| 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] ...
106th CONGRESS 2d Session S. 2311 _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES 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, SECTION 1. SHORT TITLE. This Act may be cited as the ``Ryan White CARE Act Amendments of 2000''. SEC. 2. REFERENCES; TABLE OF CONTENTS. (a) References.--Except as otherwise expressly provided, whenever in this Act an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act (42 U.S.C. 201 et seq.). (b) Table of Contents.--The table of contents of this Act is as follows: Sec. 1. Short title. Sec. 2. References; table of contents. TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM Subtitle A--Amendments to Part A (Emergency Relief Grants) Sec. 101. Duties of planning council, funding priorities, quality assessment. Sec. 102. Quality management. Sec. 103. Funded entities required to have health care relationships. Sec. 104. Support services required to be health care-related. Sec. 105. Use of grant funds for early intervention services. Sec. 106. Replacement of specified fiscal years regarding the sunset on expedited distribution 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 report. 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 B. Subtitle E--Amendments to Part F (Demonstration and Training) Sec. 161. Authorization of appropriations. TITLE II--MISCELLANEOUS PROVISIONS Sec. 201. Institute of Medicine study. TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM Subtitle A--Amendments to Part A (Emergency Relief Grants) SEC. 101. DUTIES OF PLANNING COUNCIL, FUNDING PRIORITIES, QUALITY ASSESSMENT. Section 2602 (42 U.S.C. 300ff-12) is amended-- (1) in subsection (b)-- (A) in paragraph (2)(C), by inserting before the semicolon the following: ``, including providers of housing and homeless services''; and (B) in paragraph (4), by striking ``shall--'' and all that follows and inserting ``shall have the responsibilities specified in subsection (d).''; and (2) by adding at the end the following: ``(d) Duties of Planning Council.--The planning council established under subsection (b) shall have the following duties: ``(1) Priorities for allocation of funds.--The council shall establish priorities for the allocation of funds within the eligible area, including how best to meet each such priority and additional factors that a grantee should consider in allocating funds under a grant, based on the following factors: ``(A) The size and demographic characteristics of the population with HIV disease to be served, including, subject to subsection (e), the needs of individuals living with HIV infection who are not receiving HIV-related health services. ``(B) The documented needs of the population with HIV disease with particular attention being given to disparities in health services among affected subgroups within the eligible area. ``(C) The demonstrated or probable cost and outcome effectiveness of proposed strategies and interventions, to the extent that data are reasonably available. ``(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 (1).''. SEC. 102. QUALITY MANAGEMENT. (a) Funds Available for Quality Management.--Section 2604 (42 U.S.C. 300ff-14) is amended-- (1) by redesignating subsections (c) through (f) as subsections (d) through (g), respectively; and (2) by inserting after subsection (b) the following: ``(c) Quality Management.-- ``(1) Requirement.--The chief elected official of an eligible area that receives a grant under this part shall provide for the establishment of a quality management program to assess the extent to which medical services provided to patients under the grant are consistent with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic infection and to develop strategies for improvements in the access to and quality of medical services. ``(2) Use of funds.--From amounts received under a grant awarded under this part, the chief elected official of an eligible area may use, for activities associated with its quality management program, not more than the lesser of-- ``(A) 5 percent of amounts received under the grant; or ``(B) $3,000,000.''. (b) Quality Management Required for Eligibility for Grants.-- Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended-- (1) by redesignating paragraphs (3) through (6) as paragraphs (5) through (8), respectively; and (2) by inserting after paragraph (2) the following: ``(3) that the chief elected official of the eligible area will satisfy all requirements under section 2604(c);''. SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE RELATIONSHIPS. (a) Use of Amounts.--Section 2604(e)(1) (42 U.S.C. 300ff-14(d)(1)) (as so redesignated by section 102(a)) is amended by inserting ``and the State Children's Health Insurance Program under title XXI of such Act'' after ``Social Security Act''. (b) Applications.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended by inserting after paragraph (3), as added by section 102(b), the following: ``(4) that funded entities within the eligible area that receive funds under a grant under section 2601(a) shall maintain appropriate relationships with entities in the area served that constitute key points of access to the health care system for individuals with HIV disease (including emergency rooms, substance abuse treatment programs, detoxification centers, adult and juvenile detention facilities, sexually transmitted disease clinics, HIV counseling and testing sites, 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;''. SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-RELATED. (a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-14(b)(1)) is amended-- (1) in the matter preceding subparagraph (A), by striking ``HIV-related--'' and inserting ``HIV-related services, as follows:''; (2) in subparagraph (A)-- (A) by striking ``outpatient'' and all that follows through ``substance abuse treatment and'' and inserting the following: ``Outpatient health services.-- Outpatient and ambulatory health services, including substance abuse treatment,''; and (B) by striking ``; and'' and inserting a period; (3) in subparagraph (B), by striking ``(B) inpatient case management'' and inserting ``(C) Inpatient case management services.--Inpatient case management''; and (4) by inserting after subparagraph (A) the following: ``(B) Outpatient support services.--Outpatient and ambulatory support services (including case management), to the extent that such services facilitate, enhance, support, or sustain the delivery, continuity, or benefits of health services for individuals and families with HIV disease.''. (b) Conforming Amendment to Application Requirements.--Section 2605(a) (42 U.S.C. 300ff-15(a)), as amended by section 102(b), is further amended-- (1) in paragraph (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).''. SEC. 105. USE OF GRANT FUNDS FOR EARLY INTERVENTION SERVICES. (a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-14(b)(1)), as amended by section 104(a), is further amended by adding at the end the following: ``(D) Early intervention services.--Early intervention services as described in section 2651(b)(2), with follow-through referral, provided for the purpose of facilitating the access of individuals receiving the services to HIV-related health services, but only if the entity providing such services-- ``(i)(I) is receiving funds under subparagraph (A) or (C); or ``(II) is an entity constituting a point of access to services, as described in 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 disease; ``(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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