I

103D CONGRESS

2D SESSION H. R. 5141

To reauthorize the Ryan White CARE Act of 1990, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 30, 1994

Mr. WAXMAN (for himself, Mr. DINGELL, Mr. GREENWOOD, Mr. STUDDS, Mr.

SHARP, Mr. MARKEY, Mr. SWIFT, Mrs. COLLINS of Illinois, Mr. SYNAR,

Mr. WYDEN, Mr. RICHARDSON, Mr. BRYANT, Mr. MANTON, Mr. TOWNS,

Mr. KREIDLER, Ms. DELAURO, Mr. DIXON, Mr. FRANK of Massachusetts, Mr. GUTIERREZ, Mr. KLECZKA, Mrs. MALONEY, Mr. MEEHAN,

Mrs. MORELLA, Mr. NADLER, Mr. OLVER, Mr. PASTOR, Ms. PELOSI, Mr.

RANGEL, Mr. SERRANO, and Ms. VELA ́ZQUEZ) introduced the following

bill; which was referred to the Committee on Energy and Commerce

A BILL

To reauthorize the Ryan White CARE Act of 1990, and

for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Ryan White CARE

5 Reauthorization Act of 1994’’.

6 SEC. 2. REFERENCES.

7 Whenever in this Act an amendment is expressed in

8 terms of an amendment to a section or other provision,
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1 the reference shall be considered to be made to a section

2 or other provision of title XXVI of the Public Health Serv3 ice Act (42 U.S.C. 300ff et seq.).

4 SEC. 3. AMENDMENTS.

5 (a) ESTABLISHMENT OF GRANT PROGRAM.—Section

6 2601 (42 U.S.C. 300ff–11) is amended by adding at the

7 end thereof the following new subsection:

8 ‘‘(c) POPULATION OF ELIGIBLE AREAS.—The Sec9 retary may not make a grant to an eligible area under

10 subsection (a) after the date of enactment of this sub11 section unless the area has a population of at least

12 500,000 individuals, except that this subsection shall not

13 apply to areas that are eligible as of March 31, 1994. For

14 purposes of eligibility under this title, the boundaries of

15 each metropolitan area shall be those in effect in fiscal

16 year 1994.’’.

17 (b) EMERGENCY RELIEF FOR AREAS WITH SUB18 STANTIAL NEED FOR SERVICES.—

19 (1) HEALTH SERVICES PLANNING COUNCIL.—

20 Subsection (b) of section 2602 (42 U.S.C. 300ff–

21 12(b)) is amended—

22 (A) in paragraph (1), by striking ‘‘include’’

23 and all that follows through the end thereof,

24 and inserting ‘‘be reflective of the demographics

25 of the HIV epidemic in the eligible area in-
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1 volved, with particular consideration given to

2 disproportionately affected and historically un3 derserved groups.’’;

4 (B) in paragraph (2), by adding at the end

5 thereof the following new subparagraph:

6 ‘‘(C) CHAIRPERSON.—A planning council

7 may not be chaired solely by an employee of the

8 grantee.’’;

9 (C) in paragraph (3)—

10 (i) by striking ‘‘and’’ at the end of

11 subparagraph (B);

12 (ii) by striking the period at the end

13 of subparagraph (C) and inserting ‘‘, and

14 at the discretion of the planning council,

15 assess the effectiveness, either directly or

16 through contractual arrangements, of the

17 services offered in meeting the identified

18 needs; and’’; and

19 (iii) by adding at the end thereof the

20 following new subparagraph:

21 ‘‘(D) participate in the development of the

22 Statewide coordinated statement of need initi23 ated by the State health department.’’;

24 (D) by redesignating paragraphs (2) and

25 (3) as paragraphs (3) and (4), respectively; and
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1 (E) by inserting after paragraph (1), the

2 following new paragraph:

3 ‘‘(2) REPRESENTATION.—The HIV health serv4 ices planning council shall include representatives

5 of—

6 ‘‘(A) health care providers, including feder7 ally qualified health centers;

