I
104TH CONGRESS
1ST SESSION
H. R. 1872
To amend the Public Health Service Act to revise and extend programs
established pursuant to the Ryan White Comprehensive AIDS Resources
Emergency Act of 1990.
IN THE HOUSE OF REPRESENTATIVES
JUNE 16, 1995
Mr. BILIRAKIS (for himself, Mr. WAXMAN, Mr. BLILEY, Mr. DINGELL, Mr.
HASTERT, Mr. WYDEN, Mr. UPTON, Mr. MANTON, Mr. KLUG, Mr.
TOWNS, Mr. GREENWOOD, Mr. STUDDS, Mr. BILBRAY, Mr. BROWN of
Ohio, Mr. GANSKE, Ms. FURSE, Mr. MOORHEAD, Mr. DEUTSCH, Mr.
RUSH, Ms. ESHOO, Mr. STUPAK, Mr. GUNDERSON, and Ms. PELOSI) in-
troduced the following bill; which was referred to the Committee on
Commerce
A BILL
To amend the Public Health Service Act to revise and extend
programs established pursuant to the Ryan White Com-
prehensive AIDS Resources Emergency Act of 1990.
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
Act Amendments of 1995’’.
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 that sec-
tion or other provision of the Public Health Service Act
(42 U.S.C. 201 et seq.).
TITLE 
I—EMERGENCY 
RELIEF
FOR AREAS WITH SUBSTAN-
TIAL NEED FOR SERVICES
SEC. 101. ESTABLISHMENT OF PROGRAM OF GRANTS; DE-
LAYED EFFECTIVE DATE FOR MODIFICA-
TIONS.
(a) IN GENERAL.—Effective October 1, 1996, section
2601 (42 U.S.C. 300ff–11) is amended—
(1) in subsection (a)—
(A) by striking ‘‘subject to subsection (b)’’
and inserting ‘‘subject to subsections (b)
through (d)’’; and
(B) by striking ‘‘metropolitan area’’ and
all that follows and inserting the following:
‘‘metropolitan area for which there has been re-
ported to the Director of the Centers for Dis-
ease Control and Prevention a cumulative total
of more than 2,000 cases of acquired immune
deficiency syndrome for the most recent period
of five calendar years for which such data are
available.’’; and
(2) by adding at the end thereof the following
subsections:
‘‘(c) REQUIREMENT REGARDING POPULATION.—In
the case of a metropolitan area that was not an eligible
area under this part for fiscal year 1996, the Secretary
may not make a grant under this section for the area un-
less the area has a population of 500,000 or more individ-
uals. For purposes of eligibility under this part, the bound-
aries of each metropolitan area are the boundaries in ef-
fect for fiscal year 1994.
‘‘(d) CONTINUED STATUS AS ELIGIBLE AREA.—A
metropolitan area that was an eligible area under this part
for fiscal year 1996 is an eligible area for fiscal year 1997
and each subsequent fiscal year.’’.
(b) CONFORMING AMENDMENT REGARDING DEFINI-
TION OF ELIGIBLE AREA.—Effective October 1, 1996,
section 2607(1) (42 U.S.C. 300ff–17(1)) is amended by
striking ‘‘The term’’ and all that follows and inserting the
following: ‘‘The term ‘eligible area’ means a metropolitan
area meeting the requirements of section 2601 that are
applicable to the area.’’.
SEC. 102. HIV HEALTH SERVICES PLANNING COUNCIL.
(a) 
ESTABLISHMENT.—Section 
2602(b)(1) 
(42
U.S.C. 300ff–12(b)(13)) is amended—
(1) in subparagraph (A), by inserting before the
semicolon the following: ‘‘, including federally quali-
fied health centers’’;
(2) in subparagraph (D), by inserting before
the semicolon the following: ‘‘and providers of serv-
ices regarding substance abuse’’;
(3) in subparagraph (G), by inserting before the
semicolon the following: ‘‘and historically under-
served groups and subpopulations’’;
(4) in subparagraph (I), by inserting before the
semicolon the following: ‘‘, including the State med-
icaid agency and the agency administering the pro-
gram under part B’’;
(5) in subparagraph (J), by striking ‘‘and’’
after the semicolon;
(6) by striking subparagraph (K); and
(7) by adding at the end the following subpara-
graphs:
‘‘(K) grantees under section 2671, or, if
none are operating in the area, representatives
of organizations in the area with a history of
serving children, youth, women, and families
living with HIV; and
‘‘(L) grantees under other HIV-related
Federal programs.’’.
(b) DUTIES.—Section 2602(b)(3) (42 U.S.C. 300ff–
12(b)(3)) is amended—
(1) by striking ‘‘The planning’’ in the matter
preceding subparagraph (A) and all that follows
through the semicolon at the end of subparagraph
(A) and inserting the following: ‘‘The planning coun-
cil under paragraph (1) shall carry out the following:
‘‘(A) Establish priorities for the allocation
of funds within the eligible area based on the
following factors:
‘‘(i) Documented needs of the HIV-in-
fected population.
‘‘(ii) Cost and outcome effectiveness
of proposed strategies and interventions, to
the extent that such data are reasonably
available.
‘‘(iii) Priorities of the HIV-infected
communities for whom the services are in-
tended.
