Ryan White CARE Act Amendments of 1996
PL 104-146 (S.641), enacted 05/20/1996

110 STAT. 1346 
PUBLIC LAW 104-146—MAY 20, 1996 
Public Law 104-146 
104th Congress 
An Act 
May 20, 1996 
An Act to amend the Public Health Service Act to revise and extend programs 
fS 641] 
established pursuant to the Ryan White Comprehensive AIDS Resources Emer-
gency Act of 1990. 
Be it enacted by the Senate and House of Representatives of 
Ryan White 
the United States of America in Congress assembled, 
CARE Act 
Amendments of 
SECTION 1. SHORT TITLE. 
1996 
42 use 201 note. 
This Act may be cited as the "Ryan White CARE Act Amend-
ments of 1996". 
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 the PubUc Health Service Act (42 U.S.C. 201 et seq.). 
SEC. 3. GENERAL AMENDMENTS. 
(a) PROGRAM OF GRANTS.— 
(1) NUMBER OF CASES.—Section 2601(a) (42 U.S.C. 300ff-
11) is amended— 
(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 
£ind inserting the following: "metropolitan area for which 
there has been reported to the Director of the Centers 
for Disease Control and Prevention a cumulative total of 
more than 2,000 cases of acquired immune deficiency syn-
drome for the most recent period of 5 calendar years for 
which such data are available.". 
(2) OTHER PROVISIONS REGARDING ELIGIBILITY.—Section 
2601 (42 U.S.C. 300ff-ll) is amended by adding at the end 
thereof the following new subsections: 
"(c) REQUIREMENTS REGARDING POPULATION.— 
"(1) NUMBER OF INDIVIDUALS.— 
"(A) IN GENERAL.—Except as provided in subparagraph 
(B), the Secretary may not make a gremt under this section 
for a metropolitan area unless the area has a population 
of 500,000 or more individuals. 
"(B) LIMITATION.—Subparagraph (A) does not apply 
to any metropolitan area that was an eligible area under 
this part for fiscal year 1995 or any prior fiscal year. 
"(2) GEOGRAPHIC BOUNDARIES.—For purposes of eligibility 
under this part, the boundaries of each metropolitan area are 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1347 
the boundaries that were in effect for the area for fiscal year 
1994. 
"(d) CONTINUED STATUS AS ELIGIBLE AREA.—Notwithstanding 
any other provision of this section, a metropohtan area that was 
an eUgible area under this part for fiscal year 1996 is an eligible 
area for fiscal year 1997 and each subsequent fiscal year.". 
(3) CONFORMING AMENDMENT REGARDING DEFINITION OF 
ELIGIBLE AREA.—Section 2607(1) (42 U.S.C. 300ff-17(l)) is 
amended by striking "The term" and all that follows and insert-
ing the following: "The term 'eligible area' means a metropolitan 
area meeting the requirements of section 2601 that are 
applicable to the area,". 
(b) EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED 
FOR SERVICES.— 
(1) HIV HEALTH SERVICES PLANNING COUNCIL.—Subsection 
(b) of section 2602 (42 U.S.C. 300ff-12(b)) is amended— 
(A) in paragraph (1)— 
(i) by striking "include" and all that follows 
through the end thereof, and inserting "reflect in its 
composition the demographics of the epidemic in the 
eligible area involved, with particular consideration 
given to disproportionately affected and historically 
underserved groups and subpopulations."; and 
(ii) by adding at the end thereof the following 
new sentences: "Nominations for membership on the 
council shall be identified through an open process 
and candidates shall be selected based on locally delin-
eated and publicized criteria. Such criteria shall 
include a conflict-of-interest standard that is in accord-
ance with paragraph (5)."; 
(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) in subparagraph (A), by striking "area;" and 
inserting "area, including how best to meet each such 
priority and additional factors that a grantee should 
consider in allocating funds under a grant based on 
the— 
"(i) documented needs of the HIV-infected popu-
lation; 
"(ii) cost and outcome effectiveness of proposed 
strategies and interventions, to the extent that such 
data are reasonably available (either demonstrated or 
probable); 
"(iii) priorities of the HIV-infected commimities for 
whom the services are intended; and 
"(iv) availability of other governmental and non-
governmental resources;"; 
(ii) by striking "and" at the end of subparagraph 
(B); 
(iii) by striking the period at the end of subpara-