8 ‘‘(B) community-based organizations serv9 ing affected populations and AIDS service orga10 nizations;

11 ‘‘(C) social service providers;

12 ‘‘(D) mental health and substance abuse

13 providers;

14 ‘‘(E) local public health agencies;

15 ‘‘(F) hospital planning agencies or health

16 care planning agencies;

17 ‘‘(G) affected communities, including peo18 ple of color, women, and gay and bisexual men;

19 ‘‘(H) individuals with HIV or AIDS;

20 ‘‘(I) nonelected community leaders;

21 ‘‘(J) State government (including the State

22 medicaid agency);

23 ‘‘(K) grantees under subpart II of part C;

24 ‘‘(L) grantees under section 2671, or, if

25 none are operating in the area, pediatric, youth,
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1 and women’s service organizations operating in

2 the area; and

3 ‘‘(M) grantees under other Federal HIV

4 programs.’’.

5 (2) DISTRIBUTION OF GRANTS.—Section 2603

6 (42 U.S.C. 300ff–13) is amended—

7 (A) in subsection (a)—

8 (i) in paragraph (2)—

9 (I) by striking ‘‘Not later

10 than—’’ and all that follows through

11 ‘‘the Secretary shall’’ and inserting

12 the following: ‘‘Not later than 60 days

13 after an appropriation becomes avail14 able to carry out this part for each of

15 the fiscal years 1996 through 2000,

16 the Secretary shall’’; and

17 (II) by inserting ‘‘or the provi18 sions of subsection (a)(3)(D)’’ after

19 ‘‘section 2605(c)’’;

20 (ii) in paragraph (3)(A)(ii)—

21 (I) by striking ‘‘product of 3’’ in

22 subclause (I), and inserting ‘‘product

23 of 9’’; and

24 (II) by striking ‘‘equal to the

25 product’’ in subclause (II), and insert-
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1 ing ‘‘amount equal to twice the prod2 uct’’;

3 (iii) in paragraph (3)(B)(i), by strik4 ing ‘‘cumulative number of cases’’ and in5 serting ‘‘for the 10 years prior to the fiscal

6 year in question’’;

7 (iv) in paragraph (3)(C)—

8 (I) by striking ‘‘cumulative

9 cases’’ in clause (i), and inserting

10 ‘‘the number of cases reported and

11 confirmed for the 10 years prior to

12 the fiscal year in question’’; and

13 (II) by striking ‘‘cumulative such

14 cases’’ in clause (ii), and inserting

15 ‘‘the number of cases reported and

16 confirmed for the 10 years prior to

17 the fiscal year in question’’; and

18 (v) by adding at the end of paragraph

19 (3), the following new subparagraph:

20 ‘‘(D) MINIMUM AMOUNT.—No eligible area

21 shall receive an amount less than that awarded

22 under subsection (a) to such area in fiscal year

23 1995, except for cause, as determined by the

24 Secretary based on a finding of fraud or an
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1 egregious violation by the grantee of the provi2 sions of this Act.’’; and

3 (B) in subsection (b)(1)—

4 (i) by striking ‘‘and’’ at the end of

5 subparagraph (D);

6 (ii) by striking the period at the end

7 of subparagraph (E) and inserting a semi8 colon; and

9 (iii) by adding at the end thereof the

10 following new subparagraphs:

11 ‘‘(F) demonstrates the inclusiveness of the

12 planning council membership, with particular

13 emphasis on affected communities and individ14 uals with HIV disease;

15 ‘‘(G) demonstrates the manner in which

16 the proposed services are consistent with the

17 Statewide coordinated statement of need.’’.

18 (3) USE OF AMOUNTS.—Section 2604 (42

19 U.S.C. 300ff–14) is amended—

20 (A) in subsection (b)(1)(A), by inserting

21 ‘‘treatment education and prophylactic treat22 ment for opportunistic infections,’’ after ‘‘treat23 ment services,’’; and

24 (B) in subsection (e) by striking ‘‘report25 ing, and program oversight functions’’ and in-
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1 serting ‘‘reporting, and the assessment of pro2 gram effectiveness’’.

