I

104TH CONGRESS

1ST SESSION H. R. 1872

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

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

5 Act Amendments of 1995’’.
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1 SEC. 2. REFERENCES.

2 Whenever in this Act an amendment is expressed in

3 terms of an amendment to a section or other provision,

4 the reference shall be considered to be made to that sec5 tion or other provision of the Public Health Service Act

6 (42 U.S.C. 201 et seq.).

7 TITLE I—EMERGENCY RELIEF

8 FOR AREAS WITH SUBSTAN9 TIAL NEED FOR SERVICES

10 SEC. 101. ESTABLISHMENT OF PROGRAM OF GRANTS; DE11 LAYED EFFECTIVE DATE FOR MODIFICA12 TIONS.

13 (a) IN GENERAL.—Effective October 1, 1996, section

14 2601 (42 U.S.C. 300ff–11) is amended—

15 (1) in subsection (a)—

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

17 and inserting ‘‘subject to subsections (b)

18 through (d)’’; and

19 (B) by striking ‘‘metropolitan area’’ and

20 all that follows and inserting the following:

21 ‘‘metropolitan area for which there has been re22 ported to the Director of the Centers for Dis23 ease Control and Prevention a cumulative total

24 of more than 2,000 cases of acquired immune

25 deficiency syndrome for the most recent period
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1 of five calendar years for which such data are

2 available.’’; and

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

4 subsections:

5 ‘‘(c) REQUIREMENT REGARDING POPULATION.—In

6 the case of a metropolitan area that was not an eligible

7 area under this part for fiscal year 1996, the Secretary

8 may not make a grant under this section for the area un9 less the area has a population of 500,000 or more individ10 uals. For purposes of eligibility under this part, the bound11 aries of each metropolitan area are the boundaries in ef12 fect for fiscal year 1994.

13 ‘‘(d) CONTINUED STATUS AS ELIGIBLE AREA.—A

14 metropolitan area that was an eligible area under this part

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

16 and each subsequent fiscal year.’’.

17 (b) CONFORMING AMENDMENT REGARDING DEFINI18 TION OF ELIGIBLE AREA.—Effective October 1, 1996,

19 section 2607(1) (42 U.S.C. 300ff–17(1)) is amended by

20 striking ‘‘The term’’ and all that follows and inserting the

21 following: ‘‘The term ‘eligible area’ means a metropolitan

22 area meeting the requirements of section 2601 that are

23 applicable to the area.’’.
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1 SEC. 102. HIV HEALTH SERVICES PLANNING COUNCIL.

2 (a) ESTABLISHMENT.—Section 2602(b)(1) (42

3 U.S.C. 300ff–12(b)(13)) is amended—

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

5 semicolon the following: ‘‘, including federally quali6 fied health centers’’;

7 (2) in subparagraph (D), by inserting before

8 the semicolon the following: ‘‘and providers of serv9 ices regarding substance abuse’’;

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

11 semicolon the following: ‘‘and historically under12 served groups and subpopulations’’;

13 (4) in subparagraph (I), by inserting before the

14 semicolon the following: ‘‘, including the State med15 icaid agency and the agency administering the pro16 gram under part B’’;

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

18 after the semicolon;

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

20 (7) by adding at the end the following subpara21 graphs:

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

23 none are operating in the area, representatives

24 of organizations in the area with a history of

25 serving children, youth, women, and families

26 living with HIV; and
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1 ‘‘(L) grantees under other HIV-related

2 Federal programs.’’.

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

4 12(b)(3)) is amended—

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

6 preceding subparagraph (A) and all that follows

7 through the semicolon at the end of subparagraph

8 (A) and inserting the following: ‘‘The planning coun9 cil under paragraph (1) shall carry out the following:

10 ‘‘(A) Establish priorities for the allocation

11 of funds within the eligible area based on the

12 following factors:

13 ‘‘(i) Documented needs of the HIV-in14 fected population.

15 ‘‘(ii) Cost and outcome effectiveness

16 of proposed strategies and interventions, to

17 the extent that such data are reasonably

18 available.

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

20 communities for whom the services are in21 tended.

22 ‘‘(iv) Availability of other govern23 mental and nongovernmental resources.’’;

24 (2) in subparagraph (B)—
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1 (A) by striking ‘‘develop’’ and inserting

2 ‘‘Develop’’; and

3 (B) by striking ‘‘; and’’ and inserting a pe4 riod;

5 (3) in subparagraph (C)—

6 (A) by striking ‘‘assess’’ and inserting

7 ‘‘Assess’’;

8 (B) by striking ‘‘rapidly’’; and

9 (C) by inserting before the period the fol10 lowing: ‘‘, and assess the effectiveness, either

11 directly or through contractual arrangements,

12 of the services offered in meeting the identified

13 needs’’; and

14 (4) by adding at the end the following subpara15 graphs:

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

17 statewide coordinated statement of need initi18 ated by the State health department.

19 ‘‘(E) Obtain input on community needs

20 through conducting public meetings.’’

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

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

23 following paragraph:

24 ‘‘(4) GENERAL PROVISIONS.—
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1 ‘‘(A) COMPOSITION OF COUNCIL.—The

2 planning council under paragraph (1) shall (in

3 addition to requirements under such paragraph)

4 reflect in its composition the demographics of

5 the epidemic in the eligible area involved, with

6 particular consideration given to disproportion7 ately affected and historically underserved

8 groups and subpopulations. Nominations for

9 membership on the council shall be identified

10 through an open process, and candidates shall

11 be selected based on locally delineated and pub12 licized criteria. Such criteria shall include a

13 conflict-of-interest standard for each nominee.