‘‘(iv) Availability of other govern-
mental and nongovernmental resources.’’;
(2) in subparagraph (B)—
(A) by striking ‘‘develop’’ and inserting
‘‘Develop’’; and
(B) by striking ‘‘; and’’ and inserting a pe-
riod;
(3) in subparagraph (C)—
(A) by striking ‘‘assess’’ and inserting
‘‘Assess’’;
(B) by striking ‘‘rapidly’’; and
(C) by inserting before the period the fol-
lowing: ‘‘, and assess the effectiveness, either
directly or through contractual arrangements,
of the services offered in meeting the identified
needs’’; and
(4) by adding at the end the following subpara-
graphs:
‘‘(D) Participate in the development of the
statewide coordinated statement of need initi-
ated by the State health department.
‘‘(E) Obtain input on community needs
through conducting public meetings.’’
(c) GENERAL PROVISIONS.—Section 2602(b) (42
U.S.C. 300ff–12(b)) is amended by adding at the end the
following paragraph:
‘‘(4) GENERAL PROVISIONS.—
‘‘(A) COMPOSITION
OF
COUNCIL.—The
planning council under paragraph (1) shall (in
addition to requirements under such paragraph)
reflect in its composition the demographics of
the epidemic in the eligible area involved, with
particular consideration given to disproportion-
ately affected and historically underserved
groups and subpopulations. Nominations for
membership on the council shall be identified
through an open process, and candidates shall
be selected based on locally delineated and pub-
licized criteria. Such criteria shall include a
conflict-of-interest standard for each nominee.
‘‘(B) CERTAIN RESTRICTIONS.—The plan-
ning council under paragraph (1) may not be
directly involved in the administration of a
grant under section 2601(a). With respect to
compliance with the preceding sentence, the
planning council may not designate (or other-
wise be involved in the selection of) particular
entities as recipients of any of the amounts pro-
vided in the grant.’’.
SEC. 103. TYPE AND DISTRIBUTION OF GRANTS.
(a) FORMULA GRANTS BASED ON RELATIVE NEED
OF AREAS.—Section 2603(a) (42 U.S.C. 300ff–13(a)) is
amended—
(1) in paragraph (1)—
(A) in the second sentence, by inserting ‘‘,
subject to paragraph (4)’’ before the period;
and
(B) by adding at the end the following sen-
tence: ‘‘Grants under this paragraph for a fiscal
year shall be disbursed not later than 60 days
after the date on which amounts appropriated
under section 2677 become available for the fis-
cal year, subject to any waivers under section
2605(d).’’;
(2) in paragraph (2), by amending the para-
graph to read as follows:
‘‘(2) ALLOCATIONS.—Of the amount available
under section 2677 for a fiscal year for making
grants under section 2601(a)—
‘‘(A) the Secretary shall reserve 50 percent
for making grants under paragraph (1) in
amounts determined in accordance with para-
graph (3); and
‘‘(B) the Secretary shall, after compliance
with subparagraph (A), reserve such funds as
may be necessary to carry out paragraph (4).’’;
and
(3) by adding at the end the following para-
graph:
‘‘(4) MAXIMUM REDUCTION IN GRANT.—In the
case of any eligible area for which a grant under
paragraph (1) was made for fiscal year 1995, the
Secretary, in making grants under such paragraph
for the area for the fiscal years 1996 through 2000,
shall (subject to the extent of the amount available
under section 2677 for the fiscal year involved for
making grants under section 2601(a)) ensure that
the amounts of the grants do not, relative to such
grant for the area for fiscal year 1995, constitute a
reduction of more than the following, as applicable
to the fiscal year involved:
‘‘(A) 1 percent, in the case of fiscal year
1996.
‘‘(B) 2 percent, in the case of fiscal year
1997.
‘‘(C) 3 percent, in the case of fiscal year
1998.
‘‘(D) 4 percent, in the case of fiscal year
1999.
‘‘(E) 5 percent, in the case of fiscal year
2000.’’.
(b) SUPPLEMENTAL GRANTS.—Section 2603(b) (42
U.S.C. 300ff–13(b)) is amended—
(1) in paragraph (1)—
(A) in the matter preceding subparagraph
(A), by striking ‘‘Not later than’’ and all that
follows through ‘‘section 2605(b)—’’ and insert-
ing the following: ‘‘After allocating in accord-
ance with subsection (a) the amounts available
under section 2677 for grants under section
2601(a) for a fiscal year, the Secretary, in car-
rying out section 2601(a), shall from the re-
maining amounts make grants to eligible areas
described in this paragraph. Such grants shall
be disbursed not later than 150 days after the
date on which amounts appropriated under sec-
tion 2677 become available for the fiscal year.
An eligible area described in this paragraph is
an eligible area whose application under section
2605(b)—’’;
(B) in subparagraph (D), by striking
‘‘and’’ after the semicolon;
(C) in subparagraph (E), by striking the
period at the end and inserting ‘‘; and’’; and
(D) by adding at the end thereof the fol-
lowing subparagraph:
‘‘(F) demonstrates the manner in which
the proposed services are consistent with the
local needs assessment and the statewide co-
ordinated statement of need.’’; and
(2)(A) by redesignating paragraphs (2) through
(4) as paragraphs (3) through (5), respectively; and
(B) by inserting after paragraph (1) the follow-
ing paragraph:
‘‘(2) PRIORITY.—
‘‘(A) SEVERE NEED.—In determining se-
vere need in accordance with paragraph (1)(B),
the Secretary shall give priority consideration in
awarding grants under this subsection to eligi-
ble areas that (in addition to complying with
paragraph (1)) demonstrate a more severe need
based on the prevalence in the eligible area of—
‘‘(i) sexually transmitted diseases,
substance abuse, tuberculosis, severe men-
tal illness, or other conditions determined
relevant by the Secretary, which signifi-
cantly affect the impact of HIV disease;
‘‘(ii) subpopulations with HIV disease
that were previously unknown in such area;
or
‘‘(iii) homelessness.
