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[104th Congress Public Law 146]
[From the U.S. Government Printing Office]

<DOC>
[DOCID: f:publ146.104]

[[Page 1345]]

                 RYAN WHITE CARE ACT AMENDMENTS OF 1996

[[Page 110 STAT. 1346]]

Public Law 104-146
104th Congress

                                 An Act

 
 An Act to amend the Public Health <<NOTE: May 20, 1996 -  [S. 641]>>  
 Service Act to revise and extend programs established pursuant to the 
     Ryan White Comprehensive AIDS Resources Emergency Act of 1990.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Ryan White CARE 
Act Amendments of 1996.>> 

SECTION 1. <<NOTE: 42 USC 201 note.>>  SHORT TITLE.

    This Act may be cited as the ``Ryan White CARE Act Amendments of 
1996''.

SEC. 2. REFERENCES.

    Whenever in this Act an amendment is expressed in terms of an 
amendment to a section or other provision, the reference shall be 
considered to be made to a section or other provision of the Public 
Health Service Act (42 U.S.C. 201 et seq.).

SEC. 3. GENERAL AMENDMENTS.

    (a) Program of Grants.--
            (1) Number of cases.--Section 2601(a) (42 U.S.C. 300ff-11) 
        is amended--
                    (A) by striking ``subject to subsection (b)'' and 
                inserting ``subject to subsections (b) through (d)''; 
                and
                    (B) by striking ``metropolitan area'' and all that 
                follows and inserting the following: ``metropolitan area 
                for which there has been reported to the Director of the 
                Centers for Disease Control and Prevention a cumulative 
                total of more than 2,000 cases of acquired immune 
                deficiency syndrome for the most recent period of 5 
                calendar years for which such data are available.''.
            (2) Other provisions regarding eligibility.--Section 2601 
        (42 U.S.C. 300ff-11) is amended by adding at the end thereof the 
        following new subsections:

    ``(c) Requirements Regarding Population.--
            ``(1) Number of individuals.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), the Secretary may not make a grant 
                under this section for a metropolitan area unless the 
                area has a population of 500,000 or more individuals.
                    ``(B) Limitation.--Subparagraph (A) does not apply 
                to any metropolitan area that was an eligible area under 
                this part for fiscal year 1995 or any prior fiscal year.
            ``(2) Geographic boundaries.--For purposes of eligibility 
        under this part, the boundaries of each metropolitan area are

[[Page 110 STAT. 1347]]

the boundaries that were in effect for the area for fiscal year 1994.
    ``(d) Continued Status as Eligible Area.--Notwithstanding any other 
provision of this section, a metropolitan area that was an eligible area 
under this part for fiscal year 1996 is an eligible area for fiscal year 
1997 and each subsequent fiscal year.''.
            (3) Conforming amendment regarding definition of eligible 
        area.--Section 2607(1) (42 U.S.C. 300ff-17(1)) is amended by 
        striking ``The term'' and all that follows and inserting the 
        following: ``The term `eligible area' means a metropolitan area 
        meeting the requirements of section 2601 that are applicable to 
        the area.''.

    (b) Emergency Relief for Areas With Substantial Need for Services.--
            (1) HIV health services planning council.--Subsection (b) of 
        section 2602 (42 U.S.C. 300ff-12(b)) is amended--
                    (A) in paragraph (1)--
                          (i) by striking ``include'' and all that 
                      follows through the end thereof, and inserting 
                      ``reflect in its composition the demographics of 
                      the epidemic in the eligible area involved, with 
                      particular consideration given to 
                      disproportionately affected and historically 
                      underserved groups and subpopulations.''; and
                          (ii) by adding at the end thereof the 
                      following new sentences: ``Nominations for 
                      membership on the council shall be identified 
                      through an open process and candidates shall be 
                      selected based on locally delineated and 
                      publicized criteria. Such criteria shall include a 
                      conflict-of-interest standard that is in 
                      accordance with paragraph (5).'';
                    (B) in paragraph (2), by adding at the end thereof 
                the following new subparagraph:
                    ``(C) Chairperson.--A planning council may not be 
                chaired solely by an employee of the grantee.'';
                    (C) in paragraph (3)--
                          (i) in subparagraph (A), by striking ``area;'' 
                      and inserting ``area, including how best to meet 
                      each such priority and additional factors that a 
                      grantee should consider in allocating funds under 
                      a grant based on the--
                          ``(i) documented needs of the HIV-infected 
                      population;
                          ``(ii) cost and outcome effectiveness of 
                      proposed strategies and interventions, to the 
                      extent that such data are reasonably available 
                      (either demonstrated or probable);
                          ``(iii) priorities of the HIV-infected 
                      communities for whom the services are intended; 
                      and
                          ``(iv) availability of other governmental and 
                      nongovernmental resources;'';
                          (ii) by striking ``and'' at the end of 
                      subparagraph (B);
                          (iii) by striking the period at the end of 
                      subparagraph (C) and inserting ``, and at the 
                      discretion of the planning council, assess the 
                      effectiveness, either directly or through 
                      contractual arrangements, of the services offered 
                      in meeting the identified needs;''; and

[[Page 110 STAT. 1348]]

                          (iv) by adding at the end thereof the 
                      following new subparagraphs:
                    ``(D) participate in the development of the 
                statewide coordinated statement of need initiated by the 
                State public health agency responsible for administering 
                grants under part B; and
                    ``(E) establish methods for obtaining input on 
                community needs and priorities which may include public 
                meetings, conducting focus groups, and convening ad-hoc 
                panels.'';
                    (D) by redesignating paragraphs (2) and (3) as 
                paragraphs (3) and (4), respectively;
                    (E) by inserting after paragraph (1), the following 
                new paragraph:
            ``(2) Representation.--The HIV health services planning 
        council shall include representatives of--
                    ``(A) health care providers, including federally 
                qualified health centers;
                    ``(B) community-based organizations serving affected 
                populations and AIDS service organizations;
                    ``(C) social service providers;
                    ``(D) mental health and substance abuse providers;
                    ``(E) local public health agencies;
                    ``(F) hospital planning agencies or health care 
                planning agencies;
                    ``(G) affected communities, including people with 
                HIV disease or AIDS and historically underserved groups 
                and subpopulations;
                    ``(H) nonelected community leaders;
                    ``(I) State government (including the State medicaid 
                agency and the agency administering the program under 
                part B);
                    ``(J) grantees under subpart II of part C;
                    ``(K) grantees under section 2671, or, if none are 
                operating in the area, representatives of organizations 
                with a history of serving children, youth, women, and 
                families living with HIV and operating in the area; and
                    ``(L) grantees under other Federal HIV programs.''; 
                and
                    (F) by adding at the end thereof the following:
            ``(5) Conflicts of interest.--
                    ``(A) In general.--The planning council under 
                paragraph (1) may not be directly involved in the 
                administration of a grant under section 2601(a). With 
                respect to compliance with the preceding sentence, the 
                planning council may not designate (or otherwise be 
                involved in the selection of) particular entities as 
                recipients of any of the amounts provided in the grant.
                    ``(B) Required agreements.--An individual may serve 
                on the planning council under paragraph (1) only if the 
                individual agrees that if the individual has a financial 
                interest in an entity, if the individual is an employee 
                of a public or private entity, or if the individual is a 
                member of a public or private organization, and such 
                entity or organization is seeking amounts from a grant 
                under section 2601(a), the individual will not, with 
                respect to the purpose for which the entity seeks such 
                amounts, participate

[[Page 110 STAT. 1349]]

                (directly or in an advisory capacity) in the process of 
                selecting entities to receive such amounts for such 
                purpose.
            ``(6) Grievance procedures.--A planning council under 
        paragraph (1) shall develop procedures for addressing grievances 
        with respect to funding under this part, including procedures 
        for submitting grievances that cannot be resolved to binding 
        arbitration. Such procedures shall be described in the by-laws 
        of the planning council and be consistent with the requirements 
        of subsection (c).

    ``(c) Grievance Procedures.--
            ``(1) Federal responsibility.--
                    ``(A) Models.--The Secretary shall, through a 
                process that includes consultations with grantees under 
                this part and public and private experts in grievance 
                procedures, arbitration, and mediation, develop model 
                grievance procedures that may be implemented by the 
                planning council under subsection (b)(1) and grantees 
                under this part. Such model procedures shall describe 
                the elements that must be addressed in establishing 
                local grievance procedures and provide grantees with 
                flexibility in the design of such local procedures.
                    ``(B) Review.--The Secretary shall review grievance 
                procedures established by the planning council and 
                grantees under this part to determine if such procedures 
                are adequate. In making such a determination, the 
                Secretary shall assess whether such procedures permit 
                legitimate grievances to be filed, evaluated, and 
                resolved at the local level.
            ``(2) Grantees.--To be eligible to receive funds under this 
        part, a grantee shall develop grievance procedures that are 
        determined by the Secretary to be consistent with the model 
        procedures developed under paragraph (1)(A). Such procedures 
        shall include a process for submitting grievances to binding 
        arbitration.''.
            (2) Distribution of grants.--Section 2603 (42 U.S.C. 300ff-
        13) is amended--
                    (A) in subsection (a)(2), by striking ``Not later 
                than--'' and all that follows through ``the Secretary 
                shall'' and inserting the following: ``Not later than 60 
                days after an appropriation becomes available to carry 
                out this part for each of the fiscal years 1996 through 
                2000, the Secretary shall''; and
                    (B) in subsection (b)
                          (i) in paragraph (1)--
                                    (I) by striking ``and'' at the end 
                                of subparagraph (D);
                                    (II) by striking the period at the 
                                end of subparagraph (E) and inserting a 
                                semicolon; and
                                    (III) by adding at the end thereof 
                                the following new subparagraphs:
                    ``(F) demonstrates the inclusiveness of the planning 
                council membership, with particular emphasis on affected 
                communities and individuals with HIV disease; and
                    ``(G) demonstrates the manner in which the proposed 
                services are consistent with the local needs assessment 
                and the statewide coordinated statement of need.''; and

