Administration (HRSA), to establish a transitional grant program for metropolitan areas for which there have been at least 1,000 but fewer than 2,000 reported and confirmed cases of AIDS during the most recent period of five calendar years. Considers as a transitional area a metropolitan area that received an emergency relief grant for FY2006, but does not qualify for FY2007 as an EMA or as a transitional area. Provides that a metropolitan area continues to be a transitional area until the metropolitan area, for three consecutive years, does not: (1) quality as a transitional area; and (2) have a cumulative total of 1,500 or more living cases of AIDS. Applies requirements for emergency relief grants to transitional grants except that the chief elected official need not have an HIV health services planning council if the official otherwise obtains community input for formulating the overall plan for priority setting and allocating funds.
Gives the Secretary discretion in allocating funds between emergency relief grants and transitional grants.
(Sec. 108) Authorizes appropriations for FY2007-FY2009.
Title II: Care Grants - (Sec. 201) Amends provisions relating to grants to enable states to improve the quality, availability, and organization of health care and support services for individuals and families with HIV/AIDS (Care grants). Requires the state to use not less than 75% of such a grant to provide core medical services that are needed in the state for eligible individuals with HIV/AIDS, such as outpatient and ambulatory health services and medical case management. Requires the Secretary to waive such requirement if: (1) there is no waiting list for AIDS Drug Assistance Program (ADAP) services; and (2) core medical services are available to all eligible individuals with HIV/AIDS.
(Sec. 202) Requires the Secretary to develop and maintain a list of classes of core ADAP antiretroviral therapeutics. Requires states to ensure that: (1) such therapeutics are the minimum required treatments provided by the state ADAP program; and (2) any drug rebates are applied to Care grant activities, with priority given to ADAP activities.
(Sec. 203) Distributes grants to states and territories, including Guam and Virgin Islands, based on the total number of living HIV/AIDS cased based on names-based reporting. Provides for a transition period for such reporting. Requires the Secretary to: (1) reduce by 5% the number of living non-AIDS cases of HIV reported for a state to adjust for duplicative reporting in and among systems that use code-based reporting; and (2) carry out a program to monitor the reporting of names-based cases and to detect instances of inaccurate reporting.
Limits the amount of increase in a Care grant for a state using code-based reporting.
Conditions state grants for pharmaceutical therapeutics on the state having no unobligated funds subject to reallocation. Allows the Secretary to waive state matching requirements for ADAP if the state has otherwise complied with matching requirements. Limits the increase of ADAP grants for states using code-based reporting.
Limits through FY2009 the maximum amount that a Care grant may decrease from the preceding fiscal year.
Requires each state receiving a Care grant to provide for the establishment of a clinical quality management program to: (1) assess the extent to which HIV health services provided to patients are consistent with relevant Public Health Service guidelines for the treatment of HIV/AIDS and related opportunistic infection; and (2) develop strategies for ensuring that such services are consistent with applicable guidelines for improvement in the access to and quality of HIV health services.
(Sec. 204) Requires a state application for a Care grant to include the designation of a lead state agency to: (1) administer all assistance received; (2) conduct a needs assessment and prepare state plan; (3) prepare all applications; (4) receive notices regarding the program; (5) collect and submit audits; and (6) carry out other duties to facilitate the coordination of the program. Requires the state application to include key outcomes to be measured by all entities in the state receiving assistance.
Excludes a program administered by or providing the services of the Indian Health Service from requirements that prohibit the use of grant funds to make payments for any item or service paid for by another program or insurance policy.
(Sec. 205) Requires the Secretary to make grants to states that: (1) demonstrate a need for supplemental financial assistance to provide HIV-related services; and (2) have not had more than 2% of grant funds canceled or covered by any waivers for the most recent grant year. Sets forth factors for the Secretary to consider that impact the need for supplemental financial assistance. Requires the Secretary to: (1) address the decline in services related to the decline in the amount of Care grants received under this Act; and (2) report to Congress on the amount of supplemental funds available and how such funds are disbursed.
Requires the state to use not less than 75% of a supplemental grant to provide core medical services that are needed in the state for eligible individuals with HIV/AIDS, such as outpatient and ambulatory health services and medical case management. Requires the Secretary to waive such requirement if: (1) there is no waiting list for AIDS Drug Assistance Program services; and (2) core medical services are available to all eligible individuals with HIV/AIDS.
(Sec. 206) Amends provisions regarding emerging communities grants to make eligible metropolitan areas for which there have been a cumulative total of at least 500, but fewer than 1,000 reported and confirmed cases of AIDS during the most recent period of 5 calendar years. Continues eligibility for an emerging communities grant until a metropolitan area does not, for three consecutive fiscal years: (1) meet the requirements as to the number of AIDS cases; and (2) have a cumulative total of 750 or more living cases of AIDS for the most recent calendar year.
(Sec. 207) Requires the Secretary to: (1) cancel the unobligated balance of any supplemental grant; (2) cancel the unobligated balance of a state Care grant unless the state submits, and the Secretary approves, a waiver of the cancellation; (3) use the canceled amounts for supplemental grants to states with a demonstrated need; and (4) reduce grant awards by the amount of unobligated balance.
(Sec. 208) Authorizes appropriations for FY2007-FY2009 for emerging communities and supplemental grants.
(Sec. 209) Requires the Secretary, acting through the Director of the Centers for Disease Control and Prevention (CDC), to make grants to compliant states for HIV/AIDS testing, prevention, counseling, treatment of newborns exposed to HIV/AIDS, treatment of mother infected with HIV/AIDS, and cost associated with linking those diagnosed with care and treatment. Makes eligible states that have either: (1) voluntary opt-out testing of pregnant women and universal testing of newborns; or (2) voluntary opt-out testing of clients at sexually transmitted disease clinics and voluntary opt-out testing of clients at substance abuse treatment centers.
(Sec. 210) Authorizes appropriations for FY2007-FY2009 for state HIV/AIDS partner notification programs.
Title III: Early Intervention Services - (Sec. 301) Amends provisions relating to grants to public and nonprofit private entities to provide early intervention services. Prohibits the Secretary from making a grant unless the applicant agrees to expend the grant for core medical services, support services, and administrative expenses. Requires a grantee to expend: (1) not less than 50% of the grant amount to provide specified early intervention services; and (2) not less than 75% of grant funds to provide core medical services that are needed in the area involved for individuals with HIV/AIDS. Allows the Secretary to grant waivers to the core medical services requirement if: (1) there is no waiting list for AIDS Drug Assistance Program (ADAP) services; and (2) core medical services are available to all individuals with HIV/AIDS. Allows grantees to provide, with the Secretary's approval, support services needed to achieve medical outcomes, such as respite care, medical transportation, and nutritional counseling.
(Sec. 302) Sets forth entities that are eligible for early intervention grants, including: (1) federally-qualified health centers; (2) comprehensive hemophilia diagnostic and treatment centers; and (3) rural health clinics. Requires such entities to serve underserved populations.
(Sec. 303) Authorizes appropriations for early intervention services grants for FY2007-FY2009.
(Sec. 304) Eliminates the requirement that grantees must obtain written consent from an individual before HIV/AIDS testing.
(Sec. 305) Eliminates provisions requiring grantees to offer counseling before conducting HIV/AIDS testing. Removes provisions that prevented a grantee from receiving funds if the grantee did not meet counseling requirement for HIV testing even when that testing was conducted with non-federal funds. Limits counseling requirements to only testing carried out with RWCA funds.
(Sec. 306) Requires applicants for grants to: (1) submit to the Secretary information on how the expected expenditures of the grant are related to the planning process for the delivery of HIV health care for states receiving Care grants; (2) submit to the Secretary a specification of the expected expenditures and how those expenditures will improve overall client outcomes; (3) provide additional documentation to the Secretary regarding the process used to obtain community input into the design and implementation of grant activities; and (4) submit to the lead state agency audits regarding grant funds expended that include necessary client level data to complete unmet need calculations and a statewide coordinated statement of need process.
Excludes a program administered by, or providing the services of, the Indian Health Service from requirements that prohibit the use of grant funds to make payments for any item or service paid for by another program or insurance policy.
Title IV: Women, Infants, Children, and Youth - (Sec. 401) Amends provisions related to programs to provide coordinated services for women, infants, children, and youth with HIV/AIDS. Provides that such grants are for family-centered care, involving outpatient or ambulatory care. Removes provisions regarding participation in research. Allows grant funds to be used to provide support services, such as case management, referrals for inpatient hospital services, treatment for substance abuse, social and supports services, and provision of information and education on opportunities to participate in HIV/AIDS-related clinical research.
Limits to 10% the amount of grant funds that may be used for administrative expenses.
Authorizes appropriations for FY2007-FY2009.
(Sec. 402) Requires the Comptroller General of the Government Accountability Office (GAO) to evaluate how funds provided under this title are used.
Title V: General Provisions - (Sec. 501) Requires audits received by the Secretary from the lead state agency to be posted on the website of HRSA.
Authorizes the Secretary to waive RWCA requirements in an emergency area during an emergency period to improve the health and safety of those receiving care and the general public, except that the Secretary is prohibited from spending more than 5% of funds available for supplemental emergency relief or Care grants.
Requires the Secretary to ensure that any information submitted to, or collected by, the Secretary under RWCA excludes any personally identifiable information.
Requires the Comptroller General to biennially submit to the appropriate congressional committees a report that includes: (1) a description of the federal, state, and local barriers to HIV program integration, particularly for racial and ethnic minorities; and (2) recommendations for enhancing the continuity of care and the provision of prevention services for individuals with HIV/AIDS or those at risk for such disease. Requires the Secretary to develop and submit to the appropriate congressional committees a severity of need index.
Title VI: Demonstration and Training - (Sec. 601) Amends provisions related to Special Projects of National Significance to administer projects to: (1) quickly respond to emerging needs of individuals receiving assistance under RWCA; and (2) fund special programs to develop a standard electronic client information data system to improve the ability of grantees to report client-level data to the Secretary. Requires the Secretary to award grants to eligible entities based on: (1) whether the funding will promote obtaining client level data as it relates to the creation of a severity of need index; (2) demonstrated ability to create and maintain a qualified health information technology system; (3) demonstrated reliability of the proposed qualified health information technology system across a variety of providers, geographic regions, and clients; and (4) newly emerging needs of individuals receiving assistance under RWCA.
Prohibits the Secretary from making a grant for the development of a qualified health information technology system unless the applicant provides assurances to the Secretary that the system will comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
(Sec. 602) Expands the grant program for training health personnel with regard to HIV/AIDS to allow the Secretary to provide grants to train health professionals and allied health professionals to provide treatment for hepatitis B or C CO-infected individuals.
Authorizes appropriations for FY2007-FY2009.
(Sec. 603) Authorizes appropriations for the purpose of carrying out activities to evaluate and address the disproportionate impact of HIV/AIDS and the disparities in access, treatment, care, and outcome on racial and ethnic minorities. Specifies allocation amounts for activities to be carried out through RWCA. Requires the Secretary to carry out this section consistent with other minority AIDS initiative activities.
Title VII: Miscellaneous Provisions - (Sec. 701) Requires HIV/AIDS counseling programs to provide information on the transmission and prevention of hepatitis A, B, and C, including education about the availability of hepatitis A and B vaccines and assisting patients in identifying vaccination sites.
Repeals RWCA effective October 1, 2009.
[109th Congress Public Law 415]
[From the U.S. Government Publishing Office]
[DOCID: f:publ415.109]
[[Page 120 STAT. 2767]]
Public Law 109-415
109th Congress
An Act
To amend title XXVI of the Public Health Service Act to revise and
extend the program for providing life-saving care for those with HIV/
AIDS. <<NOTE: Dec. 19, 2006 - [H.R. 6143]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Ryan White HIV/
AIDS Treatment Modernization Act of 2006.>>
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) <<NOTE: 42 USC 201 note.>> Short Title.--This Act may be cited
as the ``Ryan White HIV/AIDS Treatment Modernization Act of 2006''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS
Sec. 101. Establishment of program; general eligibility for grants.
Sec. 102. Type and distribution of grants; formula grants.
Sec. 103. Type and distribution of grants; supplemental grants.
Sec. 104. Timeframe for obligation and expenditure of grant funds.
Sec. 105. Use of amounts.
Sec. 106. Additional amendments to part A.
Sec. 107. New program in part A; transitional grants for certain areas
ineligible under section 2601.
Sec. 108. Authorization of appropriations for part A.
TITLE II--CARE GRANTS
Sec. 201. General use of grants.
Sec. 202. AIDS Drug Assistance Program.
Sec. 203. Distribution of funds.
Sec. 204. Additional amendments to subpart I of part B.
Sec. 205. Supplemental grants on basis of demonstrated need.
Sec. 206. Emerging communities.
Sec. 207. Timeframe for obligation and expenditure of grant funds.
Sec. 208. Authorization of appropriations for subpart I of part B.
Sec. 209. Early diagnosis grant program.
Sec. 210. Certain partner notification programs; authorization of
appropriations.
TITLE III--EARLY INTERVENTION SERVICES
Sec. 301. Establishment of program; core medical services.
Sec. 302. Eligible entities; preferences; planning and development
grants.
Sec. 303. Authorization of appropriations.
Sec. 304. Confidentiality and informed consent.
Sec. 305. Provision of certain counseling services.
Sec. 306. General provisions.
TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH
Sec. 401. Women, infants, children, and youth.
Sec. 402. GAO Report.
TITLE V--GENERAL PROVISIONS
Sec. 501. General provisions.
TITLE VI--DEMONSTRATION AND TRAINING
Sec. 601. Demonstration and training.
[[Page 120 STAT. 2768]]
Sec. 602. AIDS education and training centers.
Sec. 603. Codification of minority AIDS initiative.
TITLE VII--MISCELLANEOUS PROVISIONS
Sec. 701. Hepatitis; use of funds.
Sec. 702. Certain references.
Sec. 703. Repeal.
TITLE I--EMERGENCY RELIEF FOR ELIGIBLE AREAS
SEC. 101. ESTABLISHMENT OF PROGRAM; GENERAL ELIGIBILITY FOR GRANTS.
(a) In General.--Section 2601 of the Public Health Service Act (42
U.S.C. 300ff-11) is amended by striking subsections (b) through (d) and
inserting the following:
``(b) Continued Status as Eligible Area.--Notwithstanding any other
provision of this section, a metropolitan area that is an eligible area
for a fiscal year continues to be an eligible area until the
metropolitan area fails, for three consecutive fiscal years--
``(1) to meet the requirements of subsection (a); and
``(2) to have a cumulative total of 3,000 or more living
cases of AIDS (reported to and confirmed by the Director of the
Centers for Disease Control and Prevention) as of December 31 of
the most recent calendar year for which such data is available.
``(c) Boundaries.--For purposes of determining eligibility under
this part--
``(1) with respect to a metropolitan area that received
funding under this part in fiscal year 2006, the boundaries of
such metropolitan area shall be the boundaries that were in
effect for such area for fiscal year 1994; or
``(2) with respect to a metropolitan area that becomes
eligible to receive funding under this part in any fiscal year
after fiscal year 2006, the boundaries of such metropolitan area
shall be the boundaries that are in effect for such area when
such area initially receives funding under this part.''.
(b) Technical and Conforming Amendments.--Section 2601(a) of the
Public Health Service Act (42 U.S.C. 300ff-11(a)) is amended--
(1) by striking ``through (d)'' and inserting ``through
(c)''; and
(2) by inserting ``and confirmed by'' after ``reported to''.
(c) Definition of Metropolitan Area.--Section 2607(2) of the Public
Health Service Act (42 U.S.C. 300ff-17(2)) is amended--
(1) by striking ``area referred'' and inserting ``area that
is referred''; and
(2) by inserting before the period the following: ``, and
that has a population of 50,000 or more individuals''.
SEC. 102. TYPE AND DISTRIBUTION OF GRANTS; FORMULA GRANTS.
(a) Distribution Percentages.--Section 2603(a)(2) of the Public
Health Service Act (42 U.S.C. 300ff-13(a)(2)) is amended--
(1) in the first sentence--
(A) by striking ``50 percent of the amount
appropriated under section 2677'' and inserting ``66\2/
3\ percent of the
[[Page 120 STAT. 2769]]
amount made available under section 2610(b) for carrying
out this subpart''; and
(B) by striking ``paragraph (3)'' and inserting
``paragraphs (3) and (4)''.
(2) by striking the last sentence.
(b) Distribution Based on Living Cases of HIV/AIDS.--Section
2603(a)(3) of the Public Health Service Act (42 U.S.C. 300ff-13(a)(3))
is amended--
(1) in subparagraph (B), by striking ``estimated living
cases of acquired immune deficiency syndrome'' and inserting
``living cases of HIV/AIDS (reported to and confirmed by the
Director of the Centers for Disease Control and Prevention)'';
and
(2) by striking subparagraphs (C) through (E) and inserting
the following:
``(C) Living cases of hiv/aids.--
``(i) Requirement of names-based reporting.--
Except as provided in clause (ii), the number
determined under this subparagraph for an eligible
area for a fiscal year for purposes of
subparagraph (B) is the number of living names-
based cases of HIV/AIDS that, as of December 31 of
the most recent calendar year for which such data
is available, have been reported to and confirmed
by the Director of the Centers for Disease Control
and Prevention.