3 (4) APPLICATION.—Section 2605(a) (42 U.S.C.

4 300ff–15(a)) is amended—

5 (A) in paragraph (1)(B), by striking ‘‘1-

6 year period’’ and all that follows through ‘‘eligi7 ble area’’ and inserting ‘‘preceding fiscal year’’;

8 (B) in paragraph (4), by striking ‘‘and’’ at

9 the end thereof;

10 (C) in paragraph (5), by striking the pe11 riod at the end thereof and inserting ‘‘; and’’;

12 and

13 (D) by adding at the end thereof the fol14 lowing new paragraph:

15 ‘‘(6) that the applicant has participated, or will

16 agree to participate, in the Statewide coordinated

17 statement of need process where it has been initiated

18 by the State, and ensure that the services provided

19 under the comprehensive plan are consistent with

20 the Statewide coordinated statement of need.’’.

21 (5) TECHNICAL ASSISTANCE.—Section 2606

22 (42 U.S.C. 300ff–16) is amended—

23 (A) by striking ‘‘may’’ and inserting

24 ‘‘shall’’;
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1 (B) by inserting after ‘‘technical assist2 ance’’ the following: ‘‘, including peer based as3 sistance to assist newly eligible metropolitan

4 areas in the establishment of HIV health serv5 ices planning councils and,’’; and

6 (C) by adding at the end thereof the fol7 lowing new sentences: ‘‘The Administrator may

8 make planning grants available to metropolitan

9 areas projected to be eligible for funding under

10 section 2601 in the following fiscal year. Not to

11 exceed 1 percent of the amount appropriated

12 for a fiscal year under section 2608 may be

13 used to carry out this section.’’.

14 (6) AUTHORIZATION OF APPROPRIATIONS.—

15 Section 2608 (42 U.S.C. 300ff–18) is amended by

16 striking ‘‘$275,000,000’’ and all that follows

17 through the end of the section, and inserting ‘‘such

18 sums as may be necessary in each of the fiscal years

19 1996, 1997, 1998, 1999, and 2000.’’.

20 (b) CARE GRANT PROGRAM.—

21 (1) INFANTS AND WOMEN.—Subsection (b) of

22 section 2612 (42 U.S.C. 300ff–22) is amended to

23 read as follows:

24 ‘‘(b) INFANTS AND WOMEN.—For each State in

25 which the infants, children, adolescents, and women com-
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1 prise greater than 10 percent of the AIDS cases reported

2 to and confirmed by the Centers for Disease Control and

3 Prevention for the 2 most recent fiscal years in such State,

4 not less than 15 percent of funds allocated under this part

5 shall be used to provide health and support services to in6 fants, children, women, and families with HIV disease.

7 With respect to a State in which infants, children, youth,

8 and women comprise less than 10 percent of AIDS cases

9 reported to and confirmed by the Centers for Disease Con10 trol and Prevention for the 2 most recent fiscal years in

11 such State, planning activities under part B in such State

12 shall assess unmet needs and address the service needs

13 of such populations in their applications.’’.

14 (2) HIV CARE CONSORTIA.—Section 2613 (42

15 U.S.C. 300ff–23) is amended—

16 (A) in subsection (a)(2)(A), by inserting

17 ‘‘prophylactic treatment for opportunistic infec18 tions, treatment education,’’ after ‘‘monitor19 ing,’’;

20 (B) in subsection (c)—

21 (i) in subparagraph (C) of paragraph

22 (1), by inserting before ‘‘care’’ ‘‘and youth

23 centered’’; and

24 (ii) in paragraph (2)—
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1 (I) in clause (ii) of subparagraph

2 (A), by striking ‘‘served; and’’ and in3 serting ‘‘served;’’;

4 (II) in subparagraph (B), by

5 striking the period at the end and in6 serting ‘‘; and’’; and

7 (III) by adding after subpara8 graph (B), the following new subpara9 graph:

