Union Calendar No. 132

104TH CONGRESS

1ST SESSION H. R. 1872

[Report No. 104–245]

A BILL

To amend the Public Health Service Act to revise

Emergency Act of 1990.Ryan White Comprehensive AIDS Resourcesand extend programs established pursuant to the

SEPTEMBER 14, 1995

Reported with an amendment, committed to the Commitordered to be printed tee of the Whole House on the State of the Union, and
IB

Union Calendar No. 132

104TH CONGRESS

1ST SESSION H. R. 1872

[Report No. 104–245]

To amend the Public Health Service Act to revise and extend programs

established pursuant to the Ryan White Comprehensive AIDS Resources

Emergency Act of 1990.

IN THE HOUSE OF REPRESENTATIVES

JUNE 16, 1995

Mr. BILIRAKIS (for himself, Mr. WAXMAN, Mr. BLILEY, Mr. DINGELL, Mr.

HASTERT, Mr. WYDEN, Mr. UPTON, Mr. MANTON, Mr. KLUG, Mr.

TOWNS, Mr. GREENWOOD, Mr. STUDDS, Mr. BILBRAY, Mr. BROWN of

Ohio, Mr. GANSKE, Ms. FURSE, Mr. MOORHEAD, Mr. DEUTSCH, Mr.

RUSH, Ms. ESHOO, Mr. STUPAK, Mr. GUNDERSON, and Ms. PELOSI) introduced the following bill; which was referred to the Committee on

Commerce

SEPTEMBER 14, 1995

Additional sponsors: Mr. BALDACCI, Mrs. SCHROEDER, Mr. SKAGGS, Ms.

NORTON, Mr. BRYANT of Texas, Mr. FRANK of Massachusetts, Ms.

PRYCE, Mr. BARRETT of Wisconsin, Mr. RICHARDSON, Mr. FLAKE, Mr.

KLECZKA, Mrs. KELLY, Mr. ENGEL, Mrs. MINK of Hawaii, Mr. VENTO,

Mr. HINCHEY, Mr. ACKERMAN, Mr. MATSUI, Mr. ABERCROMBIE, Mr.

SERRANO, Mr. YATES, Mr. WILLIAMS, Mr. FOLEY, Mr. OLVER, Mr.

SANDERS, Mr. NADLER, Mr. GUTIERREZ, Mr. STARK, Mr. HOYER, Mr.

FILNER, Mr. OWENS, Ms. WATERS, Mr. BENTSEN, Ms. MCKINNEY, Mr.

BORSKI, Mrs. LOWEY, Mr. LAZIO of New York, Mr. DELLUMS, Mr.

BROWN of California, Mr. DURBIN, Ms. WOOLSEY, Mr. JOHNSTON of

Florida, Mr. RANGEL, Mr. WYNN, Mr. DEFAZIO, Mr. TUCKER, Mr.

WARD, Mr. DIXON, Mrs. MALONEY, Mr. FLANAGAN, Mr. LEWIS of Georgia, Ms. ROYBAL-ALLARD, Mr. COLEMAN, Mrs. MEEK of Florida, Mr.

EVANS, Ms. VELA ́ZQUEZ, Mr. GENE GREEN of Texas, Mr. BEILENSON,

Mr. SHAYS, Ms. LOFGREN, Mr. LANTOS, Mr. FROST, Mr. FOX of Pennsylvania, Mr. FAZIO of California, Mr. SABO, Mr. FATTAH, and Mr.

PAYNE of New Jersey
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SEPTEMBER 14, 1995

Reported with an amendment, committed to the Committee of the Whole

House on the State of the Union, and ordered to be printed

[Strike out all after the enacting clause and insert the part printed in italic]

[For text of introduced bill, see copy of bill as introduced on June 16, 1995]

A BILL

To amend the Public Health Service Act to revise and extend

programs established pursuant to the Ryan White Comprehensive AIDS Resources Emergency Act of 1990.

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 Act

5 Amendments of 1995’’.

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, the

9 reference shall be considered to be made to that section or

10 other provision of the Public Health Service Act (42 U.S.C.

11 201 et seq.).
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1 TITLE I—EMERGENCY RELIEF

2 FOR AREAS WITH SUBSTAN3 TIAL NEED FOR SERVICES

4 SEC. 101. ESTABLISHMENT OF PROGRAM OF GRANTS.

5 (a) IN GENERAL.—Section 2601 (42 U.S.C. 300ff–11)

6 is amended—

7 (1) in subsection (a),

8 (A) by striking ‘‘subject to subsection (b)’’

9 and inserting ‘‘subject to subsections (b) through

10 (d)’’; and

11 (B) by striking ‘‘metropolitan area’’ and all

12 that follows and inserting the following: ‘‘metro13 politan area for which there has been reported to

14 the Director of the Centers for Disease Control

15 and Prevention a cumulative total of more than

16 2,000 cases of acquired immune deficiency syn17 drome for the most recent period of five calendar

18 years for which such data are available.’’; and

19 (2) by adding at the end thereof the following

20 subsections:

21 ‘‘(c) REQUIREMENT REGARDING POPULATION.—In the

22 case of a metropolitan area that was not an eligible area

23 under this part for fiscal year 1996, the Secretary may not

24 make a grant under this section for the area unless the area

25 has a population of 500,000 or more individuals. For pur-
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1 poses of eligibility under this part, the boundaries of each

2 metropolitan area are the boundaries in effect for fiscal year

3 1994.

4 ‘‘(d) CONTINUED STATUS AS ELIGIBLE AREA.—A met5 ropolitan area that was an eligible area under this part

6 for fiscal year 1996 is an eligible area for fiscal year 1997

7 and each subsequent fiscal year.’’.

8 (b) CONFORMING AMENDMENT REGARDING DEFINI9 TION OF ELIGIBLE AREA.—Section 2607(1) (42 U.S.C.

10 300ff–17(1)) is amended by striking ‘‘The term’’ and all

11 that follows and inserting the following: ‘‘The term ‘eligible

12 area’ means a metropolitan area meeting the requirements

13 of section 2601 that are applicable to the area.’’.

14 SEC. 102. HIV HEALTH SERVICES PLANNING COUNCIL.

15 (a) ESTABLISHMENT.—Section 2602(b)(1) (42 U.S.C.

16 300ff–12(b)(1)) is amended—

17 (1) in subparagraph (A), by inserting before the

18 semicolon the following: ‘‘, including federally quali19 fied health centers’’;

20 (2) in subparagraph (D), by inserting before the

21 semicolon the following: ‘‘and providers of services re22 garding substance abuse’’;

23 (3) in subparagraph (G), by inserting before the

24 semicolon the following: ‘‘and historically underserved

25 groups and subpopulations’’;
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1 (4) in subparagraph (I), by inserting before the

2 semicolon the following: ‘‘, including the State medic3 aid agency and the agency administering the pro4 gram under part B’’;

5 (5) in subparagraph (J), by striking ‘‘and’’ after

6 the semicolon;

7 (6) by striking subparagraph (K); and

8 (7) by adding at the end the following subpara9 graphs:

10 ‘‘(K) grantees under section 2671, or, if

11 none are operating in the area, representatives of

12 organizations in the area with a history of serv13 ing children, youth, women, and families living

14 with HIV; and

15 ‘‘(L) grantees under other HIV-related Fed16 eral programs.’’.