‘‘(B) PREVALENCE.—In determining prev-
alence of conditions under subparagraph (A),
the Secretary shall use data on the prevalence
of the conditions described in such subpara-
graph among individuals with HIV disease (ex-
cept that, in the case of an eligible area for
which such data are not available, the Secretary
shall use data on the prevalences of the condi-
tions in the general population of such area).’’.
(c) ADDITIONAL REQUIREMENTS
FOR GRANTS.—
Section 2603 (42 U.S.C. 300ff–13) is amended by adding
at the end the following subsection:
‘‘(c) COMPLIANCE WITH PRIORITIES OF HIV PLAN-
NING COUNCIL.—Notwithstanding any other provision of
this part, the Secretary, in carrying out section 2601(a),
may not make any grant under subsection (a) or (b) to
an eligible area unless the application submitted by such
area under section 2605 for the grant involved dem-
onstrates that the grants made under subsections (a) and
(b) to the area for the preceding fiscal year (if any) were
expended in accordance with the priorities applicable to
such year that were established, pursuant to section
2602(b)(3)(A), by the planning council serving the area.’’.
SEC. 104. USE OF AMOUNTS.
Section 2604 (42 U.S.C. 300ff–14) is amended—
(1) in subsection (b)—
(A) in paragraph (1)(A), by striking ‘‘in-
cluding case management and comprehensive
treatment services, for individuals’’ and insert-
ing the following: ‘‘including HIV-related com-
prehensive treatment services (including treat-
ment education and measures for the preven-
tion and treatment of opportunistic infections),
case management, and substance abuse treat-
ment and mental health treatment, for individ-
uals’’;
(B) in paragraph (2)(A)—
(i) by inserting after ‘‘nonprofit pri-
vate entities,’’ the following: ‘‘, or private
for-profit entities if such entities are the
only available provider of quality HIV care
in the area,’’ ; and
(ii) by striking ‘‘and homeless health
centers’’ and inserting ‘‘homeless health
centers, substance abuse treatment pro-
grams, and mental health programs’’; and
(C) by adding at the end the following
paragraph:
‘‘(3) PRIORITY
FOR
WOMEN, INFANTS
AND
CHILDREN.—For the purpose of providing health
and support services to infants, children, and women
with HIV disease, the chief elected official of an eli-
gible area shall use, of the grants made for the area
under section 2601(a) for a fiscal year, not less than
the percentage constituted by the ratio of the popu-
lation in such area of infants, children, and women
with HIV disease to the general population in such
area of individuals with such disease, or 15 percent,
whichever is less. In expending the funds reserved
under the preceding sentence for a fiscal year, the
chief elected official shall give priority to providing,
for pregnant women, measures to prevent the
perinatal transmission of HIV.’’; and
(2) in subsection (e), by adding at the end
thereof the following sentence: ‘‘In the case of enti-
ties to which such officer allocates amounts received
by the officer under the grant, the officer shall en-
sure that, of the aggregate amount so allocated, the
total of the expenditures by such entities for admin-
istrative expenses does not exceed 10 percent (with-
out regard to whether particular entities expend
more than 10 percent for such expenses).’’.
SEC. 105. APPLICATION.
Section 2605 (42 U.S.C. 300ff–15) is amended—
(1) in subsection (a)—
(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 paragraph:
‘‘(6) that the applicant will participate in the
process for the statewide coordinated statement of
need (where it has been initiated by the State), and
will ensure that the services provided under the com-
prehensive plan are consistent with such state-
ment.’’;
(2) in subsection (b)—
(A) in the subsection heading, by striking
‘‘ADDITIONAL’’; and
(B) in the matter preceding paragraph (1),
by striking ‘‘additional’’;
(3) by redesignating subsections (c) and (d) as
subsections (d) and (e), respectively; and
(4) by inserting after subsection (b), the follow-
ing subsection:
‘‘(c) SINGLE APPLICATION.—Upon the request of the
chief elected official of an eligible area, the Secretary shall
authorize the official to submit a single application
through which the official simultaneously requests a grant
pursuant to subsection (a) of section 2603 and a grant
pursuant to subsection (b) of such section. The Secretary
may establish such criteria for carrying out this subsection
as the Secretary determines to be appropriate.’’.
SEC. 106. TECHNICAL ASSISTANCE; PLANNING GRANTS.
Section 2606 (42 U.S.C. 300ff–16) is amended—
(1) by inserting before ‘‘The Administrator’’ the
following: ‘‘(a) IN GENERAL.—’’;
(2) by striking ‘‘may, beginning’’ and all that
follows through ‘‘title,’’ and inserting ‘‘(referred to
in this section as the ‘Administrator’) shall’’; and
(3) by adding at the end the following sub-
section:
‘‘(b) PLANNING GRANTS REGARDING INITIAL ELIGI-
BILITY FOR GRANTS.—
‘‘(1) ADVANCE PAYMENTS ON FIRST-YEAR FOR-
MULA GRANTS.—With respect to a fiscal year (re-
ferred to in this subsection as the ‘planning year’),
if a metropolitan area has not previously received a
grant under section 2601 and the Administrator rea-
sonably projects that the area will be eligible for
such a grant for the subsequent fiscal year, the Ad-
ministrator may make a grant for the planning year
for the purpose of assisting the area in preparing for
the responsibilities of the area in carrying out activi-
ties under this part.