[[Page 110 STAT. 1350]]

                          (ii) by redesignating paragraphs (2), (3), and 
                      (4) as paragraphs (3), (4), and (5), respectively; 
                      and
                          (iii) by inserting after paragraph (1), the 
                      following new paragraph:
            ``(2) Definition.--
                    ``(A) Severe need.--In determining severe need in 
                accordance with paragraph (1)(B), the Secretary shall 
                consider the ability of the qualified applicant to 
                expend funds efficiently and the impact of relevant 
                factors on the cost and complexity of delivering health 
                care and support services to individuals with HIV 
                disease in the eligible area, including factors such 
                as--
                          ``(i) sexually transmitted diseases, substance 
                      abuse, tuberculosis, severe mental illness, or 
                      other comorbid factors determined relevant by the 
                      Secretary;
                          ``(ii) new or growing subpopulations of 
                      individuals with HIV disease; and
                          ``(iii) homelessness.
                    ``(B) Prevalence.--In determining the impact of the 
                factors described in subparagraph (A), the Secretary 
                shall, to the extent practicable, use national, 
                quantitative incidence data that are available for each 
                eligible area. Not later than 2 years after the date of 
                enactment of this paragraph, the Secretary shall develop 
                a mechanism to utilize such data. In the absence of such 
                data, the Secretary may consider a detailed description 
                and qualitative analysis of severe need, as determined 
                under subparagraph (A), including any local prevalence 
                data gathered and analyzed by the eligible area.
                    ``(C) Priority.--Subsequent to the development of 
                the quantitative mechanism described in subparagraph 
                (B), the Secretary shall phase in, over a 3-year period 
                beginning in fiscal year 1998, the use of such a 
                mechanism to determine the severe need of an eligible 
                area compared to other eligible areas and to determine, 
                in part, the amount of supplemental funds awarded to the 
                eligible area under this part.''.
            (3) Distribution of funds.--
                    (A) In general.--Section 2603(a)(2) (42 U.S.C. 
                300ff-13(a)(2)) (as amended by paragraph (2)) is further 
                amended--
                          (i) by inserting ``, in accordance with 
                      paragraph (3)'' before the period; and
                          (ii) by adding at the end thereof the 
                      following new sentences: ``The Secretary shall 
                      reserve an additional percentage of the amount 
                      appropriated under section 2677 for a fiscal year 
                      for grants under part A to make grants to eligible 
                      areas under section 2601(a) in accordance with 
                      paragraph (4).''.
                    (B) Increase in grant.--Section 2603(a) (42 U.S.C. 
                300ff-13(a)) is amended by adding at the end thereof the 
                following new paragraph:
            ``(4) Increase in grant.--With respect to an eligible area 
        under section 2601(a), the Secretary shall increase the amount 
        of a grant under paragraph (2) for a fiscal year to ensure that 
        such eligible area receives not less than--
                    ``(A) with respect to fiscal year 1996, 100 percent;

[[Page 110 STAT. 1351]]

                    ``(B) with respect to fiscal year 1997, 99 percent;
                    ``(C) with respect to fiscal year 1998, 98 percent;
                    ``(D) with respect to fiscal year 1999, 96.5 
                percent; and
                    ``(E) with respect to fiscal year 2000, 95 percent;
        of the amount allocated for fiscal year 1995 to such entity 
        under this subsection.''.
                    (C) Additional requirements for grants.--Section 
                2603 (42 U.S.C. 300ff-13) is amended by adding at the 
                end thereof the following subsection:

    ``(c) Compliance With Priorities of HIV Planning Council.--
Notwithstanding any other provision of this part, the Secretary, in 
carrying out section 2601(a), may not make any grant under subsection 
(a) or (b) to an eligible area unless the application submitted by such 
area under section 2605 for the grant involved demonstrates that the 
grants made under subsections (a) and (b) to the area for the preceding 
fiscal year (if any) were expended in accordance with the priorities 
applicable to such year that were established, pursuant to section 
2602(b)(3)(A), by the planning council serving the area.''.
            (4) Use of amounts.--Section 2604 (42 U.S.C. 300ff-14) is 
        amended--
                    (A) in subsection (b)(1)(A)--
                          (i) by inserting ``, substance abuse treatment 
                      and mental health treatment,'' after ``case 
                      management''; and
                          (ii) by inserting ``which shall include 
                      treatment education and prophylactic treatment for 
                      opportunistic infections,'' after ``treatment 
                      services,'';
                    (B) in subsection (b)(2)(A)--
                          (i) by inserting ``, or private for-profit 
                      entities if such entities are the only available 
                      provider of quality HIV care in the area,'' after 
                      ``nonprofit private entities,''; and
                          (ii) by striking ``and homeless health 
                      centers'' and inserting ``homeless health centers, 
                      substance abuse treatment programs, and mental 
                      health programs'';
                    (C) by adding at the end of subsection (b), the 
                following new paragraph:
            ``(3) Priority for women, infants and children.--For the 
        purpose of providing health and support services to infants, 
        children, and women with HIV disease, including treatment 
        measures to prevent the perinatal transmission of HIV, the chief 
        elected official of an eligible area, in accordance with the 
        established priorities of the planning council, shall use, from 
        the grants made for the area under section 2601(a) for a fiscal 
        year, not less than the percentage constituted by the ratio of 
        the population in such area of infants, children, and women with 
        acquired immune deficiency syndrome to the general population in 
        such area of individuals with such syndrome.''; and
                    (C) in subsection (e)--
                          (i) in the subsection heading, by striking 
                      ``and Planning;
                          (ii) by striking ``The chief'' and inserting:
            ``(1) In general.--The chief'';

[[Page 110 STAT. 1352]]

                          (iii) by striking ``accounting, reporting, and 
                      program oversight functions'';
                          (iv) by adding at the end thereof the 
                      following new sentence: ``In the case of entities 
                      and subcontractors to which such officer allocates 
                      amounts received by the officer under the grant, 
                      the officer shall ensure that, of the aggregate 
                      amount so allocated, the total of the expenditures 
                      by such entities for administrative expenses does 
                      not exceed 10 percent (without regard to whether 
                      particular entities expend more than 10 percent 
                      for such expenses).''; and
                          (v) by adding at the end thereof the following 
                      new paragraphs:
            ``(2) Administrative activities.--For the purposes of 
        paragraph (1), amounts may be used for administrative activities 
        that include--
                    ``(A) routine grant administration and monitoring 
                activities, including the development of applications 
                for part A funds, the receipt and disbursal of program 
                funds, the development and establishment of 
                reimbursement and accounting systems, the preparation of 
                routine programmatic and financial reports, and 
                compliance with grant conditions and audit requirements; 
                and
                    ``(B) all activities associated with the grantee's 
                contract award procedures, including the development of 
                requests for proposals, contract proposal review 
                activities, negotiation and awarding of contracts, 
                monitoring of contracts through telephone consultation, 
                written documentation or onsite visits, reporting on 
                contracts, and funding reallocation activities.
            ``(3) Subcontractor administrative costs.--For the purposes 
        of this subsection, subcontractor administrative activities 
        include--
                    ``(A) usual and recognized overhead, including 
                established indirect rates for agencies;
                    ``(B) management oversight of specific programs 
                funded under this title; and
                    ``(C) other types of program support such as quality 
                assurance, quality control, and related activities.''.
            (5) Application.--Section 2605 (42 U.S.C. 300ff-15) is 
        amended--
                    (A) in subsection (a)--
                          (i) in the matter preceding paragraph (1), by 
                      inserting ``, in accordance with subsection (c) 
                      regarding a single application and grant award,'' 
                      after ``application'';
                          (ii) in paragraph (1)(B), by striking ``1-year 
                      period'' and all that follows through ``eligible 
                      area'' and inserting ``preceding fiscal year'';
                          (iii) in paragraph (4), by striking ``and'' at 
                      the end thereof;
                          (iv) in paragraph (5), by striking the period 
                      at the end thereof and inserting ``; and''; and
                          (v) by adding at the end thereof the following 
                      new paragraph:
            ``(6) that the applicant has participated, or will agree to 
        participate, in the statewide coordinated statement of need

[[Page 110 STAT. 1353]]

        process where it has been initiated by the State public health 
        agency responsible for administering grants under part B, and 
        ensure that the services provided under the comprehensive plan 
        are consistent with the statewide coordinated statement of 
        need.'';
                    (B) in subsection (b)--
                          (i) in the subsection heading, by striking 
                      ``Additional''; and
                          (ii) in the matter preceding paragraph (1), by 
                      striking ``additional application'' and inserting 
                      ``application, in accordance with subsection (c) 
                      regarding a single application and grant award,''; 
                      and
                    (C) by redesignating subsections (c) and (d) as 
                subsections (d) and (e), respectively; and
                    (D) by inserting after subsection (b), the following 
                new subsection:

    ``(c) Single Application and Grant Award.--
            ``(1) Application.--The Secretary may phase in the use of a 
        single application that meets the requirements of subsections 
        (a) and (b) of section 2603 with respect to an eligible area 
        that desires to receive grants under section 2603 for a fiscal 
        year.
            ``(2) Grant award.--The Secretary may phase in the awarding 
        of a single grant to an eligible area that submits an approved 
        application under paragraph (1) for a fiscal year.''.
            (6) Technical assistance.--Section 2606 (42 U.S.C. 300ff-16) 
        is amended--
                    (A) by striking ``may'' and inserting ``shall'';
                    (B) by inserting after ``technical assistance'' the 
                following: ``, including assistance from other grantees, 
                contractors or subcontractors under this title to assist 
                newly eligible metropolitan areas in the establishment 
                of HIV health services planning councils and,''; and
                    (C) by adding at the end thereof the following new 
                sentences: ``The Administrator may make planning grants 
                available to metropolitan areas, in an amount not to 
                exceed $75,000 for any metropolitan area, projected to 
                be eligible for funding under section 2601 in the 
                following fiscal year. Such grant amounts shall be 
                deducted from the first year formula award to eligible 
                areas accepting such grants. Not to exceed 1 percent of 
                the amount appropriated for a fiscal year under section 
                2677 for grants under part A may be used to carry out 
                this section.''.

