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[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 641 Enrolled Bill (ENR)]

        S.641

                       One Hundred Fourth Congress

                                 of the

                        United States of America

                          AT THE SECOND SESSION

         Begun and held at the City of Washington on Wednesday,
   the third day of January, one thousand nine hundred and ninety-six

                                 An Act

 
   An Act to amend the Public Health Service Act to revise and extend 
   programs established pursuant to the Ryan White Comprehensive AIDS 
                    Resources Emergency Act of 1990.

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

SECTION 1. SHORT TITLE.

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

SEC. 2. REFERENCES.

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

SEC. 3. GENERAL AMENDMENTS.

    (a) Program of Grants.--
        (1) Number of cases.--Section 2601(a) (42 U.S.C. 300ff-11) is 
    amended--
            (A) by striking ``subject to subsection (b)'' and inserting 
        ``subject to subsections (b) through (d)''; and
            (B) by striking ``metropolitan area'' and all that follows 
        and inserting the following: ``metropolitan area for which 
        there has been reported to the Director of the Centers for 
        Disease Control and Prevention a cumulative total of more than 
        2,000 cases of acquired immune deficiency syndrome for the most 
        recent period of 5 calendar years for which such data are 
        available.''.
        (2) Other provisions regarding eligibility.--Section 2601 (42 
    U.S.C. 300ff-11) is amended by adding at the end thereof the 
    following new subsections:
    ``(c) Requirements Regarding Population.--
        ``(1) Number of individuals.--
            ``(A) In general.--Except as provided in subparagraph (B), 
        the Secretary may not make a grant under this section for a 
        metropolitan area unless the area has a population of 500,000 
        or more individuals.
            ``(B) Limitation.--Subparagraph (A) does not apply to any 
        metropolitan area that was an eligible area under this part for 
        fiscal year 1995 or any prior fiscal year.
        ``(2) Geographic boundaries.--For purposes of eligibility under 
    this part, the boundaries of each metropolitan area are the 
    boundaries that were in effect for the area for fiscal year 1994.
    ``(d) Continued Status as Eligible Area.--Notwithstanding any other 
provision of this section, a metropolitan area that was an eligible 
area under this part for fiscal year 1996 is an eligible area for 
fiscal year 1997 and each subsequent fiscal year.''.
        (3) Conforming amendment regarding definition of eligible 
    area.--Section 2607(1) (42 U.S.C. 300ff-17(1)) is amended by 
    striking ``The term'' and all that follows and inserting the 
    following: ``The term `eligible area' means a metropolitan area 
    meeting the requirements of section 2601 that are applicable to the 
    area.''.
    (b) Emergency Relief for Areas With Substantial Need for 
Services.--
        (1) HIV health services planning council.--Subsection (b) of 
    section 2602 (42 U.S.C. 300ff-12(b)) is amended--
            (A) in paragraph (1)--
                (i) by striking ``include'' and all that follows 
            through the end thereof, and inserting ``reflect in its 
            composition the demographics of the epidemic in the 
            eligible area involved, with particular consideration given 
            to disproportionately affected and historically underserved 
            groups and subpopulations.''; and
                (ii) by adding at the end thereof the following new 
            sentences: ``Nominations for membership on the council 
            shall be identified through an open process and candidates 
            shall be selected based on locally delineated and 
            publicized criteria. Such criteria shall include a 
            conflict-of-interest standard that is in accordance with 
            paragraph (5).'';
            (B) in paragraph (2), by adding at the end thereof the 
        following new subparagraph:
            ``(C) Chairperson.--A planning council may not be chaired 
        solely by an employee of the grantee.'';
            (C) in paragraph (3)--
                (i) in subparagraph (A), by striking ``area;'' and 
            inserting ``area, including how best to meet each such 
            priority and additional factors that a grantee should 
            consider in allocating funds under a grant based on the--
                ``(i) documented needs of the HIV-infected population;
                ``(ii) cost and outcome effectiveness of proposed 
            strategies and interventions, to the extent that such data 
            are reasonably available (either demonstrated or probable);
                ``(iii) priorities of the HIV-infected communities for 
            whom the services are intended; and
                ``(iv) availability of other governmental and 
            nongovernmental resources;'';
                (ii) by striking ``and'' at the end of subparagraph 
            (B);
                (iii) by striking the period at the end of subparagraph 
            (C) and inserting ``, and at the discretion of the planning 
            council, assess the effectiveness, either directly or 
            through contractual arrangements, of the services offered 
            in meeting the identified needs;''; and
                (iv) by adding at the end thereof the following new 
            subparagraphs:
            ``(D) participate in the development of the statewide 
        coordinated statement of need initiated by the State public 
        health agency responsible for administering grants under part 
        B; and
            ``(E) establish methods for obtaining input on community 
        needs and priorities which may include public meetings, 
        conducting focus groups, and convening ad-hoc panels.'';
            (D) by redesignating paragraphs (2) and (3) as paragraphs 
        (3) and (4), respectively;
            (E) by inserting after paragraph (1), the following new 
        paragraph:
        ``(2) Representation.--The HIV health services planning council 
    shall include representatives of--
            ``(A) health care providers, including federally qualified 
        health centers;
            ``(B) community-based organizations serving affected 
        populations and AIDS service organizations;
            ``(C) social service providers;
            ``(D) mental health and substance abuse providers;
            ``(E) local public health agencies;
            ``(F) hospital planning agencies or health care planning 
        agencies;
            ``(G) affected communities, including people with HIV 
        disease or AIDS and historically underserved groups and 
        subpopulations;
            ``(H) nonelected community leaders;
            ``(I) State government (including the State medicaid agency 
        and the agency administering the program under part B);
            ``(J) grantees under subpart II of part C;
            ``(K) grantees under section 2671, or, if none are 
        operating in the area, representatives of organizations with a 
        history of serving children, youth, women, and families living 
        with HIV and operating in the area; and
            ``(L) grantees under other Federal HIV programs.''; and
            (F) by adding at the end thereof the following:
        ``(5) Conflicts of interest.--
            ``(A) In general.--The planning council under paragraph (1) 
        may not be directly involved in the administration of a grant 
        under section 2601(a). With respect to compliance with the 
        preceding sentence, the planning council may not designate (or 
        otherwise be involved in the selection of) particular entities 
        as recipients of any of the amounts provided in the grant.
            ``(B) Required agreements.--An individual may serve on the 
        planning council under paragraph (1) only if the individual 
        agrees that if the individual has a financial interest in an 
        entity, if the individual is an employee of a public or private 
        entity, or if the individual is a member of a public or private 
        organization, and such entity or organization is seeking 
        amounts from a grant under section 2601(a), the individual will 
        not, with respect to the purpose for which the entity seeks 
        such amounts, participate (directly or in an advisory capacity) 
        in the process of selecting entities to receive such amounts 
        for such purpose.
        ``(6) Grievance procedures.--A planning council under paragraph 
    (1) shall develop procedures for addressing grievances with respect 
    to funding under this part, including procedures for submitting 
    grievances that cannot be resolved to binding arbitration. Such 
    procedures shall be described in the by-laws of the planning 
    council and be consistent with the requirements of subsection (c).
    ``(c) Grievance Procedures.--
        ``(1) Federal responsibility.--
            ``(A) Models.--The Secretary shall, through a process that 
        includes consultations with grantees under this part and public 
        and private experts in grievance procedures, arbitration, and 
        mediation, develop model grievance procedures that may be 
        implemented by the planning council under subsection (b)(1) and 
        grantees under this part. Such model procedures shall describe 
        the elements that must be addressed in establishing local 
        grievance procedures and provide grantees with flexibility in 
        the design of such local procedures.
            ``(B) Review.--The Secretary shall review grievance 
        procedures established by the planning council and grantees 
        under this part to determine if such procedures are adequate. 
        In making such a determination, the Secretary shall assess 
        whether such procedures permit legitimate grievances to be 
        filed, evaluated, and resolved at the local level.
        ``(2) Grantees.--To be eligible to receive funds under this 
    part, a grantee shall develop grievance procedures that are 
    determined by the Secretary to be consistent with the model 
    procedures developed under paragraph (1)(A). Such procedures shall 
    include a process for submitting grievances to binding 
    arbitration.''.
        (2) Distribution of grants.--Section 2603 (42 U.S.C. 300ff-13) 
    is amended--
            (A) in subsection (a)(2), by striking ``Not later than--'' 
        and all that follows through ``the Secretary shall'' and 
        inserting the following: ``Not later than 60 days after an 
        appropriation becomes available to carry out this part for each 
        of the fiscal years 1996 through 2000, the Secretary shall''; 
        and
            (B) in subsection (b)
                (i) in paragraph (1)--

