104TH CONGRESS

1ST SESSION S. 641

AN ACT

To reauthorize the Ryan White CARE Act of 1990, and

for other purposes.

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

3 SECTION 1. SHORT TITLE.

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

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

2 Whenever in this Act an amendment is expressed in

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

4 the reference shall be considered to be made to a section

5 or other provision of title XXVI of the Public Health Serv6 ice Act (42 U.S.C. 300ff–11 et seq.).

7 SEC. 3. GENERAL AMENDMENTS.

8 (a) ESTABLISHMENT OF GRANT PROGRAM.—Section

9 2601 (42 U.S.C. 300ff–11) is amended—

10 (1) in subsection (a)—

11 (A) by striking ‘‘March 31 of the most re12 cent fiscal year’’ and inserting ‘‘March 31,

13 1995, and December 31 of the most recent cal14 endar year thereafter’’; and

15 (B) by striking ‘‘fiscal year—’’ and all that

16 follows through the period and inserting ‘‘fiscal

17 year, there has been reported to and confirmed

18 by, for the 5-year period prior to the fiscal year

19 for which the grant is being made, the Director

20 of the Centers for Disease Control and Preven21 tion a cumulative total of more than 2,000

22 cases of acquired immune deficiency syn23 drome.’’; and

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

25 new subsections:
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1 ‘‘(c) POPULATION OF ELIGIBLE AREAS.—The Sec2 retary may not make a grant to an eligible area under

3 subsection (a) after the date of enactment of this sub4 section unless the area has a population of at least

5 500,000 individuals, except that this subsection shall not

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

7 purposes of eligibility under this title, the boundaries of

8 each metropolitan area shall be those in effect in fiscal

9 year 1994.

10 ‘‘(d) CONTINUED FUNDING.—A metropolitan area

11 that has received a grant under this section for the fiscal

12 year in which this subsection is enacted, shall be eligible

13 to receive such a grant in subsequent fiscal years.’’.

14 (b) EMERGENCY RELIEF FOR AREAS WITH SUB15 STANTIAL NEED FOR SERVICES.—

16 (1) HIV HEALTH SERVICES PLANNING COUN17 CIL.—Subsection (b) of section 2602 (42 U.S.C.

18 300ff–12(b)) is amended—

19 (A) in paragraph (1)—

20 (i) by striking ‘‘include’’ and all that

21 follows through the end thereof, and in22 serting ‘‘reflect in its composition the de23 mographics of the epidemic in the eligible

24 area involved, with particular consideration

25 given to disproportionately affected and
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1 historically underserved groups and sub2 populations.’’; and

3 (ii) by adding at the end thereof the

4 following new sentences: ‘‘Nominations for

5 membership on the council shall be identi6 fied through an open process and can7 didates shall be selected based on locally

8 delineated and publicized criteria. Such cri9 teria shall include a conflict-of-interest

10 standard for each nominee.’’;

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

12 thereof the following new subparagraph:

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

14 may not be chaired solely by an employee of the

15 grantee.’’;

16 (C) in paragraph (3)—

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

18 ‘‘area;’’ and inserting ‘‘area based on

19 the—

20 ‘‘(i) documented needs of the HIV-in21 fected population;

22 ‘‘(ii) cost and outcome effectiveness of

23 proposed strategies and interventions, to

24 the extent that such data are reasonably
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1 available, (either demonstrated or prob2 able);

3 ‘‘(iii) priorities of the HIV-infected

4 communities for whom the services are in5 tended; and

6 ‘‘(iv) availability of other govern7 mental and nongovernmental resources;’’;

8 (ii) by striking ‘‘and’’ at the end of

9 subparagraph (B);

10 (iii) by striking the period at the end

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

12 at the discretion of the planning council,

13 assess the effectiveness, either directly or

14 through contractual arrangements, of the

15 services offered in meeting the identified

16 needs; ’’; and

17 (iv) by adding at the end thereof the

18 following new subparagraphs:

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

20 Statewide coordinated statement of need initi21 ated by the State health department;

22 ‘‘(E) establish operating procedures which

23 include specific policies for resolving disputes,

24 responding to grievances, and minimizing and

25 managing conflict-of-interests; and
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1 ‘‘(F) establish methods for obtaining input

2 on community needs and priorities which may

3 include public meetings, conducting focus

4 groups, and convening ad-hoc panels.’’;

5 (D) by redesignating paragraphs (2) and

6 (3) as paragraphs (3) and (4), respectively; and

7 (E) by inserting after paragraph (1), the

8 following new paragraph:

9 ‘‘(2) REPRESENTATION.—The HIV health serv10 ices planning council shall include representatives

11 of—

12 ‘‘(A) health care providers, including feder13 ally qualified health centers;

14 ‘‘(B) community-based organizations serv15 ing affected populations and AIDS service orga16 nizations;

17 ‘‘(C) social service providers;

18 ‘‘(D) mental health and substance abuse

19 providers;

20 ‘‘(E) local public health agencies;

21 ‘‘(F) hospital planning agencies or health

22 care planning agencies;

23 ‘‘(G) affected communities, including peo24 ple with HIV disease or AIDS and historically

25 underserved groups and subpopulations;
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1 ‘‘(H) nonelected community leaders;

2 ‘‘(I) State government (including the State

3 medicaid agency and the agency administering

4 the program under part B);

5 ‘‘(J) grantees under subpart II of part C;

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

7 none are operating in the area, representatives

8 of organizations with a history of serving chil9 dren, youth, women, and families living with

10 HIV and operating in the area; and

11 ‘‘(L) grantees under other Federal HIV

12 programs.’’.

13 (2) DISTRIBUTION OF GRANTS.—Section 2603

14 (42 U.S.C. 300ff–13) is amended—

15 (A) in subsection (a)(2), by striking ‘‘Not

16 later than—’’ and all that follows through ‘‘the

17 Secretary shall’’ and inserting the following:

18 ‘‘Not later than 60 days after an appropriation

19 becomes available to carry out this part for

20 each of the fiscal years 1996 through 2000, the

21 Secretary shall’’; and

22 (B) in subsection (b)

23 (i) in paragraph (1)—

24 (I) by striking ‘‘and’’ at the end

25 of subparagraph (D);
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1 (II) by striking the period at the

2 end of subparagraph (E) and insert3 ing a semicolon; and

4 (III) by adding at the end thereof

5 the following new subparagraphs:

6 ‘‘(F) demonstrates the inclusiveness of the

7 planning council membership, with particular

8 emphasis on affected communities and individ9 uals with HIV disease; and

10 ‘‘(G) demonstrates the manner in which

11 the proposed services are consistent with the

12 local needs assessment and the Statewide co13 ordinated statement of need.’’; and

14 (ii) by redesignating paragraphs (2),

15 (3), and (4) as paragraphs (3), (4), and

16 (5), respectively; and

17 (iii) by inserting after paragraph (1),

18 the following new paragraph:

19 ‘‘(2) PRIORITY.—

20 ‘‘(A) SEVERE NEED.—In determining se21 vere need in accordance with paragraph (1)(B),

22 the Secretary shall give priority consideration in

23 awarding grants under this section to any quali24 fied applicant that demonstrates an ability to
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1 spend funds efficiently and demonstrates a

2 more severe need based on prevalence of—

3 ‘‘(i) sexually transmitted diseases,

4 substance abuse, tuberculosis, severe men5 tal illness, or other diseases determined

6 relevant by the Secretary, which signifi7 cantly affect the impact of HIV disease in

8 affected individuals and communities;

9 ‘‘(ii) AIDS in individuals, and sub10 populations, previously unknown in the eli11 gible metropolitan area; or

12 ‘‘(iii) homelessness.