graph (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 
110 STAT. 1348 
PUBLIC LAW 104-146—MAY 20, 1996 
(iv) by adding at the end thereof the following 
new subparagraphs: 
"(D) participate in the development of the statewide 
coordinated statement of need initiated by the State public 
health agency responsible for administering grants under 
part B; and 
"(E) establish methods for obtaining input on commu-
nity needs and priorities which may include public meet-
ings, conducting focus groups, and convening ad-hoc pan-
els."; 
(D) by redesignating paragraphs (2) and (3) as para-
graphs (3) and (4), respectively; 
(E) by inserting after paragraph (1), the following new 
paragraph: 
"(2) REPRESENTATION.—The HIV health services planning 
council shall include representatives o
f
— 
"(A) health care providers, including federally qualified 
health centers; 
"(B) community-based organizations serving affected 
populations and AIDS service organizations; 
"(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 people with HIV 
disease or AIDS and historically underserved groups and 
subpopulations; 
"(H) nonelected community leaders; 
"(I) State government (including the State medicaid 
agency and the agency administering the program under 
part B); 
"(J) grantees under subpart II of part C; 
"(K) grantees under section 2671, or, if none are operat-
ing in the area, representatives of organizations with a 
history of serving children, youth, women, and families 
living with HIV and operating in the area; and 
"(L) grantees under other Federal HIV programs."; and 
(F) by adding at the end thereof the following: 
"(5) CONFLICTS OF INTEREST.— 
"(A) IN GENERAL.—The planning coimcil under para-
graph (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 otherwise be involved in the selection 
of) particular entities as recipients of any of the amounts 
provided in the grant. 
"(B) REQUIRED AGREEMENTS.—^An individual may serve 
on the pleinning council under paragraph (1) only if the 
individual agrees that if the individual has a financial 
interest in an entity, if the individual is an employee of 
a public or private entity, or if the individual is a member 
of a public or private organization, and such entity or 
organization is seeking amounts from a grant under section 
2601(a), the individual will not, with respect to the purpose 
for which the entity seeks such amounts, participate 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1349 
(directly or in an advisory capacity) in the process of select-
ing entities to receive such amounts for such purpose. 
"(6) GRIEVANCE PROCEDURES.—A planning council under 
paragraph (1) shall develop procedures for addressing griev-
ances with respect to funding under this part, including proce-
dures for submitting grievances that cannot be resolved to 
binding arbitration. Such procedures shall be described in the 
by-laws of the planning council and be consistent with the 
requirements of subsection (c). 
"(c) GRIEVANCE PROCEDURES.— 
"(1) FEDERAL RESPONSIBILITY.— 
"(A) MODELS.—The Secretary shall, through a process 
that includes consultations with grsuitees under this part 
and public and private experts in grievance procedures, 
arbitration, and mediation, develop model grievance proce-
dures that may be implemented by the planning council 
under subsection (b)(1) £ind grsintees under this part. Such 
model procedures shall describe the elements that must 
be addressed in establishing local grievance procedures 
and provide grantees with flexibility in the design of such 
local procedures. 
"(B) REVIEW.—^The Secretary shall review grievgmce 
procedures established by the planning council and 
grantees under this part to determine if such procedures 
are adequate. In making such a determination, the Sec-
retary shall assess whether such procedures permit legiti-
mate grievsmces to be filed, evaluated, and resolved at 
the local level. 
"(2) GRANTEES.—To be eligible to receive funds under this 
part, a grantee shall develop grievance procedures that are 
determined by the Secretary to be consistent with the model 
procedures developed under paragraph (1)(A). Such procedures 
shall include a process for submitting grievances to binding 
arbitration.". 
(2) DISTRIBUTION OF GRANTS.—Section 2603 (42 U.S.C. 