10 ‘‘(C) representatives of organizations with

11 a history of serving children, youth, and women

12 and operating in the community to be served.’’;

13 and

14 (C) in subsection (d) to read as follows:

15 ‘‘(d) DEFINITION.—As used in this part, the terms

16 ‘family centered care’ and ‘youth centered care’ mean the

17 system of services described in this section that is targeted

18 specifically to the special needs of infants, children (in19 cluding those orphaned by the AIDS epidemic), youth,

20 women, and families. Family centered and youth centered

21 care shall be based on a partnership among parents, ex22 tended family members, children and youth, professionals,

23 and the community designed to ensure an integrated, co24 ordinated, culturally sensitive, and community-based con25 tinuum of care.’’.
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1 (3) PROVISION OF TREATMENTS.—Section 2616

2 (42 U.S.C. 300ff–26) is amended by striking sub3 section (c) and inserting the following new sub4 sections:

5 ‘‘(c) STANDARDS FOR TREATMENT PROGRAMS.—In

6 carrying out this section, the Secretary shall—

7 ‘‘(1) review the current status of State drug re8 imbursement programs and assess barriers to the

9 expanded availability of prophylactic treatments for

10 opportunistic infections (including active tuber11 culosis); and

12 ‘‘(2) establish, in consultation with States, pro13 viders, and affected communities, a recommended

14 minimum formulary .

15 In carrying out paragraph (2), the Secretary shall identify

16 those treatments in the recommended minimum formulary

17 that are for the prevention of opportunistic infections (in18 cluding the prevention of active tuberculosis).

19 ‘‘(d) STATE DUTIES.—

20 ‘‘(1) IN GENERAL.—In implementing subsection

21 (a), States shall document the progress made in

22 making treatments described in subsection (c)(2)

23 available to individuals eligible for assistance under

24 this section, and to develop plans to implement fully

25 the recommended minimum formulary.
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1 ‘‘(2) OTHER MECHANISMS FOR PROVIDING

2 TREATMENTS.—In meeting the standards of the rec3 ommended minimum formulary developed under sub4 section (c), a State may identify other mechanisms

5 such as consortia and public programs for providing

6 such treatments to individuals with HIV.’’.

7 (4) STATE APPLICATION.—Section 2617(b) (42

8 U.S.C. 300ff–27(b)) is amended—

9 (A) in paragraph (2)—

10 (i) in subparagraph (A), by striking

11 ‘‘and’’ at the end thereof; and

12 (ii) by adding at the end thereof the

13 following new subparagraph:

14 ‘‘(C) a description of how the allocation

15 and utilization of resources are consistent with

16 the Statewide coordinated statement of need

17 (including the needs of children, adolescents,

18 and women) developed in partnership with other

19 grantees in the State that receive funding under

20 this title;’’;

21 (B) by redesignating paragraph (3) as

22 paragraph (4); and

23 (C) by inserting after paragraph (2), the

24 following new paragraph:
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1 ‘‘(3) the public health agency administering the

2 grant for the State shall convene a meeting at least

3 annually of representatives of grantees funded under

4 this title (including HIV health services planning

5 councils, early intervention programs, children,

6 youth and family service projects, special projects of

7 national significance, and HIV care consortia) and

8 other providers (including federally qualified health

9 centers) and public agency representatives within the

10 State currently delivering HIV services to affected

11 communities for the purpose of developing a State12 wide coordinated statement of need. The State shall

13 not be required to finance attendance at such meet14 ings.’’.