13 ‘‘(B) PREVALENCE.—In determining prev14 alence of diseases under subparagraph (A), the

15 Secretary shall use data on the prevalence of

16 the illnesses described in such subparagraph in

17 HIV-infected individuals unless such data is not

18 available nationally. Where such data is not na19 tionally available, the Secretary may use the

20 prevalence (with respect to such illnesses) in the

21 general population.’’.

22 (3) DISTRIBUTION OF FUNDS.—

23 (A) IN GENERAL.—Section 2603(a)(2) (42

24 U.S.C. 300ff–13(a)(2)) (as amended by para25 graph (2)) is further amended—
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1 (i) by inserting ‘‘, in accordance with

2 paragraph (3)’’ before the period; and

3 (ii) by adding at the end thereof the

4 following new sentence: ‘‘The Secretary

5 shall reserve an additional percentage of

6 the amount appropriated under section

7 2677 for a fiscal year for grants under

8 part A to make grants to eligible areas

9 under section 2601(a) in accordance with

10 paragraph (4).’’.

11 (B) INCREASE IN GRANT.—Section

12 2603(a) (42 U.S.C. 300ff–13(a)) is amended by

13 adding at the end thereof the following new

14 paragraph:

15 ‘‘(4) INCREASE IN GRANT.—With respect to an

16 eligible area under section 2601(a), the Secretary

17 shall increase the amount of a grant under para18 graph (2) for a fiscal year to ensure that such eligi19 ble area receives not less than—

20 ‘‘(A) with respect to fiscal year 1996, 98

21 percent;

22 ‘‘(B) with respect to fiscal year 1997, 97

23 percent;

24 ‘‘(C) with respect to fiscal year 1998, 95.5

25 percent;
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1 ‘‘(D) with respect to fiscal year 1999, 94

2 percent; and

3 ‘‘(E) with respect to fiscal year 2000, 92.5

4 percent;

5 of the amount allocated for fiscal year 1995 to such

6 entity under this subsection.’’.

7 (4) USE OF AMOUNTS.—Section 2604 (42

8 U.S.C. 300ff–14) is amended—

9 (A) in subsection (b)(1)(A)—

10 (i) by inserting ‘‘, substance abuse

11 treatment and mental health treatment,’’

12 after ‘‘case management’’; and

13 (ii) by inserting ‘‘which shall include

14 treatment education and prophylactic

15 treatment for opportunistic infections,’’

16 after ‘‘treatment services,’’;

17 (B) in subsection (b)(2)(A)—

18 (i) by inserting ‘‘, or private for-profit

19 entities if such entities are the only avail20 able provider of quality HIV care in the

21 area,’’ after ‘‘nonprofit private entities,’’;

22 and

23 (ii) by striking ‘‘and homeless health

24 centers’’ and inserting ‘‘homeless health
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1 centers, substance abuse treatment pro2 grams, and mental health programs’’; and

3 (C) in subsection (e)—

4 (i) in the subsection heading, by strik5 ing ‘‘AND PLANNING;

6 (ii) by striking ‘‘The chief’’ and in7 serting:

8 ‘‘(1) IN GENERAL.—The chief’’;

9 (iii) by striking ‘‘accounting, report10 ing, and program oversight functions’’;

11 (iv) by adding at the end thereof the

12 following new sentence: ‘‘An entity (includ13 ing subcontractors) receiving an allocation

14 from the grant awarded to the chief execu15 tive officer under this part shall not use in

16 excess of 12.5 percent of amounts received

17 under such allocation for administration.’’;

18 and

19 (v) by adding at the end thereof the

20 following new paragraphs:

21 ‘‘(2) ADMINISTRATIVE ACTIVITIES.—For the

22 purposes of paragraph (1), amounts may be used for

23 administrative activities that include—

24 ‘‘(A) routine grant administration and

25 monitoring activities, including the development
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1 of applications for part A funds, the receipt and

2 disbursal of program funds, the development

3 and establishment of reimbursement and ac4 counting systems, the preparation of routine

5 programmatic and financial reports, and com6 pliance with grant conditions and audit require7 ments; and

8 ‘‘(B) all activities associated with the

9 grantee’s contract award procedures, including

10 the development of requests for proposals, con11 tract proposal review activities, negotiation and

12 awarding of contracts, monitoring of contracts

13 through telephone consultation, written docu14 mentation or onsite visits, reporting on con15 tracts, and funding reallocation activities.’’.

16 ‘‘(3) SUBCONTRACTOR ADMINISTRATIVE

17 COSTS.—For the purposes of this subsection, sub18 contractor administrative activities include—

19 ‘‘(A) usual and recognized overhead, in20 cluding established indirect rates for agencies;

21 ‘‘(B) management oversight of specific pro22 grams funded under this title; and

23 ‘‘(C) other types of program support such

24 as quality assurance, quality control, and relat25 ed activities.’’.
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1 (5) APPLICATION.—Section 2605 (42 U.S.C.

2 300ff–15) is amended—

3 (A) in subsection (a)—

4 (i) in the matter preceding paragraph

5 (1), by inserting ‘‘, in accordance with sub6 section (c) regarding a single application

7 and grant award,’’ after ‘‘application’’;

8 (ii) in paragraph (1)(B), by striking

9 ‘‘1-year period’’ and all that follows

10 through ‘‘eligible area’’ and inserting ‘‘pre11 ceding fiscal year’’;

12 (iii) in paragraph (4), by striking

13 ‘‘and’’ at the end thereof;

14 (iv) in paragraph (5), by striking the

15 period at the end thereof and inserting ‘‘;

16 and’’; and

17 (v) by adding at the end thereof the

18 following new paragraph:

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

20 agree to participate, in the Statewide coordinated

21 statement of need process where it has been initiated

22 by the State, and ensure that the services provided

23 under the comprehensive plan are consistent with

24 the Statewide coordinated statement of need.’’;

25 (B) in subsection (b)—
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1 (i) in the subsection heading, by strik2 ing ‘‘ADDITIONAL’’;

3 (ii) in the matter preceding paragraph

4 (1), by striking ‘‘additional application’’

5 and inserting ‘‘application, in accordance

6 with subsection (c) regarding a single ap7 plication and grant award,’’;

8 (iii) in paragraph (3), by striking

9 ‘‘and’’ at the end thereof; and

10 (iv) in paragraph (4), by striking the

11 period and inserting ‘‘; and’’;

12 (C) by redesignating subsections (c) and

13 (d) as subsections (d) and (e), respectively; and

14 (D) by inserting after subsection (b), the

15 following new subsection:

16 ‘‘(c) SINGLE APPLICATION AND GRANT AWARD.—

17 ‘‘(1) APPLICATION.—The Secretary may phase

18 in the use of a single application that meets the re19 quirements of subsections (a) and (b) of section

20 2603 with respect to an eligible area that desires to

21 receive grants under section 2603 for a fiscal year.

