Calendar No. 47

104TH CONGRESS

1ST SESSION S. 641

[Report No. 104–25]

A BILL

To reauthorize the Ryan White CARE Act of 1990,

and for other purposes.

APRIL 3 (legislative day, MARCH 27), 1995

Reported without amendment
Calendar No. 47

104TH CONGRESS

1ST SESSION S. 641

[Report No. 104–25]

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

IN THE SENATE OF THE UNITED STATES

MARCH 28 (legislative day, MARCH 27), 1995

Mrs. KASSEBAUM (for herself, Mr. KENNEDY, Mr. HATCH, Mr. JEFFORDS,

Mr. FRIST, Mr. PELL, Mr. DODD, Mr. COATS, Mr. SIMON, Mr.

WELLSTONE, Mrs. BOXER, Mrs. FEINSTEIN, Mr. GLENN, Mr. INOUYE,

Mr. SARBANES, Mr. BRYAN, Mr. LEAHY, Mr. FORD, Mr. BINGAMAN, Mr.

KOHL, Mr. BREAUX, Mr. LEVIN, and Mr. AKAKA) introduced the following bill; which was read twice and referred to the Committee on Labor

and Human Resources

APRIL 3 (legislative day, MARCH 27), 1995

Reported by Mrs. KASSEBAUM, without amendment

A BILL

To reauthorize the Ryan White CARE Act of 1990, and

for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
2

•S 641 RS

1 SECTION 1. SHORT TITLE.

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

3 Reauthorization Act of 1995’’.

4 SEC. 2. REFERENCES.

5 Whenever in this Act an amendment is expressed in

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

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

8 or other provision of title XXVI of the Public Health Serv9 ice Act (42 U.S.C. 300ff–11 et seq.).

10 SEC. 3. GENERAL AMENDMENTS.

11 (a) ESTABLISHMENT OF GRANT PROGRAM.—Section

12 2601 (42 U.S.C. 300ff–11) is amended—

13 (1) in subsection (a)—

14 (A) by striking ‘‘March 31 of the most re15 cent fiscal year’’ and inserting ‘‘March 31,

16 1995, and December 31 of the most recent cal17 endar year thereafter’’; and

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

19 follows through the period and inserting ‘‘fiscal

20 year, there has been reported to and confirmed

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

22 for which the grant is being made, the Director

23 of the Centers for Disease Control and Preven24 tion a cumulative total of more than 2,000

25 cases of acquired immune deficiency syn26 drome.’’; and
3

•S 641 RS

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

2 new subsections:

3 ‘‘(c) POPULATION OF ELIGIBLE AREAS.—The Sec4 retary may not make a grant to an eligible area under

5 subsection (a) after the date of enactment of this sub6 section unless the area has a population of at least

7 500,000 individuals, except that this subsection shall not

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

9 purposes of eligibility under this title, the boundaries of

10 each metropolitan area shall be those in effect in fiscal

11 year 1994.

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

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

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

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

16 (b) EMERGENCY RELIEF FOR AREAS WITH SUB17 STANTIAL NEED FOR SERVICES.—

18 (1) HIV HEALTH SERVICES PLANNING COUN19 CIL.—Subsection (b) of section 2602 (42 U.S.C.

20 300ff–12(b)) is amended—

21 (A) in paragraph (1)—

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

23 follows through the end thereof, and in24 serting ‘‘reflect in its composition the de25 mographics of the epidemic in the eligible
4

•S 641 RS

1 area involved, with particular consideration

2 given to disproportionately affected and

3 historically underserved groups and sub4 populations.’’; and

5 (ii) by adding at the end thereof the

6 following new sentences: ‘‘Nominations for

7 membership on the council shall be identi8 fied through an open process and can9 didates shall be selected based on locally

10 delineated and publicized criteria. Such cri11 teria shall include a conflict-of-interest

12 standard for each nominee.’’;

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

14 thereof the following new subparagraph:

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

16 may not be chaired solely by an employee of the

17 grantee.’’;

18 (C) in paragraph (3)—

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

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

21 the—

22 ‘‘(i) documented needs of the HIV-in23 fected population;

24 ‘‘(ii) cost and outcome effectiveness of

25 proposed strategies and interventions, to
5

•S 641 RS

1 the extent that such data are reasonably

2 available, (either demonstrated or prob3 able);

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

5 communities for whom the services are in6 tended; and

7 ‘‘(iv) availability of other govern8 mental and nongovernmental resources;’’;

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

10 subparagraph (B);

11 (iii) by striking the period at the end

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

13 at the discretion of the planning council,

14 assess the effectiveness, either directly or

15 through contractual arrangements, of the

16 services offered in meeting the identified

17 needs; ’’; and

18 (iv) by adding at the end thereof the

19 following new subparagraphs:

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

21 Statewide coordinated statement of need initi22 ated by the State health department;

23 ‘‘(E) establish operating procedures which

24 include specific policies for resolving disputes,
6

•S 641 RS

1 responding to grievances, and minimizing and

2 managing conflict-of-interests; and

3 ‘‘(F) establish methods for obtaining input

4 on community needs and priorities which may

5 include public meetings, conducting focus

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

7 (D) by redesignating paragraphs (2) and

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

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

10 following new paragraph:

11 ‘‘(2) REPRESENTATION.—The HIV health serv12 ices planning council shall include representatives

13 of—

14 ‘‘(A) health care providers, including feder15 ally qualified health centers;

16 ‘‘(B) community-based organizations serv17 ing affected populations and AIDS service orga18 nizations;

19 ‘‘(C) social service providers;

20 ‘‘(D) mental health and substance abuse

21 providers;

22 ‘‘(E) local public health agencies;

23 ‘‘(F) hospital planning agencies or health

24 care planning agencies;
7

•S 641 RS

1 ‘‘(G) affected communities, including peo2 ple with HIV disease or AIDS and historically

3 underserved groups and subpopulations;

4 ‘‘(H) nonelected community leaders;

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

6 medicaid agency and the agency administering

7 the program under part B);

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

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

10 none are operating in the area, representatives

11 of organizations with a history of serving chil12 dren, youth, women, and families living with

13 HIV and operating in the area; and

14 ‘‘(L) grantees under other Federal HIV

15 programs.’’.

