Home > 106th Congressional Bills > S. 2311 (rs) To revise and extend the Ryan White CARE Act programs under title XXVI [Reported in Senate] ...

S. 2311 (rs) To revise and extend the Ryan White CARE Act programs under title XXVI [Reported in Senate] ...

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  2d Session
                                S. 2311



                              June 7, 2000

                 Referred to the Committee on Commerce


                                 AN ACT

To revise and extend the Ryan White CARE Act programs under title XXVI 
of the Public Health Service Act, to improve access to health care and 
    the quality of care under such programs, and to provide for the 
 development of increased capacity to provide health care and related 
support services to individuals and families with HIV disease, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,


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


    (a) References.--Except as otherwise expressly provided, whenever 
in this Act an amendment or repeal is expressed in terms of an 
amendment to, or repeal of, a section or other provision, the reference 
shall be considered to be made to a section or other provision of the 
Public Health Service Act (42 U.S.C. 201 et seq.).
    (b) Table of Contents.--The table of contents of this Act is as 

Sec. 1. Short title.
Sec. 2. References; table of contents.

       Subtitle A--Amendments to Part A (Emergency Relief Grants)

Sec. 101. Duties of planning council, funding priorities, quality 
Sec. 102. Quality management.
Sec. 103. Funded entities required to have health care relationships.
Sec. 104. Support services required to be health care-related.
Sec. 105. Use of grant funds for early intervention services.
Sec. 106. Replacement of specified fiscal years regarding the sunset on 
                            expedited distribution requirements.
Sec. 107. Hold harmless provision.
Sec. 108. Set-aside for infants, children, and women.
         Subtitle B--Amendments to Part B (Care Grant Program)

Sec. 121. State requirements concerning identification of need and 
                            allocation of resources.
Sec. 122. Quality management.
Sec. 123. Funded entities required to have health care relationships.
Sec. 124. Support services required to be health care-related.
Sec. 125. Use of grant funds for early intervention services.
Sec. 126. Authorization of appropriations for HIV-related services for 
                            women and children.
Sec. 127. Repeal of requirement for completed Institute of Medicine 
Sec. 128. Supplement grants for certain States.
Sec. 129. Use of treatment funds.
Sec. 130. Increase in minimum allotment.
Sec. 131. Set-aside for infants, children, and women.
     Subtitle C--Amendments to Part C (Early Intervention Services)

Sec. 141. Amendment of heading; repeal of formula grant program.
Sec. 142. Planning and development grants.
Sec. 143. Authorization of appropriations for categorical grants.
Sec. 144. Administrative expenses ceiling; quality management program.
Sec. 145. Preference for certain areas.
Sec. 146. Technical amendment.
         Subtitle D--Amendments to Part D (General Provisions)

Sec. 151. Research involving women, infants, children, and youth.
Sec. 152. Limitation on administrative expenses.
Sec. 153. Evaluations and reports.
Sec. 154. Authorization of appropriations for grants under parts A and 
     Subtitle E--Amendments to Part F (Demonstration and Training)

Sec. 161. Authorization of appropriations.

Sec. 201. Institute of Medicine study.


       Subtitle A--Amendments to Part A (Emergency Relief Grants)


    Section 2602 (42 U.S.C. 300ff-12) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (2)(C), by inserting before the 
                semicolon the following: ``, including providers of 
                housing and homeless services''; and
                    (B) in paragraph (4), by striking ``shall--'' and 
                all that follows and inserting ``shall have the 
                responsibilities specified in subsection (d).''; and
            (2) by adding at the end the following:
    ``(d) Duties of Planning Council.--The planning council established 
under subsection (b) shall have the following duties:
            ``(1) Priorities for allocation of funds.--The council 
        shall establish priorities for the allocation of funds within 
        the eligible area, including how best to meet each such 
        priority and additional factors that a grantee should consider 
        in allocating funds under a grant, based on the following 
                    ``(A) The size and demographic characteristics of 
                the population with HIV disease to be served, 
                including, subject to subsection (e), the needs of 
                individuals living with HIV infection who are not 
                receiving HIV-related health services.
                    ``(B) The documented needs of the population with 
                HIV disease with particular attention being given to 
                disparities in health services among affected subgroups 
                within the eligible area.
                    ``(C) The demonstrated or probable cost and outcome 
                effectiveness of proposed strategies and interventions, 
                to the extent that data are reasonably available.
                    ``(D) Priorities of the communities with HIV 
                disease for whom the services are intended.
                    ``(E) The availability of other governmental and 
                non-governmental resources, including the State 
                medicaid plan under title XIX of the Social Security 
                Act and the State Children's Health Insurance Program 
                under title XXI of such Act to cover health care costs 
                of eligible individuals and families with HIV disease.
                    ``(F) Capacity development needs resulting from 
                gaps in the availability of HIV services in 
                historically underserved low-income communities.
            ``(2) Comprehensive service delivery plan.--The council 
        shall develop a comprehensive plan for the organization and 
        delivery of health and support services described in section 
        2604. Such plan shall be compatible with any existing State or 
        local plans regarding the provision of such services to 
        individuals with HIV disease.
            ``(3) Assessment of fund allocation efficiency.--The 
        council shall assess the efficiency of the administrative 
        mechanism in rapidly allocating funds to the areas of greatest 
        need within the eligible area.
            ``(4) Statewide statement of need.--The council shall 
        participate in the development of the Statewide coordinated 
        statement of need as initiated by the State public health 
        agency responsible for administering grants under part B.
            ``(5) Coordination with other federal grantees.--The 
        council shall coordinate with Federal grantees providing HIV-
        related services within the eligible area.
            ``(6) Community participation.--The council shall establish 
        methods for obtaining input on community needs and priorities 
        which may include public meetings, conducting focus groups, and 
        convening ad-hoc panels.
    ``(e) Process for Establishing Allocation Priorities.--
            ``(1) In general.--Not later than 24 months after the date 
        of enactment of the Ryan White CARE Act Amendments of 2000, the 
        Secretary shall--
                    ``(A) consult with eligible metropolitan areas, 
                affected communities, experts, and other appropriate 
                individuals and entities, to develop epidemiologic 
                measures for establishing the number of individuals 
                living with HIV disease who are not receiving HIV-
                related health services; and
                    ``(B) provide advice and technical assistance to 
                planning councils with respect to the process for 
                establishing priorities for the allocation of funds 
                under subsection (d)(1).
            ``(2) Exception.--Grantees under this part shall not be 
        required to establish priorities for individuals not in care 
        until epidemiologic measures are developed under paragraph 