22 ‘‘(2) GRANT AWARD.—The Secretary may phase

23 in the awarding of a single grant to an eligible area

24 that submits an approved application under para25 graph (1) for a fiscal year.’’.
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1 (6) TECHNICAL ASSISTANCE.—Section 2606

2 (42 U.S.C. 300ff–16) is amended—

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

4 ‘‘shall’’;

5 (B) by inserting after ‘‘technical assist6 ance’’ the following: ‘‘, including peer based as7 sistance to assist newly eligible metropolitan

8 areas in the establishment of HIV health serv9 ices planning councils and,’’; and

10 (C) by adding at the end thereof the fol11 lowing new sentences: ‘‘The Administrator may

12 make planning grants available to metropolitan

13 areas, in an amount not to exceed $75,000 for

14 any metropolitan area, projected to be eligible

15 for funding under section 2601 in the following

16 fiscal year. Such grant amounts shall be de17 ducted from the first year formula award to eli18 gible areas accepting such grants. Not to exceed

19 1 percent of the amount appropriated for a fis20 cal year under section 2677 for grants under

21 part A may be used to carry out this section.’’.

22 (b) CARE GRANT PROGRAM.—

23 (1) HIV CARE CONSORTIA.—Section 2613 (42

24 U.S.C. 300ff–23) is amended—

25 (A) in subsection (a)—
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1 (i) in paragraph (1), by inserting ‘‘(or

2 private for-profit providers or organiza3 tions if such entities are the only available

4 providers of quality HIV care in the area)’’

5 after ‘‘nonprofit private,’’; and

6 (ii) in paragraph (2)(A)—

7 (I) by inserting ‘‘substance abuse

8 treatment, mental health treatment,’’

9 after ‘‘nursing,’’; and

10 (II) by inserting ‘‘prophylactic

11 treatment for opportunistic infections,

12 treatment education to take place in

13 the context of health care delivery,’’

14 after ‘‘monitoring,’’;

15 (B) in subsection (c)—

16 (i) in subparagraph (C) of paragraph

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

18 centered’’; and

19 (ii) in paragraph (2)—

20 (I) in clause (ii) of subparagraph

21 (A), by striking ‘‘served; and’’ and in22 serting ‘‘served;’’;

23 (II) in subparagraph (B), by

24 striking the period at the end; and
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1 (III) by adding after subpara2 graph (B), the following new subpara3 graphs:

4 ‘‘(C) grantees under section 2671 and rep5 resentatives of organizations with a history of

6 serving children, youth, women, and families

7 with HIV and operating in the community to be

8 served; and

9 ‘‘(D) representatives of community-based

10 providers that are necessary to provide the full

11 continuum of HIV-related health care services,

12 which are available within the geographic area

13 to be served.’’; and

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

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

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

17 system of services described in this section that is targeted

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

20 women, and families. Family centered and youth centered

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

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

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

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

6 carrying out this section, the Secretary shall—

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

9 expended availability of prophylactic treatments for

10 opportunistic infections (including active tuber11 culosis); and

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

14 minimum formulary of pharmaceutical drug thera15 pies approved by the Food and Drug Administra16 tion.

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

18 those treatments in the recommended minimum formulary

19 that are for the prevention of opportunistic infections (in20 cluding the prevention of active tuberculosis).

21 ‘‘(d) STATE DUTIES.—

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

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

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

25 available to individuals eligible for assistance under
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1 this section, and to develop plans to implement fully

2 the recommended minimum formulary of pharma3 ceutical drug therapies approved by the Food and

4 Drug Administration.

5 ‘‘(2) OTHER MECHANISMS FOR PROVIDING

6 TREATMENTS.—In meeting the standards of the rec7 ommended minimum formulary developed under sub8 section (c), a State may identify other mechanisms

9 such as consortia and public programs for providing

10 such treatments to individuals with HIV.’’.

11 (3) STATE APPLICATION.—Section 2617(b) (42

12 U.S.C. 300ff–27(b)) is amended—

13 (A) in paragraph (2)—

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

15 ‘‘and’’ at the end thereof; and

16 (ii) by adding at the end thereof the

17 following new subparagraph:

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

19 and utilization of resources are consistent with

20 the Statewide coordinated statement of need

21 (including traditionally underserved populations

22 and subpopulations) developed in partnership

23 with other grantees in the State that receive

24 funding under this title;’’;
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1 (B) by redesignating paragraph (3) as

2 paragraph (4);

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

4 following new paragraph:

5 ‘‘(3) the public health agency administering the

6 grant for the State shall convene a meeting at least

7 annually of individuals with HIV who utilize services

8 under this part (including those individuals from

9 traditionally underserved populations and subpopula10 tions) and representatives of grantees funded under

11 this title (including HIV health services planning

12 councils, early intervention programs, children,

13 youth and family service projects, special projects of

14 national significance, and HIV care consortia) and

15 other providers (including federally qualified health

16 centers) and public agency representatives within the

17 State currently delivering HIV services to affected

18 communities for the purpose of developing a State19 wide coordinated statement of need; and’’; and

20 (D) by adding at the end thereof the fol21 lowing flush sentence:

22 ‘‘The State shall not be required to finance attendance at

23 the meetings described in paragraph (3). A State may pay

24 the travel-related expenses of individuals attending such
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1 meetings where appropriate and necessary to ensure ade2 quate participation.’’.

3 (4) PLANNING, EVALUATION AND ADMINISTRA4 TION.—Section 2618(c) (42 U.S.C. 300ff–28(c)) is

5 amended—

6 (A) in paragraphs (3) and (4), to read as

7 follows:

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

9 paragraph (5) and except as provided in paragraph

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

11 amounts received under a grant awarded under this

12 part for planning and evaluation activities.

13 ‘‘(4) ADMINISTRATION.—

14 ‘‘(A) IN GENERAL.—Subject to paragraph

15 (5) and except as provided in paragraph (6), a

16 State may not use more than 10 percent of

17 amounts received under a grant awarded under

18 this part for administration. An entity (includ19 ing subcontractors) receiving an allocation from

20 the grant awarded to the State under this part

21 shall not use in excess of 12.5 percent of

22 amounts received under such allocation for ad23 ministration.

24 ‘‘(B) ADMINISTRATIVE ACTIVITIES.—For

25 the purposes of subparagraph (A), amounts
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1 may be used for administrative activities that

2 include routine grant administration and mon3 itoring activities.

4 ‘‘(C) SUBCONTRACTOR ADMINISTRATIVE

5 COSTS.—For the purposes of this paragraph,

6 subcontractor administrative activities in7 clude—

8 ‘‘(i) usual and recognized overhead,

9 including established indirect rates for

10 agencies;

11 ‘‘(ii) management oversight of specific

12 programs funded under this title; and

13 ‘‘(iii) other types of program support

14 such as quality assurance, quality control,

15 and related activities.’’;

16 (B) by redesignating paragraph (5) as

17 paragraph (7); and

18 (C) by inserting after paragraph (4), the

19 following new paragraphs:

20 ‘‘(5) LIMITATION ON USE OF FUNDS.—Except

21 as provided in paragraph (6), a State may not use

22 more than a total of 15 percent of amounts received

23 under a grant awarded under this part for the pur24 poses described in paragraphs (3) and (4).
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1 ‘‘(6) EXCEPTION.—With respect to a State that

2 receives the minimum allotment under subsection

3 (a)(1) for a fiscal year, such State, from the

4 amounts received under a grant awarded under this

5 part for such fiscal year for the activities described

6 in paragraphs (3) and (4), may, notwithstanding

7 paragraphs (3), (4), and (5), use not more than that

8 amount required to support one full-time-equivalent

9 employee.’’.

10 (5) TECHNICAL ASSISTANCE.—Section 2619

11 (42 U.S.C. 300ff–29) is amended—

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

13 ‘‘shall’’; and

14 (B) by inserting before the period the fol15 lowing: ‘‘, including technical assistance for the

16 development and implementation of Statewide

17 coordinated statements of need’’.