    (c) Care Grant Program.--
            (1) Priority for women, infants and children.--Section 2611 
        (42 U.S.C. 300ff-21) is amended--
                    (A) by striking ``The'' and inserting ``(a) In 
                General.--The''; and
                    (B) by adding at the end thereof the following new 
                subsection:

    ``(b) Priority for Women, Infants and Children.--For the purpose of 
providing health and support services to infants, children, and women 
with HIV disease, including treatment measures to prevent the perinatal 
transmission of HIV, a State shall use, of the funds allocated under 
this part to the State for a fiscal year, not less than the percentage 
constituted by the ratio of the population in the State of infants, 
children, and women with

[[Page 110 STAT. 1354]]

acquired immune deficiency syndrome to the general population in the 
State of individuals with such syndrome.''.
            (2) Use of Grants.--Section 2612 (42 U.S.C. 300ff-22) is 
        amended--
                    (A) in subsection (a)--
                          (i) by striking the subsection designation and 
                      heading;
                          (ii) by redesignating paragraphs (1) through 
                      (4) as paragraphs (2) through (5), respectively;
                          (iii) by inserting the following new 
                      paragraph:
            ``(1) to provide the services described in section 
        2604(b)(1) for individuals with HIV disease;'';
                          (iv) in paragraph (5) (as so redesignated), by 
                      striking ``treatments'' and all that follows 
                      through ``health,'' and inserting ``therapeutics 
                      to treat HIV disease''; and
                          (v) by adding at the end thereof the following 
                      flush sentences:

``Services described in paragraph (1) shall be delivered through 
consortia designed as described in paragraph (2), where such consortia 
exist, unless the State demonstrates to the Secretary that delivery of 
such services would be more effective when other delivery mechanisms are 
used. In making a determination regarding the delivery of services, the 
State shall consult with appropriate representatives of service 
providers and recipients of services who would be affected by such 
determination, and shall include in its demonstration to the Secretary 
the findings of the State regarding such consultation.''; and
                    (B) by striking subsection (b).
            (2) HIV care consortia.--Section 2613 (42 U.S.C. 300ff-23) 
        is amended--
                    (A) in subsection (a)--
                          (i) in paragraph (1), by inserting ``(or 
                      private for-profit providers or organizations if 
                      such entities are the only available providers of 
                      quality HIV care in the area)'' after ``nonprofit 
                      private,''; and
                          (ii) in paragraph (2)(A)--
                                    (I) by inserting ``substance abuse 
                                treatment, mental health treatment,'' 
                                after ``nursing,''; and
                                    (II) by inserting ``prophylactic 
                                treatment for opportunistic infections, 
                                treatment education to take place in the 
                                context of health care delivery,'' after 
                                ``monitoring,''; and
                    (B) in subsection (c)--
                          (i) in subparagraph (C) of paragraph (1), by 
                      inserting before ``care'' ``and youth centered''; 
                      and
                          (ii) in paragraph (2)--
                                    (I) in clause (ii) of subparagraph 
                                (A), by striking ``served; and'' and 
                                inserting ``served;'';
                                    (II) in subparagraph (B), by 
                                striking the period at the end and 
                                inserting ``; and''; and
                                    (III) by adding after subparagraph 
                                (B), the following new subparagraph:
                    ``(C) grantees under section 2671, or, if none are 
                operating in the area, representatives in the area of 
                organizations with a history of serving children, youth, 
                women, and families living with HIV.''.

[[Page 110 STAT. 1355]]

            (3) Provision of treatments.--Section 2616 (42 U.S.C. 300ff-
        26) is amended--
                    (A) in subsection (a)--
                          (i) by striking ``may use amounts'' and 
                      inserting ``shall use a portion of the amounts'';
                          (ii) by striking ``section 2612(a)(4)'' and 
                      all that follows through ``prolong life'' and 
                      inserting ``section 2612(a)(5) to provide 
                      therapeutics to treat HIV disease''; and
                          (iii) by inserting before the period the 
                      following: ``, including measures for the 
                      prevention and treatment of opportunistic 
                      infections'';
                    (B) in subsection (c)--
                          (i) in paragraph (3), by striking ``and'' at 
                      the end thereof;
                          (ii) in paragraph (4), by striking the period 
                      and inserting ``; and''; and
                          (iii) by adding at the end thereof the 
                      following new paragraph:
            ``(5) document the progress made in making therapeutics 
        described in subsection (a) available to individuals eligible 
        for assistance under this section.''; and
                    (C) by adding at the end thereof the following new 
                subsection:

    ``(d) Duties of the Secretary.--In carrying out this section, the 
Secretary shall review the current status of State drug reimbursement 
programs established under section 2612(2) and assess barriers to the 
expanded availability of the treatments described in subsection (a). The 
Secretary shall also examine the extent to which States coordinate with 
other grantees under this title to reduce barriers to the expanded 
availability of the treatments described in subsection (a).''.
            (4) State application.--Section 2617(b) (42 U.S.C. 300ff-
        27(b)) is amended--
                    (A) in paragraph (2)--
                          (i) in subparagraph (A), by striking ``and'' 
                      at the end thereof; and
                          (ii) by adding at the end thereof the 
                      following new subparagraph:
                    ``(C) a description of how the allocation and 
                utilization of resources are consistent with the 
                statewide coordinated statement of need (including 
                traditionally underserved populations and 
                subpopulations) developed in partnership with other 
                grantees in the State that receive funding under this 
                title; and'';
                    (B) by redesignating paragraph (3) as paragraph (4);
                    (C) by inserting after paragraph (2), the following 
                new paragraph:
            ``(3) an assurance that the public health agency 
        administering the grant for the State will periodically convene 
        a meeting of individuals with HIV, representatives of grantees 
        under each part under this title, providers, and public agency 
        representatives for the purpose of developing a statewide 
        coordinated statement of need; and''.
            (5) Planning, evaluation and administration.--Section 
        2618(c) (42 U.S.C. 300ff-28(c)) is amended--
                    (A) by striking paragraph (1);

[[Page 110 STAT. 1356]]

                    (B) in paragraphs (3) and (4), to read as follows:
            ``(3) Planning and evaluations.--Subject to paragraph (5) 
        and except as provided in paragraph (6), a State may not use 
        more than 10 percent of amounts received under a grant awarded 
        under this part for planning and evaluation activities.
            ``(4) Administration.--
                    ``(A) In general.--Subject to paragraph (5) and 
                except as provided in paragraph (6), a State may not use 
                more than 10 percent of amounts received under a grant 
                awarded under this part for administration. In the case 
                of entities and subcontractors to which the State 
                allocates amounts received by the State under the grant 
                (including consortia under section 2613), the State 
                shall ensure that, of the aggregate amount so allocated, 
                the total of the expenditures by such entities for 
                administrative expenses does not exceed 10 percent 
                (without regard to whether particular entities expend 
                more than 10 percent for such expenses).
                    ``(B) Administrative activities.--For the purposes 
                of subparagraph (A), amounts may be used for 
                administrative activities that include routine grant 
                administration and monitoring activities.
                    ``(C) Subcontractor administrative costs.--For the 
                purposes of this paragraph, subcontractor administrative 
                activities include--
                          ``(i) usual and recognized overhead, including 
                      established indirect rates for agencies;
                          ``(ii) management oversight of specific 
                      programs funded under this title; and
                          ``(iii) other types of program support such as 
                      quality assurance, quality control, and related 
                      activities.'';
                    (C) by redesignating paragraph (5) as paragraph (7); 
                and
                    (D) by inserting after paragraph (4), the following 
                new paragraphs:
            ``(5) Limitation on use of funds.--Except as provided in 
        paragraph (6), a State may not use more than a total of 15 
        percent of amounts received under a grant awarded under this 
        part for the purposes described in paragraphs (3) and (4).
            ``(6) Exception.--With respect to a State that receives the 
        minimum allotment under subsection (a)(1) for a fiscal year, 
        such State, from the amounts received under a grant awarded 
        under this part for such fiscal year for the activities 
        described in paragraphs (3) and (4), may, notwithstanding 
        paragraphs (3), (4), and (5), use not more than that amount 
        required to support one full-time-equivalent employee.''.
            (6) Technical assistance.--Section 2619 (42 U.S.C. 300ff-29) 
        is amended--
                    (A) by striking ``may'' and inserting ``shall''; and
                    (B) by inserting before the period the following: 
                ``, including technical assistance for the development 
                and implementation of statewide coordinated statements 
                of need''.
            (7) Coordination.--Part B of title XXVI (42 U.S.C. 300ff-21 
        et seq.) is amended by adding at the end thereof the following 
        new section:

[[Page 110 STAT. 1357]]

``SEC. 2621. <<NOTE: 42 USC 300ff-31.>>  COORDINATION.

    ``The Secretary shall ensure that the Health Resources and Services 
Administration, the Centers for Disease Control and Prevention, and the 
Substance Abuse and Mental Health Services Administration coordinate the 
planning and implementation of Federal HIV programs in order to 
facilitate the local development of a complete continuum of HIV-related 
services for individuals with HIV disease and those at risk of such 
disease. <<NOTE: Reports.>>  Not later than October 1, 1996, and 
biennially thereafter, the Secretary shall submit to the appropriate 
committees of the Congress a report concerning coordination efforts 
under this title at the Federal, State, and local levels, including a 
statement of whether and to what extent there exist Federal barriers to 
integrating HIV-related programs.''.

