I

104TH CONGRESS

1ST SESSION H. R. 42

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

IN THE HOUSE OF REPRESENTATIVES

JANUARY 4, 1995

Mr. WAXMAN introduced the following bill; which was referred to the

Committee on Commerce

A BILL

To reauthorize the Ryan White CARE Act of 1990, and

for other purposes.

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

3 SECTION 1. SHORT TITLE.

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

5 Reauthorization Act of 1995’’.

6 SEC. 2. REFERENCES.

7 Whenever in this Act an amendment is expressed in

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

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

10 or other provision of title XXVI of the Public Health Serv11 ice Act (42 U.S.C. 300ff et seq.).
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1 SEC. 3. AMENDMENTS.

2 (a) ESTABLISHMENT OF GRANT PROGRAM.—Section

3 2601 (42 U.S.C. 300ff–11) is amended by adding at the

4 end thereof the following new subsection:

5 ‘‘(c) POPULATION OF ELIGIBLE AREAS.—The Sec6 retary may not make a grant to an eligible area under

7 subsection (a) after the date of enactment of this sub8 section unless the area has a population of at least

9 500,000 individuals, except that this subsection shall not

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

11 purposes of eligibility under this title, the boundaries of

12 each metropolitan area shall be those in effect in fiscal

13 year 1994.’’.

14 (b) EMERGENCY RELIEF FOR AREAS WITH SUB15 STANTIAL NEED FOR SERVICES.—

16 (1) HEALTH SERVICES PLANNING COUNCIL.—

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

18 12(b)) is amended—

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

20 and all that follows through the end thereof,

21 and inserting ‘‘be reflective of the demographics

22 of the HIV epidemic in the eligible area in23 volved, with particular consideration given to

24 disproportionately affected and historically un25 derserved groups.’’;
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1 (B) in paragraph (2), by adding at the end

2 thereof the following new subparagraph:

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

4 may not be chaired solely by an employee of the

5 grantee.’’;

6 (C) in paragraph (3)—

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

8 subparagraph (B);

9 (ii) by striking the period at the end

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

11 at the discretion of the planning council,

12 assess the effectiveness, either directly or

13 through contractual arrangements, of the

14 services offered in meeting the identified

15 needs; and’’; and

16 (iii) by adding at the end thereof the

17 following new subparagraph:

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

19 Statewide coordinated statement of need initi20 ated by the State health department.’’;

21 (D) by redesignating paragraphs (2) and

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

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

24 following new paragraph:
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1 ‘‘(2) REPRESENTATION.—The HIV health serv2 ices planning council shall include representatives

3 of—

4 ‘‘(A) health care providers, including feder5 ally qualified health centers;

6 ‘‘(B) community-based organizations serv7 ing affected populations and AIDS service orga8 nizations;

9 ‘‘(C) social service providers;

10 ‘‘(D) mental health and substance abuse

11 providers;

12 ‘‘(E) local public health agencies;

13 ‘‘(F) hospital planning agencies or health

14 care planning agencies;

15 ‘‘(G) affected communities, including peo16 ple of color, women, and gay and bisexual men;

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

18 ‘‘(I) nonelected community leaders;

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

20 medicaid agency);

21 ‘‘(K) grantees under subpart II of part C;

22 ‘‘(L) grantees under section 2671, or, if

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

24 and women’s service organizations operating in

25 the area; and
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1 ‘‘(M) grantees under other Federal HIV

2 programs.’’.