18 (6) GRIEVANCE PROCEDURES AND COORDINA19 TION.—Part B of title XXVI (42 U.S.C. 300ff–21)

20 is amended by adding at the end thereof the follow21 ing new sections:

22 ‘‘SEC. 2621. GRIEVANCE PROCEDURES.

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

24 of this section, the Administration, in consultation with

25 affected parties, shall establish grievance procedures, spe-
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1 cific to each part of this title, to address allegations of

2 egregious violations of each such part. Such procedures

3 shall include an appropriate enforcement mechanism.

4 ‘‘SEC. 2622. COORDINATION.

5 ‘‘The Secretary shall ensure that the Health Re6 sources and Services Administration, the Centers for Dis7 ease Control and Prevention, and the Substance Abuse

8 and Mental Health Services Administration coordinate the

9 planning and implementation of Federal HIV programs

10 in order to facilitate the local development of a complete

11 continuum of HIV-related services for individuals with

12 HIV disease and those at risk of such disease. The Sec13 retary shall periodically prepare and submit to the relevant

14 committees of Congress a report concerning such coordi15 nation efforts at the Federal, State, and local levels as

16 well as the existence of Federal barriers to HIV program

17 integration.’’.

18 (c) EARLY INTERVENTION SERVICES.—

19 (1) ESTABLISHMENT OF PROGRAM.—Section

20 2651(b) (42 U.S.C. 300ff–51(b)) is amended—

21 (A) in paragraph (1), by striking ‘‘grant

22 agrees to’’ and all that follows through the pe23 riod and inserting: ‘‘grant agrees to—

24 ‘‘(A) expend the grant for the purposes of

25 providing, on an out-patient basis, each of the
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1 early intervention services specified in para2 graph (2) with respect to HIV disease; and

3 ‘‘(B) expend not less than 50 percent of

4 the amount received under the grant to provide

5 a continuum of primary care services, including,

6 as appropriate, dental care services, to individ7 uals confirmed to be living with HIV.’’; and

8 (B) in paragraph (4)—

9 (i) by striking ‘‘The Secretary’’ and

10 inserting ‘‘(A) IN GENERAL.—The Sec11 retary’’;

12 (ii) by inserting ‘‘, or private for-prof13 it entities if such entities are the only

14 available provider of quality HIV care in

15 the area,’’ after ‘‘nonprofit private enti16 ties’’;

17 (iii) by realigning the margin of sub18 paragraph (A) so as to align with the mar19 gin of paragraph (3)(A); and

20 (iv) by adding at the end thereof the

21 following new subparagraph:

22 ‘‘(B) OTHER REQUIREMENTS.—Grantees

23 described in—

24 ‘‘(i) paragraphs (1), (2), (5), and (6)

25 of section 2652(a) shall use not less than
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1 50 percent of the amount of such a grant

2 to provide the services described in sub3 paragraphs (A), (B), (D), and (E) of sec4 tion 2651(b)(2) directly and on-site or at

5 sites where other primary care services are

6 rendered; and

7 ‘‘(ii) paragraphs (3) and (4) of section

8 2652(a) shall ensure the availability of

9 early intervention services through a sys10 tem of linkages to community-based pri11 mary care providers, and to establish

12 mechanisms for the referrals described in

13 section 2651(b)(2)(C), and for follow-up

14 concerning such referrals.’’.

15 (2) MINIMUM QUALIFICATIONS.—Section

16 2652(b)(1)(B) (42 U.S.C. 300ff–52(b)(1)(B)) is

17 amended by inserting ‘‘, or a private for-profit entity

18 if such entity is the only available provider of quality

19 HIV care in the area,’’ after ‘‘nonprofit private en20 tity’’;

21 (3) MISCELLANEOUS PROVISIONS.—Section

22 2654 (42 U.S.C. 300ff–54) is amended by adding at

23 the end thereof the following new subsection:

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

2 planning grants, in an amount not to exceed

3 $50,000 for each such grant, to public and nonprofit

4 private entities that are not direct providers of pri5 mary care services for the purpose of enabling such

6 providers to provide HIV primary care services.

7 ‘‘(2) REQUIREMENT.—The Secretary may only

8 award a grant to an entity under paragraph (1) if

9 the Secretary determines that the entity will use

10 such grant to assist the entity in qualifying for a

11 grant under section 2651.

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

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

14 entities that would provide HIV primary care serv15 ices in rural or underserved communities.

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

17 the amount appropriated for a fiscal year under sec18 tion 2655 may be used to carry out this section.’’.

19 (4) AUTHORIZATION OF APPROPRIATIONS.—

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

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

22 the end of the section, and inserting ‘‘such sums as

23 may be necessary in each of the fiscal years 1996,

24 1997, 1998, 1999, and 2000.’’.
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1 (5) REQUIRED AGREEMENTS.—Section 2664(g)

2 (42 U.S.C. 300ff–64(g)) is amended—

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

4 the end thereof;

5 (B) in paragraph (3)—

6 (i) by striking ‘‘5 percent’’ and insert7 ing ‘‘10 percent including planning, evalua8 tion and technical assistance’’; and

9 (ii) by striking the period and insert10 ing ‘‘; and’’; and

11 (C) by adding at the end thereof the fol12 lowing new paragraph:

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

14 proposed program is consistent with the Statewide

15 coordinated statement of need and agree to partici16 pate in the ongoing revision of such statement of

17 need.’’.

18 (d) GRANTS.—

19 (1) IN GENERAL.—Section 2671 (42 U.S.C.

20 300ff–71) is amended to read as follows:

21 ‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND AC22 CESS TO RESEARCH FOR CHILDREN, YOUTH,

23 AND FAMILIES.

24 ‘‘(a) IN GENERAL.—The Secretary, acting through

25 the Administrator of the Health Resources and Services
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1 Administration, and in consultation with the Director of

2 the National Institutes of Health, shall award grants to

3 appropriate public or nonprofit private entities that, di4 rectly or through contractual arrangements, provide pri5 mary care to the public for the purpose of—

6 ‘‘(1) providing out-patient health care and sup7 port services (which may include family-centered and

8 youth-centered care, as defined in this title, family

9 and youth support services, and services for or10 phans) to children, youth, women with HIV disease,

11 and the families of such individuals, and supporting

12 the provision of such care with programs of HIV

13 prevention and HIV research; and

14 ‘‘(2) facilitating the voluntary participation of

15 children, youth, and women with HIV disease in

16 qualified research protocols at the facilities of such

17 entities or by direct referral.

18 ‘‘(b) ELIGIBLE ENTITIES.—The Secretary may not

19 make a grant to an entity under subsection (a) unless the

20 entity involved provides assurances that—

21 ‘‘(1) the grant will be used primarily to serve

22 children, youth, and women with HIV disease;

23 ‘‘(2) the entity will enter into arrangements

24 with one or more qualified research entities to col-
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1 laborate in the conduct or facilitation of voluntary

2 patient participation in qualified research protocols;

3 ‘‘(3) the entity will coordinate activities under

4 the grant with other providers of health care services

5 under this title, and under title V of the Social Secu6 rity Act;

7 ‘‘(4) the entity will participate in the Statewide

8 coordinated statement of need under section 2619

9 and in the revision of such statement; and

10 ‘‘(5) the entity will offer appropriate research

11 opportunities to each patient, with informed consent.

12 ‘‘(c) APPLICATION.—The Secretary may not make a

13 grant under subsection (a) unless an application for the

14 grant is submitted to the Secretary and the application

15 is in such form, is made in such manner, and contains

16 such agreements, assurances, and information as the Sec17 retary determines to be necessary to carry out this section.

