In the House of Representatives, U. S.,

September 18, 1995.

Resolved, That the bill from the Senate (S. 641) entitled

‘‘An Act to reauthorize the Ryan White CARE Act of 1990,

and for other purposes’’, do pass with the following

AMENDMENTS:

Strike out all after the enacting clause, and insert:

1 SECTION 1. SHORT TITLE.

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

3 Amendments of 1995’’.

4 SEC. 2. REFERENCES.

5 Whenever in this Act an amendment is expressed in

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

7 reference shall be considered to be made to that section or

8 other provision of the Public Health Service Act (42 U.S.C.

9 201 et seq.).
2

1 TITLE I—EMERGENCY RELIEF

2 FOR AREAS WITH SUBSTAN3 TIAL NEED FOR SERVICES

4 SEC. 101. ESTABLISHMENT OF PROGRAM OF GRANTS.

5 (a) NUMBER OF CASES; DELAYED APPLICABILITY.—

6 Effective October 1, 1996, section 2601(a) (42 U.S.C. 300ff–

7 11) is amended—

8 (1) by striking ‘‘subject to subsection (b)’’ and

9 inserting ‘‘subject to subsections (b) through (d)’’; and

10 (2) by striking ‘‘metropolitan area’’ and all that

11 follows and inserting the following: ‘‘metropolitan

12 area for which there has been reported to the Director

13 of the Centers for Disease Control and Prevention a

14 cumulative total of more than 2,000 cases of acquired

15 immune deficiency syndrome for the most recent pe16 riod of five calendar years for which such data are

17 available.’’.

18 (b) OTHER PROVISIONS REGARDING ELIGIBILITY.—

19 Section 2601 (42 U.S.C. 300ff–11) is amended by adding

20 at the end thereof the following subsections:

21 ‘‘(c) REQUIREMENTS REGARDING POPULATION.—

22 ‘‘(1) NUMBER OF INDIVIDUALS.—

23 ‘‘(A) IN GENERAL.—Except as provided in

24 subparagraph (B), the Secretary may not make

25 a grant under this section for a metropolitan
3

1 area unless the area has a population of 500,000

2 or more individuals.

3 ‘‘(B) LIMITATION.—Subparagraph (A) does

4 not apply to any metropolitan area that was an

5 eligible area under this part for fiscal year 1995

6 or any prior fiscal year.

7 ‘‘(2) GEOGRAPHIC BOUNDARIES.—For purposes

8 of eligibility under this part, the boundaries of each

9 metropolitan area are the boundaries that were in ef10 fect for the area for fiscal year 1994.

11 ‘‘(d) CONTINUED STATUS AS ELIGIBLE AREA.—Not12 withstanding any other provision of this section, a metro13 politan area that was an eligible area under this part for

14 fiscal year 1996 is an eligible area for fiscal year 1997 and

15 each subsequent fiscal year.’’.

16 (c) CONFORMING AMENDMENT REGARDING DEFINI17 TION OF ELIGIBLE AREA.—Section 2607(1) (42 U.S.C.

18 300ff–17(1)) is amended by striking ‘‘The term’’ and all

19 that follows and inserting the following: ‘‘The term ‘eligible

20 area’ means a metropolitan area meeting the requirements

21 of section 2601 that are applicable to the area.’’.

22 SEC. 102. HIV HEALTH SERVICES PLANNING COUNCIL.

23 (a) ESTABLISHMENT.—Section 2602(b)(1) (42 U.S.C.

24 300ff–12(b)(1)) is amended—
4

1 (1) in subparagraph (A), by inserting before the

2 semicolon the following: ‘‘, including federally quali3 fied health centers’’;

4 (2) in subparagraph (D), by inserting before the

5 semicolon the following: ‘‘and providers of services re6 garding substance abuse’’;

7 (3) in subparagraph (G), by inserting before the

8 semicolon the following: ‘‘and historically underserved

9 groups and subpopulations’’;

10 (4) in subparagraph (I), by inserting before the

11 semicolon the following: ‘‘, including the State medic12 aid agency and the agency administering the pro13 gram under part B’’;

14 (5) in subparagraph (J), by striking ‘‘and’’ after

15 the semicolon;

16 (6) by striking subparagraph (K); and

17 (7) by adding at the end the following subpara18 graphs:

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

20 none are operating in the area, representatives of

21 organizations in the area with a history of serv22 ing children, youth, women, and families living

23 with HIV; and

24 ‘‘(L) grantees under other HIV-related Fed25 eral programs.’’.
5

1 (b) DUTIES.—Section 2602(b)(3) (42 U.S.C. 300ff–

2 12(b)(3)) is amended—

3 (1) by striking ‘‘The planning’’ in the matter

4 preceding subparagraph (A) and all that follows

5 through the semicolon at the end of subparagraph (A)

6 and inserting the following: ‘‘The planning council

7 under paragraph (1) shall carry out the following:

8 ‘‘(A) Establish priorities for the allocation

9 of funds within the eligible area based on the fol10 lowing factors:

11 ‘‘(i) Documented needs of the HIV-in12 fected population.

13 ‘‘(ii) Cost and outcome effectiveness of

14 proposed strategies and interventions, to the

15 extent that such data are reasonably avail16 able.

17 ‘‘(iii) Priorities of the HIV-infected

18 communities for which the services are in19 tended.

20 ‘‘(iv) Availability of other govern21 mental and nongovernmental resources.’’;

22 (2) in subparagraph (B)—

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

24 ‘‘Develop’’; and
6

1 (B) by striking ‘‘; and’’ and inserting a pe2 riod;

3 (3) in subparagraph (C)—

4 (A) by striking ‘‘assess’’ and inserting ‘‘As5 sess’’;

6 (B) by striking ‘‘rapidly’’; and

7 (C) by inserting before the period the follow8 ing: ‘‘, and assess the effectiveness, either directly

9 or through contractual arrangements, of the serv10 ices offered in meeting the identified needs’’; and

11 (4) by adding at the end the following subpara12 graphs:

13 ‘‘(D) Participate in the development of the

14 statewide coordinated statement of need initiated

15 by the State health department (where it has

16 been so initiated).

17 ‘‘(E) Obtain input on community needs

18 through conducting public meetings.’’.

19 (c) GENERAL PROVISIONS.—Section 2602(b) (42

20 U.S.C. 300ff–12(b)) is amended by adding at the end the

21 following paragraph:

22 ‘‘(4) GENERAL PROVISIONS.—

23 ‘‘(A) COMPOSITION OF COUNCIL.—The plan24 ning council under paragraph (1) shall (in addi25 tion to requirements under such paragraph) re-
7

1 flect in its composition the demographics of the

2 epidemic in the eligible area involved, with par3 ticular consideration given to disproportionately

4 affected and historically underserved groups and

5 subpopulations. Nominations for membership on

6 the council shall be identified through an open

7 process, and candidates shall be selected based on

8 locally delineated and publicized criteria. Such

9 criteria shall include a conflict-of-interest stand10 ard for each nominee.

11 ‘‘(B) CONFLICTS OF INTEREST.—

12 ‘‘(i) The planning council under para13 graph (1) may not be directly involved in

14 the administration of a grant under section

15 2601(a). With respect to compliance with

16 the preceding sentence, the planning council

17 may not designate (or otherwise be involved

18 in the selection of) particular entities as re19 cipients of any of the amounts provided in

20 the grant.

21 ‘‘(ii) An individual may serve on the

22 planning council under paragraph (1) only

23 if the individual agrees to comply with the

24 following:
8

1 ‘‘(I) If the individual has a finan2 cial interest in an entity, and such en3 tity is seeking amounts from a grant

4 under section 2601(a), the individual

5 will not, with respect to the purpose for

6 which the entity seeks such amounts,

7 participate (directly or in an advisory

8 capacity) in the process of selecting en9 tities to receive such amounts for such

10 purpose.

