II

103D CONGRESS

2D SESSION S. 2489

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

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 30 (legislative day, SEPTEMBER 12), 1994

Mr. KENNEDY (for himself, Mr. HATCH, Mr. AKAKA, Mr. BIDEN, Mr. BINGAMAN, Mrs. BOXER, Mr. BRADLEY, Mr. BREAUX, Mr. BRYAN, Mr. BUMPERS, Mr. CAMPBELL, Mr. CHAFEE, Mr. D’AMATO, Mr. DASCHLE, Mr.

DECONCINI, Mr. DODD, Mr. DURENBERGER, Mr. FEINGOLD, Mrs. FEINSTEIN, Mr. GLENN, Mr. GRAHAM, Mr. HARKIN, Mr. HATFIELD, Mr.

INOUYE, Mr. JEFFORDS, Mr. KERRY, Mr. KOHL, Mr. LEAHY, Mr.

LIEBERMAN, Mr. MACK, Mr. METZENBAUM, Ms. MIKULSKI, Mr. MITCHELL, Ms. MOSELEY-BRAUN, Mr. MOYNIHAN, Mrs. MURRAY, Mr. PACKWOOD, Mr. PELL, Mr. PRYOR, Mr. REID, Mr. RIEGLE, Mr. ROBB, Mr.

SARBANES, Mr. SIMON, Mr. SPECTER, Mr. WELLSTONE, and Mr.

WOFFORD) 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 1994’’.
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1 SEC. 2. REFERENCES.

2 Whenever in this Act an amendment is expressed in

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

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

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

7 SEC. 3. AMENDMENTS.

8 (a) ESTABLISHMENT OF GRANT PROGRAM.—Section

9 2601 (42 U.S.C. 300ff–11) is amended by adding at the

10 end thereof the following new subsection:

11 ‘‘(c) POPULATION OF ELIGIBLE AREAS.—The Sec12 retary may not make a grant to an eligible area under

13 subsection (a) after the date of enactment of this sub14 section unless the area has a population of at least

15 500,000 individuals, except that this subsection shall not

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

17 purposes of eligibility under this title, the boundaries of

18 each metropolitan area shall be those in effect in fiscal

19 year 1994.’’.

20 (b) EMERGENCY RELIEF FOR AREAS WITH SUB21 STANTIAL NEED FOR SERVICES.—

22 (1) HEALTH SERVICES PLANNING COUNCIL.—

23 Subsection (b) of section 2602 (42 U.S.C. 300ff–

24 12(b)) is amended—

25 (A) in paragraph (1), by striking ‘‘include’’

26 and all that follows through the end thereof,
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1 and inserting ‘‘be reflective of the demographics

2 of the HIV epidemic in the eligible area in3 volved, with particular consideration given to

4 disproportionately affected and historically un5 derserved groups.’’;

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

7 thereof the following new subparagraph:

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

9 may not be chaired solely by an employee of the

10 grantee.’’;

11 (C) in paragraph (3)—

12 (i) by striking ‘‘and’’ at the end of

13 subparagraph (B);

14 (ii) by striking the period at the end

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

16 at the discretion of the planning council,

17 assess the effectiveness, either directly or

18 through contractual arrangements, of the

19 services offered in meeting the identified

20 needs; and’’; and

21 (iii) by adding at the end thereof the

22 following new subparagraph:

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

24 Statewide coordinated statement of need initi25 ated by the State health department.’’;
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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 of color, women, and gay and bisexual men;

21 ‘‘(H) individuals with HIV or AIDS;

22 ‘‘(I) nonelected community leaders;

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

24 medicaid agency);

25 ‘‘(K) grantees under subpart II of part C;
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1 ‘‘(L) grantees under section 2671, or, if

2 none are operating in the area, pediatric, youth,

3 and women’s service organizations operating in

4 the area; and

5 ‘‘(M) grantees under other Federal HIV

6 programs.’’.