14 ‘‘(B) CERTAIN RESTRICTIONS.—The plan15 ning council under paragraph (1) may not be

16 directly involved in the administration of a

17 grant under section 2601(a). With respect to

18 compliance with the preceding sentence, the

19 planning council may not designate (or other20 wise be involved in the selection of) particular

21 entities as recipients of any of the amounts pro22 vided in the grant.’’.
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1 SEC. 103. TYPE AND DISTRIBUTION OF GRANTS.

2 (a) FORMULA GRANTS BASED ON RELATIVE NEED

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

4 amended—

5 (1) in paragraph (1)—

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

7 subject to paragraph (4)’’ before the period;

8 and

9 (B) by adding at the end the following sen10 tence: ‘‘Grants under this paragraph for a fiscal

11 year shall be disbursed not later than 60 days

12 after the date on which amounts appropriated

13 under section 2677 become available for the fis14 cal year, subject to any waivers under section

15 2605(d).’’;

16 (2) in paragraph (2), by amending the para17 graph to read as follows:

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

19 under section 2677 for a fiscal year for making

20 grants under section 2601(a)—

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

22 for making grants under paragraph (1) in

23 amounts determined in accordance with para24 graph (3); and

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

26 with subparagraph (A), reserve such funds as
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1 may be necessary to carry out paragraph (4).’’;

2 and

3 (3) by adding at the end the following para4 graph:

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

6 case of any eligible area for which a grant under

7 paragraph (1) was made for fiscal year 1995, the

8 Secretary, in making grants under such paragraph

9 for the area for the fiscal years 1996 through 2000,

10 shall (subject to the extent of the amount available

11 under section 2677 for the fiscal year involved for

12 making grants under section 2601(a)) ensure that

13 the amounts of the grants do not, relative to such

14 grant for the area for fiscal year 1995, constitute a

15 reduction of more than the following, as applicable

16 to the fiscal year involved:

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

18 1996.

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

20 1997.

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

22 1998.

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

24 1999.
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1 ‘‘(E) 5 percent, in the case of fiscal year

2 2000.’’.

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

4 U.S.C. 300ff–13(b)) is amended—

5 (1) in paragraph (1)—

6 (A) in the matter preceding subparagraph

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

8 follows through ‘‘section 2605(b)—’’ and insert9 ing the following: ‘‘After allocating in accord10 ance with subsection (a) the amounts available

11 under section 2677 for grants under section

12 2601(a) for a fiscal year, the Secretary, in car13 rying out section 2601(a), shall from the re14 maining amounts make grants to eligible areas

15 described in this paragraph. Such grants shall

16 be disbursed not later than 150 days after the

17 date on which amounts appropriated under sec18 tion 2677 become available for the fiscal year.

19 An eligible area described in this paragraph is

20 an eligible area whose application under section

21 2605(b)—’’;

22 (B) in subparagraph (D), by striking

23 ‘‘and’’ after the semicolon;

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

25 period at the end and inserting ‘‘; and’’; and
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1 (D) by adding at the end thereof the fol2 lowing subparagraph:

3 ‘‘(F) demonstrates the manner in which

4 the proposed services are consistent with the

5 local needs assessment and the statewide co6 ordinated statement of need.’’; and

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

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

9 (B) by inserting after paragraph (1) the follow10 ing paragraph:

11 ‘‘(2) PRIORITY.—

12 ‘‘(A) SEVERE NEED.—In determining se13 vere need in accordance with paragraph (1)(B),

14 the Secretary shall give priority consideration in

15 awarding grants under this subsection to eligi16 ble areas that (in addition to complying with

17 paragraph (1)) demonstrate a more severe need

18 based on the prevalence in the eligible area of—

19 ‘‘(i) sexually transmitted diseases,

20 substance abuse, tuberculosis, severe men21 tal illness, or other conditions determined

22 relevant by the Secretary, which signifi23 cantly affect the impact of HIV disease;
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1 ‘‘(ii) subpopulations with HIV disease

2 that were previously unknown in such area;

3 or

4 ‘‘(iii) homelessness.

5 ‘‘(B) PREVALENCE.—In determining prev6 alence of conditions under subparagraph (A),

7 the Secretary shall use data on the prevalence

8 of the conditions described in such subpara9 graph among individuals with HIV disease (ex10 cept that, in the case of an eligible area for

11 which such data are not available, the Secretary

12 shall use data on the prevalences of the condi13 tions in the general population of such area).’’.

14 (c) ADDITIONAL REQUIREMENTS FOR GRANTS.—

15 Section 2603 (42 U.S.C. 300ff–13) is amended by adding

16 at the end the following subsection:

17 ‘‘(c) COMPLIANCE WITH PRIORITIES OF HIV PLAN18 NING COUNCIL.—Notwithstanding any other provision of

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

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

21 an eligible area unless the application submitted by such

22 area under section 2605 for the grant involved dem23 onstrates that the grants made under subsections (a) and

24 (b) to the area for the preceding fiscal year (if any) were

25 expended in accordance with the priorities applicable to
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1 such year that were established, pursuant to section

2 2602(b)(3)(A), by the planning council serving the area.’’.