11 ‘‘(II) In the case of a public or

12 private entity of which the individual

13 is an employee, or a public or private

14 organization of which the individual is

15 a member, the individual will not par16 ticipate (directly or in an advisory ca17 pacity) in the process of making any

18 decision that relates to the expenditure

19 of a grant under section 2601(a) for

20 such entity or organization or that oth21 erwise directly affects the entity or or22 ganization.’’.
9

1 SEC. 103. TYPE AND DISTRIBUTION OF GRANTS.

2 (a) FORMULA GRANTS BASED ON RELATIVE NEED OF

3 AREAS.—Section 2603(a) (42 U.S.C. 300ff–13(a)) is

4 amended—

5 (1) in paragraph (1)—

6 (A) in the second sentence, by inserting ‘‘,

7 subject to paragraph (4)’’ before the period; and

8 (B) by adding at the end the following sen9 tence: ‘‘Grants under this paragraph for a fiscal

10 year shall be disbursed not later than 60 days

11 after the date on which amounts appropriated

12 under section 2677 become available for the fiscal

13 year, subject to any waivers under section

14 2605(d).’’;

15 (2) in paragraph (2), by amending the para16 graph to read as follows:

17 ‘‘(2) ALLOCATIONS.—Of the amount available

18 under section 2677 for a fiscal year for making

19 grants under section 2601(a)—

20 ‘‘(A) the Secretary shall reserve 50 percent

21 for making grants under paragraph (1) in

22 amounts determined in accordance with para23 graph (3); and

24 ‘‘(B) the Secretary shall, after compliance

25 with subparagraph (A), reserve such funds as
10

1 may be necessary to carry out paragraph (4).’’;

2 and

3 (3) by adding at the end the following para4 graph:

5 ‘‘(4) MAXIMUM REDUCTION IN GRANT.—In the

6 case of any eligible area for which a grant under

7 paragraph (1) was made for fiscal year 1995, the Sec8 retary, in making grants under such paragraph for

9 the area for the fiscal years 1996 through 2000, shall

10 (subject to the extent of the amount available under

11 section 2677 for the fiscal year involved for making

12 grants under section 2601(a)) ensure that the

13 amounts of the grants do not, relative to such grant

14 for the area for fiscal year 1995, constitute a reduc15 tion of more than the following, as applicable to the

16 fiscal year involved:

17 ‘‘(A) 1 percent, in the case of fiscal year

18 1996.

19 ‘‘(B) 2 percent, in the case of fiscal year

20 1997.

21 ‘‘(C) 3 percent, in the case of fiscal year

22 1998.

23 ‘‘(D) 4 percent, in the case of fiscal year

24 1999.
11

1 ‘‘(E) 5 percent, in the case of fiscal year

2 2000.’’.

3 (b) SUPPLEMENTAL GRANTS.—Section 2603(b) (42

4 U.S.C. 300ff–13(b)) is amended—

5 (1) in paragraph (1)—

6 (A) in the matter preceding subparagraph

7 (A), by striking ‘‘Not later than’’ and all that

8 follows through ‘‘section 2605(b)—’’ and insert9 ing the following: ‘‘After allocating in accordance

10 with subsection (a) the amounts available under

11 section 2677 for grants under section 2601(a) for

12 a fiscal year, the Secretary, in carrying out sec13 tion 2601(a), shall from the remaining amounts

14 make grants to eligible areas described in this

15 paragraph. Such grants shall be disbursed not

16 later than 150 days after the date on which

17 amounts appropriated under section 2677 be18 come available for the fiscal year. An eligible

19 area described in this paragraph is an eligible

20 area whose application under section 2605(b)—

21 ’’;

22 (B) in subparagraph (D), by striking ‘‘and’’

23 after the semicolon;

24 (C) in subparagraph (E), by striking the

25 period at the end and inserting ‘‘; and’’; and
12

1 (D) by adding at the end thereof the follow2 ing subparagraph:

3 ‘‘(F) demonstrates the manner in which the

4 proposed services are consistent with the local

5 needs assessment and the statewide coordinated

6 statement of need.’’; and

7 (2)(A) by redesignating paragraphs (2) through

8 (4) as paragraphs (3) through (5), respectively; and

9 (B) by inserting after paragraph (1) the follow10 ing paragraph:

11 ‘‘(2) PRIORITY.—

12 ‘‘(A) SEVERE NEED.—In determining severe

13 need in accordance with paragraph (1)(B), the

14 Secretary shall give priority consideration in

15 awarding grants under this subsection to eligible

16 areas that (in addition to complying with para17 graph (1)) demonstrate a more severe need based

18 on the prevalence in the eligible area of—

19 ‘‘(i) sexually transmitted diseases, sub20 stance abuse, tuberculosis, severe mental ill21 ness, or other conditions determined rel22 evant by the Secretary, which significantly

23 affect the impact of HIV disease;
13

1 ‘‘(ii) subpopulations with HIV disease

2 that were previously unknown in such area;

3 or

4 ‘‘(iii) homelessness.

5 ‘‘(B) PREVALENCE.—In determining preva6 lence of conditions under subparagraph (A), the

7 Secretary shall use data on the prevalence of the

8 conditions described in such subparagraph

9 among individuals with HIV disease (except

10 that, in the case of an eligible area for which

11 such data are not available, the Secretary shall

12 use data on the prevalences of the conditions in

13 the general population of such area).’’.

14 (c) ADDITIONAL REQUIREMENTS FOR GRANTS.—Sec15 tion 2603 (42 U.S.C. 300ff–13) is amended by adding at

16 the end the following subsection:

17 ‘‘(c) COMPLIANCE WITH PRIORITIES OF HIV PLAN18 NING COUNCIL.—Notwithstanding any other provision of

19 this part, the Secretary, in carrying out section 2601(a),

20 may not make any grant under subsection (a) or (b) to

21 an eligible area unless the application submitted by such

22 area under section 2605 for the grant involved demonstrates

23 that the grants made under subsections (a) and (b) to the

24 area for the preceding fiscal year (if any) were expended

25 in accordance with the priorities applicable to such year
14

1 that were established, pursuant to section 2602(b)(3)(A), by

2 the planning council serving the area.’’.

3 SEC. 104. USE OF AMOUNTS.

4 Section 2604 (42 U.S.C. 300ff–14) is amended—

5 (1) in subsection (b)—

6 (A) in paragraph (1)(A), by striking ‘‘in7 cluding case management and comprehensive

8 treatment services, for individuals’’ and insert9 ing the following: ‘‘including HIV-related com10 prehensive treatment services (including treat11 ment education and measures for the prevention

12 and treatment of opportunistic infections), case

13 management, and substance abuse treatment and

14 mental health treatment, for individuals’’;

15 (B) in paragraph (2)(A)—

16 (i) by inserting after ‘‘nonprofit pri17 vate entities,’’ the following: ‘‘or private for18 profit entities if such entities are the only

19 available provider of quality HIV care in

20 the area,’’ ; and

21 (ii) by striking ‘‘and homeless health

22 centers’’ and inserting ‘‘homeless health cen23 ters, substance abuse treatment programs,

24 and mental health programs’’; and
15

1 (C) by adding at the end the following

2 paragraph:

3 ‘‘(3) PRIORITY FOR WOMEN, INFANTS AND CHIL4 DREN.—For the purpose of providing health and sup5 port services to infants, children, and women with

6 HIV disease, the chief elected official of an eligible

7 area shall use, of the grants made for the area under

8 section 2601(a) for a fiscal year, not less than the

9 percentage constituted by the ratio of the population

10 in such area of infants, children, and women with ac11 quired immune deficiency syndrome to the general

12 population in such area of individuals with such syn13 drome, or 15 percent, whichever is less. In expending

14 the funds reserved under the preceding sentence for a

15 fiscal year, the chief elected official shall give priority

16 to providing, for pregnant women, measures to pre17 vent the perinatal transmission of HIV.’’; and

18 (2) in subsection (e), by adding at the end there19 of the following sentence: ‘‘In the case of entities to

20 which such officer allocates amounts received by the

21 officer under the grant, the officer shall ensure that,

22 of the aggregate amount so allocated, the total of the

23 expenditures by such entities for administrative ex24 penses does not exceed 10 percent (without regard to
16

1 whether particular entities expend more than 10 per2 cent for such expenses).’’.