                    (I) by striking ``and'' at the end of subparagraph 
                (D);
                    (II) by striking the period at the end of 
                subparagraph (E) and inserting a semicolon; and
                    (III) by adding at the end thereof the following 
                new subparagraphs:

            ``(F) demonstrates the inclusiveness of the planning 
        council membership, with particular emphasis on affected 
        communities and individuals with HIV disease; and
            ``(G) demonstrates the manner in which the proposed 
        services are consistent with the local needs assessment and the 
        statewide coordinated statement of need.''; and
                (ii) by redesignating paragraphs (2), (3), and (4) as 
            paragraphs (3), (4), and (5), respectively; and
                (iii) by inserting after paragraph (1), the following 
            new paragraph:
        ``(2) Definition.--
            ``(A) Severe need.--In determining severe need in 
        accordance with paragraph (1)(B), the Secretary shall consider 
        the ability of the qualified applicant to expend funds 
        efficiently and the impact of relevant factors on the cost and 
        complexity of delivering health care and support services to 
        individuals with HIV disease in the eligible area, including 
        factors such as--
                ``(i) sexually transmitted diseases, substance abuse, 
            tuberculosis, severe mental illness, or other comorbid 
            factors determined relevant by the Secretary;
                ``(ii) new or growing subpopulations of individuals 
            with HIV disease; and
                ``(iii) homelessness.
            ``(B) Prevalence.--In determining the impact of the factors 
        described in subparagraph (A), the Secretary shall, to the 
        extent practicable, use national, quantitative incidence data 
        that are available for each eligible area. Not later than 2 
        years after the date of enactment of this paragraph, the 
        Secretary shall develop a mechanism to utilize such data. In 
        the absence of such data, the Secretary may consider a detailed 
        description and qualitative analysis of severe need, as 
        determined under subparagraph (A), including any local 
        prevalence data gathered and analyzed by the eligible area.
            ``(C) Priority.--Subsequent to the development of the 
        quantitative mechanism described in subparagraph (B), the 
        Secretary shall phase in, over a 3-year period beginning in 
        fiscal year 1998, the use of such a mechanism to determine the 
        severe need of an eligible area compared to other eligible 
        areas and to determine, in part, the amount of supplemental 
        funds awarded to the eligible area under this part.''.
        (3) Distribution of funds.--
            (A) In general.--Section 2603(a)(2) (42 U.S.C. 300ff-
        13(a)(2)) (as amended by paragraph (2)) is further amended--
                (i) by inserting ``, in accordance with paragraph (3)'' 
            before the period; and
                (ii) by adding at the end thereof the following new 
            sentences: ``The Secretary shall reserve an additional 
            percentage of the amount appropriated under section 2677 
            for a fiscal year for grants under part A to make grants to 
            eligible areas under section 2601(a) in accordance with 
            paragraph (4).''.
            (B) Increase in grant.--Section 2603(a) (42 U.S.C. 300ff-
        13(a)) is amended by adding at the end thereof the following 
        new paragraph:
        ``(4) Increase in grant.--With respect to an eligible area 
    under section 2601(a), the Secretary shall increase the amount of a 
    grant under paragraph (2) for a fiscal year to ensure that such 
    eligible area receives not less than--
            ``(A) with respect to fiscal year 1996, 100 percent;
            ``(B) with respect to fiscal year 1997, 99 percent;
            ``(C) with respect to fiscal year 1998, 98 percent;
            ``(D) with respect to fiscal year 1999, 96.5 percent; and
            ``(E) with respect to fiscal year 2000, 95 percent;
    of the amount allocated for fiscal year 1995 to such entity under 
    this subsection.''.
            (C) Additional requirements for grants.--Section 2603 (42 
        U.S.C. 300ff-13) is amended by adding at the end thereof the 
        following subsection:
    ``(c) Compliance With Priorities of HIV Planning Council.--
Notwithstanding any other provision of this part, the Secretary, in 
carrying out section 2601(a), may not make any grant under subsection 
(a) or (b) to an eligible area unless the application submitted by such 
area under section 2605 for the grant involved demonstrates that the 
grants made under subsections (a) and (b) to the area for the preceding 
fiscal year (if any) were expended in accordance with the priorities 
applicable to such year that were established, pursuant to section 
2602(b)(3)(A), by the planning council serving the area.''.
        (4) Use of amounts.--Section 2604 (42 U.S.C. 300ff-14) is 
    amended--
            (A) in subsection (b)(1)(A)--
                (i) by inserting ``, substance abuse treatment and 
            mental health treatment,'' after ``case management''; and
                (ii) by inserting ``which shall include treatment 
            education and prophylactic treatment for opportunistic 
            infections,'' after ``treatment services,'';
            (B) in subsection (b)(2)(A)--
                (i) by inserting ``, or private for-profit entities if 
            such entities are the only available provider of quality 
            HIV care in the area,'' after ``nonprofit private 
            entities,''; and
                (ii) by striking ``and homeless health centers'' and 
            inserting ``homeless health centers, substance abuse 
            treatment programs, and mental health programs'';
            (C) by adding at the end of subsection (b), the following 
        new paragraph:
        ``(3) Priority for women, infants and children.--For the 
    purpose of providing health and support services to infants, 
    children, and women with HIV disease, including treatment measures 
    to prevent the perinatal transmission of HIV, the chief elected 
    official of an eligible area, in accordance with the established 
    priorities of the planning council, shall use, from the grants made 
    for the area under section 2601(a) for a fiscal year, not less than 
    the percentage constituted by the ratio of the population in such 
    area of infants, children, and women with acquired immune 
    deficiency syndrome to the general population in such area of 
    individuals with such syndrome.''; and
            (C) in subsection (e)--
                (i) in the subsection heading, by striking ``and 
            Planning;
                (ii) by striking ``The chief'' and inserting:
        ``(1) In general.--The chief'';
                (iii) by striking ``accounting, reporting, and program 
            oversight functions'';
                (iv) by adding at the end thereof the following new 
            sentence: ``In the case of entities and subcontractors to 
            which such officer allocates amounts received by the 
            officer under the grant, the officer shall ensure that, of 
            the aggregate amount so allocated, the total of the 
            expenditures by such entities for administrative expenses 
            does not exceed 10 percent (without regard to whether 
            particular entities expend more than 10 percent for such 
            expenses).''; and
                (v) by adding at the end thereof the following new 
            paragraphs:
        ``(2) Administrative activities.--For the purposes of paragraph 
    (1), amounts may be used for administrative activities that 
    include--
            ``(A) routine grant administration and monitoring 
        activities, including the development of applications for part 
        A funds, the receipt and disbursal of program funds, the 
        development and establishment of reimbursement and accounting 
        systems, the preparation of routine programmatic and financial 
        reports, and compliance with grant conditions and audit 
        requirements; and
            ``(B) all activities associated with the grantee's contract 
        award procedures, including the development of requests for 
        proposals, contract proposal review activities, negotiation and 
        awarding of contracts, monitoring of contracts through 
        telephone consultation, written documentation or onsite visits, 
        reporting on contracts, and funding reallocation activities.
        ``(3) Subcontractor administrative costs.--For the purposes of 
    this subsection, subcontractor administrative activities include--
            ``(A) usual and recognized overhead, including established 
        indirect rates for agencies;
            ``(B) management oversight of specific programs funded 
        under this title; and
            ``(C) other types of program support such as quality 
        assurance, quality control, and related activities.''.
        (5) Application.--Section 2605 (42 U.S.C. 300ff-15) is 
    amended--
            (A) in subsection (a)--
                (i) in the matter preceding paragraph (1), by inserting 
            ``, in accordance with subsection (c) regarding a single 
            application and grant award,'' after ``application'';
                (ii) in paragraph (1)(B), by striking ``1-year period'' 
            and all that follows through ``eligible area'' and 
            inserting ``preceding fiscal year'';
                (iii) in paragraph (4), by striking ``and'' at the end 
            thereof;
                (iv) in paragraph (5), by striking the period at the 
            end thereof and inserting ``; and''; and
                (v) by adding at the end thereof the following new 
            paragraph:
        ``(6) that the applicant has participated, or will agree to 
    participate, in the statewide coordinated statement of need process 
    where it has been initiated by the State public health agency 
    responsible for administering grants under part B, and ensure that 
    the services provided under the comprehensive plan are consistent 
    with the statewide coordinated statement of need.'';
            (B) in subsection (b)--
                (i) in the subsection heading, by striking 
            ``Additional''; and
                (ii) in the matter preceding paragraph (1), by striking 
            ``additional application'' and inserting ``application, in 
            accordance with subsection (c) regarding a single 
            application and grant award,''; and
            (C) by redesignating subsections (c) and (d) as subsections 
        (d) and (e), respectively; and
            (D) by inserting after subsection (b), the following new 
        subsection:
    ``(c) Single Application and Grant Award.--
        ``(1) Application.--The Secretary may phase in the use of a 
    single application that meets the requirements of subsections (a) 
    and (b) of section 2603 with respect to an eligible area that 
    desires to receive grants under section 2603 for a fiscal year.
        ``(2) Grant award.--The Secretary may phase in the awarding of 
    a single grant to an eligible area that submits an approved 
    application under paragraph (1) for a fiscal year.''.
        (6) Technical assistance.--Section 2606 (42 U.S.C. 300ff-16) is 
    amended--
            (A) by striking ``may'' and inserting ``shall'';
            (B) by inserting after ``technical assistance'' the 
        following: ``, including assistance from other grantees, 
        contractors or subcontractors under this title to assist newly 
        eligible metropolitan areas in the establishment of HIV health 
        services planning councils and,''; and
            (C) by adding at the end thereof the following new 
        sentences: ``The Administrator may make planning grants 
        available to metropolitan areas, in an amount not to exceed 
        $75,000 for any metropolitan area, projected to be eligible for 
        funding under section 2601 in the following fiscal year. Such 
        grant amounts shall be deducted from the first year formula 
        award to eligible areas accepting such grants. Not to exceed 1 
        percent of the amount appropriated for a fiscal year under 
        section 2677 for grants under part A may be used to carry out 
        this section.''.
    (c) Care Grant Program.--
        (1) Priority for women, infants and children.--Section 2611 (42 
    U.S.C. 300ff-21) is amended--
            (A) by striking ``The'' and inserting ``(a) In General.--
        The''; and
            (B) by adding at the end thereof the following new 
        subsection:
    ``(b) Priority for Women, Infants and Children.--For the purpose of 
providing health and support services to infants, children, and women 
with HIV disease, including treatment measures to prevent the perinatal 
transmission of HIV, a State shall use, of the funds allocated under 
this part to the State for a fiscal year, not less than the percentage 
constituted by the ratio of the population in the State of infants, 
children, and women with acquired immune deficiency syndrome to the 
general population in the State of individuals with such syndrome.''.
        (2) Use of Grants.--Section 2612 (42 U.S.C. 300ff-22) is 
    amended--
            (A) in subsection (a)--
                (i) by striking the subsection designation and heading;
                (ii) by redesignating paragraphs (1) through (4) as 
            paragraphs (2) through (5), respectively;
                (iii) by inserting the following new paragraph:
        ``(1) to provide the services described in section 2604(b)(1) 
    for individuals with HIV disease;'';
                (iv) in paragraph (5) (as so redesignated), by striking 
            ``treatments'' and all that follows through ``health,'' and 
            inserting ``therapeutics to treat HIV disease''; and
                (v) by adding at the end thereof the following flush 
            sentences:
``Services described in paragraph (1) shall be delivered through 
consortia designed as described in paragraph (2), where such consortia 
exist, unless the State demonstrates to the Secretary that delivery of 
such services would be more effective when other delivery mechanisms 
are used. In making a determination regarding the delivery of services, 
the State shall consult with appropriate representatives of service 
providers and recipients of services who would be affected by such 
determination, and shall include in its demonstration to the Secretary 
the findings of the State regarding such consultation.''; and
            (B) by striking subsection (b).
        (2) HIV care consortia.--Section 2613 (42 U.S.C. 300ff-23) is 
    amended--
            (A) in subsection (a)--
                (i) in paragraph (1), by inserting ``(or private for-
            profit providers or organizations if such entities are the 
            only available providers of quality HIV care in the area)'' 
            after ``nonprofit private,''; and
                (ii) in paragraph (2)(A)--