3 (2) DISTRIBUTION OF GRANTS.—Section 2603

4 (42 U.S.C. 300ff–13) is amended—

5 (A) in subsection (a)—

6 (i) in paragraph (2)—

7 (I) by striking ‘‘Not later

8 than—’’ and all that follows through

9 ‘‘the Secretary shall’’ and inserting

10 the following: ‘‘Not later than 60 days

11 after an appropriation becomes avail12 able to carry out this part for each of

13 the fiscal years 1996 through 2000,

14 the Secretary shall’’; and

15 (II) by inserting ‘‘or the provi16 sions of subsection (a)(3)(D)’’ after

17 ‘‘section 2605(c)’’;

18 (ii) in paragraph (3)(A)(ii)—

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

20 subclause (I), and inserting ‘‘product

21 of 9’’; and

22 (II) by striking ‘‘equal to the

23 product’’ in subclause (II), and insert24 ing ‘‘amount equal to twice the prod25 uct’’;
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1 (iii) in paragraph (3)(B)(i), by strik2 ing ‘‘cumulative number of cases’’ and in3 serting ‘‘for the 10 years prior to the fiscal

4 year in question’’;

5 (iv) in paragraph (3)(C)—

6 (I) by striking ‘‘cumulative

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

8 ‘‘the number of cases reported and

9 confirmed for the 10 years prior to

10 the fiscal year in question’’; and

11 (II) by striking ‘‘cumulative such

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

13 ‘‘the number of cases reported and

14 confirmed for the 10 years prior to

15 the fiscal year in question’’; and

16 (v) by adding at the end of paragraph

17 (3), the following new subparagraph:

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

19 shall receive an amount less than that awarded

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

21 1995, except for cause, as determined by the

22 Secretary based on a finding of fraud or an

23 egregious violation by the grantee of the provi24 sions of this Act.’’; and

25 (B) in subsection (b)(1)—
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1 (i) by striking ‘‘and’’ at the end of

2 subparagraph (D);

3 (ii) by striking the period at the end

4 of subparagraph (E) and inserting a semi5 colon; and

6 (iii) by adding at the end thereof the

7 following new subparagraphs:

8 ‘‘(F) demonstrates the inclusiveness of the

9 planning council membership, with particular

10 emphasis on affected communities and individ11 uals with HIV disease;

12 ‘‘(G) demonstrates the manner in which

13 the proposed services are consistent with the

14 Statewide coordinated statement of need.’’.

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

16 U.S.C. 300ff–14) is amended—

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

18 ‘‘treatment education and prophylactic treat19 ment for opportunistic infections,’’ after ‘‘treat20 ment services,’’; and

21 (B) in subsection (e) by striking ‘‘report22 ing, and program oversight functions’’ and in23 serting ‘‘reporting, and the assessment of pro24 gram effectiveness’’.
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1 (4) APPLICATION.—Section 2605(a) (42 U.S.C.

2 300ff–15(a)) is amended—

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

4 year period’’ and all that follows through ‘‘eligi5 ble area’’ and inserting ‘‘preceding fiscal year’’;

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

7 the end thereof;

8 (C) in paragraph (5), by striking the pe9 riod at the end thereof and inserting ‘‘; and’’;

10 and

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

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

14 agree to participate, in the Statewide coordinated

15 statement of need process where it has been initiated

16 by the State, and ensure that the services provided

17 under the comprehensive plan are consistent with

18 the Statewide coordinated statement of need.’’.

19 (5) TECHNICAL ASSISTANCE.—Section 2606

20 (42 U.S.C. 300ff–16) is amended—

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

22 ‘‘shall’’;

23 (B) by inserting after ‘‘technical assist24 ance’’ the following: ‘‘, including peer based as25 sistance to assist newly eligible metropolitan
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1 areas in the establishment of HIV health serv2 ices planning councils and,’’; and

3 (C) by adding at the end thereof the fol4 lowing new sentences: ‘‘The Administrator may

5 make planning grants available to metropolitan

6 areas projected to be eligible for funding under

7 section 2601 in the following fiscal year. Not to

8 exceed 1 percent of the amount appropriated

9 for a fiscal year under section 2608 may be

10 used to carry out this section.’’.

11 (6) AUTHORIZATION OF APPROPRIATIONS.—

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

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

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

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

16 1996, 1997, 1998, 1999, and 2000.’’.