18 ‘‘(d) PATIENT PARTICIPATION IN RESEARCH PROTO19 COLS.—

20 ‘‘(1) IN GENERAL.—The Secretary, acting

21 through the Administrator of the Health Resources

22 and Services Administration and the Director of the

23 Office of AIDS Research, shall establish procedures

24 to ensure that accepted standards of protection of

25 human subjects (including the provision of written
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1 informed consent) are implemented in projects sup2 ported under this section. Receipt of services by a

3 patient shall not be conditioned upon the consent of

4 the patient to participate in research.

5 ‘‘(2) RESEARCH PROTOCOLS.—

6 ‘‘(A) IN GENERAL.—The Secretary shall

7 establish mechanisms to ensure that research

8 protocols proposed to be carried out to meet the

9 requirements of this section, are of potential

10 clinical benefit to the study participants, and

11 meet accepted standards of research design.

12 ‘‘(B) REVIEW PANEL.—Mechanisms estab13 lished under subparagraph (A) shall include an

14 independent research review panel that shall re15 view all protocols proposed to be carried out to

16 meet the requirements of this section to ensure

17 that such protocols meet the requirements of

18 this section. Such panel shall make rec19 ommendations to the Secretary as to the proto20 cols that should be approved. The panel shall

21 include representatives of public and private re22 searchers, providers of services, and recipients

23 of services.

24 ‘‘(e) TRAINING AND TECHNICAL ASSISTANCE.—The

25 Secretary, acting through the Administrator of the Health
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1 Resources and Services Administration, may use not to

2 exceed five percent of the amounts appropriated under

3 subsection (h) in each fiscal year to conduct training and

4 technical assistance (including peer-based models of tech5 nical assistance) to assist applicants and grantees under

6 this section in complying with the requirements of this sec7 tion.

8 ‘‘(f) EVALUATIONS AND DATA COLLECTION.—

9 ‘‘(1) EVALUATIONS.—The Secretary shall pro10 vide for the review of programs carried out under

11 this section at the end of each grant year. Such eval12 uations may include recommendations as to the im13 provement of access to and participation in services

14 and access to and participation in qualified research

15 protocols supported under this section.

16 ‘‘(2) REPORTING REQUIREMENTS.—The Sec17 retary may establish data reporting requirements

18 and schedules as necessary to administer the pro19 gram established under this section and conduct

20 evaluations, measure outcomes, and document the

21 clients served, services provided, and participation in

22 qualified research protocols.

23 ‘‘(3) WAIVERS.—Notwithstanding the require24 ments of subsection (b), the Secretary may award

25 new grants under this section to an entity if the en-
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1 tity provide assurances, satisfactory to the Sec2 retary, that the entity will implement the assurances

3 required under paragraph (2), (3), (4), or (5) of

4 subsection (b) by the end of the second grant year.

5 If the Secretary determines through the evaluation

6 process that a recipient of funds under this section

7 is in material noncompliance with the assurances

8 provided under paragraph (2), (3), (4), or (5) of

9 subsection (b), the Secretary may provide for contin10 ued funding of up to one year if the recipient pro11 vides assurances, satisfactory to the Secretary, that

12 such noncompliance will be remedied within such pe13 riod.

14 ‘‘(g) DEFINITIONS.—For purposes of this section:

15 ‘‘(1) QUALIFIED RESEARCH ENTITY.—The term

16 ‘qualified research entity’ means a public or private

17 entity with expertise in the conduct of research that

18 has demonstrated clinical benefit to patients.

19 ‘‘(2) QUALIFIED RESEARCH PROTOCOL.—The

20 term ‘qualified research protocol’ means a research

21 study design of a public or private clinical program

22 that meets the requirements of subsection (d).

23 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There

24 are authorized to be appropriated to carry out this section,
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1 such sums as may be necessary for each of the fiscal years

2 1996 through 2000.’’.

3 (2) CONFORMING AMENDMENT.—The heading

4 for part D of title XXVI of the Public Health Serv5 ice Act is amended to read as follows:

6 ‘‘PART D—GRANTS FOR COORDINATED SERVICES

7 AND ACCESS TO RESEARCH FOR CHILDREN,

8 YOUTH, AND FAMILIES’’.

9 (e) DEMONSTRATION AND TRAINING.—

10 (1) IN GENERAL.—Title XXVI is amended by

11 adding at the end, the following new part:

12 ‘‘PART F—DEMONSTRATION AND TRAINING

13 ‘‘Subpart I—Special Projects of National Significance

14 ‘‘SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFI15 CANCE.

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

17 under each of parts A, B, C, and D of this title for each

18 fiscal year, the Secretary shall use the greater of

19 $20,000,000 or 3 percent of such amount appropriated

20 under each such part, but not to exceed $25,000,000, to

21 administer a special projects of national significance pro22 gram to award direct grants to public and nonprofit pri23 vate entities including community-based organizations to

24 fund special programs for the care and treatment of indi25 viduals with HIV disease.
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1 ‘‘(b) GRANTS.—The Secretary shall award grants

2 under subsection (a) based on—

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

4 particular model for the care and treatment of indi5 viduals with HIV disease;

6 ‘‘(2) the innovative nature of the proposed ac7 tivity; and

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

9 activity in other similar localities or nationally.

10 ‘‘(c) SPECIAL PROJECTS.—Special projects of na11 tional significance shall include the development and as12 sessment of innovative service delivery models that are de13 signed to—

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

15 ‘‘(2) assist in the development of essential com16 munity-based service delivery infrastructure; and

17 ‘‘(3) ensure the ongoing availability of services

18 for Native American communities to enable such

19 communities to care for Native Americans with HIV

20 disease.

21 ‘‘(d) SPECIAL POPULATIONS.—Special projects of na22 tional significance may include the delivery of HIV health

23 care and support services to traditionally underserved pop24 ulations including—
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1 ‘‘(1) individuals and families with HIV disease

2 living in rural communities;

3 ‘‘(2) adolescents with HIV disease;

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

5 disease;

6 ‘‘(4) homeless individuals and families with

7 HIV disease;

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

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

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

11 projects of national significance may include the develop12 ment of model approaches to delivering HIV care and sup13 port services including—

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

15 networks critical to the delivery of care in minority

16 communities;

17 ‘‘(2) programs that build organizational capac18 ity in disenfranchised communities;

19 ‘‘(3) programs designed to prepare AIDS serv20 ice organizations and grantees under this title for

21 operation within the changing health care environ22 ment; and

23 ‘‘(4) programs designed to integrate the deliv24 ery of mental health and substance abuse treatment

25 with HIV services.
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1 ‘‘(f) COORDINATION.—The Secretary may not make

2 a grant under this section unless the applicant submits

3 evidence that the proposed program is consistent with the

4 Statewide coordinated statement of need, and the appli5 cant agrees to participate in the ongoing revision process

6 of such statement of need.

7 ‘‘(g) REPLICATION.—The Secretary shall make infor8 mation concerning successful models developed under this

9 part available to grantees under this title for the purpose

10 of coordination, replication, and integration. To facilitate

11 efforts under this subsection, the Secretary may provide

12 for peer-based technical assistance from grantees funded

13 under this part.’’.

14 (2) REPEAL.—Subsection (a) of section 2618

15 (42 U.S.C. 300ff–28(a)) is repealed.

16 (f) HIV/AIDS COMMUNITIES, SCHOOLS, CEN17 TERS.—

18 (1) NEW PART.—Part F of title XXVI (as

19 added by subsection (e)) is further amended by add20 ing at the end, the following new subpart:

21 ‘‘Subpart II—AIDS Education and Training Centers

22 ‘‘SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CEN23 TERS.’’.