                    (I) by inserting ``substance abuse treatment, 
                mental health treatment,'' after ``nursing,''; and
                    (II) by inserting ``prophylactic treatment for 
                opportunistic infections, treatment education to take 
                place in the context of health care delivery,'' after 
                ``monitoring,''; and

            (B) in subsection (c)--
                (i) in subparagraph (C) of paragraph (1), by inserting 
            before ``care'' ``and youth centered''; and
                (ii) in paragraph (2)--

                    (I) in clause (ii) of subparagraph (A), by striking 
                ``served; and'' and inserting ``served;'';
                    (II) in subparagraph (B), by striking the period at 
                the end and inserting ``; and''; and
                    (III) by adding after subparagraph (B), the 
                following new subparagraph:

            ``(C) grantees under section 2671, or, if none are 
        operating in the area, representatives in the area of 
        organizations with a history of serving children, youth, women, 
        and families living with HIV.''.
        (3) Provision of treatments.--Section 2616 (42 U.S.C. 300ff-26) 
    is amended--
            (A) in subsection (a)--
                (i) by striking ``may use amounts'' and inserting 
            ``shall use a portion of the amounts'';
                (ii) by striking ``section 2612(a)(4)'' and all that 
            follows through ``prolong life'' and inserting ``section 
            2612(a)(5) to provide therapeutics to treat HIV disease''; 
            and
                (iii) by inserting before the period the following: ``, 
            including measures for the prevention and treatment of 
            opportunistic infections'';
            (B) in subsection (c)--
                (i) in paragraph (3), by striking ``and'' at the end 
            thereof;
                (ii) in paragraph (4), by striking the period and 
            inserting ``; and''; and
                (iii) by adding at the end thereof the following new 
            paragraph:
        ``(5) document the progress made in making therapeutics 
    described in subsection (a) available to individuals eligible for 
    assistance under this section.''; and
            (C) by adding at the end thereof the following new 
        subsection:
    ``(d) Duties of the Secretary.--In carrying out this section, the 
Secretary shall review the current status of State drug reimbursement 
programs established under section 2612(2) and assess barriers to the 
expanded availability of the treatments described in subsection (a). 
The Secretary shall also examine the extent to which States coordinate 
with other grantees under this title to reduce barriers to the expanded 
availability of the treatments described in subsection (a).''.
        (4) State application.--Section 2617(b) (42 U.S.C. 300ff-27(b)) 
    is amended--
            (A) in paragraph (2)--
                (i) in subparagraph (A), by striking ``and'' at the end 
            thereof; and
                (ii) by adding at the end thereof the following new 
            subparagraph:
            ``(C) a description of how the allocation and utilization 
        of resources are consistent with the statewide coordinated 
        statement of need (including traditionally underserved 
        populations and subpopulations) developed in partnership with 
        other grantees in the State that receive funding under this 
        title; and'';
            (B) by redesignating paragraph (3) as paragraph (4);
            (C) by inserting after paragraph (2), the following new 
        paragraph:
        ``(3) an assurance that the public health agency administering 
    the grant for the State will periodically convene a meeting of 
    individuals with HIV, representatives of grantees under each part 
    under this title, providers, and public agency representatives for 
    the purpose of developing a statewide coordinated statement of 
    need; and''.
        (5) Planning, evaluation and administration.--Section 2618(c) 
    (42 U.S.C. 300ff-28(c)) is amended--
            (A) by striking paragraph (1);
            (B) in paragraphs (3) and (4), to read as follows:
        ``(3) Planning and evaluations.--Subject to paragraph (5) and 
    except as provided in paragraph (6), a State may not use more than 
    10 percent of amounts received under a grant awarded under this 
    part for planning and evaluation activities.
        ``(4) Administration.--
            ``(A) In general.--Subject to paragraph (5) and except as 
        provided in paragraph (6), a State may not use more than 10 
        percent of amounts received under a grant awarded under this 
        part for administration. In the case of entities and 
        subcontractors to which the State allocates amounts received by 
        the State under the grant (including consortia under section 
        2613), the State shall ensure that, of the aggregate amount so 
        allocated, the total of the expenditures by such entities for 
        administrative expenses does not exceed 10 percent (without 
        regard to whether particular entities expend more than 10 
        percent for such expenses).
            ``(B) Administrative activities.--For the purposes of 
        subparagraph (A), amounts may be used for administrative 
        activities that include routine grant administration and 
        monitoring activities.
            ``(C) Subcontractor administrative costs.--For the purposes 
        of this paragraph, subcontractor administrative activities 
        include--
                ``(i) usual and recognized overhead, including 
            established indirect rates for agencies;
                ``(ii) management oversight of specific programs funded 
            under this title; and
                ``(iii) other types of program support such as quality 
            assurance, quality control, and related activities.'';
            (C) by redesignating paragraph (5) as paragraph (7); and
            (D) by inserting after paragraph (4), the following new 
        paragraphs:
        ``(5) Limitation on use of funds.--Except as provided in 
    paragraph (6), a State may not use more than a total of 15 percent 
    of amounts received under a grant awarded under this part for the 
    purposes described in paragraphs (3) and (4).
        ``(6) Exception.--With respect to a State that receives the 
    minimum allotment under subsection (a)(1) for a fiscal year, such 
    State, from the amounts received under a grant awarded under this 
    part for such fiscal year for the activities described in 
    paragraphs (3) and (4), may, notwithstanding paragraphs (3), (4), 
    and (5), use not more than that amount required to support one 
    full-time-equivalent employee.''.
        (6) Technical assistance.--Section 2619 (42 U.S.C. 300ff-29) is 
    amended--
            (A) by striking ``may'' and inserting ``shall''; and
            (B) by inserting before the period the following: ``, 
        including technical assistance for the development and 
        implementation of statewide coordinated statements of need''.
        (7) Coordination.--Part B of title XXVI (42 U.S.C. 300ff-21 et 
    seq.) is amended by adding at the end thereof the following new 
    section:

``SEC. 2621. COORDINATION.