17 (b) DUTIES.—Section 2602(b)(3) (42 U.S.C. 300ff–

18 12(b)(3)) is amended—

19 (1) by striking ‘‘The planning’’ in the matter

20 preceding subparagraph (A) and all that follows

21 through the semicolon at the end of subparagraph (A)

22 and inserting the following: ‘‘The planning council

23 under paragraph (1) shall carry out the following:
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1 ‘‘(A) Establish priorities for the allocation

2 of funds within the eligible area based on the fol3 lowing factors:

4 ‘‘(i) Documented needs of the HIV-in5 fected population.

6 ‘‘(ii) Cost and outcome effectiveness of

7 proposed strategies and interventions, to the

8 extent that such data are reasonably avail9 able.

10 ‘‘(iii) Priorities of the HIV-infected

11 communities for which the services are in12 tended.

13 ‘‘(iv) Availability of other govern14 mental and nongovernmental resources.’’;

15 (2) in subparagraph (B)—

16 (A) by striking ‘‘develop’’ and inserting

17 ‘‘Develop’’; and

18 (B) by striking ‘‘; and’’ and inserting a pe19 riod;

20 (3) in subparagraph (C)—

21 (A) by striking ‘‘assess’’ and inserting ‘‘As22 sess’’;

23 (B) by striking ‘‘rapidly’’; and

24 (C) by inserting before the period the follow25 ing: ‘‘, and assess the effectiveness, either directly
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1 or through contractual arrangements, of the serv2 ices offered in meeting the identified needs’’; and

3 (4) by adding at the end the following subpara4 graphs:

5 ‘‘(D) Participate in the development of the

6 statewide coordinated statement of need initiated

7 by the State health department (where it has

8 been so initiated).

9 ‘‘(E) Obtain input on community needs

10 through conducting public meetings.’’.

11 (c) GENERAL PROVISIONS.—Section 2602(b) (42

12 U.S.C. 300ff–12(b)) is amended by adding at the end the

13 following paragraph:

14 ‘‘(4) GENERAL PROVISIONS.—

15 ‘‘(A) COMPOSITION OF COUNCIL.—The plan16 ning council under paragraph (1) shall (in addi17 tion to requirements under such paragraph) re18 flect in its composition the demographics of the

19 epidemic in the eligible area involved, with par20 ticular consideration given to disproportionately

21 affected and historically underserved groups and

22 subpopulations. Nominations for membership on

23 the council shall be identified through an open

24 process, and candidates shall be selected based on

25 locally delineated and publicized criteria. Such
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1 criteria shall include a conflict-of-interest stand2 ard for each nominee.

3 ‘‘(B) CONFLICTS OF INTEREST.—

4 ‘‘(i) The planning council under para5 graph (1) may not be directly involved in

6 the administration of a grant under section

7 2601(a). With respect to compliance with

8 the preceding sentence, the planning council

9 may not designate (or otherwise be involved

10 in the selection of) particular entities as re11 cipients of any of the amounts provided in

12 the grant.

13 ‘‘(ii) An individual may serve on the

14 planning council under paragraph (1) only

15 if the individual agrees to comply with the

16 following:

17 ‘‘(I) If the individual has a finan18 cial interest in an entity, and such en19 tity is seeking amounts from a grant

20 under section 2601(a), the individual

21 will not, with respect to the purpose for

22 which the entity seeks such amounts,

23 participate (directly or in an advisory

24 capacity) in the process of selecting en-
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1 tities to receive such amounts for such

2 purpose.

3 ‘‘(II) In the case of a public or

4 private entity of which the individual

5 is an employee, or a public or private

6 organization of which the individual is

7 a member, the individual will not par8 ticipate (directly or in an advisory ca9 pacity) in the process of making any

10 decision that relates to the expenditure

11 of a grant under section 2601(a) for

12 such entity or organization or that oth13 erwise directly affects the entity or or14 ganization.’’.

15 SEC. 103. TYPE AND DISTRIBUTION OF GRANTS.

16 (a) FORMULA GRANTS BASED ON RELATIVE NEED OF

17 AREAS.—Section 2603(a) (42 U.S.C. 300ff–13(a)) is

18 amended—

19 (1) in paragraph (1)—

20 (A) in the second sentence, by inserting ‘‘,

21 subject to paragraph (4)’’ before the period; and

22 (B) by adding at the end the following sen23 tence: ‘‘Grants under this paragraph for a fiscal

24 year shall be disbursed not later than 60 days

25 after the date on which amounts appropriated
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1 under section 2677 become available for the fiscal

2 year, subject to any waivers under section

3 2605(d).’’;

4 (2) in paragraph (2), by amending the para5 graph to read as follows:

6 ‘‘(2) ALLOCATIONS.—Of the amount available

7 under section 2677 for a fiscal year for making

8 grants under section 2601(a)—

9 ‘‘(A) the Secretary shall reserve 50 percent

10 for making grants under paragraph (1) in

11 amounts determined in accordance with para12 graph (3); and

13 ‘‘(B) the Secretary shall, after compliance

14 with subparagraph (A), reserve such funds as

15 may be necessary to carry out paragraph (4).’’;

16 and

17 (3) by adding at the end the following para18 graph:

19 ‘‘(4) MAXIMUM REDUCTION IN GRANT.—In the

20 case of any eligible area for which a grant under

21 paragraph (1) was made for fiscal year 1995, the Sec22 retary, in making grants under such paragraph for

23 the area for the fiscal years 1996 through 2000, shall

24 (subject to the extent of the amount available under

25 section 2677 for the fiscal year involved for making
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1 grants under section 2601(a)) ensure that the

2 amounts of the grants do not, relative to such grant

3 for the area for fiscal year 1995, constitute a reduc4 tion of more than the following, as applicable to the

5 fiscal year involved:

6 ‘‘(A) 1 percent, in the case of fiscal year

7 1996.

8 ‘‘(B) 2 percent, in the case of fiscal year

9 1997.

10 ‘‘(C) 3 percent, in the case of fiscal year

11 1998.

12 ‘‘(D) 4 percent, in the case of fiscal year

13 1999.

14 ‘‘(E) 5 percent, in the case of fiscal year

15 2000.’’.

