II

104TH CONGRESS

1ST SESSION S. 641

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, and Mr. SIMON) introduced the following bill; which was read twice and referred to the Committee on Labor and Human Resources

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,

3 SECTION 1. SHORT TITLE.

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

5 Reauthorization Act of 1995’’.

6 SEC. 2. REFERENCES.

7 Whenever in this Act an amendment is expressed in

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

9 the reference shall be considered to be made to a section
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1 or other provision of title XXVI of the Public Health Serv2 ice Act (42 U.S.C. 300ff-11 et seq.).

3 SEC. 3. GENERAL AMENDMENTS.

4 (a) ESTABLISHMENT OF GRANT PROGRAM.—Section

5 2601 (42 U.S.C. 300ff–11) is amended—

6 (1) in subsection (a)—

7 (A) by striking ‘‘March 31 of the most re8 cent fiscal year’’ and inserting ‘‘March 31,

9 1995, and December 31 of the most recent cal10 endar year thereafter’’; and

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

12 follows through the period and inserting ‘‘fiscal

13 year, there has been reported to and confirmed

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

15 for which the grant is being made, the Director

16 of the Centers for Disease Control and Preven17 tion a cumulative total of more than 2,000

18 cases of acquired immune deficiency syn19 drome.’’; and

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

21 new subsections:

22 ‘‘(c) POPULATION OF ELIGIBLE AREAS.—The Sec23 retary may not make a grant to an eligible area under

24 subsection (a) after the date of enactment of this sub25 section unless the area has a population of at least
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1 500,000 individuals, except that this subsection shall not

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

3 purposes of eligibility under this title, the boundaries of

4 each metropolitan area shall be those in effect in fiscal

5 year 1994.

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

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

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

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

10 (b) EMERGENCY RELIEF FOR AREAS WITH SUB11 STANTIAL NEED FOR SERVICES.—

12 (1) HIV HEALTH SERVICES PLANNING COUN13 CIL.—Subsection (b) of section 2602 (42 U.S.C.

14 300ff–12(b)) is amended—

15 (A) in paragraph (1)—

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

17 follows through the end thereof, and in18 serting ‘‘reflect in its composition the de19 mographics of the epidemic in the eligible

20 area involved, with particular consideration

21 given to disproportionately affected and

22 historically underserved groups and sub23 populations.’’; and

24 (ii) by adding at the end thereof the

25 following new sentences: ‘‘Nominations for
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1 membership on the council shall be identi2 fied through an open process and can3 didates shall be selected based on locally

4 delineated and publicized criteria. Such cri5 teria shall include a conflict-of-interest

6 standard for each nominee.’’;

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

8 thereof the following new subparagraph:

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

10 may not be chaired solely by an employee of the

11 grantee.’’;

12 (C) in paragraph (3)—

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

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

15 the—

16 ‘‘(i) documented needs of the HIV-in17 fected population;

18 ‘‘(ii) cost and outcome effectiveness of

19 proposed strategies and interventions, to

20 the extent that such data are reasonably

21 available, (either demonstrated or prob22 able);

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

24 communities for whom the services are in25 tended; and
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1 ‘‘(iv) availability of other govern2 mental and nongovernmental resources;’’;

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

4 subparagraph (B);

5 (iii) by striking the period at the end

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

7 at the discretion of the planning council,

8 assess the effectiveness, either directly or

9 through contractual arrangements, of the

10 services offered in meeting the identified

11 needs; ’’; and

12 (iv) by adding at the end thereof the

13 following new subparagraphs:

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

15 Statewide coordinated statement of need initi16 ated by the State health department;

17 ‘‘(E) establish operating procedures which

18 include specific policies for resolving disputes,

19 responding to grievances, and minimizing and

20 managing conflict-of-interests; and

21 ‘‘(F) establish methods for obtaining input

22 on community needs and priorities which may

23 include public meetings, conducting focus

24 groups, and convening ad-hoc panels.’’;
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1 (D) by redesignating paragraphs (2) and

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

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

4 following new paragraph:

5 ‘‘(2) REPRESENTATION.—The HIV health serv6 ices planning council shall include representatives

7 of—

8 ‘‘(A) health care providers, including feder9 ally qualified health centers;

10 ‘‘(B) community-based organizations serv11 ing affected populations and AIDS service orga12 nizations;

13 ‘‘(C) social service providers;

14 ‘‘(D) mental health and substance abuse

15 providers;

16 ‘‘(E) local public health agencies;

17 ‘‘(F) hospital planning agencies or health

18 care planning agencies;

19 ‘‘(G) affected communities, including peo20 ple with HIV disease or AIDS and historically

21 underserved groups and subpopulations;

22 ‘‘(H) nonelected community leaders;

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

24 medicaid agency and the agency administering

25 the program under part B);
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1 ‘‘(J) grantees under subpart II of part C;

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

3 none are operating in the area, representatives

4 of organizations with a history of serving chil5 dren, youth, women, and families living with

6 HIV and operating in the area; and

7 ‘‘(L) grantees under other Federal HIV

8 programs.’’.