    ``The Secretary shall ensure that the Health Resources and Services 
Administration, the Centers for Disease Control and Prevention, and the 
Substance Abuse and Mental Health Services Administration coordinate 
the planning and implementation of Federal HIV programs in order to 
facilitate the local development of a complete continuum of HIV-related 
services for individuals with HIV disease and those at risk of such 
disease. Not later than October 1, 1996, and biennially thereafter, the 
Secretary shall submit to the appropriate committees of the Congress a 
report concerning coordination efforts under this title at the Federal, 
State, and local levels, including a statement of whether and to what 
extent there exist Federal barriers to integrating HIV-related 
programs.''.
    (d) Early Intervention Services.--
        (1) Establishment of program.--Section 2651(b) (42 U.S.C. 
    300ff-51(b)) is amended--
            (A) in paragraph (1), by inserting before the period the 
        following: ``, and unless the applicant agrees to expend not 
        less than 50 percent of the grant for such services that are 
        specified in subparagraphs (B) through (E) of such paragraph 
        for individuals with HIV disease''; and
            (B) in paragraph (4)--
                (i) by striking ``The Secretary'' and inserting ``(A) 
            In general.--The Secretary'';
                (ii) by inserting ``, or private for-profit entities if 
            such entities are the only available provider of quality 
            HIV care in the area,'' after ``nonprofit private 
            entities'';
                (iii) by realigning the margin of subparagraph (A) so 
            as to align with the margin of paragraph (3)(A); and
                (iv) by adding at the end thereof the following new 
            subparagraph:
            ``(B) Other requirements.--Grantees described in--
                ``(i) paragraphs (1), (2), (5), and (6) of section 
            2652(a) shall use not less than 50 percent of the amount of 
            such a grant to provide the services described in 
            subparagraphs (A), (B), (D), and (E) of section 2651(b)(2) 
            directly and on-site or at sites where other primary care 
            services are rendered; and
                ``(ii) paragraphs (3) and (4) of section 2652(a) shall 
            ensure the availability of early intervention services 
            through a system of linkages to community-based primary 
            care providers, and to establish mechanisms for the 
            referrals described in section 2651(b)(2)(C), and for 
            follow-up concerning such referrals.''.
        (2) Minimum qualifications.--Section 2652(b)(1)(B) (42 U.S.C. 
    300ff-52(b)(1)(B)) is amended by inserting ``, or a private for-
    profit entity if such entity is the only available provider of 
    quality HIV care in the area,'' after ``nonprofit private entity''.
        (3) Miscellaneous provisions.--Section 2654 (42 U.S.C. 300ff-
    54) is amended by adding at the end thereof the following new 
    subsection:
    ``(c) Planning and Development Grants.--
        ``(1) In general.--The Secretary may provide planning grants, 
    in an amount not to exceed $50,000 for each such grant, to public 
    and nonprofit private entities for the purpose of enabling such 
    entities to provide HIV early intervention services.
        ``(2) Requirement.--The Secretary may only award a grant to an 
    entity under paragraph (1) if the Secretary determines that the 
    entity will use such grant to assist the entity in qualifying for a 
    grant under section 2651.
        ``(3) Preference.--In awarding grants under paragraph (1), the 
    Secretary shall give preference to entities that provide primary 
    care services in rural or underserved communities.
        ``(4) Limitation.--Not to exceed 1 percent of the amount 
    appropriated for a fiscal year under section 2655 may be used to 
    carry out this section.''.
        (4) Authorization of appropriations.--Section 2655 (42 U.S.C. 
    300ff-55) is amended by striking ``$75,000,000'' and all that 
    follows through the end of the section, and inserting ``such sums 
    as may be necessary in each of the fiscal years 1996, 1997, 1998, 
    1999, and 2000.''.
        (5) Required agreements.--Section 2664(g) (42 U.S.C. 300ff-
    64(g)) is amended--
            (A) in paragraph (2), by striking ``and'' at the end 
        thereof;
            (B) in paragraph (3)--
                (i) by striking ``5 percent'' and inserting ``7.5 
            percent including planning and evaluation''; and
                (ii) by striking the period and inserting ``; and''; 
            and
            (C) by adding at the end thereof the following new 
        paragraph:
        ``(4) the applicant will submit evidence that the proposed 
    program is consistent with the statewide coordinated statement of 
    need and agree to participate in the ongoing revision of such 
    statement of need.''.
    (e) Demonstration Grants for Research and Services for Pediatric 
Patients.--Section 2671 (42 U.S.C. 300f-71) is amended to read as 
follows:
``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR 
WOMEN, INFANTS, CHILDREN, AND YOUTH.
    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration and in consultation 
with the Director of the National Institutes of Health, shall make 
grants to public and nonprofit private entities that provide primary 
care (directly or through contracts) for the following purposes:
        ``(1) Providing through such entities, in accordance with this 
    section, opportunities for women, infants, children, and youth to 
    be voluntary participants in research of potential clinical benefit 
    to individuals with HIV disease.
        ``(2) In the case of women, infants, children, and youth with 
    HIV disease, and the families of such individuals, providing to 
    such individuals--
            ``(A) health care on an outpatient basis; and
            ``(B) additional services in accordance with subsection 
        (d).
    ``(b) Provisions Regarding Participation in Research.--
        ``(1) In general.--With respect to the projects of research 
    with which an applicant under subsection (a) is concerned, the 
    Secretary may make a grant under such subsection to the applicant 
    only if the following conditions are met:
            ``(A) The applicant agrees to make reasonable efforts--
                ``(i) to identify which of the patients of the 
            applicant are women, infants, children, and youth who would 
            be appropriate participants in the projects;
                ``(ii) to carry out clause (i) through the use of 
            criteria provided for such purpose by the entities that 
            will be conducting the projects of research; and
                ``(iii) to offer women, infants, children, and youth 
            the opportunity to participate in the projects (as 
            appropriate), including the provision of services under 
            subsection (d)(3).
            ``(B) The applicant agrees that, in the case of the 
        research-related functions to be carried out by the applicant 
        pursuant to subsection (a)(1), the applicant will comply with 
        accepted standards that are applicable to such functions 
        (including accepted standards regarding informed consent and 
        other protections for human subjects).
            ``(C) For the first and second fiscal years for which 
        grants under subsection (a) are to be made to the applicant, 
        the applicant agrees that, not later than the end of the second 
        fiscal year of receiving such a grant, a significant number of 
        women, infants, children, and youth who are patients of the 
        applicant will be participating in the projects of research.
            ``(D) Except as provided in paragraph (3) (and paragraph 
        (4), as applicable), for the third and subsequent fiscal years 
        for which such grants are to be made to the applicant, the 
        Secretary has determined that a significant number of such 
        individuals are participating in the projects.
        ``(2) Prohibition.--Receipt of services by a patient shall not 
    be conditioned upon the consent of the patient to participate in 
    research.
        ``(3) Significant participation; consideration by secretary of 
    certain circumstances.--In administering the requirement of 
    paragraph (1)(D), the Secretary shall take into account 
    circumstances in which a grantee under subsection (a) is 