15 (5) DISTRIBUTION OF FUNDS.—Section 2618

16 (42 U.S.C. 300ff–28) is amended—

17 (A) by striking subsection (a);

18 (B) by redesignating subsections (b), (c),

19 (d), and (e) as subsections (a), (b), (c), and (d),

20 respectively;

21 (C) by amending subsection (a), as so re22 designated, to read as follows:

23 ‘‘(a) AMOUNT OF GRANT.—

24 ‘‘(1) MINIMUM ALLOTMENT.—
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1 ‘‘(A) IN GENERAL.—Subject to the amount

2 made available pursuant to section 2620, the

3 amount of a grant to be made under this part

4 for each of the 50 States, the District of Co5 lumbia, and Puerto Rico, shall be the greater

6 of—

7 ‘‘(i) $250,000; and

8 ‘‘(ii) an amount determined under

9 paragraph (2).

10 ‘‘(B) VIRGIN ISLANDS.—The United States

11 Virgin Islands shall be eligible for an allotment

12 under subparagraph (A) if the Secretary cer13 tifies that the Virgin Islands has a program in

14 place to effectively utilize additional resources

15 provided under such allotment.

16 ‘‘(C) SUPPLEMENTAL ENHANCEMENT

17 GRANTS.—

18 ‘‘(i) IN GENERAL.—The Secretary

19 shall award supplemental grants to eligible

20 entities to enhance community-based care,

21 treatment, and supportive services through

22 the development and operation of consortia

23 and innovative approaches.

24 ‘‘(ii) ELIGIBILITY.—A State shall be

25 eligible for—
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1 ‘‘(I) a tier I supplemental grant

2 in the amount of $500,000 if the

3 number of AIDS cases (in the State)

4 reported to and confirmed by the Cen5 ters for Disease Control and Preven6 tion total not less than 1500 cases for

7 the 10 years prior to the fiscal year

8 for which the grant is to be awarded

9 and the State does not contain a met10 ropolitan area whose chief elected offi11 cial is a grantee for funding under

12 part A; or

13 ‘‘(II) a tier II supplemental grant

14 in the amount of $250,000 if the

15 number of AIDS cases (in the State)

16 reported to and confirmed by the Cen17 ters for Disease Control and Preven18 tion total less than 1500 cases for the

19 10 years prior to the fiscal year for

20 which the grant is to be awarded and

21 the State does not contain a metro22 politan area whose chief elected offi23 cial is a grantee under part A and

24 whose formula grant exceeds the mini-
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1 mum allotment described in subpara2 graph (A)(i).

3 ‘‘(iii) REDUCTION.—A State that re4 ceives a grant under clause (ii)(I), or

5 which would have been eligible to receive

6 such a grant in fiscal year 1995, that sub7 sequently contains a metropolitan area

8 that becomes eligible for funding under

9 part A, shall be subject to a 2-year phased

10 reduction in the amount of the grant under

11 clause (ii)(I) as follows:

12 ‘‘(I) With respect to the first

13 year in which the metropolitan area

14 receives funds under part A, the State

15 would receive $500,000 under clause

16 (ii)(I).

17 ‘‘(II) With respect to the second

18 year in which the metropolitan area

19 receives funds under part A, the State

20 would receive $250,000 under clause

21 (ii)(I).

22 ‘‘(III) The State would not be eli23 gible for funds under this subpara24 graph in years subsequent to the year

25 described in subclause (II).
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1 ‘‘(iv) TERMS.—All terms and condi2 tions contained under subsections (b) and

3 (c) of section 2617 shall apply to funds re4 ceived under this subsection.

5 ‘‘(2) DETERMINATION.—

6 ‘‘(A) FORMULA.—The amount referred to

7 in paragraph (1)(A) shall be the product of—

8 ‘‘(i) an amount equal to the amount

9 appropriated under section 2620 for the

10 fiscal year involved less the amount needed

11 to carry out subparagraph (B); and

12 ‘‘(ii) the ratio of the distribution fac13 tor for the State or territory to the sum of

14 the distribution factors for all the States

15 or territories.