17 (b) CARE GRANT PROGRAM.—

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

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

20 read as follows:

21 ‘‘(b) INFANTS AND WOMEN.—For each State in

22 which the infants, children, adolescents, and women com23 prise greater than 10 percent of the AIDS cases reported

24 to and confirmed by the Centers for Disease Control and

25 Prevention for the 2 most recent fiscal years in such State,
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1 not less than 15 percent of funds allocated under this part

2 shall be used to provide health and support services to in3 fants, children, women, and families with HIV disease.

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

5 and women comprise less than 10 percent of AIDS cases

6 reported to and confirmed by the Centers for Disease Con7 trol and Prevention for the 2 most recent fiscal years in

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

9 shall assess unmet needs and address the service needs

10 of such populations in their applications.’’.

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

12 U.S.C. 300ff–23) is amended—

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

14 ‘‘prophylactic treatment for opportunistic infec15 tions, treatment education,’’ after ‘‘monitor16 ing,’’;

17 (B) in subsection (c)—

18 (i) in subparagraph (C) of paragraph

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

20 centered’’; and

21 (ii) in paragraph (2)—

22 (I) in clause (ii) of subparagraph

23 (A), by striking ‘‘served; and’’ and in24 serting ‘‘served;’’;
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1 (II) in subparagraph (B), by

2 striking the period at the end and in3 serting ‘‘; and’’; and

4 (III) by adding after subpara5 graph (B), the following new subpara6 graph:

7 ‘‘(C) representatives of organizations with

8 a history of serving children, youth, and women

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

10 and

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

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

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

14 system of services described in this section that is targeted

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

17 women, and families. Family centered and youth centered

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

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

23 (3) PROVISION OF TREATMENTS.—Section 2616

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

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

4 carrying out this section, the Secretary shall—

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

7 expanded availability of prophylactic treatments for

8 opportunistic infections (including active tuber9 culosis); and

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

12 minimum formulary .

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

14 those treatments in the recommended minimum formulary

15 that are for the prevention of opportunistic infections (in16 cluding the prevention of active tuberculosis).

17 ‘‘(d) STATE DUTIES.—

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

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

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

21 available to individuals eligible for assistance under

22 this section, and to develop plans to implement fully

23 the recommended minimum formulary.

24 ‘‘(2) OTHER MECHANISMS FOR PROVIDING

25 TREATMENTS.—In meeting the standards of the rec-
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1 ommended minimum formulary developed under sub2 section (c), a State may identify other mechanisms

3 such as consortia and public programs for providing

4 such treatments to individuals with HIV.’’.

5 (4) STATE APPLICATION.—Section 2617(b) (42

6 U.S.C. 300ff–27(b)) is amended—

7 (A) in paragraph (2)—

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

9 ‘‘and’’ at the end thereof; and

10 (ii) by adding at the end thereof the

11 following new subparagraph:

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

13 and utilization of resources are consistent with

14 the Statewide coordinated statement of need

15 (including the needs of children, adolescents,

16 and women) developed in partnership with other

17 grantees in the State that receive funding under

18 this title;’’;

19 (B) by redesignating paragraph (3) as

20 paragraph (4); and

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

22 following new paragraph:

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

24 grant for the State shall convene a meeting at least

25 annually of representatives of grantees funded under
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1 this title (including HIV health services planning

2 councils, early intervention programs, children,

3 youth and family service projects, special projects of

4 national significance, and HIV care consortia) and

5 other providers (including federally qualified health

6 centers) and public agency representatives within the

7 State currently delivering HIV services to affected

8 communities for the purpose of developing a State9 wide coordinated statement of need. The State shall

10 not be required to finance attendance at such meet11 ings.’’.

12 (5) DISTRIBUTION OF FUNDS.—Section 2618

13 (42 U.S.C. 300ff–28) is amended—

14 (A) by striking subsection (a);

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

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

17 respectively;

18 (C) by amending subsection (a), as so re19 designated, to read as follows:

20 ‘‘(a) AMOUNT OF GRANT.—

21 ‘‘(1) MINIMUM ALLOTMENT.—

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

23 made available pursuant to section 2620, the

24 amount of a grant to be made under this part

25 for each of the 50 States, the District of Co-
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1 lumbia, and Puerto Rico, shall be the greater

2 of—

3 ‘‘(i) $250,000; and

4 ‘‘(ii) an amount determined under

5 paragraph (2).