3 SEC. 104. USE OF AMOUNTS.

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

5 (1) in subsection (b)—

6 (A) in paragraph (1)(A), by striking ‘‘in7 cluding case management and comprehensive

8 treatment services, for individuals’’ and insert9 ing the following: ‘‘including HIV-related com10 prehensive treatment services (including treat11 ment education and measures for the preven12 tion and treatment of opportunistic infections),

13 case management, and substance abuse treat14 ment and mental health treatment, for individ15 uals’’;

16 (B) in paragraph (2)(A)—

17 (i) by inserting after ‘‘nonprofit pri18 vate entities,’’ the following: ‘‘, or private

19 for-profit entities if such entities are the

20 only available provider of quality HIV care

21 in the area,’’ ; and

22 (ii) by striking ‘‘and homeless health

23 centers’’ and inserting ‘‘homeless health

24 centers, substance abuse treatment pro25 grams, and mental health programs’’; and
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1 (C) by adding at the end the following

2 paragraph:

3 ‘‘(3) PRIORITY FOR WOMEN, INFANTS AND

4 CHILDREN.—For the purpose of providing health

5 and support services to infants, children, and women

6 with HIV disease, the chief elected official of an eli7 gible area shall use, of the grants made for the area

8 under section 2601(a) for a fiscal year, not less than

9 the percentage constituted by the ratio of the popu10 lation in such area of infants, children, and women

11 with HIV disease to the general population in such

12 area of individuals with such disease, or 15 percent,

13 whichever is less. In expending the funds reserved

14 under the preceding sentence for a fiscal year, the

15 chief elected official shall give priority to providing,

16 for pregnant women, measures to prevent the

17 perinatal transmission of HIV.’’; and

18 (2) in subsection (e), by adding at the end

19 thereof the following sentence: ‘‘In the case of enti20 ties to which such officer allocates amounts received

21 by the officer under the grant, the officer shall en22 sure that, of the aggregate amount so allocated, the

23 total of the expenditures by such entities for admin24 istrative expenses does not exceed 10 percent (with-
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1 out regard to whether particular entities expend

2 more than 10 percent for such expenses).’’.

3 SEC. 105. APPLICATION.

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

5 (1) in subsection (a)—

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

7 year period’’ and all that follows through ‘‘eligi8 ble area’’ and inserting ‘‘preceding fiscal year’’;

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

10 the end thereof;

11 (C) in paragraph (5), by striking the pe12 riod at the end thereof and inserting ‘‘; and’’;

13 and

14 (D) by adding at the end thereof the fol15 lowing paragraph:

16 ‘‘(6) that the applicant will participate in the

17 process for the statewide coordinated statement of

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

19 will ensure that the services provided under the com20 prehensive plan are consistent with such state21 ment.’’;

22 (2) in subsection (b)—

23 (A) in the subsection heading, by striking

24 ‘‘ADDITIONAL’’; and
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1 (B) in the matter preceding paragraph (1),

2 by striking ‘‘additional’’;

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

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

5 (4) by inserting after subsection (b), the follow6 ing subsection:

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

8 chief elected official of an eligible area, the Secretary shall

9 authorize the official to submit a single application

10 through which the official simultaneously requests a grant

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

12 pursuant to subsection (b) of such section. The Secretary

13 may establish such criteria for carrying out this subsection

14 as the Secretary determines to be appropriate.’’.

15 SEC. 106. TECHNICAL ASSISTANCE; PLANNING GRANTS.

16 Section 2606 (42 U.S.C. 300ff–16) is amended—

17 (1) by inserting before ‘‘The Administrator’’ the

18 following: ‘‘(a) IN GENERAL.—’’;

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

20 follows through ‘‘title,’’ and inserting ‘‘(referred to

21 in this section as the ‘Administrator’) shall’’; and

22 (3) by adding at the end the following sub23 section:

24 ‘‘(b) PLANNING GRANTS REGARDING INITIAL ELIGI25 BILITY FOR GRANTS.—
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1 ‘‘(1) ADVANCE PAYMENTS ON FIRST-YEAR FOR2 MULA GRANTS.—With respect to a fiscal year (re3 ferred to in this subsection as the ‘planning year’),

4 if a metropolitan area has not previously received a

5 grant under section 2601 and the Administrator rea6 sonably projects that the area will be eligible for

7 such a grant for the subsequent fiscal year, the Ad8 ministrator may make a grant for the planning year

9 for the purpose of assisting the area in preparing for

10 the responsibilities of the area in carrying out activi11 ties under this part.

12 ‘‘(2) REQUIREMENTS.—

13 ‘‘(A) IN GENERAL.—A grant under para14 graph (1) for a planning year shall be made di15 rectly to the chief elected official of the city or

16 urban county that administers the public health

17 agency to which section 2602(a)(1) is projected

18 to apply for purposes of such paragraph. The

19 grant may not be made in an amount exceeding

20 $75,000.

21 ‘‘(B) OFFSETTING REDUCTION IN FIRST

22 FORMULA GRANT.—In the case of a metropoli23 tan area that has received a grant under para24 graph (1) for a planning year, the first grant

25 made pursuant to section 2603(a) for such area
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1 shall be reduced by an amount equal to the

2 amount of the grant under such paragraph for

3 the planning year. With respect to amounts re4 sulting from reductions under the preceding

5 sentence for a fiscal year, the Secretary shall

6 use such amounts to make grants under section

7 2603(a) for the fiscal year, subject to ensuring

8 that none of such amounts are provided to any

9 metropolitan area for which such a reduction

10 was made for the fiscal year.

11 ‘‘(3) FUNDING.—Of the amounts available

12 under section 2677 for a fiscal year for carrying out

13 this part, the Administrator may reserve not more

14 than 1 percent for making grants under paragraph

15 (1).’’.

16 TITLE II—CARE GRANT

17 PROGRAM

18 SEC. 201. GENERAL USE OF GRANTS.

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

20 read as follows:

21 ‘‘SEC. 2612. GENERAL USE OF GRANTS.