16 ‘‘(B) DISTRIBUTION FACTOR.—As used in

17 subparagraph (A), the term ‘distribution factor’

18 means the product of—

19 ‘‘(i) the number of cases of acquired

20 immune deficiency syndrome in the State

21 or territory, as indicated by the number of

22 cases reported to and confirmed by the

23 Centers for Disease Control and Preven24 tion for the 2 most recent fiscal years for

25 which such data are available; and
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1 ‘‘(ii) the cube root of the ratio (based

2 on the most recent available data) of—

3 ‘‘(I) the average per capita in4 come of individuals in the United

5 States (including territories); to

6 ‘‘(II) the average per capita in7 come of individuals in the State or

8 territory.’’;

9 (D) in subsection (b), as so redesignated—

10 (i) by amending paragraphs (3) and

11 (4) to read as follows:

12 ‘‘(3) PLANNING AND EVALUATIONS.—Subject to

13 paragraph (5), a State may not use more than 10

14 percent of amounts received under a grant awarded

15 under this part for planning and evaluation activi16 ties.

17 ‘‘(4) ADMINISTRATION.—Subject to paragraph

18 (5), a State may not use more than 10 percent of

19 amounts received under a grant awarded under this

20 part for administration, accounting, reporting, and

21 program oversight functions.’’;

22 (ii) by redesignating paragraph (5) as

23 paragraph (6); and

24 (iii) by inserting after paragraph (4),

25 the following new paragraph (5):
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1 ‘‘(5) LIMITATION ON USE OF FUNDS.—A State

2 may not use more than a total of 15 percent of

3 amounts received under a grant awarded under this

4 part for the purposes described in paragraphs (3)

5 and (4).’’

6 (6) TECHNICAL ASSISTANCE.—Section 2619

7 (42 U.S.C. 300ff–29) is amended—

8 (A) by striking ‘‘may’’ and inserting

9 ‘‘shall’’; and

10 (B) by inserting before the period the fol11 lowing: ‘‘, including technical assistance for the

12 development and implementation of Statewide

13 coordinated statements of need’’.

14 (7) AUTHORIZATION OF APPROPRIATIONS.—

15 Section 2620 (42 U.S.C. 300ff–30), by striking

16 ‘‘$275,000,000’’ and all that follows through the end

17 of the section, and inserting ‘‘such sums as may be

18 necessary in each of the fiscal years 1996, 1997,

19 1998, 1999, and 2000.’’.

20 (8) GRIEVANCE PROCEDURES AND COORDINA21 TION.—Part B of title XXVI (42 U.S.C. 300ff-21)

22 is amended by adding at the end thereof the follow23 ing new sections:
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1 ‘‘SEC. 2621. GRIEVANCE PROCEDURES.

2 ‘‘Not later than 90 days after the date of enactment

3 of this section, the Administration, in consultation with

4 affected parties, shall establish grievance procedures, spe5 cific to each part of this title, to address allegations of

6 egregious violations of each such part or the intent of the

7 provisions of each such part. Such procedures shall include

8 an appropriate enforcement mechanism.

9 ‘‘SEC. 2622. COORDINATION.

10 ‘‘The Secretary shall ensure that the Health Re11 sources and Services Administration, the Centers for Dis12 ease Control and Prevention, and the Substance Abuse

13 and Mental Health Services Administration coordinate the

14 planning and implementation of Federal HIV programs

15 in order to facilitate the development of a complete contin16 uum of HIV-related services for individuals with HIV dis17 ease and those at risk of such disease. The Secretary shall

18 periodically prepare and submit to the relevant committees

19 of Congress a report concerning such coordination efforts

20 at the Federal, State, and local levels as well as the exist21 ence of Federal barriers to HIV program integration.’’.

22 (c) EARLY INTERVENTION SERVICES.—

23 (1) AUTHORIZATION OF APPROPRIATIONS.—

24 Section 2655 (42 U.S.C. 300ff–55) is amended by

25 striking ‘‘$75,000,000’’ and all that follows through

26 the end of the section, and inserting ‘‘such sums as
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1 may be necessary in each of the fiscal years 1996,

2 1997, 1998, 1999, and 2000.’’.