7 (2) DISTRIBUTION OF GRANTS.—Section 2603

8 (42 U.S.C. 300ff–13) is amended—

9 (A) in subsection (a)—

10 (i) in paragraph (2)—

11 (I) by striking ‘‘Not later

12 than—’’ and all that follows through

13 ‘‘the Secretary shall’’ and inserting

14 the following: ‘‘Not later than 60 days

15 after an appropriation becomes avail16 able to carry out this part for each of

17 the fiscal years 1996 through 2000,

18 the Secretary shall’’; and

19 (II) by inserting ‘‘or the provi20 sions of subsection (a)(3)(D)’’ after

21 ‘‘section 2605(c)’’;

22 (ii) in paragraph (3)(A)(ii)—

23 (I) by striking ‘‘product of 3’’ in

24 subclause (I), and inserting ‘‘product

25 of 9’’; and
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1 (II) by striking ‘‘equal to the

2 product’’ in subclause (II), and insert3 ing ‘‘amount equal to twice the prod4 uct’’;

5 (iii) in paragraph (3)(B)(i), by strik6 ing ‘‘cumulative number of cases’’ and in7 serting ‘‘for the 10 years prior to the fiscal

8 year in question’’;

9 (iv) in paragraph (3)(C)—

10 (I) by striking ‘‘cumulative

11 cases’’ in clause (i), and inserting

12 ‘‘the number of cases reported and

13 confirmed for the 10 years prior to

14 the fiscal year in question’’; and

15 (II) by striking ‘‘cumulative such

16 cases’’ in clause (ii), and inserting

17 ‘‘the number of cases reported and

18 confirmed for the 10 years prior to

19 the fiscal year in question’’; and

20 (v) by adding at the end of paragraph

21 (3), the following new subparagraph:

22 ‘‘(D) MINIMUM AMOUNT.—No eligible area

23 shall receive an amount less than that awarded

24 under subsection (a) to such area in fiscal year

25 1995, except for cause, as determined by the
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1 Secretary based on a finding of fraud or an

2 egregious violation by the grantee of the provi3 sions of this Act.’’; and

4 (B) in subsection (b)(1)—

5 (i) by striking ‘‘and’’ at the end of

6 subparagraph (D);

7 (ii) by striking the period at the end

8 of subparagraph (E) and inserting a semi9 colon; and

10 (iii) by adding at the end thereof the

11 following new subparagraphs:

12 ‘‘(F) demonstrates the inclusiveness of the

13 planning council membership, with particular

14 emphasis on affected communities and individ15 uals with HIV disease; and

16 ‘‘(G) demonstrates the manner in which

17 the proposed services are consistent with the

18 Statewide coordinated statement of need.’’.

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

20 U.S.C. 300ff–14) is amended—

21 (A) in subsection (b)(1)(A), by inserting

22 ‘‘treatment education and prophylactic treat23 ment for opportunistic infections,’’ after ‘‘treat24 ment services,’’; and
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1 (B) in subsection (e) by striking ‘‘report2 ing, and program oversight functions’’ and in3 serting ‘‘reporting, and the assessment of pro4 gram effectiveness’’.

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

6 300ff–15(a)) is amended—

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

8 year period’’ and all that follows through ‘‘eligi9 ble area’’ and inserting ‘‘preceding fiscal year’’;

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

11 the end thereof;

12 (C) in paragraph (5), by striking the pe13 riod at the end thereof and inserting ‘‘; and’’;

14 and

15 (D) by adding at the end thereof the fol16 lowing new paragraph:

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

18 agree to participate, in the Statewide coordinated

19 statement of need process where it has been initiated

20 by the State, and ensure that the services provided

21 under the comprehensive plan are consistent with

22 the Statewide coordinated statement of need.’’.

23 (5) TECHNICAL ASSISTANCE.—Section 2606

24 (42 U.S.C. 300ff–16) is amended—
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1 (A) by striking ‘‘may’’ and inserting

2 ‘‘shall’’;

3 (B) by inserting after ‘‘technical assist4 ance’’ the following: ‘‘, including peer based as5 sistance to assist newly eligible metropolitan

6 areas in the establishment of HIV health serv7 ices planning councils and,’’; and

8 (C) by adding at the end thereof the fol9 lowing new sentences: ‘‘The Administrator may

10 make planning grants available to metropolitan

11 areas projected to be eligible for funding under

12 section 2601 in the following fiscal year. Not to

13 exceed 1 percent of the amount appropriated

14 for a fiscal year under section 2608 may be

15 used to carry out this section.’’.

16 (6) AUTHORIZATION OF APPROPRIATIONS.—

17 Section 2608 (42 U.S.C. 300ff–18) is amended by

18 striking ‘‘$275,000,000’’ and all that follows

19 through the end of the section, and inserting ‘‘such

20 sums as may be necessary in each of the fiscal years

21 1996, 1997, 1998, 1999, and 2000.’’.