3 SEC. 105. APPLICATION.

4 Section 2605 (42 U.S.C. 300ff–15) is amended—

5 (1) in subsection (a)—

6 (A) in paragraph (1)(B), by striking ‘‘1-

7 year period’’ and all that follows through ‘‘eligi8 ble area’’ and inserting ‘‘preceding fiscal year’’;

9 (B) in paragraph (4), by striking ‘‘and’’ at

10 the end thereof;

11 (C) in paragraph (5), by striking the period

12 at the end thereof and inserting ‘‘; and’’; and

13 (D) by adding at the end thereof the follow14 ing paragraph:

15 ‘‘(6) that the applicant will participate in the

16 process for the statewide coordinated statement of

17 need (where it has been initiated by the State), and

18 will ensure that the services provided under the com19 prehensive plan are consistent with such statement.’’;

20 (2) in subsection (b)—

21 (A) in the subsection heading, by striking

22 ‘‘ADDITIONAL’’; and

23 (B) in the matter preceding paragraph (1),

24 by striking ‘‘additional’’;
17

1 (3) by redesignating subsections (c) and (d) as

2 subsections (d) and (e), respectively; and

3 (4) by inserting after subsection (b), the follow4 ing subsection:

5 ‘‘(c) SINGLE APPLICATION.—Upon the request of the

6 chief elected official of an eligible area, the Secretary may

7 authorize the official to submit a single application through

8 which the official simultaneously requests a grant pursuant

9 to subsection (a) of section 2603 and a grant pursuant to

10 subsection (b) of such section. The Secretary may establish

11 such criteria for carrying out this subsection as the Sec12 retary determines to be appropriate.’’.

13 SEC. 106. TECHNICAL ASSISTANCE; PLANNING GRANTS.

14 Section 2606 (42 U.S.C. 300ff–16) is amended—

15 (1) by inserting before ‘‘The Administrator’’ the

16 following: ‘‘(a) IN GENERAL.—’’;

17 (2) by striking ‘‘may, beginning’’ and all that

18 follows through ‘‘title,’’ and inserting ‘‘(referred to in

19 this section as the ‘Administrator’) shall’’; and

20 (3) by adding at the end the following subsection:

21 ‘‘(b) PLANNING GRANTS REGARDING INITIAL ELIGI22 BILITY FOR GRANTS.—

23 ‘‘(1) ADVANCE PAYMENTS ON FIRST-YEAR FOR24 MULA GRANTS.—With respect to a fiscal year (re25 ferred to in this subsection as the ‘planning year’), if
18

1 a metropolitan area has not previously received a

2 grant under section 2601 and the Administrator rea3 sonably projects that the area will be eligible for such

4 a grant for the subsequent fiscal year, the Adminis5 trator may make a grant for the planning year for

6 the purpose of assisting the area in preparing for the

7 responsibilities of the area in carrying out activities

8 under this part.

9 ‘‘(2) REQUIREMENTS.—

10 ‘‘(A) IN GENERAL.—A grant under para11 graph (1) for a planning year shall be made di12 rectly to the chief elected official of the city or

13 urban county that administers the public health

14 agency to which section 2602(a)(1) is projected

15 to apply for purposes of such paragraph. The

16 grant may not be made in an amount exceeding

17 $75,000.

18 ‘‘(B) OFFSETTING REDUCTION IN FIRST

19 FORMULA GRANT.—In the case of a metropolitan

20 area that has received a grant under paragraph

21 (1) for a planning year, the first grant made

22 pursuant to section 2603(a) for such area shall

23 be reduced by an amount equal to the amount of

24 the grant under such paragraph for the planning

25 year. With respect to amounts resulting from re-
19

1 ductions under the preceding sentence for a fiscal

2 year, the Secretary shall use such amounts to

3 make grants under section 2603(a) for the fiscal

4 year, subject to ensuring that none of such

5 amounts are provided to any metropolitan area

6 for which such a reduction was made for the fis7 cal year.

8 ‘‘(3) FUNDING.—Of the amounts available under

9 section 2677 for a fiscal year for carrying out this

10 part, the Administrator may reserve not more than 1

11 percent for making grants under paragraph (1).’’.

12 TITLE II—CARE GRANT

13 PROGRAM

14 SEC. 201. GENERAL USE OF GRANTS.

15 Section 2612 (42 U.S.C. 300ff–22) is amended to read

16 as follows:

17 ‘‘SEC. 2612. GENERAL USE OF GRANTS.

18 ‘‘(a) IN GENERAL.—A State may use amounts pro19 vided under grants made under this part for the following:

20 ‘‘(1) To provide the services described in section

21 2604(b)(1) for individuals with HIV disease.

22 ‘‘(2) To provide to such individuals treatments

23 that in accordance with section 2616 have been deter24 mined to prolong life or prevent serious deterioration

25 of health.
20

1 ‘‘(3) To provide home- and community-based

2 care services for such individuals in accordance with

3 section 2614.

4 ‘‘(4) To provide assistance to assure the continu5 ity of health insurance coverage for such individuals

6 in accordance with section 2615.

7 ‘‘(5) To establish and operate consortia under

8 section 2613 within areas most affected by HIV dis9 ease, which consortia shall be designed to provide a

10 comprehensive continuum of care to individuals and

11 families with such disease in accordance with such

12 section.

13 ‘‘(b) PRIORITY FOR WOMEN, INFANTS AND CHIL14 DREN.—For the purpose of providing health and support

15 services to infants, children, and women with HIV disease,

16 a State shall use, of the funds allocated under this part to

17 the State for a fiscal year, not less than the percentage con18 stituted by the ratio of the population in the State of in19 fants, children, and women with acquired immune defi20 ciency syndrome to the general population in the State of

21 individuals with such syndrome, or 15 percent, whichever

22 is less. In expending the funds reserved under the preceding

23 sentence for a fiscal year, the State shall give priority to

24 providing, for pregnant women, measures to prevent the

25 perinatal transmission of HIV.’’.
21

1 SEC. 202. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

2 Section 2613 (42 U.S.C. 300ff–23) is amended—

3 (1) in subsection (a)—

4 (A) in paragraph (1), by inserting ‘‘(or pri5 vate for-profit providers or organizations if such

6 entities are the only available providers of qual7 ity HIV care in the area)’’ after ‘‘nonprofit pri8 vate,’’; and

9 (B) in paragraph (2)(A)—

10 (i) by inserting ‘‘substance abuse treat11 ment, mental health treatment,’’ after

12 ‘‘nursing,’’; and

13 (ii) by inserting after ‘‘monitoring,’’

14 the following: ‘‘measures for the prevention

15 and treatment of opportunistic infections,

16 treatment education for patients (provided

17 in the context of health care delivery),’’; and

18 (2) in subsection (c)(2)—

19 (A) in clause (ii) of subparagraph (A), by

20 striking ‘‘and’’ after the semicolon;

21 (B) in subparagraph (B), by striking the

22 period at the end and inserting ‘‘; and’’; and

23 (C) by adding after subparagraph (B) the

24 following subparagraph:

25 ‘‘(C) grantees under section 2671, or, if

26 none are operating in the area, representatives
22

1 in the area of organizations with a history of

2 serving children, youth, women, and families liv3 ing with HIV.’’.

4 SEC. 203. PROVISION OF TREATMENTS.

5 Section 2616(a) (42 U.S.C. 300ff–26(a)) is amended—

6 (1) by striking ‘‘may use amounts’’ and insert7 ing ‘‘shall use a portion of the amounts’’;

8 (2) by striking ‘‘section 2612(a)(4)’’ and insert9 ing ‘‘section 2612(a)(2)’’; and

10 (3) by inserting before the period the following:

11 ‘‘, including measures for the prevention and treat12 ment of opportunistic infections’’.

13 SEC. 204. ADDITIONAL REQUIREMENTS FOR GRANTS.

14 (a) FINDINGS.—The Congress finds as follows:

15 (1) Research studies have demonstrated that ad16 ministration of antiviral medication during preg17 nancy can significantly reduce the transmission of the

18 human immunodeficiency virus (commonly known as

19 HIV) from an infected mother to her baby.

20 (2) The Centers for Disease Control and Preven21 tion have recommended that all pregnant women re22 ceive HIV counseling; voluntary, confidential HIV

23 testing; and appropriate medical treatment (includ24 ing antiviral therapy) and support services.
23

1 (3) The provision of such testing without access

2 to such counseling, treatment, and services will not

3 improve the health of the woman or the child.