300ff-13) is amended— 
(A) in subsection (a)(2), 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 available to carry out this part 
for each of the fiscal years 1996 through 2000, the Secretary 
shall"; and 
(B) in subsection (b) 
(i) in paragraph (1)— 
(I) by striking "and" at the end of subpara-
graph (D); 
(II) by striking the period at the end of 
subparagraph (E) and inserting a semicolon; 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 individuals with HIV disease; and 
"(G) demonstrates the manner in which the proposed 
services are consistent with the local needs assessment 
and the statewide coordinated statement of need."; and 
110 STAT. 1350 
PUBLIC LAW 104-146—MAY 20, 1996 
(ii) by redesignating paragraphs (2), (3), and (4) 
as paragraphs (3), (4), and (5), respectively; and 
(iii) by inserting after paragraph (1), the following 
new paragraph: 
"(2) DEFINITION.— 
"(A) SEVERE NEED.—In determining severe need in 
accordance with paragraph (1)(B), the Secretary shall con-
sider the ability of the qualified applicant to expend funds 
efficiently and the impact of relevant factors on the cost 
and complexity of delivering health care and support serv-
ices to individuals with HIV disease in the eligible area, 
including factors such as— 
"(i) sexually trginsmitted diseases, substance abuse, 
tuberculosis, severe mental illness, or other comorbid 
factors determined relevant by the Secretary; 
"(ii) new or growing subpopulations of individuals 
with HIV disease; and 
"(iii) homelessness. 
"(B) PREVALENCE.—In determining the impact of the 
factors described in subparagraph (A), the Secretary shall, 
to the extent practicable, use national, 
quantitative 
incidence data that are available for each eligible area. 
Not later than 2 years after the date of enactment of 
this paragraph, the Secretary shall develop a mechanism 
to utilize such data. In the absence of such data, the 
Secretary may consider a detailed description and quali-
tative analysis of severe need, as determined 
under 
subparagraph (A), including any local prevalence data gath-
ered and analyzed by the eligible area. 
"(C) PRIORITY.—Subsequent to the development of the 
quantitative mechanism described in subparagraph (B), the 
Secretary shall phase in, over a 3-year period beginning 
in fiscal year 1998, the use of such a mechanism to deter-
mine the severe need of an eligible area compared to other 
eligible areas and to determine, in part, the amount of 
supplemental funds awarded to the eligible area under 
this part.". 
(3) DISTRIBUTION OF FUNDS.— 
(A) IN GENERAL.—Section 2603(a)(2) (42 U.S.C. 300ff-
13(a)(2)) (as amended by paragraph (2)) is further amend-
ed— 
(i) by inserting ", in accordance with paragraph 
(3)" before the period; and 
(ii) by adding at the end thereof the following 
new sentences: "The Secretary shall reserve an addi-
tional percentage of the amount appropriated under 
section 2677 for a fiscal year for grants under part 
A to make grants to eligible areas under section 2601(a) 
in accordance with paragraph (4).". 
(B) INCREASE IN GRANT.—Section 2603(a) (42 U.S.C. 
300ff-13(a)) is amended by adding at the end thereof the 
following new paragraph: 
"(4) INCREASE IN GRANT.—With respect to an eligible area 
under section 2601(a), the Secretary shall increase the amount 
of a grant under paragraph (2) for a fiscal year to ensure 
that such eligible area receives not less than— 
"(A) with respect to fiscal year 1996,100 percent; 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1351 
"(B) with respect to fiscal year 1997, 99 percent; 
"(C) with respect to fiscal year 1998, 98 percent; 
"(D) with respect to fiscal year 1999, 96.5 percent; 
and 
"(E) with respect to fiscal year 2000, 95 percent; 
of the amount allocated for fiscal year 1995 to such entity 
under this subsection.". 
(C) ADDITIONAL REQUIREMENTS FOR GRANTS.—Section 
2603 (42 U.S.C. 300ff-13) is amended by adding at the 
end thereof the following subsection: 
"(c) COMPLIANCE WITH PRIORITIES OF HIV 
PLANNING COUN-
CIL.—^Notwithstanding any other provision of this part, the Sec-
retary, 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 
demonstrates that the grants made under subsections (a) and (b) 
to the £irea 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 coun-
cil serving the area.". 