    temporarily unable to comply with the requirement for reasons 
    beyond the control of the grantee, and shall in such circumstances 
    provide to the grantee a reasonable period of opportunity in which 
    to reestablish compliance with the requirement.
        ``(4) Significant participation; temporary waiver for original 
    grantees.--
            ``(A) In general.--In the case of an applicant under 
        subsection (a) who received a grant under such subsection for 
        fiscal year 1995, the Secretary may, subject to subparagraph 
        (B), provide to the applicant a waiver of the requirement of 
        paragraph (1)(D) if the Secretary determines that the applicant 
        is making reasonable progress toward meeting the requirement.
            ``(B) Termination of authority for waivers.--The Secretary 
        may not provide any waiver under subparagraph (A) on or after 
        October 1, 1998. Any such waiver provided prior to such date 
        terminates on such date, or on such earlier date as the 
        Secretary may specify.
    ``(c) Provisions Regarding Conduct of Research.--
        ``(1) In general.--With respect to eligibility for a grant 
    under subsection (a):
            ``(A) A project of research for which subjects are sought 
        pursuant to such subsection may be conducted by the applicant 
        for the grant, or by an entity with which the applicant has 
        made arrangements for purposes of the grant. The grant may not 
        be expended for the conduct of any project of research, except 
        for such research-related functions as are appropriate for 
        providing opportunities under subsection (a)(1) (including the 
        functions specified in subsection (b)(1)).
            ``(B) The grant may be made only if the Secretary makes the 
        following determinations:
                ``(i) The applicant or other entity (as the case may be 
            under subparagraph (A)) is appropriately qualified to 
            conduct the project of research. An entity shall be 
            considered to be so qualified if any research protocol of 
            the entity has been recommended for funding under this Act 
            pursuant to technical and scientific peer review through 
            the National Institutes of Health.
                ``(ii) The project of research is being conducted in 
            accordance with a research protocol to which the Secretary 
            gives priority regarding the prevention or treatment of HIV 
            disease in women, infants, children, or youth, subject to 
            paragraph (2).
        ``(2) List of research protocols.--
            ``(A) In general.--From among the research protocols 
        described in paragraph (1)(B)(ii), the Secretary shall 
        establish a list of research protocols that are appropriate for 
        purposes of subsection (a)(1). Such list shall be established 
        only after consultation with public and private entities that 
        conduct such research, and with providers of services under 
        subsection (a) and recipients of such services.
            ``(B) Discretion of secretary.--The Secretary may authorize 
        the use, for purposes of subsection (a)(1), of a research 
        protocol that is not included on the list under subparagraph 
        (A). The Secretary may waive the requirement specified in 
        paragraph (1)(B)(ii) in such circumstances as the Secretary 
        determines to be appropriate.
    ``(d) Additional Services for Patients and Families.--A grant under 
subsection (a) may be made only if the applicant for the grant agrees 
as follows:
        ``(1) The applicant will provide for the case management of the 
    patient involved and the family of the patient.
        ``(2) The applicant will provide for the patient and the family 
    of the patient--
            ``(A) referrals for inpatient hospital services, treatment 
        for substance abuse, and mental health services; and
            ``(B) referrals for other social and support services, as 
        appropriate.
        ``(3) The applicant will provide the patient and the family of 
    the patient with such transportation, child care, and other 
    incidental services as may be necessary to enable the patient and 
    the family to participate in the program established by the 
    applicant pursuant to such subsection.
    ``(e) Coordination With Other Entities.--A grant under subsection 
(a) may be made only if the applicant for the grant agrees as follows:
        ``(1) The applicant will coordinate activities under the grant 
    with other providers of health care services under this Act, and 
    under title V of the Social Security Act.
        ``(2) The applicant will participate in the statewide 
    coordinated statement of need under part B (where it has been 
    initiated by the public health agency responsible for administering 
    grants under part B) and in revisions of such statement.
    ``(f) Application.--A grant under subsection (a) may be made only 
if an application for the grant is submitted to the Secretary and the 
application is in such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary determines to 
be necessary to carry out this section.
    ``(g) Coordination With National Institutes of Health.--The 
Secretary shall develop and implement a plan that provides for the 
coordination of the activities of the National Institutes of Health 
with the activities carried out under this section. In carrying out the 
preceding sentence, the Secretary shall ensure that projects of 
research conducted or supported by such Institutes are made aware of 
applicants and grantees under subsection (a), shall require that the 
projects, as appropriate, enter into arrangements for purposes of such 
subsection, and shall require that each project entering into such an 
arrangement inform the applicant or grantee under such subsection of 
the needs of the project for the participation of women, infants, 
children, and youth.
    ``(h) Annual Review of Programs; Evaluations.--
        ``(1) Review regarding access to and participation in 
    programs.--With respect to a grant under subsection (a) for an 
    entity for a fiscal year, the Secretary shall, not later than 180 
    days after the end of the fiscal year, provide for the conduct and 
    completion of a review of the operation during the year of the 
    program carried out under such subsection by the entity. The 
    purpose of such review shall be the development of recommendations, 
    as appropriate, for improvements in the following:
            ``(A) Procedures used by the entity to allocate 
        opportunities and services under subsection (a) among patients 
        of the entity who are women, infants, children, or youth.
            ``(B) Other procedures or policies of the entity regarding 
        the participation of such individuals in such program.
        ``(2) Evaluations.--The Secretary shall, directly or through 
    contracts with public and private entities, provide for evaluations 
    of programs carried out pursuant to subsection (a).
    ``(i) Training and Technical Assistance.--Of the amounts 
appropriated under subsection (j) for a fiscal year, the Secretary may 
use not more than five percent to provide, directly or through 
contracts with public and private entities (which may include grantees 
under subsection (a)), training and technical assistance to assist 
applicants and grantees under subsection (a) in complying with the 
requirements of this section.
    ``(j) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 1996 through 2000.''.
    (f) Evaluations and Reports.--Section 2674 (42 U.S.C. 300ff-74) is 
amended--
        (1) in subsection (b)--
            (A) in the matter preceding paragraph (1), by striking 
        ``not later than 1 year'' and all that follows through 
        ``title,'' and inserting the following: ``not later than 
        October 1, 1996,'';
            (B) by striking paragraphs (1) through (3) and inserting 
        the following paragraph:
        ``(1) evaluating the programs carried out under this title; 
    and''; and
            (C) by redesignating paragraph (4) as paragraph (2); and
        (2) by adding at the end the following subsection:
    ``(d) Allocation of Funds.--The Secretary shall carry out this 
section with amounts available under section 241. Such amounts are in 
addition to any other amounts that are available to the Secretary for 
such purpose.''.
    (g) Demonstration and Training.--
        (1) In general.--Title XXVI is amended by adding at the end, 
    the following new part:

                  ``PART F--DEMONSTRATION AND TRAINING

         ``Subpart I--Special Projects of National Significance

``SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

    ``(a) In General.--Of the amount appropriated under each of parts 
A, B, C, and D of this title for each fiscal year, the Secretary shall 
use the greater of $20,000,000 or 3 percent of such amount appropriated 
under each such part, but not to exceed $25,000,000, to administer a 
special projects of national significance program to award direct 
grants to public and nonprofit private entities including community-
based organizations to fund special programs for the care and treatment 
of individuals with HIV disease.
    ``(b) Grants.--The Secretary shall award grants under subsection 
(a) based on--
        ``(1) the need to assess the effectiveness of a particular 
    model for the care and treatment of individuals with HIV disease;
        ``(2) the innovative nature of the proposed activity; and
        ``(3) the potential replicability of the proposed activity in 
    other similar localities or nationally.
    ``(c) Special Projects.--Special projects of national significance 
shall include the development and assessment of innovative service 
delivery models that are designed to--
        ``(1) address the needs of special populations;
        ``(2) assist in the development of essential community-based 
    service delivery infrastructure; and
        ``(3) ensure the ongoing availability of services for Native 
    American communities to enable such communities to care for Native 
    Americans with HIV disease.
    ``(d) Special Populations.--Special projects of national 
significance may include the delivery of HIV health care and support 
services to traditionally underserved populations including--
        ``(1) individuals and families with HIV disease living in rural 
    communities;
        ``(2) adolescents with HIV disease;
        ``(3) Indian individuals and families with HIV disease;
        ``(4) homeless individuals and families with HIV disease;
        ``(5) hemophiliacs with HIV disease; and
        ``(6) incarcerated individuals with HIV disease.
    ``(e) Service Development Grants.--Special projects of national 
significance may include the development of model approaches to 
delivering HIV care and support services including--
        ``(1) programs that support family-based care networks and 
    programs that build organizational capacity critical to the 
    delivery of care in minority communities;
        ``(2) programs designed to prepare AIDS service organizations 
    and grantees under this title for operation within the changing 
    health care environment; and
        ``(3) programs designed to integrate the delivery of mental 
    health and substance abuse treatment with HIV services.
    ``(f) Coordination.--The Secretary may not make a grant under this 
section unless the applicant submits evidence that the proposed program 
is consistent with the statewide coordinated statement of need, and the 
applicant agrees to participate in the ongoing revision process of such 
statement of need.
    ``(g) Replication.--The Secretary shall make information concerning 
successful models developed under this part available to grantees under 
this title for the purpose of coordination, replication, and 
integration. To facilitate efforts under this subsection, the Secretary 
may provide for peer-based technical assistance from grantees funded 
under this part.''.
        (2) Repeal.--Subsection (a) of section 2618 (42 U.S.C. 300ff-
    28(a)) is repealed.
    (h) HIV/AIDS Communities, Schools, Centers.--
        (1) New part.--Part F of title XXVI (as added by subsection 
    (e)) is further amended by adding at the end, the following new 
    subpart:

           ``Subpart II--AIDS Education and Training Centers

``SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.''.

        (2) Amendments.--Section 776 (42 U.S.C. 294n) is amended--
            (A) by striking the section heading; and
            (B) in subsection (a)(1)--
                (i) by striking subparagraphs (B) and (C);
                (ii) by redesignating subparagraphs (A) and (D) as 
            subparagraphs (B) and (C), respectively;
                (iii) by inserting before subparagraph (B) (as so 
            redesignated) the following new subparagraph:
            ``(A) training health personnel, including practitioners in 
        title XXVI programs and other community providers, in the 
        diagnosis, treatment, and prevention of HIV infection and 
        disease, including the prevention of the perinatal transmission 
        of the disease and including measures for the prevention and 
        treatment of opportunistic infections;''; and
                (iv) in subparagraph (B) (as so redesignated) by adding 
            ``and'' after the semicolon.
        (3) Transfer.--Section 776 (42 U.S.C. 294n) (as amended by 
    paragraph (2)) is amended by transferring such section to section 
    2692 (as added by paragraph (1)).
        (4) Authorization of appropriations.--Section 2692 (as added by 
    paragraph (1)) is amended by adding at the end thereof the 
    following new subsection:
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of the fiscal years 1996 through 2000.''.

SEC. 4. AMOUNT OF EMERGENCY RELIEF GRANTS.

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

                    ``(I) the first year during such period, .06;
                    ``(II) the second year during such period, .06;
                    ``(III) the third year during such period, .08;
                    ``(IV) the fourth year during such period, .10;
                    ``(V) the fifth year during such period, .16;
                    ``(VI) the sixth year during such period, .16;
                    ``(VII) the seventh year during such period, .24;
                    ``(VIII) the eighth year during such period, .40;
                    ``(IX) the ninth year during such period, .57; and
                    ``(X) the tenth year during such period, .88.

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

SEC. 5. AMOUNT OF CARE GRANTS.

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

                    ``(I) the product of .80 and the ratio of the State 
                distribution factor for the State or territory (as 
                determined under subsection (B)) to the sum of the 
                respective State distribution factors for all States or 
                territories; and
                    ``(II) the product of .20 and the ratio of the non-
                EMA distribution factor for the State or territory (as 
                determined under subparagraph (C)) to the sum of the 
                respective distribution factors for all States or 
                territories.

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

                    ``(I) with respect to fiscal year 1996, 100 
                percent;
                    ``(II) with respect to fiscal year 1997, 99 
                percent;
                    ``(III) with respect to fiscal year 1998, 98 
                percent;
                    ``(IV) with respect to fiscal year 1999, 96.5 
                percent; and
                    ``(V) with respect to fiscal year 2000, 95 percent;

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

SEC. 6. CONSOLIDATION OF AUTHORIZATIONS OF APPROPRIATIONS.

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

``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) In General.--Subject to subsection (b), there are authorized 
to be appropriated to make grants under parts A and B, such sums as may 
be necessary for each of the fiscal years 1996 through 2000.
    ``(b) Development of Methodology.--
        ``(1) In general.--With respect to each of the fiscal years 
    1997 through 2000, the Secretary shall develop and implement a 
    methodology for adjusting the percentages allocated to part A and 
    part B to account for grants to new eligible areas under part A and 
    other relevant factors. Not later than July 1, 1996, the Secretary 
    shall prepare and submit to the appropriate committees of Congress 
    a report regarding the findings with respect to the methodology 
    developed under this paragraph.
        ``(2) Failure to implement.--If the Secretary determines that 
    such a methodology under paragraph (1) cannot be developed, there 
    are authorized to be appropriated--
            ``(A) such sums as may be necessary to carry out part A for 
        each of the fiscal years 1997 through 2000; and
            ``(B) such sums as may be necessary to carry out part B for 
        each of the fiscal years 1997 through 2000.''.
    (b) Repeals.--Sections 2608 and 2620 (42 U.S.C. 300ff-18 and 300ff-
30) are repealed.
    (c) Conforming Amendments.--Title XXVI is amended--
        (1) in section 2603 (42 U.S.C. 300ff-13)--
            (A) in subsection (a)(2), by striking ``2608'' and 
        inserting ``2677''; and
            (B) in subsection (b)(1), by striking ``2608'' and 
        inserting ``2677'';
        (2) in section 2605(c)(1) (42 U.S.C. 300ff-15(c)(1)) is amended 
    by striking ``2608'' and inserting ``2677''; and
        (3) in section 2618 (42 U.S.C. 300ff-28)--
            (A) in subsection (a)(1), is amended by striking ``2620'' 
        and inserting ``2677''; and
            (B) in subsection (b)(1), is amended by striking ``2620'' 
        and inserting ``2677''.