24 (2) AMENDMENTS.—Section 776(a)(1) (42

25 U.S.C. 294n(a)) is amended—
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1 (A) by striking subparagraphs (B) and

2 (C);

3 (B) by redesignating subparagraphs (A)

4 and (D) as subparagraphs (B) and (C), respec5 tively;

6 (C) by inserting before subparagraph (B)

7 (as so redesignated) the following new subpara8 graph:

9 ‘‘(A) training health personnel, including

10 practitioners in title XXVI programs and other

11 community providers, in the diagnosis, treat12 ment, and prevention of HIV infection and dis13 ease;’’; and

14 (D) in subparagraph (B) (as so redesig15 nated) by adding ‘‘and’’ after the semicolon.

16 (3) TRANSFER.—Subsection (a) of section 776

17 (42 U.S.C. 294n(a)) (as amended by paragraph (2))

18 is amended by transferring such subsection to sec19 tion 2692 (as added by paragraph (1)).

20 (4) AUTHORIZATION OF APPROPRIATIONS.—

21 Section 2692 (as added by paragraph (1)) is amend22 ed by adding at the end thereof the following new

23 subsection:

24 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There

25 are authorized to be appropriated to carry out this section,
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1 such sums as may be necessary for each of the fiscal years

2 1996 through 2000.’’.

3 SEC. 4. AMOUNT OF EMERGENCY RELIEF GRANTS.

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

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

6 ‘‘(3) AMOUNT OF GRANT.—

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

8 of amounts made available in appropriations

9 Acts, a grant made for purposes of this para10 graph to an eligible area shall be made in an

11 amount equal to the product of—

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

13 available for distribution under paragraph

14 (2) for the fiscal year involved; and

15 ‘‘(ii) the percentage constituted by the

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

19 ‘‘(B) DISTRIBUTION FACTOR.—For pur20 poses of subparagraph (A)(ii), the term ‘dis21 tribution factor’ means an amount equal to the

22 estimated number of living cases of acquired

23 immune deficiency syndrome in the eligible area

24 involved, as determined under subparagraph

25 (C).
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1 ‘‘(C) ESTIMATE OF LIVING CASES.—The

2 amount determined in this subparagraph is an

3 amount equal to the product of—

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

5 immune deficiency syndrome in the eligible

6 area during each year in the most recent

7 120-month period for which data are avail8 able with respect to all eligible areas, as in9 dicated by the number of such cases re10 ported to and confirmed by the Director of

11 the Centers for Disease Control and Pre12 vention for each year during such period;

13 and

14 ‘‘(ii) with respect to—

15 ‘‘(I) the first year during such

16 period, .06;

17 ‘‘(II) the second year during such

18 period, .06;

19 ‘‘(III) the third year during such

20 period, .08;

21 ‘‘(IV) the fourth year during

22 such period, .10;

23 ‘‘(V) the fifth year during such

24 period, .16;
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1 ‘‘(VI) the sixth year during such

2 period, .16;

3 ‘‘(VII) the seventh year during

4 such period, .24;

5 ‘‘(VIII) the eighth year during

6 such period, .40;

7 ‘‘(IX) the ninth year during such

8 period, .57; and

9 ‘‘(X) the tenth year during such

10 period, .88.

11 ‘‘(D) UNEXPENDED FUNDS.—The Sec12 retary may, in determining the amount of a

13 grant for a fiscal year under this paragraph,

14 adjust the grant amount to reflect the amount

15 of unexpended and uncanceled grant funds re16 maining at the end of the fiscal year preceding

17 the year for which the grant determination is to

18 be made. The amount of any such unexpended

19 funds shall be determined using the financial

20 status report of the grantee.

21 ‘‘(E) PUERTO RICO, VIRGIN ISLANDS,

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

23 cost index for an eligible area within Puerto

24 Rico, the Virgin Islands, or Guam shall be

25 1.0.’’.
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1 SEC. 5. AMOUNT OF CARE GRANTS.

2 Paragraphs (1) and (2) of section 2618(b) (42 U.S.C.

3 300ff–28(b)(1) and (2)) are amended to read as follows:

4 ‘‘(1) MINIMUM ALLOTMENT.—Subject to the ex5 tent of amounts made available under section 2677,

6 the amount of a grant to be made under this part

7 for—

8 ‘‘(A) each of the several States and the

9 District of Columbia for a fiscal year shall be

10 the greater of—

11 ‘‘(i)(I) with respect to a State or Dis12 trict that has less than 90 living cases of

13 acquired immune deficiency syndrome, as

14 determined under paragraph (2)(D),

15 $100,000; or

16 ‘‘(i)(I) with respect to a State or Dis17 trict that has 90 or more living cases of

18 acquired immune deficiency syndrome, as

19 determined under paragraph (2)(D),

20 $250,000;

21 ‘‘(ii) an amount determined under

22 paragraph (2); and

23 ‘‘(B) each territory of the United States,

24 as defined in paragraph (3), shall be an amount

25 determined under paragraph (2).

26 ‘‘(2) DETERMINATION.—
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1 ‘‘(A) FORMULA.—The amount referred to

2 in paragraph (1)(A)(ii) for a State and para3 graph (1)(B) for a territory of the United

4 States shall be the product of—

5 ‘‘(i) an amount equal to the amount

6 appropriated under section 2677 for the

7 fiscal year involved for grants under part

8 B; and

9 ‘‘(ii) the percentage constituted by the

10 sum of—

11 ‘‘(I) the product of .50 and the

12 ratio of the State distribution factor

13 for the State or territory (as deter14 mined under subsection (B)) to the

15 sum of the respective State distribu16 tion factors for all States or terri17 tories; and

18 ‘‘(II) the product of .50 and the

19 ratio of the non-EMA distribution fac20 tor for the State or territory (as de21 termined under subparagraph (C)) to

22 the sum of the respective distribution

23 factors for all States or territories.

24 ‘‘(B) STATE DISTRIBUTION FACTOR.—For

25 purposes of subparagraph (A)(ii)(I), the term
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1 ‘State distribution factor’ means an amount

2 equal to the estimated number of living cases of

3 acquired immune deficiency syndrome in the eli4 gible area involved, as determined under sub5 paragraph (D).

6 ‘‘(C) NON-EMA DISTRIBUTION FACTOR.—

7 For purposes of subparagraph (A)(ii)(II), the

8 term ‘non-ema distribution factor’ means an

9 amount equal to the sum of—

10 ‘‘(i) the estimated number of living

11 cases of acquired immune deficiency syn12 drome in the State or territory involved, as

13 determined under subparagraph (D); less

14 ‘‘(ii) the estimated number of living

15 cases of acquired immune deficiency syn16 drome in such State or territory that are

17 within an eligible area (as determined

18 under part A).

19 ‘‘(D) ESTIMATE OF LIVING CASES.—The

20 amount determined in this subparagraph is an

21 amount equal to the product of—

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

23 immune deficiency syndrome in the State

24 or territory during each year in the most

25 recent 120-month period for which data
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1 are available with respect to all States and

2 territories, as indicated by the number of

3 such cases reported to and confirmed by

4 the Director of the Centers for Disease

5 Control and Prevention for each year dur6 ing such period; and

7 ‘‘(ii) with respect to each of the first

8 through the tenth year during such period,

9 the amount referred to in

10 2603(a)(3)(C)(ii).

11 ‘‘(E) PUERTO RICO, VIRGIN ISLANDS,

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

13 cost index for Puerto Rico, the Virgin Islands,

14 and Guam shall be 1.0.’’.