(4) USE OF AMOUNTS.—Section 2604 (42 U.S.C. 300fif-14) 
is amended— 
(A) in subsection (b)(1)(A)— 
(i) by inserting ", substance abuse treatment and 
mental health treatment," after "case management"; 
and 
(ii) by inserting "which shall include treatment 
education and prophylactic treatment for opportunistic 
infections," after "treatment services,"; 
(B) in subsection (b)(2)(A)— 
(i) by inserting ", or private for-profit entities if 
such entities are the only available provider of quality 
HIV care in the area," after "nonprofit private enti-
ties,"; and 
(ii) by striking "and homeless health centers" and 
inserting "homeless health centers, substance abuse 
treatment programs, and mental health programs"; 
(C) by adding at the end of subsection (b), the following 
new 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, including treatment 
measures to prevtjnt the perinatal transmission of HIV, the 
chief elected ofKcial of an eligible eirea, in accordance with 
the established priorities of the planning coimcil, shall use, 
firom 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 population in such area of infants, children, and 
women with acquired immune deficiency syndrome to the gen-
eral population in such area of individuals with such syn-
drome."; and 
(C) in subsection (e)— 
(i) in the subsection heading, by striking "AND 
PLANNING; 
(ii) by striking "The chief and inserting: 
"(1) IN GENERAL.—The chief; 
110 STAT. 1352 
PUBLIC LAW 104-146—MAY 20, 1996 
(iii) by striking "accounting, reporting, and pro-
gram oversight functions"; 
(iv) by adding at the end thereof the following 
new sentence: "In the case of entities and subcontrac-
tors to which such officer allocates amounts received 
by the officer under the grant, the officer shall ensure 
that, of the aggregate amount so allocated, the total 
of the expenditures by such entities for administrative 
expenses does not exceed 10 percent (without regard 
to whether particular entities expend more than 10 
percent for such expenses)."; and 
(v) by adding at the end thereof the following 
new paragraphs: 
"(2) ADMINISTRATIVE ACTIVITIES.—For the purposes of para-
graph (1), amounts may be used for administrative activities 
that include— 
"(A) routine grant administration and monitoring 
activities, including the development of applications for 
part A funds, the receipt and disbursal of program funds, 
the development and establishment of reimbursement and 
accounting systems, the preparation 
of routine pro-
grammatic and financial reports, and compliance with 
grant conditions and audit requirements; and 
"(B) all activities associated with the grantee's contract 
award procedures, including the development of requests 
for proposals, contract proposal review activities, negotia-
tion and awarding of contracts, monitoring of contracts 
through telephone consultation, written documentation or 
onsite visits, reporting on contracts, and funding realloca-
tion activities. 
"(3) SUBCONTRACTOR ADMINISTRATIVE COSTS.—For the pur-
poses of this subsection, subcontractor administrative activities 
include— 
"(A) usual and recognized overhead, including estab-
lished indirect rates for agencies; 
"(B) management oversight of specific programs funded 
under this title; and 
"(C) other types of program support such as quality 
assurance, quality control, and related activities.". 
(5) APPLICATION.—Section 2605 (42 U.S.C. 300ff-15) is 
amended— 
(A) in subsection (a)— 
(i) in the matter preceding paragraph (1), by insert-
ing ", in accordance with subsection (c) regarding a 
single application and grant award," after "applica-
tion"; 
(ii) in paragraph (1)(B), by striking "1-year period" 
and all that follows through "eligible area" and insert-
ing "preceding fiscal year"; 
(iii) in paragraph (4), by striking "and" at the 
end thereof; 
(iv) in paragraph (5), by striking the period at 
the end thereof and inserting "; and"; and 
(v) by adding at the end thereof the following 
new paragraph: 
"(6) that the applicant has participated, or will agree to 
participate, in the statewide coordinated statement of need 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1353 
process where it has been initiated by the State pubhc health 
agency responsible for administering grants under part B, and 
ensure that the services provided under the comprehensive 
plan are consistent with the statewide coordinated statement 
of need."; 
(B) in subsection (b)— 
(i) in the subsection heading, by striking "ADDI-
TIONAL"; and 
(ii) in the matter preceding paragraph (1), by strik-
ing "additional application" and inserting "application, 
in accordance with subsection (c) regarding a single 
application £ind grant award,"; and 
(C) by redesignating subsections (c) and (d) as sub-
sections (d) and (e), respectively; and 
(D) by inserting after subsection (b), the following new 
subsection: 
"(c) SINGLE APPLICATION AND GRANT AWARD.— 
"(1) APPLICATION.—The Secretary may phase in the use 
of a single application that meets the requirements of sub-
sections (a) and (b) of section 2603 with respect to an eligible 
area that desires to receive grants under section 2603 for a 
fiscal year. 
"(2) GRANT AWARD.—^The Secretary may phase in the 
awarding of a single grant to an eligible area that submits 
an approved application under paragraph (1) for a fiscal year.". 