SEC. 7. PERINATAL TRANSMISSION OF HIV DISEASE.

    (a) Findings.--The Congress finds as follows:
        (1) Research studies and statewide clinical experiences have 
    demonstrated that administration of anti-retroviral medication 
    during pregnancy can significantly reduce the transmission of the 
    human immunodeficiency virus (commonly known as HIV) from an 
    infected mother to her baby.
        (2) The Centers for Disease Control and Prevention have 
    recommended that all pregnant women receive HIV counseling; 
    voluntary, confidential HIV testing; and appropriate medical 
    treatment (including anti-retroviral therapy) and support services.
        (3) The provision of such testing without access to such 
    counseling, treatment, and services will not improve the health of 
    the woman or the child.
        (4) The provision of such counseling, testing, treatment, and 
    services can reduce the number of pediatric cases of acquired 
    immune deficiency syndrome, can improve access to and provision of 
    medical care for the woman, and can provide opportunities for 
    counseling to reduce transmission among adults, and from mother to 
    child.
        (5) The provision of such counseling, testing, treatment, and 
    services can reduce the overall cost of pediatric cases of acquired 
    immune deficiency syndrome.
        (6) The cancellation or limitation of health insurance or other 
    health coverage on the basis of HIV status should be impermissible 
    under applicable law. Such cancellation or limitation could result 
    in disincentives for appropriate counseling, testing, treatment, 
    and services.
        (7) For the reasons specified in paragraphs (1) through (6)--
            (A) routine HIV counseling and voluntary testing of 
        pregnant women should become the standard of care; and
            (B) the relevant medical organizations as well as public 
        health officials should issue guidelines making such counseling 
        and testing the standard of care.
    (b) Additional Requirements for Grants.--Part B of title XXVI (42 
U.S.C. 300ff-21 et seq.) is amended--
        (1) by inserting after the part heading the following:

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

        (2) in section 2611(a), by adding at the end the following 
    sentence: ``The authority of the Secretary to provide grants under 
    part B is subject to section 2626(e)(2) (relating to the decrease 
    in perinatal transmission of HIV disease).''; and
        (3) by adding at the end thereof the following new subpart:

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

``SEC. 2625. CDC GUIDELINES FOR PREGNANT WOMEN.

    ``(a) Requirement.--Notwithstanding any other provision of law, a 
State shall, not later than 120 days after the date of enactment of 
this subpart, certify to the Secretary that such State has in effect 
regulations or measures to adopt the guidelines issued by the Centers 
for Disease Control and Prevention concerning recommendations for human 
immunodeficiency virus counseling and voluntary testing for pregnant 
women.
    ``(b) Noncompliance.--If a State does not provide the certification 
required under subsection (a) within the 120-day period described in 
such subsection, such State shall not be eligible to receive assistance 
for HIV counseling and testing under this section until such 
certification is provided.
    ``(c) Additional Funds Regarding Women and Infants.--
        ``(1) In general.--If a State provides the certification 
    required in subsection (a) and is receiving funds under part B for 
    a fiscal year, the Secretary may (from the amounts available 
    pursuant to paragraph (2)) make a grant to the State for the fiscal 
    year for the following purposes:
            ``(A) Making available to pregnant women appropriate 
        counseling on HIV disease.
            ``(B) Making available outreach efforts to pregnant women 
        at high risk of HIV who are not currently receiving prenatal 
        care.
            ``(C) Making available to such women voluntary HIV testing 
        for such disease.
            ``(D) Offsetting other State costs associated with the 
        implementation of this section and subsections (a) and (b) of 
        section 2626.
            ``(E) Offsetting State costs associated with the 
        implementation of mandatory newborn testing in accordance with 
        this title or at an earlier date than is required by this 
        title.
        ``(2) Funding.--For purposes of carrying out this subsection, 
    there are authorized to be appropriated $10,000,000 for each of the 
    fiscal years 1996 through 2000. Amounts made available under 
    section 2677 for carrying out this part are not available for 
    carrying out this section unless otherwise authorized.
        ``(3) Priority.--In awarding grants under this subsection the 
    Secretary shall give priority to States that have the greatest 
    proportion of HIV seroprevalance among child bearing women using 
    the most recent data available as determined by the Centers for 
    Disease Control and Prevention.
``SEC. 2626. PERINATAL TRANSMISSION OF HIV DISEASE; CONTINGENT 
REQUIREMENT REGARDING STATE GRANTS UNDER THIS PART.
    ``(a) Annual Determination of Reported Cases.--A State shall 
annually determine the rate of reported cases of AIDS as a result of 
perinatal transmission among residents of the State.
    ``(b) Causes of Perinatal Transmission.--In determining the rate 
under subsection (a), a State shall also determine the possible causes 
of perinatal transmission. Such causes may include--
        ``(1) the inadequate provision within the State of prenatal 
    counseling and testing in accordance with the guidelines issued by 
    the Centers for Disease Control and Prevention;
        ``(2) the inadequate provision or utilization within the State 
    of appropriate therapy or failure of such therapy to reduce 
    perinatal transmission of HIV, including--
            ``(A) that therapy is not available, accessible or offered 
        to mothers; or
            ``(B) that available therapy is offered but not accepted by 
        mothers; or
        ``(3) other factors (which may include the lack of prenatal 
    care) determined relevant by the State.
    ``(c) CDC Reporting System.--Not later than 4 months after the date 
of enactment of this subpart, the Director of the Centers for Disease 
Control and Prevention shall develop and implement a system to be used 
by States to comply with the requirements of subsections (a) and (b). 
The Director shall issue guidelines to ensure that the data collected 
is statistically valid.
    ``(d) Determination by Secretary.--Not later than 180 days after 
the expiration of the 18-month period beginning on the date on which 
the system is implemented under subsection (c), the Secretary shall 
publish in the Federal Register a determination of whether it has 
become a routine practice in the provision of health care in the United 
States to carry out each of the activities described in paragraphs (1) 
through (5) of section 2627. In making the determination, the Secretary 
shall consult with the States and with other public or private entities 
that have knowledge or expertise relevant to the determination.
    ``(e) Contingent Applicability.--
        ``(1) In general.--If the determination published in the 
    Federal Register under subsection (d) is that (for purposes of such 
    subsection) the activities involved have become routine practices, 
    paragraph (2) shall apply on and after the expiration of the 18-
    month period beginning on the date on which the determination is so 
    published.
        ``(2) Requirement.--Subject to subsection (f), the Secretary 
    shall not make a grant under part B to a State unless the State 
    meets not less than one of the following requirements:
            ``(A) A 50 percent reduction (or a comparable measure for 
        States with less than 10 cases) in the rate of new cases of 
        AIDS (recognizing that AIDS is a suboptimal proxy for tracking 
        HIV in infants and was selected because such data is 
        universally available) as a result of perinatal transmission as 
        compared to the rate of such cases reported in 1993 (a State 
        may use HIV data if such data is available).
            ``(B) At least 95 percent of women in the State who have 
        received at least two prenatal visits (consultations) prior to 
        34 weeks gestation with a health care provider or provider 
        group have been tested for the human immunodeficiency virus.
            ``(C) The State has in effect, in statute or through 
        regulations, the requirements specified in paragraphs (1) 
        through (5) of section 2627.
    ``(f) Limitation Regarding Availability of Funds.--With respect to 
an activity described in any of paragraphs (1) through (5) of section 
2627, the requirements established by a State under this section apply 
for purposes of this section only to the extent that the following 
sources of funds are available for carrying out the activity:
        ``(1) Federal funds provided to the State in grants under part 
    B or under section 2625, or through other Federal sources under 
    which payments for routine HIV testing, counseling or treatment are 
    an eligible use.
        ``(2) Funds that the State or private entities have elected to 
    provide, including through entering into contracts under which 
    health benefits are provided. This section does not require any 
    entity to expend non-Federal funds.

``SEC. 2627. TESTING OF PREGNANT WOMEN AND NEWBORN INFANTS.

