I
103D CONGRESS
2D SESSION
H. R. 5141
To reauthorize the Ryan White CARE Act of 1990, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 30, 1994
Mr. WAXMAN (for himself, Mr. DINGELL, Mr. GREENWOOD, Mr. STUDDS, Mr.
SHARP, Mr. MARKEY, Mr. SWIFT, Mrs. COLLINS of Illinois, Mr. SYNAR,
Mr. WYDEN, Mr. RICHARDSON, Mr. BRYANT, Mr. MANTON, Mr. TOWNS,
Mr. KREIDLER, Ms. DELAURO, Mr. DIXON, Mr. FRANK of Massachu-
setts, Mr. GUTIERREZ, Mr. KLECZKA, Mrs. MALONEY, Mr. MEEHAN,
Mrs. MORELLA, Mr. NADLER, Mr. OLVER, Mr. PASTOR, Ms. PELOSI, Mr.
RANGEL, Mr. SERRANO, and Ms. VELA´ZQUEZ) introduced the following
bill; which was referred to the Committee on Energy and Commerce
A BILL
To reauthorize the Ryan White CARE Act of 1990, and
for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Ryan White CARE
Reauthorization Act of 1994’’.
SEC. 2. REFERENCES.
Whenever in this Act an amendment is expressed in
terms of an amendment to a section or other provision,
the reference shall be considered to be made to a section
or other provision of title XXVI of the Public Health Serv-
ice Act (42 U.S.C. 300ff et seq.).
SEC. 3. AMENDMENTS.
(a) ESTABLISHMENT OF GRANT PROGRAM.—Section
2601 (42 U.S.C. 300ff–11) is amended by adding at the
end thereof the following new subsection:
‘‘(c) POPULATION OF ELIGIBLE AREAS.—The Sec-
retary may not make a grant to an eligible area under
subsection (a) after the date of enactment of this sub-
section unless the area has a population of at least
500,000 individuals, except that this subsection shall not
apply to areas that are eligible as of March 31, 1994. For
purposes of eligibility under this title, the boundaries of
each metropolitan area shall be those in effect in fiscal
year 1994.’’.
(b) EMERGENCY RELIEF FOR AREAS WITH SUB-
STANTIAL NEED FOR SERVICES.—
(1) HEALTH SERVICES PLANNING COUNCIL.—
Subsection (b) of section 2602 (42 U.S.C. 300ff–
12(b)) is amended—
(A) in paragraph (1), by striking ‘‘include’’
and all that follows through the end thereof,
and inserting ‘‘be reflective of the demographics
of the HIV epidemic in the eligible area in-
volved, with particular consideration given to
disproportionately affected and historically un-
derserved groups.’’;
(B) in paragraph (2), by adding at the end
thereof the following new subparagraph:
‘‘(C) CHAIRPERSON.—A planning council
may not be chaired solely by an employee of the
grantee.’’;
(C) in paragraph (3)—
(i) by striking ‘‘and’’ at the end of
subparagraph (B);
(ii) by striking the period at the end
of subparagraph (C) and inserting ‘‘, and
at the discretion of the planning council,
assess the effectiveness, either directly or
through contractual arrangements, of the
services offered in meeting the identified
needs; and’’; and
(iii) by adding at the end thereof the
following new subparagraph:
‘‘(D) participate in the development of the
Statewide coordinated statement of need initi-
ated by the State health department.’’;
(D) by redesignating paragraphs (2) and
(3) as paragraphs (3) and (4), respectively; and
(E) by inserting after paragraph (1), the
following new paragraph:
‘‘(2) REPRESENTATION.—The HIV health serv-
ices planning council shall include representatives
of—
‘‘(A) health care providers, including feder-
ally qualified health centers;
‘‘(B) community-based organizations serv-
ing affected populations and AIDS service orga-
nizations;
‘‘(C) social service providers;
‘‘(D) mental health and substance abuse
providers;
‘‘(E) local public health agencies;
‘‘(F) hospital planning agencies or health
care planning agencies;
‘‘(G) affected communities, including peo-
ple of color, women, and gay and bisexual men;
‘‘(H) individuals with HIV or AIDS;
‘‘(I) nonelected community leaders;
‘‘(J) State government (including the State
medicaid agency);
‘‘(K) grantees under subpart II of part C;
‘‘(L) grantees under section 2671, or, if
none are operating in the area, pediatric, youth,
and women’s service organizations operating in
the area; and
‘‘(M) grantees under other Federal HIV
programs.’’.