``(ii) Transition period; exemption regarding
non-aids cases.--For each of the fiscal years 2007
through 2009, an eligible area is, subject to
clauses (iii) through (v), exempt from the
requirement under clause (i) that living names-
based non-AIDS cases of HIV be reported unless--
``(I) a system was in operation as
of December 31, 2005, that provides
sufficiently accurate and reliable
names-based reporting of such cases
throughout the State in which the area
is located, subject to clause (viii); or
``(II) <<NOTE: Deadline.>> no later
than the beginning of fiscal year 2008
or 2009, the Secretary, in consultation
with the chief executive of the State in
which the area is located, determines
that a system has become operational in
the State that provides sufficiently
accurate and reliable names-based
reporting of such cases throughout the
State.
``(iii)
Requirements <<NOTE: Applicability. Deadline.>> for
exemption for fiscal year 2007.--For fiscal year
2007, an exemption under clause (ii) for an
eligible area applies only if, by October 1,
2006--
``(I)(aa) the State in which the
area is located had submitted to the
Secretary a plan for making the
transition to sufficiently accurate and
reliable names-based reporting of living
non-AIDS cases of HIV; or
``(bb) all statutory changes
necessary to provide for sufficiently
accurate and reliable reporting of such
cases had been made; and
``(II) the State had agreed that, by
April 1, 2008, the State will begin
accurate and reliable names-based
reporting of such cases, except that
[[Page 120 STAT. 2770]]
such agreement is not required to
provide that, as of such date, the
system for such reporting be fully
sufficient with respect to accuracy and
reliability throughout the area.
``(iv)
Requirement <<NOTE: Applicability. Deadline.>> for
exemption as of fiscal year 2008.--For each of the
fiscal years 2008 through 2010, an exemption under
clause (ii) for an eligible area applies only if,
as of April 1, 2008, the State in which the area
is located is substantially in compliance with the
agreement under clause (iii)(II).
``(v) Progress toward names-based reporting.--
For fiscal year 2009, the Secretary may terminate
an exemption under clause (ii) for an eligible
area if the State in which the area is located
submitted a plan under clause (iii)(I)(aa) and the
Secretary determines that the State is not
substantially following the plan.
``(vi) Counting of cases in areas with
exemptions.--
``(I) In general.--With respect to
an eligible area that is under a
reporting system for living non-AIDS
cases of HIV that is not names-based
(referred to in this subparagraph as
`code-based reporting'), the Secretary
shall, for purposes of this
subparagraph, modify the number of such
cases reported for the eligible area in
order to adjust for duplicative
reporting in and among systems that use
code-based reporting.
``(II) Adjustment rate.--The
adjustment rate under subclause (I) for
an eligible area shall be a reduction of
5 percent in the number of living non-
AIDS cases of HIV reported for the area.
``(vii)
Multiple <<NOTE: Applicability.>> political
jurisdictions.--With respect to living non-AIDS
cases of HIV, if an eligible area is not entirely
within one political jurisdiction and as a result
is subject to more than one reporting system for
purposes of this subparagraph:
``(I) Names-based reporting under
clause (i) applies in a jurisdictional
portion of the area, or an exemption
under clause (ii) applies in such
portion (subject to applicable
provisions of this subparagraph),
according to whether names-based
reporting or code-based reporting is
used in such portion.
``(II) If under subclause (I) both
names-based reporting and code-based
reporting apply in the area, the number
of code-based cases shall be reduced
under clause (vi).
``(viii) List of eligible areas meeting
standard regarding December 31, 2005.--
``(I) In general.--If an eligible
area or portion thereof is in a State
specified in subclause (II), the
eligible area or portion shall be
considered to meet the standard
described in clause (ii)(I). No other
eligible area or portion thereof may be
considered to meet such standard.
``(II) Relevant states.--For
purposes of subclause (I), the States
specified in this subclause
[[Page 120 STAT. 2771]]
are the following: Alaska, Alabama,
Arkansas, Arizona, Colorado, Florida,
Indiana, Iowa, Idaho, Kansas, Louisiana,
Michigan, Minnesota, Missouri,
Mississippi, North Carolina, North
Dakota, Nebraska, New Jersey, New
Mexico, New York, Nevada, Ohio,
Oklahoma, South Carolina, South Dakota,
Tennessee, Texas, Utah, Virginia,
Wisconsin, West Virginia, Wyoming, Guam,
and the Virgin Islands.
``(ix) Rules of construction regarding
acceptance of reports.--
``(I) Cases of aids.--With respect
to an eligible area that is subject to
the requirement under clause (i) and is
not in compliance with the requirement
for names-based reporting of living non-
AIDS cases of HIV, the Secretary shall,
notwithstanding such noncompliance,
accept reports of living cases of AIDS
that are in accordance with such clause.
``(II) Applicability of exemption
requirements.--The provisions of clauses
(ii) through (viii) may not be construed
as having any legal effect for fiscal
year 2010 or any subsequent fiscal year,
and accordingly, the status of a State
for purposes of such clauses may not be
considered after fiscal year 2009.
``(x) Program for detecting inaccurate or
fraudulent counting.--The Secretary shall carry
out a program to monitor the reporting of names-
based cases for purposes of this subparagraph and
to detect instances of inaccurate reporting,
including fraudulent reporting.''.
(c) Code-Based Areas; Limitation on Increase in Grant.--Section
2603(a)(3) of the Public Health Service Act (42 U.S.C. 300ff-13(a)), as
amended by subsection (b)(2) of this section, is amended by adding at
the end the following subparagraph:
``(D) Code-based areas; limitation on increase in
grant .--
``(i) In general.--
For <<NOTE: Applicability.>> each of the fiscal
years 2007 through 2009, if code-based reporting
(within the meaning of subparagraph (C)(vi))
applies in an eligible area or any portion thereof
as of the beginning of the fiscal year involved,
then notwithstanding any other provision of this
paragraph, the amount of the grant pursuant to
this paragraph for such area for such fiscal year
may not--
``(I) for fiscal year 2007, exceed
by more than 5 percent the amount of the
grant for the area that would have been
made pursuant to this paragraph and
paragraph (4) for fiscal year 2006 (as
such paragraphs were in effect for such
fiscal year) if paragraph (2) (as so in
effect) had been applied by substituting
`66\2/3\ percent' for `50 percent'; and
``(II) for each of the fiscal years
2008 and 2009, exceed by more than 5
percent the amount of the grant pursuant
to this paragraph and paragraph (4) for
the area for the preceding fiscal year.
[[Page 120 STAT. 2772]]
``(ii) Use of amounts involved.--For each of
the fiscal years 2007 through 2009, amounts
available as a result of the limitation under
clause (i) shall be made available by the
Secretary as additional amounts for grants
pursuant to subsection (b) for the fiscal year
involved, subject to paragraph (4) and section
2610(d)(2).''.
(d) Hold Harmless.--Section 2603(a) of the Public Health Service Act
(42 U.S.C. 300ff-13(a)) is amended--
(1) in paragraph (3)(A)--
(A) in clause (ii), by striking the period at the
end and inserting a semicolon; and
(B) by inserting after and below clause (ii) the
following:
``which product shall then, as applicable, be increased
under paragraph (4).''.
(2) by amending paragraph (4) to read as follows:
``(4) Increases in grant.--
``(A) In general.--For each eligible area that
received a grant pursuant to this subsection for fiscal
year 2006, the Secretary shall, for each of the fiscal
years 2007 through 2009, increase the amount of the
grant made pursuant to paragraph (3) for the area to
ensure that the amount of the grant for the fiscal year
involved is not less than the following amount, as
applicable to such fiscal year:
``(i) For fiscal year 2007, an amount equal to
95 percent of the amount of the grant that would
have been made pursuant to paragraph (3) and this
paragraph for fiscal year 2006 (as such paragraphs
were in effect for such fiscal year) if paragraph
(2) (as so in effect) had been applied by
substituting `66\2/3\ percent' for `50 percent'.
``(ii) For each of the fiscal years 2008 and
2009, an amount equal to 100 percent of the amount
of the grant made pursuant to paragraph (3) and
this paragraph for fiscal year 2007.
``(B) Source of funds for increase.--
``(i) In general.--From the amounts available
for carrying out the single program referred to in
section 2609(d)(2)(C) for a fiscal year (relating
to supplemental grants), the Secretary shall make
available such amounts as may be necessary to
comply with subparagraph (A), subject to section
2610(d)(2).
``(ii) Pro rata reduction.--If the amounts
referred to in clause (i) for a fiscal year are
insufficient to fully comply with subparagraph (A)
for the year, the Secretary, in order to provide
the additional funds necessary for such
compliance, shall reduce on a pro rata basis the
amount of each grant pursuant to this subsection
for the fiscal year, other than grants for
eligible areas for which increases under
subparagraph (A) apply. A reduction under the
preceding sentence may not be made in an amount
that would result in the eligible area involved
becoming eligible for such an increase.
``(C) Limitation.--This paragraph may not be
construed as having any applicability after fiscal year
2009.''.
[[Page 120 STAT. 2773]]
SEC. 103. TYPE AND DISTRIBUTION OF GRANTS; SUPPLEMENTAL GRANTS.
Section 2603(b) of the Public Health Service Act (42 U.S.C. 300ff-
13(b)) is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by
striking ``Not later than'' and all that follows through
``the Secretary shall'' and inserting the following:
``Subject to subsection (a)(4)(B)(i) and section
2610(d), the Secretary shall'';
(B) in subparagraph (B), by striking ``demonstrates
the severe need in such area'' and inserting
``demonstrates the need in such area, on an objective
and quantified basis,'';
(C) by striking subparagraph (F) and inserting the
following:
``(F) demonstrates the inclusiveness of affected
communities and individuals with HIV/AIDS;'';
(D) in subparagraph (G), by striking the period and
inserting ``; and''; and
(E) by adding at the end the following:
``(H) demonstrates the ability of the applicant to
expend funds efficiently by not having had, for the most
recent grant year under subsection (a) for which data is
available, more than 2 percent of grant funds under such
subsection canceled or covered by any waivers under
subsection (c)(3).''; and
(2) in paragraph (2)--
(A) in subparagraph (A), by striking ``severe need''
and inserting ``demonstrated need'';
(B) by striking subparagraph (B) and inserting the
following:
``(B) Demonstrated need.--The factors considered by
the Secretary in determining whether an eligible area
has a demonstrated need for purposes of paragraph (1)(B)
may include any or all of the following:
``(i) The unmet need for such services, as
determined under section 2602(b)(4) or other
community input process as defined under section
2609(d)(1)(A).
``(ii) An increasing need for HIV/AIDS-related
services, including relative rates of increase in
the number of cases of HIV/AIDS.
``(iii) The relative rates of increase in the
number of cases of HIV/AIDS within new or emerging
subpopulations.
``(iv) The current prevalence of HIV/AIDS.
``(v) Relevant factors related to the cost and
complexity of delivering health care to
individuals with HIV/AIDS in the eligible area.
``(vi) The impact of co-morbid factors,
including co-occurring conditions, determined
relevant by the Secretary.
``(vii) The prevalence of homelessness.
``(viii) The prevalence of individuals
described under section 2602(b)(2)(M).
[[Page 120 STAT. 2774]]
``(ix) The relevant factors that limit access
to health care, including geographic variation,
adequacy of health insurance coverage, and
language barriers.
``(x) The impact of a decline in the amount
received pursuant to subsection (a) on services
available to all individuals with HIV/AIDS
identified and eligible under this title.''; and
(C) by striking subparagraphs (C) and (D) and
inserting the following:
``(C) Priority in making grants.--The Secretary
shall provide funds under this subsection to an eligible
area to address the decline or disruption of all EMA-
provided services related to the decline in the amounts
received pursuant to subsection (a) consistent with the
grant award for the eligible area for fiscal year 2006,
to the extent that the factor under subparagraph (B)(x)
(relating to a decline in funding) applies to the
eligible area.''.
SEC. 104. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT FUNDS.
Section 2603 of the Public Health Service Act (42 U.S.C. 300ff-13)
is amended--
(1) by redesignating subsection (c) as subsection (d);
(2) by inserting after subsection (b) the following:
``(c) Timeframe <<NOTE: Effective dates.>> for Obligation and
Expenditure of Grant Funds.--
``(1) Obligation by end of grant year.--Effective for fiscal
year 2007 and subsequent fiscal years, funds from a grant award
made pursuant to subsection (a) or (b) for a fiscal year are
available for obligation by the eligible area involved through
the end of the one-year period beginning on the date in such
fiscal year on which funds from the award first become available
to the area (referred to in this subsection as the `grant year
for the award'), except as provided in paragraph (3)(A).
``(2) Supplemental grants; cancellation of unobligated
balance of grant award.--Effective for fiscal year 2007 and
subsequent fiscal years, if a grant award made pursuant to
subsection (b) for an eligible area for a fiscal year has an
unobligated balance as of the end of the grant year for the
award--
``(A) the Secretary shall cancel that unobligated
balance of the award, and shall require the eligible
area to return any amounts from such balance that have
been disbursed to the area; and
``(B) the funds involved shall be made available by
the Secretary as additional amounts for grants pursuant
to subsection (b) for the first fiscal year beginning
after the fiscal year in which the Secretary obtains the
information necessary for determining that the balance
is required under subparagraph (A) to be canceled,
except that the availability of the funds for such
grants is subject to subsection (a)(4) and section
2610(d)(2) as applied for such year.
``(3) Formula grants; cancellation of unobligated balance of
grant award; waiver permitting carryover.--
[[Page 120 STAT. 2775]]
``(A) In general.--Effective for fiscal year 2007
and subsequent fiscal years, if a grant award made
pursuant to subsection (a) for an eligible area for a
fiscal year has an unobligated balance as of the end of
the grant year for the award, the Secretary shall cancel
that unobligated balance of the award, and shall require
the eligible area to return any amounts from such
balance that have been disbursed to the area, unless--
``(i) before the end of the grant year, the
chief elected official of the area submits to the
Secretary a written application for a waiver of
the cancellation, which application includes a
description of the purposes for which the area
intends to expend the funds involved; and
``(ii) the Secretary approves the waiver.
``(B) Expenditure by end of carryover year.--With
respect to a waiver under subparagraph (A) that is
approved for a balance that is unobligated as of the end
of a grant year for an award:
``(i) The unobligated funds are available for
expenditure by the eligible area involved for the
one-year period beginning upon the expiration of
the grant year (referred to in this subsection as
the `carryover year').
``(ii) If the funds are not expended by the
end of the carryover year, the Secretary shall
cancel that unexpended balance of the award, and
shall require the eligible area to return any
amounts from such balance that have been disbursed
to the area.
``(C) Use of cancelled balances.--In the case of any
balance of a grant award that is cancelled under
subparagraph (A) or (B)(ii), the grant funds involved
shall be made available by the Secretary as additional
amounts for grants pursuant to subsection (b) for the
first fiscal year beginning after the fiscal year in
which the Secretary obtains the information necessary
for determining that the balance is required under such
subparagraph to be canceled, except that the
availability of the funds for such grants is subject to
subsection (a)(4) and section 2610(d)(2) as applied for
such year.
``(D) Corresponding reduction in future grant.--
``(i) In general.--In the case of an eligible
area for which a balance from a grant award under
subsection (a) is unobligated as of the end of the
grant year for the award--
``(I) the Secretary shall reduce, by
the same amount as such unobligated
balance, the amount of the grant under
such subsection for the first fiscal
year beginning after the fiscal year in
which the Secretary obtains the
information necessary for determining
that such balance was unobligated as of
the end of the grant year (which
requirement for a reduction applies
without regard to whether a waiver under
subparagraph (A) has been approved with
respect to such balance); and
[[Page 120 STAT. 2776]]
``(II) the grant funds involved in
such reduction shall be made available
by the Secretary as additional funds for
grants pursuant to subsection (b) for
such first fiscal year, subject to
subsection (a)(4) and section
2610(d)(2);
except that this clause does not apply to the
eligible area if the amount of the unobligated
balance was 2 percent or less.
``(ii) Relation to increases in grant.--A
reduction under clause (i) for an eligible area
for a fiscal year may not be taken into account in
applying subsection (a)(4) with respect to the
area for the subsequent fiscal year.''; and
(3) by adding at the end the following:
``(e) Report on the Awarding of Supplemental Funds.--Not later than
45 days after the awarding of supplemental funds under this section, the
Secretary shall submit to Congress a report concerning such funds. Such
report shall include information detailing--
``(1) the total amount of supplemental funds available under
this section for the year involved;
``(2) the amount of supplemental funds used in accordance
with the hold harmless provisions of subsection (a)(4);
``(3) the amount of supplemental funds disbursed pursuant to
subsection (b)(2)(C);
``(4) the disbursement of the remainder of the supplemental
funds after taking into account the uses described in paragraphs
(2) and (3); and
``(5) the rationale used for the amount of funds disbursed
as described under paragraphs (2), (3), and (4).''.
SEC. 105. USE OF AMOUNTS.
Section 2604 of the Public Health Service Act (42 U.S.C. 300ff-14)
is amended to read as follows:
``SEC. 2604. USE OF AMOUNTS.