‘‘(2) REQUIREMENTS.—
‘‘(A) IN GENERAL.—A grant under para-
graph (1) for a planning year shall be made di-
rectly to the chief elected official of the city or
urban county that administers the public health
agency to which section 2602(a)(1) is projected
to apply for purposes of such paragraph. The
grant may not be made in an amount exceeding
$75,000.
‘‘(B) OFFSETTING
REDUCTION
IN
FIRST
FORMULA GRANT.—In the case of a metropoli-
tan area that has received a grant under para-
graph (1) for a planning year, the first grant
made pursuant to section 2603(a) for such area
shall be reduced by an amount equal to the
amount of the grant under such paragraph for
the planning year. With respect to amounts re-
sulting from reductions under the preceding
sentence for a fiscal year, the Secretary shall
use such amounts to make grants under section
2603(a) for the fiscal year, subject to ensuring
that none of such amounts are provided to any
metropolitan area for which such a reduction
was made for the fiscal year.
‘‘(3) FUNDING.—Of the amounts available
under section 2677 for a fiscal year for carrying out
this part, the Administrator may reserve not more
than 1 percent for making grants under paragraph
(1).’’.
TITLE II—CARE GRANT
PROGRAM
SEC. 201. GENERAL USE OF GRANTS.
Section 2612 (42 U.S.C. 300ff–22) is amended to
read as follows:
‘‘SEC. 2612. GENERAL USE OF GRANTS.
(a) IN GENERAL.—A State may use amounts pro-
vided under grants made under this part for the following:
‘‘(1) To provide the services described in section
2604(b)(1) for individuals with HIV disease.
‘‘(2) To provide to such individuals treatments
that in accordance with section 2616 have been de-
termined to prolong life or prevent serious deteriora-
tion of health.
‘‘(3) To provide home- and community-based
care services for such individuals in accordance with
section 2614.
‘‘(4) To provide assistance to assure the con-
tinuity of health insurance coverage for such individ-
uals in accordance with section 2615.
‘‘(5) To establish and operate consortia under
section 2613 within areas most affected by HIV dis-
ease, which consortia shall be designed to provide a
comprehensive continuum of care to individuals and
families with such disease in accordance with such
section.
‘‘(b) PRIORITY FOR WOMEN, INFANTS AND CHIL-
DREN.—For the purpose of providing health and support
services to infants, children, and women with HIV disease,
a State shall use, of the funds allocated under this part
to the State for a fiscal year, not less than the percentage
constituted by the ratio of the population in the State of
infants, children, and women with HIV disease to the gen-
eral population in the State of individuals with such dis-
ease, or 15 percent, whichever is less. In expending the
funds reserved under the preceding sentence for a fiscal
year, the State shall give priority to providing, for preg-
nant women, measures to prevent the perinatal trans-
mission of HIV.’’.
SEC. 202. GRANTS TO ESTABLISH HIV CARE CONSORTIA.
Section 2613 (42 U.S.C. 300ff–23) is amended—
(1) in subsection (a)—
(A) in paragraph (1), by inserting ‘‘(or pri-
vate for-profit providers or organizations if such
entities are the only available providers of qual-
ity HIV care in the area)’’ after ‘‘nonprofit pri-
vate,’’; and
(B) in paragraph (2)(A)—
(i) by inserting ‘‘substance abuse
treatment, mental health treatment,’’ after
‘‘nursing,’’; and
(ii) by inserting after ‘‘monitoring,’’
the following: ‘‘measures for the prevention
and treatment of opportunistic infections,
treatment education for patients (provided
in the context of health care delivery),’’ ;
and
(2) in subsection (c)(2)—
(A) in clause (ii) of subparagraph (A), by
striking ‘‘and’’ after the semicolon;
(B) in subparagraph (B), by striking the
period at the end and inserting ‘‘; and’’; and
(C) by adding after subparagraph (B) the
following subparagraph:
‘‘(C) grantees under section 2671, or, if
none are operating in the area, representatives
in the area of organizations with a history of
serving children, youth, women, and families
living with HIV.’’.
SEC. 203. PROVISION OF TREATMENTS.
Section 
2616(a) 
(42 
U.S.C. 
300ff–26(a)) 
is
amended—
(1) by striking ‘‘may use amounts’’ and insert-
ing ‘‘shall use a portion of the amounts’’;
(2) by striking ‘‘section 2612(a)(4)’’ and insert-
ing ‘‘section 2612(a)(2)’’; and
(3) by inserting before the period the following:
‘‘, including measures for the prevention and treat-
ment of opportunistic infections’’.
SEC. 204. STATE APPLICATION.
Section 2617(b)(2) (42 U.S.C. 300ff–27(b)(2)) is
amended—
(1) in subparagraph (A), by striking ‘‘and’’
after the semicolon; and
(2) in subparagraph (B), by striking ‘‘and’’
after the semicolon; and
(3) by adding at the end thereof the following
subparagraphs:
‘‘(C) a description of the activities carried
out by the State under section 2616; and
‘‘(D) a description of how the allocation
and utilization of resources are consistent with
a statewide coordinated statement of need, de-
veloped in partnership with other grantees in
the State that receive funding under this title
and after consultation with individuals receiving
services under this part.’’.
SEC. 205. ALLOCATION OF ASSISTANCE BY STATES; PLAN-
NING, EVALUATION, AND ADMINISTRATION.
Section 
2618(c) 
(42 
U.S.C. 