    (d) Early Intervention Services.--
            (1) Establishment of program.--Section 2651(b) (42 U.S.C. 
        300ff-51(b)) is amended--
                    (A) in paragraph (1), by inserting before the period 
                the following: ``, and unless the applicant agrees to 
                expend not less than 50 percent of the grant for such 
                services that are specified in subparagraphs (B) through 
                (E) of such paragraph for individuals with HIV 
                disease''; and
                    (B) in paragraph (4)--
                          (i) by striking ``The Secretary'' and 
                      inserting ``(A) In general.--The Secretary'';
                          (ii) by inserting ``, or private for-profit 
                      entities if such entities are the only available 
                      provider of quality HIV care in the area,'' after 
                      ``nonprofit private entities'';
                          (iii) by realigning the margin of subparagraph 
                      (A) so as to align with the margin of paragraph 
                      (3)(A); and
                          (iv) by adding at the end thereof the 
                      following new subparagraph:
                    ``(B) Other requirements.--Grantees described in--
                          ``(i) paragraphs (1), (2), (5), and (6) of 
                      section 2652(a) shall use not less than 50 percent 
                      of the amount of such a grant to provide the 
                      services described in subparagraphs (A), (B), (D), 
                      and (E) of section 2651(b)(2) directly and on-site 
                      or at sites where other primary care services are 
                      rendered; and
                          ``(ii) paragraphs (3) and (4) of section 
                      2652(a) shall ensure the availability of early 
                      intervention services through a system of linkages 
                      to community-based primary care providers, and to 
                      establish mechanisms for the referrals described 
                      in section 2651(b)(2)(C), and for follow-up 
                      concerning such referrals.''.
            (2) Minimum qualifications.--Section 2652(b)(1)(B) (42 
        U.S.C. 300ff-52(b)(1)(B)) is amended by inserting ``, or a 
        private for-profit entity if such entity is the only available 
        provider of quality HIV care in the area,'' after ``nonprofit 
        private entity''.
            (3) Miscellaneous provisions.--Section 2654 (42 U.S.C. 
        300ff-54) is amended by adding at the end thereof the following 
        new subsection:

    ``(c) Planning and Development Grants.--
            ``(1) In general.--The Secretary may provide planning 
        grants, in an amount not to exceed $50,000 for each such grant, 
        to public and nonprofit private entities for the purpose

[[Page 110 STAT. 1358]]

        of enabling such entities to provide HIV early intervention 
        services.
            ``(2) Requirement.--The Secretary may only award a grant to 
        an entity under paragraph (1) if the Secretary determines that 
        the entity will use such grant to assist the entity in 
        qualifying for a grant under section 2651.
            ``(3) Preference.--In awarding grants under paragraph (1), 
        the Secretary shall give preference to entities that provide 
        primary care services in rural or underserved communities.
            ``(4) Limitation.--Not to exceed 1 percent of the amount 
        appropriated for a fiscal year under section 2655 may be used to 
        carry out this section.''.
            (4) Authorization of appropriations.--Section 2655 (42 
        U.S.C. 300ff-55) is amended by striking ``$75,000,000'' and all 
        that follows through the end of the section, and inserting 
        ``such sums as may be necessary in each of the fiscal years 
        1996, 1997, 1998, 1999, and 2000.''.
            (5) Required agreements.--Section 2664(g) (42 U.S.C. 300ff-
        64(g)) is amended--
                    (A) in paragraph (2), by striking ``and'' at the end 
                thereof;
                    (B) in paragraph (3)--
                          (i) by striking ``5 percent'' and inserting 
                      ``7.5 percent including planning and evaluation''; 
                      and
                          (ii) by striking the period and inserting ``; 
                      and''; and
                    (C) by adding at the end thereof the following new 
                paragraph:
            ``(4) the applicant will submit evidence that the proposed 
        program is consistent with the statewide coordinated statement 
        of need and agree to participate in the ongoing revision of such 
        statement of need.''.

    (e) Demonstration Grants for Research and Services for Pediatric 
Patients.--Section 2671 (42 U.S.C. 300f-71) <<NOTE: 42 USC 300ff-71.>>  
is amended to read as follows:
``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO 
                            RESEARCH FOR WOMEN, INFANTS, CHILDREN, 
                            AND YOUTH.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration and in consultation 
with the Director of the National Institutes of Health, shall make 
grants to public and nonprofit private entities that provide primary 
care (directly or through contracts) for the following purposes:
            ``(1) Providing through such entities, in accordance with 
        this section, opportunities for women, infants, children, and 
        youth to be voluntary participants in research of potential 
        clinical benefit to individuals with HIV disease.
            ``(2) In the case of women, infants, children, and youth 
        with HIV disease, and the families of such individuals, 
        providing to such individuals--
                    ``(A) health care on an outpatient basis; and
                    ``(B) additional services in accordance with 
                subsection (d).

    ``(b) Provisions Regarding Participation in Research.--

[[Page 110 STAT. 1359]]

            ``(1) In general.--With respect to the projects of research 
        with which an applicant under subsection (a) is concerned, the 
        Secretary may make a grant under such subsection to the 
        applicant only if the following conditions are met:
                    ``(A) The applicant agrees to make reasonable 
                efforts--
                          ``(i) to identify which of the patients of the 
                      applicant are women, infants, children, and youth 
                      who would be appropriate participants in the 
                      projects;
                          ``(ii) to carry out clause (i) through the use 
                      of criteria provided for such purpose by the 
                      entities that will be conducting the projects of 
                      research; and
                          ``(iii) to offer women, infants, children, and 
                      youth the opportunity to participate in the 
                      projects (as appropriate), including the provision 
                      of services under subsection (d)(3).
                    ``(B) The applicant agrees that, in the case of the 
                research-related functions to be carried out by the 
                applicant pursuant to subsection (a)(1), the applicant 
                will comply with accepted standards that are applicable 
                to such functions (including accepted standards 
                regarding informed consent and other protections for 
                human subjects).
                    ``(C) For the first and second fiscal years for 
                which grants under subsection (a) are to be made to the 
                applicant, the applicant agrees that, not later than the 
                end of the second fiscal year of receiving such a grant, 
                a significant number of women, infants, children, and 
                youth who are patients of the applicant will be 
                participating in the projects of research.
                    ``(D) Except as provided in paragraph (3) (and 
                paragraph (4), as applicable), for the third and 
                subsequent fiscal years for which such grants are to be 
                made to the applicant, the Secretary has determined that 
                a significant number of such individuals are 
                participating in the projects.
            ``(2) Prohibition.--Receipt of services by a patient shall 
        not be conditioned upon the consent of the patient to 
        participate in research.
            ``(3) Significant participation; consideration by secretary 
        of certain circumstances.--In administering the requirement of 
        paragraph (1)(D), the Secretary shall take into account 
        circumstances in which a grantee under subsection (a) is 
        temporarily unable to comply with the requirement for reasons 
        beyond the control of the grantee, and shall in such 
        circumstances provide to the grantee a reasonable period of 
        opportunity in which to reestablish compliance with the 
        requirement.
            ``(4) Significant participation; temporary waiver for 
        original grantees.--
                    ``(A) In general.--In the case of an applicant under 
                subsection (a) who received a grant under such 
                subsection for fiscal year 1995, the Secretary may, 
                subject to subparagraph (B), provide to the applicant a 
                waiver of the requirement of paragraph (1)(D) if the 
                Secretary determines that the applicant is making 
                reasonable progress toward meeting the requirement.
                    ``(B) Termination of authority for waivers.--The 
                Secretary may not provide any waiver under subparagraph 
                (A) on or after October 1, 1998. Any such waiver 
                provided

[[Page 110 STAT. 1360]]

                prior to such date terminates on such date, or on such 
                earlier date as the Secretary may specify.

    ``(c) Provisions Regarding Conduct of Research.--
            ``(1) In general.--With respect to eligibility for a grant 
        under subsection (a):
                    ``(A) A project of research for which subjects are 
                sought pursuant to such subsection may be conducted by 
                the applicant for the grant, or by an entity with which 
                the applicant has made arrangements for purposes of the 
                grant. The grant may not be expended for the conduct of 
                any project of research, except for such research-
                related functions as are appropriate for providing 
                opportunities under subsection (a)(1) (including the 
                functions specified in subsection (b)(1)).
                    ``(B) The grant may be made only if the Secretary 
                makes the following determinations:
                          ``(i) The applicant or other entity (as the 
                      case may be under subparagraph (A)) is 
                      appropriately qualified to conduct the project of 
                      research. An entity shall be considered to be so 
                      qualified if any research protocol of the entity 
                      has been recommended for funding under this Act 
                      pursuant to technical and scientific peer review 
                      through the National Institutes of Health.
                          ``(ii) The project of research is being 
                      conducted in accordance with a research protocol 
                      to which the Secretary gives priority regarding 
                      the prevention or treatment of HIV disease in 
                      women, infants, children, or youth, subject to 
                      paragraph (2).
            ``(2) List of research protocols.--
                    ``(A) In general.--From among the research protocols 
                described in paragraph (1)(B)(ii), the Secretary shall 
                establish a list of research protocols that are 
                appropriate for purposes of subsection (a)(1). Such list 
                shall be established only after consultation with public 
                and private entities that conduct such research, and 
                with providers of services under subsection (a) and 
                recipients of such services.
                    ``(B) Discretion of secretary.--The Secretary may 
                authorize the use, for purposes of subsection (a)(1), of 
                a research protocol that is not included on the list 
                under subparagraph (A). The Secretary may waive the 
                requirement specified in paragraph (1)(B)(ii) in such 
                circumstances as the Secretary determines to be 
                appropriate.