3 (2) REQUIRED AGREEMENTS.—Section 2664(g)

4 (42 U.S.C. 300ff–64(g)) is amended—

5 (A) in paragraph (2), by striking ‘‘and’’ at

6 the end thereof;

7 (B) in paragraph (3)—

8 (i) by striking ‘‘5 percent’’ and insert9 ing ‘‘10 percent including planning, evalua10 tion and technical assistance’’; and

11 (ii) by striking the period and insert12 ing ‘‘; and’’; and

13 (C) by adding at the end thereof the fol14 lowing new paragraph:

15 ‘‘(4) the applicant will submit evidence that the

16 proposed program is consistent with the Statewide

17 coordinated statement of need and agree to partici18 pate in the ongoing revision of such statement of

19 need.’’.

20 (d) GENERAL PROVISIONS.—Section 2671 (42

21 U.S.C. 300ff–71) is amended—

22 (1) by amending the title to read as follows:
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1 ‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND AC2 CESS TO RESEARCH FOR CHILDREN, YOUTH,

3 WOMEN, AND FAMILIES.’’;

4 (2) in subsection (a)—

5 (i) by striking ‘‘demonstration’’;

6 (ii) by striking ‘‘and the Director’’

7 and inserting ‘‘, in coordination with the

8 Director’’;

9 (iii) by striking paragraph (1), and in10 serting the following new paragraph:

11 ‘‘(1) supporting, at the health facilities of such

12 entities, access to and linkages with clinical research

13 on therapies for pediatric patients, youth, and

14 women with HIV disease, and special initiatives re15 lated to clinical research and care findings;’’; and

16 (iv) by amending paragraph (2) to

17 read as follows:

18 ‘‘(2) providing and coordinating outpatient

19 health care services and systems of care, directly or

20 through contractual arrangements, to children,

21 youth, and women and their families.’’;

22 (3) in subsection (c)—

23 (A) in paragraph (1), to read as follows:

24 ‘‘(1) LINKAGES TO RESEARCH.—The Secretary

25 may not make a grant to an applicant under sub26 section (a) unless the applicant enters into an agree-
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1 ment with an appropriately qualified entity with ex2 pertise in biomedical or behavioral research to en3 hance voluntary access to research.’’; and

4 (B) in paragraph (2)—

5 (i) by inserting after ‘‘through the’’

6 the following: ‘‘Director of the Adminis7 trator of the Health Resources and Serv8 ices Administration, and in coordination

9 with the’’;

10 (ii) in subparagraph (A), by striking

11 ‘‘; and’’ and inserting a semicolon;

12 (iii) in subparagraph (B), by striking

13 the period at the end and inserting ‘‘;

14 and’’; and

15 (iv) by inserting after subparagraph

16 (B), the following new subparagraph:

17 ‘‘(C) may provide training and technical

18 assistance including peer-based assistance

19 through the Health Resources and Services Ad20 ministration.’’;

21 (4) in subsections (d), (e), and (f), by striking

22 ‘‘pediatric patient’’ each place such term appears

23 and inserting ‘‘children and youth’’;

24 (5) in subsection (f), by inserting before the pe25 riod the following: ‘‘, including coordination and ac-
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1 cess to child welfare services, support services, kin2 ship care services, and other appropriate services for

3 orphans of the AIDS epidemic.’’;

4 (6) in subsection (h), to read as follows:

5 ‘‘(h) COORDINATION.—The Secretary may not make

6 a grant under subsection (c) unless the applicant submits

7 evidence that the proposed program is consistent with the

8 Statewide coordinated statement of need and the applicant

9 agrees to annually participate in the ongoing revision proc10 ess of such statement of need.’’; and

11 (7) in subsection (j), by striking ‘‘$20,000,000’’

12 and all that follows through the end of the section,

13 and inserting ‘‘such sums as may be necessary in

14 each of the fiscal years 1996, 1997, 1998, 1999, and

15 2000.’’.