16 (b) SUPPLEMENTAL GRANTS.—Section 2603(b) (42

17 U.S.C. 300ff–13(b)) is amended—

18 (1) in paragraph (1)—

19 (A) in the matter preceding subparagraph

20 (A), by striking ‘‘Not later than’’ and all that

21 follows through ‘‘section 2605(b)—’’ and insert22 ing the following: ‘‘After allocating in accordance

23 with subsection (a) the amounts available under

24 section 2677 for grants under section 2601(a) for

25 a fiscal year, the Secretary, in carrying out sec-
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1 tion 2601(a), shall from the remaining amounts

2 make grants to eligible areas described in this

3 paragraph. Such grants shall be disbursed not

4 later than 150 days after the date on which

5 amounts appropriated under section 2677 be6 come available for the fiscal year. An eligible

7 area described in this paragraph is an eligible

8 area whose application under section

9 2605(b)—’’;

10 (B) in subparagraph (D), by striking ‘‘and’’

11 after the semicolon;

12 (C) in subparagraph (E), by striking the

13 period at the end and inserting ‘‘; and’’; and

14 (D) by adding at the end thereof the follow15 ing subparagraph:

16 ‘‘(F) demonstrates the manner in which the

17 proposed services are consistent with the local

18 needs assessment and the statewide coordinated

19 statement of need.’’; and

20 (2)(A) by redesignating paragraphs (2) through

21 (4) as paragraphs (3) through (5), respectively; and

22 (B) by inserting after paragraph (1) the follow23 ing paragraph:

24 ‘‘(2) PRIORITY.—
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1 ‘‘(A) SEVERE NEED.—In determining severe

2 need in accordance with paragraph (1)(B), the

3 Secretary shall give priority consideration in

4 awarding grants under this subsection to eligible

5 areas that (in addition to complying with para6 graph (1)) demonstrate a more severe need based

7 on the prevalence in the eligible area of—

8 ‘‘(i) sexually transmitted diseases, sub9 stance abuse, tuberculosis, severe mental ill10 ness, or other conditions determined rel11 evant by the Secretary, which significantly

12 affect the impact of HIV disease;

13 ‘‘(ii) subpopulations with HIV disease

14 that were previously unknown in such area;

15 or

16 ‘‘(iii) homelessness.

17 ‘‘(B) PREVALENCE.—In determining preva18 lence of conditions under subparagraph (A), the

19 Secretary shall use data on the prevalence of the

20 conditions described in such subparagraph

21 among individuals with HIV disease (except

22 that, in the case of an eligible area for which

23 such data are not available, the Secretary shall

24 use data on the prevalences of the conditions in

25 the general population of such area).’’.
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1 (c) ADDITIONAL REQUIREMENTS FOR GRANTS.—Sec2 tion 2603 (42 U.S.C. 300ff–13) is amended by adding at

3 the end the following subsection:

4 ‘‘(c) COMPLIANCE WITH PRIORITIES OF HIV PLAN5 NING COUNCIL.—Notwithstanding any other provision of

6 this part, the Secretary, in carrying out section 2601(a),

7 may not make any grant under subsection (a) or (b) to

8 an eligible area unless the application submitted by such

9 area under section 2605 for the grant involved demonstrates

10 that the grants made under subsections (a) and (b) to the

11 area for the preceding fiscal year (if any) were expended

12 in accordance with the priorities applicable to such year

13 that were established, pursuant to section 2602(b)(3)(A), by

14 the planning council serving the area.’’.

15 SEC. 104. USE OF AMOUNTS.

16 Section 2604 (42 U.S.C. 300ff–14) is amended—

17 (1) in subsection (b)—

18 (A) in paragraph (1)(A), by striking ‘‘in19 cluding case management and comprehensive

20 treatment services, for individuals’’ and insert21 ing the following: ‘‘including HIV-related com22 prehensive treatment services (including treat23 ment education and measures for the prevention

24 and treatment of opportunistic infections), case
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1 management, and substance abuse treatment and

2 mental health treatment, for individuals’’;

3 (B) in paragraph (2)(A)—

4 (i) by inserting after ‘‘nonprofit pri5 vate entities,’’ the following: ‘‘or private for6 profit entities if such entities are the only

7 available provider of quality HIV care in

8 the area,’’; and

9 (ii) by striking ‘‘and homeless health

10 centers’’ and inserting ‘‘homeless health cen11 ters, substance abuse treatment programs,

12 and mental health programs’’; and

13 (C) by adding at the end the following

14 paragraph:

15 ‘‘(3) PRIORITY FOR WOMEN, INFANTS AND CHIL16 DREN.—For the purpose of providing health and sup17 port services to infants, children, and women with

18 HIV disease, the chief elected official of an eligible

19 area shall use, of the grants made for the area under

20 section 2601(a) for a fiscal year, not less than the

21 percentage constituted by the ratio of the population

22 in such area of infants, children, and women with ac23 quired immune deficiency syndrome to the general

24 population in such area of individuals with such syn25 drome, or 15 percent, whichever is less. In expending
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1 the funds reserved under the preceding sentence for a

2 fiscal year, the chief elected official shall give priority

3 to providing, for pregnant women, measures to pre4 vent the perinatal transmission of HIV.’’; and

5 (2) in subsection (e), by adding at the end there6 of the following sentence: ‘‘In the case of entities to

7 which such officer allocates amounts received by the

8 officer under the grant, the officer shall ensure that,

9 of the aggregate amount so allocated, the total of the

10 expenditures by such entities for administrative ex11 penses does not exceed 10 percent (without regard to

12 whether particular entities expend more than 10 per13 cent for such expenses).’’.

14 SEC. 105. APPLICATION.

15 Section 2605 (42 U.S.C. 300ff–15) is amended—

16 (1) in subsection (a)—

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

18 year period’’ and all that follows through ‘‘eligi19 ble area’’ and inserting ‘‘preceding fiscal year’’;

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

21 the end thereof;

22 (C) in paragraph (5), by striking the period

23 at the end thereof and inserting ‘‘; and’’; and

24 (D) by adding at the end thereof the follow25 ing paragraph:
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1 ‘‘(6) that the applicant will participate in the

2 process for the statewide coordinated statement of

3 need (where it has been initiated by the State), and

4 will ensure that the services provided under the com5 prehensive plan are consistent with such statement.’’;

6 (2) in subsection (b)—

7 (A) in the subsection heading, by striking

8 ‘‘ADDITIONAL’’; and

9 (B) in the matter preceding paragraph (1),

10 by striking ‘‘additional’’;

11 (3) by redesignating subsections (c) and (d) as

12 subsections (d) and (e), respectively; and

13 (4) by inserting after subsection (b), the follow14 ing subsection:

15 ‘‘(c) SINGLE APPLICATION.—Upon the request of the

16 chief elected official of an eligible area, the Secretary may

17 authorize the official to submit a single application through

18 which the official simultaneously requests a grant pursuant

19 to subsection (a) of section 2603 and a grant pursuant to

20 subsection (b) of such section. The Secretary may establish

21 such criteria for carrying out this subsection as the Sec22 retary determines to be appropriate.’’.