    ``(d) Additional Services for Patients and Families.--A grant under 
subsection (a) may be made only if the applicant for the grant agrees as 
follows:
            ``(1) The applicant will provide for the case management of 
        the patient involved and the family of the patient.
            ``(2) The applicant will provide for the patient and the 
        family of the patient--
                    ``(A) referrals for inpatient hospital services, 
                treatment for substance abuse, and mental health 
                services; and
                    ``(B) referrals for other social and support 
                services, as appropriate.
            ``(3) The applicant will provide the patient and the family 
        of the patient with such transportation, child care, and other 
        incidental services as may be necessary to enable the patient

[[Page 110 STAT. 1361]]

        and the family to participate in the program established by the 
        applicant pursuant to such subsection.

    ``(e) Coordination With Other Entities.--A grant under subsection 
(a) may be made only if the applicant for the grant agrees as follows:
            ``(1) The applicant will coordinate activities under the 
        grant with other providers of health care services under this 
        Act, and under title V of the Social Security Act.
            ``(2) The applicant will participate in the statewide 
        coordinated statement of need under part B (where it has been 
        initiated by the public health agency responsible for 
        administering grants under part B) and in revisions of such 
        statement.

    ``(f) Application.--A grant under subsection (a) may be made only if 
an application for the grant is submitted to the Secretary and the 
application is in such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary determines to 
be necessary to carry out this section.
    ``(g) Coordination With National Institutes of Health.--The 
Secretary shall develop and implement a plan that provides for the 
coordination of the activities of the National Institutes of Health with 
the activities carried out under this section. In carrying out the 
preceding sentence, the Secretary shall ensure that projects of research 
conducted or supported by such Institutes are made aware of applicants 
and grantees under subsection (a), shall require that the projects, as 
appropriate, enter into arrangements for purposes of such subsection, 
and shall require that each project entering into such an arrangement 
inform the applicant or grantee under such subsection of the needs of 
the project for the participation of women, infants, children, and 
youth.
    ``(h) Annual Review of Programs; Evaluations.--
            ``(1) Review regarding access to and participation in 
        programs.--With respect to a grant under subsection (a) for an 
        entity for a fiscal year, the Secretary shall, not later than 
        180 days after the end of the fiscal year, provide for the 
        conduct and completion of a review of the operation during the 
        year of the program carried out under such subsection by the 
        entity. The purpose of such review shall be the development of 
        recommendations, as appropriate, for improvements in the 
        following:
                    ``(A) Procedures used by the entity to allocate 
                opportunities and services under subsection (a) among 
                patients of the entity who are women, infants, children, 
                or youth.
                    ``(B) Other procedures or policies of the entity 
                regarding the participation of such individuals in such 
                program.
            ``(2) Evaluations.--The Secretary shall, directly or through 
        contracts with public and private entities, provide for 
        evaluations of programs carried out pursuant to subsection (a).

    ``(i) Training and Technical Assistance.--Of the amounts 
appropriated under subsection (j) for a fiscal year, the Secretary may 
use not more than five percent to provide, directly or through contracts 
with public and private entities (which may include grantees under 
subsection (a)), training and technical assistance to assist applicants 
and grantees under subsection (a) in complying with the requirements of 
this section.
    ``(j) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated

[[Page 110 STAT. 1362]]

such sums as may be necessary for each of the fiscal years 1996 through 
2000.''.
    (f) Evaluations and Reports.--Section 2674 (42 U.S.C. 300ff-74) is 
amended--
            (1) in subsection (b)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``not later than 1 year'' and all that follows 
                through ``title,'' and inserting the following: ``not 
                later than October 1, 1996,'';
                    (B) by striking paragraphs (1) through (3) and 
                inserting the following paragraph:
            ``(1) evaluating the programs carried out under this title; 
        and''; and
                    (C) by redesignating paragraph (4) as paragraph (2); 
                and
            (2) by adding at the end the following subsection:

    ``(d) Allocation of Funds.--The Secretary shall carry out this 
section with amounts available under section 241. Such amounts are in 
addition to any other amounts that are available to the Secretary for 
such purpose.''.
    (g) Demonstration and Training.--
            (1) In general.--Title XXVI is amended by adding at the end, 
        the following new part:

                  ``PART F--DEMONSTRATION AND TRAINING

         ``Subpart I--Special Projects of National Significance

``SEC. 2691. <<NOTE: 42 USC 300ff-101.>>  SPECIAL PROJECTS OF NATIONAL 
            SIGNIFICANCE.

    ``(a) In General.--Of the amount appropriated under each of parts A, 
B, C, and D of this title for each fiscal year, the Secretary shall use 
the greater of $20,000,000 or 3 percent of such amount appropriated 
under each such part, but not to exceed $25,000,000, to administer a 
special projects of national significance program to award direct grants 
to public and nonprofit private entities including community-based 
organizations to fund special programs for the care and treatment of 
individuals with HIV disease.
    ``(b) Grants.--The Secretary shall award grants under subsection (a) 
based on--
            ``(1) the need to assess the effectiveness of a particular 
        model for the care and treatment of individuals with HIV 
        disease;
            ``(2) the innovative nature of the proposed activity; and
            ``(3) the potential replicability of the proposed activity 
        in other similar localities or nationally.

    ``(c) Special Projects.--Special projects of national significance 
shall include the development and assessment of innovative service 
delivery models that are designed to--
            ``(1) address the needs of special populations;
            ``(2) assist in the development of essential community-based 
        service delivery infrastructure; and
            ``(3) ensure the ongoing availability of services for Native 
        American communities to enable such communities to care for 
        Native Americans with HIV disease.

[[Page 110 STAT. 1363]]

    ``(d) Special Populations.--Special projects of national 
significance may include the delivery of HIV health care and support 
services to traditionally underserved populations including--
            ``(1) individuals and families with HIV disease living in 
        rural communities;
            ``(2) adolescents with HIV disease;
            ``(3) Indian individuals and families with HIV disease;
            ``(4) homeless individuals and families with HIV disease;
            ``(5) hemophiliacs with HIV disease; and
            ``(6) incarcerated individuals with HIV disease.

    ``(e) Service Development Grants.--Special projects of national 
significance may include the development of model approaches to 
delivering HIV care and support services including--
            ``(1) programs that support family-based care networks and 
        programs that build organizational capacity critical to the 
        delivery of care in minority communities;
            ``(2) programs designed to prepare AIDS service 
        organizations and grantees under this title for operation within 
        the changing health care environment; and
            ``(3) programs designed to integrate the delivery of mental 
        health and substance abuse treatment with HIV services.

    ``(f) Coordination.--The Secretary may not make a grant under this 
section unless the applicant submits evidence that the proposed program 
is consistent with the statewide coordinated statement of need, and the 
applicant agrees to participate in the ongoing revision process of such 
statement of need.
    ``(g) Replication.--The Secretary shall make information concerning 
successful models developed under this part available to grantees under 
this title for the purpose of coordination, replication, and 
integration. To facilitate efforts under this subsection, the Secretary 
may provide for peer-based technical assistance from grantees funded 
under this part.''.
            (2) Repeal.--Subsection (a) of section 2618 (42 U.S.C. 
        300ff-28(a)) is repealed.

    (h) HIV/AIDS Communities, Schools, Centers.--
            (1) New part.--Part F of title XXVI (as added by subsection 
        (e)) is further amended by adding at the end, the following new 
        subpart:

            ``Subpart II--AIDS Education and Training Centers

``SEC. 2692. <<NOTE: 42 USC 300ff-111.>>  HIV/AIDS COMMUNITIES, SCHOOLS, 
            AND CENTERS.''.
            (2) Amendments.--Section 776 (42 U.S.C. 294n) is amended--
                    (A) by striking the section heading; and
                    (B) in subsection (a)(1)--
                          (i) by striking subparagraphs (B) and (C);
                          (ii) by redesignating subparagraphs (A) and 
                      (D) as subparagraphs (B) and (C), respectively;
                          (iii) by inserting before subparagraph (B) (as 
                      so redesignated) the following new subparagraph:
                    ``(A) training health personnel, including 
                practitioners in title XXVI programs and other community 
                providers, in the diagnosis, treatment, and prevention 
                of HIV infection and disease, including the prevention 
                of the perinatal trans

[[Page 110 STAT. 1364]]

                mission of the disease and including measures for the 
                prevention and treatment of opportunistic infections;''; 
                and
                          (iv) in subparagraph (B) (as so redesignated) 
                      by adding ``and'' after the semicolon.
            (3) Transfer.--Section 776 (42 U.S.C. 294n) (as amended by 
        paragraph (2)) <<NOTE: 42 USC 300ff-111.>>  is amended by 
        transferring such section to section 2692 (as added by paragraph 
        (1)).
            (4) Authorization of appropriations.--Section 2692 (as added 
        by paragraph (1)) <<NOTE: 42 USC 300ff-111.>>  is amended by 
        adding at the end thereof the following new subsection:

    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of the fiscal years 1996 through 2000.''.

SEC. 4. AMOUNT OF EMERGENCY RELIEF GRANTS.