16 (2) DISTRIBUTION OF GRANTS.—Section 2603

17 (42 U.S.C. 300ff–13) is amended—

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

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

20 Secretary shall’’ and inserting the following:

21 ‘‘Not later than 60 days after an appropriation

22 becomes available to carry out this part for

23 each of the fiscal years 1996 through 2000, the

24 Secretary shall’’; and

25 (B) in subsection (b)
8

•S 641 RS

1 (i) in paragraph (1)—

2 (I) by striking ‘‘and’’ at the end

3 of subparagraph (D);

4 (II) by striking the period at the

5 end of subparagraph (E) and insert6 ing a semicolon; and

7 (III) by adding at the end thereof

8 the following new subparagraphs:

9 ‘‘(F) demonstrates the inclusiveness of the

10 planning council membership, with particular

11 emphasis on affected communities and individ12 uals with HIV disease; and

13 ‘‘(G) demonstrates the manner in which

14 the proposed services are consistent with the

15 local needs assessment and the Statewide co16 ordinated statement of need.’’; and

17 (ii) by redesignating paragraphs (2),

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

19 (5), respectively; and

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

21 the following new paragraph:

22 ‘‘(2) PRIORITY.—

23 ‘‘(A) SEVERE NEED.—In determining se24 vere need in accordance with paragraph (1)(B),

25 the Secretary shall give priority consideration in
9

•S 641 RS

1 awarding grants under this section to any quali2 fied applicant that demonstrates an ability to

3 spend funds efficiently and demonstrates a

4 more severe need based on prevalence of—

5 ‘‘(i) sexually transmitted diseases,

6 substance abuse, tuberculosis, severe men7 tal illness, or other diseases determined

8 relevant by the Secretary, which signifi9 cantly affect the impact of HIV disease in

10 affected individuals and communities;

11 ‘‘(ii) AIDS in individuals, and sub12 populations, previously unknown in the eli13 gible metropolitan area; or

14 ‘‘(iii) homelessness.

15 ‘‘(B) PREVALENCE.—In determining prev16 alence of diseases under subparagraph (A), the

17 Secretary shall use data on the prevalence of

18 the illnesses described in such subparagraph in

19 HIV-infected individuals unless such data is not

20 available nationally. Where such data is not na21 tionally available, the Secretary may use the

22 prevalence (with respect to such illnesses) in the

23 general population.’’.

24 (3) DISTRIBUTION OF FUNDS.—
10

•S 641 RS

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

2 U.S.C. 300ff–13(a)(2)) (as amended by para3 graph (2)) is further amended—

4 (i) by inserting ‘‘, in accordance with

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

6 (ii) by adding at the end thereof the

7 following new sentence: ‘‘The Secretary

8 shall reserve an additional percentage of

9 the amount appropriated under section

10 2677 for a fiscal year for grants under

11 part A to make grants to eligible areas

12 under section 2601(a) in accordance with

13 paragraph (4).’’.

14 (B) INCREASE IN GRANT.—Section

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

16 adding at the end thereof the following new

17 paragraph:

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

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

20 shall increase the amount of a grant under para21 graph (2) for a fiscal year to ensure that such eligi22 ble area receives not less than—

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

24 percent;
11

•S 641 RS

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

2 percent;

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

4 percent;

5 ‘‘(D) with respect to fiscal year 1999, 94

6 percent; and

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

8 percent;

9 of the amount allocated for fiscal year 1995 to such

10 entity under this subsection.’’.

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

12 U.S.C. 300ff–14) is amended—

13 (A) in subsection (b)(1)(A)—

14 (i) by inserting ‘‘, substance abuse

15 treatment and mental health treatment,’’

16 after ‘‘case management’’; and

17 (ii) by inserting ‘‘which shall include

18 treatment education and prophylactic

19 treatment for opportunistic infections,’’

20 after ‘‘treatment services,’’;

21 (B) in subsection (b)(2)(A)—

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

23 entities if such entities are the only avail24 able provider of quality HIV care in the
12

•S 641 RS

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

2 and

3 (ii) by striking ‘‘and homeless health

4 centers’’ and inserting ‘‘homeless health

5 centers, substance abuse treatment pro6 grams, and mental health programs’’; and

7 (C) in subsection (e)—

8 (i) in the subsection heading, by strik9 ing ‘‘AND PLANNING;

10 (ii) by striking ‘‘The chief’’ and in11 serting:

12 ‘‘(1) IN GENERAL.—The chief’’;

13 (iii) by striking ‘‘accounting, report14 ing, and program oversight functions’’;

15 (iv) by adding at the end thereof the

16 following new sentence: ‘‘An entity (includ17 ing subcontractors) receiving an allocation

18 from the grant awarded to the chief execu19 tive officer under this part shall not use in

20 excess of 12.5 percent of amounts received

21 under such allocation for administration.’’;

22 and

23 (v) by adding at the end thereof the

24 following new paragraphs:
13

•S 641 RS

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

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

3 administrative activities that include—

4 ‘‘(A) routine grant administration and

5 monitoring activities, including the development

6 of applications for part A funds, the receipt and

7 disbursal of program funds, the development

8 and establishment of reimbursement and ac9 counting systems, the preparation of routine

10 programmatic and financial reports, and com11 pliance with grant conditions and audit require12 ments; and

13 ‘‘(B) all activities associated with the

14 grantee’s contract award procedures, including

15 the development of requests for proposals, con16 tract proposal review activities, negotiation and

17 awarding of contracts, monitoring of contracts

18 through telephone consultation, written docu19 mentation or onsite visits, reporting on con20 tracts, and funding reallocation activities.’’.

21 ‘‘(3) SUBCONTRACTOR ADMINISTRATIVE

22 COSTS.—For the purposes of this subsection, sub23 contractor administrative activities include—

24 ‘‘(A) usual and recognized overhead, in25 cluding established indirect rates for agencies;
14

•S 641 RS

1 ‘‘(B) management oversight of specific pro2 grams funded under this title; and

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

4 as quality assurance, quality control, and relat5 ed activities.’’.