    ``An activity or requirement described in this section is any of 
the following:
        ``(1) In the case of newborn infants who are born in the State 
    and whose biological mothers have not undergone prenatal testing 
    for HIV disease, that each such infant undergo testing for such 
    disease.
        ``(2) That the results of such testing of a newborn infant be 
    promptly disclosed in accordance with the following, as applicable 
    to the infant involved:
            ``(A) To the biological mother of the infant (without 
        regard to whether she is the legal guardian of the infant).
            ``(B) If the State is the legal guardian of the infant:
                ``(i) To the appropriate official of the State agency 
            with responsibility for the care of the infant.
                ``(ii) To the appropriate official of each authorized 
            agency providing assistance in the placement of the infant.
                ``(iii) If the authorized agency is giving significant 
            consideration to approving an individual as a foster parent 
            of the infant, to the prospective foster parent.
                ``(iv) If the authorized agency is giving significant 
            consideration to approving an individual as an adoptive 
            parent of the infant, to the prospective adoptive parent.
            ``(C) If neither the biological mother nor the State is the 
        legal guardian of the infant, to another legal guardian of the 
        infant.
            ``(D) To the child's health care provider.
        ``(3) That, in the case of prenatal testing for HIV disease 
    that is conducted in the State, the results of such testing be 
    promptly disclosed to the pregnant woman involved.
        ``(4) That, in disclosing the test results to an individual 
    under paragraph (2) or (3), appropriate counseling on the human 
    immunodeficiency virus be made available to the individual (except 
    in the case of a disclosure to an official of a State or an 
    authorized agency).
        ``(5) With respect to State insurance laws, that such laws 
    require--
            ``(A) that, if health insurance is in effect for an 
        individual, the insurer involved may not (without the consent 
        of the individual) discontinue the insurance, or alter the 
        terms of the insurance (except as provided in subparagraph 
        (C)), solely on the basis that the individual is infected with 
        HIV disease or solely on the basis that the individual has been 
        tested for the disease or its manifestation;
            ``(B) that subparagraph (A) does not apply to an individual 
        who, in applying for the health insurance involved, knowingly 
        misrepresented the HIV status of the individual; and
            ``(C) that subparagraph (A) does not apply to any 
        reasonable alteration in the terms of health insurance for an 
        individual with HIV disease that would have been made if the 
        individual had a serious disease other than HIV disease.
    For purposes of this subparagraph, a statute or regulation shall be 
    deemed to regulate insurance for purposes of this paragraph only to 
    the extent that such statute or regulation is treated as regulating 
    insurance for purposes of section 514(b)(2) of the Employee 
    Retirement Income Security Act of 1974.

``SEC. 2628. REPORT BY THE INSTITUTE OF MEDICINE.

    ``(a) In General.--The Secretary shall request that the Institute 
of Medicine of the National Academy of Sciences conduct an evaluation 
of the extent to which State efforts have been effective in reducing 
the perinatal transmission of the human immuno deficiency virus, and an 
analysis of the existing barriers to the further reduction in such 
transmission.
    ``(b) Report to Congress.--The Secretary shall ensure that, not 
later than 2 years after the date of enactment of this section, the 
evaluation and analysis described in subsection (a) is completed and a 
report summarizing the results of such evaluation and analysis is 
prepared by the Institute of Medicine and submitted to the appropriate 
committees of Congress together with the recommendations of the 
Institute.
``SEC. 2629. STATE HIV TESTING PROGRAMS ESTABLISHED PRIOR TO OR AFTER 
ENACTMENT.
    ``Nothing in this subpart shall be construed to disqualify a State 
from receiving grants under this title if such State has established at 
any time prior to or after the date of enactment of this subpart a 
program of mandatory HIV testing.''.

SEC. 8. SPOUSAL NOTIFICATION.

    (a) In General.--The Secretary of Health and Human Services shall 
not make a grant under part B of title XXVI of the Public Health 
Service Act (42 U.S.C. 300ff-21 et seq.) to any State unless such State 
takes administrative or legislative action to require that a good faith 
effort be made to notify a spouse of a known HIV-infected patient that 
such spouse may have been exposed to the human immunodeficiency virus 
and should seek testing.
    (b) Definitions.--For purposes of this section:
        (1) Spouse.--The term ``spouse'' means any individual who is 
    the marriage partner of an HIV-infected patient, or who has been 
    the marriage partner of that patient at any time within the 10-year 
    period prior to the diagnosis of HIV infection.
        (2) HIV-infected patient.--The term ``HIV-infected patient'' 
    means any individual who has been diagnosed to be infected with the 
    human immunodeficiency virus.
        (3) State.--The term ``State'' means any of the 50 States, the 
    District of Columbia, or any territory of the United States.
SEC. 9. OPTIONAL PARTICIPATION OF FEDERAL EMPLOYEES IN AIDS TRAINING 
PROGRAMS.
    (a) In General.--Notwithstanding any other provision of law, a 
Federal employee may not be required to attend or participate in an 
AIDS or HIV training program if such employee refuses to consent to 
such attendance or participation, except for training necessary to 
protect the health and safety of the Federal employee and the 
individuals served by such employees. An employer may not retaliate in 
any manner against such an employee because of the refusal of such 
employee to consent to such attendance or participation.
    (b) Definition.--As used in subsection (a), the term ``Federal 
employee'' has the same meaning given the term ``employee'' in section 
2105 of title 5, United States Code, and such term shall include 
members of the armed forces.

SEC. 10. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

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

``SEC. 2678. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

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

SEC. 11. LIMITATION ON APPROPRIATIONS.

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

SEC. 12. ADDITIONAL PROVISIONS.

    (a) Definitions.--Section 2676(4) (42 U.S.C. 300ff-76(4)) is 
amended by inserting ``funeral-service practitioners,'' after 
``emergency medical technicians,''.
    (b) Miscellaneous Amendment.--Section 1201(a) (42 U.S.C. 300d(a)) 
is amended in the matter preceding paragraph (1) by striking ``The 
Secretary,'' and all that follows through ``shall,'' and inserting 
``The Secretary shall,''.
    (c) Technical Corrections.--Title XXVI (42 U.S.C. 300ff-11 et seq.) 
is amended--
        (1) in section 2601(a), by inserting ``section'' before 
    ``2604'';
        (2) in section 2603(b)(4)(B), by striking ``an expedited 
    grants'' and inserting ``an expedited grant'';
        (3) in section 2617(b)(3)(B)(iv), by inserting ``section'' 
    before ``2615'';
        (4) in section 2647--
            (A) in subsection (a)(1), by inserting ``to'' before 
        ``HIV'';
            (B) in subsection (c), by striking ``section 2601'' and 
        inserting ``section 2641''; and
            (C) in subsection (d)--
                (i) in the matter preceding paragraph (1), by striking 
            ``section 2601'' and inserting ``section 2641''; and
                (ii) in paragraph (1), by striking ``has in place'' and 
            inserting ``will have in place'';
        (5) in section 2648--
            (A) by converting the heading for the section to boldface 
        type; and
            (B) by redesignating the second subsection (g) as 
        subsection (h);
        (6) in section 2649--
            (A) in subsection (b)(1), by striking ``subsection (a) 
        of''; and
            (B) in subsection (c)(1), by striking ``this subsection'' 
        and inserting ``subsection'';
        (7) in section 2651--
            (A) in subsection (b)(3)(B), by striking ``facility'' and 
        inserting ``facilities''; and
            (B) in subsection (c), by striking ``exist'' and inserting 
        ``exists'';
        (8) in section 2676--
            (A) in paragraph (2), by striking ``section'' and all that 
        follows through ``by the'' and inserting ``section 2686 by 
        the''; and
            (B) in paragraph (10), by striking ``673(a)'' and inserting 
        ``673(2)'';
        (9) in part E, by converting the headings for subparts I and II 
    to Roman typeface; and
        (10) in section 2684(b), in the matter preceding paragraph (1), 
    by striking ``section 2682(d)(2)'' and inserting ``section 
    2683(d)(2)''.

SEC. 13. EFFECTIVE DATE.

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

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.
```