22 (a) IN GENERAL.—A State may use amounts pro23 vided under grants made under this part for the following:

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

25 2604(b)(1) for individuals with HIV disease.
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1 ‘‘(2) To provide to such individuals treatments

2 that in accordance with section 2616 have been de3 termined to prolong life or prevent serious deteriora4 tion of health.

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

6 care services for such individuals in accordance with

7 section 2614.

8 ‘‘(4) To provide assistance to assure the con9 tinuity of health insurance coverage for such individ10 uals in accordance with section 2615.

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

12 section 2613 within areas most affected by HIV dis13 ease, which consortia shall be designed to provide a

14 comprehensive continuum of care to individuals and

15 families with such disease in accordance with such

16 section.

17 ‘‘(b) PRIORITY FOR WOMEN, INFANTS AND CHIL18 DREN.—For the purpose of providing health and support

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

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

21 to the State for a fiscal year, not less than the percentage

22 constituted by the ratio of the population in the State of

23 infants, children, and women with HIV disease to the gen24 eral population in the State of individuals with such dis25 ease, or 15 percent, whichever is less. In expending the
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1 funds reserved under the preceding sentence for a fiscal

2 year, the State shall give priority to providing, for preg3 nant women, measures to prevent the perinatal trans4 mission of HIV.’’.

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

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

7 (1) in subsection (a)—

8 (A) in paragraph (1), by inserting ‘‘(or pri9 vate for-profit providers or organizations if such

10 entities are the only available providers of qual11 ity HIV care in the area)’’ after ‘‘nonprofit pri12 vate,’’; and

13 (B) in paragraph (2)(A)—

14 (i) by inserting ‘‘substance abuse

15 treatment, mental health treatment,’’ after

16 ‘‘nursing,’’; and

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

18 the following: ‘‘measures for the prevention

19 and treatment of opportunistic infections,

20 treatment education for patients (provided

21 in the context of health care delivery),’’ ;

22 and

23 (2) in subsection (c)(2)—

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

25 striking ‘‘and’’ after the semicolon;
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1 (B) in subparagraph (B), by striking the

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

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

4 following subparagraph:

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

6 none are operating in the area, representatives

7 in the area of organizations with a history of

8 serving children, youth, women, and families

9 living with HIV.’’.

10 SEC. 203. PROVISION OF TREATMENTS.

11 Section 2616(a) (42 U.S.C. 300ff–26(a)) is

12 amended—

13 (1) by striking ‘‘may use amounts’’ and insert14 ing ‘‘shall use a portion of the amounts’’;

15 (2) by striking ‘‘section 2612(a)(4)’’ and insert16 ing ‘‘section 2612(a)(2)’’; and

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

18 ‘‘, including measures for the prevention and treat19 ment of opportunistic infections’’.

20 SEC. 204. STATE APPLICATION.

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

22 amended—

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

24 after the semicolon; and
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1 (2) in subparagraph (B), by striking ‘‘and’’

2 after the semicolon; and

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

4 subparagraphs:

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

6 out by the State under section 2616; and

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

8 and utilization of resources are consistent with

9 a statewide coordinated statement of need, de10 veloped in partnership with other grantees in

11 the State that receive funding under this title

12 and after consultation with individuals receiving

13 services under this part.’’.

14 SEC. 205. ALLOCATION OF ASSISTANCE BY STATES; PLAN15 NING, EVALUATION, AND ADMINISTRATION.

16 Section 2618(c) (42 U.S.C. 300ff–28(c)) is

17 amended—

18 (1) by striking paragraph (1);

19 (2) by redesignating paragraphs (2) through

20 (5) as paragraphs (1) through (4), respectively; and

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

22 adding at the end the following sentences: ‘‘In the

23 case of entities to which the State allocates amounts

24 received by the State under the grant (including con25 sortia under section 2613), the State shall ensure
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1 that, of the aggregate amount so allocated, the total

2 of the expenditures by such entities for administra3 tive expenses does not exceed 10 percent (without

4 regard to whether particular entities expend more

5 than 10 percent for such expenses). For purposes of

6 the preceding sentence, the costs of establishing and

7 operating consortia under section 2613 shall be con8 sidered administrative expenses.’’.

9 SEC. 206. TECHNICAL ASSISTANCE.

10 Section 2619 (42 U.S.C. 300ff–29) is amended by

11 inserting before the period the following: ‘‘, including tech12 nical assistance for the development and implementation

13 of statewide coordinated statements of need’’.

14 TITLE III—EARLY

15 INTERVENTION SERVICES

16 SEC. 301. ESTABLISHMENT OF PROGRAM.

17 Section 2651(b) (42 U.S.C. 300ff–51(b)) is

18 amended—

19 (1) in paragraph (1), by inserting before the pe20 riod the following: ‘‘, and unless the applicant agrees

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

22 such services that are specified in subparagraphs

23 (B) through (E) of such paragraph’’; and

24 (2) in paragraph (4), by inserting after ‘‘non25 profit private entities’’ the following: ‘‘(or private
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1 for-profit entities, if such entities are the only avail2 able providers of quality HIV care in the area)’’.

3 SEC. 302. MINIMUM QUALIFICATIONS OF GRANTEES.

4 Section 2652(b)(1)(B) (42 U.S.C. 300ff–

5 52(b)(1)(B)) is amended by inserting after ‘‘nonprofit pri6 vate entity’’ the following: ‘‘(or a private for-profit entity,

7 if such an entity is the only available provider of quality

8 HIV care in the area)’’.

9 SEC. 303. MISCELLANEOUS PROVISIONS; PLANNING AND

10 DEVELOPMENT GRANTS.

11 Section 2654 (42 U.S.C. 300ff–54) is amended by

12 adding at the end thereof the following subsection:

13 ‘‘(c) PLANNING AND DEVELOPMENT GRANTS.—

14 ‘‘(1) IN GENERAL.—The Secretary may provide

15 planning grants, in an amount not to exceed

16 $50,000 for each such grant, to public and nonprofit

17 private entities for the purpose of enabling such en18 tities to provide early intervention services.