6 (5) APPLICATION.—Section 2605 (42 U.S.C.

7 300ff–15) is amended—

8 (A) in subsection (a)—

9 (i) in the matter preceding paragraph

10 (1), by inserting ‘‘, in accordance with sub11 section (c) regarding a single application

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

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

14 ‘‘1-year period’’ and all that follows

15 through ‘‘eligible area’’ and inserting ‘‘pre16 ceding fiscal year’’;

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

18 ‘‘and’’ at the end thereof;

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

20 period at the end thereof and inserting ‘‘;

21 and’’; and

22 (v) by adding at the end thereof the

23 following new paragraph:

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

25 agree to participate, in the Statewide coordinated
15

•S 641 RS

1 statement of need process where it has been initiated

2 by the State, and ensure that the services provided

3 under the comprehensive plan are consistent with

4 the Statewide coordinated statement of need.’’;

5 (B) in subsection (b)—

6 (i) in the subsection heading, by strik7 ing ‘‘ADDITIONAL’’;

8 (ii) in the matter preceding paragraph

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

10 and inserting ‘‘application, in accordance

11 with subsection (c) regarding a single ap12 plication and grant award,’’;

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

14 ‘‘and’’ at the end thereof; and

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

16 period and inserting ‘‘; and’’;

17 (C) by redesignating subsections (c) and

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

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

20 following new subsection:

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

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

23 in the use of a single application that meets the re24 quirements of subsections (a) and (b) of section
16

•S 641 RS

1 2603 with respect to an eligible area that desires to

2 receive grants under section 2603 for a fiscal year.

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

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

5 that submits an approved application under para6 graph (1) for a fiscal year.’’.

7 (6) TECHNICAL ASSISTANCE.—Section 2606

8 (42 U.S.C. 300ff–16) is amended—

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

10 ‘‘shall’’;

11 (B) by inserting after ‘‘technical assist12 ance’’ the following: ‘‘, including peer based as13 sistance to assist newly eligible metropolitan

14 areas in the establishment of HIV health serv15 ices planning councils and,’’; and

16 (C) by adding at the end thereof the fol17 lowing new sentences: ‘‘The Administrator may

18 make planning grants available to metropolitan

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

20 any metropolitan area, projected to be eligible

21 for funding under section 2601 in the following

22 fiscal year. Such grant amounts shall be de23 ducted from the first year formula award to eli24 gible areas accepting such grants. Not to exceed

25 1 percent of the amount appropriated for a fis-
17

•S 641 RS

1 cal year under section 2677 for grants under

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

3 (b) CARE GRANT PROGRAM.—

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

5 U.S.C. 300ff–23) is amended—

6 (A) in subsection (a)—

7 (i) in paragraph (1), by inserting ‘‘(or

8 private for-profit providers or organiza9 tions if such entities are the only available

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

11 after ‘‘nonprofit private,’’; and

12 (ii) in paragraph (2)(A)—

13 (I) by inserting ‘‘substance abuse

14 treatment, mental health treatment,’’

15 after ‘‘nursing,’’; and

16 (II) by inserting ‘‘prophylactic

17 treatment for opportunistic infections,

18 treatment education to take place in

19 the context of health care delivery,’’

20 after ‘‘monitoring,’’;

21 (B) in subsection (c)—

22 (i) in subparagraph (C) of paragraph

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

24 centered’’; and

25 (ii) in paragraph (2)—
18

•S 641 RS

1 (I) in clause (ii) of subparagraph

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

4 (II) in subparagraph (B), by

5 striking the period at the end; and

6 (III) by adding after subpara7 graph (B), the following new subpara8 graphs:

9 ‘‘(C) grantees under section 2671 and rep10 resentatives of organizations with a history of

11 serving children, youth, women, and families

12 with HIV and operating in the community to be

13 served; and

14 ‘‘(D) representatives of community-based

15 providers that are necessary to provide the full

16 continuum of HIV-related health care services,

17 which are available within the geographic area

18 to be served.’’; and

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

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

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

22 system of services described in this section that is targeted

23 specifically to the special needs of infants, children (in24 cluding those orphaned by the AIDS epidemic), youth,

25 women, and families. Family centered and youth centered
19

•S 641 RS

1 care shall be based on a partnership among parents, ex2 tended family members, children and youth, professionals,

3 and the community designed to ensure an integrated, co4 ordinated, culturally sensitive, and community-based con5 tinuum of care.’’.

6 (2) PROVISION OF TREATMENTS.—Section 2616

7 (42 U.S.C. 300ff–26) is amended by striking sub8 section (c) and inserting the following new sub9 sections:

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

11 carrying out this section, the Secretary shall—

12 ‘‘(1) review the current status of State drug re13 imbursement programs and assess barriers to the

14 expended availability of prophylactic treatments for

15 opportunistic infections (including active tuber16 culosis); and

17 ‘‘(2) establish, in consultation with States, pro18 viders, and affected communities, a recommended

19 minimum formulary of pharmaceutical drug thera20 pies approved by the Food and Drug Administra21 tion.

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

23 those treatments in the recommended minimum formulary

24 that are for the prevention of opportunistic infections (in25 cluding the prevention of active tuberculosis).
20

•S 641 RS

1 ‘‘(d) STATE DUTIES.—

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

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

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

5 available to individuals eligible for assistance under

6 this section, and to develop plans to implement fully

7 the recommended minimum formulary of pharma8 ceutical drug therapies approved by the Food and

9 Drug Administration.

10 ‘‘(2) OTHER MECHANISMS FOR PROVIDING

11 TREATMENTS.—In meeting the standards of the rec12 ommended minimum formulary developed under sub13 section (c), a State may identify other mechanisms

14 such as consortia and public programs for providing

15 such treatments to individuals with HIV.’’.