9 (2) DISTRIBUTION OF GRANTS.—Section 2603

10 (42 U.S.C. 300ff–13) is amended—

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

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

13 Secretary shall’’ and inserting the following:

14 ‘‘Not later than 60 days after an appropriation

15 becomes available to carry out this part for

16 each of the fiscal years 1996 through 2000, the

17 Secretary shall’’; and

18 (B) in subsection (b)

19 (i) in paragraph (1)—

20 (I) by striking ‘‘and’’ at the end

21 of subparagraph (D);

22 (II) by striking the period at the

23 end of subparagraph (E) and insert24 ing a semicolon; and
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1 (III) by adding at the end thereof

2 the following new subparagraphs:

3 ‘‘(F) demonstrates the inclusiveness of the

4 planning council membership, with particular

5 emphasis on affected communities and individ6 uals with HIV disease; and

7 ‘‘(G) demonstrates the manner in which

8 the proposed services are consistent with the

9 local needs assessment and the Statewide co10 ordinated statement of need.’’; and

11 (ii) by redesignating paragraphs (2),

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

13 (5), respectively; and

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

15 the following new paragraph:

16 ‘‘(2) PRIORITY.—

17 ‘‘(A) SEVERE NEED.—In determining se18 vere need in accordance with paragraph (1)(B),

19 the Secretary shall give priority consideration in

20 awarding grants under this section to any quali21 fied applicant that demonstrates an ability to

22 spend funds efficiently and demonstrates a

23 more severe need based on prevalence of—

24 ‘‘(i) sexually transmitted diseases,

25 substance abuse, tuberculosis, severe men-
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1 tal illness, or other diseases determined

2 relevant by the Secretary, which signifi3 cantly effect the impact of HIV disease in

4 affected individuals and communities;

5 ‘‘(ii) AIDS in individuals, and sub6 populations, previously unknown in the eli7 gible metropolitan area; or

8 ‘‘(iii) homelessness.

9 ‘‘(B) PREVALENCE.—In determining prev10 alence of diseases under subparagraph (A), the

11 Secretary shall use data on the prevalence of

12 the illnesses described in such subparagraph in

13 HIV-infected individuals unless such data is not

14 available nationally. Where such data is not na15 tionally available, the Secretary may use the

16 prevalence (with respect to such illnesses) in the

17 general population.’’.

18 (3) DISTRIBUTION OF FUNDS.—

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

20 U.S.C. 300ff–13(a)(2)) (as amended by para21 graph (2)) is further amended—

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

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

24 (ii) by adding at the end thereof the

25 following new sentence: ‘‘The Secretary
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1 shall reserve an additional percentage of

2 the amount appropriated under section

3 2677 for a fiscal year for grants under

4 part A to make grants to eligible areas

5 under section 2601(a) in accordance with

6 paragraph (4).’’.

7 (B) INCREASE IN GRANT.—Section

8 2603(a) (42 U.S.C. 300ff–13(a)) is amended by

9 adding at the end thereof the following new

10 paragraph:

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

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

13 shall increase the amount of a grant under para14 graph (2) for a fiscal year to ensure that such eligi15 ble area receives not less than—

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

17 percent;

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

19 percent;

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

21 percent;

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

23 percent; and

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

25 percent;
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1 of the amount allocated for fiscal year 1995 to such

2 entity under this subsection.’’.

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

4 U.S.C. 300ff–14) is amended—

5 (A) in subsection (b)(1)(A)—

6 (i) by inserting ‘‘, substance abuse

7 treatment and mental health treatment,’’

8 after ‘‘case management’’; and

9 (ii) by inserting ‘‘which shall include

10 treatment education and prophylactic

11 treatment for opportunistic infections,’’

12 after ‘‘treatment services,’’;

13 (B) in subsection (b)(2)(A)—

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

15 entities if such entities are the only avail16 able provider of quality HIV care in the

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

18 and

19 (ii) by striking ‘‘and homeless health

20 centers’’ and inserting ‘‘homeless health

21 centers, substance abuse treatment pro22 grams, and mental health programs’’; and

23 (C) in subsection (e)—

24 (i) in the subsection heading, by strik25 ing ‘‘AND PLANNING;
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1 (ii) by striking ‘‘The chief’’ and in2 serting:

3 ‘‘(1) IN GENERAL.—The chief’’;

4 (iii) by striking ‘‘accounting, report5 ing, and program oversight functions’’;

6 (iv) by adding at the end thereof the

7 following new sentence: ‘‘An entity (includ8 ing subcontractors) receiving an allocation

9 from the grant awarded to the chief execu10 tive officer under this part shall not use in

11 excess of 12.5 percent of amounts received

12 under such allocation for administration.’’;

13 and

14 (v) by adding at the end thereof the

15 following new paragraphs:

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

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

18 administrative activities that include—

19 ‘‘(A) routine grant administration and

20 monitoring activities, including the development

21 of applications for part A funds, the receipt and

22 disbursal of program funds, the development

23 and establishment of reimbursement and ac24 counting systems, the preparation of routine

25 programmatic and financial reports, and com-
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1 pliance with grant conditions and audit require2 ments; and

3 ‘‘(B) all activities associated with the

4 grantee’s contract award procedures, including

5 the development of requests for proposals, con6 tract proposal review activities, negotiation and

7 awarding of contracts, monitoring of contracts

8 through telephone consultation, written docu9 mentation or onsite visits, reporting on con10 tracts, and funding reallocation activities.’’.