(6) TECHNICAL ASSISTANCE.—Section 2606 (42 U.S.C. 300ff-
16) is amended— 
(A) by striking "may" and inserting "shall"; 
(B) by inserting after "technical assistance" the follow-
ing: ", including assistance from other grantees, contractors 
or subcontractors under this title to assist newly eligible 
metropolitan areas in the establishment of HIV health 
services planning councils and,"; and 
(C) by adding at the end thereof the following new 
sentences: "The Administrator may make planning grants 
available to metropolitan areas, in an amount not to exceed 
$75,000 for any metropolitan area, projected to be eligible 
for funding under section 2601 in the following fiscal year. 
Such grant amounts shall be deducted fi-om the first year 
formula award to eligible areas accepting such grants. Not 
to exceed 1 percent of the amount appropriated for a fiscal 
year imder section 2677 for grants imider part A may 
be used to carry out this section.". 
(c) CARE GRANT PROGRAM.— 
(1) PRIORITY FOR WOMEN, INFANTS AND CHILDREN.—Section 
2611 (42 U.S.C. 300ff-21) is amended— 
(A) by striking "The" and inserting "(a) IN GENERAL.— 
The"; and 
(B) by adding at the end thereof the following new 
subsection: 
"(b) PRIORITY FOR WOMEN, INFANTS AND CHILDREN.—For the 
purpose of providing health and support services to infants, chil-
dren, £ind women with HIV disease, including treatment measures 
to prevent the perinatal transmission of HIV, 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 
110 STAT. 1354 
PUBLIC LAW 104-146—MAY 20, 1996 
acquired immune deficiency syndrome to the general population 
in the State of individuals with such S5nidrome.". 
(2) USE OF GRANTS.—Section 2612 (42 U.S.C. 300ff-22) 
is amended— 
(A) in subsection (a)— 
(i) by striking the subsection designation and head-
ing; 
(ii) by redesignating paragraphs (1) through (4) 
as paragraphs (2) through (5), respectively; 
(iii) by inserting the following new paragraph: 
"(1) to provide the services described in section 2604(b)(1) 
for individuals with HIV disease;"; 
(iv) in paragraph (5) (as so redesignated), by strik-
ing "treatments" and all that follows through "health," 
and inserting "therapeutics to treat HIV disease"; and 
(v) by adding at the end thereof the following 
flush sentences: 
"Services described in paragraph (1) shall be delivered through 
consortia designed as described in paragraph (2), where such consor-
tia exist, unless the State demonstrates to the Secretary that deliv-
ery of such services would be more effective when other delivery 
mechanisms are used. In making a determination regarding the 
delivery of services, the State shall consult with appropriate rep-
resentatives of service providers and recipients of services who 
would be affected by such determination, and shall include in its 
demonstration to the Secretary the findings of the State regarding 
such consultation."; and 
(B) by striking subsection (b). 
(2) HIV CARE CONSORTIA.—Section 2613 (42 U.S.C. SOOff-
23) is amended— 
(A) in subsection (a)— 
(i) in paragraph (1), by inserting "(or private for-
profit providers or organizations if such entities are 
the only available providers of quality HIV care in 
the area)" after "nonprofit private,"; and 
(ii) in paragraph (2)(A)— 
(I) by inserting "substance abuse treatment, 
mental health treatment," after "nursing,"; smd 
(II) by inserting "prophylactic treatment for 
opportunistic infections, treatment education to 
take place in the context of health care delivery," 
after "monitoring,"; and 
(B) in subsection (c)— 
(i) in subparagraph (C) of paragraph (1), by insert-
ing before "care" "and youth centered"; and 
(ii) in paragraph (2)— 
(I) in clause (ii) of subparagraph (A), by strik-
ing "served; and" and inserting "served;"; 
(II) in subpsuragraph (B), by striking the period 
at the end and inserting "; and"; and 
(III) by adding after subparagraph (B), the 
following new subparagraph: 
"(C) grantees under section 2671, or, if none are operat-
ing in the area, representatives in the area of organizations 
with a history of serving children, youth, women, and fami-
lies living with HIV.". 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1355 
(3) PROVISION OF TREATMENTS.—Section 2616 (42 U.S.C. 
