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Senate Amendments to Ryan White HIV/AIDS Treatment Act (HR 6143) & NIH Bill
 
 
  FLOOR SITUATION: The bill was considered under unanimous consent, early Saturday morning, December 9. The House passed the measure by voice vote, clearing it for the president.
 
BACKGROUND: The House suspended the rules and passed the bill on Sept. 28 by a vote of 325 to 98 (see House Action Reports Legislative Week of September 25). The Senate amended the measure and passed it by unanimous consent on December 6.
 
Although the authorizations for federal Ryan White HIV/AIDS programs expired at the end of FY 2005, Congress appropriated about $2 billion for these programs in FY 2006.
 
SUMMARY: Following is a summary of the bill as cleared for the president.
 
As amended by the Senate, this bill reauthorizes the Ryan White HIV/AIDS programs - including the emergency relief, comprehensive care and early intervention programs - for three years, through FY 2009. As passed by the House, the measure would have authorized the programs for five years, through FY 2011.
 
Emergency Relief
 
As amended by the Senate, the bill authorizes $604 million in FY 2007, $626 million in FY 2008, and $649.5 million in FY 2009 for the Ryan White Emergency Relief program, which provides grants to metropolitan areas with very high numbers of AIDS cases. (The House-passed version had appropriated funds for fiscal years 2010 and 2011). These grants fund outpatient health care and support services, including home health care, hospice care, housing, transportation and nutrition services.
 
Under the prior authorization, formula grants were awarded to local governments in metropolitan areas whose population is at least 50,000 and have at least 500 AIDS cases. The bill modifies the allocation formula to include both HIV cases as well as AIDS cases so that the formula grant funds would be allocated on the basis of the number of people living with HIV or AIDS. Supplemental grants are awarded to applicants that show a demonstrated need for AIDS-related services.
 
Like the House-passed version, the bill requires grantees to spend at least 75% of grant funds on primary care and other core medical services. The remaining 25% could be used for support services.
 
For grantees that received a formula grant in FY 2006, the bill establishes a "hold-harmless" mechanism. As amended by the Senate, this mechanism provides that if the specified amounts are not appropriated in fiscal years 2008 through 2009, funding for supplemental grants would be reduced if necessary to maintain formula grants at 100% of the amount awarded in the previous year. Comprehensive Care Program
 
As amended by the Senate, the bill authorizes $1.2 billion in FY 2007 and FY 2008, and $1.3 billion in FY 2009 for the comprehensive care program, which provides grants to states for health care and support services for persons with HIV/AIDS. (The House-passed bill would have authorized funds for fiscal years 2010 and 2011). These grants fund home and community-based health care and support services, and an AIDS drug assistance program.
 
Like the House-passed version, the measure requires states to use some of their comprehensive care grant funds to pay for drug treatments through the AIDS Drug Assistance (ADAP) program. It requires the Health and Human Services (HHS) department to develop a list of core antiretroviral drugs to ensure that they would be included on the ADAP list of drugs. States would be permitted to add additional drugs to the list. The measure requires that rebates for drugs purchased with Ryan White funds must be used for activities under the ADAP program.
 
The measure authorizes the Centers for Disease Control and Prevention (CDC) to make grants to eligible states to pay for certain services including HIV/AIDS testing, prevention counseling, and treatment of newborns exposed to HIV/AIDS. In order to qualify for these funds, states must have an early diagnosis program.
 
Early Intervention Program
 
As amended by the Senate, the bill authorizes $219 million in FY 2007, $227 million in FY 2008, and $235 million in FY 2009 for early intervention services. (The House-passed version would have authorized funds for fiscal years 2010 and 2011). This program provides grants to public and non-public entities to pay for community-based programs that provide comprehensive primary care services intended to prevent or reduce HIV-related deaths. Like the House-passed version, the measure requires that grantees provide counseling and information about hepatitis A, B, and C. It also requires them to develop an electronic information system to improve their ability to report data.
 
Other Provisions
 
* Pediatric Program
- As amended by the Senate, it authorizes $72 million in each of fiscal years 2007 through 2009 for the Pediatric AIDS program, which provides grants to improve and expand primary care and support services for women, infants, or children with HIV/AIDS and for their families. (The House version would have authorized the same amount in each of fiscal years 2007 through 2011).
 
* Minority AIDS Initiative - Authorizes $131 million in FY 2007, $135 million in FY 2008, and $139 million in FY 2009 for the Minority AIDS Initiative, intended to evaluate and address the disproportionate impact of HIV/AIDS on racial and ethnic minorities and the disparities in access, treatment, care, and outcomes for racial and ethnic minorities. (The House version would have authorized funds through FY 2011 for the initiative).
 
CBO Cost Estimate
 
This measure is an authorization measure and is not covered by spending limitations in the Budget Act or any budget resolution because it does not directly result in expenditures. As of press time, the Congressional Budget Office (CBO) had not released a cost estimate for the version of the bill that has been cleared for the president.
 
AMENDMENTS: None permitted.
 
COMMENTARY: The administration position was unavailable as of press time.
 
Senate Amendments to National Institutes of Health Reform Act (HR 6164)
 
FLOOR SITUATION: The bill was considered under suspension of the rules early Saturday morning, December 9, with no amendments permitted. The House passed the measure by voice vote, clearing it for the president.
 
BACKGROUND: The House suspended the rules and passed the bill on September 26 by a vote of 414 to 2 (see House Action Reports Legislative Week of September 25). The Senate amended the measure and passed it by unanimous consent on December 8.
 
SUMMARY: Following is a summary of the bill as cleared for the president.
 
As amended by the Senate, this bill authorizes $30.3 billion in FY 2007, $32.8 billion in FY 2008, and such sums as are necessary in FY 2009 for the National Institutes of Health (NIH). The measure does not provide specific authorizations for any of the component institutes that make up the NIH. (The House-passed version would have authorized $29.7 billion in FY 2007, $31.2 billion in FY 2008, and $32.8 billion in FY 2009.)
 
Like the House version, it establishes a "common fund" to promote research that involves more than one NIH institute or center. Under this provision, the NIH director would be authorized to identify research that is important to the advancement of biomedical science and involves more than one NIH institute or center. As amended by the Senate, the bill requires that the NIH director reserve a certain amount for the common fund, subject to appropriations by Congress. It requires that the same percentage of money be set aside for the common fund in each fiscal year, although it does not specify that percentage. (The House-passed version of the bill would have required the common fund to eventually reach 5% of each year's appropriations.)
 
Like the House version, the bill requires that NIH maintain an accurate, electronic reporting system to track research grants and programs. It also establishes a formal public process to review the structural organization of the NIH every seven years. A "scientific management review" group composed of institute and center directors and other scientific experts would evaluate the existing structure, and recommend any necessary restructuring. The bill lays out a series of public meetings and reports to Congress that would be required to follow up on these restructuring recommendations.
 
As amended by the Senate, the bill provides that unused funds that were allocated for fiscal years 2004 and 2005 for the State Children's Health Insurance Program (SCHIP) be reallocated to SCHIP programs that face funding shortfalls in FY 2007. It sets guidelines for how the NIH would determine a state funding shortfall and how the money would be distributed to states.
 
This measure is an authorization measure and is not covered by spending limitations in the Budget Act or any budget resolution because it does not directly result in expenditures. As of press time Friday, the Congressional Budget Office (CBO) had not released a cost estimate for the bill. In many cases, however, Congress does not appropriate the full amount contained in authorization measures.
 
AMENDMENTS: None permitted.
 
COMMENTARY: The administration position was unavailable as of press time.
 
 
 
 
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