11 ‘‘(3) SUBCONTRACTOR ADMINISTRATIVE

12 COSTS.—For the purposes of this subsection, sub13 contractor administrative activities include—

14 ‘‘(A) usual and recognized overhead, in15 cluding established indirect rates for agencies;

16 ‘‘(B) management oversight of specific pro17 grams funded under this title; and

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

19 as quality assurance, quality control, and relat20 ed activities.’’.

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

22 300ff–15) is amended—

23 (A) in subsection (a)—

24 (i) in the matter preceding paragraph

25 (1), by inserting ‘‘, in accordance with sub-
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1 section (c) regarding a single application

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

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

4 ‘‘1-year period’’ and all that follows

5 through ‘‘eligible area’’ and inserting ‘‘pre6 ceding fiscal year’’;

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

8 ‘‘and’’ at the end thereof;

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

10 period at the end thereof and inserting ‘‘;

11 and’’; and

12 (v) by adding at the end thereof the

13 following new paragraph:

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

15 agree to participate, in the Statewide coordinated

16 statement of need process where it has been initiated

17 by the State, and ensure that the services provided

18 under the comprehensive plan are consistent with

19 the Statewide coordinated statement of need.’’;

20 (B) in subsection (b)—

21 (i) in the subsection heading, by strik22 ing ‘‘ADDITIONAL’’;

23 (ii) in the matter preceding paragraph

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

25 and inserting ‘‘application, in accordance
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1 with subsection (c) regarding a single ap2 plication and grant award,’’;

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

4 ‘‘and’’ at the end thereof; and

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

6 period and inserting ‘‘; and’’;

7 (C) by redesignating subsections (c) and

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

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

10 following new subsection:

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

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

13 in the use of a single application that meets the re14 quirements of subsections (a) and (b) of section

15 2603 with respect to an eligible area that desires to

16 receive grants under section 2603 for a fiscal year.

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

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

19 that submits an approved application under para20 graph (1) for a fiscal year.’’.

21 (6) TECHNICAL ASSISTANCE.—Section 2606

22 (42 U.S.C. 300ff–16) is amended—

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

24 ‘‘shall’’;
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1 (B) by inserting after ‘‘technical assist2 ance’’ the following: ‘‘, including peer based as3 sistance to assist newly eligible metropolitan

4 areas in the establishment of HIV health serv5 ices planning councils and,’’; and

6 (C) by adding at the end thereof the fol7 lowing new sentences: ‘‘The Administrator may

8 make planning grants available to metropolitan

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

10 any metropolitan area, projected to be eligible

11 for funding under section 2601 in the following

12 fiscal year. Such grant amounts shall be de13 ducted from the first year formula award to eli14 gible areas accepting such grants. Not to exceed

15 1 percent of the amount appropriated for a fis16 cal year under section 2677 for grants under

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

18 (b) CARE GRANT PROGRAM.—

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

20 U.S.C. 300ff–23) is amended—

21 (A) in subsection (a)—

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

23 private for-profit providers or organiza24 tions if such entities are the only available
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1 providers of quality HIV care in the area)’’

2 after ‘‘nonprofit private,’’; and

3 (ii) in paragraph (2)(A)—

4 (I) by inserting ‘‘substance abuse

5 treatment, mental health treatment,’’

6 after ‘‘nursing,’’; and

7 (II) by inserting ‘‘prophylactic

8 treatment for opportunistic infections,

9 treatment education to take place in

10 the context of health care delivery,’’

11 after ‘‘monitoring,’’;

12 (B) in subsection (c)—

13 (i) in subparagraph (C) of paragraph

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

15 centered’’; and

16 (ii) in paragraph (2)—

17 (I) in clause (ii) of subparagraph

18 (A), by striking ‘‘served; and’’ and in19 serting ‘‘served;’’;

20 (II) in subparagraph (B), by

21 striking the period at the end; and

22 (III) by adding after subpara23 graph (B), the following new subpara24 graphs:
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1 ‘‘(C) grantees under section 2671 and rep2 resentatives of organizations with a history of

3 serving children, youth, women, and families

4 with HIV and operating in the community to be

5 served; and

6 ‘‘(D) representatives of community-based

7 providers that are necessary to provide the full

8 continuum of HIV-related health care services,

9 which are available within the geographic area

10 to be served.’’; and

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

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

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

14 system of services described in this section that is targeted

15 specifically to the special needs of infants, children (in16 cluding those orphaned by the AIDS epidemic), youth,

17 women, and families. Family centered and youth centered

18 care shall be based on a partnership among parents, ex19 tended family members, children and youth, professionals,

20 and the community designed to ensure an integrated, co21 ordinated, culturally sensitive, and community-based con22 tinuum of care.’’.