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

7 Virgin Islands shall be eligible for an allotment

8 under subparagraph (A) if the Secretary cer9 tifies that the Virgin Islands has a program in

10 place to effectively utilize additional resources

11 provided under such allotment.

12 ‘‘(C) SUPPLEMENTAL ENHANCEMENT

13 GRANTS.—

14 ‘‘(i) IN GENERAL.—The Secretary

15 shall award supplemental grants to eligible

16 entities to enhance community-based care,

17 treatment, and supportive services through

18 the development and operation of consortia

19 and innovative approaches.

20 ‘‘(ii) ELIGIBILITY.—A State shall be

21 eligible for—

22 ‘‘(I) a tier I supplemental grant

23 in the amount of $500,000 if the

24 number of AIDS cases (in the State)

25 reported to and confirmed by the Cen-
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1 ters for Disease Control and Preven2 tion total not less than 1500 cases for

3 the 10 years prior to the fiscal year

4 for which the grant is to be awarded

5 and the State does not contain a met6 ropolitan area whose chief elected offi7 cial is a grantee for funding under

8 part A; or

9 ‘‘(II) a tier II supplemental grant

10 in the amount of $250,000 if the

11 number of AIDS cases (in the State)

12 reported to and confirmed by the Cen13 ters for Disease Control and Preven14 tion total less than 1500 cases for the

15 10 years prior to the fiscal year for

16 which the grant is to be awarded and

17 the State does not contain a metro18 politan area whose chief elected offi19 cial is a grantee under part A and

20 whose formula grant exceeds the mini21 mum allotment described in subpara22 graph (A)(i).

23 ‘‘(iii) REDUCTION.—A State that re24 ceives a grant under clause (ii)(I), or

25 which would have been eligible to receive
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1 such a grant in fiscal year 1995, that sub2 sequently contains a metropolitan area

3 that becomes eligible for funding under

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

5 reduction in the amount of the grant under

6 clause (ii)(I) as follows:

7 ‘‘(I) With respect to the first

8 year in which the metropolitan area

9 receives funds under part A, the State

10 would receive $500,000 under clause

11 (ii)(I).

12 ‘‘(II) With respect to the second

13 year in which the metropolitan area

14 receives funds under part A, the State

15 would receive $250,000 under clause

16 (ii)(I).

17 ‘‘(III) The State would not be eli18 gible for funds under this subpara19 graph in years subsequent to the year

20 described in subclause (II).

21 ‘‘(iv) TERMS.—All terms and condi22 tions contained under subsections (b) and

23 (c) of section 2617 shall apply to funds re24 ceived under this subsection.

25 ‘‘(2) DETERMINATION.—
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1 ‘‘(A) FORMULA.—The amount referred to

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

3 ‘‘(i) an amount equal to the amount

4 appropriated under section 2620 for the

5 fiscal year involved less the amount needed

6 to carry out subparagraph (B); and

7 ‘‘(ii) the ratio of the distribution fac8 tor for the State or territory to the sum of

9 the distribution factors for all the States

10 or territories.

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

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

13 means the product of—

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

15 immune deficiency syndrome in the State

16 or territory, as indicated by the number of

17 cases reported to and confirmed by the

18 Centers for Disease Control and Preven19 tion for the 2 most recent fiscal years for

20 which such data are available; and

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

22 on the most recent available data) of—

23 ‘‘(I) the average per capita in24 come of individuals in the United

25 States (including territories); to
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1 ‘‘(II) the average per capita in2 come of individuals in the State or

3 territory.’’;

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

5 (i) by amending paragraphs (3) and

6 (4) to read as follows:

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

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

9 percent of amounts received under a grant awarded

10 under this part for planning and evaluation activi11 ties.