19 ‘‘(2) REQUIREMENT.—The Secretary may

20 award a grant to an entity under paragraph (1) only

21 if the Secretary determines that the entity will use

22 such grant to assist the entity in qualifying for a

23 grant under section 2651.

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

25 paragraph (1), the Secretary shall give preference to
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1 entities that provide HIV primary care services in

2 rural or underserved communities.

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

4 the amount appropriated for a fiscal year under sec5 tion 2655 may be used to carry out this section.’’.

6 SEC. 304. ADDITIONAL REQUIRED AGREEMENTS.

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

8 amended—

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

10 after the semicolon;

11 (2) in subparagraph (B), by striking the period

12 at the end and inserting ‘‘; and’’; and

13 (3) by adding at the end the following subpara14 graph:

15 ‘‘(C) evidence that the proposed program is

16 consistent with the statewide coordinated state17 ment of need and that the applicant will partici18 pate in the ongoing revision of such statement

19 of need.’’.

20 SEC. 305. AUTHORIZATION OF APPROPRIATIONS.

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

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

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

24 years 1996 through 2000.’’.
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1 TITLE IV—GENERAL

2 PROVISIONS

3 SEC. 401. GRANTS REGARDING CLINICAL RESEARCH AND

4 WOMEN, INFANTS, AND CHILDREN.

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

6 71) is amended—

7 (1) in subsection (a), by amending the sub8 section to read as follows:

9 ‘‘(a) IN GENERAL.—

10 ‘‘(1) PROGRAM OF GRANTS.—The Secretary,

11 acting through the Administrator of the Health Re12 sources and Services Administration and in consulta13 tion with the Director of the National Institutes of

14 Health, shall make grants to public and nonprofit

15 private entities that provide primary care (directly or

16 through contracts) for the purpose of—

17 ‘‘(A) providing through such entities, in

18 accordance with this section, opportunities for

19 women, infants, and children to participate as

20 subjects in research of potential clinical benefit

21 to individuals with HIV disease; and

22 ‘‘(B) providing to women, infants, and chil23 dren health care on an outpatient basis.

24 ‘‘(2) PROVISIONS REGARDING PARTICIPATION

25 IN RESEARCH.—With respect to the projects of re-
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1 search with which an applicant under paragraph (1)

2 is concerned, the Secretary may not make a grant

3 under such paragraph to the applicant unless the

4 following conditions are met:

5 ‘‘(A) The applicant agrees to make reason6 able efforts—

7 ‘‘(i) to identify the needs of the

8 projects for women, infants, and children

9 to participate as subjects in the projects;

10 ‘‘(ii) to identify which of the patients

11 of the applicant are women, infants, and

12 children who would be appropriate subjects

13 in the projects; and

14 ‘‘(iii) to offer women, infants, and

15 children the opportunity to so participate

16 (as appropriate), including the provision of

17 services under subsection (f).

18 ‘‘(B) The applicant agrees that the appli19 cant, and the projects of research, will comply

20 with accepted standards of protection for

21 human subjects (including the provision of writ22 ten informed consent) who participate as sub23 jects in clinical research.

24 ‘‘(C) For the second or subsequent fiscal

25 year for which a grant under such paragraph is
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1 sought by the applicant, the Secretary has de2 termined that—

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

4 infants, and children who are patients of

5 the applicant are participating in the

6 projects (except to the extent this clause is

7 waived under subsection (k)); and

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

9 research, have complied with the standards

10 referred to in subparagraph (B).

11 ‘‘(3) PROHIBITION.—Receipt of services by a

12 patient shall not be conditioned upon the consent of

13 the patient to participate in research.

14 ‘‘(4) CONSIDERATION BY SECRETARY OF CER15 TAIN CIRCUMSTANCES.—In administering the re16 quirement of paragraph (2)(C)(i), the Secretary

17 shall take into account circumstances in which a

18 grantee under paragraph (1) is temporarily unable

19 to comply with the requirement for reasons beyond

20 the control of the grantee, and shall in such cir21 cumstances provide to the grantee a reasonable pe22 riod of opportunity in which to reestablish compli23 ance with the requirement.’’;

24 (2) in subsection (c), by amending the sub25 section to read as follows:
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1 ‘‘(c) PROVISIONS REGARDING CONDUCT OF RE2 SEARCH.—With respect to eligibility for a grant under

3 subsection (a):

4 ‘‘(1) A project of research for which subjects

5 are sought pursuant to such subsection may be con6 ducted by the applicant for the grant, or by an en7 tity with which the applicant has made arrange8 ments for purposes of the grant. The grant may not

9 be expended for the conduct of any project of re10 search.

11 ‘‘(2) The grant may not be made unless the

12 Secretary makes the following determinations:

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

14 case may be under paragraph (1)) is appro15 priately qualified to conduct the project of re16 search.

17 ‘‘(B) The project of research is being con18 ducted in accordance with a research protocol

19 to which the Secretary gives priority regarding

20 the prevention and treatment of HIV disease in

21 women, infants, and children. After consulta22 tion with public and private entities that con23 duct such research, and with providers of serv24 ices under this section and recipients of such

25 services, the Secretary shall establish a list of
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1 such protocols that are appropriate for purposes

2 of this section. The Secretary may give priority

3 under this subparagraph to a research protocol

4 that is not on such list.’’;

5 (3) by striking subsection (i);

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

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

8 (5) by inserting after subsection (f) the follow9 ing subsection:

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

11 not make a grant under subsection (a) unless the appli12 cant for the grant agrees as follows:

13 ‘‘(1) The applicant will coordinate activities

14 under the grant with other providers of health care

15 services under this Act, and under title V of the So16 cial Security Act.