23 (2) PROVISION OF TREATMENTS.—Section 2616

24 (42 U.S.C. 300ff–26) is amended by striking sub-
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1 section (c) and inserting the following new sub2 sections:

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

4 carrying out this section, the Secretary shall—

5 ‘‘(1) review the current status of State drug re6 imbursement programs and assess barriers to the

7 expended availability of prophylactic treatments for

8 opportunistic infections (including active tuber9 culosis); and

10 ‘‘(2) establish, in consultation with States, pro11 viders, and affected communities, a recommended

12 minimum formulary of pharmaceutical drug thera13 pies approved by the Food and Drug Administra14 tion.

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

16 those treatments in the recommended minimum formulary

17 that are for the prevention of opportunistic infections (in18 cluding the prevention of active tuberculosis).

19 ‘‘(d) STATE DUTIES.—

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

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

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

23 available to individuals eligible for assistance under

24 this section, and to develop plans to implement fully

25 the recommended minimum formulary of pharma-
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1 ceutical drug therapies approved by the Food and

2 Drug Administration.

3 ‘‘(2) OTHER MECHANISMS FOR PROVIDING

4 TREATMENTS.—In meeting the standards of the rec5 ommended minimum formulary developed under sub6 section (c), a State may identify other mechanisms

7 such as consortia and public programs for providing

8 such treatments to individuals with HIV.’’.

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

10 U.S.C. 300ff–27(b)) is amended—

11 (A) in paragraph (2)—

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

13 ‘‘and’’ at the end thereof; and

14 (ii) by adding at the end thereof the

15 following new subparagraph:

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

17 and utilization of resources are consistent with

18 the Statewide coordinated statement of need

19 (including traditionally underserved populations

20 and subpopulations) developed in partnership

21 with other grantees in the State that receive

22 funding under this title;’’;

23 (B) by redesignating paragraph (3) as

24 paragraph (4);
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1 (C) by inserting after paragraph (2), the

2 following new paragraph:

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

4 grant for the State shall convene a meeting at least

5 annually of individuals with HIV who utilize services

6 under this part (including those individuals from

7 traditionally underserved populations and subpopula8 tions) and representatives of grantees funded under

9 this title (including HIV health services planning

10 councils, early intervention programs, children,

11 youth and family service projects, special projects of

12 national significance, and HIV care consortia) and

13 other providers (including federally qualified health

14 centers) and public agency representatives within the

15 State currently delivering HIV services to affected

16 communities for the purpose of developing a State17 wide coordinated statement of need; and’’; and

18 (D) by adding at the end thereof the fol19 lowing flush sentence:

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

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

22 the travel-related expenses of individuals attending such

23 meetings where appropriate and necessary to ensure ade24 quate participation.’’.
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1 (4) PLANNING, EVALUATION AND ADMINISTRA2 TION.—Section 2618(c) (42 U.S.C. 300ff–28(c)) is

3 amended—

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

5 follows:

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

7 paragraph (5) and except as provided in paragraph

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

9 amounts received under a grant awarded under this

10 part for planning and evaluation activities.

11 ‘‘(4) ADMINISTRATION.—

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

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

14 State may not use more than 10 percent of

15 amounts received under a grant awarded under

16 this part for administration. An entity (includ17 ing subcontractors) receiving an allocation from

18 the grant awarded to the State under this part

19 shall not use in excess of 12.5 percent of

20 amounts received under such allocation for ad21 ministration.

22 ‘‘(B) ADMINISTRATIVE ACTIVITIES.—For

23 the purposes of subparagraph (A), amounts

24 may be used for administrative activities that
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1 include routine grant administration and mon2 itoring activities.

3 ‘‘(C) SUBCONTRACTOR ADMINISTRATIVE

4 COSTS.—For the purposes of this paragraph,

5 subcontractor administrative activities in6 clude—

7 ‘‘(i) usual and recognized overhead,

8 including established indirect rates for

9 agencies;

10 ‘‘(ii) management oversight of specific

11 programs funded under this title; and

12 ‘‘(iii) other types of program support

13 such as quality assurance, quality control,

14 and related activities.’’;

15 (B) by redesignating paragraph (5) as

16 paragraph (7); and

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

18 following new paragraphs:

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

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

21 more than a total of 15 percent of amounts received

22 under a grant awarded under this part for the pur23 poses described in paragraphs (3) and (4).

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

25 receives the minimum allotment under subsection
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1 (a)(1) for a fiscal year, such State, from the

2 amounts received under a grant awarded under this

3 part for such fiscal year for the activities described

4 in paragraph (3) and (4), may, notwithstanding

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

6 amount required to support one full-time-equivalent

7 employee.’’.

8 (5) TECHNICAL ASSISTANCE.—Section 2619

9 (42 U.S.C. 300ff–29) is amended—

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

11 ‘‘shall’’; and

12 (B) by inserting before the period the fol13 lowing: ‘‘, including technical assistance for the

14 development and implementation of Statewide

15 coordinated statements of need’’.