    Paragraph (3) of section 2603(a) (42 U.S.C. 300ff-13(a)(3)) is 
amended to read as follows:
            ``(3) Amount of grant.--
                    ``(A) In general.--Subject to the extent of amounts 
                made available in appropriations Acts, a grant made for 
                purposes of this paragraph to an eligible area shall be 
                made in an amount equal to the product of--
                          ``(i) an amount equal to the amount available 
                      for distribution under paragraph (2) for the 
                      fiscal year involved; and
                          ``(ii) the percentage constituted by the ratio 
                      of the distribution factor for the eligible area 
                      to the sum of the respective distribution factors 
                      for all eligible areas.
                    ``(B) Distribution factor.--For purposes of 
                subparagraph (A)(ii), the term `distribution factor' 
                means an amount equal to the estimated number of living 
                cases of acquired immune deficiency syndrome in the 
                eligible area involved, as determined under subparagraph 
                (C).
                    ``(C) Estimate of living cases.--The amount 
                determined in this subparagraph is an amount equal to 
                the product of--
                          ``(i) the number of cases of acquired immune 
                      deficiency syndrome in the eligible area during 
                      each year in the most recent 120-month period for 
                      which data are available with respect to all 
                      eligible areas, as indicated by the number of such 
                      cases reported to and confirmed by the Director of 
                      the Centers for Disease Control and Prevention for 
                      each year during such period; and
                          ``(ii) with respect to--
                                    ``(I) the first year during such 
                                period, .06;
                                    ``(II) the second year during such 
                                period, .06;
                                    ``(III) the third year during such 
                                period, .08;
                                    ``(IV) the fourth year during such 
                                period, .10;
                                    ``(V) the fifth year during such 
                                period, .16;
                                    ``(VI) the sixth year during such 
                                period, .16;
                                    ``(VII) the seventh year during such 
                                period, .24;
                                    ``(VIII) the eighth year during such 
                                period, .40;

[[Page 110 STAT. 1365]]

                                    ``(IX) the ninth year during such 
                                period, .57; and
                                    ``(X) the tenth year during such 
                                period, .88.
                The yearly percentage described in subparagraph (ii) 
                shall be updated biennially by the Secretary, after 
                consultation with the Centers for Disease Control and 
                Prevention. The first such update shall occur prior to 
                the determination of grant awards under this part for 
                fiscal year 1998.
                    ``(D) Unexpended funds.--The Secretary may, in 
                determining the amount of a grant for a fiscal year 
                under this paragraph, adjust the grant amount to reflect 
                the amount of unexpended and uncanceled grant funds 
                remaining at the end of the fiscal year preceding the 
                year for which the grant determination is to be made. 
                The amount of any such unexpended funds shall be 
                determined using the financial status report of the 
                grantee.''.

SEC. 5. AMOUNT OF CARE GRANTS.

    Paragraphs (1) and (2) of section 2618(b) (42 U.S.C. 300ff-28(b) (1) 
and (2)) are amended to read as follows:
            ``(1) Minimum allotment.--Subject to the extent of amounts 
        made available under section 2677, the amount of a grant to be 
        made under this part for--
                    ``(A) each of the several States and the District of 
                Columbia for a fiscal year shall be the greater of--
                          ``(i)(I) with respect to a State or District 
                      that has less than 90 living cases of acquired 
                      immune deficiency syndrome, as determined under 
                      paragraph (2)(D), $100,000; or
                          ``(II) with respect to a State or District 
                      that has 90 or more living cases of acquired 
                      immune deficiency syndrome, as determined under 
                      paragraph (2)(D), $250,000;
                          ``(ii) an amount determined under paragraph 
                      (2); and
                    ``(B) each territory of the United States, as 
                defined in paragraph (3), shall be an amount determined 
                under paragraph (2).
            ``(2) Determination.--
                    ``(A) Formula.--The amount referred to in paragraph 
                (1)(A)(ii) for a State and paragraph (1)(B) for a 
                territory of the United States shall be the product of--
                          ``(i) an amount equal to the amount 
                      appropriated under section 2677 for the fiscal 
                      year involved for grants under part B, subject to 
                      subparagraph (H); and
                          ``(ii) the percentage constituted by the sum 
                      of--
                                    ``(I) the product of .80 and the 
                                ratio of the State distribution factor 
                                for the State or territory (as 
                                determined under subsection (B)) to the 
                                sum of the respective State distribution 
                                factors for all States or territories; 
                                and
                                    ``(II) the product of .20 and the 
                                ratio of the non-EMA distribution factor 
                                for the State or territory (as 
                                determined under subparagraph (C)) to 
                                the sum of the respective distribution 
                                factors for all States or territories.

[[Page 110 STAT. 1366]]

                    ``(B) State distribution factor.--For purposes of 
                subparagraph (A)(ii)(I), the term `State distribution 
                factor' means an amount equal to the estimated number of 
                living cases of acquired immune deficiency syndrome in 
                the eligible area involved, as determined under 
                subparagraph (D).
                    ``(C) Non-ema distribution factor.--For purposes of 
                subparagraph (A)(ii)(II), the term `non-ema distribution 
                factor' means an amount equal to the sum of--
                          ``(i) the estimated number of living cases of 
                      acquired immune deficiency syndrome in the State 
                      or territory involved, as determined under 
                      subparagraph (D); less
                          ``(ii) the estimated number of living cases of 
                      acquired immune deficiency syndrome in such State 
                      or territory that are within an eligible area (as 
                      determined under part A).
                    ``(D) Estimate of living cases.--The amount 
                determined in this subparagraph is an amount equal to 
                the product of--
                          ``(i) the number of cases of acquired immune 
                      deficiency syndrome in the State or territory 
                      during each year in the most recent 120-month 
                      period for which data are available with respect 
                      to all States and territories, as indicated by the 
                      number of such cases reported to and confirmed by 
                      the Director of the Centers for Disease Control 
                      and Prevention for each year during such period; 
                      and
                          ``(ii) with respect to each of the first 
                      through the tenth year during such period, the 
                      amount referred to in section 2603(a)(3)(C)(ii).
                    ``(E) Puerto rico, virgin islands, guam.--For 
                purposes of subparagraph (D), the cost index for Puerto 
                Rico, the Virgin Islands, and Guam shall be 1.0.
                    ``(F) Unexpended funds.--The Secretary may, in 
                determining the amount of a grant for a fiscal year 
                under this subsection, adjust the grant amount to 
                reflect the amount of unexpended and uncanceled grant 
                funds remaining at the end of the fiscal year preceding 
                the year for which the grant determination is to be 
                made. The amount of any such unexpended funds shall be 
                determined using the financial status report of the 
                grantee.
                    ``(G) Limitation.--
                          ``(i) In general.--The Secretary shall ensure 
                      that the amount of a grant awarded to a State or 
                      territory for a fiscal year under this part is 
                      equal to not less than--
                                    ``(I) with respect to fiscal year 
                                1996, 100 percent;
                                    ``(II) with respect to fiscal year 
                                1997, 99 percent;
                                    ``(III) with respect to fiscal year 
                                1998, 98 percent;
                                    ``(IV) with respect to fiscal year 
                                1999, 96.5 percent; and
                                    ``(V) with respect to fiscal year 
                                2000, 95 percent;

[[Page 110 STAT. 1367]]

                      of the amount such State or territory received for 
                      fiscal year 1995 under this part. In administering 
                      this subparagraph, the Secretary shall, with 
                      respect to States that will receive grants in 
                      amounts that exceed the amounts that such States 
                      received under this part in fiscal year 1995, 
                      proportionally reduce such amounts to ensure 
                      compliance with this subparagraph. In making such 
                      reductions, the Secretary shall ensure that no 
                      such State receives less than that State received 
                      for fiscal year 1995.
                          ``(ii) Ratable reduction.--If the amount 
                      appropriated under section 2677 and available for 
                      allocation under this part is less than the amount 
                      appropriated and available under this part for 
                      fiscal year 1995, the limitation contained in 
                      clause (i) shall be reduced by a percentage equal 
                      to the percentage of the reduction in such amounts 
                      appropriated and available.
                    ``(H) Appropriations for treatment drug program.--
                With respect to the fiscal year involved, if under 
                section 2677 an appropriations Act provides an amount 
                exclusively for carrying out section 2616, the portion 
                of such amount allocated to a State shall be the product 
                of--
                          ``(i) 100 percent of such amount; and
                          ``(ii) the percentage constituted by the ratio 
                      of the State distribution factor for the State (as 
                      determined under subparagraph (B)) to the sum of 
                      the State distribution factors for all States.''.

SEC. 6. CONSOLIDATION OF AUTHORIZATIONS OF APPROPRIATIONS.

    (a) In General.--Part D of title XXVI (42 U.S.C. 300ff-71) is 
amended by adding at the end thereof the following new section:

``SEC. 2677. <<NOTE: 42 USC 300ff-77.>>  AUTHORIZATION OF 
            APPROPRIATIONS.

    ``(a) In General.--Subject to subsection (b), there are authorized 
to be appropriated to make grants under parts A and B, such sums as may 
be necessary for each of the fiscal years 1996 through 2000.
    ``(b) Development of Methodology.--
            ``(1) In general.--With respect to each of the fiscal years 
        1997 through 2000, the Secretary shall develop and implement a 
        methodology for adjusting the percentages allocated to part A 
        and part B to account for grants to new eligible areas under 
        part A and other relevant factors. <<NOTE: Reports.>>  Not later 
        than July 1, 1996, the Secretary shall prepare and submit to the 
        appropriate committees of Congress a report regarding the 
        findings with respect to the methodology developed under this 
        paragraph.
            ``(2) Failure to implement.--If the Secretary determines 
        that such a methodology under paragraph (1) cannot be developed, 
        there are authorized to be appropriated--
                    ``(A) such sums as may be necessary to carry out 
                part A for each of the fiscal years 1997 through 2000; 
                and
                    ``(B) such sums as may be necessary to carry out 
                part B for each of the fiscal years 1997 through 
                2000.''.

    (b) Repeals.--Sections 2608 and 2620 (42 U.S.C. 300ff-18 and 300ff-
30) are repealed.
    (c) Conforming Amendments.--Title XXVI is amended--
            (1) in section 2603 (42 U.S.C. 300ff-13)--

[[Page 110 STAT. 1368]]

                    (A) in subsection (a)(2), by striking ``2608'' and 
                inserting ``2677''; and
                    (B) in subsection (b)(1), by striking ``2608'' and 
                inserting ``2677'';
            (2) in section 2605(c)(1) (42 U.S.C. 300ff-15(c)(1)) is 
        amended by striking ``2608'' and inserting ``2677''; and
            (3) in section 2618 (42 U.S.C. 300ff-28)--
                    (A) in subsection (a)(1), is amended by striking 
                ``2620'' and inserting ``2677''; and
                    (B) in subsection (b)(1), is amended by striking 
                ``2620'' and inserting ``2677''.

SEC. 7. PERINATAL TRANSMISSION OF HIV DISEASE.