``(a) Requirements.--The Secretary may not make a grant under
section 2601(a) to the chief elected official of an eligible area unless
such political subdivision agrees that--
``(1) subject to paragraph (2), the allocation of funds and
services within the eligible area will be made in accordance
with the priorities established, pursuant to section
2602(b)(4)(C), by the HIV health services planning council that
serves such eligible area;
``(2) funds provided under section 2601 will be expended
only for--
``(A) core medical services described in subsection
(c);
``(B) support services described in subsection (d);
and
``(C) administrative expenses described in
subsection (h); and
``(3) the use of such funds will comply with the
requirements of this section.
``(b) Direct Financial Assistance to Appropriate Entities.--
``(1) In general.--The chief elected official of an eligible
area shall use amounts from a grant under section 2601 to
provide direct financial assistance to entities described in
paragraph (2) for the purpose of providing core medical services
and support services.
[[Page 120 STAT. 2777]]
``(2) Appropriate entities.--Direct financial assistance may
be provided under paragraph (1) to public or nonprofit private
entities, or private for-profit entities if such entities are
the only available provider of quality HIV care in the area.
``(c) Required Funding for Core Medical Services.--
``(1) In general.--With respect to a grant under section
2601 for an eligible area for a grant year, the chief elected
official of the area shall, of the portion of the grant
remaining after reserving amounts for purposes of paragraphs (1)
and (5)(B)(i) of subsection (h), use not less than 75 percent to
provide core medical services that are needed in the eligible
area for individuals with HIV/AIDS who are identified and
eligible under this title (including services regarding the co-
occurring conditions of the individuals).
``(2) Waiver.--
``(A) In general.--The Secretary shall waive the
application of paragraph (1) with respect to a chief
elected official for a grant year if the Secretary
determines that, within the eligible area involved--
``(i) there are no waiting lists for AIDS Drug
Assistance Program services under section 2616;
and
``(ii) core medical services are available to
all individuals with HIV/AIDS identified and
eligible under this title.
``(B) Notification of waiver status.--When informing
the chief elected official of an eligible area that a
grant under section 2601 is being made for the area for
a grant year, the Secretary shall inform the official
whether a waiver under subparagraph (A) is in effect for
such year.
``(3) Core medical services.--For purposes of this
subsection, the term `core medical services', with respect to an
individual with HIV/AIDS (including the co-occurring conditions
of the individual), means the following services:
``(A) Outpatient and ambulatory health services.
``(B) AIDS Drug Assistance Program treatments in
accordance with section 2616.
``(C) AIDS pharmaceutical assistance.
``(D) Oral health care.
``(E) Early intervention services described in
subsection (e).
``(F) Health insurance premium and cost sharing
assistance for low-income individuals in accordance with
section 2615.
``(G) Home health care.
``(H) Medical nutrition therapy.
``(I) Hospice services.
``(J) Home and community-based health services as
defined under section 2614(c).
``(K) Mental health services.
``(L) Substance abuse outpatient care.
``(M) Medical case management, including treatment
adherence services.
``(d) Support Services.--
``(1) In general.--For purposes of this section, the term
`support services' means services, subject to the approval of
[[Page 120 STAT. 2778]]
the Secretary, that are needed for individuals with HIV/AIDS to
achieve their medical outcomes (such as respite care for persons
caring for individuals with HIV/AIDS, outreach services, medical
transportation, linguistic services, and referrals for health
care and support services).
``(2) Medical outcomes.--In this subsection, the term
`medical outcomes' means those outcomes affecting the HIV-
related clinical status of an individual with HIV/AIDS.
``(e) Early Intervention Services.--
``(1) In general.--For purposes of this section, the term
`early intervention services' means HIV/AIDS early intervention
services described in section 2651(e), 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/
AIDS 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.
``(2) Conditions.--With <<NOTE: Applicability.>> respect to
an entity that proposes to provide early intervention services
under paragraph (1), such paragraph shall apply only if the
entity demonstrates to the satisfaction of the chief elected
official for the eligible area 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.
``(f) Priority for Women, Infants, Children, and Youth.--
``(1) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with
HIV/AIDS, 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 HIV/AIDS to the
general population in such area of individuals with HIV/AIDS.
``(2) 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 paragraph (1) 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.
``(g) Requirement of Status as Medicaid Provider.--
[[Page 120 STAT. 2779]]
``(1) Provision of service.--Subject to paragraph (2), the
Secretary may not make a grant under section 2601(a) for the
provision of services under this section in a State unless, in
the case of any such service that is available pursuant to the
State plan approved under title XIX of the Social Security Act
for the State--
``(A) the political subdivision involved will
provide the service directly, and the political
subdivision has entered into a participation agreement
under the State plan and is qualified to receive
payments under such plan; or
``(B) <<NOTE: Contracts.>> the political subdivision
will enter into an agreement with a public or nonprofit
private entity under which the entity will provide the
service, and the entity has entered into such a
participation agreement and is qualified to receive such
payments.
``(2) Waiver.--
``(A) In general.--In the case of an entity making
an agreement pursuant to paragraph (1)(B) regarding the
provision of services, the requirement established in
such paragraph shall be waived by the HIV health
services planning council for the eligible area if the
entity does not, in providing health care services,
impose a charge or accept reimbursement available from
any third-party payor, including reimbursement under any
insurance policy or under any Federal or State health
benefits program.
``(B) Determination.--A determination by the HIV
health services planning council of whether an entity
referred to in subparagraph (A) meets the criteria for a
waiver under such subparagraph shall be made without
regard to whether the entity accepts voluntary donations
for the purpose of providing services to the public.
``(h) Administration.--
``(1) Limitation.--The chief elected official of an eligible
area shall not use in excess of 10 percent of amounts received
under a grant under this part for administrative expenses.
``(2) Allocations by chief elected official.--In the case of
entities and subcontractors to which the chief elected official
of an eligible area allocates amounts received by the official
under a grant under this part, the official shall ensure that,
of the aggregate amount so allocated, the total of the
expenditures by such entities for administrative expenses does
not exceed 10 percent (without regard to whether particular
entities expend more than 10 percent for such expenses).
``(3) Administrative activities.--For purposes of paragraph
(1), amounts may be used for administrative activities that
include--
``(A) routine grant administration and monitoring
activities, including the development of applications
for part A funds, the receipt and disbursal of program
funds, the development and establishment of
reimbursement and accounting systems, the development of
a clinical quality management program as described in
paragraph (5), the preparation of routine programmatic
and financial reports, and compliance with grant
conditions and audit requirements; and
``(B) all activities associated with the grantee's
contract award procedures, including the activities
carried out by
[[Page 120 STAT. 2780]]
the HIV health services planning council as established
under section 2602(b), the development of requests for
proposals, contract proposal review activities,
negotiation and awarding of contracts, monitoring of
contracts through telephone consultation, written
documentation or onsite visits, reporting on contracts,
and funding reallocation activities.
``(4) Subcontractor administrative activities.--For the
purposes of this subsection, subcontractor administrative
activities include--
``(A) usual and recognized overhead activities,
including established indirect rates for agencies;
``(B) management oversight of specific programs
funded under this title; and
``(C) other types of program support such as quality
assurance, quality control, and related activities.
``(5) Clinical quality management.--
``(A) Requirement.--The chief elected official of an
eligible area that receives a grant under this part
shall provide for the establishment of a clinical
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/AIDS 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.
``(B) Use of funds.--
``(i) In general.--From amounts received under
a grant awarded under this subpart for a fiscal
year, the chief elected official of an eligible
area may use for activities associated with the
clinical quality management program required in
subparagraph (A) not to exceed the lesser of--
``(I) 5 percent of amounts received
under the grant; or
``(II) $3,000,000.
``(ii) Relation to limitation on
administrative expenses.--The costs of a clinical
quality management program under subparagraph (A)
may not be considered administrative expenses for
purposes of the limitation established in
paragraph (1).
``(i) Construction.--A chief elected official may not use amounts
received under a grant awarded under this part to purchase or improve
land, or to purchase, construct, or permanently improve (other than
minor remodeling) any building or other facility, or to make cash
payments to intended recipients of services.''.
SEC. 106. ADDITIONAL AMENDMENTS TO PART A.
(a) Reporting of Cases.--Section 2601(a) of the Public Health
Service Act (42 U.S.C. 300ff-11(a)) is amended by striking ``for the
most recent period'' and inserting ``during the most recent period''.
(b) Planning Council Representation.--Section 2602(b)(2)(G) of the
Public Health Service Act (42 U.S.C. 300ff-12(b)(2)(G)) is amended by
inserting ``, members of a Federally
[[Page 120 STAT. 2781]]
recognized Indian tribe as represented in the population, individuals
co-infected with hepatitis B or C'' after ``disease''.
(c) Application for Grant.--
(1) Payer of last resort.--Section 2605(a)(6)(A) of the
Public Health Service Act (42 U.S.C. 300ff-15(a)(6)(A)) is
amended by inserting ``(except for a program administered by or
providing the services of the Indian Health Service)'' before
the semicolon.
(2) Audits.--Section 2605(a) of the Public Health Service
Act (42 U.S.C. 300ff-15(a)) is amended--
(A) in paragraph (8), by striking ``and'' at the
end;
(B) in paragraph (9), by striking the period and
inserting ``; and''; and
(C) by adding at the end the following:
``(10) that the chief elected official will submit to the
lead State agency under section 2617(b)(4), audits, consistent
with Office of Management and Budget circular A133, regarding
funds expended in accordance with this part every 2 years and
shall include necessary client-based data to compile unmet need
calculations and Statewide coordinated statements of need
process.''.
(3) Coordination.--Section 2605(b) of the Public Health
Service Act (42 U.S.C. 300ff-15(b)) is amended--
(A) in paragraph (3), by striking ``and'' at the
end;
(B) in paragraph (4), by striking the period and
inserting a semicolon; and
(C) by adding at the end the following:
``(5) the manner in which the expected expenditures are
related to the planning process for States that receive funding
under part B (including the planning process described in
section 2617(b)); and
``(6) the expected expenditures and how those expenditures
will improve overall client outcomes, as described under the
State plan under section 2617(b), and through additional
outcomes measures as identified by the HIV health services
planning council under section 2602(b).''.
SEC. 107. NEW PROGRAM IN PART A; TRANSITIONAL GRANTS FOR CERTAIN AREAS
INELIGIBLE UNDER SECTION 2601.
(a) In General.--Part A of title XXVI of the Public Health Service
Act (42 U.S.C. 300ff-11) is amended--
(1) by inserting after the part heading the following:
``Subpart I--General Grant Provisions''; and
(2) by adding at the end the following:
``Subpart II--Transitional Grants
``SEC. 2609. <<NOTE: 42 USC 300ff-19.>> ESTABLISHMENT OF PROGRAM.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall make grants
for the purpose of providing services described in section 2604 in
transitional areas, subject to the same provisions regarding the
allocation of grant funds as apply under subsection (c) of such section.
[[Page 120 STAT. 2782]]
``(b) Transitional Areas.--For purposes of this section, the term
`transitional area' means, subject to subsection (c), a metropolitan
area for which there has been reported to and confirmed by the Director
of the Centers for Disease Control and Prevention a cumulative total of
at least 1,000, but fewer than 2,000, cases of AIDS during the most
recent period of 5 calendar years for which such data are available.
``(c) Certain Eligibility Rules.--
``(1) Fiscal year 2007.--With respect to grants under
subsection (a) for fiscal year 2007, a metropolitan area that
received funding under subpart I for fiscal year 2006 but does
not for fiscal year 2007 qualify under such subpart as an
eligible area and does not qualify under subsection (b) as a
transitional area shall, notwithstanding subsection (b), be
considered a transitional area.
``(2) Continued status as transitional area.--
``(A) In general.--Notwithstanding subsection (b), a
metropolitan area that is a transitional area for a
fiscal year continues, except as provided in
subparagraph (B), to be a transitional area until the
metropolitan area fails, for three consecutive fiscal
years--
``(i) to qualify under such subsection as a
transitional area; and
``(ii) to have a cumulative total of 1,500 or
more living cases of AIDS (reported to and
confirmed by the Director of the Centers for
Disease Control and Prevention) as of December 31
of the most recent calendar year for which such
data is available.
``(B) Exception regarding status as eligible area.--
Subparagraph (A) does not apply for a fiscal year if the
metropolitan area involved qualifies under subpart I as
an eligible area.
``(d) Application of Certain Provisions of Subpart I.--
``(1) Administration; planning council.--
``(A) In general.--The provisions of section 2602
apply with respect to a grant under subsection (a) for a
transitional area to the same extent and in the same
manner as such provisions apply with respect to a grant
under subpart I for an eligible area, except that,
subject to subparagraph (B), the chief elected official
of the transitional area may elect not to comply with
the provisions of section 2602(b) if the official
provides documentation to the Secretary that details the
process used to obtain community input (particularly
from those with HIV) in the transitional area for
formulating the overall plan for priority setting and
allocating funds from the grant under subsection (a).
``(B) Exception.--For each of the fiscal years 2007
through 2009, the exception described in subparagraph
(A) does not apply if the transitional area involved
received funding under subpart I for fiscal year 2006.
``(2) Type and distribution of grants; timeframe for
obligation and expenditure of grant funds.--
``(A) Formula grants; supplemental grants.--The
provisions of section 2603 apply with respect to grants
under subsection (a) to the same extent and in the same
[[Page 120 STAT. 2783]]
manner as such provisions apply with respect to grants
under subpart I, subject to subparagraphs (B) and (C).
``(B) Formula grants; increase in grant.--For
purposes of subparagraph (A), section 2603(a)(4) does
not apply.
``(C) Supplemental grants; single program with
subpart i program.--With respect to section 2603(b) as
applied for purposes of subparagraph (A):
``(i) The Secretary shall combine amounts
available pursuant to such subparagraph with
amounts available for carrying out section 2603(b)
and shall administer the two programs as a single
program.
``(ii) In the single program, the Secretary
has discretion in allocating amounts between
eligible areas under subpart I and transitional
areas under this section, subject to the
eligibility criteria that apply under such
section, and subject to section 2603(b)(2)(C)
(relating to priority in making grants).
``(iii) Pursuant to section 2603(b)(1),
amounts for the single program are subject to use
under sections 2603(a)(4) and 2610(d)(1).
``(3) Application; technical assistance; definitions.--The
provisions of sections 2605, 2606, and 2607 apply with respect
to grants under subsection (a) to the same extent and in the
same manner as such provisions apply with respect to grants
under subpart I.''.
(b) Conforming Amendments.--Subpart I of part A of title XXVI of the
Public Health Service Act, as designated by subsection (a)(1) of this
section, <<NOTE: 42 USC 300ff-11 et seq.>> is amended by striking ``this
part'' each place such term appears and inserting ``this subpart''.
SEC. 108. AUTHORIZATION OF APPROPRIATIONS FOR PART A.
Part A of title XXVI of the Public Health Service Act, as amended by
section 106(a), is amended by adding at the end the following:
``Subpart III--General Provisions
``SEC. 2610. <<NOTE: 42 USC 300ff-20.>> AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--For the purpose of carrying out this part, there
are authorized to be appropriated $604,000,000 for fiscal year 2007,
$626,300,000 for fiscal year 2008, and $649,500,000 for fiscal year
2009. Amounts appropriated under the preceding sentence for a fiscal
year are available for obligation by the Secretary until the end of the
second succeeding fiscal year.
``(b) Reservation of Amounts.--
``(1) Fiscal year 2007.--Of the amount appropriated under
subsection (a) for fiscal year 2007, the Secretary shall
reserve--
``(A) $458,310,000 for grants under subpart I; and
``(B) $145,690,000 for grants under section 2609.
``(2) Subsequent fiscal years.--Of the amount appropriated
under subsection (a) for fiscal year 2008 and each subsequent
fiscal year--
``(A) the Secretary shall reserve an amount for
grants under subpart I; and
``(B) the Secretary shall reserve an amount for
grants under section 2609.
[[Page 120 STAT. 2784]]
``(c) Transfer of Certain Amounts; Change in Status as Eligible Area
or Transitional Area.--Notwithstanding subsection (b):
``(1) If a metropolitan area is an eligible area under
subpart I for a fiscal year, but for a subsequent fiscal year
ceases to be an eligible area by reason of section 2601(b)--
``(A)(i) the amount reserved under paragraph (1)(A)
or (2)(A) of subsection (b) of this section for the
first such subsequent year of not being an eligible area
is deemed to be reduced by an amount equal to the amount
of the grant made pursuant to section 2603(a) for the
metropolitan area for the preceding fiscal year; and
``(ii)(I) if the metropolitan area qualifies for
such first subsequent fiscal year as a transitional area
under 2609, the amount reserved under paragraph (1)(B)
or (2)(B) of subsection (b) for such fiscal year is
deemed to be increased by an amount equal to the amount
of the reduction under subparagraph (A) for such year;
or
``(II) if the metropolitan area does not qualify for
such first subsequent fiscal year as a transitional area
under 2609, an amount equal to the amount of such
reduction is, notwithstanding subsection (a),
transferred and made available for grants pursuant to
section 2618(a)(1), in addition to amounts available for
such grants under section 2623; and
``(B) if a transfer under subparagraph (A)(ii)(II)
is made with respect to the metropolitan area for such
first subsequent fiscal year, then--
``(i) the amount reserved under paragraph
(1)(A) or (2)(A) of subsection (b) of this section
for such year is deemed to be reduced by an
additional $500,000; and
``(ii) an amount equal to the amount of such
additional reduction is, notwithstanding
subsection (a), transferred and made available for
grants pursuant to section 2618(a)(1), in addition
to amounts available for such grants under section
2623.