16 (6) GRIEVANCE PROCEDURES AND COORDINA17 TION.—Part B of title XXVI (42 U.S.C. 300ff–21)

18 is amended by adding at the end thereof the follow19 ing new sections:

20 ‘‘SEC. 2621. GRIEVANCE PROCEDURES.

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

22 of this section, the Administration, in consultation with

23 affected parties, shall establish grievance procedures, spe24 cific to each part of this title, to address allegations of
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1 egregious violations of each such part. Such procedures

2 shall include an appropriate enforcement mechanism.

3 ‘‘SEC. 2622. COORDINATION.

4 ‘‘The Secretary shall ensure that the Health Re5 sources and Services Administration, the Centers for Dis6 ease Control and Prevention, and the Substance Abuse

7 and Mental Health Services Administration coordinate the

8 planning and implementation of Federal HIV programs

9 in order to facilitate the local development of a complete

10 continuum of HIV-related services for individuals with

11 HIV disease and those at risk of such disease. The Sec12 retary shall periodically prepare and submit to the relevant

13 committees of Congress a report concerning such coordi14 nation efforts at the Federal, State, and local levels as

15 well as the existence of Federal barriers to HIV program

16 integration.’’.

17 (c) EARLY INTERVENTION SERVICES.—

18 (1) ESTABLISHMENT OF PROGRAM.—Section

19 2651(b) (42 U.S.C. 300ff–51(b)) is amended—

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

21 agrees to’’ and all that follows through the pe22 riod and inserting: ‘‘grant agrees to—

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

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

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

4 the amount received under the grant to provide

5 a continuum of primary care services, including,

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

8 (B) in paragraph (4)—

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

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

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

14 available provider of quality HIV care in

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

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

20 (iv) by adding at the end thereof the

21 following new subparagraph:

22 ‘‘(B) OTHER REQUIREMENTS.—Grantees

23 described in—

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

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

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

5 sites where other primary care services are

6 rendered; and

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

8 2652(a) shall ensure the availability of

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

12 mechanisms for the referrals described in

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

14 concerning such referrals.’’.

15 (2) MINIMUM QUALIFICATIONS.—Section

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

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

18 if such entity is the only available provider of quality

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

21 (3) MISCELLANEOUS PROVISIONS.—Section

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

23 the end thereof the following new subsection:

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

2 planning grants, in an amount not to exceed

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

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

6 providers to provide HIV primary care services.

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

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

9 the Secretary determines that the entity will use

10 such grant to assist the entity in qualifying for a

11 grant under section 2651.

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

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

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

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

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

19 (4) AUTHORIZATION OF APPROPRIATIONS.—

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

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

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

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

24 1997, 1998, 1999, and 2000.’’.
29

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

2 (42 U.S.C. 300ff–64(g)) is amended—

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

4 the end thereof;

5 (B) in paragraph (3)—

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

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

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

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

14 proposed program is consistent with the Statewide

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

17 need.’’.

18 (d) GRANTS.—

19 (1) IN GENERAL.—Section section 2671 (42

20 U.S.C. 300ff–71) is amended to read as follows:

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

23 AND FAMILIES.

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

25 the Administrator of the Health Resources and Services
30

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1 Administration, and in consultation with the Director of

2 the National Institutes of Health, shall award grants to

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

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

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

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

11 and the families of such individuals, and supporting

12 the provision of such care with programs of HIV

13 prevention and HIV research; and

14 ‘‘(2) facilitating the voluntary participation of

15 children, youth, and women with HIV disease in

16 qualified research protocols at the facilities of such

17 entities or by direct referral.

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

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

20 entity involved provides assurances that—

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

22 children, youth, and women with HIV disease;

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

24 with one or more qualified research entities to col-
31

•S 641 IS

1 laborate in the conduct or facilitation of voluntary

2 patient participation in qualified research protocols;

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

4 the grant with other providers of health care services

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

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

8 coordinated statement of need under section 2619

9 and in the revision of such statement; and

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

11 opportunities to each patient, with informed consent.

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

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

14 grant is submitted to the Secretary and the application

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

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

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

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

21 through the Administrator of the Health Resources

22 and Services Administration and the Director of the

23 Office of AIDS Research, shall establish procedures

24 to ensure that accepted standards of protection of

25 human subjects (including the provision of written
32

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1 informed consent) are implemented in projects sup2 ported under this section. Receipt of services by a

3 patient shall not be conditioned upon the consent of

4 the patient to participate in research.

5 ‘‘(2) RESEARCH PROTOCOLS.—

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

7 establish mechanisms to ensure that research

8 protocols proposed to be carried out to meet the

9 requirements of this section, are of potential

10 clinical benefit to the study participants, and

11 meet accepted standards of research design.

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

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

16 meet the requirements of this section to ensure

17 that such protocols meet the requirements of

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

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

23 of services.

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

25 Secretary, acting through the Administrator of the Health
33

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1 Resources and Services Administration, may use not to

2 exceed five percent of the amounts appropriated under

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

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

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

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

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

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

14 and access to and participation in qualified research

15 protocols supported under this section.