15 ‘‘(F) UNEXPENDED FUNDS.—The Sec16 retary may, in determining the amount of a

17 grant for a fiscal year under this subsection,

18 adjust the grant amount to reflect the amount

19 of unexpended and uncanceled grant funds re20 maining at the end of the fiscal year preceding

21 the year for which the grant determination is to

22 be made. The amount of any such unexpended

23 funds shall be determined using the financial

24 status report of the grantee.

25 ‘‘(G) LIMITATION.—
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1 ‘‘(i) IN GENERAL.—The Secretary

2 shall ensure that the amount of a grant

3 awarded to a State or territory for a fiscal

4 year under this part is equal to not less

5 than—

6 ‘‘(I) with respect to fiscal year

7 1996, 98 percent;

8 ‘‘(II) with respect to fiscal year

9 1997, 97 percent;

10 ‘‘(III) with respect to fiscal year

11 1998, 95.5 percent;

12 ‘‘(IV) with respect to fiscal year

13 1999, 94 percent; and

14 ‘‘(V) with respect to fiscal year

15 2000, 92.5 percent;

16 of the amount such State or territory re17 ceived for fiscal year 1995 under this part.

18 In administering this subparagraph, the

19 Secretary shall, with respect to States that

20 will receive grants in amounts that exceed

21 the amounts that such States received

22 under this part in fiscal year 1995, propor23 tionally reduce such amounts to ensure

24 compliance with this subparagraph. In

25 making such reductions, the Secretary
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1 shall ensure that no such State receives

2 less than that State received for fiscal year

3 1995.

4 ‘‘(ii) RATABLE REDUCTION.—If the

5 amount appropriated under section 2677

6 and available for allocation under this part

7 is less than the amount appropriated and

8 available under this part for fiscal year

9 1995, the limitation contained in clause (i)

10 shall be reduced by a percentage equal to

11 the percentage of the reduction in such

12 amounts appropriated and available.’’.

13 SEC. 6. CONSOLIDATION OF AUTHORIZATIONS OF APPRO14 PRIATIONS.

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

16 300ff–71) is amended by adding at the end thereof the

17 following new section:

18 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

19 ‘‘(a) IN GENERAL.—Subject to subsection (b), there

20 are authorized to be appropriated to make grants under

21 parts A and B, such sums as may be necessary for each

22 of the fiscal years 1996 through 2000. Of the amount ap23 propriated under this section for fiscal year 1996, the Sec24 retary shall make available 64 percent of such amount to
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1 carry out part A and 36 percent of such amount to carry

2 out part B.

3 ‘‘(b) DEVELOPMENT OF METHODOLOGY.—

4 ‘‘(1) IN GENERAL.—With respect to each of the

5 fiscal years 1997 through 2000, the Secretary shall

6 develop and implement a methodology for adjusting

7 the percentages referred to in subsection (a) to ac8 count for grants to new eligible areas under part A

9 and other relevant factors. Not later than 1 year

10 after the date of enactment of this section, the Sec11 retary shall prepare and submit to the appropriate

12 committees of Congress a report regarding the find13 ings with respect to the methodology developed

14 under this paragraph.

15 ‘‘(2) FAILURE TO IMPLEMENT.—If the Sec16 retary fails to implement a methodology under para17 graph (1) by October 1, 1996, there are authorized

18 to be appropriated—

19 ‘‘(A) such sums as may be necessary to

20 carry out part A for each of the fiscal years

21 1997 through 2000; and

22 ‘‘(B) such sums as may be necessary to

23 carry out part B for each of the fiscal years

24 1997 through 2000.’’.
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1 (b) REPEALS.—Sections 2608 and 2620 (42 U.S.C.

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

3 (c) CONFORMING AMENDMENTS.—Title XXVI is

4 amended—

5 (1) in section 2603 (42 U.S.C. 300ff–13)—

6 (A) in subsection (a)(2), by striking

7 ‘‘2608’’ and inserting ‘‘2677’’; and

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

9 ‘‘2608’’ and inserting ‘‘2677’’;

10 (2) in section 2605(c)(1) (42 U.S.C. 300ff–

11 15(c)(1)) is amended by striking ‘‘2608’’ and insert12 ing ‘‘2677’’; and

13 (3) in section 2618 (42 U.S.C. 300ff–28)—

14 (A) in subsection (a)(1), is amended by

15 striking ‘‘2620’’ and inserting ‘‘2677’’; and

16 (B) in subsection (b)(1), is amended by

17 striking ‘‘2620’’ and inserting ‘‘2677’’.

18 SEC. 7. CDC GUIDELINES FOR PREGNANT WOMEN.

19 (a) REQUIREMENT.—Notwithstanding any other pro20 vision of law, a State described in subsection (b) shall,

21 not later than 1 year after the date of enactment of this

22 Act, certify to the Secretary of Health and Human Serv23 ices that such State has in effect regulations to adopt the

24 guidelines issued by the Centers for Disease Control and

25 Prevention concerning recommendations for immuno-
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1 deficiency virus counseling and voluntary testing for preg2 nant women.

3 (b) APPLICATION OF SECTION.—A State described in

4 this subsection is a State that has—

5 (1) an HIV seroprevalance among child bearing

6 women during the period beginning on January 1,

7 1991 and ending on December 31, 1992, of .25 or

8 greater as determined by the Centers for Disease

9 Control and Prevention; or

10 (2) an estimated number of births to HIV posi11 tive women in 1993 of 175 or greater as determined

12 by the Centers for Disease Control and Prevention

13 using 1992 natality statistics.

14 (c) NONCOMPLIANCE.—If a State does not provide

15 the certification required under subsection (a) within the

16 1 year period described in such subsection, such State

17 shall not be eligible to receive assistance for HIV counsel18 ing and testing under the Public Health Service Act (42

19 U.S.C. 201 et seq.) until such certification is provided.

20 (d) ADDITIONAL FUNDS REGARDING WOMEN AND

21 INFANTS.—

22 (1) IN GENERAL.—If a State described in sub23 section (b) provides the certification required in sub24 section (a) and is receiving funds under part B of

25 title XXVI of the Public Health Service Act for a
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1 fiscal year, the Secretary of Health and Human

2 Services may (from the amounts available pursuant

3 to paragraph (3)) make a grant to the State for the

4 fiscal year for the following purposes:

5 (A) Making available to pregnant women

6 appropriate counseling on HIV disease.

7 (B) Making available outreach efforts to

8 pregnant women at high risk of HIV who are

9 not currently receiving prenatal care.

10 (C) Making available to such women test11 ing for such disease.

12 (D) Offsetting other State costs associated

13 with the implementation of the requirement of

14 subsection (a).

15 (2) EVALUATION BY INSTITUTE OF MEDI16 CINE.—

17 (A) IN GENERAL.—The Secretary of

18 Health and Human Services shall request the

19 Institute of Medicine of the National Academy

20 of Sciences to enter into a contract with the

21 Secretary for the purpose of conducting an eval22 uation of the extent to which grants under

23 paragraph (1) have been effective in preventing

24 the perinatal transmission of the human

25 immunodeficiency virus.
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1 (B) ALTERNATIVE CONTRACT.—If the In2 stitute referred to in subparagraph (A) declines

3 to conduct the evaluation under such subpara4 graph, the Secretary of Health and Human

5 Services shall carry out such subparagraph

6 through another public or nonprofit private en7 tity.