``(2) If a metropolitan area is a transitional area under
section 2609 for a fiscal year, but for a subsequent fiscal year
ceases to be a transitional area by reason of section 2609(c)(2)
(and does not qualify for such subsequent fiscal year as an
eligible area under subpart I)--
``(A) the amount reserved under subsection (b)(2)(B)
of this section for the first such subsequent fiscal
year of not being a transitional area is deemed to be
reduced by an amount equal to the total of--
``(i) the amount of the grant that, pursuant
to section 2603(a), was made under section
2609(d)(2)(A) for the metropolitan area for the
preceding fiscal year; and
``(ii) $500,000; and
``(B) an amount equal to the amount of the reduction
under subparagraph (A) for such year is, notwithstanding
subsection (a), transferred and made available for
grants pursuant to section 2618(a)(1), in addition to
amounts available for such grants under section 2623.
[[Page 120 STAT. 2785]]
``(3) If a metropolitan area is a transitional area under
section 2609 for a fiscal year, but for a subsequent fiscal year
qualifies as an eligible area under subpart I--
``(A) the amount reserved under subsection (b)(2)(B)
of this section for the first such subsequent fiscal
year of becoming an eligible area is deemed to be
reduced by an amount equal to the amount of the grant
that, pursuant to section 2603(a), was made under
section 2609(d)(2)(A) for the metropolitan area for the
preceding fiscal year; and
``(B) the amount reserved under subsection (b)(2)(A)
for such fiscal year is deemed to be increased by an
amount equal to the amount of the reduction under
subparagraph (A) for such year.
``(d) Certain Transfers; Allocations Between Programs Under Subpart
I.--With respect to paragraphs (1)(B)(i) and (2)(A)(ii) of subsection
(c), the Secretary shall administer any reductions under such paragraphs
for a fiscal year in accordance with the following:
``(1) The reductions shall be made from amounts available
for the single program referred to in section 2609(d)(2)(C)
(relating to supplemental grants).
``(2) The reductions shall be made before the amounts
referred to in paragraph (1) are used for purposes of section
2603(a)(4).
``(3) If the amounts referred to in paragraph (1) are not
sufficient for making all the reductions, the reductions shall
be reduced until the total amount of the reductions equals the
total of the amounts referred to in such paragraph.
``(e) Rules <<NOTE: Applicability.>> of Construction Regarding First
Subsequent Fiscal Year.--Paragraphs (1) and (2) of subsection (c) apply
with respect to each series of fiscal years during which a metropolitan
area is an eligible area under subpart I or a transitional area under
section 2609 for a fiscal year and then for a subsequent fiscal year
ceases to be such an area by reason of section 2601(b) or 2609(c)(2),
respectively, rather than applying to a single such series. Paragraph
(3) of subsection (c) applies with respect to each series of fiscal
years during which a metropolitan area is a transitional area under
section 2609 for a fiscal year and then for a subsequent fiscal year
becomes an eligible area under subpart I, rather than applying to a
single such series.''.
TITLE II--CARE GRANTS
SEC. 201. GENERAL USE OF GRANTS.
(a) In General.--Section 2612 of the Public Health Service Act (42
U.S.C. 300ff-22) is amended to read as follows:
``SEC. 2612. GENERAL USE OF GRANTS.
``(a) In General.--A State may use amounts provided under grants
made under section 2611 for--
``(1) core medical services described in subsection (b);
``(2) support services described in subsection (c); and
``(3) administrative expenses described in section
2618(b)(3).
``(b) Required Funding for Core Medical Services.--
[[Page 120 STAT. 2786]]
``(1) In general.--With respect to a grant under section
2611 for a State for a grant year, the State shall, of the
portion of the grant remaining after reserving amounts for
purposes of subparagraphs (A) and (E)(ii)(I) of section
2618(b)(3), use not less than 75 percent to provide core medical
services that are needed in the State for individuals with HIV/
AIDS who are identified and eligible under this title (including
services regarding the co-occurring conditions of the
individuals).
``(2) Waiver.--
``(A) In general.--The Secretary shall waive the
application of paragraph (1) with respect to a State for
a grant year if the Secretary determines that, within
the State--
``(i) there are no waiting lists for AIDS Drug
Assistance Program services under section 2616;
and
``(ii) core medical services are available to
all individuals with HIV/AIDS identified and
eligible under this title.
``(B) Notification of waiver status.--When informing
a State that a grant under section 2611 is being made to
the State for a fiscal year, the Secretary shall inform
the State whether a waiver under subparagraph (A) is in
effect for the fiscal year.
``(3) Core medical services.--For purposes of this
subsection, the term `core medical services', with respect to an
individual infected with HIV/AIDS (including the co-occurring
conditions of the individual) means the following services:
``(A) Outpatient and ambulatory health services.
``(B) AIDS Drug Assistance Program treatments in
accordance with section 2616.
``(C) AIDS pharmaceutical assistance.
``(D) Oral health care.
``(E) Early intervention services described in
subsection (d).
``(F) Health insurance premium and cost sharing
assistance for low-income individuals in accordance with
section 2615.
``(G) Home health care.
``(H) Medical nutrition therapy.
``(I) Hospice services.
``(J) Home and community-based health services as
defined under section 2614(c).
``(K) Mental health services.
``(L) Substance abuse outpatient care.
``(M) Medical case management, including treatment
adherence services.
``(c) Support Services.--
``(1) In general.--For purposes of this subsection, the term
`support services' means services, subject to the approval of
the Secretary, that are needed for individuals with HIV/AIDS to
achieve their medical outcomes (such as respite care for persons
caring for individuals with HIV/AIDS, outreach services, medical
transportation, linguistic services, and referrals for health
care and support services).
[[Page 120 STAT. 2787]]
``(2) Definition of medical outcomes.--In this subsection,
the term `medical outcomes' means those outcomes affecting the
HIV-related clinical status of an individual with HIV/AIDS.
``(d) Early Intervention Services.--
``(1) In general.--For purposes of this section, the term
`early intervention services' means HIV/AIDS early intervention
services described in section 2651(e), 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/
AIDS counseling and testing sites, health care points of entry
specified by States, federally qualified health centers, and
entities described in section 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 shall apply only if the entity demonstrates to the
satisfaction of the chief elected official for 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
subparagraph to supplement and not supplant other funds
available to the entity for the provision of early
intervention services for the fiscal year involved.
``(e) Priority for Women, Infants, Children, and Youth.--
``(1) In general.--For the purpose of providing health and
support services to infants, children, youth, and women with
HIV/AIDS, including treatment measures to prevent the perinatal
transmission of HIV, a State 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 HIV/AIDS
to the general population in such area of individuals with HIV/
AIDS.
``(2) Waiver.--With respect to the population involved, the
Secretary may provide to a State a waiver of the requirement of
paragraph (1) if such 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.
``(f) Construction.--A State may not use amounts received under a
grant awarded under section 2611 to purchase or improve land, or to
purchase, construct, or permanently improve (other than minor
remodeling) any building or other facility, or to make cash payments to
intended recipients of services.''.
(b) HIV Care Consortia.--Section 2613 of the Public Health Service
Act (42 U.S.C. 300ff-23) is amended--
[[Page 120 STAT. 2788]]
(1) in subsection (a), in the matter preceding paragraph
(1)--
(A) by striking ``may use'' and inserting ``may,
subject to subsection (f), use''; and
(B) by striking ``section 2612(a)(1)'' and inserting
``section 2612(a)''; and
(2) by adding at the end the following subsection:
``(f) Allocation of Funds; Treatment as Support Services.--For
purposes of the requirement of section 2612(b)(1), expenditures of
grants under section 2611 for or through consortia under this section
are deemed to be support services, not core medical services. The
preceding sentence may not be construed as having any legal effect on
the provisions of subsection (a) that relate to authorized expenditures
of the grant.''.
(c) Technical Amendments.--Part B of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-21 et seq.) is amended--
(1) in section 2611-- <<NOTE: 42 USC 300ff-21.>>
(A) in subsection (a), by striking the subsection
designation and heading; and
(B) by striking subsection (b);
(2) in section 2614-- <<NOTE: 42 USC 300ff-24.>>
(A) in subsection (a), in the matter preceding
paragraph (1), by striking ``section 2612(a)(2)'' and
inserting ``section 2612(b)(3)(J)''; and
(B) in subsection (c)(2)(B), by striking ``homemaker
or'';
(3) in section 2615(a) <<NOTE: 42 USC 300ff-25.>> by
striking ``section 2612(a)(3)'' and inserting ``section
2612(b)(3)(F)''; and
(4) in section <<NOTE: 42 USC 300ff-26.>> 2616(a) by
striking ``section 2612(a)(5)'' and inserting ``section
2612(b)(3)(B)''.
SEC. 202. AIDS DRUG ASSISTANCE PROGRAM.
(a) Requirement of Minimum Drug List.--Section 2616 of the Public
Health Service Act (42 U.S.C. 300ff-26) is amended--
(1) in subsection (c), by striking paragraph (1) and
inserting the following:
``(1) ensure that the therapeutics included on the list of
classes of core antiretroviral therapeutics established by the
Secretary under subsection (e) are, at a minimum, the treatments
provided by the State pursuant to this section;'';
(2) by redesignating subsection (e) as subsection (f); and
(3) by inserting after subsection (d) the following:
``(e) List of Classes of Core Antiretroviral Therapeutics.--For
purposes of subsection (c)(1), the Secretary shall develop and maintain
a list of classes of core antiretroviral therapeutics, which list shall
be based on the therapeutics included in the guidelines of the Secretary
known as the Clinical Practice Guidelines for Use of HIV/AIDS Drugs,
relating to drugs needed to manage symptoms associated with HIV. The
preceding sentence does not affect the authority of the Secretary to
modify such Guidelines.''.
(b) Drug Rebate Program.--Section 2616 of the Public Health Service
Act, as amended by subsection (a)(2) of this section, is amended by
adding at the end the following:
``(g) Drug Rebate Program.--A State shall ensure that any drug
rebates received on drugs purchased from funds provided pursuant to this
section are applied to activities supported under
[[Page 120 STAT. 2789]]
this subpart, with priority given to activities described under this
section.''.
SEC. 203. DISTRIBUTION OF FUNDS.
(a) Distribution Based on Living Cases of HIV/AIDS.--
(1) State distribution factor.--Section 2618(a)(2) of the
Public Health Service Act (42 U.S.C. 300ff-28(a)(2)) is
amended--
(A) in subparagraph (B), by striking ``estimated
number of living cases of acquired immune deficiency
syndrome in the eligible area involved'' and inserting
``number of living cases of HIV/AIDS in the State
involved''; and
(B) by amending subparagraph (D) to read as follows:
``(D) Living cases of hiv/aids.--
``(i) Requirement of names-based reporting.--
Except as provided in clause (ii), the number
determined under this subparagraph for a State for
a fiscal year for purposes of subparagraph (B) is
the number of living names-based cases of HIV/AIDS
in the State that, as of December 31 of the most
recent calendar year for which such data is
available, have been reported to and confirmed by
the Director of the Centers for Disease Control
and Prevention.
``(ii) Transition period; exemption regarding
non-aids cases.--For each of the fiscal years 2007
through 2009, a State is, subject to clauses (iii)
through (v), exempt from the requirement under
clause (i) that living non-AIDS names-based cases
of HIV be reported unless--
``(I) a system was in operation as
of December 31, 2005, that provides
sufficiently accurate and reliable
names-based reporting of such cases
throughout the State, subject to clause
(vii); or
``(II) <<NOTE: Deadline.>> no later
than the beginning of fiscal year 2008
or 2009, the Secretary, after
consultation with the chief executive of
the State, determines that a system has
become operational in the State that
provides sufficiently accurate and
reliable names-based reporting of such
cases throughout the State.
``(iii)
Requirements <<NOTE: Applicability. Deadline.>> for
exemption for fiscal year 2007.--For fiscal year
2007, an exemption under clause (ii) for a State
applies only if, by October 1, 2006--
``(I)(aa) the State had submitted to
the Secretary a plan for making the
transition to sufficiently accurate and
reliable names-based reporting of living
non-AIDS cases of HIV; or
``(bb) all statutory changes
necessary to provide for sufficiently
accurate and reliable reporting of such
cases had been made; and
``(II) the State had agreed that, by
April 1, 2008, the State will begin
accurate and reliable names-based
reporting of such cases, except that
such agreement is not required to
provide that, as of such date, the
system for such reporting
[[Page 120 STAT. 2790]]
be fully sufficient with respect to
accuracy and reliability throughout the
area.
``(iv)
Requirement <<NOTE: Applicability. Deadline.>> for
exemption as of fiscal year 2008.--For each of the
fiscal years 2008 through 2010, an exemption under
clause (ii) for a State applies only if, as of
April 1, 2008, the State is substantially in
compliance with the agreement under clause
(iii)(II).
``(v) Progress toward names-based reporting.--
For fiscal year 2009, the Secretary may terminate
an exemption under clause (ii) for a State if the
State submitted a plan under clause (iii)(I)(aa)
and the Secretary determines that the State is not
substantially following the plan.
``(vi) Counting of cases in areas with
exemptions.--
``(I) In general.--With respect to a
State that is under a reporting system
for living non-AIDS cases of HIV that is
not names-based (referred to in this
subparagraph as `code-based reporting'),
the Secretary shall, for purposes of
this subparagraph, modify the number of
such cases reported for the State in
order to adjust for duplicative
reporting in and among systems that use
code-based reporting.
``(II) Adjustment rate.--The
adjustment rate under subclause (I) for
a State shall be a reduction of 5
percent in the number of living non-AIDS
cases of HIV reported for the State.
``(vii) List of states meeting standard
regarding december 31, 2005.--
``(I) In general.--If a State is
specified in subclause (II), the State
shall be considered to meet the standard
described in clause (ii)(I). No other
State may be considered to meet such
standard.
``(II) Relevant states.--For
purposes of subclause (I), the States
specified in this subclause are the
following: Alaska, Alabama, Arkansas,
Arizona, Colorado, Florida, Indiana,
Iowa, Idaho, Kansas, Louisiana,
Michigan, Minnesota, Missouri,
Mississippi, North Carolina, North
Dakota, Nebraska, New Jersey, New
Mexico, New York, Nevada, Ohio,
Oklahoma, South Carolina, South Dakota,
Tennessee, Texas, Utah, Virginia,
Wisconsin, West Virginia, Wyoming, Guam,
and the Virgin Islands.
``(viii) Rules of construction regarding
acceptance of reports.--
``(I) Cases of aids.--With respect
to a State that is subject to the
requirement under clause (i) and is not
in compliance with the requirement for
names-based reporting of living non-AIDS
cases of HIV, the Secretary shall,
notwithstanding such noncompliance,
accept reports of living cases of AIDS
that are in accordance with such clause.
``(II) Applicability of exemption
requirements.--The provisions of clauses
(ii) through (vii)
[[Page 120 STAT. 2791]]
may not be construed as having any legal
effect for fiscal year 2010 or any
subsequent fiscal year, and accordingly,
the status of a State for purposes of
such clauses may not be considered after
fiscal year 2009.
``(ix) Program for detecting inaccurate or
fraudulent counting.--The Secretary shall carry
out a program to monitor the reporting of names-
based cases for purposes of this subparagraph and
to detect instances of inaccurate reporting,
including fraudulent reporting.''.
(2) Non-ema distribution factor.--Section 2618(a)(2)(C) of
the Public Health Service Act (42 U.S.C. 300ff-28(a)(2)(C)) is
amended--
(A) in clause (i), by striking ``estimated number of
living cases of acquired immune deficiency syndrome''
each place such term appears and inserting ``number of
living cases of HIV/AIDS''; and
(B) in clause (ii), by amending such clause to read
as follows:
``(ii) a number equal to the sum of--
``(I) the total number of living
cases of HIV/AIDS that are within areas
in such State that are eligible areas
under subpart I of part A for the fiscal
year involved, which individual number
for an area is the number that applies
under section 2601 for the area for such
fiscal year; and
``(II) the total number of such
cases that are within areas in such
State that are transitional areas under
section 2609 for such fiscal year, which
individual number for an area is the
number that applies under such section
for the fiscal year.''.