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

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

20 evaluations, measure outcomes, and document the

21 clients served, services provided, and participation in

22 qualified research protocols.

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

25 new grants under this section to an entity if the en-
34

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1 tity provide assurances, satisfactory to the Sec2 retary, that the entity will implement the assurances

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

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

5 If the Secretary determines through the evaluation

6 process that a recipient of funds under this section

7 is in material noncompliance with the assurances

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

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

12 such noncompliance will be remedied within such pe13 riod.

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

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

16 ‘qualified research entity’ means a public or private

17 entity with expertise in the conduct of research that

18 has demonstrated clinical benefit to patients.

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

20 term ‘qualified research protocol’ means a research

21 study design of a public or private clinical program

22 that meets the requirements of subsection (d).

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

24 are authorized to be appropriated to carry out this section,
35

•S 641 IS

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

2 1996 through 2000.’’.

3 (2) CONFORMING AMENDMENT.—The heading

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

6 ‘‘Part D—Grants for Coordinated Services and Access

7 to Research for Children, Youth, and Families’’.

8 (e) DEMONSTRATION AND TRAINING.—

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

10 adding at the end, the following new part:

11 ‘‘PART F—DEMONSTRATION AND TRAINING

12 ‘‘Subpart I—Special Projects of National Significance

13 ‘‘SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFI14 CANCE.

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

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

17 fiscal year, the Secretary shall use the greater of

18 $20,000,000 or 3 percent of such amount appropriated

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

20 administer a special projects of national significance pro21 gram to award direct grants to public and nonprofit pri22 vate entities including community-based organizations to

23 fund special programs for the care and treatment of indi24 viduals with HIV disease.
36

•S 641 IS

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

2 under subsection (a) based on—

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

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

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

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

9 activity in other similar localities or nationally.

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

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

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

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

18 for Native American communities to enable such

19 communities to care for Native Americans with HIV

20 disease.

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

23 care and support services to traditionally underserved pop24 ulations including—
37

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

2 living in rural communities;

3 ‘‘(2) adolescents with HIV disease;

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

5 disease;

6 ‘‘(4) homeless individuals and families with

7 HIV disease;

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

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

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

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

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

15 networks critical to the delivery of care in minority

16 communities;

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

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

21 operation within the changing health care environ22 ment; and

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

25 with HIV services.
38

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

2 a grant under this section unless the applicant submits

3 evidence that the proposed program is consistent with the

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

6 of such statement of need.

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

9 part available to grantees under this title for the purpose

10 of coordination, replication, and integration. To facilitate

11 efforts under this subsection, the Secretary may provide

12 for peer-based technical assistance from grantees funded

13 under this part.’’.

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

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

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

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

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

21 ‘‘Subpart II—AIDS Education and Training Centers

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

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

25 U.S.C. 294n(a)) is amended—
39

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1 (A) by striking subparagraphs (B) and

2 (C);

3 (B) by redesignating subparagraphs (A)

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

6 (C) by inserting before subparagraph (B)

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

9 ‘‘(A) training health personnel, including

10 practitioners in title XXVI programs and other

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

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

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

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

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

20 (4) AUTHORIZATION OF APPROPRIATIONS.—

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

23 subsection:

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

25 are authorized to be appropriated to carry out this section,
40

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

2 1996 through 2000.’’.

3 SEC. 4. AMOUNT OF EMERGENCY RELIEF GRANTS.

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

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

6 ‘‘(3) AMOUNT OF GRANT.—

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

8 of amounts made available in appropriations

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

11 amount equal to the product of—

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

13 available for distribution under paragraph

14 (2) for the fiscal year involved; and

15 ‘‘(ii) the percentage constituted by the

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

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

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

23 number of living cases of acquired immune

24 deficiency syndrome in the eligible area in-
41

•S 641 IS

1 volved, as determined under subparagraph

2 (C); and

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

4 area involved, as determined under sub5 paragraph (D).

6 ‘‘(C) ESTIMATE OF LIVING CASES.—The

7 amount determined in this subparagraph is an

8 amount equal to the product of—

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

10 immune deficiency syndrome in the eligible

11 area during each year in the most recent

12 120-month period for which data are avail13 able with respect to all eligible areas, as in14 dicated by the number of such cases re15 ported to and confirmed by the Director of

16 the Centers for Disease Control and Pre17 vention for each year during such period;

18 and

19 ‘‘(ii) with respect to—

20 ‘‘(I) the first year during such

21 period, .06;

22 ‘‘(II) the second year during such

23 period, .06;

24 ‘‘(III) the third year during such

25 period, .08;
42

•S 641 IS

1 ‘‘(IV) the fourth year during

2 such period, .10;

3 ‘‘(V) the fifth year during such

4 period, .16;

5 ‘‘(VI) the sixth year during such

6 period, .16;

7 ‘‘(VII) the seventh year during

8 such period, .24;

9 ‘‘(VIII) the eighth year during

10 such period, .40;

11 ‘‘(IX) the ninth year during such

12 period, .57; and

13 ‘‘(X) the tenth year during such

14 period, .88.