4 (4) The provision of such counseling, testing,

5 treatment, and services can reduce the number of pe6 diatric cases of acquired immune deficiency syn7 drome, can improve access to and provision of medi8 cal care for the woman, and can provide opportuni9 ties for counseling to reduce transmission among

10 adults.

11 (5) The provision of such counseling, testing,

12 treatment, and services can reduce the overall cost of

13 pediatric cases of acquired immune deficiency syn14 drome.

15 (6) The cancellation or limitation of health in16 surance or other health coverage on the basis of HIV

17 status should be impermissible under applicable law.

18 Such cancellation or limitation could result in dis19 incentives for appropriate counseling, testing, treat20 ment, and services.

21 (7) For the reasons specified in paragraphs (1)

22 through (6)—

23 (A) mandatory counseling and voluntary

24 testing of pregnant women should be the stand25 ard of care; and
24

1 (B) the relevant medical organizations as

2 well as public health officials should issue guide3 lines making such counseling and testing the

4 standard of care.

5 (b) ADDITIONAL REQUIREMENTS FOR GRANTS.—Part

6 B (42 U.S.C. 300ff–21 et seq.) is amended—

7 (1) in section 2611, by adding at the end the fol8 lowing sentence: ‘‘The authority of the Secretary to

9 provide grants under this part is subject to section

10 2673D (relating to the testing of pregnant women and

11 newborn infants).’’; and

12 (2) by inserting after section 2616 the following

13 section:

14 ‘‘SEC. 2616A. REQUIREMENT REGARDING HEALTH INSUR15 ANCE.

16 ‘‘(a) IN GENERAL.—Subject to subsection (c), the Sec17 retary shall not make a grant under this part to a State

18 unless the State has in effect a statute or regulations regu19 lating insurance that imposes the following requirements:

20 ‘‘(1) That, if health insurance is in effect for an

21 individual, the insurer involved may not (without the

22 consent of the individual) discontinue the insurance,

23 or alter the terms of the insurance (except as provided

24 in paragraph (3)), solely on the basis that the indi25 vidual is infected with HIV disease or solely on the
25

1 basis that the individual has been tested for the dis2 ease.

3 ‘‘(2) That paragraph (1) does not apply to an

4 individual who, in applying for the health insurance

5 involved, knowingly misrepresented any of the follow6 ing:

7 ‘‘(A) The HIV status of the individual.

8 ‘‘(B) Facts regarding whether the individ9 ual has been tested for HIV disease.

10 ‘‘(C) Facts regarding whether the individual

11 has engaged in any behavior that places the in12 dividual at risk for the disease.

13 ‘‘(3) That paragraph (1) does not apply to any

14 reasonable alteration in the terms of health insurance

15 for an individual with HIV disease that would have

16 been made if the individual had a serious disease

17 other than HIV disease.

18 ‘‘(b) REGULATION OF HEALTH INSURANCE.—A statute

19 or regulation shall be deemed to regulate insurance for pur20 poses of this section only to the extent that it is treated

21 as regulating insurance for purposes of section 514(b)(2)

22 of the Employee Retirement Income Security Act of 1974.

23 ‘‘(c) APPLICABILITY OF REQUIREMENT.—

24 ‘‘(1) IN GENERAL.—Except as provided in para25 graph (2), this section applies upon the expiration of
26

1 the 120-day period beginning on the date of the enact2 ment of the Ryan White CARE Act Amendments of

3 1995.

4 ‘‘(2) DELAYED APPLICABILITY FOR CERTAIN

5 STATES.—In the case of the State involved, if the Sec6 retary determines that a requirement of this section

7 cannot be implemented in the State without the en8 actment of State legislation, then such requirement

9 applies to the State on and after the first day of the

10 first calendar quarter that begins after the close of the

11 first regular session of the State legislature that be12 gins after the date of the enactment of the Ryan

13 White CARE Act Amendments of 1995. For purposes

14 of the preceding sentence, in the case of a State that

15 has a 2-year legislative session, each year of such ses16 sion is deemed to be a separate regular session of the

17 State legislature.’’.

18 (c) TESTING OF NEWBORNS; PRENATAL TESTING.—

19 Part D (42 U.S.C. 300ff–71 et seq.) is amended by inserting

20 before section 2674 the following sections:

21 ‘‘SEC. 2673C. TESTING OF PREGNANT WOMEN AND NEW22 BORN INFANTS; PROGRAM OF GRANTS.

23 ‘‘(a) PROGRAM OF GRANTS.—The Secretary may make

24 grants to States described in subsection (b) for the following

25 purposes:
27

1 ‘‘(1) Making available to pregnant women ap2 propriate counseling on HIV disease.

3 ‘‘(2) Making available to such women testing for

4 such disease.

5 ‘‘(3) Testing newborn infants for such disease.

6 ‘‘(4) In the case of newborn infants who test

7 positive for such disease, making available counseling

8 on such disease to the parents or other legal guard9 ians of the infant.

10 ‘‘(5) Collecting data on the number of pregnant

11 women and newborn infants in the State who have

12 undergone testing for such disease.

13 ‘‘(b) ELIGIBLE STATES.—Subject to subsection (c), a

14 State referred to in subsection (a) is a State that has in

15 effect, in statute or through regulations, the following re16 quirements:

17 ‘‘(1) In the case of newborn infants who are born

18 in the State and whose biological mothers have not

19 undergone prenatal testing for HIV disease, that each

20 such infant undergo testing for such disease.

21 ‘‘(2) That the results of such testing of a newborn

22 infant be promptly disclosed in accordance with the

23 following, as applicable to the infant involved:
28

1 ‘‘(A) To the biological mother of the infant

2 (without regard to whether she is the legal

3 guardian of the infant).

4 ‘‘(B) If the State is the legal guardian of the

5 infant:

6 ‘‘(i) To the appropriate official of the

7 State agency with responsibility for the care

8 of the infant.

9 ‘‘(ii) To the appropriate official of each

10 authorized agency providing assistance in

11 the placement of the infant.

12 ‘‘(iii) If the authorized agency is giv13 ing significant consideration to approving

14 an individual as a foster parent of the in15 fant, to the prospective foster parent.

16 ‘‘(iv) If the authorized agency is giving

17 significant consideration to approving an

18 individual as an adoptive parent of the in19 fant, to the prospective adoptive parent.

20 ‘‘(C) If neither the biological mother nor the

21 State is the legal guardian of the infant, to an22 other legal guardian of the infant.

23 ‘‘(3) That, in the case of prenatal testing for

24 HIV disease that is conducted in the State, the results
29

1 of such testing be promptly disclosed to the pregnant

2 woman involved.

3 ‘‘(4) That, in disclosing the test results to an in4 dividual under paragraph (2) or (3), appropriate

5 counseling on the human immunodeficiency virus be

6 made available to the individual (except in the case

7 of a disclosure to an official of a State or an author8 ized agency).

9 ‘‘(c) LIMITATION REGARDING AVAILABILITY OF GRANT

10 FUNDS.—With respect to an activity described in any of

11 paragraphs (1) through (4) of subsection (b), the require12 ment established by a State under such subsection that the

13 activity be carried out applies for purposes of this section

14 only to the extent that the following sources of funds are

15 available for carrying out the activity:

16 ‘‘(1) Federal funds provided to the State in

17 grants under subsection (a).

18 ‘‘(2) Funds that the State or private entities

19 have elected to provide, including through entering

20 into contracts under which health benefits are pro21 vided. This section does not require any entity to ex22 pend non-Federal funds.

23 ‘‘(d) DEFINITIONS.—For purposes of this section, the

24 term ‘authorized agency’, with respect to the placement of

25 a child (including an infant) for whom a State is a legal
30

1 guardian, means an entity licensed or otherwise approved

2 by the State to assist in such placement.

3 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the

4 purpose of carrying out this section, there is authorized to

5 be appropriated $10,000,000 for each of the fiscal years

6 1996 through 2000.