(2) DISTRIBUTION OF GRANTS.—Section 2603
(42 U.S.C. 300ff–13) is amended—
(A) in subsection (a)—
(i) in paragraph (2)—
(I)
by
striking
‘‘Not
later
than—’’ and all that follows through
‘‘the Secretary shall’’ and inserting
the following: ‘‘Not later than 60 days
after an appropriation becomes avail-
able to carry out this part for each of
the fiscal years 1996 through 2000,
the Secretary shall’’; and
(II) by inserting ‘‘or the provi-
sions of subsection (a)(3)(D)’’ after
‘‘section 2605(c)’’;
(ii) in paragraph (3)(A)(ii)—
(I) by striking ‘‘product of 3’’ in
subclause (I), and inserting ‘‘product
of 9’’; and
(II) by striking ‘‘equal to the
product’’ in subclause (II), and insert-
ing ‘‘amount equal to twice the prod-
uct’’;
(iii) in paragraph (3)(B)(i), by strik-
ing ‘‘cumulative number of cases’’ and in-
serting ‘‘for the 10 years prior to the fiscal
year in question’’;
(iv) in paragraph (3)(C)—
(I) 
by 
striking 
‘‘cumulative
cases’’ in clause (i), and inserting
‘‘the number of cases reported and
confirmed for the 10 years prior to
the fiscal year in question’’; and
(II) by striking ‘‘cumulative such
cases’’ in clause (ii), and inserting
‘‘the number of cases reported and
confirmed for the 10 years prior to
the fiscal year in question’’; and
(v) by adding at the end of paragraph
(3), the following new subparagraph:
‘‘(D) MINIMUM AMOUNT.—No eligible area
shall receive an amount less than that awarded
under subsection (a) to such area in fiscal year
1995, except for cause, as determined by the
Secretary based on a finding of fraud or an
egregious violation by the grantee of the provi-
sions of this Act.’’; and
(B) in subsection (b)(1)—
(i) by striking ‘‘and’’ at the end of
subparagraph (D);
(ii) by striking the period at the end
of subparagraph (E) and inserting a semi-
colon; and
(iii) by adding at the end thereof the
following new subparagraphs:
‘‘(F) demonstrates the inclusiveness of the
planning council membership, with particular
emphasis on affected communities and individ-
uals with HIV disease;
‘‘(G) demonstrates the manner in which
the proposed services are consistent with the
Statewide coordinated statement of need.’’.
(3) USE
OF
AMOUNTS.—Section 2604 (42
U.S.C. 300ff–14) is amended—
(A) in subsection (b)(1)(A), by inserting
‘‘treatment education and prophylactic treat-
ment for opportunistic infections,’’ after ‘‘treat-
ment services,’’; and
(B) in subsection (e) by striking ‘‘report-
ing, and program oversight functions’’ and in-
serting ‘‘reporting, and the assessment of pro-
gram effectiveness’’.
(4) APPLICATION.—Section 2605(a) (42 U.S.C.
300ff–15(a)) is amended—
(A) in paragraph (1)(B), by striking ‘‘1-
year period’’ and all that follows through ‘‘eligi-
ble area’’ and inserting ‘‘preceding fiscal year’’;
(B) in paragraph (4), by striking ‘‘and’’ at
the end thereof;
(C) in paragraph (5), by striking the pe-
riod at the end thereof and inserting ‘‘; and’’;
and
(D) by adding at the end thereof the fol-
lowing new paragraph:
‘‘(6) that the applicant has participated, or will
agree to participate, in the Statewide coordinated
statement of need process where it has been initiated
by the State, and ensure that the services provided
under the comprehensive plan are consistent with
the Statewide coordinated statement of need.’’.