23 SEC. 106. TECHNICAL ASSISTANCE; PLANNING GRANTS.

24 Section 2606 (42 U.S.C. 300ff–16) is amended—
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1 (1) by inserting before ‘‘The Administrator’’ the

2 following: ‘‘(a) IN GENERAL.—’’;

3 (2) by striking ‘‘may, beginning’’ and all that

4 follows through ‘‘title,’’ and inserting ‘‘(referred to in

5 this section as the ‘Administrator’) shall’’; and

6 (3) by adding at the end the following subsection:

7 ‘‘(b) PLANNING GRANTS REGARDING INITIAL ELIGI8 BILITY FOR GRANTS.—

9 ‘‘(1) ADVANCE PAYMENTS ON FIRST-YEAR FOR10 MULA GRANTS.—With respect to a fiscal year (re11 ferred to in this subsection as the ‘planning year’), if

12 a metropolitan area has not previously received a

13 grant under section 2601 and the Administrator rea14 sonably projects that the area will be eligible for such

15 a grant for the subsequent fiscal year, the Adminis16 trator may make a grant for the planning year for

17 the purpose of assisting the area in preparing for the

18 responsibilities of the area in carrying out activities

19 under this part.

20 ‘‘(2) REQUIREMENTS.—

21 ‘‘(A) IN GENERAL.—A grant under para22 graph (1) for a planning year shall be made di23 rectly to the chief elected official of the city or

24 urban county that administers the public health

25 agency to which section 2602(a)(1) is projected
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1 to apply for purposes of such paragraph. The

2 grant may not be made in an amount exceeding

3 $75,000.

4 ‘‘(B) OFFSETTING REDUCTION IN FIRST

5 FORMULA GRANT.—In the case of a metropolitan

6 area that has received a grant under paragraph

7 (1) for a planning year, the first grant made

8 pursuant to section 2603(a) for such area shall

9 be reduced by an amount equal to the amount of

10 the grant under such paragraph for the planning

11 year. With respect to amounts resulting from re12 ductions under the preceding sentence for a fiscal

13 year, the Secretary shall use such amounts to

14 make grants under section 2603(a) for the fiscal

15 year, subject to ensuring that none of such

16 amounts are provided to any metropolitan area

17 for which such a reduction was made for the fis18 cal year.

19 ‘‘(3) FUNDING.—Of the amounts available under

20 section 2677 for a fiscal year for carrying out this

21 part, the Administrator may reserve not more than 1

22 percent for making grants under paragraph (1).’’.
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1 TITLE II—CARE GRANT

2 PROGRAM

3 SEC. 201. GENERAL USE OF GRANTS.

4 Section 2612 (42 U.S.C. 300ff–22) is amended to read

5 as follows:

6 ‘‘SEC. 2612. GENERAL USE OF GRANTS.

7 ‘‘(a) IN GENERAL.—A State may use amounts pro8 vided under grants made under this part for the following:

9 ‘‘(1) To provide the services described in section

10 2604(b)(1) for individuals with HIV disease.

11 ‘‘(2) To provide to such individuals treatments

12 that in accordance with section 2616 have been deter13 mined to prolong life or prevent serious deterioration

14 of health.

15 ‘‘(3) To provide home- and community-based

16 care services for such individuals in accordance with

17 section 2614.

18 ‘‘(4) To provide assistance to assure the continu19 ity of health insurance coverage for such individuals

20 in accordance with section 2615.

21 ‘‘(5) To establish and operate consortia under

22 section 2613 within areas most affected by HIV dis23 ease, which consortia shall be designed to provide a

24 comprehensive continuum of care to individuals and
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1 families with such disease in accordance with such

2 section.

3 ‘‘(b) PRIORITY FOR WOMEN, INFANTS AND CHIL4 DREN.—For the purpose of providing health and support

5 services to infants, children, and women with HIV disease,

6 a State shall use, of the funds allocated under this part to

7 the State for a fiscal year, not less than the percentage con8 stituted by the ratio of the population in the State of in9 fants, children, and women with acquired immune defi10 ciency syndrome to the general population in the State of

11 individuals with such syndrome, or 15 percent, whichever

12 is less. In expending the funds reserved under the preceding

13 sentence for a fiscal year, the State shall give priority to

14 providing, for pregnant women, measures to prevent the

15 perinatal transmission of HIV.’’.

16 SEC. 202. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

17 Section 2613 (42 U.S.C. 300ff–23) is amended—

18 (1) in subsection (a)—

19 (A) in paragraph (1), by inserting ‘‘(or pri20 vate for-profit providers or organizations if such

21 entities are the only available providers of qual22 ity HIV care in the area)’’ after ‘‘nonprofit pri23 vate,’’; and

24 (B) in paragraph (2)(A)—
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1 (i) by inserting ‘‘substance abuse treat2 ment, mental health treatment,’’ after

3 ‘‘nursing,’’; and

4 (ii) by inserting after ‘‘monitoring,’’

5 the following: ‘‘measures for the prevention

6 and treatment of opportunistic infections,

7 treatment education for patients (provided

8 in the context of health care delivery),’’; and

9 (2) in subsection (c)(2)—

10 (A) in clause (ii) of subparagraph (A), by

11 striking ‘‘and’’ after the semicolon;

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

13 period at the end and inserting ‘‘; and’’; and

14 (C) by adding after subparagraph (B) the

15 following subparagraph:

16 ‘‘(C) grantees under section 2671, or, if

17 none are operating in the area, representatives

18 in the area of organizations with a history of

19 serving children, youth, women, and families liv20 ing with HIV.’’.

21 SEC. 203. PROVISION OF TREATMENTS.

22 Section 2616(a) (42 U.S.C. 300ff–26(a)) is amended—

23 (1) by striking ‘‘may use amounts’’ and insert24 ing ‘‘shall use a portion of the amounts’’;
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1 (2) by striking ‘‘section 2612(a)(4)’’ and insert2 ing ‘‘section 2612(a)(2)’’; and

3 (3) by inserting before the period the following:

4 ‘‘, including measures for the prevention and treat5 ment of opportunistic infections’’.

6 SEC. 204. STATE APPLICATION.

7 Section 2617(b)(2) (42 U.S.C. 300ff–27(b)(2)) is

8 amended—

9 (1) in subparagraph (A), by striking ‘‘and’’ after

10 the semicolon;

11 (2) in subparagraph (B), by striking ‘‘and’’ after

12 the semicolon; and

13 (3) by adding at the end thereof the following

14 subparagraphs:

15 ‘‘(C) a description of the activities carried

16 out by the State under section 2616; and

17 ‘‘(D) a description of how the allocation

18 and utilization of resources are consistent with a

19 statewide coordinated statement of need, devel20 oped in partnership with other grantees in the

21 State that receive funding under this title and

22 after consultation with individuals receiving

23 services under this part.’’.
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1 SEC. 205. ALLOCATION OF ASSISTANCE BY STATES; PLAN2 NING, EVALUATION, AND ADMINISTRATION.

3 Section 2618(c) (42 U.S.C. 300ff–28(c)) is amended—

4 (1) by striking paragraph (1);

5 (2) by redesignating paragraphs (2) through (5)

6 as paragraphs (1) through (4), respectively; and

7 (3) in paragraph (3) (as so redesignated), by

8 adding at the end the following sentences: ‘‘In the case

9 of entities to which the State allocates amounts re10 ceived by the State under the grant (including consor11 tia under section 2613), the State shall ensure that,

12 of the aggregate amount so allocated, the total of the

13 expenditures by such entities for administrative ex14 penses does not exceed 10 percent (without regard to

15 whether particular entities expend more than 10 per16 cent for such expenses). For purposes of the preceding

17 sentence, the costs of establishing and operating con18 sortia under section 2613 shall be considered adminis19 trative expenses.’’.