7 ‘‘SEC. 2673D. TESTING OF PREGNANT WOMEN AND NEW8 BORN INFANTS; CONTINGENT REQUIREMENT

9 REGARDING STATE GRANTS UNDER PART B.

10 ‘‘(a) DETERMINATION BY SECRETARY.—During the

11 first 30 days following the expiration of the 2-year period

12 beginning on the date of the enactment of the Ryan White

13 CARE Act Amendments of 1995, the Secretary shall publish

14 in the Federal Register a determination of whether it has

15 become a routine practice in the provision of health care

16 in the United States to carry out each of the activities de17 scribed in paragraphs (1) through (4) of section 2673C(b).

18 In making the determination, the Secretary shall consult

19 with the States and with other public or private entities

20 that have knowledge or expertise relevant to the determina21 tion.

22 ‘‘(b) CONTINGENT APPLICABILITY.—

23 ‘‘(1) IN GENERAL.—If the determination pub24 lished in the Federal Register under subsection (a) is

25 that (for purposes of such subsection) the activities in-
31

1 volved have become routine practices, paragraph (2)

2 applies on and after the expiration of the 18-month

3 period beginning on the date on which the determina4 tion is so published.

5 ‘‘(2) REQUIREMENT.—Subject to subsection (c),

6 the Secretary shall not make a grant under part B

7 to a State unless the State meets not less than one of

8 the following requirements:

9 ‘‘(A) The State has in effect, in statute or

10 through regulations, the requirements specified

11 in paragraphs (1) through (4) of section

12 2673C(b).

13 ‘‘(B) The State demonstrates that, of the

14 newborn infants born in the State during the

15 most recent 1-year period for which the data are

16 available, the HIV antibody status of 95 percent

17 of the infants is known.

18 ‘‘(c) LIMITATION REGARDING AVAILABILITY OF

19 FUNDS.—With respect to an activity described in any of

20 paragraphs (1) through (4) of section 2673C(b), the require21 ments established by a State under subsection (b)(2)(A) that

22 the activity be carried out applies for purposes of this sec23 tion only to the extent that the following sources of funds

24 are available for carrying out the activity:
32

1 ‘‘(1) Federal funds provided to the State in

2 grants under part B.

3 ‘‘(2) Federal funds provided to the State in

4 grants under section 2673C.

5 ‘‘(3) Funds that the State or private entities

6 have elected to provide, including through entering

7 into contracts under which health benefits are pro8 vided. This section does not require any entity to ex9 pend non-Federal funds.’’.

10 SEC. 205. STATE APPLICATION.

11 Section 2617(b)(2) (42 U.S.C. 300ff–27(b)(2)) is

12 amended—

13 (1) in subparagraph (A), by striking ‘‘and’’ after

14 the semicolon;

15 (2) in subparagraph (B), by striking ‘‘and’’ after

16 the semicolon; and

17 (3) by adding at the end thereof the following

18 subparagraphs:

19 ‘‘(C) a description of the activities carried

20 out by the State under section 2616; and

21 ‘‘(D) a description of how the allocation

22 and utilization of resources are consistent with a

23 statewide coordinated statement of need, devel24 oped in partnership with other grantees in the

25 State that receive funding under this title and
33

1 after consultation with individuals receiving

2 services under this part.’’.

3 SEC. 206. ALLOCATION OF ASSISTANCE BY STATES; PLAN4 NING, EVALUATION, AND ADMINISTRATION.

5 Section 2618(c) (42 U.S.C. 300ff–28(c)) is amended—

6 (1) by striking paragraph (1);

7 (2) by redesignating paragraphs (2) through (5)

8 as paragraphs (1) through (4), respectively; and

9 (3) in paragraph (3) (as so redesignated), by

10 adding at the end the following sentences: ‘‘In the case

11 of entities to which the State allocates amounts re12 ceived by the State under the grant (including consor13 tia under section 2613), the State shall ensure that,

14 of the aggregate amount so allocated, the total of the

15 expenditures by such entities for administrative ex16 penses does not exceed 10 percent (without regard to

17 whether particular entities expend more than 10 per18 cent for such expenses).’’.

19 SEC. 207. TECHNICAL ASSISTANCE.

20 Section 2619 (42 U.S.C. 300ff–29) is amended by in21 serting before the period the following: ‘‘, including tech22 nical assistance for the development and implementation of

23 statewide coordinated statements of need’’.
34

1 TITLE III—EARLY

2 INTERVENTION SERVICES

3 SEC. 301. ESTABLISHMENT OF PROGRAM.

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

5 (1) in paragraph (1), by inserting before the pe6 riod the following: ‘‘, and unless the applicant agrees

7 to expend not less than 50 percent of the grant for

8 such services that are specified in subparagraphs (B)

9 through (E) of such paragraph’’; and

10 (2) in paragraph (4), by inserting after ‘‘non11 profit private entities’’ the following: ‘‘(or private for12 profit entities, if such entities are the only available

13 providers of quality HIV care in the area)’’.

14 SEC. 302. MINIMUM QUALIFICATIONS OF GRANTEES.

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

16 amended by inserting after ‘‘nonprofit private entity’’ the

17 following: ‘‘(or a private for-profit entity, if such an entity

18 is the only available provider of quality HIV care in the

19 area)’’.

20 SEC. 303. MISCELLANEOUS PROVISIONS; PLANNING AND

21 DEVELOPMENT GRANTS.

22 Section 2654 (42 U.S.C. 300ff–54) is amended by add23 ing at the end thereof the following subsection:

24 ‘‘(c) PLANNING AND DEVELOPMENT GRANTS.—
35

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

2 planning grants, in an amount not to exceed $50,000

3 for each such grant, to public and nonprofit private

4 entities for the purpose of enabling such entities to

5 provide early intervention services.

6 ‘‘(2) REQUIREMENT.—The Secretary may award

7 a grant to an entity under paragraph (1) only if the

8 Secretary determines that the entity will use such

9 grant to assist the entity in qualifying for a grant

10 under section 2651.

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

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

13 entities that provide HIV primary care services in

14 rural or underserved communities.

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

16 amount appropriated for a fiscal year under section

17 2655 may be used to carry out this section.’’.

18 SEC. 304. ADDITIONAL REQUIRED AGREEMENTS.

19 Section 2664(a)(1) (42 U.S.C. 300ff–64(a)(1)) is

20 amended—

21 (1) in subparagraph (A), by striking ‘‘and’’ after

22 the semicolon; and

23 (2) by adding at the end the following subpara24 graph:
36

1 ‘‘(C) evidence that the proposed program is

2 consistent with the statewide coordinated state3 ment of need and that the applicant will partici4 pate in the ongoing revision of such statement of

5 need.’’.

6 SEC. 305. AUTHORIZATION OF APPROPRIATIONS.

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

8 striking ‘‘$75,000,000’’ and all that follows and inserting

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

10 1996 through 2000.’’.

11 TITLE IV—GENERAL PROVISIONS

12 SEC. 401. COORDINATED SERVICES AND ACCESS TO RE13 SEARCH FOR WOMEN, INFANTS, AND CHIL14 DREN.

15 (a) IN GENERAL.—Section 2671 (42 U.S.C. 300ff–71)

16 is amended—

17 (1) in subsection (a), by amending the subsection

18 to read as follows:

19 ‘‘(a) IN GENERAL.—

20 ‘‘(1) PROGRAM OF GRANTS.—The Secretary, act21 ing through the Administrator of the Health Re22 sources and Services Administration and in consulta23 tion with the Director of the National Institutes of

24 Health, shall make grants to public and nonprofit
37

1 private entities that provide primary care (directly or

2 through contracts) for the purpose of—

3 ‘‘(A) providing through such entities, in ac4 cordance with this section, opportunities for

5 women, infants, and children to be participants

6 in research of potential clinical benefit to indi7 viduals with HIV disease; and

8 ‘‘(B) providing to women, infants, and chil9 dren health care on an outpatient basis.