300ff-26) is amended— 
(A) in subsection (a)— 
(i) by striking "may use amounts" and inserting 
"shall use a portion of the amounts"; 
(ii) by striking "section 2612(a)(4)" and all that 
follows through "prolong life" and inserting "section 
2612(a)(5) to provide therapeutics to treat HIV dis-
ease"; and 
(iii) by inserting before the period the following: 
", including measures for the prevention and treatment 
of opportunistic infections"; 
(B) in subsection (c)— 
(i) in paragraph (3), by striking "and" at the end 
thereof; 
(ii) in paragraph (4), by striking the period and 
inserting "; ;and"; and 
(iii) by adding at the end thereof the following 
new paragraph: 
"(5) document the progress made in making therapeutics 
described in subsection (a) available to individuals eligible for 
assistance under this section."; and 
(C) by adding at the end thereof the following new 
subsection: 
"(d) DUTIES OF THE SECRETARY.—In carrying out this section, 
the Secretary shall review the current status of State drug 
reimbursement programs established under section 2612(2) and 
assess barriers to the expanded availability of the treatments 
described in subsection (a). The Secretary shall also examine the 
extent to which States coordinate with other grantees under this 
title to reduce barriers to the expsmded availability of the treat-
ments described in subsection (a).". 
(4) STATE APPLiCATiON.-^ection 2617(b) (42 U.S.C. SOOff-
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 traditionally underserved 
populations and subpopulations) developed in partnership 
with other grantees in the State that receive funding under 
this title; and"; 
(B) by redesignating paragraph (3) as paragraph (4); 
(C) by inserting after paragraph (2), the following new 
paragraph: 
"(3) an assurance that the public health agency administer-
ing the grant for the State will periodically convene a meeting 
of individuals with HIV, representatives of grantees under each 
part under this title, providers, and public agency representa-
tives for the purpose of developing a statewide coordinated 
statement of need; and". 
(5) PLANNING, EVALUATION AND ADMINISTRATION.—Section 
2618(c) (42 U.S.C. 300ff-28(c)) is amended— 
(A) by striking paragraph (1); 
110 STAT. 1356 
PUBLIC LAW 104-146—MAY 20, 1996 
(B) in paragraphs (3) and (4), to read as follows: 
"(3) PLANNING AND EVALUATIONS.—Subject to paragraph 
(5) and except as provided in paragraph (6), a State may 
not use more than 10 percent of amounts received under a 
grant awarded under this part for planning and evaluation 
activities. 
"(4) ADMINISTRATION.— 
"(A) IN GENERAL.—Subject to paragraph (5) and except 
as provided in paragraph (6), a State may not use more 
than 10 percent of amounts received under a grant awarded 
under this part for administration. In the case of entities 
and subcontractors to which the State allocates amoimts 
received by the State xinder the grant (including consortia 
under section 2613), the State shall ensure that, of the 
aggregate amount so allocated, the total of the expenditures 
by such entities for administrative expenses does not exceed 
10 percent (without regard to whether particular entities 
expend more than 10 percent for such expenses). 
"(B) ADMINISTRATIVE ACTIVITIES.—For the purposes of 
subparagraph (A), amounts may be used for administrative 
activities that include routine grant administration and 
monitoring activities. 
"(C) SUBCONTRACTOR ADMINISTRATIVE COSTS.—For the 
purposes of this paragraph, subcontractor administrative 
activities include— 
"(i) usual and recognized overhead, including 
established indirect rates for agencies; 
"(ii) management oversight of specific programs 
funded under this title; and 
"(iii) other types of program support such as qual-
ity assurance, quality control, and related activities."; 
(C) by redesignating paragraph (5) as paragraph (7); 
and 
(D) by inserting after paragraph (4), the following new 
paragraphs: 
"(5) LIMITATION ON USE OF FUNDS.—Except as provided 
in paragraph (6), 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) EXCEPTION.—With respect to a State that receives 
the minimum allotment under subsection (a)(1) for a fiscal 
yesir, such State, from the amounts received under a grant 
awarded under this part for such fiscal year for the activities 
described in paragraphs (3) and (4), may, notwithstanding para-
graphs (3), (4), and (5), use not more than that amount required 
to support one full-time-equivalent employee.". 
(6) TECHNICAL ASSISTANCE.—Section 2619 (42 U.S.C. 300ff-
29) is amended— 
(A) by striking "may" and inserting "shall"; smd 
(B) by inserting before the period the following: ", 
including technical assistance for the development and 
implementation of statewide coordinated statements of 
need". 