300ff–28(c)) 
is
amended—
(1) by striking paragraph (1);
(2) by redesignating paragraphs (2) through
(5) as paragraphs (1) through (4), respectively; and
(3) in paragraph (3) (as so redesignated), by
adding at the end the following sentences: ‘‘In the
case of entities to which the State allocates amounts
received by the State under the grant (including con-
sortia under section 2613), the State shall ensure
that, of the aggregate amount so allocated, the total
of the expenditures by such entities for administra-
tive expenses does not exceed 10 percent (without
regard to whether particular entities expend more
than 10 percent for such expenses). For purposes of
the preceding sentence, the costs of establishing and
operating consortia under section 2613 shall be con-
sidered administrative expenses.’’.
SEC. 206. TECHNICAL ASSISTANCE.
Section 2619 (42 U.S.C. 300ff–29) is amended by
inserting before the period the following: ‘‘, including tech-
nical assistance for the development and implementation
of statewide coordinated statements of need’’.
TITLE III—EARLY
INTERVENTION SERVICES
SEC. 301. ESTABLISHMENT OF PROGRAM.
Section 
2651(b) 
(42 
U.S.C. 
300ff–51(b)) 
is
amended—
(1) in paragraph (1), by inserting before the pe-
riod the following: ‘‘, and unless the applicant agrees
to expend not less than 50 percent of the grant for
such services that are specified in subparagraphs
(B) through (E) of such paragraph’’; and
(2) in paragraph (4), by inserting after ‘‘non-
profit private entities’’ the following: ‘‘(or private
entities that provide HIV primary care services in
rural or underserved communities.
‘‘(4) LIMITATION.—Not to exceed 1 percent of
the amount appropriated for a fiscal year under sec-
tion 2655 may be used to carry out this section.’’.
SEC. 304. ADDITIONAL REQUIRED AGREEMENTS.
Section 2664(a)(1) (42 U.S.C. 300ff–64(a)(1)) is
amended—
(1) in subparagraph (A), by striking ‘‘and’’
after the semicolon;
(2) in subparagraph (B), by striking the period
at the end and inserting ‘‘; and’’; and
(3) by adding at the end the following subpara-
graph:
‘‘(C) evidence that the proposed program is
consistent with the statewide coordinated state-
ment of need and that the applicant will partici-
pate in the ongoing revision of such statement
of need.’’.
SEC. 305. AUTHORIZATION OF APPROPRIATIONS.
Section 2655 (42 U.S.C. 300ff–55) is amended by
striking ‘‘$75,000,000’’ and all that follows and inserting
‘‘such sums as may be necessary for each of the fiscal
years 1996 through 2000.’’.
TITLE IV—GENERAL
PROVISIONS
SEC. 401. GRANTS REGARDING CLINICAL RESEARCH AND
WOMEN, INFANTS, AND CHILDREN.
(a) IN GENERAL.—Section 2671 (42 U.S.C. 300ff–
71) is amended—
(1) in subsection (a), by amending the sub-
section to read as follows:
‘‘(a) IN GENERAL.—
‘‘(1) PROGRAM
OF
GRANTS.—The Secretary,
acting through the Administrator of the Health Re-
sources and Services Administration and in consulta-
tion with the Director of the National Institutes of
Health, shall make grants to public and nonprofit
private entities that provide primary care (directly or
through contracts) for the purpose of—
‘‘(A) providing through such entities, in
accordance with this section, opportunities for
women, infants, and children to participate as
subjects in research of potential clinical benefit
to individuals with HIV disease; and
‘‘(B) providing to women, infants, and chil-
dren health care on an outpatient basis.
‘‘(2) PROVISIONS
REGARDING
PARTICIPATION
IN RESEARCH.—With respect to the projects of re-
search with which an applicant under paragraph (1)
is concerned, the Secretary may not make a grant
under such paragraph to the applicant unless the
following conditions are met:
‘‘(A) The applicant agrees to make reason-
able efforts—
‘‘(i) to identify the needs of the
projects for women, infants, and children
to participate as subjects in the projects;
‘‘(ii) to identify which of the patients
of the applicant are women, infants, and
children who would be appropriate subjects
in the projects; and
‘‘(iii) to offer women, infants, and
children the opportunity to so participate
(as appropriate), including the provision of
services under subsection (f).
‘‘(B) The applicant agrees that the appli-
cant, and the projects of research, will comply
with accepted standards of protection for
human subjects (including the provision of writ-
ten informed consent) who participate as sub-
jects in clinical research.
‘‘(C) For the second or subsequent fiscal
year for which a grant under such paragraph is
sought by the applicant, the Secretary has de-
termined that—
‘‘(i) a significant number of women,
infants, and children who are patients of
the applicant are participating in the
projects (except to the extent this clause is
waived under subsection (k)); and
‘‘(ii) the applicant, and the projects of
research, have complied with the standards
referred to in subparagraph (B).
‘‘(3) PROHIBITION.—Receipt of services by a
patient shall not be conditioned upon the consent of
the patient to participate in research.
‘‘(4) CONSIDERATION BY SECRETARY OF CER-
TAIN
CIRCUMSTANCES.—In administering the re-
quirement of paragraph (2)(C)(i), the Secretary
shall take into account circumstances in which a
grantee under paragraph (1) is temporarily unable
to comply with the requirement for reasons beyond
the control of the grantee, and shall in such cir-
cumstances provide to the grantee a reasonable pe-
riod of opportunity in which to reestablish compli-
ance with the requirement.’’;
(2) in subsection (c), by amending the sub-
section to read as follows:
‘‘(c) PROVISIONS REGARDING CONDUCT
OF RE-
SEARCH.—With respect to eligibility for a grant under
subsection (a):
‘‘(1) A project of research for which subjects
are sought pursuant to such subsection may be con-
ducted by the applicant for the grant, or by an en-
tity with which the applicant has made arrange-
ments for purposes of the grant. The grant may not
be expended for the conduct of any project of re-
search.