    (a) <<NOTE: 42 USC 300ff-33 note.>>  Findings.--The Congress finds 
as follows:
            (1) Research studies and statewide clinical experiences have 
        demonstrated that administration of anti-retroviral medication 
        during pregnancy can significantly reduce the transmission of 
        the human immunodeficiency virus (commonly known as HIV) from an 
        infected mother to her baby.
            (2) The Centers for Disease Control and Prevention have 
        recommended that all pregnant women receive HIV counseling; 
        voluntary, confidential HIV testing; and appropriate medical 
        treatment (including anti-retroviral therapy) and support 
        services.
            (3) The provision of such testing without access to such 
        counseling, treatment, and services will not improve the health 
        of the woman or the child.
            (4) The provision of such counseling, testing, treatment, 
        and services can reduce the number of pediatric cases of 
        acquired immune deficiency syndrome, can improve access to and 
        provision of medical care for the woman, and can provide 
        opportunities for counseling to reduce transmission among 
        adults, and from mother to child.
            (5) The provision of such counseling, testing, treatment, 
        and services can reduce the overall cost of pediatric cases of 
        acquired immune deficiency syndrome.
            (6) The cancellation or limitation of health insurance or 
        other health coverage on the basis of HIV status should be 
        impermissible under applicable law. Such cancellation or 
        limitation could result in disincentives for appropriate 
        counseling, testing, treatment, and services.
            (7) For the reasons specified in paragraphs (1) through 
        (6)--
                    (A) routine HIV counseling and voluntary testing of 
                pregnant women should become the standard of care; and
                    (B) the relevant medical organizations as well as 
                public health officials should issue guidelines making 
                such counseling and testing the standard of care.

    (b) Additional Requirements for Grants.--Part B of title XXVI (42 
U.S.C. 300ff-21 et seq.) is amended--
            (1) by inserting after the part heading the following:

                ``Subpart I--General Grant Provisions'';

            (2) in section 2611(a), <<NOTE: 42 USC 300ff-21.>>  by 
        adding at the end the following sentence: ``The authority of the 
        Secretary to provide grants under part B is subject to section 
        2626(e)(2) (relating to the decrease in perinatal transmission 
        of HIV disease).''; and

[[Page 110 STAT. 1369]]

            (3) by adding at the end thereof the following new subpart:

``Subpart II--Provisions Concerning Pregnancy and Perinatal Transmission 
                                 of HIV

``SEC. 2625. <<NOTE: 42 USC 300ff-33.>>  CDC GUIDELINES FOR PREGNANT 
            WOMEN.

    ``(a) <<NOTE: Certification.>>  Requirement.--Notwithstanding any 
other provision of law, a State shall, not later than 120 days after the 
date of enactment of this subpart, certify to the Secretary that such 
State has in effect regulations or measures to adopt the guidelines 
issued by the Centers for Disease Control and Prevention concerning 
recommendations for human immunodeficiency virus counseling and 
voluntary testing for pregnant women.

    ``(b) Noncompliance.--If a State does not provide the certification 
required under subsection (a) within the 120-day period described in 
such subsection, such State shall not be eligible to receive assistance 
for HIV counseling and testing under this section until such 
certification is provided.
    ``(c) Additional Funds Regarding Women and Infants.--
            ``(1) In general.--If a State provides the certification 
        required in subsection (a) and is receiving funds under part B 
        for a fiscal year, the Secretary may (from the amounts available 
        pursuant to paragraph (2)) make a grant to the State for the 
        fiscal year for the following purposes:
                    ``(A) Making available to pregnant women appropriate 
                counseling on HIV disease.
                    ``(B) Making available outreach efforts to pregnant 
                women at high risk of HIV who are not currently 
                receiving prenatal care.
                    ``(C) Making available to such women voluntary HIV 
                testing for such disease.
                    ``(D) Offsetting other State costs associated with 
                the implementation of this section and subsections (a) 
                and (b) of section 2626.
                    ``(E) Offsetting State costs associated with the 
                implementation of mandatory newborn testing in 
                accordance with this title or at an earlier date than is 
                required by this title.
            ``(2) Funding.--For purposes of carrying out this 
        subsection, there are authorized to be appropriated $10,000,000 
        for each of the fiscal years 1996 through 2000. Amounts made 
        available under section 2677 for carrying out this part are not 
        available for carrying out this section unless otherwise 
        authorized.
            ``(3) Priority.--In awarding grants under this subsection 
        the Secretary shall give priority to States that have the 
        greatest proportion of HIV seroprevalance among child bearing 
        women using the most recent data available as determined by the 
        Centers for Disease Control and Prevention.
``SEC. 2626. <<NOTE: 42 USC 300ff-34.>>  PERINATAL TRANSMISSION OF 
                            HIV DISEASE; CONTINGENT REQUIREMENT 
                            REGARDING STATE GRANTS UNDER THIS 
                            PART.

    ``(a) Annual Determination of Reported Cases.--A State shall 
annually determine the rate of reported cases of AIDS as a result of 
perinatal transmission among residents of the State.

[[Page 110 STAT. 1370]]

    ``(b) Causes of Perinatal Transmission.--In determining the rate 
under subsection (a), a State shall also determine the possible causes 
of perinatal transmission. Such causes may include--
            ``(1) the inadequate provision within the State of prenatal 
        counseling and testing in accordance with the guidelines issued 
        by the Centers for Disease Control and Prevention;
            ``(2) the inadequate provision or utilization within the 
        State of appropriate therapy or failure of such therapy to 
        reduce perinatal transmission of HIV, including--
                    ``(A) that therapy is not available, accessible or 
                offered to mothers; or
                    ``(B) that available therapy is offered but not 
                accepted by mothers; or
            ``(3) other factors (which may include the lack of prenatal 
        care) determined relevant by the State.

    ``(c) CDC Reporting System.--Not later than 4 months after the date 
of enactment of this subpart, the Director of the Centers for Disease 
Control and Prevention shall develop and implement a system to be used 
by States to comply with the requirements of subsections (a) and 
(b). <<NOTE: Guidelines.>>  The Director shall issue guidelines to 
ensure that the data collected is statistically valid.

    ``(d) <<NOTE: Federal Register, publication.>>  Determination by 
Secretary.--Not later than 180 days after the expiration of the 18-month 
period beginning on the date on which the system is implemented under 
subsection (c), the Secretary shall publish in the Federal Register a 
determination of whether it has become a routine practice in the 
provision of health care in the United States to carry out each of the 
activities described in paragraphs (1) through (5) of section 2627. In 
making the determination, the Secretary shall consult with the States 
and with other public or private entities that have knowledge or 
expertise relevant to the determination.

    ``(e) Contingent Applicability.--
            ``(1) In general.--If the determination published in the 
        Federal Register under subsection (d) is that (for purposes of 
        such subsection) the activities involved have become routine 
        practices, paragraph (2) shall apply on and after the expiration 
        of the 18-month period beginning on the date on which the 
        determination is so published.
            ``(2) Requirement.--Subject to subsection (f), the Secretary 
        shall not make a grant under part B to a State unless the State 
        meets not less than one of the following requirements:
                    ``(A) A 50 percent reduction (or a comparable 
                measure for States with less than 10 cases) in the rate 
                of new cases of AIDS (recognizing that AIDS is a 
                suboptimal proxy for tracking HIV in infants and was 
                selected because such data is universally available) as 
                a result of perinatal transmission as compared to the 
                rate of such cases reported in 1993 (a State may use HIV 
                data if such data is available).
                    ``(B) At least 95 percent of women in the State who 
                have received at least two prenatal visits 
                (consultations) prior to 34 weeks gestation with a 
                health care provider or provider group have been tested 
                for the human immunodeficiency virus.
                    ``(C) The State has in effect, in statute or through 
                regulations, the requirements specified in paragraphs 
                (1) through (5) of section 2627.

[[Page 110 STAT. 1371]]

    ``(f) Limitation Regarding Availability of Funds.--With respect to 
an activity described in any of paragraphs (1) through (5) of section 
2627, the requirements established by a State under this section apply 
for purposes of this section only to the extent that the following 
sources of funds are available for carrying out the activity:
            ``(1) Federal funds provided to the State in grants under 
        part B or under section 2625, or through other Federal sources 
        under which payments for routine HIV testing, counseling or 
        treatment are an eligible use.
            ``(2) Funds that the State or private entities have elected 
        to provide, including through entering into contracts under 
        which health benefits are provided. This section does not 
        require any entity to expend non-Federal funds.

``SEC. 2627. <<NOTE: 42 USC 300ff-35.>>  TESTING OF PREGNANT WOMEN AND 
            NEWBORN INFANTS.