10 ‘‘(2) PROVISIONS REGARDING PARTICIPATION IN

11 RESEARCH.—With respect to the projects of research

12 with which an applicant under paragraph (1) is con13 cerned, the Secretary may not make a grant under

14 such paragraph to the applicant unless the following

15 conditions are met:

16 ‘‘(A) The applicant agrees to make reason17 able efforts—

18 ‘‘(i) to identify which of the patients of

19 the applicant are women, infants, and chil20 dren who would be appropriate participants

21 in the projects; and

22 ‘‘(ii) to offer women, infants, and chil23 dren the opportunity to so participate (as

24 appropriate), including the provision of

25 services under subsection (f).
38

1 ‘‘(B) The applicant agrees that the appli2 cant, and the projects of research, will comply

3 with accepted standards of protection for human

4 subjects (including the provision of written in5 formed consent) who participate as subjects in

6 clinical research.

7 ‘‘(C) For the third or subsequent fiscal year

8 for which a grant under such paragraph is

9 sought by the applicant, the Secretary has deter10 mined that—

11 ‘‘(i) a significant number of women,

12 infants, and children who are patients of

13 the applicant are participating in the

14 projects (except to the extent this clause is

15 waived under subsection (k)); and

16 ‘‘(ii) the applicant, and the projects of

17 research, have complied with the standards

18 referred to in subparagraph (B).

19 ‘‘(3) PROHIBITION.—Receipt of services by a pa20 tient shall not be conditioned upon the consent of the

21 patient to participate in research.

22 ‘‘(4) CONSIDERATION BY SECRETARY OF CERTAIN

23 CIRCUMSTANCES.—In administering the requirement

24 of paragraph (2)(C)(i), the Secretary shall take into

25 account circumstances in which a grantee under
39

1 paragraph (1) is temporarily unable to comply with

2 the requirement for reasons beyond the control of the

3 grantee, and shall in such circumstances provide to

4 the grantee a reasonable period of opportunity in

5 which to reestablish compliance with the require6 ment.’’;

7 (2) in subsection (c), by amending the subsection

8 to read as follows:

9 ‘‘(c) PROVISIONS REGARDING CONDUCT OF RE10 SEARCH.—With respect to eligibility for a grant under sub11 section (a):

12 ‘‘(1) A project of research for which subjects are

13 sought pursuant to such subsection may be conducted

14 by the applicant for the grant, or by an entity with

15 which the applicant has made arrangements for pur16 poses of the grant. The grant may not be expended for

17 the conduct of any project of research.

18 ‘‘(2) The grant may not be made unless the Sec19 retary makes the following determinations:

20 ‘‘(A) The applicant or other entity (as the

21 case may be under paragraph (1)) is appro22 priately qualified to conduct the project of re23 search. An entity shall be considered to be so

24 qualified if any research protocol of the entity

25 has been recommended for funding under this
40

1 Act pursuant to technical and scientific peer re2 view through the National Institutes of Health.

3 ‘‘(B) The project of research is being con4 ducted in accordance with a research protocol to

5 which the Secretary gives priority regarding the

6 prevention and treatment of HIV disease in

7 women, infants, and children. After consultation

8 with public and private entities that conduct

9 such research, and with providers of services

10 under this section and recipients of such services,

11 the Secretary shall establish a list of such proto12 cols that are appropriate for purposes of this sec13 tion. The Secretary may give priority under this

14 subparagraph to a research protocol that is not

15 on such list.’’;

16 (3) by striking subsection (i);

17 (4) by redesignating subsections (g) and (h) as

18 subsections (h) and (i), respectively;

19 (5) by inserting after subsection (f) the following

20 subsection:

21 ‘‘(g) ADDITIONAL PROVISIONS.—The Secretary may

22 not make a grant under subsection (a) unless the applicant

23 for the grant agrees as follows:

24 ‘‘(1) The applicant will coordinate activities

25 under the grant with other providers of health care
41

1 services under this Act, and under title V of the So2 cial Security Act.

3 ‘‘(2) The applicant will participate in the state4 wide coordinated statement of need under part B

5 (where it has been initiated by the State) and in revi6 sions of such statement.’’;

7 (6) by redesignating subsection (j) as subsection

8 (m); and

9 (7) by inserting before subsection (m) (as so re10 designated) the following subsections:

11 ‘‘(j) COORDINATION WITH NATIONAL INSTITUTES OF

12 HEALTH.—The Secretary shall develop and implement a

13 plan that provides for the coordination of the activities of

14 the National Institutes of Health with the activities carried

15 out under this section. In carrying out the preceding sen16 tence, the Secretary shall ensure that projects of research

17 conducted or supported by such Institutes are made aware

18 of applicants and grantees under this section, shall require

19 that the projects, as appropriate, enter into arrangements

20 for purposes of this section, and shall require that each

21 project entering into such an arrangement inform the ap22 plicant or grantee under this section of the needs of the

23 project for the participation of women, infants, and chil24 dren.
42

1 ‘‘(k) TEMPORARY WAIVER REGARDING SIGNIFICANT

2 PARTICIPATION.—

3 ‘‘(1) IN GENERAL.—In the case of an applicant

4 under subsection (a) who received a grant under this

5 section for fiscal year 1995, the Secretary may, sub6 ject to paragraph (2), provide to the applicant a

7 waiver of the requirement of subsection (a)(2)(C)(i) if

8 the Secretary determines that the applicant is making

9 reasonable progress toward meeting the requirement.

10 ‘‘(2) TERMINATION OF AUTHORITY FOR WAIV11 ERS.—The Secretary may not provide any waiver

12 under paragraph (1) on or after October 1, 1998. Any

13 such waiver provided prior to such date terminates on

14 such date, or on such earlier date as the Secretary

15 may specify.

16 ‘‘(l) TRAINING AND TECHNICAL ASSISTANCE.—Of the

17 amounts appropriated under subsection (m) for a fiscal

18 year, the Secretary may use not more than five percent to

19 provide training and technical assistance to assist appli20 cants and grantees under subsection (a) in complying with

21 the requirements of this section.’’.

22 (b) CONFORMING AMENDMENTS.—Section 2671 (42

23 U.S.C. 300ff–71) is amended—

24 (1) in the heading for the section, by striking

25 ‘‘DEMONSTRATION’’ and all that follows and insert-
43

1 ing ‘‘COORDINATED SERVICES AND ACCESS TO

2 RESEARCH FOR WOMEN, INFANTS, AND CHIL3 DREN.’’;

4 (2) in subsection (b), by striking ‘‘pediatric pa5 tients and pregnant women’’ and inserting ‘‘women,

6 infants, and children’’; and

7 (3) in each of subsections (d) through (f), by

8 striking ‘‘pediatric’’, each place such term appears.

9 (c) AUTHORIZATION OF APPROPRIATIONS.—Section

10 2671 (42 U.S.C. 300ff–71) is amended in subsection (m)

11 (as redesignated by subsection (a)(6)) by striking ‘‘there

12 are’’ and all that follows and inserting the following: ‘‘there

13 are authorized to be appropriated such sums as may be nec14 essary for each of the fiscal years 1996 through 2000.’’.

15 SEC. 402. PROJECTS OF NATIONAL SIGNIFICANCE.

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

17 300ff–71 et seq.) is amended by inserting after section 2673

18 the following section:

19 ‘‘SEC. 2673A. DEMONSTRATION PROJECTS OF NATIONAL

20 SIGNIFICANCE.

21 ‘‘(a) IN GENERAL.—The Secretary shall make grants

22 to public and nonprofit private entities (including commu23 nity-based organizations and Indian tribes and tribal orga24 nizations) for the purpose of carrying out demonstration
44

1 projects that provide for the care and treatment of individ2 uals with HIV disease, and that—

3 ‘‘(1) assess the effectiveness of particular models

4 for the care and treatment of individuals with such

5 disease;

6 ‘‘(2) are of an innovative nature; and

7 ‘‘(3) have the potential to be replicated in simi8 lar localities, or nationally.

9 ‘‘(b) CERTAIN PROJECTS.—Demonstration projects

10 under subsection (a) shall include the development and as11 sessment of innovative models for the delivery of HIV serv12 ices that are designed—

13 ‘‘(1) to address the needs of special populations

14 (including individuals and families with HIV disease

15 living in rural communities, adolescents with HIV

16 disease, Native American individuals and families

17 with HIV disease, homeless individuals and families

18 with HIV disease, hemophiliacs with HIV disease,

19 and incarcerated individuals with HIV disease); and

20 ‘‘(2) to ensure the ongoing availability of services

21 for Native American communities to enable such com22 munities to care for Native Americans with HIV dis23 ease.