22 (b) CARE GRANT PROGRAM.—

23 (1) INFANTS AND WOMEN.—Subsection (b) of

24 section 2612 (42 U.S.C. 300ff–22) is amended to

25 read as follows:
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1 ‘‘(b) INFANTS AND WOMEN.—For each State in

2 which the infants, children, adolescents, and women com3 prise greater than 10 percent of the AIDS cases reported

4 to and confirmed by the Centers for Disease Control and

5 Prevention for the 2 most recent fiscal years in such State,

6 not less than 15 percent of funds allocated under this part

7 shall be used to provide health and support services to in8 fants, children, women, and families with HIV disease.

9 With respect to a State in which infants, children, youth,

10 and women comprise less than 10 percent of AIDS cases

11 reported to and confirmed by the Centers for Disease Con12 trol and Prevention for the 2 most recent fiscal years in

13 such State, planning activities under part B in such State

14 shall assess unmet needs and address the service needs

15 of such populations in their applications.’’.

16 (2) HIV CARE CONSORTIA.—Section 2613 (42

17 U.S.C. 300ff–23) is amended—

18 (A) in subsection (a)(2)(A), by inserting

19 ‘‘prophylactic treatment for opportunistic infec20 tions, treatment education,’’ after ‘‘monitor21 ing,’’;

22 (B) in subsection (c)—

23 (i) in subparagraph (C) of paragraph

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

25 centered’’; and
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1 (ii) in paragraph (2)—

2 (I) in clause (ii) of subparagraph

3 (A), by striking ‘‘served; and’’ and in4 serting ‘‘served;’’;

5 (II) in subparagraph (B), by

6 striking the period at the end and in7 serting ‘‘; and’’; and

8 (III) by adding after subpara9 graph (B), the following new subpara10 graph:

11 ‘‘(C) representatives of organizations with

12 a history of serving children, youth, and women

13 and operating in the community to be served.’’;

14 and

15 (C) in subsection (d) to read as follows:

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

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

18 system of services described in this section that is targeted

19 specifically to the special needs of infants, children (in20 cluding those orphaned by the AIDS epidemic), youth,

21 women, and families. Family centered and youth centered

22 care shall be based on a partnership among parents, ex23 tended family members, children and youth, professionals,

24 and the community designed to ensure an integrated, co-
12

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1 ordinated, culturally sensitive, and community-based con2 tinuum of care.’’.

3 (3) PROVISION OF TREATMENTS.—Section 2616

4 (42 U.S.C. 300ff–26) is amended by striking sub5 section (c) and inserting the following new sub6 sections:

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

8 carrying out this section, the Secretary shall—

9 ‘‘(1) review the current status of State drug re10 imbursement programs and assess barriers to the

11 expended availability of prophylactic treatments for

12 opportunistic infections (including active tuber13 culosis); and

14 ‘‘(2) establish, in consultation with States, pro15 viders, and affected communities, a recommended

16 minimum formulary .

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

18 those treatments in the recommended minimum formulary

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

21 ‘‘(d) STATE DUTIES.—

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

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

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

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

2 the recommended minimum formulary.

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 (4) 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 the needs of children, adolescents,

20 and women) developed in partnership with other

21 grantees in the State that receive funding under

22 this title;’’;

23 (B) by redesignating paragraph (3) as

24 paragraph (4); and
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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 representatives of grantees funded under

6 this title (including HIV health services planning

7 councils, early intervention programs, children,

8 youth and family service projects, special projects of

9 national significance, and HIV care consortia) and

10 other providers (including federally qualified health

11 centers) and public agency representatives within the

12 State currently delivering HIV services to affected

13 communities for the purpose of developing a State14 wide coordinated statement of need. The State shall

15 not be required to finance attendance at such meet16 ings.’’.

17 (5) DISTRIBUTION OF FUNDS.—Section 2618

18 (42 U.S.C. 300ff–28) is amended—

19 (A) by striking subsection (a);

20 (B) by redesignating subsections (b), (c),

21 (d), and (e) as subsections (a), (b), (c), and (d),

22 respectively;

23 (C) by amending subsection (a), as so re24 designated, to read as follows:

25 ‘‘(a) AMOUNT OF GRANT.—
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1 ‘‘(1) MINIMUM ALLOTMENT.—

2 ‘‘(A) IN GENERAL.—Subject to the amount

3 made available pursuant to section 2620, the

4 amount of a grant to be made under this part

5 for each of the 50 States, the District of Co6 lumbia, and Puerto Rico, shall be the greater

7 of—

8 ‘‘(i) $250,000; and

9 ‘‘(ii) an amount determined under

10 paragraph (2).