(5) TECHNICAL
ASSISTANCE.—Section 2606
(42 U.S.C. 300ff–16) is amended—
(A) by striking ‘‘may’’ and inserting
‘‘shall’’;
(B) by inserting after ‘‘technical assist-
ance’’ the following: ‘‘, including peer based as-
sistance to assist newly eligible metropolitan
areas in the establishment of HIV health serv-
ices planning councils and,’’; and
(C) by adding at the end thereof the fol-
lowing new sentences: ‘‘The Administrator may
make planning grants available to metropolitan
areas projected to be eligible for funding under
section 2601 in the following fiscal year. Not to
exceed 1 percent of the amount appropriated
for a fiscal year under section 2608 may be
used to carry out this section.’’.
(6) AUTHORIZATION
OF
APPROPRIATIONS.—
Section 2608 (42 U.S.C. 300ff–18) is amended by
striking ‘‘$275,000,000’’ and all that follows
through the end of the section, and inserting ‘‘such
sums as may be necessary in each of the fiscal years
1996, 1997, 1998, 1999, and 2000.’’.
(b) CARE GRANT PROGRAM.—
(1) INFANTS AND WOMEN.—Subsection (b) of
section 2612 (42 U.S.C. 300ff–22) is amended to
read as follows:
‘‘(b) INFANTS
AND WOMEN.—For each State in
which the infants, children, adolescents, and women com-
prise greater than 10 percent of the AIDS cases reported
to and confirmed by the Centers for Disease Control and
Prevention for the 2 most recent fiscal years in such State,
not less than 15 percent of funds allocated under this part
shall be used to provide health and support services to in-
fants, children, women, and families with HIV disease.
With respect to a State in which infants, children, youth,
and women comprise less than 10 percent of AIDS cases
reported to and confirmed by the Centers for Disease Con-
trol and Prevention for the 2 most recent fiscal years in
such State, planning activities under part B in such State
shall assess unmet needs and address the service needs
of such populations in their applications.’’.
(2) HIV CARE CONSORTIA.—Section 2613 (42
U.S.C. 300ff–23) is amended—
(A) in subsection (a)(2)(A), by inserting
‘‘prophylactic treatment for opportunistic infec-
tions, treatment education,’’ after ‘‘monitor-
ing,’’;
(B) in subsection (c)—
(i) in subparagraph (C) of paragraph
(1), by inserting before ‘‘care’’ ‘‘and youth
centered’’; and
(ii) in paragraph (2)—
(I) in clause (ii) of subparagraph
(A), by striking ‘‘served; and’’ and in-
serting ‘‘served;’’;
(II) in subparagraph (B), by
striking the period at the end and in-
serting ‘‘; and’’; and
(III) by adding after subpara-
graph (B), the following new subpara-
graph:
‘‘(C) representatives of organizations with
a history of serving children, youth, and women
and operating in the community to be served.’’;
and
(C) in subsection (d) to read as follows:
‘‘(d) DEFINITION.—As used in this part, the terms
‘family centered care’ and ‘youth centered care’ mean the
system of services described in this section that is targeted
specifically to the special needs of infants, children (in-
cluding those orphaned by the AIDS epidemic), youth,
women, and families. Family centered and youth centered
care shall be based on a partnership among parents, ex-
tended family members, children and youth, professionals,
and the community designed to ensure an integrated, co-
ordinated, culturally sensitive, and community-based con-
tinuum of care.’’.
(3) PROVISION OF TREATMENTS.—Section 2616
(42 U.S.C. 300ff–26) is amended by striking sub-
section (c) and inserting the following new sub-
sections:
‘‘(c) STANDARDS FOR TREATMENT PROGRAMS.—In
carrying out this section, the Secretary shall—
‘‘(1) review the current status of State drug re-
imbursement programs and assess barriers to the
expanded availability of prophylactic treatments for
opportunistic infections (including active tuber-
culosis); and
‘‘(2) establish, in consultation with States, pro-
viders, and affected communities, a recommended
minimum formulary .
In carrying out paragraph (2), the Secretary shall identify
those treatments in the recommended minimum formulary
that are for the prevention of opportunistic infections (in-
cluding the prevention of active tuberculosis).