(7) COORDINATION.—Part B of title XXVI (42 U.S.C. 300ff-
21 et seq.) is amended by adding at the end thereof the following 
new section: 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1357 
"SEC. 2621. COORDINATION. 
42 USC 300ff-31. 
"The Secretary shall ensure that the Health Resources and 
Services Administration, the Centers for Disease Control and 
Prevention, and the Substance Abuse and Mental Health Services 
Administration coordinate the planning and implementation of Fed-
eral HIV programs in order to facilitate the local development 
of a complete continuum of HIV-related services for individuals 
with HIV disease and those at risk of such disease. Not later Reports. 
than October 1, 1996, and biennially thereafter, the Secretary shall 
submit to the appropriate committees of the Congress a report 
concerning coordination efforts under this title at the Federal, State, 
and local levels, including a statement of whether and to what 
extent there exist Federal barriers to integrating HIV-related pro-
grams.". 
(d) EARLY INTERVENTION SERVICES.— 
(1) ESTABLISHMENT OF PROGRAM.—Section 2651(b) (42 
U.S.C. 300ff-51(b)) is amended— 
(A) in paragraph (1), by inserting before the period 
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 for individuals with HIV disease"; and 
(B) in paragraph (4)— 
(i) by striking "The Secretary" and inserting "(A) 
IN GENERAL.—The Secretary"; 
(ii) by inserting ", or private for-profit entities if 
such entities are the only available provider of quality 
HIV care in the area," after "nonprofit private entities"; 
(iii) by realigning the margin of subparagraph (A) 
so as to align with the margin of paragraph (3)(A); 
and 
(iv) by adding at the end thereof the following 
new subparagraph: 
"(B) OTHER REQUIREMENTS.—Grantees described in— 
"(i) paragraphs (1), (2), (5), and (6) of section 
2652(a) shall use not less than 50 percent of the 
amount of such a grant to provide the services 
described in subparagraphs (A), (B), (D), and (E) of 
section 2651(b)(2) directly £ind on-site or at sites where 
other primary care services are rendered; and 
"(ii) paragraphs (3) and (4) of section 2652(a) shall 
ensure the availability of early intervention services 
through a system of linkages to community-based pri-
mary care providers, and to establish mechanisms for 
the referrals described in section 2651(b)(2)(C), and 
for follow-up concerning such referrals.". 
(2) MINIMUM QUiVLiFiCATiONS.-Section 2652(b)(1)(B) (42 
U.S.C. 300ff-52(b)(l)(B)) is amended by inserting ", or a private 
for-profit entity if such entity is the only available provider 
of quality HIV care in the area," after "nonprofit private entity. 
(3) MISCELLANEOUS PROVISIONS.—Section 2654 (42 U.S.C. 
300ff-54) is amended by adding at the end thereof the following 
new subsection: 
"(c) PLANNING AND DEVELOPMENT GRANTS.— 
"(1) IN GENERAL.—The Secretary may provide planning 
grants, in an amount not to exceed $50,000 for each such 
grant, to public and nonprofit private entities for the purpose 
110 STAT. 1358 
PUBLIC LAW 104-146—MAY 20, 1996 
of enabling such entities to provide HIV early intervention 
services. 
"(2) REQUIREMENT.—The Secretary may only award a grant 
to an entity under paragraph (1) if the Secretary determines 
that the entity will use such grant to assist the entity in 
qualifying for a grant under section 2651. 
"(3) PREFERENCE.—In awarding grants under paragraph 
(1), the Secretary shall give preference to entities that provide 
primary care services in rural or underserved communities. 
"(4) LIMITATION.—Not to exceed 1 percent of the amount 
appropriated for a fiscal year under section 2655 may be used 
to carry out this section.". 
(4) 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.". 
(5) 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 inserting "7.5 per-
cent including planning and evaluation"; and 
(ii) by striking the period and inserting "; and"; 
and 
(C) by adding at the end thereof the following new 
paragraph: 
"(4) the applicant will submit evidence that the proposed 
program is consistent with the statewide coordinated statement 
of need and agree to participate in the ongoing revision of 
such statement of need.". 
(e) DEMONSTRATION GRANTS FOR RESEARCH AND SERVICES FOR 
42 use 300fr-7i. 