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

17 U.S.C. 300ff–27(b)) is amended—

18 (A) in paragraph (2)—

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

20 ‘‘and’’ at the end thereof; and

21 (ii) by adding at the end thereof the

22 following new subparagraph:

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

24 and utilization of resources are consistent with

25 the Statewide coordinated statement of need
21

•S 641 RS

1 (including traditionally underserved populations

2 and subpopulations) developed in partnership

3 with other grantees in the State that receive

4 funding under this title;’’;

5 (B) by redesignating paragraph (3) as

6 paragraph (4);

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

8 following new paragraph:

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

10 grant for the State shall convene a meeting at least

11 annually of individuals with HIV who utilize services

12 under this part (including those individuals from

13 traditionally underserved populations and subpopula14 tions) and representatives of grantees funded under

15 this title (including HIV health services planning

16 councils, early intervention programs, children,

17 youth and family service projects, special projects of

18 national significance, and HIV care consortia) and

19 other providers (including federally qualified health

20 centers) and public agency representatives within the

21 State currently delivering HIV services to affected

22 communities for the purpose of developing a State23 wide coordinated statement of need; and’’; and

24 (D) by adding at the end thereof the fol25 lowing flush sentence:
22

•S 641 RS

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

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

3 the travel-related expenses of individuals attending such

4 meetings where appropriate and necessary to ensure ade5 quate participation.’’.

6 (4) PLANNING, EVALUATION AND ADMINISTRA7 TION.—Section 2618(c) (42 U.S.C. 300ff–28(c)) is

8 amended—

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

10 follows:

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

12 paragraph (5) and except as provided in paragraph

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

14 amounts received under a grant awarded under this

15 part for planning and evaluation activities.

16 ‘‘(4) ADMINISTRATION.—

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

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

19 State may not use more than 10 percent of

20 amounts received under a grant awarded under

21 this part for administration. An entity (includ22 ing subcontractors) receiving an allocation from

23 the grant awarded to the State under this part

24 shall not use in excess of 12.5 percent of
23

•S 641 RS

1 amounts received under such allocation for ad2 ministration.

3 ‘‘(B) ADMINISTRATIVE ACTIVITIES.—For

4 the purposes of subparagraph (A), amounts

5 may be used for administrative activities that

6 include routine grant administration and mon7 itoring activities.

8 ‘‘(C) SUBCONTRACTOR ADMINISTRATIVE

9 COSTS.—For the purposes of this paragraph,

10 subcontractor administrative activities in11 clude—

12 ‘‘(i) usual and recognized overhead,

13 including established indirect rates for

14 agencies;

15 ‘‘(ii) management oversight of specific

16 programs funded under this title; and

17 ‘‘(iii) other types of program support

18 such as quality assurance, quality control,

19 and related activities.’’;

20 (B) by redesignating paragraph (5) as

21 paragraph (7); and

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

23 following new paragraphs:

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

25 as provided in paragraph (6), a State may not use
24

•S 641 RS

1 more than a total of 15 percent of amounts received

2 under a grant awarded under this part for the pur3 poses described in paragraphs (3) and (4).

4 ‘‘(6) EXCEPTION.—With respect to a State that

5 receives the minimum allotment under subsection

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

7 amounts received under a grant awarded under this

8 part for such fiscal year for the activities described

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

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

11 amount required to support one full-time-equivalent

12 employee.’’.

13 (5) TECHNICAL ASSISTANCE.—Section 2619

14 (42 U.S.C. 300ff–29) is amended—

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

16 ‘‘shall’’; and

17 (B) by inserting before the period the fol18 lowing: ‘‘, including technical assistance for the

19 development and implementation of Statewide

20 coordinated statements of need’’.

21 (6) GRIEVANCE PROCEDURES AND COORDINA22 TION.—Part B of title XXVI (42 U.S.C. 300ff–21)

23 is amended by adding at the end thereof the follow24 ing new sections:
25

•S 641 RS

1 ‘‘SEC. 2621. GRIEVANCE PROCEDURES.

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

3 of this section, the Administration, in consultation with

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

6 egregious violations of each such part. Such procedures

7 shall include an appropriate enforcement mechanism.

8 ‘‘SEC. 2622. COORDINATION.

9 ‘‘The Secretary shall ensure that the Health Re10 sources and Services Administration, the Centers for Dis11 ease Control and Prevention, and the Substance Abuse

12 and Mental Health Services Administration coordinate the

13 planning and implementation of Federal HIV programs

14 in order to facilitate the local development of a complete

15 continuum of HIV-related services for individuals with

16 HIV disease and those at risk of such disease. The Sec17 retary shall periodically prepare and submit to the relevant

18 committees of Congress a report concerning such coordi19 nation efforts at the Federal, State, and local levels as

20 well as the existence of Federal barriers to HIV program

21 integration.’’.

22 (c) EARLY INTERVENTION SERVICES.—

23 (1) ESTABLISHMENT OF PROGRAM.—Section

24 2651(b) (42 U.S.C. 300ff–51(b)) is amended—
26

•S 641 RS

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

2 agrees to’’ and all that follows through the pe3 riod and inserting: ‘‘grant agrees to—

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

5 providing, on an out-patient basis, each of the

6 early intervention services specified in para7 graph (2) with respect to HIV disease; and

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

9 the amount received under the grant to provide

10 a continuum of primary care services, including,

11 as appropriate, dental care services, to individ12 uals confirmed to be living with HIV.’’; and

13 (B) in paragraph (4)—

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

15 inserting ‘‘(A) IN GENERAL.—The Sec16 retary’’;

17 (ii) by inserting ‘‘, or private for-prof18 it entities if such entities are the only

19 available provider of quality HIV care in

20 the area,’’ after ‘‘nonprofit private enti21 ties’’;

22 (iii) by realigning the margin of sub23 paragraph (A) so as to align with the mar24 gin of paragraph (3)(A); and
27

•S 641 RS

1 (iv) by adding at the end thereof the

2 following new subparagraph:

3 ‘‘(B) OTHER REQUIREMENTS.—Grantees

4 described in—

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

6 of section 2652(a) shall use not less than

7 50 percent of the amount of such a grant

8 to provide the services described in sub9 paragraphs (A), (B), (D), and (E) of sec10 tion 2651(b)(2) directly and on-site or at

11 sites where other primary care services are

12 rendered; and

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

14 2652(a) shall ensure the availability of

15 early intervention services through a sys16 tem of linkages to community-based pri17 mary care providers, and to establish

18 mechanisms for the referrals described in

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

20 concerning such referrals.’’.