‘‘(d) STATE DUTIES.—
‘‘(1) IN GENERAL.—In implementing subsection
(a), States shall document the progress made in
making treatments described in subsection (c)(2)
available to individuals eligible for assistance under
this section, and to develop plans to implement fully
the recommended minimum formulary.
‘‘(2) OTHER
MECHANISMS
FOR
PROVIDING
TREATMENTS.—In meeting the standards of the rec-
ommended minimum formulary developed under sub-
section (c), a State may identify other mechanisms
such as consortia and public programs for providing
such treatments to individuals with HIV.’’.
(4) STATE APPLICATION.—Section 2617(b) (42
U.S.C. 300ff–27(b)) is amended—
(A) in paragraph (2)—
(i) in subparagraph (A), by striking
‘‘and’’ at the end thereof; and
(ii) by adding at the end thereof the
following new subparagraph:
‘‘(C) a description of how the allocation
and utilization of resources are consistent with
the Statewide coordinated statement of need
(including the needs of children, adolescents,
and women) developed in partnership with other
grantees in the State that receive funding under
this title;’’;
(B) by redesignating paragraph (3) as
paragraph (4); and
(C) by inserting after paragraph (2), the
following new paragraph:
‘‘(3) the public health agency administering the
grant for the State shall convene a meeting at least
annually of representatives of grantees funded under
this title (including HIV health services planning
councils, early intervention programs, children,
youth and family service projects, special projects of
national significance, and HIV care consortia) and
other providers (including federally qualified health
centers) and public agency representatives within the
State currently delivering HIV services to affected
communities for the purpose of developing a State-
wide coordinated statement of need. The State shall
not be required to finance attendance at such meet-
ings.’’.
(5) DISTRIBUTION
OF
FUNDS.—Section 2618
(42 U.S.C. 300ff–28) is amended—
(A) by striking subsection (a);
(B) by redesignating subsections (b), (c),
(d), and (e) as subsections (a), (b), (c), and (d),
respectively;
(C) by amending subsection (a), as so re-
designated, to read as follows:
‘‘(a) AMOUNT OF GRANT.—
‘‘(1) MINIMUM ALLOTMENT.—
‘‘(A) IN GENERAL.—Subject to the amount
made available pursuant to section 2620, the
amount of a grant to be made under this part
for each of the 50 States, the District of Co-
lumbia, and Puerto Rico, shall be the greater
of—
‘‘(i) $250,000; and
‘‘(ii) an amount determined under
paragraph (2).
‘‘(B) VIRGIN ISLANDS.—The United States
Virgin Islands shall be eligible for an allotment
under subparagraph (A) if the Secretary cer-
tifies that the Virgin Islands has a program in
place to effectively utilize additional resources
provided under such allotment.
‘‘(C) 
SUPPLEMENTAL
ENHANCEMENT
GRANTS.—
‘‘(i) IN
GENERAL.—The Secretary
shall award supplemental grants to eligible
entities to enhance community-based care,
treatment, and supportive services through
the development and operation of consortia
and innovative approaches.
‘‘(ii) ELIGIBILITY.—A State shall be
eligible for—
‘‘(I) a tier I supplemental grant
in the amount of $500,000 if the
number of AIDS cases (in the State)
reported to and confirmed by the Cen-
ters for Disease Control and Preven-
tion total not less than 1500 cases for
the 10 years prior to the fiscal year
for which the grant is to be awarded
and the State does not contain a met-
ropolitan area whose chief elected offi-
cial is a grantee for funding under
part A; or
‘‘(II) a tier II supplemental grant
in the amount of $250,000 if the
number of AIDS cases (in the State)
reported to and confirmed by the Cen-
ters for Disease Control and Preven-
tion total less than 1500 cases for the
10 years prior to the fiscal year for
which the grant is to be awarded and
the State does not contain a metro-
politan area whose chief elected offi-
cial is a grantee under part A and
whose formula grant exceeds the mini-
mum allotment described in subpara-
graph (A)(i).