24 ‘‘(c) COORDINATION.—The Secretary may not make a

25 grant under this section unless the applicant submits evi-
45

1 dence that the proposed program is consistent with the ap2 plicable statewide coordinated statement of need under part

3 B, and the applicant agrees to participate in the ongoing

4 revision process of such statement of need (where it has been

5 initiated by the State).

6 ‘‘(d) REPLICATION.—The Secretary shall make infor7 mation concerning successful models developed under this

8 section available to grantees under this title for the purpose

9 of coordination, replication, and integration.

10 ‘‘(e) FUNDING; ALLOCATION OF AMOUNTS.—

11 ‘‘(1) IN GENERAL.—Of the amounts available

12 under this title for a fiscal year for each program

13 specified in paragraph (2), the Secretary shall reserve

14 3 percent for making grants under subsection (a).

15 ‘‘(2) RELEVANT PROGRAMS.—The programs re16 ferred to in subsection (a) are the program under

17 part A, the program under part B, the program

18 under part C, the program under section 2671, the

19 program under section 2672, and the program under

20 section 2673.’’.

21 (b) STRIKING OF RELATED PROVISION.—Section 2618

22 (42 U.S.C. 300ff–28) is amended by striking subsection (a).

23 SEC. 403. SPECIAL TRAINING PROJECTS.

24 (a) TRANSFER OF PROGRAM.—The Public Health

25 Service Act (42 U.S.C. 201 et seq.) is amended—
46

1 (1) by transferring section 776 from the current

2 placement of the section;

3 (2) by redesignating the section as section

4 2673B; and

5 (3) by inserting the section after section 2673A

6 (as added by section 402(a)).

7 (b) MODIFICATIONS.—Section 2673B (as transferred

8 and redesignated by subsection (a)) is amended—

9 (1) in subsection (a)(1)—

10 (A) by striking subparagraphs (B) and (C);

11 (B) by redesignating subparagraphs (A)

12 and (D) as subparagraphs (B) and (C), respec13 tively;

14 (C) by inserting before subparagraph (B)

15 (as so redesignated) the following subparagraph:

16 ‘‘(A) to train health personnel, including

17 practitioners in programs under this title and

18 other community providers, in the diagnosis,

19 treatment, and prevention of HIV disease, in20 cluding the prevention of the perinatal trans21 mission of the disease and including measures

22 for the prevention and treatment of opportunistic

23 infections;’’;

24 (D) in subparagraph (B) (as so redesig25 nated), by adding ‘‘and’’ after the semicolon; and
47

1 (E) in subparagraph (C) (as so redesig2 nated), by striking ‘‘curricula and’’;

3 (2) by striking subsection (c) and redesignating

4 subsection (d) as subsection (c); and

5 (3) in subsection (c) (as so redesignated)—

6 (A) in paragraph (1)—

7 (i) by striking ‘‘is authorized’’ and in8 serting ‘‘are authorized’’; and

9 (ii) by inserting before the period the

10 following: ‘‘, and such sums as may be nec11 essary for each of the fiscal years 1996

12 through 2000’’; and

13 (B) in paragraph (2)—

14 (i) by striking ‘‘is authorized’’ and in15 serting ‘‘are authorized’’; and

16 (ii) by inserting before the period the

17 following: ‘‘, and such sums as may be nec18 essary for each of the fiscal years 1996

19 through 2000’’.

20 SEC. 404. EVALUATIONS AND REPORTS.

21 Section 2674 (42 U.S.C. 300ff–74) is amended—

22 (1) in subsection (b)—

23 (A) in the matter preceding paragraph (1),

24 by striking ‘‘not later than 1 year’’ and all that
48

1 follows through ‘‘title,’’ and inserting the follow2 ing: ‘‘not later than October 1, 1996,’’;

3 (B) by striking paragraphs (1) through (3)

4 and inserting the following paragraph:

5 ‘‘(1) evaluating the programs carried out under

6 this title; and’’; and

7 (C) by redesignating paragraph (4) as

8 paragraph (2); and

9 (2) by adding at the end the following subsection:

10 ‘‘(d) ALLOCATION OF FUNDS.—The Secretary shall

11 carry out this section with amounts available under section

12 241. Such amounts are in addition to any other amounts

13 that are available to the Secretary for such purpose.’’.

14 SEC. 405. COORDINATION OF PROGRAM.

15 Section 2675 of the Public Health Service Act (42

16 U.S.C. 300ff–75) is amended by adding at the end the fol17 lowing subsection:

18 ‘‘(d) ANNUAL REPORT.—Not later than October 1,

19 1996, and annually thereafter, the Secretary shall submit

20 to the appropriate committees of the Congress a report con21 cerning coordination efforts under this title at the Federal,

22 State, and local levels, including a statement of whether and

23 to what extent there exist Federal barriers to integrating

24 HIV-related programs.’’.
49

1 TITLE V—ADDITIONAL

2 PROVISIONS

3 SEC. 501. 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 of

8 amounts made available in appropriations Acts,

9 a grant made for purposes of this paragraph to

10 an eligible area shall be made in an amount

11 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 purposes

20 of subparagraph (A)(ii), the term ‘distribution

21 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-
50

1 volved, as determined under subparagraph

2 (C); and

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

4 involved, as determined under subpara5 graph (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 reported

15 to and confirmed by the Director of the Cen16 ters for Disease Control and Prevention for

17 each year during such period; and

18 ‘‘(ii) with respect to—

19 ‘‘(I) the first year during such pe20 riod, .06;

21 ‘‘(II) the second year during such

22 period, .06;

23 ‘‘(III) the third year during such

24 period, .08;
51

1 ‘‘(IV) the fourth year during such

2 period, .10;

3 ‘‘(V) the fifth year during such pe4 riod, .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 eligi21 ble 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 which the grant

25 is being awarded; and
52

1 ‘‘(II) .70; and

2 ‘‘(ii) .30.

3 ‘‘(E) UNEXPENDED FUNDS.—The Secretary

4 may, in determining the amount of a grant for

5 a fiscal year under this paragraph, adjust the

6 grant amount to reflect the amount of unex7 pended and uncanceled grant funds remaining

8 at the end of the most recent fiscal year for

9 which the amount of such funds can be deter10 mined using the required financial status report.

11 The amount of any such unexpended funds shall

12 be determined using the financial status report

13 of the grantee.

14 ‘‘(F) PUERTO RICO, VIRGIN ISLANDS,

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

16 cost index for an eligible area within Puerto

17 Rico, the Virgin Islands, or Guam shall be 1.0.’’.

18 SEC. 502. AMOUNT OF CARE GRANTS.

19 Section 2618 (42 U.S.C. 300ff–28), as amended by sec20 tion 402(b), is amended by striking subsection (b) and in21 serting the following subsections:

22 ‘‘(a) AMOUNT OF GRANT.—

23 ‘‘(1) IN GENERAL.—Subject to subsection (b) (re24 lating to minimum grants), the amount of a grant
53

1 under this part for a State for a fiscal year shall be

2 the sum of—

3 ‘‘(A) the amount determined for the State

4 under paragraph (2); and

5 ‘‘(B) the amount determined for the State

6 under paragraph (4) (if applicable).

7 ‘‘(2) PRINCIPAL FORMULA GRANTS.—For pur8 poses of paragraph (1)(A), the amount determined

9 under this paragraph for a State for a fiscal year

10 shall be the product of—

11 ‘‘(A) the amount available under section

12 2677 for carrying out this part, less the reserva13 tion of funds made in paragraph (4)(A) and less

14 any other applicable reservation of funds author15 ized or required in this Act (which amount is

16 subject to subsection (b)); and

17 ‘‘(B) the percentage constituted by the ratio

18 of—

19 ‘‘(i) the distribution factor for the

20 State; to

21 ‘‘(ii) the sum of the distribution factors

22 for all States.