21 (2) MINIMUM QUALIFICATIONS.—Section

22 2652(b)(1)(B) (42 U.S.C. 300ff–52(b)(1)(B)) is

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

24 if such entity is the only available provider of quality
28

•S 641 RS

1 HIV care in the area,’’ after ‘‘nonprofit private en2 tity’’;

3 (3) MISCELLANEOUS PROVISIONS.—Section

4 2654 (42 U.S.C. 300ff–54) is amended by adding at

5 the end thereof the following new subsection:

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

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

8 planning grants, in an amount not to exceed

9 $50,000 for each such grant, to public and nonprofit

10 private entities that are not direct providers of pri11 mary care services for the purpose of enabling such

12 providers to provide HIV primary care services.

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

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

15 the Secretary determines that the entity will use

16 such grant to assist the entity in qualifying for a

17 grant under section 2651.

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

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

20 entities that would provide HIV primary care serv21 ices in rural or underserved communities.

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

23 the amount appropriated for a fiscal year under sec24 tion 2655 may be used to carry out this section.’’.
29

•S 641 RS

1 (4) AUTHORIZATION OF APPROPRIATIONS.—

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

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

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

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

6 1997, 1998, 1999, and 2000.’’.

7 (5) REQUIRED AGREEMENTS.—Section 2664(g)

8 (42 U.S.C. 300ff–64(g)) is amended—

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

10 the end thereof;

11 (B) in paragraph (3)—

12 (i) by striking ‘‘5 percent’’ and insert13 ing ‘‘10 percent including planning, evalua14 tion and technical assistance’’; and

15 (ii) by striking the period and insert16 ing ‘‘; and’’; and

17 (C) by adding at the end thereof the fol18 lowing new paragraph:

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

20 proposed program is consistent with the Statewide

21 coordinated statement of need and agree to partici22 pate in the ongoing revision of such statement of

23 need.’’.

24 (d) GRANTS.—
30

•S 641 RS

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

2 300ff–71) is amended to read as follows:

3 ‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND AC4 CESS TO RESEARCH FOR CHILDREN, YOUTH,

5 AND FAMILIES.

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

7 the Administrator of the Health Resources and Services

8 Administration, and in consultation with the Director of

9 the National Institutes of Health, shall award grants to

10 appropriate public or nonprofit private entities that, di11 rectly or through contractual arrangements, provide pri12 mary care to the public for the purpose of—

13 ‘‘(1) providing out-patient health care and sup14 port services (which may include family-centered and

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

16 and youth support services, and services for or17 phans) to children, youth, women with HIV disease,

18 and the families of such individuals, and supporting

19 the provision of such care with programs of HIV

20 prevention and HIV research; and

21 ‘‘(2) facilitating the voluntary participation of

22 children, youth, and women with HIV disease in

23 qualified research protocols at the facilities of such

24 entities or by direct referral.
31

•S 641 RS

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

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

3 entity involved provides assurances that—

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

5 children, youth, and women with HIV disease;

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

7 with one or more qualified research entities to col8 laborate in the conduct or facilitation of voluntary

9 patient participation in qualified research protocols;

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

11 the grant with other providers of health care services

12 under this title, and under title V of the Social Secu13 rity Act;

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

15 coordinated statement of need under section 2619

16 and in the revision of such statement; and

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

18 opportunities to each patient, with informed consent.

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

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

21 grant is submitted to the Secretary and the application

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

23 such agreements, assurances, and information as the Sec24 retary determines to be necessary to carry out this section.
32

•S 641 RS

1 ‘‘(d) PATIENT PARTICIPATION IN RESEARCH PROTO2 COLS.—

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

4 through the Administrator of the Health Resources

5 and Services Administration and the Director of the

6 Office of AIDS Research, shall establish procedures

7 to ensure that accepted standards of protection of

8 human subjects (including the provision of written

9 informed consent) are implemented in projects sup10 ported under this section. Receipt of services by a

11 patient shall not be conditioned upon the consent of

12 the patient to participate in research.

13 ‘‘(2) RESEARCH PROTOCOLS.—

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

15 establish mechanisms to ensure that research

16 protocols proposed to be carried out to meet the

17 requirements of this section, are of potential

18 clinical benefit to the study participants, and

19 meet accepted standards of research design.

20 ‘‘(B) REVIEW PANEL.—Mechanisms estab21 lished under subparagraph (A) shall include an

22 independent research review panel that shall re23 view all protocols proposed to be carried out to

24 meet the requirements of this section to ensure

25 that such protocols meet the requirements of
33

•S 641 RS

1 this section. Such panel shall make rec2 ommendations to the Secretary as to the proto3 cols that should be approved. The panel shall

4 include representatives of public and private re5 searchers, providers of services, and recipients

6 of services.

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

8 Secretary, acting through the Administrator of the Health

9 Resources and Services Administration, may use not to

10 exceed five percent of the amounts appropriated under

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

12 technical assistance (including peer-based models of tech13 nical assistance) to assist applicants and grantees under

14 this section in complying with the requirements of this sec15 tion.

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

17 ‘‘(1) EVALUATIONS.—The Secretary shall pro18 vide for the review of programs carried out under

19 this section at the end of each grant year. Such eval20 uations may include recommendations as to the im21 provement of access to and participation in services

22 and access to and participation in qualified research

23 protocols supported under this section.

24 ‘‘(2) REPORTING REQUIREMENTS.—The Sec25 retary may establish data reporting requirements
34

•S 641 RS

1 and schedules as necessary to administer the pro2 gram established under this section and conduct

3 evaluations, measure outcomes, and document the

4 clients served, services provided, and participation in

5 qualified research protocols.