‘‘(iii) REDUCTION.—A State that re-
ceives a grant under clause (ii)(I), or
which would have been eligible to receive
such a grant in fiscal year 1995, that sub-
sequently contains a metropolitan area
that becomes eligible for funding under
part A, shall be subject to a 2-year phased
reduction in the amount of the grant under
clause (ii)(I) as follows:
‘‘(I) With respect to the first
year in which the metropolitan area
receives funds under part A, the State
would receive $500,000 under clause
(ii)(I).
‘‘(II) With respect to the second
year in which the metropolitan area
receives funds under part A, the State
would receive $250,000 under clause
(ii)(I).
‘‘(III) The State would not be eli-
gible for funds under this subpara-
graph in years subsequent to the year
described in subclause (II).
‘‘(iv) TERMS.—All terms and condi-
tions contained under subsections (b) and
(c) of section 2617 shall apply to funds re-
ceived under this subsection.
‘‘(2) DETERMINATION.—
‘‘(A) FORMULA.—The amount referred to
in paragraph (1)(A) shall be the product of—
‘‘(i) an amount equal to the amount
appropriated under section 2620 for the
fiscal year involved less the amount needed
to carry out subparagraph (B); and
‘‘(ii) the ratio of the distribution fac-
tor for the State or territory to the sum of
the distribution factors for all the States
or territories.
‘‘(B) DISTRIBUTION FACTOR.—As used in
subparagraph (A), the term ‘distribution factor’
means the product of—
‘‘(i) the number of cases of acquired
immune deficiency syndrome in the State
or territory, as indicated by the number of
cases reported to and confirmed by the
Centers for Disease Control and Preven-
tion for the 2 most recent fiscal years for
which such data are available; and
‘‘(ii) the cube root of the ratio (based
on the most recent available data) of—
‘‘(I) the average per capita in-
come of individuals in the United
States (including territories); to
‘‘(II) the average per capita in-
come of individuals in the State or
territory.’’;
(D) in subsection (b), as so redesignated—
(i) by amending paragraphs (3) and
(4) to read as follows:
‘‘(3) PLANNING AND EVALUATIONS.—Subject to
paragraph (5), a State may not use more than 10
percent of amounts received under a grant awarded
under this part for planning and evaluation activi-
ties.
‘‘(4) ADMINISTRATION.—Subject to paragraph
(5), a State may not use more than 10 percent of
amounts received under a grant awarded under this
part for administration, accounting, reporting, and
program oversight functions.’’;
(ii) by redesignating paragraph (5) as
paragraph (6); and
(iii) by inserting after paragraph (4),
the following new paragraph (5):
‘‘(5) LIMITATION ON USE OF FUNDS.—A State
may not use more than a total of 15 percent of
amounts received under a grant awarded under this
part for the purposes described in paragraphs (3)
and (4).’’
(6) TECHNICAL
ASSISTANCE.—Section 2619
(42 U.S.C. 300ff–29) is amended—
(A) by striking ‘‘may’’ and inserting
‘‘shall’’; and
(B) by inserting before the period the fol-
lowing: ‘‘, including technical assistance for the
development and implementation of Statewide
coordinated statements of need’’.
(7) AUTHORIZATION
OF
APPROPRIATIONS.—
Section 2620 (42 U.S.C. 300ff–30), by striking
‘‘$275,000,000’’ and all that follows through the end
of the section, and inserting ‘‘such sums as may be
necessary in each of the fiscal years 1996, 1997,
1998, 1999, and 2000.’’.
(8) GRIEVANCE PROCEDURES AND COORDINA-
TION.—Part B of title XXVI (42 U.S.C. 300ff-21)
is amended by adding at the end thereof the follow-
ing new sections:
‘‘SEC. 2621. GRIEVANCE PROCEDURES.
‘‘Not later than 90 days after the date of enactment
of this section, the Administration, in consultation with
affected parties, shall establish grievance procedures, spe-
cific to each part of this title, to address allegations of
egregious violations of each such part or the intent of the
provisions of each such part. Such procedures shall include
an appropriate enforcement mechanism.
‘‘SEC. 2622. COORDINATION.