‘‘(2) The grant may not be made unless the
Secretary makes the following determinations:
‘‘(A) The applicant or other entity (as the
case may be under paragraph (1)) is appro-
priately qualified to conduct the project of re-
search.
‘‘(B) The project of research is being con-
ducted in accordance with a research protocol
to which the Secretary gives priority regarding
the prevention and treatment of HIV disease in
women, infants, and children. After consulta-
tion with public and private entities that con-
duct such research, and with providers of serv-
ices under this section and recipients of such
services, the Secretary shall establish a list of
such protocols that are appropriate for purposes
of this section. The Secretary may give priority
under this subparagraph to a research protocol
that is not on such list.’’;
(3) by striking subsection (i);
(4) by redesignating subsections (g) and (h) as
subsections (h) and (i), respectively;
(5) by inserting after subsection (f) the follow-
ing subsection:
‘‘(g) ADDITIONAL PROVISIONS.—The Secretary may
not make a grant under subsection (a) unless the appli-
cant for the grant agrees as follows:
‘‘(1) The applicant will coordinate activities
under the grant with other providers of health care
services under this Act, and under title V of the So-
cial Security Act.
‘‘(2) The applicant will participate in the state-
wide coordinated statement of need under part B
and in revisions of such statement.’’;
(6) by redesignating subsection (j) as sub-
section (m); and
(7) by inserting before subsection (m) (as so re-
designated) the following subsections:
‘‘(j) COORDINATION WITH NATIONAL INSTITUTES OF
HEALTH.—The Secretary shall develop and implement a
‘‘(l) TRAINING
AND TECHNICAL ASSISTANCE.—Of
the amounts appropriated under subsection (m) for a fis-
cal year, the Secretary may use not more than five percent
to provide training and technical assistance to assist appli-
cants and grantees under subsection (a) in complying with
the requirements of this section.’’.
(b) CONFORMING AMENDMENTS.—Section 2671 (42
U.S.C. 300ff–71) is amended—
(1) in the heading for the section, by striking
‘‘DEMONSTRATION’’ and all that follows and in-
serting ‘‘GRANTS
REGARDING
CLINICAL
RE-
SEARCH
AND
WOMEN, INFANTS, AND
CHIL-
DREN.’’;
(2) in subsection (b), by striking ‘‘pediatric pa-
tients and pregnant women’’ and inserting ‘‘women,
infants, and children’’; and
(3) in each of subsections (d) through (f), by
striking ‘‘pediatric’’.
(c) AUTHORIZATION OF APPROPRIATIONS.—Section
2671 (42 U.S.C. 300ff–71) is amended in subsection (m)
(as redesignated by subsection (a)(6)) by striking ‘‘there
are’’ and all that follows and inserting the following:
‘‘there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1996 through
2000.’’.
SEC. 402. PROJECTS OF NATIONAL SIGNIFICANCE.
(a) IN GENERAL.—Part D of title XXVI (42 U.S.C.
300ff–71 et seq.) is amended by inserting after section
2673 the following section:
‘‘SEC. 2673A. DEMONSTRATION PROJECTS OF NATIONAL
SIGNIFICANCE.
‘‘(a) IN GENERAL.—The Secretary shall make grants
to public and nonprofit private entities (including non-
profit private community-based organizations) for the pur-
pose of carrying out demonstration projects that provide
for the care and treatment of individuals with HIV dis-
ease, and that—
‘‘(1) assess the effectiveness of particular mod-
els for the care and treatment of individuals with
such disease;
‘‘(2) are of an innovative nature; and
‘‘(3) have the potential to be replicated in simi-
lar localities, or nationally.
‘‘(b) CERTAIN PROJECTS.—Demonstration projects
under subsection (a) shall include the development and as-
sessment of innovative models for the delivery of HIV
services that are designed—
‘‘(1) to address the needs of special populations
(including individuals and families with HIV disease
living in rural communities, adolescents with HIV
disease, Native American individuals and families
with HIV disease, homeless individuals and families
with HIV disease, hemophiliacs with HIV disease,
and incarcerated individuals with HIV disease); and
‘‘(2) to ensure the ongoing availability of serv-
ices for Native American communities to enable such
communities to care for Native Americans with HIV
disease.
‘‘(c) COORDINATION.—The Secretary may not make
a grant under this section unless the applicant submits
evidence that the proposed program is consistent with the
applicable statewide coordinated statement of need under
part B, and the applicant agrees to participate in the on-
going revision process of such statement of need.
‘‘(d) REPLICATION.—The Secretary shall make infor-
mation concerning successful models developed under this
section available to grantees under this title for the pur-
pose of coordination, replication, and integration.
‘‘(e) FUNDING; ALLOCATION OF AMOUNTS.—
‘‘(1) IN GENERAL.—Of the amounts available
under this title for a fiscal year for each program
specified in paragraph (2), the Secretary shall re-
serve 3 percent for making grants under subsection
(a).
‘‘(2) RELEVANT PROGRAMS.—The programs re-
ferred to in subsection (a) are the program under
part A, the program under part B, the program
under part C, the program under section 2671, the
program under section 2672, and the program under
section 2673.’’.