(b) Formula Amendments Generally.--Section 2618(a)(2) of the Public
Health Service Act (42 U.S.C. 300ff-28(a)(2)) is amended--
(1) in subparagraph (A)--
(A) by striking ``The amount referred to'' in the
matter preceding clause (i) and all that follows through
the end of clause (i) and inserting the following: ``For
purposes of paragraph (1), the amount referred to in
this paragraph for a State (including a territory) for a
fiscal year is, subject to subparagraphs (E) and (F)--
``(i) an amount equal to the amount made
available under section 2623 for the fiscal year
involved for grants pursuant to paragraph (1),
subject to subparagraph (G); and''; and
(B) in clause (ii)--
(i) in subclause (I)--
(I) by striking ``.80'' and
inserting ``0.75''; and
(II) by striking ``and'' at the end;
(ii) in subclause (II)--
(I) by inserting ``non-EMA'' after
``respective''; and
(II) by striking the period and
inserting ``; and''; and
(iii) by adding at the end the following:
[[Page 120 STAT. 2792]]
``(III) if the State does not for
such fiscal year contain any area that
is an eligible area under subpart I of
part A or any area that is a
transitional area under section 2609
(referred to in this subclause as a `no-
EMA State'), the product of 0.05 and the
ratio of the number of cases that
applies for the State under subparagraph
(D) to the sum of the respective numbers
of cases that so apply for all no-EMA
States.'';
(2) by striking subparagraphs (E) through (H);
(3) by inserting after subparagraph (D) the following
subparagraphs:
``(E) Code-based states; limitation on increase in
grant.--
``(i) In general.--
For <<NOTE: Applicability.>> each of the fiscal
years 2007 through 2009, if code-based reporting
(within the meaning of subparagraph (D)(vi))
applies in a State as of the beginning of the
fiscal year involved, then notwithstanding any
other provision of this paragraph, the amount of
the grant pursuant to paragraph (1) for the State
may not for the fiscal year involved exceed by
more than 5 percent the amount of the grant
pursuant to this paragraph for the State for the
preceding fiscal year, except that the limitation
under this clause may not result in a grant
pursuant to paragraph (1) for a fiscal year that
is less than the minimum amount that applies to
the State under such paragraph for such fiscal
year.
``(ii) Use of amounts involved.--For each of
the fiscal years 2007 through 2009, amounts
available as a result of the limitation under
clause (i) shall be made available by the
Secretary as additional amounts for grants
pursuant to section 2620, subject to subparagraph
(H).''; and
(4) by redesignating subparagraph (I) as subparagraph (F).
(c) Separate ADAP Grants.--Section 2618(a)(2)(G) of the Public
Health Service Act (42 U.S.C. 300ff-28(a)(2)(G)), as redesignated by
subsection (b)(4) of this section, is amended--
(1) in clause (i)--
(A) in the matter preceding subclause (I), by
striking ``section 2677'' and inserting ``section
2623'';
(B) in subclause (II), by striking the period at the
end and inserting a semicolon; and
(C) by adding after and below subclause (II) the
following:
``which product shall then, as applicable, be
increased under subparagraph (H).'';
(2) in clause (ii)--
(A) by striking subclauses (I) through (III) and
inserting the following:
``(I) In general.--From amounts made
available under subclause (V), the
Secretary shall award supplemental
grants to States described in subclause
(II) to enable such States to purchase
and distribute to eligible individuals
under section 2616(b) pharmaceutical
therapeutics described under subsections
(c)(2) and (e) of such section.
[[Page 120 STAT. 2793]]
``(II) Eligible states.--For
purposes of subclause (I), a State shall
be an eligible State if the State did
not have unobligated funds subject to
reallocation under section 2618(d) in
the previous fiscal year and, in
accordance with criteria established by
the Secretary, demonstrates a severe
need for a grant under this clause. For
purposes of determining severe need, the
Secretary shall consider eligibility
standards, formulary composition, the
number of eligible individuals to whom a
State is unable to provide therapeutics
described in section 2616(a), and an
unanticipated increase of eligible
individuals with HIV/AIDS.
``(III) State requirements.--The
Secretary may not make a grant to a
State under this clause unless the State
agrees that the State will make
available (directly or through donations
of 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, except that the Secretary may
waive this subclause if the State has
otherwise fully complied with section
2617(d) with respect to the grant year
involved. The provisions of this
subclause shall apply to States that are
not required to comply with such section
2617(d).''.
(B) in subclause (IV), by moving the subclause two
ems to the left;
(C) in subclause (V), by striking ``3 percent'' and
inserting ``5 percent''; and
(D) by striking subclause (VI); and
(3) by adding at the end the following clause:
``(iii) Code-based
states; <<NOTE: Applicability.>> limitation on
increase in formula grant.--The limitation under
subparagraph (E)(i) applies to grants pursuant to
clause (i) of this subparagraph to the same extent
and in the same manner as such limitation applies
to grants pursuant to paragraph (1), except that
the reference to minimum grants does not apply for
purposes of this clause. Amounts available as a
result of the limitation under the preceding
sentence shall be made available by the Secretary
as additional amounts for grants under clause (ii)
of this subparagraph.''.
(d) Hold Harmless.--Section 2618(a)(2) of the Public Health Service
Act (42 U.S.C. 300ff-28(a)(2)), as amended by subsection (b)(4) of this
section, is amended by adding at the end the following subparagraph:
``(H) Increase in formula grants.--
``(i) Assurance of amount.--
``(I) General rule.--For fiscal year
2007, the Secretary shall ensure,
subject to clauses (ii) through (iv),
that the total for a State of the grant
pursuant to paragraph (1) and the grant
pursuant to subparagraph (G) is not less
than 95 percent of such total for the
State for fiscal year 2006.
[[Page 120 STAT. 2794]]
``(II) Rule
of <<NOTE: Applicability.>> construction.
--With respect to the application of
subclause (I), the 95 percent
requirement under such subclause shall
apply with respect to each grant awarded
under paragraph (1) and with respect to
each grant awarded under subparagraph
(G).
``(ii) Fiscal year 2007.--For purposes of
clause (i) as applied for fiscal year 2007, the
references in such clause to subparagraph (G) are
deemed to be references to subparagraph (I) as
such subparagraph was in effect for fiscal year
2006.
``(iii) Fiscal years 2008 and 2009.--For each
of the fiscal years 2008 and 2009, the Secretary
shall ensure that the total for a State of the
grant pursuant to paragraph (1) and the grant
pursuant to subparagraph (G) is not less than 100
percent of such total for the State for fiscal
year 2007.
``(iv) Source of funds for increase.--
``(I) In general.--From the amount
reserved under section 2623(b)(2) for a
fiscal year, and from amounts available
for such section pursuant to subsection
(d) of this section, the Secretary shall
make available such amounts as may be
necessary to comply with clause (i).
``(II) Pro rata reduction.--If the
amounts referred to in subclause (I) for
a fiscal year are insufficient to fully
comply with clause (i) for the year, the
Secretary, in order to provide the
additional funds necessary for such
compliance, shall reduce on a pro rata
basis the amount of each grant pursuant
to paragraph (1) for the fiscal year,
other than grants for States for which
increases under clause (i) apply and
other than States described in paragraph
(1)(A)(i)(I). A reduction under the
preceding sentence may not be made in an
amount that would result in the State
involved becoming eligible for such an
increase.
``(v) Applicability.--This paragraph may not
be construed as having any applicability after
fiscal year 2009.''.
(e) Administrative Expenses; Clinical Quality Management.--Section
2618(b) of the Public Health Service Act (42 U.S.C. 300ff-28(b)) is
amended--
(1) by redesignating paragraphs (2) through (7) as
paragraphs (1) through (6);
(2) in paragraph (2) (as so redesignated)--
(A) by striking ``paragraph (5)'' and inserting
``paragraph (4)''; and
(B) by striking ``paragraph (6)'' and inserting
``paragraph (5)'';
(3) in paragraph (3) (as so redesignated)--
(A) by amending subparagraph (A) to read as follows:
``(A) In general.--Subject to paragraph (4), and
except as provided in paragraph (5), a State may not use
more than 10 percent of amounts received under a grant
awarded under section 2611 for administration.'';
[[Page 120 STAT. 2795]]
(B) by redesignating subparagraphs (B) and (C) as
subparagraphs (C) and (D), respectively;
(C) by inserting after subparagraph (A) the
following:
``(B) Allocations.--In the case of entities and
subcontractors to which a State allocates amounts
received by the State under a grant under section 2611,
the State shall ensure that, of the aggregate amount so
allocated, the total of the expenditures by such
entities for administrative expenses does not exceed 10
percent (without regard to whether particular entities
expend more than 10 percent for such expenses).'';
(D) in subparagraph (C) (as so redesignated), by
inserting before the period the following: ``, including
a clinical quality management program under subparagraph
(E)''; and
(E) by adding at the end the following:
``(E) Clinical quality management.--
``(i) Requirement.--Each State that receives a
grant under section 2611 shall provide for the
establishment of a clinical 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/AIDS
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.
``(ii) Use of funds.--
``(I) In general.--From amounts
received under a grant awarded under
section 2611 for a fiscal year, a State
may use for activities associated with
the clinical quality management program
required in clause (i) not to exceed the
lesser of--
``(aa) 5 percent of amounts
received under the grant; or
``(bb) $3,000,000.
``(II) Relation to limitation on
administrative expenses.--The costs of a
clinical quality management program
under clause (i) may not be considered
administrative expenses for purposes of
the limitation established in
subparagraph (A).'';
(4) in paragraph (4) (as so redesignated)--
(A) by striking ``paragraph (6)'' and inserting
``paragraph (5)''; and
(B) by striking ``paragraphs (3) and (4)'' and
inserting ``paragraphs (2) and (3)''; and
(5) in paragraph (5) (as so redesignated), by striking
``paragraphs (3)'' and all that follows through ``(5),'' and
inserting the following: ``paragraphs (2) and (3), may,
notwithstanding paragraphs (2) through (4),''.
(f) Reallocation for Supplemental Grants.--Section 2618(d) of the
Public Health Service Act (42 U.S.C. 300ff-28(d)) is amended to read as
follows:
``(d) Reallocation.--Any portion of a grant made to a State under
section 2611 for a fiscal year that has not been obligated
[[Page 120 STAT. 2796]]
as described in subsection (c) ceases to be available to the State and
shall be made available by the Secretary for grants under section 2620,
in addition to amounts made available for such grants under section
2623(b)(2).''.
(g) Definitions; Other Technical Amendments.--Section 2618(a) of the
Public Health Service Act (42 U.S.C. 300ff-28(a)) is amended--
(1) in paragraph (1), in the matter preceding subparagraph
(A), by striking ``section 2677'' and inserting ``section
2623'';
(2) in paragraph (1)(A)--
(A) in the matter preceding clause (i), by striking
``each of the several States and the District of
Columbia'' and inserting ``each of the 50 States, the
District of Columbia, Guam, and the Virgin Islands
(referred to in this paragraph as a `covered State')'';
and
(B) in clause (i)--
(i) in subclause (I), by striking ``State or
District'' and inserting ``covered State''; and
(ii) in subclause (II)--
(I) by striking ``State or
District'' and inserting ``covered
State''; and
(II) by inserting ``and'' after the
semicolon; and
(3) in paragraph (1)(B), by striking ``each territory of the
United States, as defined in paragraph (3),'' and inserting
``each territory other than Guam and the Virgin Islands'';
(4) in paragraph (2)(C)(i), by striking ``or territory'';
and
(5) by striking paragraph (3).
SEC. 204. ADDITIONAL AMENDMENTS TO SUBPART I OF PART B.
(a) References to Part B.--Subpart I of part B of title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-21 et seq.) is amended by
striking ``this part'' each place such term appears and inserting
``section 2611''.
(b) Hepatitis.--Section 2614(a)(3) of the Public Health Service Act
(42 U.S.C. 300ff-24(a)(3)) is amended by inserting ``, including
specialty care and vaccinations for hepatitis co-infection,'' after
``health services''.
(c) Application for Grant.--
(1) Coordination.--Section 2617(b) of the Public Health
Service Act (42 U.S.C. 300ff-27(b)) is amended--
(A) by redesignating paragraphs (4) through (6) as
paragraphs (5) through (7), respectively;
(B) by inserting after paragraph (3), the following:
``(4) the designation of a lead State agency that shall--
``(A) administer all assistance received under this
part;
``(B) conduct the needs assessment and prepare the
State plan under paragraph (3);
``(C) prepare all applications for assistance under
this part;
``(D) receive notices with respect to programs under
this title;
``(E) <<NOTE: Deadline. Audits.>> every 2 years,
collect and submit to the Secretary all audits,
consistent with Office of Management and Budget circular
A133, from grantees within the State, including audits
regarding funds expended in accordance with this part;
and
[[Page 120 STAT. 2797]]
``(F) carry out any other duties determined
appropriate by the Secretary to facilitate the
coordination of programs under this title.'';
(C) in paragraph (5) (as so redesignated)--
(i) in subparagraph (E), by striking ``and''
at the end; and
(ii) by inserting after subparagraph (F) the
following:
``(G) includes key outcomes to be measured by all
entities in the State receiving assistance under this
title; and''; and
(D) in paragraph (7) (as so redesignated), in
subparagraph (A)--
(i) by striking ``paragraph (5)'' and
inserting ``paragraph (6)''; and
(ii) by striking ``paragraph (4)'' and
inserting ``paragraph (5)''.
(2) Native american representation.--Section 2617(b)(6) of
the Public Health Service Act, as redesignated by paragraph
(1)(A) of this subsection, is amended by inserting before
``representatives of grantees'' the following: ``members of a
Federally recognized Indian tribe as represented in the
State,''.
(3) Payer of last resort.--Section 2617(b)(7)(F)(ii) of the
Public Health Service Act, as redesignated by paragraph (1)(A)
of this subsection, is amended by inserting before the semicolon
the following: ``(except for a program administered by or
providing the services of the Indian Health Service)''.
(d) Matching Funds; Applicability of Requirement.--Section
2617(d)(3) of the Public Health Service Act (42 U.S.C. 300ff-27(d)(3))
is amended--
(1) in subparagraph (A), by striking ``acquired immune
deficiency syndrome'' and inserting ``HIV/AIDS''; and
(2) in subparagraph (C), by striking ``acquired immune
deficiency syndrome'' and inserting ``HIV/AIDS''.
SEC. 205. SUPPLEMENTAL GRANTS ON BASIS OF DEMONSTRATED NEED.
Subpart I of part B of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-21 et seq.) is amended--
(1) by redesignating section <<NOTE: 42 USC 300ff-30.>> 2620
as section 2621; and
(2) by inserting after section 2619 the following:
``SEC. 2620. SUPPLEMENTAL <<NOTE: 42 USC 300ff-29a.>> GRANTS.
``(a) In General.--For the purpose of providing services described
in section 2612(a), the Secretary shall make grants to States--
``(1) whose applications under section 2617 have
demonstrated the need in the State, on an objective and
quantified basis, for supplemental financial assistance to
provide such services; and
``(2) that did not, for the most recent grant year pursuant
to section 2618(a)(1) or 2618(a)(2)(G)(i) for which data is
available, have more than 2 percent of grant funds under such
sections canceled or covered by any waivers under section
2622(c).
``(b) Demonstrated Need.--The factors considered by the Secretary in
determining whether an eligible area has a demonstrated
[[Page 120 STAT. 2798]]
need for purposes of subsection (a)(1) may include any or all of the
following:
``(1) The unmet need for such services, as determined under
section 2617(b).
``(2) An increasing need for HIV/AIDS-related services,
including relative rates of increase in the number of cases of
HIV/AIDS.
``(3) The relative rates of increase in the number of cases
of HIV/AIDS within new or emerging subpopulations.
``(4) The current prevalence of HIV/AIDS.
``(5) Relevant factors related to the cost and complexity of
delivering health care to individuals with HIV/AIDS in the
eligible area.
``(6) The impact of co-morbid factors, including co-
occurring conditions, determined relevant by the Secretary.
``(7) The prevalence of homelessness.
``(8) The prevalence of individuals described under section
2602(b)(2)(M).
``(9) The relevant factors that limit access to health care,
including geographic variation, adequacy of health insurance
coverage, and language barriers.
``(10) The impact of a decline in the amount received
pursuant to section 2618 on services available to all
individuals with HIV/AIDS identified and eligible under this
title.
``(c) Priority in Making Grants.--The Secretary shall provide funds
under this section to a State to address the decline in services related
to the decline in the amounts received pursuant to section 2618
consistent with the grant award to the State for fiscal year 2006, to
the extent that the factor under subsection (b)(10) (relating to a
decline in funding) applies to the State.
``(d) Report on the Awarding of Supplemental Funds.--Not later than
45 days after the awarding of supplemental funds under this section, the
Secretary shall submit to Congress a report concerning such funds. Such
report shall include information detailing--
``(1) the total amount of supplemental funds available under
this section for the year involved;
``(2) the amount of supplemental funds used in accordance
with the hold harmless provisions of section 2618(a)(2);
``(3) the amount of supplemental funds disbursed pursuant to
subsection (c);
``(4) the disbursement of the remainder of the supplemental
funds after taking into account the uses described in paragraphs
(2) and (3); and
``(5) the rationale used for the amount of funds disbursed
as described under paragraphs (2), (3), and (4).
``(e) Core Medical Services.--The provisions of section 2612(b)
apply with respect to a grant under this section to the same extent and
in the same manner as such provisions apply with respect to a grant made
pursuant to section 2618(a)(1).
``(f) Applicability of Grant Authority.--The authority to make
grants under this section applies beginning with the first fiscal year
for which amounts are made available for such grants under section
2623(b)(1).''.
[[Page 120 STAT. 2799]]
SEC. 206. EMERGING COMMUNITIES.
Section 2621 of the Public Health Service Act, as redesignated by
section 205(1) of this Act, is amended--
(1) in the heading for the section, by striking
``supplemental grants'' and inserting ``emerging communities'';
(2) in subsection (b)--
(A) in paragraph (2), by striking ``and'' at the
end;
(B) by redesignating paragraph (3) as paragraph (4);
and
(C) by inserting after paragraph (2) the following:
``(3) agree that the grant will be used to provide funds
directly to emerging communities in the State, separately from
other funds under this title that are provided by the State to
such communities; and''.