‘‘The Secretary shall ensure that the Health Re-
sources and Services Administration, the Centers for Dis-
ease Control and Prevention, and the Substance Abuse
and Mental Health Services Administration coordinate the
planning and implementation of Federal HIV programs
in order to facilitate the development of a complete contin-
uum of HIV-related services for individuals with HIV dis-
ease and those at risk of such disease. The Secretary shall
periodically prepare and submit to the relevant committees
of Congress a report concerning such coordination efforts
at the Federal, State, and local levels as well as the exist-
ence of Federal barriers to HIV program integration.’’.
(c) EARLY INTERVENTION SERVICES.—
(1) AUTHORIZATION
OF
APPROPRIATIONS.—
Section 2655 (42 U.S.C. 300ff–55) is amended by
striking ‘‘$75,000,000’’ and all that follows through
the end of the section, and inserting ‘‘such sums as
may be necessary in each of the fiscal years 1996,
1997, 1998, 1999, and 2000.’’.
(2) REQUIRED AGREEMENTS.—Section 2664(g)
(42 U.S.C. 300ff–64(g)) is amended—
(A) in paragraph (2), by striking ‘‘and’’ at
the end thereof;
(B) in paragraph (3)—
(i) by striking ‘‘5 percent’’ and insert-
ing ‘‘10 percent including planning, evalua-
tion and technical assistance’’; and
(ii) by striking the period and insert-
ing ‘‘; and’’; and
(C) by adding at the end thereof the fol-
lowing new paragraph:
‘‘(4) the applicant will submit evidence that the
proposed program is consistent with the Statewide
coordinated statement of need and agree to partici-
pate in the ongoing revision of such statement of
need.’’.
(d) GENERAL
PROVISIONS.—Section 2671 (42
U.S.C. 300ff–71) is amended—
(1) by amending the title to read as follows:
‘‘SEC. 2671. GRANTS FOR COORDINATED SERVICES AND AC-
CESS TO RESEARCH FOR CHILDREN, YOUTH,
WOMEN, AND FAMILIES.’’;
(2) in subsection (a)—
(i) by striking ‘‘demonstration’’;
(ii) by striking ‘‘and the Director’’
and inserting ‘‘, in coordination with the
Director’’;
(iii) by striking paragraph (1), and in-
serting the following new paragraph:
‘‘(1) supporting, at the health facilities of such
entities, access to and linkages with clinical research
on therapies for pediatric patients, youth, and
women with HIV disease, and special initiatives re-
lated to clinical research and care findings;’’; and
(iv) by amending paragraph (2) to
read as follows:
‘‘(2) providing and coordinating outpatient
health care services and systems of care, directly or
through contractual arrangements, to children,
youth, and women and their families.’’;
(3) in subsection (c)—
(A) in paragraph (1), to read as follows:
‘‘(1) LINKAGES TO RESEARCH.—The Secretary
may not make a grant to an applicant under sub-
section (a) unless the applicant enters into an agree-
ment with an appropriately qualified entity with ex-
pertise in biomedical or behavioral research to en-
hance voluntary access to research.’’; and
(B) in paragraph (2)—
(i) by inserting after ‘‘through the’’
the following: ‘‘Director of the Adminis-
trator of the Health Resources and Serv-
ices Administration, and in coordination
with the’’;
(ii) in subparagraph (A), by striking
‘‘; and’’ and inserting a semicolon;
(iii) in subparagraph (B), by striking
the period at the end and inserting ‘‘;
and’’; and
(iv) by inserting after subparagraph
(B), the following new subparagraph:
‘‘(C) may provide training and technical
assistance 
including 
peer-based 
assistance
through the Health Resources and Services Ad-
ministration.’’;
(4) in subsections (d), (e), and (f), by striking
‘‘pediatric patient’’ each place such term appears
and inserting ‘‘children and youth’’;
(5) in subsection (f), by inserting before the pe-
riod the following: ‘‘, including coordination and ac-
cess to child welfare services, support services, kin-
ship care services, and other appropriate services for
orphans of the AIDS epidemic.’’;
(6) in subsection (h), to read as follows:
‘‘(h) COORDINATION.—The Secretary may not make
a grant under subsection (c) unless the applicant submits
evidence that the proposed program is consistent with the
Statewide coordinated statement of need and the applicant
agrees to annually participate in the ongoing revision proc-
ess of such statement of need.’’; and
(7) in subsection (j), by striking ‘‘$20,000,000’’
and all that follows through the end of the section,
and inserting ‘‘such sums as may be necessary in
each of the fiscal years 1996, 1997, 1998, 1999, and
2000.’’.