20 SEC. 206. TECHNICAL ASSISTANCE.

21 Section 2619 (42 U.S.C. 300ff–29) is amended by in22 serting before the period the following: ‘‘, including tech23 nical assistance for the development and implementation of

24 statewide coordinated statements of need’’.
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1 TITLE III—EARLY

2 INTERVENTION SERVICES

3 SEC. 301. ESTABLISHMENT OF PROGRAM.

4 Section 2651(b) (42 U.S.C. 300ff–51(b)) is amended—

5 (1) in paragraph (1), by inserting before the pe6 riod the following: ‘‘, and unless the applicant agrees

7 to expend not less than 50 percent of the grant for

8 such services that are specified in subparagraphs (B)

9 through (E) of such paragraph’’; and

10 (2) in paragraph (4), by inserting after ‘‘non11 profit private entities’’ the following: ‘‘(or private for12 profit entities, if such entities are the only available

13 providers of quality HIV care in the area)’’.

14 SEC. 302. MINIMUM QUALIFICATIONS OF GRANTEES.

15 Section 2652(b)(1)(B) (42 U.S.C. 300ff–52(b)(1)(B)) is

16 amended by inserting after ‘‘nonprofit private entity’’ the

17 following: ‘‘(or a private for-profit entity, if such an entity

18 is the only available provider of quality HIV care in the

19 area)’’.

20 SEC. 303. MISCELLANEOUS PROVISIONS; PLANNING AND

21 DEVELOPMENT GRANTS.

22 Section 2654 (42 U.S.C. 300ff–54) is amended by add23 ing at the end thereof the following subsection:

24 ‘‘(c) PLANNING AND DEVELOPMENT GRANTS.—
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1 ‘‘(1) IN GENERAL.—The Secretary may provide

2 planning grants, in an amount not to exceed $50,000

3 for each such grant, to public and nonprofit private

4 entities for the purpose of enabling such entities to

5 provide early intervention services.

6 ‘‘(2) REQUIREMENT.—The Secretary may award

7 a grant to an entity under paragraph (1) only if the

8 Secretary determines that the entity will use such

9 grant to assist the entity in qualifying for a grant

10 under section 2651.

11 ‘‘(3) PREFERENCE.—In awarding grants under

12 paragraph (1), the Secretary shall give preference to

13 entities that provide HIV primary care services in

14 rural or underserved communities.

15 ‘‘(4) LIMITATION.—Not to exceed 1 percent of the

16 amount appropriated for a fiscal year under section

17 2655 may be used to carry out this section.’’.

18 SEC. 304. ADDITIONAL REQUIRED AGREEMENTS.

19 Section 2664(a)(1) (42 U.S.C. 300ff–64(a)(1)) is

20 amended—

21 (1) in subparagraph (A), by striking ‘‘and’’ after

22 the semicolon; and

23 (2) by adding at the end the following subpara24 graph:
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1 ‘‘(C) evidence that the proposed program is

2 consistent with the statewide coordinated state3 ment of need and that the applicant will partici4 pate in the ongoing revision of such statement of

5 need.’’.

6 SEC. 305. AUTHORIZATION OF APPROPRIATIONS.

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

8 striking ‘‘$75,000,000’’ and all that follows and inserting

9 ‘‘such sums as may be necessary for each of the fiscal years

10 1996 through 2000.’’.

11 TITLE IV—GENERAL PROVISIONS

12 SEC. 401. COORDINATED SERVICES AND ACCESS TO RE13 SEARCH FOR WOMEN, INFANTS, AND CHIL14 DREN.

15 (a) IN GENERAL.—Section 2671 (42 U.S.C. 300ff–71)

16 is amended—

17 (1) in subsection (a), by amending the subsection

18 to read as follows:

19 ‘‘(a) IN GENERAL.—

20 ‘‘(1) PROGRAM OF GRANTS.—The Secretary, act21 ing through the Administrator of the Health Re22 sources and Services Administration and in consulta23 tion with the Director of the National Institutes of

24 Health, shall make grants to public and nonprofit
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1 private entities that provide primary care (directly or

2 through contracts) for the purpose of—

3 ‘‘(A) providing through such entities, in ac4 cordance with this section, opportunities for

5 women, infants, and children to be participants

6 in research of potential clinical benefit to indi7 viduals with HIV disease; and

8 ‘‘(B) providing to women, infants, and chil9 dren health care on an outpatient basis.

10 ‘‘(2) PROVISIONS REGARDING PARTICIPATION IN

11 RESEARCH.—With respect to the projects of research

12 with which an applicant under paragraph (1) is con13 cerned, the Secretary may not make a grant under

14 such paragraph to the applicant unless the following

15 conditions are met:

16 ‘‘(A) The applicant agrees to make reason17 able efforts—

18 ‘‘(i) to identify which of the patients of

19 the applicant are women, infants, and chil20 dren who would be appropriate participants

21 in the projects; and

22 ‘‘(ii) to offer women, infants, and chil23 dren the opportunity to so participate (as

24 appropriate), including the provision of

25 services under subsection (f).
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1 ‘‘(B) The applicant agrees that the appli2 cant, and the projects of research, will comply

3 with accepted standards of protection for human

4 subjects (including the provision of written in5 formed consent) who participate as subjects in

6 clinical research.

7 ‘‘(C) For the third or subsequent fiscal year

8 for which a grant under such paragraph is

9 sought by the applicant, the Secretary has deter10 mined that—

11 ‘‘(i) a significant number of women,

12 infants, and children who are patients of

13 the applicant are participating in the

14 projects (except to the extent this clause is

15 waived under subsection (k)); and

16 ‘‘(ii) the applicant, and the projects of

17 research, have complied with the standards

18 referred to in subparagraph (B).

19 ‘‘(3) PROHIBITION.—Receipt of services by a pa20 tient shall not be conditioned upon the consent of the

21 patient to participate in research.

22 ‘‘(4) CONSIDERATION BY SECRETARY OF CERTAIN

23 CIRCUMSTANCES.—In administering the requirement

24 of paragraph (2)(C)(i), the Secretary shall take into

25 account circumstances in which a grantee under
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1 paragraph (1) is temporarily unable to comply with

2 the requirement for reasons beyond the control of the

3 grantee, and shall in such circumstances provide to

4 the grantee a reasonable period of opportunity in

5 which to reestablish compliance with the require6 ment.’’;

7 (2) in subsection (c), by amending the subsection

8 to read as follows:

9 ‘‘(c) PROVISIONS REGARDING CONDUCT OF RE10 SEARCH.—With respect to eligibility for a grant under sub11 section (a):

12 ‘‘(1) A project of research for which subjects are

13 sought pursuant to such subsection may be conducted

14 by the applicant for the grant, or by an entity with

15 which the applicant has made arrangements for pur16 poses of the grant. The grant may not be expended for

17 the conduct of any project of research.