8 (C) DATE CERTAIN FOR REPORT.—The

9 Secretary of Health and Human Services shall

10 ensure that, not later than after 2 years after

11 the date of the enactment of this Act, the eval12 uation required in this paragraph is completed

13 and a report describing the findings made as a

14 result of the evaluation is submitted to the Con15 gress.

16 (3) FUNDING.—For the purpose of carrying out

17 this subsection, there are authorized to be appro18 priated $10,000,000 for each of the fiscal years

19 1996 through 2000. Amounts made available under

20 section 2677 for carrying out this part are not avail21 able for carrying out this subsection.

22 SEC. 8. SPOUSAL NOTIFICATION.

23 (a) PROHIBITION ON THE USE OF FUNDS.—The Sec24 retary shall not make a grant under this Act to any State

25 or political subdivision of any State, nor shall any other
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1 funds made available under this Act, be obligated or ex2 pended in any State unless such State takes administra3 tive or legislative action to require that a good faith effort

4 shall be made to notify a spouse of an AIDS-infected pa5 tient that such AIDS-infected patient is infected with the

6 human immunodeficiency virus.

7 (b) DEFINITIONS.—As used in this section—

8 (1) AIDS-INFECTED PATIENT.—The term

9 ‘‘AIDS-infected patient’’ means any person who has

10 been diagnosed by a physician or surgeon practicing

11 medicine in such State to be infected with the

12 human immunodeficiency virus.

13 (2) STATE.—The term ‘‘State’’ means a State,

14 the District of Columbia, or any territory of the

15 United States.

16 (3) SPOUSE.—The term ‘‘spouse’’ means a per17 son who is or at any time since December 31, 1976,

18 has been the marriage partner of a person diagnosed

19 as an AIDS-infected patient.

20 (c) EFFECTIVE DATE.—Subsection (a) shall take ef21 fect with respect to a State on January 1 of the calendar

22 year following the first regular session of the legislative

23 body of such State that is convened following the date of

24 enactment of this section.
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1 SEC. 9. STUDY ON ALLOTMENT FORMULA.

2 (a) STUDY.—The Secretary of Health and Human

3 Services (hereafter referred to in this section as the ‘‘Sec4 retary’’) shall enter into a contract with a public or non5 profit private entity, subject to subsection (b), for the pur6 pose of conducting a study or studies concerning the statu7 tory formulas under which funds made available under

8 part A or B of title XXVI of the Public Health Service

9 Act are allocated among eligible areas (in the case of

10 grants under part A) and States and territories (in the

11 case of grants under part B). Such study or studies shall

12 include—

13 (1) an assessment of the degree to which each

14 such formula allocates funds according to the respec15 tive needs of eligible areas, State, and territories;

16 (2) an assessment of the validity and relevance

17 of the factors currently included in each such for18 mula;

19 (3) in the case of the formula under part A, an

20 assessment of the degree to which the formula re21 flects the relative costs of providing services under

22 such title XXVI within eligible areas;

23 (4) in the case of the formula under part B, an

24 assessment of the degree to which the formula re25 flects the relative costs of providing services under
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1 such title XXVI within eligible States and terri2 tories; and

3 (5) any other information that would contribute

4 to a thorough assessment of the appropriateness of

5 the current formulas.

6 (b) NATIONAL ACADEMY OF SCIENCES.—The Sec7 retary shall request the National Academy of Sciences to

8 enter into the contract under subsection (a) to conduct

9 the study described in such subsection. If such Academy

10 declines to conduct the study, the Secretary shall carry

11 out such subsection through another public or nonprofit

12 private entity.

13 (c) REPORT.—The Secretary shall ensure that not

14 later than 6 months after the date of enactment of this

15 Act, the study required under subsection (a) is completed

16 and a report describing the findings made as a result of

17 such study is submitted to the Committee on Commerce

18 of the House of Representatives and the Committee on

19 Labor and Human Resources of the Senate.

20 (d) CONSULTATION.—The entity preparing the report

21 required under subsection (c), shall consult with the

22 Comptroller General of the United States. The Comptrol23 ler General shall review the study after its transmittal to

24 the committees described in subsection (c) and within 3
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1 months make appropriate recommendations concerning

2 such report to such committees.

3 SEC. 10. PROHIBITIONS AND LIMITATIONS ON THE USE OF

4 FEDERAL FUNDS

5 (a) PROMOTION OR ENCOURAGEMENT OF CERTAIN

6 ACTIVITIES.—No funds authorized to be appropriated

7 under this Act may be used to promote or encourage, di8 rectly or indirectly, homosexuality, or intravenous drug

9 use.

10 (b) DEFINITION.—As used in subsection (a), the

11 term ‘‘to promote or encourage, directly or indirectly, ho12 mosexuality’’ includes, but is not limited to, affirming ho13 mosexuality as natural, normal, or healthy, or, in the proc14 ess of addressing related ‘‘at-risk’’ issues, affirming in any

15 way that engaging in a homosexual act is desirable, ac16 ceptable, or permissible, or, describing in any way tech17 niques of homosexual sex.

18 SEC. 11. OPTIONAL PARTICIPATION OF FEDERAL EMPLOY19 EES IN AIDS TRAINING PROGRAMS.

20 (a) IN GENERAL.—Notwithstanding any other provi21 sion of law, a Federal employee may not be required to

22 attend or participate in an AIDS or HIV training program

23 if such employee refuses to consent to such attendance or

24 participation. An employer may not retaliate in any man25 ner against such an employee because of the refusal of
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1 such employee to consent to such attendance or participa2 tion.

3 (b) DEFINITION.—As used in subsection (a), the

4 term ‘‘Federal employee’’ has the same meaning given the

5 term ‘‘employee’’ in section 2105 of title 5, United States

6 Code, and such term shall include members of the armed

7 forces.

8 SEC. 12. PROHIBITION ON PROMOTION OF CERTAIN AC9 TIVITIES.

10 Part D of title XXVI of the Public Health Service

11 Act (42 U.S.C. 300ff-71) as amended by section 6, is fur12 ther amended by adding at the end thereof the following

13 new section:

14 ‘‘SEC. 2678. PROHIBITION ON PROMOTION OF CERTAIN AC15 TIVITIES.

16 ‘‘None of the funds authorized under this title shall

17 be used to fund AIDS programs, or to develop materials,

18 designed to promote or encourage, directly, intravenous

19 drug use or sexual activity, whether homosexual or hetero20 sexual. Funds authorized under this title may be used to

21 provide medical treatment and support services for indi22 viduals with HIV.’’.

23 SEC. 13. LIMITATION ON APPROPRIATIONS.

24 Notwithstanding any other provision of law, the total

25 amounts of Federal funds expended in any fiscal year for
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1 AIDS and HIV activities may not exceed the total

2 amounts expended in such fiscal year for activities related

3 to cancer.

4 SEC. 14. EFFECTIVE DATE.

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

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

7 become effective on October 1, 1995.

8 (b) ELIGIBLE AREAS.—

9 (1) IN GENERAL.—The amendments made by

10 subsections (a)(1)(A), (a)(2), and (b)(4)(A) of sec11 tion 3 shall become effective on the date of enact12 ment of this Act.

13 (2) REPORTED CASES.—The amendment made

14 by subsection (a)(1)(B) of section 3 shall become ef15 fective on October 1, 1997.

Passed the Senate July 27 (legislative day, July 10),

1995.

Attest:

Secretary.
104TH CONGRESS

1ST SESSION S. 641

AN ACT

To reauthorize the Ryan White CARE Act of 1990,

and for other purposes.
S 641 ES——5S 641 ES——4S 641 ES——3S 641 ES——2