(e) SPECIAL
PROJECTS
OF
NATIONAL
SIGNIFI-
CANCE.—Title XXVI is amended by adding at the end,
the following new part:
‘‘PART F—SPECIAL PROJECTS OF NATIONAL
SIGNIFICANCE
‘‘SEC. 2701. SPECIAL PROJECTS OF NATIONAL SIGNIFI-
CANCE.
‘‘(a) IN GENERAL.—Of the amount appropriated
under each of parts A, B, and C of this title for each fiscal
year, the Secretary shall use the greater of $20,000,000
or 3 percent of such amount appropriated under each such
part, but not to exceed $25,000,000, to administer a spe-
cial projects of national significance program to award di-
rect grants to public and nonprofit private entities includ-
ing community-based organizations to fund special pro-
grams for the care and treatment of individuals with HIV
disease.
‘‘(b) GRANTS.—The Secretary shall award grants
under subsection (a) based on—
‘‘(1) the need to assess the effectiveness of a
particular model for the care and treatment of indi-
viduals with HIV disease;
‘‘(2) the innovative nature of the proposed ac-
tivity; and
‘‘(3) the potential replicability of the proposed
activity in other similar localities or nationally.
‘‘(c) SPECIAL PROJECTS.—Special projects of na-
tional significance may include the development and as-
sessment of innovative service delivery models that are de-
signed to—
‘‘(1) address the needs of special populations;
and
‘‘(2) assist in the development of essential com-
munity-based service delivery infrastructure.
‘‘(d) SPECIAL POPULATIONS.—Special projects of na-
tional significance may include the delivery of HIV health
care and support services to traditionally underserved pop-
ulations including—
‘‘(1) individuals and families with HIV disease
living in rural communities;
‘‘(2) adolescents with HIV disease;
‘‘(3) Indian individuals and families with HIV
disease;
‘‘(4) homeless individuals and families with
HIV disease;
‘‘(5) hemophiliacs with HIV disease; and
‘‘(6) incarcerated individuals with HIV disease.
‘‘(e) SERVICE
DEVELOPMENT
GRANTS.—Special
projects of national significance may include the develop-
ment of model approaches to delivering HIV care and sup-
port services including—
‘‘(1) programs that support family-based care
networks critical to the delivery of care in minority
communities;
‘‘(2) programs that build organizational capac-
ity in disenfranchised communities;
‘‘(3) programs designed to prepare AIDS serv-
ice organizations and grantees under this title for
operation within the changing health care environ-
ment; and
‘‘(4) programs designed to integrate the deliv-
ery of mental health and substance abuse treatment
with HIV services.
‘‘(f) DISTRIBUTION OF FUNDS.—Fifty percent of the
funds made available under this section shall be provided
to geographic areas that are not eligible for funds under
section 2603 except that existing grantees shall continue
to receive funding for the length of the project period.
‘‘(g) COORDINATION.—The Secretary may not make
a grant under this section unless the applicant submits
evidence that the proposed program is consistent with the
Statewide coordinated statement of need, and the appli-
cant agrees to participate in the ongoing revision process
of such statement of need.
‘‘(h) REPLICATION.—The Secretary shall make infor-
mation concerning successful models developed under this
part available to grantees under this title for the purpose
of coordination, replication, and integration. To facilitate
efforts under this subsection, the Secretary may provide
for peer-based technical assistance from grantees funded
under this part.’’.
SEC. 4. EFFECTIVE DATE.
(a) IN GENERAL.—Except as provided in subsection
(b), this Act, and the amendments made by this Act, shall
become effective on October 1, 1995.
(b) ELIGIBLE AREAS.—The amendments made by
subsections (a) and (b)(4)(A) of section 3 become effective
on the date of enactment of this Act.
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HR 5141 IH——3