18 ‘‘(2) The grant may not be made unless the Sec19 retary makes the following determinations:

20 ‘‘(A) The applicant or other entity (as the

21 case may be under paragraph (1)) is appro22 priately qualified to conduct the project of re23 search. An entity shall be considered to be so

24 qualified if any research protocol of the entity

25 has been recommended for funding under this
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1 Act pursuant to technical and scientific peer re2 view through the National Institutes of Health.

3 ‘‘(B) The project of research is being con4 ducted in accordance with a research protocol to

5 which the Secretary gives priority regarding the

6 prevention and treatment of HIV disease in

7 women, infants, and children. After consultation

8 with public and private entities that conduct

9 such research, and with providers of services

10 under this section and recipients of such services,

11 the Secretary shall establish a list of such proto12 cols that are appropriate for purposes of this sec13 tion. The Secretary may give priority under this

14 subparagraph to a research protocol that is not

15 on such list.’’;

16 (3) by striking subsection (i);

17 (4) by redesignating subsections (g) and (h) as

18 subsections (h) and (i), respectively;

19 (5) by inserting after subsection (f) the following

20 subsection:

21 ‘‘(g) ADDITIONAL PROVISIONS.—The Secretary may

22 not make a grant under subsection (a) unless the applicant

23 for the grant agrees as follows:

24 ‘‘(1) The applicant will coordinate activities

25 under the grant with other providers of health care
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1 services under this Act, and under title V of the So2 cial Security Act.

3 ‘‘(2) The applicant will participate in the state4 wide coordinated statement of need under part B

5 (where it has been initiated by the State) and in revi6 sions of such statement.’’;

7 (6) by redesignating subsection (j) as subsection

8 (m); and

9 (7) by inserting before subsection (m) (as so re10 designated) the following subsections:

11 ‘‘(j) COORDINATION WITH NATIONAL INSTITUTES OF

12 HEALTH.—The Secretary shall develop and implement a

13 plan that provides for the coordination of the activities of

14 the National Institutes of Health with the activities carried

15 out under this section. In carrying out the preceding sen16 tence, the Secretary shall ensure that projects of research

17 conducted or supported by such Institutes are made aware

18 of applicants and grantees under this section, shall require

19 that the projects, as appropriate, enter into arrangements

20 for purposes of this section, and shall require that each

21 project entering into such an arrangement inform the ap22 plicant or grantee under this section of the needs of the

23 project for the participation of women, infants, and chil24 dren.
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1 ‘‘(k) TEMPORARY WAIVER REGARDING SIGNIFICANT

2 PARTICIPATION.—

3 ‘‘(1) IN GENERAL.—In the case of an applicant

4 under subsection (a) who received a grant under this

5 section for fiscal year 1995, the Secretary may, sub6 ject to paragraph (2), provide to the applicant a

7 waiver of the requirement of subsection (a)(2)(C)(i) if

8 the Secretary determines that the applicant is making

9 reasonable progress toward meeting the requirement.

10 ‘‘(2) TERMINATION OF AUTHORITY FOR WAIV11 ERS.—The Secretary may not provide any waiver

12 under paragraph (1) on or after October 1, 1998. Any

13 such waiver provided prior to such date terminates on

14 such date, or on such earlier date as the Secretary

15 may specify.

16 ‘‘(l) TRAINING AND TECHNICAL ASSISTANCE.—Of the

17 amounts appropriated under subsection (m) for a fiscal

18 year, the Secretary may use not more than five percent to

19 provide training and technical assistance to assist appli20 cants and grantees under subsection (a) in complying with

21 the requirements of this section.’’.

22 (b) CONFORMING AMENDMENTS.—Section 2671 (42

23 U.S.C. 300ff–71) is amended—

24 (1) in the heading for the section, by striking

25 ‘‘DEMONSTRATION’’ and all that follows and insert-
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1 ing ‘‘COORDINATED SERVICES AND ACCESS TO

2 RESEARCH FOR WOMEN, INFANTS, AND CHIL3 DREN.’’;

4 (2) in subsection (b), by striking ‘‘pediatric pa5 tients and pregnant women’’ and inserting ‘‘women,

6 infants, and children’’; and

7 (3) in each of subsections (d) through (f), by

8 striking ‘‘pediatric’’, each place such term appears.

9 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

10 2671 (42 U.S.C. 300ff–71) is amended in subsection (m)

11 (as redesignated by subsection (a)(6)) by striking ‘‘there

12 are’’ and all that follows and inserting the following: ‘‘there

13 are authorized to be appropriated such sums as may be nec14 essary for each of the fiscal years 1996 through 2000.’’.

15 SEC. 402. PROJECTS OF NATIONAL SIGNIFICANCE.

16 (a) IN GENERAL.—Part D of title XXVI (42 U.S.C.

17 300ff–71 et seq.) is amended by inserting after section 2673

18 the following section:

19 ‘‘SEC. 2673A. DEMONSTRATION PROJECTS OF NATIONAL

20 SIGNIFICANCE.

21 ‘‘(a) IN GENERAL.—The Secretary shall make grants

22 to public and nonprofit private entities (including commu23 nity-based organizations and Indian tribes and tribal orga24 nizations) for the purpose of carrying out demonstration
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1 projects that provide for the care and treatment of individ2 uals with HIV disease, and that—

3 ‘‘(1) assess the effectiveness of particular models

4 for the care and treatment of individuals with such

5 disease;

6 ‘‘(2) are of an innovative nature; and

7 ‘‘(3) have the potential to be replicated in simi8 lar localities, or nationally.

9 ‘‘(b) CERTAIN PROJECTS.—Demonstration projects

10 under subsection (a) shall include the development and as11 sessment of innovative models for the delivery of HIV serv12 ices that are designed—

13 ‘‘(1) to address the needs of special populations

14 (including individuals and families with HIV disease

15 living in rural communities, adolescents with HIV

16 disease, Native American individuals and families

17 with HIV disease, homeless individuals and families

18 with HIV disease, hemophiliacs with HIV disease,

19 and incarcerated individuals with HIV disease); and

20 ‘‘(2) to ensure the ongoing availability of services

21 for Native American communities to enable such com22 munities to care for Native Americans with HIV dis23 ease.

24 ‘‘(c) COORDINATION.—The Secretary may not make a

25 grant under this section unless the applicant submits evi-
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1 dence that the proposed program is consistent with the ap2 plicable statewide coordinated statement of need under part

3 B, and the applicant agrees to participate in the ongoing

4 revision process of such statement of need (where it has been

5 initiated by the State).

6 ‘‘(d) REPLICATION.—The Secretary shall make infor7 mation concerning successful models developed under this

8 section available to grantees under this title for the purpose

9 of coordination, replication, and integration.

10 ‘‘(e) FUNDING; ALLOCATION OF AMOUNTS.—

11 ‘‘(1) IN GENERAL.—Of the amounts available

12 under this title for a fiscal year for each program

13 specified in paragraph (2), the Secretary shall reserve

14 3 percent for making grants under subsection (a).