17 ‘‘(2) The applicant will participate in the state18 wide coordinated statement of need under part B

19 and in revisions of such statement.’’;

20 (6) by redesignating subsection (j) as sub21 section (m); and

22 (7) by inserting before subsection (m) (as so re23 designated) the following subsections:

24 ‘‘(j) COORDINATION WITH NATIONAL INSTITUTES OF

25 HEALTH.—The Secretary shall develop and implement a
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1 plan that provides for the coordination of the activities of

2 the National Institutes of Health with the activities car3 ried out under this section. In carrying out the preceding

4 sentence, the Secretary shall ensure that projects of re5 search conducted or supported by such Institutes are

6 made aware of applicants and grantees under this section,

7 and shall require that the projects, as appropriate, enter

8 into arrangements for purposes of this section.

9 ‘‘(k) TEMPORARY WAIVER REGARDING SIGNIFICANT

10 PARTICIPATION.—

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

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

13 section for fiscal year 1995, the Secretary may, sub14 ject to paragraph (2), provide to the applicant a

15 waiver of the requirement of subsection (a)(2)(C)(i)

16 if the Secretary determines that the applicant is

17 making reasonable progress toward meeting the re18 quirement.

19 ‘‘(2) TERMINATION OF AUTHORITY FOR WAIV20 ERS.—The Secretary may not provide any waiver

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

22 Any such waiver provided prior to such date termi23 nates on such date, or on such earlier date as the

24 Secretary may specify.
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1 ‘‘(l) TRAINING AND TECHNICAL ASSISTANCE.—Of

2 the amounts appropriated under subsection (m) for a fis3 cal year, the Secretary may use not more than five percent

4 to provide training and technical assistance to assist appli5 cants and grantees under subsection (a) in complying with

6 the requirements of this section.’’.

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

8 U.S.C. 300ff–71) is amended—

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

10 ‘‘DEMONSTRATION’’ and all that follows and in11 serting ‘‘GRANTS REGARDING CLINICAL RE12 SEARCH AND WOMEN, INFANTS, AND CHIL13 DREN.’’;

14 (2) in subsection (b), by striking ‘‘pediatric pa15 tients and pregnant women’’ and inserting ‘‘women,

16 infants, and children’’; and

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

18 striking ‘‘pediatric’’.

19 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

20 2671 (42 U.S.C. 300ff–71) is amended in subsection (m)

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

22 are’’ and all that follows and inserting the following:

23 ‘‘there are authorized to be appropriated such sums as

24 may be necessary for each of the fiscal years 1996 through

25 2000.’’.
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1 SEC. 402. PROJECTS OF NATIONAL SIGNIFICANCE.

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

3 300ff–71 et seq.) is amended by inserting after section

4 2673 the following section:

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

6 SIGNIFICANCE.

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

8 to public and nonprofit private entities (including non9 profit private community-based organizations) for the pur10 pose of carrying out demonstration projects that provide

11 for the care and treatment of individuals with HIV dis12 ease, and that—

13 ‘‘(1) assess the effectiveness of particular mod14 els for the care and treatment of individuals with

15 such disease;

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

17 ‘‘(3) have the potential to be replicated in simi18 lar localities, or nationally.

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

20 under subsection (a) shall include the development and as21 sessment of innovative models for the delivery of HIV

22 services that are designed—

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

24 (including individuals and families with HIV disease

25 living in rural communities, adolescents with HIV

26 disease, Native American individuals and families
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1 with HIV disease, homeless individuals and families

2 with HIV disease, hemophiliacs with HIV disease,

3 and incarcerated individuals with HIV disease); and

4 ‘‘(2) to ensure the ongoing availability of serv5 ices for Native American communities to enable such

6 communities to care for Native Americans with HIV

7 disease.

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

9 a grant under this section unless the applicant submits

10 evidence that the proposed program is consistent with the

11 applicable statewide coordinated statement of need under

12 part B, and the applicant agrees to participate in the on13 going revision process of such statement of need.

14 ‘‘(d) REPLICATION.—The Secretary shall make infor15 mation concerning successful models developed under this

16 section available to grantees under this title for the pur17 pose of coordination, replication, and integration.

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

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

20 under this title for a fiscal year for each program

21 specified in paragraph (2), the Secretary shall re22 serve 3 percent for making grants under subsection

23 (a).

24 ‘‘(2) RELEVANT PROGRAMS.—The programs re25 ferred to in subsection (a) are the program under
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1 part A, the program under part B, the program

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

3 program under section 2672, and the program under

4 section 2673.’’.

5 (b) STRIKING OF RELATED PROVISION.—Section

6 2618 (42 U.S.C. 300ff–28) is amended striking subsection

7 (a).

8 SEC. 403. SPECIAL TRAINING PROJECTS.

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

10 Service Act (42 U.S.C. 201 et seq.) is amended—

11 (1) by transferring section 776 from the cur12 rent placement of the section;

13 (2) by redesignating the section as section

14 2673B; and

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

16 (as added by section 402).