15 ‘‘(D) COST INDEX.—The amount deter16 mined in this subparagraph is an amount equal

17 to the sum of—

18 ‘‘(i) the product of—

19 ‘‘(I) the average hospital wage

20 index reported by hospitals in the eli21 gible area involved under section

22 1886(d)(3)(E) of the Social Security

23 Act for the 3-year period immediately

24 preceding the year for with the grant

25 is being awarded; and
43

•S 641 IS

1 ‘‘(II) .70; and

2 ‘‘(ii) .30.

3 ‘‘(E) UNEXPENDED FUNDS.—The Sec4 retary may, in determining the amount of a

5 grant for a fiscal year under this paragraph,

6 adjust the grant amount to reflect the amount

7 of unexpended and uncanceled grant funds re8 maining at the end of the fiscal year preceding

9 the year for which the grant determination is to

10 be made. The amount of any such unexpended

11 funds shall be determined using the financial

12 status report of the grantee.

13 ‘‘(F) PUERTO RICO, VIRGIN ISLANDS,

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

15 cost index for an eligible area within Puerto

16 Rico, the Virgin Islands, or Guam shall be

17 1.0.’’.

18 SEC. 5. AMOUNT OF CARE GRANTS.

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

20 300ff–28(b)(1) and (2)) are amended to read as follows:

21 ‘‘(1) MINIMUM ALLOTMENT.—Subject to the ex22 tent of amounts made available under section 2677,

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

24 for—
44

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

2 District of Columbia for a fiscal year shall be

3 the greater of—

4 ‘‘(i)(I) with respect to a State or Dis5 trict that has less than 90 living cases of

6 acquired immune deficiency syndrome, as

7 determined under paragraph (2)(D),

8 $100,000; or

9 ‘‘(i)(I) with respect to a State or Dis10 trict that has 90 or more living cases of

11 acquired immune deficiency syndrome, as

12 determined under paragraph (2)(D),

13 $250,000;

14 ‘‘(ii) an amount determined under

15 paragraph (2); and

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

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

18 determined under paragraph (2).

19 ‘‘(2) DETERMINATION.—

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

21 in paragraph (1)(A)(ii) for a State and para22 graph (1)(B) for a territory of the United

23 States shall be the product of—

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

25 appropriated under section 2677 for the
45

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1 fiscal year involved for grants under part

2 B; and

3 ‘‘(ii) the percentage constituted by the

4 sum of—

5 ‘‘(I) the product of .50 and the

6 ratio of the State distribution factor

7 for the State or territory (as deter8 mined under subsection (B)) to the

9 sum of the respective State distribu10 tion factors for all States or terri11 tories; and

12 ‘‘(II) the product of .50 and the

13 ratio of the non-EMA distribution fac14 tor for the State or territory (as de15 termined under subparagraph (C)) to

16 the sum of the respective distribution

17 factors for all States or territories.

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

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

20 ‘State distribution factor’ means the product

21 of—

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

23 number of living cases of acquired immune

24 deficiency syndrome in the State or terri-
46

•S 641 IS

1 tory involved, as determined under sub2 paragraph (D); and

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

4 territory involved, as determined under

5 subparagraph (E).

6 ‘‘(C) NON-EMA DISTRIBUTION FACTOR.—

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

8 term ‘non-ema distribution factor’ means the

9 product of—

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

11 ‘‘(I) the estimated number of liv12 ing cases of acquired immune defi13 ciency syndrome in the State or terri14 tory involved, as determined under

15 subparagraph (D); less

16 ‘‘(II) the estimated number of

17 living cases of acquired immune defi18 ciency syndrome in such State or ter19 ritory that are within an eligible area

20 (as determined under part A); and

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

22 territory involved, as determined under

23 subparagraph (E).
47

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1 ‘‘(D) ESTIMATE OF LIVING CASES.—The

2 amount determined in this subparagraph is an

3 amount equal to the product of—

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

5 immune deficiency syndrome in the State

6 or territory during each year in the most

7 recent 120-month period for which data

8 are available with respect to all States and

9 territories, as indicated by the number of

10 such cases reported to and confirmed by

11 the Director of the Centers for Disease

12 Control and Prevention for each year dur13 ing such period; and

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

15 through the tenth year during such period,

16 the amount referred to in

17 2603(a)(3)(C)(ii).

18 ‘‘(E) COST INDEX.—

19 ‘‘(i) The amount determined in this

20 subparagraph is an amount equal to the

21 sum of—

22 ‘‘(I) the amount determined

23 under clause (ii) for a fiscal year;

24 ‘‘(II) the product of—
48

•S 641 IS

1 ‘‘(aa) the average hospital

2 wage index reported by hospitals

3 in the State or territory involved

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

5 the Social Security Act for the 3-

6 year period immediately preced7 ing the year for with the grant is

8 being awarded; and

9 ‘‘(bb) .70; and

10 ‘‘(III) .30.