15 ‘‘(2) RELEVANT PROGRAMS.—The programs re16 ferred to in subsection (a) are the program under

17 part A, the program under part B, the program

18 under part C, the program under section 2671, the

19 program under section 2672, and the program under

20 section 2673.’’.

21 (b) STRIKING OF RELATED PROVISION.—Section 2618

22 (42 U.S.C. 300ff–28) is amended by striking subsection (a).

23 SEC. 403. SPECIAL TRAINING PROJECTS.

24 (a) TRANSFER OF PROGRAM.—The Public Health

25 Service Act (42 U.S.C. 201 et seq.) is amended—
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1 (1) by transferring section 776 from the current

2 placement of the section;

3 (2) by redesignating the section as section

4 2673B; and

5 (3) by inserting the section after section 2673A

6 (as added by section 402(a)).

7 (b) MODIFICATIONS.—Section 2673B (as transferred

8 and redesignated by subsection (a)) is amended—

9 (1) in subsection (a)(1)—

10 (A) by striking subparagraphs (B) and (C);

11 (B) by redesignating subparagraphs (A)

12 and (D) as subparagraphs (B) and (C), respec13 tively;

14 (C) by inserting before subparagraph (B)

15 (as so redesignated) the following subparagraph:

16 ‘‘(A) to train health personnel, including

17 practitioners in programs under this title and

18 other community providers, in the diagnosis,

19 treatment, and prevention of HIV disease, in20 cluding the prevention of the perinatal trans21 mission of the disease and including measures

22 for the prevention and treatment of opportunistic

23 infections;’’;

24 (D) in subparagraph (B) (as so redesig25 nated), by adding ‘‘and’’ after the semicolon; and
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1 (E) in subparagraph (C) (as so redesig2 nated), by striking ‘‘curricula and’’;

3 (2) by striking subsection (c) and redesignating

4 subsection (d) as subsection (c); and

5 (3) in subsection (c) (as so redesignated)—

6 (A) in paragraph (1)—

7 (i) by striking ‘‘is authorized’’ and in8 serting ‘‘are authorized’’; and

9 (ii) by inserting before the period the

10 following: ‘‘, and such sums as may be nec11 essary for each of the fiscal years 1996

12 through 2000’’; and

13 (B) in paragraph (2)—

14 (i) by striking ‘‘is authorized’’ and in15 serting ‘‘are authorized’’; and

16 (ii) by inserting before the period the

17 following: ‘‘, and such sums as may be nec18 essary for each of the fiscal years 1996

19 through 2000’’.

20 SEC. 404. EVALUATIONS AND REPORTS.

21 Section 2674 (42 U.S.C. 300ff–74) is amended—

22 (1) in subsection (b)—

23 (A) in the matter preceding paragraph (1),

24 by striking ‘‘not later than 1 year’’ and all that
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1 follows through ‘‘title,’’ and inserting the follow2 ing: ‘‘not later than October 1, 1996,’’;

3 (B) by striking paragraphs (1) through (3)

4 and inserting the following paragraph:

5 ‘‘(1) evaluating the programs carried out under

6 this title; and’’; and

7 (C) by redesignating paragraph (4) as

8 paragraph (2); and

9 (2) by adding at the end the following subsection:

10 ‘‘(d) ALLOCATION OF FUNDS.—The Secretary shall

11 carry out this section with amounts available under section

12 241. Such amounts are in addition to any other amounts

13 that are available to the Secretary for such purpose.’’.

14 SEC. 405. COORDINATION OF PROGRAM.

15 Section 2675 of the Public Health Service Act (42

16 U.S.C. 300ff–75) is amended by adding at the end the fol17 lowing subsection:

18 ‘‘(d) ANNUAL REPORT.—Not later than October 1,

19 1996, and annually thereafter, the Secretary shall submit

20 to the appropriate committees of the Congress a report con21 cerning coordination efforts under this title at the Federal,

22 State, and local levels, including a statement of whether and

23 to what extent there exist Federal barriers to integrating

24 HIV-related programs.’’.
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1 TITLE V—ADDITIONAL

2 PROVISIONS

3 SEC. 501. AMOUNT OF EMERGENCY RELIEF GRANTS.

4 Paragraph (3) of section 2603(a) (42 U.S.C. 300ff–

5 13(a)(3)) is amended to read as follows:

6 ‘‘(3) AMOUNT OF GRANT.—

7 ‘‘(A) IN GENERAL.—Subject to the extent of

8 amounts made available in appropriations Acts,

9 a grant made for purposes of this paragraph to

10 an eligible area shall be made in an amount

11 equal to the product of—

12 ‘‘(i) an amount equal to the amount

13 available for distribution under paragraph

14 (2) for the fiscal year involved; and

15 ‘‘(ii) the percentage constituted by the

16 ratio of the distribution factor for the eligi17 ble area to the sum of the respective dis18 tribution factors for all eligible areas.

19 ‘‘(B) DISTRIBUTION FACTOR.—For purposes

20 of subparagraph (A)(ii), the term ‘distribution

21 factor’ means the product of—

22 ‘‘(i) an amount equal to the estimated

23 number of living cases of acquired immune

24 deficiency syndrome in the eligible area in-
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1 volved, as determined under subparagraph

2 (C); and

3 ‘‘(ii) the cost index for the eligible area

4 involved, as determined under subpara5 graph (D).

6 ‘‘(C) ESTIMATE OF LIVING CASES.—The

7 amount determined in this subparagraph is an

8 amount equal to the product of—

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

10 immune deficiency syndrome in the eligible

11 area during each year in the most recent

12 120-month period for which data are avail13 able with respect to all eligible areas, as in14 dicated by the number of such cases reported

15 to and confirmed by the Director of the Cen16 ters for Disease Control and Prevention for

17 each year during such period; and

18 ‘‘(ii) with respect to—

19 ‘‘(I) the first year during such pe20 riod, .06;

21 ‘‘(II) the second year during such

22 period, .06;

23 ‘‘(III) the third year during such

24 period, .08;
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1 ‘‘(IV) the fourth year during such

2 period, .10;

3 ‘‘(V) the fifth year during such pe4 riod, .16;

5 ‘‘(VI) the sixth year during such

6 period, .16;

7 ‘‘(VII) the seventh year during

8 such period, .24;

9 ‘‘(VIII) the eighth year during

10 such period, .40;

11 ‘‘(IX) the ninth year during such

12 period, .57; and

13 ‘‘(X) the tenth year during such

14 period, .88.

15 ‘‘(D) COST INDEX.—The amount deter16 mined in this subparagraph is an amount equal

17 to the sum of—

18 ‘‘(i) the product of—

19 ‘‘(I) the average hospital wage

20 index reported by hospitals in the eligi21 ble area involved under section

22 1886(d)(3)(E) of the Social Security

23 Act for the 3-year period immediately

24 preceding the year for which the grant

25 is being awarded; and
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1 ‘‘(II) .70; and

2 ‘‘(ii) .30.