6 ‘‘(3) WAIVERS.—Notwithstanding the require7 ments of subsection (b), the Secretary may award

8 new grants under this section to an entity if the en9 tity provide assurances, satisfactory to the Sec10 retary, that the entity will implement the assurances

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

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

13 If the Secretary determines through the evaluation

14 process that a recipient of funds under this section

15 is in material noncompliance with the assurances

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

17 subsection (b), the Secretary may provide for contin18 ued funding of up to one year if the recipient pro19 vides assurances, satisfactory to the Secretary, that

20 such noncompliance will be remedied within such pe21 riod.

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

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

24 ‘qualified research entity’ means a public or private
35

•S 641 RS

1 entity with expertise in the conduct of research that

2 has demonstrated clinical benefit to patients.

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

4 term ‘qualified research protocol’ means a research

5 study design of a public or private clinical program

6 that meets the requirements of subsection (d).

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

8 are authorized to be appropriated to carry out this section,

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

10 1996 through 2000.’’.

11 (2) CONFORMING AMENDMENT.—The heading

12 for part D of title XXVI of the Public Health Serv13 ice Act is amended to read as follows:

14 ‘‘PART D—GRANTS FOR COORDINATED SERVICES

15 AND ACCESS TO RESEARCH FOR CHILDREN,

16 YOUTH, AND FAMILIES’’.

17 (e) DEMONSTRATION AND TRAINING.—

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

19 adding at the end, the following new part:

20 ‘‘PART F—DEMONSTRATION AND TRAINING

21 ‘‘Subpart I—Special Projects of National Significance

22 ‘‘SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFI23 CANCE.

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

25 under each of parts A, B, C, and D of this title for each
36

•S 641 RS

1 fiscal year, the Secretary shall use the greater of

2 $20,000,000 or 3 percent of such amount appropriated

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

4 administer a special projects of national significance pro5 gram to award direct grants to public and nonprofit pri6 vate entities including community-based organizations to

7 fund special programs for the care and treatment of indi8 viduals with HIV disease.

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

10 under subsection (a) based on—

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

12 particular model for the care and treatment of indi13 viduals with HIV disease;

14 ‘‘(2) the innovative nature of the proposed ac15 tivity; and

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

17 activity in other similar localities or nationally.

18 ‘‘(c) SPECIAL PROJECTS.—Special projects of na19 tional significance shall include the development and as20 sessment of innovative service delivery models that are de21 signed to—

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

23 ‘‘(2) assist in the development of essential com24 munity-based service delivery infrastructure; and
37

•S 641 RS

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

2 for Native American communities to enable such

3 communities to care for Native Americans with HIV

4 disease.

5 ‘‘(d) SPECIAL POPULATIONS.—Special projects of na6 tional significance may include the delivery of HIV health

7 care and support services to traditionally underserved pop8 ulations including—

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

10 living in rural communities;

11 ‘‘(2) adolescents with HIV disease;

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

13 disease;

14 ‘‘(4) homeless individuals and families with

15 HIV disease;

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

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

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

19 projects of national significance may include the develop20 ment of model approaches to delivering HIV care and sup21 port services including—

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

23 networks critical to the delivery of care in minority

24 communities;
38

•S 641 RS

1 ‘‘(2) programs that build organizational capac2 ity in disenfranchised communities;

3 ‘‘(3) programs designed to prepare AIDS serv4 ice organizations and grantees under this title for

5 operation within the changing health care environ6 ment; and

7 ‘‘(4) programs designed to integrate the deliv8 ery of mental health and substance abuse treatment

9 with HIV services.

10 ‘‘(f) COORDINATION.—The Secretary may not make

11 a grant under this section unless the applicant submits

12 evidence that the proposed program is consistent with the

13 Statewide coordinated statement of need, and the appli14 cant agrees to participate in the ongoing revision process

15 of such statement of need.

16 ‘‘(g) REPLICATION.—The Secretary shall make infor17 mation concerning successful models developed under this

18 part available to grantees under this title for the purpose

19 of coordination, replication, and integration. To facilitate

20 efforts under this subsection, the Secretary may provide

21 for peer-based technical assistance from grantees funded

22 under this part.’’.

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

24 (42 U.S.C. 300ff–28(a)) is repealed.
39

•S 641 RS

1 (f) HIV/AIDS COMMUNITIES, SCHOOLS, CEN2 TERS.—

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

4 added by subsection (e)) is further amended by add5 ing at the end, the following new subpart:

6 ‘‘Subpart II—AIDS Education and Training Centers

7 ‘‘SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CEN8 TERS.’’.

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

10 U.S.C. 294n(a)) is amended—

11 (A) by striking subparagraphs (B) and

12 (C);

13 (B) by redesignating subparagraphs (A)

14 and (D) as subparagraphs (B) and (C), respec15 tively;

16 (C) by inserting before subparagraph (B)

17 (as so redesignated) the following new subpara18 graph:

19 ‘‘(A) training health personnel, including

20 practitioners in title XXVI programs and other

21 community providers, in the diagnosis, treat22 ment, and prevention of HIV infection and dis23 ease;’’; and

24 (D) in subparagraph (B) (as so redesig25 nated) by adding ‘‘and’’ after the semicolon.
40

•S 641 RS

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

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

3 is amended by transferring such subsection to sec4 tion 2692 (as added by paragraph (1)).

5 (4) AUTHORIZATION OF APPROPRIATIONS.—

6 Section 2692 (as added by paragraph (1)) is amend7 ed by adding at the end thereof the following new

8 subsection:

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

10 are authorized to be appropriated to carry out this section,

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

12 1996 through 2000.’’.

13 SEC. 4. AMOUNT OF EMERGENCY RELIEF GRANTS.

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

15 13(a)(3)) is amended to read as follows:

16 ‘‘(3) AMOUNT OF GRANT.—

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

18 of amounts made available in appropriations

19 Acts, a grant made for purposes of this para20 graph to an eligible area shall be made in an

21 amount equal to the product of—

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

23 available for distribution under paragraph

24 (2) for the fiscal year involved; and
41

•S 641 RS

1 ‘‘(ii) the percentage constituted by the

2 ratio of the distribution factor for the eligi3 ble area to the sum of the respective dis4 tribution factors for all eligible areas.