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

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

19 (1) in subsection (a)(1)—

20 (A) by striking subparagraphs (B) and

21 (C);

22 (B) by redesignating subparagraphs (A)

23 and (D) as subparagraphs (B) and (C), respec24 tively;
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1 (C) by inserting before subparagraph (B)

2 (as so redesignated) the following subpara3 graph:

4 ‘‘(A) training health personnel, including

5 practitioners in programs under this title and

6 other community providers, in the diagnosis,

7 treatment, and prevention of HIV disease, in8 cluding the prevention of the perinatal trans9 mission of the disease and including measures

10 for the prevention and treatment of opportun11 istic infections;’’;

12 (D) in subparagraph (B) (as so redesig13 nated), by adding ‘‘and’’ after the semicolon;

14 and

15 (E) in subparagraph (C) (as so redesig16 nated), by striking ‘‘curricula and’’;

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

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

19 (3) in subsection (c) (as so redesignated), by

20 amending the subsection to read as follows:

21 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the

22 purpose of carrying out this section, there are authorized

23 to be appropriated such sums as may be necessary for

24 each of the fiscal years 1996 through 2000.’’.
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1 SEC. 404. EVALUATIONS AND REPORTS.

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

3 (1) in subsection (b)—

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

5 by striking ‘‘not later than 1 year’’ and all that

6 follows through ‘‘title,’’ and inserting the fol7 lowing: ‘‘not later than October 1, 1996,’’;

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

9 and inserting the following paragraph:

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

11 this title; and’’; and

12 (C) by redesignating paragraph (4) as

13 paragraph (2); and

14 (2) by adding at the end the following sub15 section:

16 ‘‘(c) ALLOCATION OF FUNDS.—The Secretary shall

17 carry out this section with amounts available under section

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

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

20 SEC. 405. COORDINATION OF PROGRAM.

21 Section 2675 of the Public Health Service Act (42

22 U.S.C. 300ff–75) is amended by adding at the end the

23 following subsection:

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

25 1996, and annually thereafter, the Secretary shall submit

26 to the appropriate committees of the Congress a report
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1 concerning coordination efforts under this title at the Fed2 eral, State, and local levels, including a statement of

3 whether and to what extent there exist Federal barriers

4 to integrating HIV-related programs.’’.

5 TITLE V—ADDITIONAL

6 PROVISIONS

7 SEC. 501. AMOUNT OF EMERGENCY RELIEF GRANTS.

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

9 13(a)(3)) is amended to read as follows:

10 ‘‘(3) AMOUNT OF GRANT.—

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

12 of amounts made available in appropriations

13 Acts, a grant made for purposes of this para14 graph to an eligible area shall be made in an

15 amount equal to the product of—

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

17 available for distribution under paragraph

18 (2) for the fiscal year involved; and

19 ‘‘(ii) the percentage constituted by the

20 ratio of the distribution factor for the eligi21 ble area to the sum of the respective dis22 tribution factors for all eligible areas.

23 ‘‘(B) DISTRIBUTION FACTOR.—For pur24 poses of subparagraph (A)(ii), the term ‘dis25 tribution factor’ means the product of—
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1 ‘‘(i) an amount equal to the estimated

2 number of living cases of acquired immune

3 deficiency syndrome in the eligible area in4 volved, as determined under subparagraph

5 (C); and

6 ‘‘(ii) the cost index for the eligible

7 area involved, as determined under sub8 paragraph (D).

9 ‘‘(C) ESTIMATE OF LIVING CASES.—The

10 amount determined in this subparagraph is an

11 amount equal to the product of—

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

13 immune deficiency syndrome in the eligible

14 area during each year in the most recent

15 120-month period for which data are avail16 able with respect to all eligible areas, as in17 dicated by the number of such cases re18 ported to and confirmed by the Director of

19 the Centers for Disease Control and Pre20 vention for each year during such period;

21 and

22 ‘‘(ii) with respect to—

23 ‘‘(I) the first year during such

24 period, .06;
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1 ‘‘(II) the second year during such

2 period, .06;

3 ‘‘(III) the third year during such

4 period, .08;

5 ‘‘(IV) the fourth year during

6 such period, .10;

7 ‘‘(V) the fifth year during such

8 period, .16;

9 ‘‘(VI) the sixth year during such

10 period, .16;

11 ‘‘(VII) the seventh year during

12 such period, .24;

13 ‘‘(VIII) the eighth year during

14 such period, .40;

15 ‘‘(IX) the ninth year during such

16 period, .57; and

17 ‘‘(X) the tenth year during such

18 period, .88.

19 ‘‘(D) COST INDEX.—The amount deter20 mined in this subparagraph is an amount equal

21 to the sum of—

22 ‘‘(i) the product of—

23 ‘‘(I) the average hospital wage

24 index reported by hospitals in the eli25 gible area involved under section
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1 1886(d)(3)(E) of the Social Security

2 Act for the 3-year period immediately

3 preceding the year for which the grant

4 is being awarded; and

5 ‘‘(II) .70; and

6 ‘‘(ii) .30.

7 ‘‘(E) UNEXPENDED FUNDS.—The Sec8 retary may, in determining the amount of a

9 grant for a fiscal year under this paragraph,

10 adjust the grant amount to reflect the amount

11 of unexpended and uncanceled grant funds re12 maining at the end of the fiscal year preceding

13 the year for which the grant determination is to

14 be made. The amount of any such unexpended

15 funds shall be determined using the financial

16 status report of the grantee.

17 ‘‘(F) PUERTO RICO, VIRGIN ISLANDS,

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

19 cost index for an eligible area within Puerto

20 Rico, the Virgin Islands, or Guam shall be

21 1.0.’’.