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

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

14 amounts received under a grant awarded under this

15 part for administration, accounting, reporting, and

16 program oversight functions.’’;

17 (ii) by redesignating paragraph (5) as

18 paragraph (6); and

19 (iii) by inserting after paragraph (4),

20 the following new paragraph (5):

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

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

23 amounts received under a grant awarded under this

24 part for the purposes described in paragraphs (3)

25 and (4).’’
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1 (6) TECHNICAL ASSISTANCE.—Section 2619

2 (42 U.S.C. 300ff–29) is amended—

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

4 ‘‘shall’’; and

5 (B) by inserting before the period the fol6 lowing: ‘‘, including technical assistance for the

7 development and implementation of Statewide

8 coordinated statements of need’’.

9 (7) AUTHORIZATION OF APPROPRIATIONS.—

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

11 ‘‘$275,000,000’’ and all that follows through the end

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

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

14 1998, 1999, and 2000.’’.

15 (8) GRIEVANCE PROCEDURES AND COORDINA16 TION.—Part B of title XXVI (42 U.S.C. 300ff-21)

17 is amended by adding at the end thereof the follow18 ing new sections:

19 ‘‘SEC. 2621. GRIEVANCE PROCEDURES.

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

21 of this section, the Administration, in consultation with

22 affected parties, shall establish grievance procedures, spe23 cific to each part of this title, to address allegations of

24 egregious violations of each such part or the intent of the
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1 provisions of each such part. Such procedures shall include

2 an appropriate enforcement mechanism.

3 ‘‘SEC. 2622. COORDINATION.

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

7 and Mental Health Services Administration coordinate the

8 planning and implementation of Federal HIV programs

9 in order to facilitate the development of a complete contin10 uum of HIV-related services for individuals with HIV dis11 ease and those at risk of such disease. The Secretary shall

12 periodically prepare and submit to the relevant committees

13 of Congress a report concerning such coordination efforts

14 at the Federal, State, and local levels as well as the exist15 ence of Federal barriers to HIV program integration.’’.

16 (c) EARLY INTERVENTION SERVICES.—

17 (1) AUTHORIZATION OF APPROPRIATIONS.—

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

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

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

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

22 1997, 1998, 1999, and 2000.’’.

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

24 (42 U.S.C. 300ff–64(g)) is amended—
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1 (A) in paragraph (2), by striking ‘‘and’’ at

2 the end thereof;

3 (B) in paragraph (3)—

4 (i) by striking ‘‘5 percent’’ and insert5 ing ‘‘10 percent including planning, evalua6 tion and technical assistance’’; and

7 (ii) by striking the period and insert8 ing ‘‘; and’’; and

9 (C) by adding at the end thereof the fol10 lowing new paragraph:

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

12 proposed program is consistent with the Statewide

13 coordinated statement of need and agree to partici14 pate in the ongoing revision of such statement of

15 need.’’.

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

17 U.S.C. 300ff–71) is amended—

18 (1) by amending the title to read as follows:

19 ‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND AC20 CESS TO RESEARCH FOR CHILDREN, YOUTH,

21 WOMEN, AND FAMILIES.’’;

22 (2) in subsection (a)—

23 (i) by striking ‘‘demonstration’’;
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1 (ii) by striking ‘‘and the Director’’

2 and inserting ‘‘, in coordination with the

3 Director’’;

4 (iii) by striking paragraph (1), and in5 serting the following new paragraph:

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

7 entities, access to and linkages with clinical research

8 on therapies for pediatric patients, youth, and

9 women with HIV disease, and special initiatives re10 lated to clinical research and care findings;’’; and

11 (iv) by amending paragraph (2) to

12 read as follows:

13 ‘‘(2) providing and coordinating outpatient

14 health care services and systems of care, directly or

15 through contractual arrangements, to children,

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

17 (3) in subsection (c)—

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

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

20 may not make a grant to an applicant under sub21 section (a) unless the applicant enters into an agree22 ment with an appropriately qualified entity with ex23 pertise in biomedical or behavioral research to en24 hance voluntary access to research.’’; and