(3) by striking subsections (d) and (e) and inserting the
following:
``(d) Definitions of Emerging Community.--For purposes of this
section, the term `emerging community' means a metropolitan area (as
defined in section 2607) for which there has been reported to and
confirmed by the Director of the Centers for Disease Control and
Prevention a cumulative total of at least 500, but fewer than 1,000,
cases of AIDS during the most recent period of 5 calendar years for
which such data are available.
``(e) Continued Status as Emerging Community.--Notwithstanding any
other provision of this section, a metropolitan area that is an emerging
community for a fiscal year continues to be an emerging community until
the metropolitan area fails, for three consecutive fiscal years--
``(1) to meet the requirements of subsection (d); and
``(2) to have a cumulative total of 750 or more living cases
of AIDS (reported to and confirmed by the Director of the
Centers for Disease Control and Prevention) as of December 31 of
the most recent calendar year for which such data is available.
``(f) Distribution.--The amount of a grant under subsection (a) for
a State for a fiscal year shall be an amount equal to the product of--
``(1) the amount available under section 2623(b)(1) for the
fiscal year; and
``(2) a percentage equal to the ratio constituted by the
number of living cases of HIV/AIDS in emerging communities in
the State to the sum of the respective numbers of such cases in
such communities for all States.''.
SEC. 207. TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT FUNDS.
Subpart I of part B of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-21 et seq.), as amended by section 205, is further
amended by adding at the end the following:
``SEC. 2622. <<NOTE: Effective date. 42 USC 300ff-31a.>> TIMEFRAME FOR
OBLIGATION AND EXPENDITURE OF GRANT FUNDS.
``(a) Obligation by end of Grant Year.--Effective for fiscal year
2007 and subsequent fiscal years, funds from a grant award made to a
State for a fiscal year pursuant to section 2618(a)(1) or 2618(a)(2)(G),
or under section 2620 or 2621, are available for obligation by the State
through the end of the one-year period
[[Page 120 STAT. 2800]]
beginning on the date in such fiscal year on which funds from the award
first become available to the State (referred to in this section as the
`grant year for the award'), except as provided in subsection (c)(1).
``(b) Supplemental Grants; Cancellation of Unobligated Balance of
Grant Award.--Effective for fiscal year 2007 and subsequent fiscal
years, if a grant award made to a State for a fiscal year pursuant to
section 2618(a)(2)(G)(ii), or under section 2620 or 2621, has an
unobligated balance as of the end of the grant year for the award--
``(1) the Secretary shall cancel that unobligated balance of
the award, and shall require the State to return any amounts
from such balance that have been disbursed to the State; and
``(2) the funds involved shall be made available by the
Secretary as additional amounts for grants pursuant to section
2620 for the first fiscal year beginning after the fiscal year
in which the Secretary obtains the information necessary for
determining that the balance is required under paragraph (1) to
be canceled, except that the availability of the funds for such
grants is subject to section 2618(a)(2)(H) as applied for such
year.
``(c) Formula Grants; Cancellation of Unobligated Balance of Grant
Award; Waiver Permitting Carryover.--
``(1) In general.--Effective for fiscal year 2007 and
subsequent fiscal years, if a grant award made to a State for a
fiscal year pursuant to section 2618(a)(1) or 2618(a)(2)(G)(i)
has an unobligated balance as of the end of the grant year for
the award, the Secretary shall cancel that unobligated balance
of the award, and shall require the State to return any amounts
from such balance that have been disbursed to the State,
unless--
``(A) before the end of the grant year, the State
submits to the Secretary a written application for a
waiver of the cancellation, which application includes a
description of the purposes for which the State intends
to expend the funds involved; and
``(B) the Secretary approves the waiver.
``(2) Expenditure by end of carryover year.--With respect to
a waiver under paragraph (1) that is approved for a balance that
is unobligated as of the end of a grant year for an award:
``(A) The unobligated funds are available for
expenditure by the State involved for the one-year
period beginning upon the expiration of the grant year
(referred to in this section as the `carryover year').
``(B) If the funds are not expended by the end of
the carryover year, the Secretary shall cancel that
unexpended balance of the award, and shall require the
State to return any amounts from such balance that have
been disbursed to the State.
``(3) Use of cancelled balances.--In the case of any balance
of a grant award that is cancelled under paragraph (1) or
(2)(B), the grant funds involved shall be made available by the
Secretary as additional amounts for grants under section 2620
for the first fiscal year beginning after the fiscal year in
which the Secretary obtains the information necessary for
determining that the balance is required under such paragraph
[[Page 120 STAT. 2801]]
to be canceled, except that the availability of the funds for
such grants is subject to section 2618(a)(2)(H) as applied for
such year.
``(4) Corresponding reduction in future grant.--
``(A) In general.--In the case of a State for which
a balance from a grant award made pursuant to section
2618(a)(1) or 2618(a)(2)(G)(i) is unobligated as of the
end of the grant year for the award--
``(i) the Secretary shall reduce, by the same
amount as such unobligated balance, the amount of
the grant under such section for the first fiscal
year beginning after the fiscal year in which the
Secretary obtains the information necessary for
determining that such balance was unobligated as
of the end of the grant year (which requirement
for a reduction applies without regard to whether
a waiver under paragraph (1) has been approved
with respect to such balance); and
``(ii) the grant funds involved in such
reduction shall be made available by the Secretary
as additional funds for grants under section 2620
for such first fiscal year, subject to section
2618(a)(2)(H);
except that this subparagraph does not apply to the
State if the amount of the unobligated balance was 2
percent or less.
``(B) Relation to increases in grant.--A reduction
under subparagraph (A) for a State for a fiscal year may
not be taken into account in applying section
2618(a)(2)(H) with respect to the State for the
subsequent fiscal year.
``(d) Treatment of Drug Rebates.--For purposes of this section,
funds that are drug rebates referred to in section 2616(g) may not be
considered part of any grant award referred to in subsection (a).''.
SEC. 208. AUTHORIZATION OF APPROPRIATIONS FOR SUBPART I OF PART B.
Subpart I of part B of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-21 et seq.), as amended by section 207, is further
amended by adding at the end the following:
``SEC. 2623. <<NOTE: 42 USC 300ff-31b.>> AUTHORIZATION OF
APPROPRIATIONS.
``(a) In General.--For the purpose of carrying out this subpart,
there are authorized to be appropriated $1,195,500,000 for fiscal year
2007, $1,239,500,000 for fiscal year 2008, and $1,285,200,000 for fiscal
year 2009. Amounts appropriated under the preceding sentence for a
fiscal year are available for obligation by the Secretary until the end
of the second succeeding fiscal year.
``(b) Reservation of Amounts.--
``(1) Emerging communities.--Of the amount appropriated
under subsection (a) for a fiscal year, the Secretary shall
reserve $5,000,000 for grants under section 2621.
``(2) Supplemental grants.--
``(A) In general.--Of the amount appropriated under
subsection (a) for a fiscal year in excess of the 2006
adjusted amount, the Secretary shall reserve \1/3\ for
grants under section 2620, except that the availability
of the reserved funds for such grants is subject to
section 2618(a)(2)(H) as applied for such year, and
except that any amount appropriated exclusively for
carrying out section 2616 (and,
[[Page 120 STAT. 2802]]
accordingly, distributed under section 2618(a)(2)(G)) is
not subject to this subparagraph.
``(B) 2006 adjusted amount.--For purposes of
subparagraph (A), the term `2006 adjusted amount' means
the amount appropriated for fiscal year 2006 under
section 2677(b) (as such section was in effect for such
fiscal year), excluding any amount appropriated for such
year exclusively for carrying out section 2616 (and,
accordingly, distributed under section 2618(a)(2)(I), as
so in effect).''.
SEC. 209. EARLY DIAGNOSIS GRANT PROGRAM.
Section 2625 of the Public Health Service Act (42 U.S.C. 300ff-33)
is amended to read as follows:
``SEC. 2625. EARLY DIAGNOSIS GRANT PROGRAM.
``(a) In General.--In the case of States whose laws or regulations
are in accordance with subsection (b), the Secretary, acting through the
Centers for Disease Control and Prevention, shall make grants to such
States for the purposes described in subsection (c).
``(b) Description of Compliant States.--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), both of the
policies described in paragraph (1) are in effect, or both of the
policies described in paragraph (2) are in effect, as follows:
``(1)(A) Voluntary opt-out testing of pregnant women.
``(B) Universal testing of newborns.
``(2)(A) Voluntary opt-out testing of clients at sexually
transmitted disease clinics.
``(B) Voluntary opt-out testing of clients at substance
abuse treatment centers.
The Secretary shall periodically ensure that the applicable policies are
being carried out and recertify compliance.
``(c) Use of Funds.--A State may use funds provided under subsection
(a) for HIV/AIDS testing (including rapid testing), prevention
counseling, treatment of newborns exposed to HIV/AIDS, treatment of
mothers infected with HIV/AIDS, and costs associated with linking those
diagnosed with HIV/AIDS to care and treatment for HIV/AIDS.
``(d) Application.--A State that is eligible for the grant under
subsection (a) shall submit an application to the Secretary, in such
form, in such manner, and containing such information as the Secretary
may require.
``(e) Limitation on Amount of Grant.--A grant under subsection (a)
to a State for a fiscal year may not be made in an amount exceeding
$10,000,000.
``(f) Rule of Construction.--Nothing in this section shall be
construed to pre-empt State laws regarding HIV/AIDS counseling and
testing.
``(g) Definitions.--In this section:
``(1) The term `voluntary opt-out testing' means HIV/AIDS
testing--
``(A) that is administered to an individual seeking
other health care services; and
``(B) in which--
[[Page 120 STAT. 2803]]
``(i) pre-test counseling is not required but
the individual is informed that the individual
will receive an HIV/AIDS test and the individual
may opt out of such testing; and
``(ii) for those individuals with a positive
test result, post-test counseling (including
referrals for care) is provided and
confidentiality is protected.
``(2) The term `universal testing of newborns' means HIV/
AIDS testing that is administered within 48 hours of delivery
to--
``(A) all infants born in the State; or
``(B) all infants born in the State whose mother's
HIV/AIDS status is unknown at the time of delivery.
``(h) Authorization of Appropriations.--Of the funds appropriated
annually to the Centers for Disease Control and Prevention for HIV/AIDS
prevention activities, $30,000,000 shall be made available for each of
the fiscal years 2007 through 2009 for grants under subsection (a), of
which $20,000,000 shall be made available for grants to States with the
policies described in subsection (b)(1), and $10,000,000 shall be made
available for grants to States with the policies described in subsection
(b)(2). Funds provided under this section are available until
expended.''.
SEC. 210. CERTAIN PARTNER NOTIFICATION PROGRAMS; AUTHORIZATION OF
APPROPRIATIONS.
Section 2631(d) of the Public Health Service Act (42 U.S.C. 300ff-
38(d)) is amended by striking ``there are'' and all that follows and
inserting the following: ``there is authorized to be appropriated
$10,000,000 for each of the fiscal years 2007 through 2009.''.
TITLE III--EARLY INTERVENTION SERVICES
SEC. 301. ESTABLISHMENT OF PROGRAM; CORE MEDICAL SERVICES.
(a) In General.--Section 2651 of the Public Health Service Act (42
U.S.C. 300ff-51) is amended to read as follows:
``SEC. 2651. ESTABLISHMENT OF A PROGRAM.
``(a) In General.--For the purposes described in subsection (b), the
Secretary, acting through the Administrator of the Health Resources and
Services Administration, may make grants to public and nonprofit private
entities specified in section 2652(a).
``(b) Requirements.--
``(1) In general.--The Secretary may not make a grant under
subsection (a) unless the applicant for the grant agrees to
expend the grant only for--
``(A) core medical services described in subsection
(c);
``(B) support services described in subsection (d);
and
``(C) administrative expenses as described in
section 2664(g)(3).
``(2) Early intervention services.--An applicant for a grant
under subsection (a) shall expend not less than 50 percent of
the amount received under the grant for the services described
in subparagraphs (B) through (E) of subsection (e)(1) for
individuals with HIV/AIDS.
``(c) Required Funding for Core Medical Services.--
[[Page 120 STAT. 2804]]
``(1) In general.--With respect to a grant under subsection
(a) to an applicant for a fiscal year, the applicant shall, of
the portion of the grant remaining after reserving amounts for
purposes of paragraphs (3) and (5) of section 2664(g), use not
less than 75 percent to provide core medical services that are
needed in the area involved for individuals with HIV/AIDS who
are identified and eligible under this title (including services
regarding the co-occurring conditions of the individuals).
``(2) Waiver.--
``(A) The Secretary shall waive the application of
paragraph (1) with respect to an applicant for a grant
if the Secretary determines that, within the service
area of the applicant--
``(i) there are no waiting lists for AIDS Drug
Assistance Program services under section 2616;
and
``(ii) core medical services are available to
all individuals with HIV/AIDS identified and
eligible under this title.
``(B) Notification of waiver status.--When informing
an applicant that a grant under subsection (a) is being
made for a fiscal year, the Secretary shall inform the
applicant whether a waiver under subparagraph (A) is in
effect for the fiscal year.
``(3) Core medical services.--For purposes of this
subsection, the term `core medical services', with respect to an
individual with HIV/AIDS (including the co-occurring conditions
of the individual) means the following services:
``(A) Outpatient and ambulatory health services.
``(B) AIDS Drug Assistance Program treatments under
section 2616.
``(C) AIDS pharmaceutical assistance.
``(D) Oral health care.
``(E) Early intervention services described in
subsection (e).
``(F) Health insurance premium and cost sharing
assistance for low-income individuals in accordance with
section 2615.
``(G) Home health care.
``(H) Medical nutrition therapy.
``(I) Hospice services.
``(J) Home and community-based health services as
defined under section 2614(c).
``(K) Mental health services.
``(L) Substance abuse outpatient care.
``(M) Medical case management, including treatment
adherence services.
``(d) Support Services.--
``(1) In general.--For purposes of this section, the term
`support services' means services, subject to the approval of
the Secretary, that are needed for individuals with HIV/AIDS to
achieve their medical outcomes (such as respite care for persons
caring for individuals with HIV/AIDS, outreach services, medical
transportation, linguistic services, and referrals for health
care and support services).
[[Page 120 STAT. 2805]]
``(2) Definition of medical outcomes.--In this section, the
term `medical outcomes' means those outcomes affecting the HIV-
related clinical status of an individual with HIV/AIDS.
``(e) Specification of Early Intervention Services.--
``(1) In general.--The early intervention services referred
to in this section are--
``(A) counseling individuals with respect to HIV/
AIDS in accordance with section 2662;
``(B) testing individuals with respect to HIV/AIDS,
including tests to confirm the presence of the disease,
tests to diagnose the extent of the deficiency in the
immune system, and tests to provide information on
appropriate therapeutic measures for preventing and
treating the deterioration of the immune system and for
preventing and treating conditions arising from HIV/
AIDS;
``(C) referrals described in paragraph (2);
``(D) other clinical and diagnostic services
regarding HIV/AIDS, and periodic medical evaluations of
individuals with HIV/AIDS; and
``(E) providing the therapeutic measures described
in subparagraph (B).
``(2) Referrals.--The services referred to in paragraph
(1)(C) are referrals of individuals with HIV/AIDS to appropriate
providers of health and support services, including, as
appropriate--
``(A) to entities receiving amounts under part A or
B for the provision of such services;
``(B) to biomedical research facilities of
institutions of higher education that offer experimental
treatment for such disease, or to community-based
organizations or other entities that provide such
treatment; or
``(C) to grantees under section 2671, in the case of
a pregnant woman.
``(3) Requirement of availability of all early intervention
services through each grantee.--
``(A) In general.--The Secretary may not make a
grant under subsection (a) unless the applicant for the
grant agrees that each of the early intervention
services specified in paragraph (2) will be available
through the grantee. With respect to compliance with
such agreement, such a grantee may expend the grant to
provide the early intervention services directly, and
may expend the grant to enter into agreements with
public or nonprofit private entities, or private for-
profit entities if such entities are the only available
provider of quality HIV care in the area, under which
the entities provide the services.
``(B) Other requirements.--Grantees described in--
``(i) subparagraphs (A), (D), (E), and (F) of
section 2652(a)(1) shall use not less than 50
percent of the amount of such a grant to provide
the services described in subparagraphs (A), (B),
(D), and (E) of paragraph (1) directly and on-site
or at sites where other primary care services are
rendered; and
``(ii) subparagraphs (B) and (C) of section
2652(a)(1) shall ensure the availability of early
intervention services through a system of linkages
to
[[Page 120 STAT. 2806]]
community-based primary care providers, and to
establish mechanisms for the referrals described
in paragraph (1)(C), and for follow-up concerning
such referrals.''.
(b) Administrative Expenses; Clinical Quality Management Program.--
Section 2664(g) of the Public Health Service Act (42 U.S.C. 300ff-64(g))
is amended--
(1) in paragraph (3), by amending the paragraph to read as
follows:
``(3) the applicant will not expend more than 10 percent of
the grant for administrative expenses with respect to the grant,
including planning and evaluation, except that the costs of a
clinical quality management program under paragraph (5) may not
be considered administrative expenses for purposes of such
limitation;''; and
(2) in paragraph (5), by inserting ``clinical'' before
``quality management''.