    (a) Funds Available for Quality Management.--Section 2604 (42 
U.S.C. 300ff-14) is amended--
            (1) by redesignating subsections (c) through (f) as 
        subsections (d) through (g), respectively; and
            (2) by inserting after subsection (b) the following:
    ``(c) Quality Management.--
            ``(1) Requirement.--The chief elected official of an 
        eligible area that receives a grant under this part shall 
        provide for the establishment of a quality management program 
        to assess the extent to which medical services provided to 
        patients under the grant are consistent with the most recent 
        Public Health Service guidelines for the treatment of HIV 
        disease and related opportunistic infection and to develop 
        strategies for improvements in the access to and quality of 
        medical services.
            ``(2) Use of funds.--From amounts received under a grant 
        awarded under this part, the chief elected official of an 
        eligible area may use, for activities associated with its 
        quality management program, not more than the lesser of--
                    ``(A) 5 percent of amounts received under the 
                grant; or
                    ``(B) $3,000,000.''.
    (b) Quality Management Required for Eligibility for Grants.--
Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended--
            (1) by redesignating paragraphs (3) through (6) as 
        paragraphs (5) through (8), respectively; and
            (2) by inserting after paragraph (2) the following:
            ``(3) that the chief elected official of the eligible area 
        will satisfy all requirements under section 2604(c);''.


    (a) Use of Amounts.--Section 2604(e)(1) (42 U.S.C. 300ff-14(d)(1)) 
(as so redesignated by section 102(a)) is amended by inserting ``and 
the State Children's Health Insurance Program under title XXI of such 
Act'' after ``Social Security Act''.
    (b) Applications.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is 
amended by inserting after paragraph (3), as added by section 102(b), 
the following:
            ``(4) that funded entities within the eligible area that 
        receive funds under a grant under section 2601(a) shall 
        maintain appropriate relationships with entities in the area 
        served that constitute key points of access to the health care 
        system for individuals with HIV disease (including emergency 
        rooms, substance abuse treatment programs, detoxification 
        centers, adult and juvenile detention facilities, sexually 
        transmitted disease clinics, HIV counseling and testing sites, 
        mental health programs, and homeless shelters) and other 
        entities under section 2652(a) for the purpose of facilitating 
        early intervention for individuals newly diagnosed with HIV 
        disease and individuals knowledgeable of their status but not 
        in care;''.


    (a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-14(b)(1)) is 
            (1) in the matter preceding subparagraph (A), by striking 
        ``HIV-related--'' and inserting ``HIV-related services, as 
            (2) in subparagraph (A)--
                    (A) by striking ``outpatient'' and all that follows 
                through ``substance abuse treatment and'' and inserting 
                the following: ``Outpatient health services.--
                Outpatient and ambulatory health services, including 
                substance abuse treatment,''; and
                    (B) by striking ``; and'' and inserting a period;
            (3) in subparagraph (B), by striking ``(B) inpatient case 
        management'' and inserting ``(C) Inpatient case management 
        services.--Inpatient case management''; and
            (4) by inserting after subparagraph (A) the following:
                    ``(B) Outpatient support services.--Outpatient and 
                ambulatory support services (including case 
                management), to the extent that such services 
                facilitate, enhance, support, or sustain the delivery, 
                continuity, or benefits of health services for 
                individuals and families with HIV disease.''.
    (b) Conforming Amendment to Application Requirements.--Section 
2605(a) (42 U.S.C. 300ff-15(a)), as amended by section 102(b), is 
further amended--
            (1) in paragraph (7) (as so redesignated), by striking 
        ``and'' at the end thereof;
            (2) in paragraph (8) (as so redesignated), by striking the 
        period and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(9) that the eligible area has procedures in place to 
        ensure that services provided with funds received under this 
        part meet the criteria specified in section 2604(b)(1).''.


    (a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-14(b)(1)), as 
amended by section 104(a), is further amended by adding at the end the 
                    ``(D) Early intervention services.--Early 
                intervention services as described in section 
                2651(b)(2), with follow-through referral, provided for 
                the purpose of facilitating the access of individuals 
                receiving the services to HIV-related health services, 
                but only if the entity providing such services--
                            ``(i)(I) is receiving funds under 
                        subparagraph (A) or (C); or
                            ``(II) is an entity constituting a point of 
                        access to services, as described in section 
                        2605(a)(4), that maintains a relationship with 
                        an entity described in subclause (I) and that 
                        is serving individuals at elevated risk of HIV 
                            ``(ii) demonstrates to the satisfaction of 
                        the chief elected official that Federal, State, 
                        or local funds are inadequate for the early 

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