16 (e) SPECIAL PROJECTS OF NATIONAL SIGNIFI17 CANCE.—Title XXVI is amended by adding at the end,

18 the following new part:

19 ‘‘PART F—SPECIAL PROJECTS OF NATIONAL

20 SIGNIFICANCE

21 ‘‘SEC. 2701. SPECIAL PROJECTS OF NATIONAL SIGNIFI22 CANCE.

23 ‘‘(a) IN GENERAL.—Of the amount appropriated

24 under each of parts A, B, and C of this title for each fiscal

25 year, the Secretary shall use the greater of $20,000,000
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1 or 3 percent of such amount appropriated under each such

2 part, but not to exceed $25,000,000, to administer a spe3 cial projects of national significance program to award di4 rect grants to public and nonprofit private entities includ5 ing community-based organizations to fund special pro6 grams for the care and treatment of individuals with HIV

7 disease.

8 ‘‘(b) GRANTS.—The Secretary shall award grants

9 under subsection (a) based on—

10 ‘‘(1) the need to assess the effectiveness of a

11 particular model for the care and treatment of indi12 viduals with HIV disease;

13 ‘‘(2) the innovative nature of the proposed ac14 tivity; and

15 ‘‘(3) the potential replicability of the proposed

16 activity in other similar localities or nationally.

17 ‘‘(c) SPECIAL PROJECTS.—Special projects of na18 tional significance may include the development and as19 sessment of innovative service delivery models that are de20 signed to—

21 ‘‘(1) address the needs of special populations;

22 and

23 ‘‘(2) assist in the development of essential com24 munity-based service delivery infrastructure.
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1 ‘‘(d) SPECIAL POPULATIONS.—Special projects of na2 tional significance may include the delivery of HIV health

3 care and support services to traditionally underserved pop4 ulations including—

5 ‘‘(1) individuals and families with HIV disease

6 living in rural communities;

7 ‘‘(2) adolescents with HIV disease;

8 ‘‘(3) Indian individuals and families with HIV

9 disease;

10 ‘‘(4) homeless individuals and families with

11 HIV disease;

12 ‘‘(5) hemophiliacs with HIV disease; and

13 ‘‘(6) incarcerated individuals with HIV disease.

14 ‘‘(e) SERVICE DEVELOPMENT GRANTS.—Special

15 projects of national significance may include the develop16 ment of model approaches to delivering HIV care and sup17 port services including—

18 ‘‘(1) programs that support family-based care

19 networks critical to the delivery of care in minority

20 communities;

21 ‘‘(2) programs that build organizational capac22 ity in disenfranchised communities;

23 ‘‘(3) programs designed to prepare AIDS serv24 ice organizations and grantees under this title for
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1 operation within the changing health care environ2 ment; and

3 ‘‘(4) programs designed to integrate the deliv4 ery of mental health and substance abuse treatment

5 with HIV services.

6 ‘‘(f) DISTRIBUTION OF FUNDS.—Fifty percent of the

7 funds made available under this section shall be provided

8 to geographic areas that are not eligible for funds under

9 section 2603 except that existing grantees shall continue

10 to receive funding for the length of the project period.

11 ‘‘(g) COORDINATION.—The Secretary may not make

12 a grant under this section unless the applicant submits

13 evidence that the proposed program is consistent with the

14 Statewide coordinated statement of need, and the appli15 cant agrees to participate in the ongoing revision process

16 of such statement of need.

17 ‘‘(h) REPLICATION.—The Secretary shall make infor18 mation concerning successful models developed under this

19 part available to grantees under this title for the purpose

20 of coordination, replication, and integration. To facilitate

21 efforts under this subsection, the Secretary may provide

22 for peer-based technical assistance from grantees funded

23 under this part.’’.
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1 SEC. 4. EFFECTIVE DATE.

2 (a) IN GENERAL.—Except as provided in subsection

3 (b), this Act, and the amendments made by this Act, shall

4 become effective on October 1, 1995.

5 (b) ELIGIBLE AREAS.—The amendments made by

6 subsections (a) and (b)(4)(A) of section 3 become effective

7 on the date of enactment of this Act.

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