25 (B) in paragraph (2)—
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1 (i) by inserting after ‘‘through the’’

2 the following: ‘‘Director of the Adminis3 trator of the Health Resources and Serv4 ices Administration, and in coordination

5 with the’’;

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

7 ‘‘; and’’ and inserting a semicolon;

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

9 the period at the end and inserting ‘‘;

10 and’’; and

11 (iv) by inserting after subparagraph

12 (B), the following new subparagraph:

13 ‘‘(C) may provide training and technical

14 assistance including peer-based assistance

15 through the Health Resources and Services Ad16 ministration.’’;

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

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

19 and inserting ‘‘children and youth’’;

20 (5) in subsection (f), by inserting before the pe21 riod the following: ‘‘, including coordination and ac22 cess to child welfare services, support services, kin23 ship care services, and other appropriate services for

24 orphans of the AIDS epidemic.’’;

25 (6) in subsection (h), to read as follows:
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1 ‘‘(h) COORDINATION.—The Secretary may not make

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

3 evidence that the proposed program is consistent with the

4 Statewide coordinated statement of need and the applicant

5 agrees to annually participate in the ongoing revision proc6 ess of such statement of need.’’; and

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

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

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

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

11 2000.’’.

12 (e) SPECIAL PROJECTS OF NATIONAL SIGNIFI13 CANCE.—Title XXVI is amended by adding at the end,

14 the following new part:

15 ‘‘PART F—SPECIAL PROJECTS OF NATIONAL

16 SIGNIFICANCE

17 ‘‘SEC. 2701. SPECIAL PROJECTS OF NATIONAL SIGNIFI18 CANCE.

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

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

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

22 or 3 percent of such amount appropriated under each such

23 part, but not to exceed $25,000,000, to administer a spe24 cial projects of national significance program to award di25 rect grants to public and nonprofit private entities includ-
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1 ing community-based organizations to fund special pro2 grams for the care and treatment of individuals with HIV

3 disease.

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

5 under subsection (a) based on—

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

7 particular model for the care and treatment of indi8 viduals with HIV disease;

9 ‘‘(2) the innovative nature of the proposed ac10 tivity; and

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

12 activity in other similar localities or nationally.

13 ‘‘(c) SPECIAL PROJECTS.—Special projects of na14 tional significance may include the development and as15 sessment of innovative service delivery models that are de16 signed to—

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

18 and

19 ‘‘(2) assist in the development of essential com20 munity-based service delivery infrastructure.

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

23 care and support services to traditionally underserved pop24 ulations including—
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1 ‘‘(1) individuals and families with HIV disease

2 living in rural communities;

3 ‘‘(2) adolescents with HIV disease;

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

5 disease;

6 ‘‘(4) homeless individuals and families with

7 HIV disease;

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

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

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

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

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

15 networks critical to the delivery of care in minority

16 communities;

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

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

21 operation within the changing health care environ22 ment; and

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

25 with HIV services.
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1 ‘‘(f) DISTRIBUTION OF FUNDS.—Fifty percent of the

2 funds made available under this section shall be provided

3 to geographic areas that are not eligible for funds under

4 section 2603 except that existing grantees shall continue

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

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

7 a grant under this section unless the applicant submits

8 evidence that the proposed program is consistent with the

9 Statewide coordinated statement of need, and the appli10 cant agrees to participate in the ongoing revision process

11 of such statement of need.

12 ‘‘(h) REPLICATION.—The Secretary shall make infor13 mation concerning successful models developed under this

14 part available to grantees under this title for the purpose

15 of coordination, replication, and integration. To facilitate

16 efforts under this subsection, the Secretary may provide

17 for peer-based technical assistance from grantees funded

18 under this part.’’.

19 SEC. 4. EFFECTIVE DATE.

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

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

22 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.

Æ

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