11 ‘‘(B) VIRGIN ISLANDS.—The United States

12 Virgin Islands shall be eligible for an allotment

13 under subparagraph (A) if the Secretary cer14 tifies that the Virgin Islands has a program in

15 place to effectively utilize additional resources

16 provided under such allotment.

17 ‘‘(C) SUPPLEMENTAL ENHANCEMENT

18 GRANTS.—

19 ‘‘(i) IN GENERAL.—The Secretary

20 shall award supplemental grants to eligible

21 entities to enhance community-based care,

22 treatment, and supportive services through

23 the development and operation of consortia

24 and innovative approaches.
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1 ‘‘(ii) ELIGIBILITY.—A State shall be

2 eligible for—

3 ‘‘(I) a tier I supplemental grant

4 in the amount of $500,000 if the

5 number of AIDS cases (in the State)

6 reported to and confirmed by the Cen7 ters for Disease Control and Preven8 tion total not less than 1500 cases for

9 the 10 years prior to the fiscal year

10 for which the grant is to be awarded

11 and the State does not contain a met12 ropolitan area whose chief elected offi13 cial is a grantee for funding under

14 part A; or

15 ‘‘(II) a tier II supplemental grant

16 in the amount of $250,000 if the

17 number of AIDS cases (in the State)

18 reported to and confirmed by the Cen19 ters for Disease Control and Preven20 tion total less than 1500 cases for the

21 10 years prior to the fiscal year for

22 which the grant is to be awarded and

23 the State does not contain a metro24 politan area whose chief elected offi25 cial is a grantee under part A and
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1 whose formula grant exceeds the mini2 mum allotment described in subpara3 graph (A)(i).

4 ‘‘(iii) REDUCTION.—A State that re5 ceives a grant under clause (ii)(I), or

6 which would have been eligible to receive

7 such a grant in fiscal year 1995, that sub8 sequently contains a metropolitan area

9 that becomes eligible for funding under

10 part A, shall be subject to a 2-year phased

11 reduction in the amount of the grant under

12 clause (ii)(I) as follows:

13 ‘‘(I) With respect to the first

14 year in which the metropolitan area

15 receives funds under part A, the State

16 would receive $500,000 under clause

17 (ii)(I).

18 ‘‘(II) With respect to the second

19 year in which the metropolitan area

20 receives funds under part A, the State

21 would receive $250,000 under clause

22 (ii)(I).

23 ‘‘(III) The State would not be eli24 gible for funds under this subpara-
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1 graph in years subsequent to the year

2 described in subclause (II).

3 ‘‘(iv) TERMS.—All terms and condi4 tions contained under subsections (b) and

5 (c) of section 2617 shall apply to funds re6 ceived under this subsection.

7 ‘‘(2) DETERMINATION.—

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

9 in paragraph (1)(A) shall be the product of—

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

11 appropriated under section 2620 for the

12 fiscal year involved less the amount needed

13 to carry out subparagraph (B); and

14 ‘‘(ii) the ratio of the distribution fac15 tor for the State or territory to the sum of

16 the distribution factors for all the States

17 or territories.

18 ‘‘(B) DISTRIBUTION FACTOR.—As used in

19 subparagraph (A), the term ‘distribution factor’

20 means the product of—

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

22 immune deficiency syndrome in the State

23 or territory, as indicated by the number of

24 cases reported to and confirmed by the

25 Centers for Disease Control and Preven-
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1 tion for the 2 most recent fiscal years for

2 which such data are available; and

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

4 on the most recent available data) of—

5 ‘‘(I) the average per capita in6 come of individuals in the United

7 States (including territories); to

8 ‘‘(II) the average per capita in9 come of individuals in the State or

10 territory.’’;

11 (D) in subsection (b), as so redesignated—

12 (i) by amending paragraphs (3) and

13 (4) to read as follows:

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

15 paragraph (5), a State may not use more than 10

16 percent of amounts received under a grant awarded

17 under this part for planning and evaluation activi18 ties.

19 ‘‘(4) ADMINISTRATION.—Subject to paragraph

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

21 amounts received under a grant awarded under this

22 part for administration, accounting, reporting, and

23 program oversight functions.’’;

24 (ii) by redesignating paragraph (5) as

25 paragraph (6); and
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1 (iii) by inserting after paragraph (4),

2 the following new paragraph (5):

3 ‘‘(5) LIMITATION ON USE OF FUNDS.—A State

4 may not use more than a total of 15 percent of

5 amounts received under a grant awarded under this

6 part for the purposes described in paragraphs (3)

7 and (4).’’