23 ‘‘(3) DISTRIBUTION FACTOR FOR PRINCIPAL FOR24 MULA GRANTS.—For purposes of paragraph (2)(B),
54

1 the term ‘distribution factor’ means the following, as

2 applicable:

3 ‘‘(A) In the case of each of the 50 States, the

4 District of Columbia, and the Commonwealth of

5 Puerto Rico, the product of—

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

7 immune deficiency syndrome in the State,

8 as indicated by the number of cases reported

9 to and confirmed by the Secretary for the 2

10 most recent fiscal years for which such data

11 are available; and

12 ‘‘(ii) the cube root of the ratio (based

13 on the most recent available data) of—

14 ‘‘(I) the average per capita in15 come of individuals in the United

16 States (including the territories); to

17 ‘‘(II) the average per capita in18 come of individuals in the State.

19 ‘‘(B) In the case of a territory of the United

20 States (other than the Commonwealth of Puerto

21 Rico), the number of additional cases of such

22 syndrome in the specific territory, as indicated

23 by the number of cases reported to and confirmed

24 by the Secretary for the 2 most recent fiscal

25 years for which such data is available.
55

1 ‘‘(4) SUPPLEMENTAL AMOUNTS FOR CERTAIN

2 STATES.—For purposes of paragraph (1)(B), an

3 amount shall be determined under this paragraph for

4 each State that does not contain any metropolitan

5 area whose chief elected official received a grant

6 under part A for fiscal year 1996. The amount deter7 mined under this paragraph for such a State for a

8 fiscal year shall be the product of—

9 ‘‘(A) an amount equal to 7 percent of the

10 amount available under section 2677 for carry11 ing out this part for the fiscal year (subject to

12 subsection (b)); and

13 ‘‘(B) the percentage constituted by the ratio

14 of—

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

16 immune deficiency syndrome in the State

17 (as determined under paragraph (3)(A)(i));

18 to

19 ‘‘(ii) the sum of the respective numbers

20 determined under clause (i) for each State

21 to which this paragraph applies.

22 ‘‘(5) DEFINITIONS.—For purposes of this sub23 section and subsection (b):
56

1 ‘‘(A) The term ‘State’ means each of the 50

2 States, the District of Columbia, and the terri3 tories of the United States.

4 ‘‘(B) The term ‘territory of the United

5 States’ means each of the Virgin Islands, Guam,

6 American Samoa, the Commonwealth of the

7 Northern Mariana Islands, the Commonwealth of

8 Puerto Rico, and the Republic of the Marshall

9 Islands.

10 ‘‘(b) MINIMUM AMOUNT OF GRANT.—

11 ‘‘(1) IN GENERAL.—Subject to the extent of the

12 amounts specified in paragraphs (2)(A) and (4)(A) of

13 subsection (a), a grant under this part for a State for

14 a fiscal year shall be the greater of—

15 ‘‘(A) the amount determined for the State

16 under subsection (a); and

17 ‘‘(B) the amount applicable under para18 graph (2) to the State.

19 ‘‘(2) APPLICABLE AMOUNT.—For purposes of

20 paragraph (1)(B), the amount applicable under this

21 paragraph for a fiscal year is the following:

22 ‘‘(A) In the case of the 50 States, the Dis23 trict of Columbia, and the Commonwealth of

24 Puerto Rico—
57

1 ‘‘(i) $100,000, if it has less than 90

2 cases of acquired immune deficiency syn3 drome (as determined under subsection

4 (a)(3)(A)(i)); and

5 ‘‘(ii) $250,000, if it has 90 or more

6 such cases (as so determined).

7 ‘‘(B) In the case of each of the territories of

8 the United States (other than the Commonwealth

9 of Puerto Rico), $0.0.’’.

10 SEC. 503. 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 fol14 lowing section:

15 ‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

16 ‘‘(a) IN GENERAL.—For the purpose of carrying out

17 parts A and B, there are authorized to be appropriated such

18 sums as may be necessary for each of the fiscal years 1996

19 through 2000. Subject to section 2673A and to subsection

20 (b), of the amount appropriated under this section for a

21 fiscal year, the Secretary shall make available 64 percent

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

23 amount to carry out part B.

24 ‘‘(b) DEVELOPMENT OF METHODOLOGY.—With respect

25 to each of the fiscal years 1997 through 2000, the Secretary
58

1 may develop and implement a methodology for adjusting

2 the percentages referred to in subsection (a).’’.

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

4 300ff–18 and 300ff–30) are repealed.

5 (c) CONFORMING AMENDMENTS.—Section 2605(d)(1)

6 (as redesignated by section 105(3)), is amended by striking

7 ‘‘2608’’ and inserting ‘‘2677’’.

8 SEC. 504. ADDITIONAL PROVISIONS.

9 (a) DEFINITIONS.—Section 2676(4) (42 U.S.C. 300ff–

10 76(4)) is amended by inserting ‘‘funeral-service practition11 ers,’’ after ‘‘emergency medical technicians,’’.

12 (b) MISCELLANEOUS AMENDMENT.—Section 1201(a)

13 (42 U.S.C. 300d(a)) is amended in the matter preceding

14 paragraph (1) by striking ‘‘The Secretary,’’ and all that

15 follows through ‘‘shall,’’ and inserting ‘‘The Secretary

16 shall,’’.

17 (c) TECHNICAL CORRECTIONS.—Title XXVI (42

18 U.S.C. 300ff–11 et seq.) is amended—

19 (1) in section 2601(a), by inserting ‘‘section’’ be20 fore ‘‘2604’’;

21 (2) in section 2603(b)(4)(B), by striking ‘‘an ex22 pedited grants’’ and inserting ‘‘an expedited grant’’;

23 (3) in section 2617(b)(3)(B)(iv), by inserting

24 ‘‘section’’ before ‘‘2615’’;
59

1 (4) in section 2618(b)(1)(B), by striking ‘‘para2 graph 3’’ and inserting ‘‘paragraph (3)’’;

3 (5) in section 2647—

4 (A) in subsection (a)(1), by inserting ‘‘to’’

5 before ‘‘HIV’’;

6 (B) in subsection (c), by striking ‘‘section

7 2601’’ and inserting ‘‘section 2641’’; and

8 (C) in subsection (d)—

9 (i) in the matter preceding paragraph

10 (1), by striking ‘‘section 2601’’ and insert11 ing ‘‘section 2641’’; and

12 (ii) in paragraph (1), by striking ‘‘has

13 in place’’ and inserting ‘‘will have in

14 place’’;

15 (6) in section 2648—

16 (A) by converting the heading for the sec17 tion to boldface type; and

18 (B) by redesignating the second subsection

19 (g) as subsection (h);

20 (7) in section 2649—

21 (A) in subsection (b)(1), by striking ‘‘sub22 section (a) of’’; and

23 (B) in subsection (c)(1), by striking ‘‘this

24 subsection’’ and inserting ‘‘subsection’’;

25 (8) in section 2651—
60

1 (A) in subsection (b)(3)(B), by striking ‘‘fa2 cility’’ and inserting ‘‘facilities’’; and

3 (B) in subsection (c), by striking ‘‘exist’’

4 and inserting ‘‘exists’’;

5 (9) in section 2676—

6 (A) in paragraph (2), by striking ‘‘section’’

7 and all that follows through ‘‘by the’’ and insert8 ing ‘‘section 2686 by the’’; and

9 (B) in paragraph (10), by striking

10 ‘‘673(a)’’ and inserting ‘‘673(2)’’;

11 (10) in part E, by converting the headings for

12 subparts I and II to Roman typeface; and

13 (11) in section 2684(b), in the matter preceding

14 paragraph (1), by striking ‘‘section 2682(d)(2)’’ and

15 inserting ‘‘section 2683(d)(2)’’.

16 TITLE VI—EFFECTIVE DATE

17 SEC. 601. EFFECTIVE DATE.

18 Except as provided in section 101(a), this Act takes effect

19 October 1, 1995.

20 Amend the title so as to read: ‘‘An Act to amend the

21 Public Health Service Act to revise and extend programs

22 established pursuant to the Ryan White Comprehensive

23 AIDS Resources Emergency Act of 1990.’’.

Attest:

Clerk.
104TH CONGRESS

1ST SESSION S. 641

AMENDMENTS