11 ‘‘(ii) The amount determined in this

12 clause for a fiscal year is an amount equal

13 to the percentage constituted by the ratio

14 of—

15 ‘‘(I) the total amount—

16 ‘‘(aa) of salaries reported by

17 each hospital within the State or

18 territory under the medicare pro19 spective payment system under

20 title XVIII of the Social Security

21 Act for the fiscal year involved;

22 divided by

23 ‘‘(bb) the total number of

24 hours worked by those included

25 in the reported salaries under
49

•S 641 IS

1 subclause (II) for the fiscal year

2 involved, as determined under

3 regulations promulgated by the

4 Secretary; and

5 ‘‘(II) the sum of the amount de6 termined under subclause (I) with re7 spect to all States and territories.

8 ‘‘(F) PUERTO RICO, VIRGIN ISLANDS,

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

10 cost index for Puerto Rico, the Virgin Islands,

11 and Guam shall be 1.0.’’.

12 ‘‘(G) UNEXPENDED FUNDS.—The Sec13 retary may, in determining the amount of a

14 grant for a fiscal year under this subsection,

15 adjust the grant amount to reflect the amount

16 of unexpended and uncanceled grant funds re17 maining at the end of the fiscal year preceding

18 the year for which the grant determination is to

19 be made. The amount of any such unexpended

20 funds shall be determined using the financial

21 status report of the grantee.

22 ‘‘(H) LIMITATION.—

23 ‘‘(i) IN GENERAL.—The Secretary

24 shall ensure that the amount of a grant

25 awarded to a State or territory for a fiscal
50

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1 year under this part is equal to not less

2 than—

3 ‘‘(I) with respect to fiscal year

4 1996, 98 percent;

5 ‘‘(II) with respect to fiscal year

6 1997, 97 percent;

7 ‘‘(III) with respect to fiscal year

8 1998, 95.5 percent;

9 ‘‘(IV) with respect to fiscal year

10 1999, 94 percent; and

11 ‘‘(V) with respect to fiscal year

12 2000, 92.5 percent;

13 of the amount such State or territory re14 ceived for fiscal year 1995 under this part.

15 In administering this subparagraph, the

16 Secretary shall, with respect to States that

17 will receive grants in amounts that exceed

18 the amounts that such States received

19 under this part in fiscal year 1995, propor20 tionally reduce such amounts to ensure

21 compliance with this subparagraph. In

22 making such reductions, the Secretary

23 shall ensure that no such State receives

24 less than that State received for fiscal year

25 1995.
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1 ‘‘(ii) RATABLE REDUCTION.—If the

2 amount appropriated under section 2677

3 and available for allocation under this part

4 is less than the amount appropriated and

5 available under this part for fiscal year

6 1995, the limitation contained in clause (i)

7 shall be reduced by a percentage equal to

8 the percentage of the reduction in such

9 amounts appropriated and available.’’.

10 SEC. 6. CONSOLIDATION OF AUTHORIZATIONS OF APPRO11 PRIATIONS.

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

13 300ff–71) is amended by adding at the end thereof the

14 following new section:

15 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

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

17 are authorized to be appropriated to make grants under

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

19 of the fiscal years 1996 through 2000. Of the amount ap20 propriated under this section for fiscal year 1996, the Sec21 retary shall make available 64 percent of such amount to

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

23 out part B.

24 ‘‘(b) DEVELOPMENT OF METHODOLOGY.—
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1 ‘‘(1) IN GENERAL.—With respect to each of the

2 fiscal years 1997 through 2000, the Secretary shall

3 develop and implement a methodology for adjusting

4 the percentages referred to in subsection (a) to ac5 count for grants to new eligible areas under part A

6 and other relevant factors. Not later than 1 year

7 after the date of enactment of this section, the Sec8 retary shall prepare and submit to the appropriate

9 committees of Congress a report regarding the find10 ings with respect to the methodology developed

11 under this paragraph.

12 ‘‘(2) FAILURE TO IMPLEMENT.—If the Sec13 retary fails to implement a methodology under para14 graph (1) by October 1, 1996, there are authorized

15 to be appropriated—

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

17 carry out part A for each of the fiscal years

18 1997 through 2000; and

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

20 carry out part B for each of the fiscal years

21 1997 through 2000.’’.

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

23 300ff–18 and 300ff–30) are repealed.

24 (c) CONFORMING AMENDMENTS.—Title XXVI is

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

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

3 ‘‘2608’’ and inserting ‘‘2677’’; and

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

5 ‘‘2608’’ and inserting ‘‘2677’’;

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

7 15(c)(1)) is amended by striking ‘‘2608’’ and insert8 ing ‘‘2677’’; and

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

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

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

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

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

14 SEC. 7. EFFECTIVE DATE.

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

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

17 become effective on October 1, 1995.

18 (b) ELIGIBLE AREAS.—

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

20 subsections (a)(1)(A), (a)(2), and (b)(4)(A) of sec21 tion 3 shall become effective on the date of enact22 ment of this Act.
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1 (2) REPORTED CASES.—The amendment made

2 by subsection (a)(1)(B) of section 3 shall become ef3 fective on October 1, 1997.

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