(b) STRIKING
OF RELATED PROVISION.—Section
2618 (42 U.S.C. 300ff–28) is amended striking subsection
(a).
SEC. 403. SPECIAL TRAINING PROJECTS.
(a) TRANSFER OF PROGRAM.—The Public Health
Service Act (42 U.S.C. 201 et seq.) is amended—
(1) by transferring section 776 from the cur-
rent placement of the section;
(2) by redesignating the section as section
2673B; and
(3) by inserting the section after section 2673A
(as added by section 402).
(b) MODIFICATIONS.—Section 2673B (as transferred
and redesignated by subsection (a)) is amended—
(1) in subsection (a)(1)—
(A) by striking subparagraphs (B) and
(C);
(B) by redesignating subparagraphs (A)
and (D) as subparagraphs (B) and (C), respec-
tively;
(C) by inserting before subparagraph (B)
(as so redesignated) the following subpara-
graph:
‘‘(A) training health personnel, including
practitioners in programs under this title and
other community providers, in the diagnosis,
treatment, and prevention of HIV disease, in-
cluding the prevention of the perinatal trans-
mission of the disease and including measures
for the prevention and treatment of opportun-
istic infections;’’;
(D) in subparagraph (B) (as so redesig-
nated), by adding ‘‘and’’ after the semicolon;
and
(E) in subparagraph (C) (as so redesig-
nated), by striking ‘‘curricula and’’;
(2) by striking subsection (c) and redesignating
subsection (d) as subsection (c); and
(3) in subsection (c) (as so redesignated), by
amending the subsection to read as follows:
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there are authorized
to be appropriated such sums as may be necessary for
each of the fiscal years 1996 through 2000.’’.
concerning coordination efforts under this title at the Fed-
eral, State, and local levels, including a statement of
whether and to what extent there exist Federal barriers
to integrating HIV-related programs.’’.
TITLE V—ADDITIONAL
PROVISIONS
SEC. 501. AMOUNT OF EMERGENCY RELIEF GRANTS.
Paragraph (3) of section 2603(a) (42 U.S.C. 300ff–
13(a)(3)) is amended to read as follows:
‘‘(3) AMOUNT OF GRANT.—
‘‘(A) IN GENERAL.—Subject to the extent
of amounts made available in appropriations
Acts, a grant made for purposes of this para-
graph to an eligible area shall be made in an
amount equal to the product of—
‘‘(i) an amount equal to the amount
available for distribution under paragraph
(2) for the fiscal year involved; and
‘‘(ii) the percentage constituted by the
ratio of the distribution factor for the eligi-
ble area to the sum of the respective dis-
tribution factors for all eligible areas.
‘‘(B) DISTRIBUTION
FACTOR.—For pur-
poses of subparagraph (A)(ii), the term ‘dis-
tribution factor’ means the product of—
‘‘(i) an amount equal to the estimated
number of living cases of acquired immune
deficiency syndrome in the eligible area in-
volved, as determined under subparagraph
(C); and
‘‘(ii) the cost index for the eligible
area involved, as determined under sub-
paragraph (D).
‘‘(C) ESTIMATE
OF
LIVING
CASES.—The
amount determined in this subparagraph is an
amount equal to the product of—
‘‘(i) the number of cases of acquired
immune deficiency syndrome in the eligible
area during each year in the most recent
120-month period for which data are avail-
able with respect to all eligible areas, as in-
dicated by the number of such cases re-
ported to and confirmed by the Director of
the Centers for Disease Control and Pre-
vention for each year during such period;
and
‘‘(ii) with respect to—
‘‘(I) the first year during such
period, .06;
‘‘(II) the second year during such
period, .06;
‘‘(III) the third year during such
period, .08;
‘‘(IV) the fourth year during
such period, .10;
‘‘(V) the fifth year during such
period, .16;
‘‘(VI) the sixth year during such
period, .16;
‘‘(VII) the seventh year during
such period, .24;
‘‘(VIII) the eighth year during
such period, .40;
‘‘(IX) the ninth year during such
period, .57; and
‘‘(X) the tenth year during such
period, .88.
‘‘(D) COST
INDEX.—The amount deter-
mined in this subparagraph is an amount equal
to the sum of—
‘‘(i) the product of—
‘‘(I) the average hospital wage
index reported by hospitals in the eli-
gible area involved under section
1886(d)(3)(E) of the Social Security
Act for the 3-year period immediately
preceding the year for which the grant
is being awarded; and
‘‘(II) .70; and
‘‘(ii) .30.
‘‘(E) UNEXPENDED
FUNDS.—The Sec-
retary may, in determining the amount of a
grant for a fiscal year under this paragraph,
adjust the grant amount to reflect the amount
of unexpended and uncanceled grant funds re-
maining at the end of the fiscal year preceding
the year for which the grant determination is to
be made. The amount of any such unexpended
funds shall be determined using the financial
status report of the grantee.
‘‘(F) PUERTO
RICO, 
VIRGIN
ISLANDS,
GUAM.—For purposes of subparagraph (D), the
cost index for an eligible area within Puerto
Rico, the Virgin Islands, or Guam shall be
1.0.’’.
SEC. 502. AMOUNT OF CARE GRANTS.
Section 2618 (42 U.S.C. 300ff–28), as amended by
section 402(b), is amended by striking subsection (b) and
inserting the following subsections:
‘‘(a) AMOUNT OF GRANT.—
‘‘(1) IN GENERAL.—Subject to subsection (b)
(relating to minimum grants), the amount of a grant
under this part for a State for a fiscal year shall be
the sum of—
‘‘(A) the amount determined for the State
under paragraph (2); and
‘‘(B) the amount determined for the State
under paragraph (4) (if applicable).