8 (6) 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 (7) AUTHORIZATION OF APPROPRIATIONS.—

17 Section 2620 (42 U.S.C. 300ff–30), by striking

18 ‘‘$275,000,000’’ and all that follows through the end

19 of the section, and inserting ‘‘such sums as may be

20 necessary in each of the fiscal years 1996, 1997,

21 1998, 1999, and 2000.’’.

22 (8) GRIEVANCE PROCEDURES AND COORDINA23 TION.—Part B of title XXVI (42 U.S.C. 300ff–21)

24 is amended by adding at the end thereof the follow25 ing new sections:
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1 ‘‘SEC. 2621. GRIEVANCE PROCEDURES.

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

3 of this section, the Administration, in consultation with

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

6 egregious violations of each such part or the intent of the

7 provisions of each such part. Such procedures shall include

8 an appropriate enforcement mechanism.

9 ‘‘SEC. 2622. COORDINATION.

10 ‘‘The Secretary shall ensure that the Health Re11 sources and Services Administration, the Centers for Dis12 ease Control and Prevention, and the Substance Abuse

13 and Mental Health Services Administration coordinate the

14 planning and implementation of Federal HIV programs

15 in order to facilitate the development of a complete contin16 uum of HIV-related services for individuals with HIV dis17 ease and those at risk of such disease. The Secretary shall

18 periodically prepare and submit to the relevant committees

19 of Congress a report concerning such coordination efforts

20 at the Federal, State, and local levels as well as the exist21 ence of Federal barriers to HIV program integration.’’.

22 (c) EARLY INTERVENTION SERVICES.—

23 (1) AUTHORIZATION OF APPROPRIATIONS.—

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

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

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

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

2 1997, 1998, 1999, and 2000.’’.

3 (2) REQUIRED AGREEMENTS.—Section 2664(g)

4 (42 U.S.C. 300ff–64(g)) is amended—

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

6 the end thereof;

7 (B) in paragraph (3)—

8 (i) by striking ‘‘5 percent’’ and insert9 ing ‘‘10 percent including planning, evalua10 tion and technical assistance’’; and

11 (ii) by striking the period and insert12 ing ‘‘; and’’; and

13 (C) by adding at the end thereof the fol14 lowing new paragraph:

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

16 proposed program is consistent with the Statewide

17 coordinated statement of need and agree to partici18 pate in the ongoing revision of such statement of

19 need.’’.

20 (d) GENERAL PROVISIONS.—Section 2671 (42

21 U.S.C. 300ff–71) is amended—

22 (1) by amending the title to read as follows:
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1 ‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND AC2 CESS TO RESEARCH FOR CHILDREN, YOUTH,

3 WOMEN, AND FAMILIES.’’;

4 (2) in subsection (a)—

5 (A) by striking ‘‘demonstration’’;

6 (B) by striking ‘‘and the Director’’ and in7 serting ‘‘, in coordination with the Director’’;

8 (C) by striking paragraph (1), and insert9 ing the following new paragraph:

10 ‘‘(1) supporting, at the health facilities of such

11 entities, access to and linkages with clinical research

12 on therapies for pediatric patients, youth, and

13 women with HIV disease, and special initiatives re14 lated to clinical research and care findings;’’; and

15 (D) by amending paragraph (2) to read as

16 follows:

17 ‘‘(2) providing and coordinating outpatient

18 health care services and systems of care, directly or

19 through contractual arrangements, to children,

20 youth, and women and their families.’’;

21 (3) in subsection (c)—

22 (A) in paragraph (1), to read as follows:

23 ‘‘(1) LINKAGES TO RESEARCH.—The Secretary

24 may not make a grant to an applicant under sub25 section (a) unless the applicant enters into an agree26 ment with an appropriately qualified entity with ex-
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1 pertise in biomedical or behavioral research to en2 hance voluntary access to research.’’; and

3 (B) in paragraph (2)—

4 (i) by inserting after ‘‘through the’’

5 the following: ‘‘Director of the Adminis6 trator of the Health Resources and Serv7 ices Administration, and in coordination

8 with the’’;

9 (ii) in subparagraph (A), by striking

10 ‘‘; and’’ and inserting a semicolon;

11 (iii) in subparagraph (B), by striking

12 the period at the end and inserting ‘‘;

13 and’’; and

14 (iv) by inserting after subparagraph

15 (B), the following new subparagraph:

16 ‘‘(C) may provide training and technical

17 assistance including peer-based assistance

18 through the Health Resources and Services Ad19 ministration.’’;

20 (4) in subsections (d), (e), and (f), by striking

21 ‘‘pediatric patient’’ each place such term appears

22 and inserting ‘‘children and youth’’;

23 (5) in subsection (f), by inserting before the pe24 riod the following: ‘‘, including coordination and ac25 cess to child welfare services, support services, kin-
25

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1 ship care services, and other appropriate services for

2 orphans of the AIDS epidemic.’’;

3 (6) in subsection (h), to read as follows:

4 ‘‘(h) COORDINATION.—The Secretary may not make

5 a grant under subsection (c) unless the applicant submits

6 evidence that the proposed program is consistent with the

7 Statewide coordinated statement of need and the applicant

8 agrees to annually participate in the ongoing revision proc9 ess of such statement of need.’’; and

10 (7) in subsection (j), by striking ‘‘$20,000,000’’

11 and all that follows through the end of the section,

12 and inserting ‘‘such sums as may be necessary in

13 each of the fiscal years 1996, 1997, 1998, 1999, and

14 2000.’’.

15 (e) SPECIAL PROJECTS OF NATIONAL SIGNIFI16 CANCE.—Title XXVI is amended by adding at the end,

17 the following new part:

18 ‘‘PART F—SPECIAL PROJECTS OF NATIONAL

19 SIGNIFICANCE

20 ‘‘SEC. 2701. SPECIAL PROJECTS OF NATIONAL SIGNIFI21 CANCE.

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

23 under each of parts A, B, and C of this title for each fiscal

24 year, the Secretary shall use the greater of $20,000,000

25 or 3 percent of such amount appropriated under each such
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1 part, but not to exceed $25,000,000, to administer a spe2 cial projects of national significance program to award di3 rect grants to public and nonprofit private entities includ4 ing community-based organizations to fund special pro5 grams for the care and treatment of individuals with HIV

6 disease.

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

8 under subsection (a) based on—

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

10 particular model for the care and treatment of indi11 viduals with HIV disease;

12 ‘‘(2) the innovative nature of the proposed ac13 tivity; and

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

15 activity in other similar localities or nationally.

16 ‘‘(c) SPECIAL PROJECTS.—Special projects of na17 tional significance may include the development and as18 sessment of innovative service delivery models that are de19 signed to—

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

21 and

22 ‘‘(2) assist in the development of essential com23 munity-based service delivery infrastructure.

24 ‘‘(d) SPECIAL POPULATIONS.—Special projects of na25 tional significance may include the delivery of HIV health
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1 care and support services to traditionally underserved pop2 ulations including—

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

4 living in rural communities;

5 ‘‘(2) adolescents with HIV disease;

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

7 disease;

8 ‘‘(4) homeless individuals and families with

9 HIV disease;

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

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

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

13 projects of national significance may include the develop14 ment of model approaches to delivering HIV care and sup15 port services including—

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

17 networks critical to the delivery of care in minority

18 communities;

19 ‘‘(2) programs that build organizational capac20 ity in disenfranchised communities;

21 ‘‘(3) programs designed to prepare AIDS serv22 ice organizations and grantees under this title for

23 operation within the changing health care environ24 ment; and
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1 ‘‘(4) programs designed to integrate the deliv2 ery of mental health and substance abuse treatment

3 with HIV services.

4 ‘‘(f) DISTRIBUTION OF FUNDS.—Fifty percent of the

5 funds made available under this section shall be provided

6 to geographic areas that are not eligible for funds under

7 section 2603 except that existing grantees shall continue

8 to receive funding for the length of the project period.

9 ‘‘(g) COORDINATION.—The Secretary may not make

10 a grant under this section unless the applicant submits

11 evidence that the proposed program is consistent with the

12 Statewide coordinated statement of need, and the appli13 cant agrees to participate in the ongoing revision process

14 of such statement of need.

15 ‘‘(h) REPLICATION.—The Secretary shall make infor16 mation concerning successful models developed under this

17 part available to grantees under this title for the purpose

18 of coordination, replication, and integration. To facilitate

19 efforts under this subsection, the Secretary may provide

20 for peer-based technical assistance from grantees funded

21 under this part.’’.

22 SEC. 4. EFFECTIVE DATE.

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

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

25 become effective on October 1, 1995.
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1 (b) ELIGIBLE AREAS.—The amendments made by

2 subsections (a) and (b)(4)(A) of section 3 become effective

3 on the date of enactment of this Act.

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