Home > 106th Congressional Bills > S. 2312 (is) To amend title XVIII of the Social Security Act to provide for a [Introduced in Senate] ...

S. 2312 (is) To amend title XVIII of the Social Security Act to provide for a [Introduced in Senate] ...


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                                                       Calendar No. 548
106th CONGRESS
  2d Session
                                S. 2311

                          [Report No. 106-294]

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.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 29, 2000

Mr. Jeffords (for himself, Mr. Kennedy, Mr. Frist, Mr. Hatch, Mr. Dodd, 
 Mr. Enzi, Mr. Harkin, Ms. Mikulski, Mr. Bingaman, Mr. Wellstone, Mr. 
Reed, Mr. Biden,  Mr. Durbin, Mr. Bennett, Mr. Lieberman, Mr. Cleland, 
Mr. Robb, Mrs. Murray, Mr. Sarbanes, Mr. Gregg, Mr. Gorton, Mr. Breaux, 
 Mr. Kerry, Mr. Warner, Mr. Lugar, Mr. Lautenberg, Mr. L. Chafee, Ms. 
   Collins, Mr. Moynihan, Mr. Schumer, Mr. Bayh, Mr. Inouye, and Mr. 
Wyden) introduced the following bill; which was read twice and referred 
       to the Committee on Health, Education, Labor, and Pensions

                              May 15, 2000

              Reported by Mr. Jeffords, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
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,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

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

<DELETED>SEC. 2. REFERENCES; TABLE OF CONTENTS.</DELETED>

<DELETED>    (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.).</DELETED>
<DELETED>    (b) Table of Contents.--The table of contents of this Act 
is as follows:</DELETED>

<DELETED>Sec. 1. Short title.
<DELETED>Sec. 2. References; table of contents.
        <DELETED>TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM

 <DELETED>Subtitle A--Purpose; Amendments to Part A (Emergency Relief 
                                Grants)

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

<DELETED>Sec. 121. State requirements concerning identification of need 
                            and allocation of resources.
<DELETED>Sec. 122. Quality management.
<DELETED>Sec. 123. Funded entities required to have health care 
                            referral relationships.
<DELETED>Sec. 124. Support services required to be health care-related.
<DELETED>Sec. 125. Use of grant funds for early intervention services.
<DELETED>Sec. 126. Authorization of appropriations for HIV-related 
                            services for women and children.
<DELETED>Sec. 127. Repeal of requirement for completed Institute of 
                            Medicine report.
<DELETED>Sec. 130. Supplement grants for certain States.
<DELETED>Sec. 131. Use of treatment funds.
<DELETED>Sec. 132. Increase in minimum allotment.
<DELETED>Sec. 133. Set-aside for infants, children, and women.
<DELETED>Subtitle C--Amendments to Part C (Early Intervention Services)

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

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

<DELETED>Sec. 161. Authorization of appropriations.
              <DELETED>TITLE II--MISCELLANEOUS PROVISIONS

<DELETED>Sec. 201. Institute of Medicine study.

   <DELETED>TITLE I--AMENDMENTS TO HIV HEALTH CARE PROGRAM</DELETED>

 <DELETED>Subtitle A--Purpose; Amendments to Part A (Emergency Relief 
                           Grants)</DELETED>

<DELETED>SEC. 101. DUTIES OF PLANNING COUNCIL, FUNDING PRIORITIES, 
              QUALITY ASSESSMENT.</DELETED>

<DELETED>    Section 2602 (42 U.S.C. 300ff-12) is amended--</DELETED>
        <DELETED>    (1) in subsection (b)--</DELETED>
                <DELETED>    (A) in paragraph (2)(C), by inserting 
                before the semicolon the following: ``, including 
                providers of housing and homeless services''; 
                and</DELETED>
                <DELETED>    (B) in paragraph (4), by striking 
                ``shall--'' and all that follows and inserting ``shall 
                have the responsibilities specified in subsection 
                (d).''; and</DELETED>
        <DELETED>    (2) by adding at the end the following:</DELETED>
<DELETED>    ``(d) Duties of Planning Council.--The planning council 
established under subsection (b) shall have the following 
duties:</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(C) The demonstrated or probable cost 
                and outcome effectiveness of proposed strategies and 
                interventions, to the extent that data are reasonably 
                available.</DELETED>
                <DELETED>    ``(D) Priorities of the communities with 
                HIV disease for whom the services are 
                intended.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(F) Capacity development needs resulting 
                from gaps in the availability of HIV services in 
                historically underserved low-income 
                communities.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(5) Coordination with other federal grantees.--
        The council shall coordinate with Federal grantees providing 
        HIV-related services within the eligible area.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Process for Establishing Allocation Priorities.--
</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(2) Exception.--Grantees under subsection 
        (d)(1)(A) shall not be required to establish priorities for 
        individuals not in care until epidemiologic measures are 
        developed under paragraph (1).''.</DELETED>

<DELETED>SEC. 102. QUALITY MANAGEMENT.</DELETED>

<DELETED>    (a) Funds Available for Quality Management.--Section 2604 
(42 U.S.C. 300ff-14) is amended--</DELETED>
        <DELETED>    (1) by redesignating subsections (c) through (f) 
        as subsections (d) through (g), respectively; and</DELETED>
        <DELETED>    (2) by inserting after subsection (b) the 
        following:</DELETED>
<DELETED>    ``(c) Quality Management.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--
        </DELETED>
                <DELETED>    ``(A) 5 percent of amounts received under 
                the grant; or</DELETED>
                <DELETED>    ``(B) $3,000,000.''.</DELETED>
<DELETED>    (b) Quality Management Required for Eligibility for 
Grants.--Section 2605(a) (42 U.S.C. 300ff-15(a)) is amended--</DELETED>
        <DELETED>    (1) by redesignating paragraphs (3) through (6) as 
        paragraphs (5) through (8), respectively; and</DELETED>
        <DELETED>    (2) by inserting after paragraph (2) the 
        following:</DELETED>
        <DELETED>    ``(3) that the chief elected official of the 
        eligible area will satisfy all requirements under section 
        2604(c);''.</DELETED>

<DELETED>SEC. 103. FUNDED ENTITIES REQUIRED TO HAVE HEALTH CARE 
              RELATIONSHIPS.</DELETED>

<DELETED>    (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''.</DELETED>
<DELETED>    (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:</DELETED>
        <DELETED>    ``(4) that funded entities within the eligible 
        area that receive funds under a grant under section 2601(a) 
        shall maintain appropriate relationships with entities in the 
        area served that constitute key points of access to the health 
        care system for individuals with HIV disease (including 
        emergency rooms, substance abuse treatment programs, 
        detoxification centers, adult and juvenile detention 
        facilities, sexually transmitted disease clinics, HIV 
        counseling and testing sites, and homeless shelters) and other 
        entities under section 2652(a) for the purpose of facilitating 
        early intervention for individuals newly diagnosed with HIV 
        disease and individuals knowledgeable of their status but not 
        in care;''.</DELETED>

<DELETED>SEC. 104. SUPPORT SERVICES REQUIRED TO BE HEALTH CARE-
              RELATED.</DELETED>

<DELETED>    (a) In General.--Section 2604(b)(1) (42 U.S.C. 300ff-
14(b)(1)) is amended--</DELETED>
        <DELETED>    (1) in the matter preceding subparagraph (A), by 
        striking ``HIV-related--'' and inserting ``HIV-related 
        services, as follows:'';</DELETED>

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