    ``An activity or requirement described in this section is any of the 
following:
            ``(1) In the case of newborn infants who are born in the 
        State and whose biological mothers have not undergone prenatal 
        testing for HIV disease, that each such infant undergo testing 
        for such disease.
            ``(2) That the results of such testing of a newborn infant 
        be promptly disclosed in accordance with the following, as 
        applicable to the infant involved:
                    ``(A) To the biological mother of the infant 
                (without regard to whether she is the legal guardian of 
                the infant).
                    ``(B) If the State is the legal guardian of the 
                infant:
                          ``(i) To the appropriate official of the State 
                      agency with responsibility for the care of the 
                      infant.
                          ``(ii) To the appropriate official of each 
                      authorized agency providing assistance in the 
                      placement of the infant.
                          ``(iii) If the authorized agency is giving 
                      significant consideration to approving an 
                      individual as a foster parent of the infant, to 
                      the prospective foster parent.
                          ``(iv) If the authorized agency is giving 
                      significant consideration to approving an 
                      individual as an adoptive parent of the infant, to 
                      the prospective adoptive parent.
                    ``(C) If neither the biological mother nor the State 
                is the legal guardian of the infant, to another legal 
                guardian of the infant.
                    ``(D) To the child's health care provider.
            ``(3) That, in the case of prenatal testing for HIV disease 
        that is conducted in the State, the results of such testing be 
        promptly disclosed to the pregnant woman involved.
            ``(4) That, in disclosing the test results to an individual 
        under paragraph (2) or (3), appropriate counseling on the human 
        immunodeficiency virus be made available to the individual 
        (except in the case of a disclosure to an official of a State or 
        an authorized agency).
            ``(5) With respect to State insurance laws, that such laws 
        require--
                    ``(A) that, if health insurance is in effect for an 
                individual, the insurer involved may not (without the 
                consent of the individual) discontinue the insurance, or 
                alter the terms of the insurance (except as provided in 
                subparagraph

[[Page 110 STAT. 1372]]

                (C)), solely on the basis that the individual is 
                infected with HIV disease or solely on the basis that 
                the individual has been tested for the disease or its 
                manifestation;
                    ``(B) that subparagraph (A) does not apply to an 
                individual who, in applying for the health insurance 
                involved, knowingly misrepresented the HIV status of the 
                individual; and
                    ``(C) that subparagraph (A) does not apply to any 
                reasonable alteration in the terms of health insurance 
                for an individual with HIV disease that would have been 
                made if the individual had a serious disease other than 
                HIV disease.
        For purposes of this subparagraph, a statute or regulation shall 
        be deemed to regulate insurance for purposes of this paragraph 
        only to the extent that such statute or regulation is treated as 
        regulating insurance for purposes of section 514(b)(2) of the 
        Employee Retirement Income Security Act of 1974.

``SEC. 2628. <<NOTE: 42 USC 300ff-36.>>  REPORT BY THE INSTITUTE OF 
            MEDICINE.

    ``(a) In General.--The Secretary shall request that the Institute of 
Medicine of the National Academy of Sciences conduct an evaluation of 
the extent to which State efforts have been effective in reducing the 
perinatal transmission of the human immuno
deficiency virus, and an analysis of the existing barriers to the 
further reduction in such transmission.
    ``(b) Report to Congress.--The Secretary shall ensure that, not 
later than 2 years after the date of enactment of this section, the 
evaluation and analysis described in subsection (a) is completed and a 
report summarizing the results of such evaluation and analysis is 
prepared by the Institute of Medicine and submitted to the appropriate 
committees of Congress together with the recommendations of the 
Institute.
``SEC. 2629. <<NOTE: 42 USC 300ff-37.>>  STATE HIV TESTING 
                            PROGRAMS ESTABLISHED PRIOR TO OR AFTER 
                            ENACTMENT.

    ``Nothing in this subpart shall be construed to disqualify a State 
from receiving grants under this title if such State has established at 
any time prior to or after the date of enactment of this subpart a 
program of mandatory HIV testing.''.

SEC. 8. <<NOTE: 42 USC 300ff-27a.>>  SPOUSAL NOTIFICATION.

    (a) In General.--The Secretary of Health and Human Services shall 
not make a grant under part B of title XXVI of the Public Health Service 
Act (42 U.S.C. 300ff-21 et seq.) to any State unless such State takes 
administrative or legislative action to require that a good faith effort 
be made to notify a spouse of a known HIV-infected patient that such 
spouse may have been exposed to the human immunodeficiency virus and 
should seek testing.
    (b) Definitions.--For purposes of this section:
            (1) Spouse.--The term ``spouse'' means any individual who is 
        the marriage partner of an HIV-infected patient, or who has been 
        the marriage partner of that patient at any time within the 10-
        year period prior to the diagnosis of HIV infection.
            (2) HIV-infected patient.--The term ``HIV-infected patient'' 
        means any individual who has been diagnosed to be infected with 
        the human immunodeficiency virus.

[[Page 110 STAT. 1373]]

            (3) State.--The term ``State'' means any of the 50 States, 
        the District of Columbia, or any territory of the United States.
SEC. 9. <<NOTE: 5 USC 4103 note.>>  OPTIONAL PARTICIPATION OF 
                    FEDERAL EMPLOYEES IN AIDS TRAINING PROGRAMS.

    (a) In General.--Notwithstanding any other provision of law, a 
Federal employee may not be required to attend or participate in an AIDS 
or HIV training program if such employee refuses to consent to such 
attendance or participation, except for training necessary to protect 
the health and safety of the Federal employee and the individuals served 
by such employees. An employer may not retaliate in any manner against 
such an employee because of the refusal of such employee to consent to 
such attendance or participation.
    (b) Definition.--As used in subsection (a), the term ``Federal 
employee'' has the same meaning given the term ``employee'' in section 
2105 of title 5, United States Code, and such term shall include members 
of the armed forces.

SEC. 10. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

    Part D of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff-71) as amended by section 6, is further amended by adding at the 
end thereof the following new section:

``SEC. 2678. <<NOTE: 42 USC 300ff-78.>>  PROHIBITION ON PROMOTION OF 
            CERTAIN ACTIVITIES.

    ``None of the funds authorized under this title shall be used to 
fund AIDS programs, or to develop materials, designed to promote or 
encourage, directly, intravenous drug use or sexual activity, whether 
homosexual or heterosexual. Funds authorized under this title may be 
used to provide medical treatment and support services for individuals 
with HIV.''.

SEC. 11. <<NOTE: 42 USC 300cc note.>>  LIMITATION ON APPROPRIATIONS.

    Notwithstanding any other provision of law, the total amounts of 
Federal funds expended in any fiscal year for AIDS and HIV activities 
may not exceed the total amounts expended in such fiscal year for 
activities related to cancer.

SEC. 12. ADDITIONAL PROVISIONS.

    (a) Definitions.--Section 2676(4) (42 U.S.C. 300ff-76(4)) is amended 
by inserting ``funeral-service practitioners,'' after ``emergency 
medical technicians,''.
    (b) Miscellaneous Amendment.--Section 1201(a) (42 U.S.C. 300d(a)) is 
amended in the matter preceding paragraph (1) by striking ``The 
Secretary,'' and all that follows through ``shall,'' and inserting ``The 
Secretary shall,''.
    (c) Technical Corrections.--Title XXVI (42 U.S.C. 300ff-11 et seq.) 
is amended--
            (1) in section 2601(a), <<NOTE: 42 USC 300ff-11.>>  by 
        inserting ``section'' before ``2604'';
            (2) in section 2603(b)(4)(B), <<NOTE: 42 USC 300ff-13.>>  by 
        striking ``an expedited grants'' and inserting ``an expedited 
        grant'';
            (3) in section 2617(b)(3)(B)(iv), <<NOTE: 42 USC 300ff-
        27.>>  by inserting ``section'' before ``2615'';
            (4) in section 2647-- <<NOTE: 42 USC 300ff-47.>> 
                    (A) in subsection (a)(1), by inserting ``to'' before 
                ``HIV'';
                    (B) in subsection (c), by striking ``section 2601'' 
                and inserting ``section 2641''; and
                    (C) in subsection (d)--

[[Page 110 STAT. 1374]]

                          (i) in the matter preceding paragraph (1), by 
                      striking ``section 2601'' and inserting ``section 
                      2641''; and
                          (ii) in paragraph (1), by striking ``has in 
                      place'' and inserting ``will have in place'';
            (5) in section 2648-- <<NOTE: 42 USC 300ff-48.>> 
                    (A) by converting the heading for the section to 
                boldface type; and
                    (B) by redesignating the second subsection (g) as 
                subsection (h);
            (6) in section 2649-- <<NOTE: 42 USC 300ff-49.>> 
                    (A) in subsection (b)(1), by striking ``subsection 
                (a) of''; and
                    (B) in subsection (c)(1), by striking ``this 
                subsection'' and inserting ``subsection'';
            (7) in section 2651-- <<NOTE: 42 USC 300ff-51.>> 
                    (A) in subsection (b)(3)(B), by striking 
                ``facility'' and inserting ``facilities''; and
                    (B) in subsection (c), by striking ``exist'' and 
                inserting ``exists'';
            (8) in section 2676-- <<NOTE: 42 USC 300ff-76.>> 
                    (A) in paragraph (2), by striking ``section'' and 
                all that follows through ``by the'' and inserting 
                ``section 2686 by the''; and
                    (B) in paragraph (10), by striking ``673(a)'' and 
                inserting ``673(2)'';
            (9) in part E, by converting the headings for subparts I and 
        II to Roman typeface; and
            (10) in section 2684(b), <<NOTE: 42 USC 300ff-84.>>  in the 
        matter preceding paragraph (1), by striking ``section 
        2682(d)(2)'' and inserting ``section 2683(d)(2)''.

SEC. 13. <<NOTE: 42 USC 300ff-11 note.>>  EFFECTIVE DATE.

    (a) In General.--Except as provided in subsection (b), this Act, and 
the amendments made by this Act, shall become effective on October 1, 
1996.
    (b) Exception.--The amendments made by sections 3(a), 5, 6, and 7 of 
this Act to sections 2601(c), 2601(d), 2603(a), 2618(b), 2626, 2677, and 
2691 of the Public Health Service Act, shall become effective on the 
date of enactment of this Act.

    Approved May 20, 1996.

LEGISLATIVE HISTORY--S. 641 (H.R. 1872):
---------------------------------------------------------------------------

HOUSE REPORTS: Nos. 104-245 accompanying H.R. 1872 (Comm. on Commerce) 
and 104-545 (Comm. of Conference).
SENATE REPORTS: No. 104-25 (Comm. on Labor and Human Resources).
CONGRESSIONAL RECORD:
                                                        Vol. 141 (1995):
                                    July 21, 26, 27, considered and 
                                        passed Senate.
                                    Sept. 18, H.R. 1872 considered and 
                                        passed House; S. 641, amended, 
                                        passed in lieu.
                                                        Vol. 142 (1996):
                                    May 1, House agreed to conference 
                                        report.
                                    May 2, Senate agreed to conference 
                                        report.
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 32 (1996):
            May 20, Presidential remarks and statement.

                                  <all>
```