22 SEC. 502. AMOUNT OF CARE GRANTS.

23 Section 2618 (42 U.S.C. 300ff–28), as amended by

24 section 402(b), is amended by striking subsection (b) and

25 inserting the following subsections:
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1 ‘‘(a) AMOUNT OF GRANT.—

2 ‘‘(1) IN GENERAL.—Subject to subsection (b)

3 (relating to minimum grants), the amount of a grant

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

5 the sum of—

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

7 under paragraph (2); and

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

9 under paragraph (4) (if applicable).

10 ‘‘(2) PRINCIPAL FORMULA GRANTS.—For pur11 poses of paragraph (1)(A), the amount determined

12 under this paragraph for a State for a fiscal year

13 shall be the product of—

14 ‘‘(A) the amount available under section

15 2677 for carrying out this part, less the res16 ervation of funds made in paragraph (4)(A) and

17 less any other applicable reservation of funds

18 authorized or required in this title (which

19 amount is subject to subsection (b)); and

20 ‘‘(B) the percentage constituted by the

21 ratio of—

22 ‘‘(i) the distribution factor for the

23 State; to

24 ‘‘(ii) the sum of the distribution fac25 tors for all States.
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1 ‘‘(3) DISTRIBUTION FACTOR FOR PRINCIPAL

2 FORMULA GRANTS.—For purposes of paragraph

3 (2)(B), the term ‘‘distribution factor’’ means the fol4 lowing, as applicable:

5 ‘‘(A) In the case of each of the 50 States,

6 the product of—

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

8 immune deficiency syndrome in the State,

9 as indicated by the number of cases re10 ported to and confirmed by the Secretary

11 for the 2 most recent fiscal years for which

12 such data are available; and

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

14 on the most recent available data) of—

15 ‘‘(I) the average per capita in16 come of individuals in the United

17 States (including the territories); to

18 ‘‘(II) the average per capita in19 come of individuals in the State.

20 ‘‘(B) In the case of a territory of the Unit21 ed States, the number of additional cases of

22 such syndrome in the specific territory, as indi23 cated by the number of cases reported to and

24 confirmed by the Secretary for the 2 most re-
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1 cent fiscal years for which such data is avail2 able.

3 ‘‘(4) SUPPLEMENTAL AMOUNTS FOR CERTAIN

4 STATES.—For purposes of paragraph (1)(B), an

5 amount shall be determined under this paragraph

6 for each State that does not contain any metropoli7 tan area whose chief elected official received a grant

8 under part A for fiscal year 1996. The amount de9 termined under this paragraph for such a State for

10 a fiscal year shall be the product of—

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

12 amount available under section 2677 for carry13 ing out this part for the fiscal year (subject to

14 subsection (b)); and

15 ‘‘(B) the percentage constituted by the

16 ratio of—

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

18 immune deficiency syndrome in the State

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

20 to

21 ‘‘(ii) the sum of the respective num22 bers determined under clause (i) for each

23 State to which this paragraph applies.

24 ‘‘(5) DEFINITIONS.—For purposes of this sub25 section and subsection (b):
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1 ‘‘(A) The term ‘State’ means each of the

2 50 States, the District of Columbia, and the

3 Commonwealth of Puerto Rico.

4 ‘‘(B) The term ‘territory of the United

5 States’ means the Virgin Islands, Guam, Amer6 ican Samoa, the Commonwealth of the North7 ern Mariana Islands, and the Republic of the

8 Marshall Islands.

9 ‘‘(b) MINIMUM AMOUNT OF GRANT.—

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

11 amounts specified in paragraphs (2)(A) and (4)(A)

12 of subsection (a), a grant under this part for a State

13 for a fiscal year shall be the greater of—

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

15 under subsection (a); and

16 ‘‘(B) the amount applicable under para17 graph (2) to the State.

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

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

20 paragraph for a fiscal year is the following:

21 ‘‘(A) In the case of each of the 50 States

22 and the District of Columbia—

23 ‘‘(i) $100,000, if the State or District

24 has less than 90 cases of acquired immune
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1 deficiency syndrome (as determined under

2 subsection (a)(3)(A)(i)); and

3 ‘‘(ii) $250,000, if the State or District

4 has 90 or more such cases (as so deter5 mined).

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

7 of the United States, $0.0.’’.

8 SEC. 503. CONSOLIDATION OF AUTHORIZATIONS OF APPRO9 PRIATIONS.

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

11 300ff–71) is amended by adding at the end thereof the

12 following section:

13 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

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

15 parts A and B, there are authorized to be appropriated

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

17 1996 through 2000. Subject to section 2673A and to sub18 section (b), of the amount appropriated under this section

19 for a fiscal year, the Secretary shall make available 64

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

21 of such amount to carry out part B.

22 ‘‘(b) DEVELOPMENT OF METHODOLOGY.—With re23 spect to each of the fiscal years 1997 through 2000, the

24 Secretary may develop and implement a methodology for

25 adjusting the percentages referred to in subsection (a).’’.
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1 (b) REPEALS.—Sections 2608 and 2620 (42 U.S.C.

2 300ff–18 and 300ff–30) are repealed.

3 (c) CONFORMING AMENDMENTS.—Title XXVI is

4 amended—

5 (1) in section 2603(b)(1), by striking ‘‘2608’’

6 and inserting ‘‘2677’’;

7 (2) in section 2605(c)(1), by striking ‘‘2608’’

8 and inserting ‘‘2677’’; and

9 (3) in section 2618—

10 (A) in subsection (a)(1), by striking

11 ‘‘2620’’ and inserting ‘‘2677’’; and

12 (B) in subsection (b)(1), by striking

13 ‘‘2620’’ and inserting ‘‘2677’’.

14 TITLE VI—EFFECTIVE DATE

15 SEC. 601. EFFECTIVE DATE.

16 Except as provided in section 101, this Act takes effect

17 October 1, 1995.

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