3 ‘‘(E) UNEXPENDED FUNDS.—The Secretary

4 may, in determining the amount of a grant for

5 a fiscal year under this paragraph, adjust the

6 grant amount to reflect the amount of unex7 pended and uncanceled grant funds remaining

8 at the end of the fiscal year preceding the year

9 for which the grant determination is to be made.

10 The amount of any such unexpended funds shall

11 be determined using the financial status report

12 of the grantee.

13 ‘‘(F) PUERTO RICO, VIRGIN ISLANDS,

14 GUAM.—For purposes of subparagraph (D), the

15 cost index for an eligible area within Puerto

16 Rico, the Virgin Islands, or Guam shall be 1.0.’’.

17 SEC. 502. AMOUNT OF CARE GRANTS.

18 Section 2618 (42 U.S.C. 300ff–28), as amended by sec19 tion 402(b), is amended by striking subsection (b) and in20 serting the following subsections:

21 ‘‘(a) AMOUNT OF GRANT.—

22 ‘‘(1) IN GENERAL.—Subject to subsection (b) (re23 lating to minimum grants), the amount of a grant

24 under this part for a State for a fiscal year shall be

25 the sum of—
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1 ‘‘(A) the amount determined for the State

2 under paragraph (2); and

3 ‘‘(B) the amount determined for the State

4 under paragraph (4) (if applicable).

5 ‘‘(2) PRINCIPAL FORMULA GRANTS.—For pur6 poses of paragraph (1)(A), the amount determined

7 under this paragraph for a State for a fiscal year

8 shall be the product of—

9 ‘‘(A) the amount available under section

10 2677 for carrying out this part, less the reserva11 tion of funds made in paragraph (4)(A) and less

12 any other applicable reservation of funds author13 ized or required in this Act (which amount is

14 subject to subsection (b)); and

15 ‘‘(B) the percentage constituted by the ratio

16 of—

17 ‘‘(i) the distribution factor for the

18 State; to

19 ‘‘(ii) the sum of the distribution factors

20 for all States.

21 ‘‘(3) DISTRIBUTION FACTOR FOR PRINCIPAL FOR22 MULA GRANTS.—For purposes of paragraph (2)(B),

23 the term ‘distribution factor’ means the following, as

24 applicable:
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1 ‘‘(A) In the case of each of the 50 States, the

2 District of Columbia, and the Commonwealth of

3 Puerto Rico, the product of—

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

5 immune deficiency syndrome in the State,

6 as indicated by the number of cases reported

7 to and confirmed by the Secretary for the 2

8 most recent fiscal years for which such data

9 are available; and

10 ‘‘(ii) the cube root of the ratio (based

11 on the most recent available data) of—

12 ‘‘(I) the average per capita in13 come of individuals in the United

14 States (including the territories); to

15 ‘‘(II) the average per capita in16 come of individuals in the State.

17 ‘‘(B) In the case of a territory of the United

18 States (other than the Commonwealth of Puerto

19 Rico), the number of additional cases of such

20 syndrome in the specific territory, as indicated

21 by the number of cases reported to and confirmed

22 by the Secretary for the 2 most recent fiscal

23 years for which such data is available.

24 ‘‘(4) SUPPLEMENTAL AMOUNTS FOR CERTAIN

25 STATES.—For purposes of paragraph (1)(B), an
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1 amount shall be determined under this paragraph for

2 each State that does not contain any metropolitan

3 area whose chief elected official received a grant

4 under part A for fiscal year 1996. The amount deter5 mined under this paragraph for such a State for a

6 fiscal year shall be the product of—

7 ‘‘(A) an amount equal to 7 percent of the

8 amount available under section 2677 for carry9 ing out this part for the fiscal year (subject to

10 subsection (b)); and

11 ‘‘(B) the percentage constituted by the ratio

12 of—

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

14 immune deficiency syndrome in the State

15 (as determined under paragraph (3)(A)(i));

16 to

17 ‘‘(ii) the sum of the respective numbers

18 determined under clause (i) for each State

19 to which this paragraph applies.

20 ‘‘(5) DEFINITIONS.—For purposes of this sub21 section and subsection (b):

22 ‘‘(A) The term ‘State’ means each of the 50

23 States, the District of Columbia, and the terri24 tories of the United States.
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1 ‘‘(B) The term ‘territory of the United

2 States’ means each of the Virgin Islands, Guam,

3 American Samoa, the Commonwealth of the

4 Northern Mariana Islands, the Commonwealth of

5 Puerto Rico, and the Republic of the Marshall

6 Islands.

7 ‘‘(b) MINIMUM AMOUNT OF GRANT.—

8 ‘‘(1) IN GENERAL.—Subject to the extent of the

9 amounts specified in paragraphs (2)(A) and (4)(A) of

10 subsection (a), a grant under this part for a State for

11 a fiscal year shall be the greater of—

12 ‘‘(A) the amount determined for the State

13 under subsection (a); and

14 ‘‘(B) the amount applicable under para15 graph (2) to the State.

16 ‘‘(2) APPLICABLE AMOUNT.—For purposes of

17 paragraph (1)(B), the amount applicable under this

18 paragraph for a fiscal year is the following:

19 ‘‘(A) In the case of the 50 States, the Dis20 trict of Columbia, and the Commonwealth of

21 Puerto Rico—

22 ‘‘(i) $100,000, if it has less than 90

23 cases of acquired immune deficiency syn24 drome (as determined under subsection

25 (a)(3)(A)(i)); and
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1 ‘‘(ii) $250,000, if it has 90 or more

2 such cases (as so determined).

3 ‘‘(B) In the case of each of the territories of

4 the United States (other than the Commonwealth

5 of Puerto Rico), $0.0.’’.

6 SEC. 503. CONSOLIDATION OF AUTHORIZATIONS OF APPRO7 PRIATIONS.

8 (a) IN GENERAL.—Part D of title XXVI (42 U.S.C.

9 300ff–71) is amended by adding at the end thereof the fol10 lowing section:

11 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

12 ‘‘(a) IN GENERAL.—For the purpose of carrying out

13 parts A and B, there are authorized to be appropriated such

14 sums as may be necessary for each of the fiscal years 1996

15 through 2000. Subject to section 2673A and to subsection

16 (b), of the amount appropriated under this section for a

17 fiscal year, the Secretary shall make available 64 percent

18 of such amount to carry out part A and 36 percent of such

19 amount to carry out part B.

20 ‘‘(b) DEVELOPMENT OF METHODOLOGY.—With respect

21 to each of the fiscal years 1997 through 2000, the Secretary

22 may develop and implement a methodology for adjusting

23 the percentages referred to in subsection (a).’’.

24 (b) REPEALS.—Sections 2608 and 2620 (42 U.S.C.

25 300ff–18 and 300ff–30) are repealed.
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1 (c) CONFORMING AMENDMENTS.—Section 2605(d)(1)

2 (as redesignated by section 105(3)), is amended by striking

3 ‘‘2608’’ and inserting ‘‘2677’’.

4 TITLE VI—EFFECTIVE DATE

5 SEC. 601. EFFECTIVE DATE.

6 This Act takes effect October 1, 1995.

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