‘‘(2) PRINCIPAL FORMULA GRANTS.—For pur-
poses of paragraph (1)(A), the amount determined
under this paragraph for a State for a fiscal year
shall be the product of—
‘‘(A) the amount available under section
2677 for carrying out this part, less the res-
ervation of funds made in paragraph (4)(A) and
less any other applicable reservation of funds
authorized or required in this title (which
amount is subject to subsection (b)); and
‘‘(B) the percentage constituted by the
ratio of—
‘‘(i) the distribution factor for the
State; to
‘‘(ii) the sum of the distribution fac-
tors for all States.
‘‘(3) DISTRIBUTION
FACTOR
FOR
PRINCIPAL
FORMULA
GRANTS.—For purposes of paragraph
(2)(B), the term ‘‘distribution factor’’ means the fol-
lowing, as applicable:
‘‘(A) In the case of each of the 50 States,
the product of—
‘‘(i) the number of cases of acquired
immune deficiency syndrome in the State,
as indicated by the number of cases re-
ported to and confirmed by the Secretary
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 the territories); to
‘‘(II) the average per capita in-
come of individuals in the State.
‘‘(B) In the case of a territory of the Unit-
ed States, the number of additional cases of
such syndrome in the specific territory, as indi-
cated by the number of cases reported to and
confirmed by the Secretary for the 2 most re-
cent fiscal years for which such data is avail-
able.
‘‘(4) SUPPLEMENTAL AMOUNTS FOR CERTAIN
STATES.—For purposes of paragraph (1)(B), an
amount shall be determined under this paragraph
for each State that does not contain any metropoli-
tan area whose chief elected official received a grant
under part A for fiscal year 1996. The amount de-
termined under this paragraph for such a State for
a fiscal year shall be the product of—
‘‘(A) an amount equal to 7 percent of the
amount available under section 2677 for carry-
ing out this part for the fiscal year (subject to
subsection (b)); and
‘‘(B) the percentage constituted by the
ratio of—
‘‘(i) the number of cases of acquired
immune deficiency syndrome in the State
(as determined under paragraph (3)(A)(i));
to
‘‘(ii) the sum of the respective num-
bers determined under clause (i) for each
State to which this paragraph applies.
‘‘(5) DEFINITIONS.—For purposes of this sub-
section and subsection (b):
‘‘(A) The term ‘State’ means each of the
50 States, the District of Columbia, and the
Commonwealth of Puerto Rico.
‘‘(B) The term ‘territory of the United
States’ means the Virgin Islands, Guam, Amer-
ican Samoa, the Commonwealth of the North-
ern Mariana Islands, and the Republic of the
Marshall Islands.
‘‘(b) MINIMUM AMOUNT OF GRANT.—
‘‘(1) IN GENERAL.—Subject to the extent of the
amounts specified in paragraphs (2)(A) and (4)(A)
of subsection (a), a grant under this part for a State
for a fiscal year shall be the greater of—
‘‘(A) the amount determined for the State
under subsection (a); and
‘‘(B) the amount applicable under para-
graph (2) to the State.
‘‘(2) APPLICABLE AMOUNT.—For purposes of
paragraph (1)(B), the amount applicable under this
paragraph for a fiscal year is the following:
‘‘(A) In the case of each of the 50 States
and the District of Columbia—
‘‘(i) $100,000, if the State or District
has less than 90 cases of acquired immune
deficiency syndrome (as determined under
subsection (a)(3)(A)(i)); and
‘‘(ii) $250,000, if the State or District
has 90 or more such cases (as so deter-
mined).
‘‘(B) In the case of each of the territories
of the United States, $0.0.’’.
SEC. 503. CONSOLIDATION OF AUTHORIZATIONS OF APPRO-
PRIATIONS.
(a) IN GENERAL.—Part D of title XXVI (42 U.S.C.
300ff–71) is amended by adding at the end thereof the
following section:
‘‘SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.
‘‘(a) IN GENERAL.—For the purpose of carrying out
parts A and B, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years
1996 through 2000. Subject to section 2673A and to sub-
section (b), of the amount appropriated under this section
for a fiscal year, the Secretary shall make available 64
percent of such amount to carry out part A and 36 percent
of such amount to carry out part B.
‘‘(b) DEVELOPMENT OF METHODOLOGY.—With re-
spect to each of the fiscal years 1997 through 2000, the
Secretary may develop and implement a methodology for
adjusting the percentages referred to in subsection (a).’’.
(b) REPEALS.—Sections 2608 and 2620 (42 U.S.C.
300ff–18 and 300ff–30) are repealed.
(c) CONFORMING AMENDMENTS.—Title XXVI is
amended—
(1) in section 2603(b)(1), by striking ‘‘2608’’
and inserting ‘‘2677’’;
(2) in section 2605(c)(1), by striking ‘‘2608’’
and inserting ‘‘2677’’; and
(3) in section 2618—
(A) in subsection (a)(1), by striking
‘‘2620’’ and inserting ‘‘2677’’; and
(B) in subsection (b)(1), by striking
‘‘2620’’ and inserting ‘‘2677’’.
TITLE VI—EFFECTIVE DATE
SEC. 601. EFFECTIVE DATE.
Except as provided in section 101, this Act takes effect
October 1, 1995.
Æ
HR 1872 IH——2
HR 1872 IH——3
HR 1872 IH——4