5 ‘‘(B) DISTRIBUTION FACTOR.—For pur6 poses of subparagraph (A)(ii), the term ‘dis7 tribution factor’ means the product of—

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

9 number of living cases of acquired immune

10 deficiency syndrome in the eligible area in11 volved, as determined under subparagraph

12 (C); and

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

14 area involved, as determined under sub15 paragraph (D).

16 ‘‘(C) ESTIMATE OF LIVING CASES.—The

17 amount determined in this subparagraph is an

18 amount equal to the product of—

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

20 immune deficiency syndrome in the eligible

21 area during each year in the most recent

22 120-month period for which data are avail23 able with respect to all eligible areas, as in24 dicated by the number of such cases re25 ported to and confirmed by the Director of
42

•S 641 RS

1 the Centers for Disease Control and Pre2 vention for each year during such period;

3 and

4 ‘‘(ii) with respect to—

5 ‘‘(I) the first year during such

6 period, .06;

7 ‘‘(II) the second year during such

8 period, .06;

9 ‘‘(III) the third year during such

10 period, .08;

11 ‘‘(IV) the fourth year during

12 such period, .10;

13 ‘‘(V) the fifth year during such

14 period, .16;

15 ‘‘(VI) the sixth year during such

16 period, .16;

17 ‘‘(VII) the seventh year during

18 such period, .24;

19 ‘‘(VIII) the eighth year during

20 such period, .40;

21 ‘‘(IX) the ninth year during such

22 period, .57; and

23 ‘‘(X) the tenth year during such

24 period, .88.
43

•S 641 RS

1 ‘‘(D) COST INDEX.—The amount deter2 mined in this subparagraph is an amount equal

3 to the sum of—

4 ‘‘(i) the product of—

5 ‘‘(I) the average hospital wage

6 index reported by hospitals in the eli7 gible area involved under section

8 1886(d)(3)(E) of the Social Security

9 Act for the 3-year period immediately

10 preceding the year for which the grant

11 is being awarded; and

12 ‘‘(II) .70; and

13 ‘‘(ii) .30.

14 ‘‘(E) UNEXPENDED FUNDS.—The Sec15 retary may, in determining the amount of a

16 grant for a fiscal year under this paragraph,

17 adjust the grant amount to reflect the amount

18 of unexpended and uncanceled grant funds re19 maining at the end of the fiscal year preceding

20 the year for which the grant determination is to

21 be made. The amount of any such unexpended

22 funds shall be determined using the financial

23 status report of the grantee.

24 ‘‘(F) PUERTO RICO, VIRGIN ISLANDS,

25 GUAM.—For purposes of subparagraph (D), the
44

•S 641 RS

1 cost index for an eligible area within Puerto

2 Rico, the Virgin Islands, or Guam shall be

3 1.0.’’.

4 SEC. 5. AMOUNT OF CARE GRANTS.

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

6 300ff–28(b)(1) and (2)) are amended to read as follows:

7 ‘‘(1) MINIMUM ALLOTMENT.—Subject to the ex8 tent of amounts made available under section 2677,

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

10 for—

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

12 District of Columbia for a fiscal year shall be

13 the greater of—

14 ‘‘(i)(I) with respect to a State or Dis15 trict that has less than 90 living cases of

16 acquired immune deficiency syndrome, as

17 determined under paragraph (2)(D),

18 $100,000; or

19 ‘‘(i)(I) with respect to a State or Dis20 trict that has 90 or more living cases of

21 acquired immune deficiency syndrome, as

22 determined under paragraph (2)(D),

23 $250,000;

24 ‘‘(ii) an amount determined under

25 paragraph (2); and
45

•S 641 RS

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

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

3 determined under paragraph (2).

4 ‘‘(2) DETERMINATION.—

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

6 in paragraph (1)(A)(ii) for a State and para7 graph (1)(B) for a territory of the United

8 States shall be the product of—

9 ‘‘(i) an amount equal to the amount

10 appropriated under section 2677 for the

11 fiscal year involved for grants under part

12 B; and

13 ‘‘(ii) the percentage constituted by the

14 sum of—

15 ‘‘(I) the product of .50 and the

16 ratio of the State distribution factor

17 for the State or territory (as deter18 mined under subsection (B)) to the

19 sum of the respective State distribu20 tion factors for all States or terri21 tories; and

22 ‘‘(II) the product of .50 and the

23 ratio of the non-EMA distribution fac24 tor for the State or territory (as de25 termined under subparagraph (C)) to
46

•S 641 RS

1 the sum of the respective distribution

2 factors for all States or territories.

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

4 purposes of subparagraph (A)(ii)(I), the term

5 ‘State distribution factor’ means the product

6 of—

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

8 number of living cases of acquired immune

9 deficiency syndrome in the State or terri10 tory involved, as determined under sub11 paragraph (D); and

12 ‘‘(ii) the cost index for the State or

13 territory involved, as determined under

14 subparagraph (E).

15 ‘‘(C) NON-EMA DISTRIBUTION FACTOR.—

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

17 term ‘non-ema distribution factor’ means the

18 product of—

19 ‘‘(i) an amount equal to the sum of—

20 ‘‘(I) the estimated number of liv21 ing cases of acquired immune defi22 ciency syndrome in the State or terri23 tory involved, as determined under

24 subparagraph (D); less
47

•S 641 RS

1 ‘‘(II) the estimated number of

2 living cases of acquired immune defi3 ciency syndrome in such State or ter4 ritory that are within an eligible area

5 (as determined under part A); and

6 ‘‘(ii) the cost index for the State or

7 territory involved, as determined under

8 subparagraph (E).