SEC. 302. ELIGIBLE ENTITIES; PREFERENCES; PLANNING AND DEVELOPMENT
GRANTS.
(a) Minimum Qualification of Grantees.--Section 2652(a) of the
Public Health Service Act (42 U.S.C. 300ff-52(a)) is amended to read as
follows:
``(a) Eligible Entities.--
``(1) In general.--The entities referred to in section
2651(a) are public entities and nonprofit private entities that
are--
``(A) federally-qualified health centers under
section 1905(l)(2)(B) of the Social Security Act;
``(B) grantees under section 1001 (regarding family
planning) other than States;
``(C) comprehensive hemophilia diagnostic and
treatment centers;
``(D) rural health clinics;
``(E) health facilities operated by or pursuant to a
contract with the Indian Health Service;
``(F) community-based organizations, clinics,
hospitals and other health facilities that provide early
intervention services to those persons infected with
HIV/AIDS through intravenous drug use; or
``(G) nonprofit private entities that provide
comprehensive primary care services to populations at
risk of HIV/AIDS, including faith-based and community-
based organizations.
``(2) Underserved populations.--Entities described in
paragraph (1) shall serve underserved populations which may
include minority populations and Native American populations,
ex-offenders, individuals with comorbidities including hepatitis
B or C, mental illness, or substance abuse, low-income
populations, inner city populations, and rural populations.''.
(b) Preferences in Making Grants.--Section 2653 of the Public Health
Service Act (42 U.S.C. 300ff-53) is amended--
(1) in subsection (b)(1)--
(A) in subparagraph (A), by striking ``acquired
immune deficiency syndrome'' and inserting ``HIV/AIDS'';
and
(B) in subparagraph (D), by inserting before the
semicolon the following: ``and the number of cases of
individuals co-infected with HIV/AIDS and hepatitis B or
C''; and
[[Page 120 STAT. 2807]]
(2) in subsection (d)(2), by striking ``special
consideration'' and inserting ``preference''.
(c) Planning and Development Grants.--Section 2654(c) of the Public
Health Service Act (42 U.S.C. 300ff-54(c)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by striking ``HIV''; and
(B) in subparagraph (B), by striking ``HIV'' and
inserting ``HIV/AIDS''; and
(2) in paragraph (3), by striking ``or underserved
communities'' and inserting ``areas or to underserved
populations''.
SEC. 303. AUTHORIZATION OF APPROPRIATIONS.
Section 2655 of the Public Health Service Act (42 U.S.C. 300ff-55)
is amended by striking ``such sums'' and all that follows through
``2005'' and inserting ``, $218,600,000 for fiscal year 2007,
$226,700,000 for fiscal year 2008, and $235,100,000 for fiscal year
2009''.
SEC. 304. CONFIDENTIALITY AND INFORMED CONSENT.
Section 2661 of the Public Health Service Act (42 U.S.C. 300ff-61)
is amended to read as follows:
``SEC. 2661. CONFIDENTIALITY AND INFORMED CONSENT.
``(a) Confidentiality.--The Secretary may not make a grant under
this part unless, in the case of any entity applying for a grant under
section 2651, the entity agrees to ensure that information regarding the
receipt of early intervention services pursuant to the grant is
maintained confidentially in a manner not inconsistent with applicable
law.
``(b) Informed Consent.--The Secretary may not make a grant under
this part unless the applicant for the grant agrees that, in testing an
individual for HIV/AIDS, the applicant will test an individual only
after the individual confirms that the decision of the individual with
respect to undergoing such testing is voluntarily made.''.
SEC. 305. PROVISION OF CERTAIN COUNSELING SERVICES.
Section 2662 of the Public Health Service Act (42 U.S.C. 300ff-62)
is amended to read as follows:
``SEC. 2662. PROVISION OF CERTAIN COUNSELING SERVICES.
``(a) Counseling of Individuals With Negative Test Results.--The
Secretary may not make a grant under this part unless the applicant for
the grant agrees that, if the results of testing conducted for HIV/AIDS
indicate that an individual does not have such condition, the applicant
will provide the individual information, including--
``(1) measures for prevention of, exposure to, and
transmission of HIV/AIDS, hepatitis B, hepatitis C, and other
sexually transmitted diseases;
``(2) the accuracy and reliability of results of testing for
HIV/AIDS, hepatitis B, and hepatitis C;
``(3) the significance of the results of such testing,
including the potential for developing AIDS, hepatitis B, or
hepatitis C;
``(4) the appropriateness of further counseling, testing,
and education of the individual regarding HIV/AIDS and other
sexually transmitted diseases;
[[Page 120 STAT. 2808]]
``(5) if diagnosed with chronic hepatitis B or hepatitis C
co-infection, the potential of developing hepatitis-related
liver disease and its impact on HIV/AIDS; and
``(6) information regarding the availability of hepatitis B
vaccine and information about hepatitis treatments.
``(b) Counseling of Individuals With Positive Test Results.--The
Secretary may not make a grant under this part unless the applicant for
the grant agrees that, if the results of testing for HIV/AIDS indicate
that the individual has such condition, the applicant will provide to
the individual appropriate counseling regarding the condition,
including--
``(1) information regarding--
``(A) measures for prevention of, exposure to, and
transmission of HIV/AIDS, hepatitis B, and hepatitis C;
``(B) the accuracy and reliability of results of
testing for HIV/AIDS, hepatitis B, and hepatitis C; and
``(C) the significance of the results of such
testing, including the potential for developing AIDS,
hepatitis B, or hepatitis C;
``(2) reviewing the appropriateness of further counseling,
testing, and education of the individual regarding HIV/AIDS and
other sexually transmitted diseases; and
``(3) providing counseling--
``(A) on the availability, through the applicant, of
early intervention services;
``(B) on the availability in the geographic area of
appropriate health care, mental health care, and social
and support services, including providing referrals for
such services, as appropriate;
``(C)(i) that explains the benefits of locating and
counseling any individual by whom the infected
individual may have been exposed to HIV/AIDS, hepatitis
B, or hepatitis C and any individual whom the infected
individual may have exposed to HIV/AIDS, hepatitis B, or
hepatitis C; and
``(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/AIDS, hepatitis B, or hepatitis C;
and
``(D) on the availability of the services of public
health authorities with respect to locating and
counseling any individual described in subparagraph (C);
``(4) if diagnosed with chronic hepatitis B or hepatitis C
co-infection, the potential of developing hepatitis-related
liver disease and its impact on HIV/AIDS; and
``(5) information regarding the availability of hepatitis B
vaccine.
``(c) Additional Requirements Regarding Appropriate Counseling.--The
Secretary may not make a grant under this part unless the applicant for
the grant agrees that, in counseling individuals with respect to HIV/
AIDS, the applicant will ensure that the counseling is provided under
conditions appropriate to the needs of the individuals.
[[Page 120 STAT. 2809]]
``(d) Counseling of Emergency Response Employees.--The Secretary may
not make a grant under this part to a State unless the State agrees
that, in counseling individuals with respect to HIV/AIDS, the State will
ensure that, in the case of emergency response employees, the counseling
is provided to such employees under conditions appropriate to the needs
of the employees regarding the counseling.
``(e) Rule of Construction Regarding Counseling Without Testing.--
Agreements made pursuant to this section may not be construed to
prohibit any grantee under this part from expending the grant for the
purpose of providing counseling services described in this section to an
individual who does not undergo testing for HIV/AIDS as a result of the
grantee or the individual determining that such testing of the
individual is not appropriate.''.
SEC. 306. GENERAL PROVISIONS.
(a) Applicability of Certain Requirements.--Section 2663 of the
Public Health Service Act (42 U.S.C. 300ff-63) is amended by striking
``will, without'' and all that follows through ``be carried'' and
inserting ``with funds appropriated through this Act will be carried''.
(b) Additional Required Agreements.--Section 2664(a) of the Public
Health Service Act (42 U.S.C. 300ff-64(a)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A), by striking ``and'' at the
end;
(B) in subparagraph (B), by striking ``and'' at the
end; and
(C) by adding at the end the following:
``(C) information regarding how the expected
expenditures of the grant are related to the planning
process for localities funded under part A (including
the planning process described in section 2602) and for
States funded under part B (including the planning
process described in section 2617(b)); and
``(D) a specification of the expected expenditures
and how those expenditures will improve overall client
outcomes, as described in the State plan under section
2617(b);'';
(2) in paragraph (2), by striking the period and inserting a
semicolon; and
(3) by adding at the end the following:
``(3) the applicant agrees to provide additional
documentation to the Secretary regarding the process used to
obtain community input into the design and implementation of
activities related to such grant; and
``(4) the applicant agrees to submit, every 2 years, to the
lead State agency under section 2617(b)(4) audits, consistent
with Office of Management and Budget circular A133, regarding
funds expended in accordance with this title and shall include
necessary client level data to complete unmet need calculations
and Statewide coordinated statements of need process.''.
(c) Payer of Last Resort.--Section 2664(f)(1)(A) of the Public
Health Service Act (42 U.S.C. 300ff-64(f)(1)(A)) is amended by inserting
``(except for a program administered by or providing the services of the
Indian Health Service)'' before the semicolon.
[[Page 120 STAT. 2810]]
TITLE IV--WOMEN, INFANTS, CHILDREN, AND YOUTH
SEC. 401. WOMEN, INFANTS, CHILDREN, AND YOUTH.
Part D of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-71 et seq.) is amended to read as follows:
``PART D--WOMEN, INFANTS, CHILDREN, AND YOUTH
``SEC. 2671. <<NOTE: 42 USC 300ff-71.>> GRANTS FOR COORDINATED SERVICES
AND ACCESS TO RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND
YOUTH.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall award grants
to public and nonprofit private entities (including a health facility
operated by or pursuant to a contract with the Indian Health Service)
for the purpose of providing family-centered care involving outpatient
or ambulatory care (directly or through contracts) for women, infants,
children, and youth with HIV/AIDS.
``(b) Additional Services for Patients and Families.--Funds provided
under grants awarded under subsection (a) may be used for the following
support services:
``(1) Family-centered care including case management.
``(2) Referrals for additional services including--
``(A) referrals for inpatient hospital services,
treatment for substance abuse, and mental health
services; and
``(B) referrals for other social and support
services, as appropriate.
``(3) Additional services necessary to enable the patient
and the family to participate in the program established by the
applicant pursuant to such subsection including services
designed to recruit and retain youth with HIV.
``(4) The provision of information and education on
opportunities to participate in HIV/AIDS-related clinical
research.
``(c) Coordination With Other Entities.--A grant awarded under
subsection (a) may be made only if the applicant provides an agreement
that includes the following:
``(1) The applicant will coordinate activities under the
grant with other providers of health care services under this
Act, and under title V of the Social Security Act, including
programs promoting the reduction and elimination of risk of HIV/
AIDS for youth.
``(2) The applicant will participate in the statewide
coordinated statement of need under part B (where it has been
initiated by the public health agency responsible for
administering grants under part B) and in revisions of such
statement.
``(3) <<NOTE: Deadline. Audits.>> The applicant will every 2
years submit to the lead State agency under section 2617(b)(4)
audits regarding funds expended in accordance with this title
and shall include necessary client-level data to complete unmet
need calculations and Statewide coordinated statements of need
process.
[[Page 120 STAT. 2811]]
``(d) Administration; Application.--A grant may only be awarded to
an entity under subsection (a) if an application for the grant is
submitted to the Secretary and the application is in such form, is made
in such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to carry out
this section. Such application shall include the following:
``(1) Information regarding how the expected expenditures of
the grant are related to the planning process for localities
funded under part A (including the planning process outlined in
section 2602) and for States funded under part B (including the
planning process outlined in section 2617(b)).
``(2) A specification of the expected expenditures and how
those expenditures will improve overall patient outcomes, as
outlined as part of the State plan (under section 2617(b)) or
through additional outcome measures.
``(e) Annual Review of Programs; Evaluations.--
``(1) Review regarding access to and participation in
programs.--With <<NOTE: Deadline.>> respect to a grant under
subsection (a) for an entity for a fiscal year, the Secretary
shall, not later than 180 days after the end of the fiscal year,
provide for the conduct and completion of a review of the
operation during the year of the program carried out under such
subsection by the entity. The purpose of such review shall be
the development of recommendations, as appropriate, for
improvements in the following:
``(A) Procedures used by the entity to allocate
opportunities and services under subsection (a) among
patients of the entity who are women, infants, children,
or youth.
``(B) Other procedures or policies of the entity
regarding the participation of such individuals in such
program.
``(2) Evaluations.----The <<NOTE: Contracts.>> Secretary
shall, directly or through contracts with public and private
entities, provide for evaluations of programs carried out
pursuant to subsection (a).
``(f) Administrative Expenses.--
``(1) Limitation.--A grantee may not use more than 10
percent of amounts received under a grant awarded under this
section for administrative expenses.
``(2) Clinical quality management program.--A grantee under
this section shall implement a clinical 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/AIDS 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.
``(g) Training and Technical Assistance.--From the amounts
appropriated under subsection (i) for a fiscal year, the Secretary may
use not more than 5 percent to provide, directly or through contracts
with public and private entities (which may include grantees under
subsection (a)), training and technical assistance to assist applicants
and grantees under subsection (a) in complying with the requirements of
this section.
``(h) Definitions.--In this section:
[[Page 120 STAT. 2812]]
``(1) Administrative expenses.--The term `administrative
expenses' means funds that are to be used by grantees for grant
management and monitoring activities, including costs related to
any staff or activity unrelated to services or indirect costs.
``(2) Indirect costs.--The term `indirect costs' means costs
included in a Federally negotiated indirect rate.
``(3) Services.--The term `services' means--
``(A) services that are provided to clients to meet
the goals and objectives of the program under this
section, including the provision of professional,
diagnostic, and therapeutic services by a primary care
provider or a referral to and provision of specialty
care; and
``(B) services that sustain program activity and
contribute to or help improve services under
subparagraph (A).
``(i) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated, $71,800,000
for each of the fiscal years 2007 through 2009.''.
SEC. 402. GAO REPORT.
Not later than 24 months after the date of enactment of this Act,
the Comptroller General of the Government Accountability Office shall
conduct an evaluation, and submit to Congress a report, concerning the
funding provided for under part D of title XXVI of the Public Health
Service Act to determine--
(1) how funds are used to provide the administrative
expenses, indirect costs, and services, as defined in section
2671(h) of such title, for individuals with HIV/AIDS;
(2) how funds are used to provide the administrative
expenses, indirect costs, and services, as defined in section
2671(h) of such title, to family members of women, infants,
children, and youth infected with HIV/AIDS;
(3) how funds are used to provide family-centered care
involving outpatient or ambulatory care authorized under section
2671(a) of such title;
(4) how funds are used to provide additional services
authorized under section 2671(b) of such title; and
(5) how funds are used to help identify HIV-positive
pregnant women and their children who are exposed to HIV and
connect them with care that can improve their health and prevent
perinatal transmission.
TITLE V--GENERAL PROVISIONS
SEC. 501. GENERAL PROVISIONS.
Part E of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-80 et seq.) is amended to read as follows:
``PART E--GENERAL PROVISIONS
``SEC. 2681. <<NOTE: 42 USC 300ff-81.>> COORDINATION.
``(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 Centers for Medicare & Medicaid
[[Page 120 STAT. 2813]]
Services coordinate the planning, funding, and implementation of Federal
HIV programs (including all minority AIDS initiatives of the Public
Health Service, including under section 2693) to enhance the continuity
of care and prevention services for individuals with HIV/AIDS 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 assistance under this title.
``(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/AIDS or those at risk of such disease.
``(c) Integration by State.--As a condition of receipt of funds
under this title, a State shall provide assurances to the Secretary that
health support services funded under this title will be integrated with
other such services, that programs will be coordinated with other
available programs (including Medicaid), and that the continuity of care
and prevention services of individuals with HIV/AIDS is enhanced.
``(d) Integration by Local or Private Entities.--As a condition of
receipt of funds under this title, a local government or private
nonprofit entity shall provide assurances to the Secretary that services
funded under this title will be integrated with other such services,
that programs will be coordinated with other available programs
(including Medicaid), and that the continuity of care and prevention
services of individuals with HIV is enhanced.
``SEC. 2682. <<NOTE: 42 USC 300ff-82.>> AUDITS.
``(a) In General.--For <<NOTE: Effective date.>> fiscal year 2009,
and each subsequent fiscal year, 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.
``(b) Posting on the Internet.--All audits that the Secretary
receives from the State lead agency under section 2617(b)(4) shall be
posted, in their entirety, on the Internet website of the Health
Resources and Services Administration.
``SEC. 2683. PUBLIC <<NOTE: 42 USC 300ff-83.>> HEALTH EMERGENCY.
``(a) In General.--In an emergency area and during an emergency
period, the Secretary shall have the authority to waive such
requirements of this title to improve the health and safety of those
receiving care under this title and the general public, except that the
Secretary may not expend more than 5 percent of the funds allocated
under this title for sections 2620 and section 2603(b).