9 ‘‘(D) ESTIMATE OF LIVING CASES.—The

10 amount determined in this subparagraph is an

11 amount equal to the product of—

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

13 immune deficiency syndrome in the State

14 or territory during each year in the most

15 recent 120-month period for which data

16 are available with respect to all States and

17 territories, as indicated by the number of

18 such cases reported to and confirmed by

19 the Director of the Centers for Disease

20 Control and Prevention for each year dur21 ing such period; and

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

23 through the tenth year during such period,

24 the amount referred to in

25 2603(a)(3)(C)(ii).
48

•S 641 RS

1 ‘‘(E) COST INDEX.—

2 ‘‘(i) The amount determined in this

3 subparagraph is an amount equal to the

4 sum of—

5 ‘‘(I) the amount determined

6 under clause (ii) for a fiscal year;

7 ‘‘(II) the product of—

8 ‘‘(aa) the average hospital

9 wage index reported by hospitals

10 in the State or territory involved

11 under section 1886(d)(3)(E) of

12 the Social Security Act for the 3-

13 year period immediately preced14 ing the year for with the grant is

15 being awarded; and

16 ‘‘(bb) .70; and

17 ‘‘(III) .30.

18 ‘‘(ii) The amount determined in this

19 clause for a fiscal year is an amount equal

20 to the percentage constituted by the ratio

21 of—

22 ‘‘(I) the total amount—

23 ‘‘(aa) of salaries reported by

24 each hospital within the State or

25 territory under the medicare pro-
49

•S 641 RS

1 spective payment system under

2 title XVIII of the Social Security

3 Act for the fiscal year involved;

4 divided by

5 ‘‘(bb) the total number of

6 hours worked by those included

7 in the reported salaries under

8 subclause (II) for the fiscal year

9 involved, as determined under

10 regulations promulgated by the

11 Secretary; and

12 ‘‘(II) the sum of the amount de13 termined under subclause (I) with re14 spect to all States and territories.

15 ‘‘(F) PUERTO RICO, VIRGIN ISLANDS,

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

17 cost index for Puerto Rico, the Virgin Islands,

18 and Guam shall be 1.0.’’.

19 ‘‘(G) UNEXPENDED FUNDS.—The Sec20 retary may, in determining the amount of a

21 grant for a fiscal year under this subsection,

22 adjust the grant amount to reflect the amount

23 of unexpended and uncanceled grant funds re24 maining at the end of the fiscal year preceding

25 the year for which the grant determination is to
50

•S 641 RS

1 be made. The amount of any such unexpended

2 funds shall be determined using the financial

3 status report of the grantee.

4 ‘‘(H) LIMITATION.—

5 ‘‘(i) IN GENERAL.—The Secretary

6 shall ensure that the amount of a grant

7 awarded to a State or territory for a fiscal

8 year under this part is equal to not less

9 than—

10 ‘‘(I) with respect to fiscal year

11 1996, 98 percent;

12 ‘‘(II) with respect to fiscal year

13 1997, 97 percent;

14 ‘‘(III) with respect to fiscal year

15 1998, 95.5 percent;

16 ‘‘(IV) with respect to fiscal year

17 1999, 94 percent; and

18 ‘‘(V) with respect to fiscal year

19 2000, 92.5 percent;

20 of the amount such State or territory re21 ceived for fiscal year 1995 under this part.

22 In administering this subparagraph, the

23 Secretary shall, with respect to States that

24 will receive grants in amounts that exceed

25 the amounts that such States received
51

•S 641 RS

1 under this part in fiscal year 1995, propor2 tionally reduce such amounts to ensure

3 compliance with this subparagraph. In

4 making such reductions, the Secretary

5 shall ensure that no such State receives

6 less than that State received for fiscal year

7 1995.

8 ‘‘(ii) RATABLE REDUCTION.—If the

9 amount appropriated under section 2677

10 and available for allocation under this part

11 is less than the amount appropriated and

12 available under this part for fiscal year

13 1995, the limitation contained in clause (i)

14 shall be reduced by a percentage equal to

15 the percentage of the reduction in such

16 amounts appropriated and available.’’.

17 SEC. 6. CONSOLIDATION OF AUTHORIZATIONS OF APPRO18 PRIATIONS.

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

20 300ff–71) is amended by adding at the end thereof the

21 following new section:

22 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

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

24 are authorized to be appropriated to make grants under

25 parts A and B, such sums as may be necessary for each
52

•S 641 RS

1 of the fiscal years 1996 through 2000. Of the amount ap2 propriated under this section for fiscal year 1996, the Sec3 retary shall make available 64 percent of such amount to

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

5 out part B.

6 ‘‘(b) DEVELOPMENT OF METHODOLOGY.—

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

8 fiscal years 1997 through 2000, the Secretary shall

9 develop and implement a methodology for adjusting

10 the percentages referred to in subsection (a) to ac11 count for grants to new eligible areas under part A

12 and other relevant factors. Not later than 1 year

13 after the date of enactment of this section, the Sec14 retary shall prepare and submit to the appropriate

15 committees of Congress a report regarding the find16 ings with respect to the methodology developed

17 under this paragraph.

18 ‘‘(2) FAILURE TO IMPLEMENT.—If the Sec19 retary fails to implement a methodology under para20 graph (1) by October 1, 1996, there are authorized

21 to be appropriated—

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

23 carry out part A for each of the fiscal years

24 1997 through 2000; and
53

•S 641 RS

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

2 carry out part B for each of the fiscal years

3 1997 through 2000.’’.

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

5 300ff–18 and 300ff–30) are repealed.

6 (c) CONFORMING AMENDMENTS.—Title XXVI is

7 amended—

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

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

10 ‘‘2608’’ and inserting ‘‘2677’’; and

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

12 ‘‘2608’’ and inserting ‘‘2677’’;

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

14 15(c)(1)) is amended by striking ‘‘2608’’ and insert15 ing ‘‘2677’’; and

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

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

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

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

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

21 SEC. 7. EFFECTIVE DATE.

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

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

24 become effective on October 1, 1995.

25 (b) ELIGIBLE AREAS.—
54

•S 641 RS

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

2 subsections (a)(1)(A), (a)(2), and (b)(4)(A) of sec3 tion 3 shall become effective on the date of enact4 ment of this Act.

5 (2) REPORTED CASES.—The amendment made

6 by subsection (a)(1)(B) of section 3 shall become ef7 fective on October 1, 1997.

8 S 641 RS——2

9 S 641 RS——3

10 S 641 RS——4