``(b) Emergency Area and Emergency Period.--In this section:
``(1) Emergency area.--The term `emergency area' means a
geographic area in which there exists--
[[Page 120 STAT. 2814]]
``(A) an emergency or disaster declared by the
President pursuant to the National Emergencies Act or
the Robert T. Stafford Disaster Relief and Emergency
Assistance Act; or
``(B) a public health emergency declared by the
Secretary pursuant to section 319.
``(2) Emergency period.--The term `emergency period' means
the period in which there exists--
``(A) an emergency or disaster declared by the
President pursuant to the National Emergencies Act or
the Robert T. Stafford Disaster Relief and Emergency
Assistance Act; or
``(B) a public health emergency declared by the
Secretary pursuant to section 319.
``(c) Unobligated Funds.--If funds under a grant under this section
are not expended for an emergency in the fiscal year in which the
emergency is declared, such funds shall be returned to the Secretary for
reallocation under sections 2603(b) and 2620.
``SEC. 2684. <<NOTE: 42 USC 300ff-84.>> PROHIBITION ON PROMOTION OF
CERTAIN ACTIVITIES.
``None of the funds appropriated under this title shall be used to
fund AIDS programs, or to develop materials, designed to promote or
encourage, directly, intravenous drug use or sexual activity, whether
homosexual or heterosexual. Funds authorized under this title may be
used to provide medical treatment and support services for individuals
with HIV.
``SEC. 2685. <<NOTE: 42 USC 300ff-85.>> PRIVACY PROTECTIONS.
``(a) In General.--The Secretary shall ensure that any information
submitted to, or collected by, the Secretary under this title excludes
any personally identifiable information.
``(b) Definition.--In this section, the term `personally
identifiable information' has the meaning given such term under the
regulations promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996.
``SEC. 2686. <<NOTE: 42 USC 300ff-86.>> GAO REPORT.
``The Comptroller General of the Government Accountability Office
shall biennially submit to the appropriate committees of Congress a
report that includes a description of Federal, State, and local barriers
to HIV program integration, particularly for racial and ethnic
minorities, including activities carried out under subpart III of part
F, and recommendations for enhancing the continuity of care and the
provision of prevention services for individuals with HIV/AIDS or those
at risk for such disease. Such report shall include a demonstration of
the manner in which funds under this subpart are being expended and to
what extent the services provided with such funds increase access to
prevention and care services for individuals with HIV/AIDS and build
stronger community linkages to address HIV prevention and care for
racial and ethnic minority communities.
``SEC. 2687. <<NOTE: 42 USC 300ff-87.>> SEVERITY OF NEED INDEX.
``(a) Development <<NOTE: Deadline.>> of Index.--Not later than
September 30, 2008, the Secretary shall develop and submit to the
appropriate committees of Congress a severity of need index in
accordance with subsection (c).
[[Page 120 STAT. 2815]]
``(b) Definition of Severity of Need Index.--In this section, the
term `severity of need index' means the index of the relative needs of
individuals within a State or area, as identified by a number of
different factors, and is a factor or set of factors that is multiplied
by the number of living HIV/AIDS cases in a State or area, providing
different weights to those cases based on needs. Such factors or set of
factors may be different for different components of the provisions
under this title.
``(c) Requirements for Secretarial Submission.--When the Secretary
submits to the appropriate committees of Congress the severity of need
index under subsection (a), the Secretary shall provide the following:
``(1) Methodology for and rationale behind developing the
severity of need index, including information related to the
field testing of the severity of need index.
``(2) An independent contractor analysis of activities
carried out under paragraph (1).
``(3) Information regarding the process by which the
Secretary received community input regarding the application and
development of the severity of need index.
``(d) Annual Reports.--If the Secretary fails to submit the severity
of need index under subsection (a) in either of fiscal years 2007 or
2008, the Secretary shall prepare and submit to the appropriate
committees of Congress a report for such fiscal year--
``(1) that updates progress toward having client level data;
``(2) that updates the progress toward having a severity of
need index, including information related to the methodology and
process for obtaining community input; and
``(3) that, as applicable, states whether the Secretary
could develop a severity of need index before fiscal year 2009.
``SEC. 2688. <<NOTE: 42 USC 300ff-88.>> DEFINITIONS.
``For purposes of this title:
``(1) AIDS.--The term `AIDS' means acquired immune
deficiency syndrome.
``(2) Co-occurring conditions.--The term `co-occurring
conditions' means one or more adverse health conditions in an
individual with HIV/AIDS, without regard to whether the
individual has AIDS and without regard to whether the conditions
arise from HIV.
``(3) Counseling.--The term `counseling' means such
counseling provided by an individual trained to provide such
counseling.
``(4) Family-centered care.--The term `family-centered care'
means the system of services described in this title that is
targeted specifically to the special needs of infants, children,
women and families. Family-centered care shall be based on a
partnership between parents, professionals, and the community
designed to ensure an integrated, coordinated, culturally
sensitive, and community-based continuum of care for children,
women, and families with HIV/AIDS.
``(5) Families with hiv/aids.--The term `families with HIV/
AIDS' means families in which one or more members have HIV/AIDS.
``(6) HIV.--The term `HIV' means infection with the human
immunodeficiency virus.
``(7) HIV/AIDS.--
[[Page 120 STAT. 2816]]
``(A) In general.--The term `HIV/AIDS' means HIV,
and includes AIDS and any condition arising from AIDS.
``(B) Counting of cases.--The term `living cases of
HIV/AIDS', with respect to the counting of cases in a
geographic area during a period of time, means the sum
of--
``(i) the number of living non-AIDS cases of
HIV in the area; and
``(ii) the number of living cases of AIDS in
the area.
``(C) Non-aids cases.--The term `non-AIDS', with
respect to a case of HIV, means that the individual
involved has HIV but does not have AIDS.
``(8) Human immunodeficiency virus.--The term `human
immunodeficiency virus' means the etiologic agent for AIDS.
``(9) Official poverty line.--The term `official poverty
line' means the poverty line established by the Director of the
Office of Management and Budget and revised by the Secretary in
accordance with section 673(2) of the Omnibus Budget
Reconciliation Act of 1981.
``(10) Person.--The term `person' includes one or more
individuals, governments (including the Federal Government and
the governments of the States), governmental agencies, political
subdivisions, labor unions, partnerships, associations,
corporations, legal representatives, mutual companies, joint-
stock companies, trusts, unincorporated organizations,
receivers, trustees, and trustees in cases under title 11,
United States Code.
``(11) State.--
``(A) In general.--The term `State' means each of
the 50 States, the District of Columbia, and each of the
territories.
``(B) Territories.--The term `territory' means each
of American Samoa, Guam, the Commonwealth of Puerto
Rico, the Commonwealth of the Northern Mariana Islands,
the Virgin Islands, the Republic of the Marshall
Islands, the Federated States of Micronesia, and Palau.
``(12) Youth with hiv.--The term `youth with HIV' means
individuals who are 13 through 24 years old and who have HIV/
AIDS.''.
TITLE VI--DEMONSTRATION AND TRAINING
SEC. 601. DEMONSTRATION AND TRAINING.
Subpart I of part F of title XXVI of the Public Health Service Act
(42 U.S.C. 300ff-101 et seq.) is amended to read as follows:
``Subpart I--Special Projects of National Significance
``SEC. 2691. <<NOTE: 42 USC 300ff-101.>> SPECIAL PROJECTS OF NATIONAL
SIGNIFICANCE.
``(a) In General.--Of the amount appropriated under each of parts A,
B, C, and D for each fiscal year, the Secretary shall use the greater of
$20,000,000 or an amount equal to 3 percent
[[Page 120 STAT. 2817]]
of such amount appropriated under each such part, but not to exceed
$25,000,000, to administer special projects of national significance
to--
``(1) quickly respond to emerging needs of individuals
receiving assistance under this title; and
``(2) to fund special programs to develop a standard
electronic client information data system to improve the ability
of grantees under this title to report client-level data to the
Secretary.
``(b) Grants.--The Secretary shall award grants under subsection (a)
to entities eligible for funding under parts A, B, C, and D based on--
``(1) whether the funding will promote obtaining client
level data as it relates to the creation of a severity of need
index, including funds to facilitate the purchase and enhance
the utilization of qualified health information technology
systems;
``(2) demonstrated ability to create and maintain a
qualified health information technology system;
``(3) the potential replicability of the proposed activity
in other similar localities or nationally;
``(4) the demonstrated reliability of the proposed qualified
health information technology system across a variety of
providers, geographic regions, and clients; and
``(5) the demonstrated ability to maintain a safe and secure
qualified health information system; or
``(6) newly emerging needs of individuals receiving
assistance under this title.
``(c) Coordination.--The Secretary may not make a grant under this
section unless the applicant submits evidence that the proposed program
is consistent with the statewide coordinated statement of need, and the
applicant agrees to participate in the ongoing revision process of such
statement of need.
``(d) Privacy Protection.--The Secretary may not make a grant under
this section for the development of a qualified health information
technology system unless the applicant provides assurances to the
Secretary that the system will, at a minimum, comply with the privacy
regulations promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996.
``(e) Replication.--The Secretary shall make information concerning
successful models or programs developed under this part available to
grantees under this title for the purpose of coordination, replication,
and integration. To facilitate efforts under this subsection, the
Secretary may provide for peer-based technical assistance for grantees
funded under this part.''.
SEC. 602. AIDS EDUCATION AND TRAINING CENTERS.
(a) Amendments Regarding Schools and Centers.--Section 2692(a)(2) of
the Public Health Service Act (42 U.S.C. 300ff-111(a)(2)) is amended--
(1) in subparagraph (A)--
(A) by inserting ``and Native Americans'' after
``minority individuals''; and
(B) by striking ``and'' at the end;
(2) in subparagraph (B), by striking the period and
inserting ``; and''; and
(3) by adding at the end the following:
[[Page 120 STAT. 2818]]
``(C) train or result in the training of health
professionals and allied health professionals to provide
treatment for hepatitis B or C co-infected
individuals.''.
(b) Authorizations of Appropriations for Schools, Centers, and
Dental Programs.--Section 2692(c) of the Public Health Service Act (42
U.S.C. 300ff-111(c)) is amended to read as follows:
``(c) Authorization of Appropriations.--
``(1) Schools; centers.--For the purpose of awarding grants
under subsection (a), there is authorized to be appropriated
$34,700,000 for each of the fiscal years 2007 through 2009.
``(2) Dental schools.--For the purpose of awarding grants
under subsection (b), there is authorized to be appropriated
$13,000,000 for each of the fiscal years 2007 through 2009.''.
SEC. 603. CODIFICATION OF MINORITY AIDS INITIATIVE.
Part F of title XXVI of the Public Health Service Act (42 U.S.C.
300ff-101 et seq.) is amended by adding at the end the following:
``Subpart III--Minority AIDS Initiative
``SEC. 2693. <<NOTE: 42 USC 300ff-121.>> MINORITY AIDS INITIATIVE.
``(a) In General.--For the purpose of carrying out activities under
this section to evaluate and address the disproportionate impact of HIV/
AIDS on, and the disparities in access, treatment, care, and outcomes
for, racial and ethnic minorities (including African Americans, Alaska
Natives, Latinos, American Indians, Asian Americans, Native Hawaiians,
and Pacific Islanders), there are authorized to be appropriated
$131,200,000 for fiscal year 2007, $135,100,000 for fiscal year 2008,
and $139,100,000 for fiscal year 2009.
``(b) Certain Activities.--
``(1) In general.--In carrying out the purpose described in
subsection (a), the Secretary shall provide for--
``(A) emergency assistance under part A;
``(B) care grants under part B;
``(C) early intervention services under part C;
``(D) services through projects for HIV-related care
under part D; and
``(E) activities through education and training
centers under section 2692.
``(2) Allocations among activities.--Activities under
paragraph (1) shall be carried out by the Secretary in
accordance with the following:
``(A) For competitive, supplemental grants to
improve HIV-related health outcomes to reduce existing
racial and ethnic health disparities, the Secretary
shall, of the amount appropriated under subsection (a)
for a fiscal year, reserve the following, as applicable:
``(i) For fiscal year 2007, $43,800,000.
``(ii) For fiscal year 2008, $45,400,000.
``(iii) For fiscal year 2009, $47,100,000.
``(B) For competitive grants used for supplemental
support education and outreach services to increase the
number of eligible racial and ethnic minorities who have
access to treatment through the program under section
[[Page 120 STAT. 2819]]
2616 for therapeutics, the Secretary shall, of the
amount appropriated for a fiscal year under subsection
(a), reserve the following, as applicable:
``(i) For fiscal year 2007, $7,000,000.
``(ii) For fiscal year 2008, $7,300,000.
``(iii) For fiscal year 2009, $7,500,000.
``(C) For planning grants, capacity-building grants,
and services grants to health care providers who have a
history of providing culturally and linguistically
appropriate care and services to racial and ethnic
minorities, the Secretary shall, of the amount
appropriated for a fiscal year under subsection (a),
reserve the following, as applicable:
``(i) For fiscal year 2007, $53,400,000.
``(ii) For fiscal year 2008, $55,400,000.
``(iii) For fiscal year 2009, $57,400,000.
``(D) For eliminating racial and ethnic disparities
in the delivery of comprehensive, culturally and
linguistically appropriate care services for HIV disease
for women, infants, children, and youth, the Secretary
shall, of the amount appropriated under subsection (a),
reserve $18,500,000 for each of the fiscal years 2007
through 2009.
``(E) For increasing the training capacity of
centers to expand the number of health care
professionals with treatment expertise and knowledge
about the most appropriate standards of HIV disease-
related treatments and medical care for racial and
ethnic minority adults, adolescents, and children with
HIV disease, the Secretary shall, of the amount
appropriated under subsection (a), reserve $8,500,000
for each of the fiscal years 2007 through 2009.
``(c) Consistency With Prior Program.--With respect to the purpose
described in subsection (a), the Secretary shall carry out this section
consistent with the activities carried out under this title by the
Secretary pursuant to the Departments of Labor, Health and Human
Services, and Education, and Related Agencies Appropriations Act, 2002
(Public Law 107-116).''.
TITLE VII--MISCELLANEOUS PROVISIONS
SEC. 701. HEPATITIS; USE OF FUNDS.
Section 2667 of the Public Health Service Act (42 U.S.C. 300ff-67)
is amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by striking the period and inserting
``; and''; and
(3) by adding at the end the following:
``(4) shall provide information on the transmission and
prevention of hepatitis A, B, and C, including education about
the availability of hepatitis A and B vaccines and assisting
patients in identifying vaccination sites.''.
SEC. 702. CERTAIN REFERENCES.
Title XXVI of the Public Health Service Act (42 U.S.C. 300ff et
seq.) is amended--
[[Page 120 STAT. 2820]]
(1) by <<NOTE: 42 USC 300ff-11, 300ff-28.>> striking
``acquired immune deficiency syndrome'' each place such term
appears, other than in section 2687(1) (as added by section 501
of this Act), and inserting ``AIDS'';
(2) by striking ``such syndrome'' and inserting ``AIDS'';
and
(3) by <<NOTE: 42 USC 300ff-12 et seq.>> striking ``HIV
disease'' each place such term appears and inserting ``HIV/
AIDS''.
SEC. 703. <<NOTE: 42 USC 300ff-11 et seq.>> REPEAL.
Effective <<NOTE: Effective date.>> on October 1, 2009, title XXVI
of the Public Health Service Act (42 U.S.C. 300ff et seq.) is repealed.
Approved December 19, 2006.
LEGISLATIVE HISTORY--H.R. 6143:
---------------------------------------------------------------------------
HOUSE REPORTS: No. 109-695 (Comm. on Energy and Commerce).
CONGRESSIONAL RECORD, Vol. 152 (2006):
Sept. 28, considered and passed House.
Dec. 6, considered and passed Senate, amended.
Dec. 8, House concurred in Senate amendment.
<all>
Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by the Yeas and Nays: (2/3 required): 325 - 98 (Roll no. 503).(text: CR H7711-7726)
Roll Call #503 (House)On motion to suspend the rules and pass the bill, as amended Agreed to by the Yeas and Nays: (2/3 required): 325 - 98 (Roll no. 503). (text: CR H7711-7726)
Roll Call #503 (House)Motion to reconsider laid on the table Agreed to without objection.
Received in the Senate.
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Senate Committee on Health, Education, Labor, and Pensions discharged by Unanimous Consent.(consideration: CR S11240-11243)
Senate Committee on Health, Education, Labor, and Pensions discharged by Unanimous Consent. (consideration: CR S11240-11243)
Passed/agreed to in Senate: Passed Senate with an amendment by Unanimous Consent.
Passed Senate with an amendment by Unanimous Consent.
Message on Senate action sent to the House.
Enacted as Public Law 109-415
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Mr. Barton (TX) asked unanimous consent that the House agree to the Senate amendment. (consideration: CR 12/8/2006 H9282-9296)
Resolving differences -- House actions: On motion that the House agree to the Senate amendment Agreed to without objection.(text as House agreed to Senate amendment: CR 12/8/2006 H9282-9295)
On motion that the House agree to the Senate amendment Agreed to without objection. (text as House agreed to Senate amendment: CR 12/8/2006 H9282-9295)
Motion to reconsider laid on the table Agreed to without objection.
Presented to President.
Presented to President.
Signed by President.
Signed by President.
Became Public Law No: 109-415.
Became Public Law No: 109-415.