PEDIATRIC PATIENTS.—Section 2671 (42 U.S.C. 300f-71) is amended 
to read as follows: 
"SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO 
RESEARCH FOR WOMEN, INFANTS, CHILDREN, AND 
YOUTH. 
"(a) IN GENERAL.—^The Secretary, acting through the Adminis-
trator of tihe Health Resources and Services Administration and 
in consultation 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 
following purposes: 
"(1) Providing through such entities, in accordance with 
this section, opportunities for women, infants, children, and 
youth to be voluntary participants in research of potential 
clinical benefit to individuals with HIV disease. 
"(2) In the case of women, infants, children, and youth 
with HIV disease, and the families of such individuals, provid-
ing to such individuals— 
"(A) health care on an outpatient basis; and 
"(B) additional services in accordance with subsection 
(d). 
"(b) PROVISIONS REGARDING PARTICIPATION IN RESEARCH.— 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1359 
"(1) IN GENERAL.—^With respect to the projects of research 
with which an applicant under subsection (a) is concerned, 
the Secretary may make a grant under such subsection to 
the applicant only if the following conditions are met: 
"(A) The applicant agrees to make reasonable efforts— 
"(i) to identify which of the patients of the 
applicant are women, infants, children, and youth who 
would be appropriate participants in the projects; 
"(ii) to carry out clause (i) through the use of 
criteria provided for such purpose by the entities that 
will be conducting the projects of research; and 
"(iii) to offer women, infants, children, and youth 
the opportunity to participate in the projects (as appro-
priate), including the provision of services under sub-
section (d)(3). 
"(B) The applic£int agrees that, in the case of the 
research-related ranctions to be carried out by the applicant 
pursuant to subsection (a)(1), the applicant will comply 
with accepted standards that are applicable to such func-
tions (including accepted standards regarding informed con-
sent and other protections for human subjects). 
"(C) For the first and second fiscal years for which 
grants under subsection (a) are to be made to the applicant, 
the applicant agrees that, not later than the end of the 
second fiscal year of receiving such a grant, a significant 
number of women, infants, children, and youth who are 
patients of the applicant will be participating in the projects 
of research. 
"(D) Except as provided in paragpraph (3) (and para-
graph (4), as applicable), for the third and subsequent 
fiscal years for which such grants are to be made to the 
applicant, the Secretary has determined that a significant 
number of such individuals are pEirticipating in the projects. 
"(2) PROHIBITION.—Receipt of services by a patient shall 
not be conditioned upon the consent of the patient to participate 
in research. 
"(3) 
SIGNIFICANT PARTICIPATION; CONSIDERATION BY SEC-
RETARY OF CERTAIN CIRCUMSTANCES.—In administering the 
requirement of paragraph (1)(D), the Secretary shall take into 
account circumstances in which a grantee under subsection 
(a) is temporarily unable to comply with the requirement for 
reasons beyond the control of the grantee, and shall in such 
circumstances provide to the grantee a reasonable period of 
opportunity in which to reestablish compliance with the require-
ment. 
"(4) 
SIGNIFICANT PARTICIPATION; TEMPORARY WAIVER FOR 
ORIGINAL GRANTEES.— 
"(A) IN GENERAL.—In the case of an applicant under 
subsection (a) who received a grant under such subsection 
for fiscal year 1995, the Secretary may, subject to subpara-
graph (B), provide to the applicant a waiver of the require-
ment of paragraph (1)(D) if the Secretary determines that 
the applicant is making reasonable progress toward meet-
ing the requirement. 
"(B) TERMINATION OF AUTHORITY FOR WAIVERS.—The 
Secretary may not provide any waiver imder subparagraph 
(A) on or after October 1, 1998. Any such waiver provided 
110 STAT. 1360 
PUBLIC LAW 104-146—MAY 20, 1996 
prior to such date terminates on such date, or on such 
earlier date as the Secretary may specify. 
"(c) PROVISIONS REGARDING CONDUCT OF RESEARCH.— 
"(1) IN GENERAL.—^With respect to eligibihty for a grant 
under subsection (a): 
"(A) A project of research for which subjects are sought 
pursuant to such subsection may be conducted by the 
applicant for the grant, or by an entity with which the 
applicant has made arrangements for purposes of the grant. 
The grant may not be expended for the conduct of any 
project of research, except for such research-related func-
tions as are appropriate for providing opportunities under 
subsection (a)(1) (including the functions specified in sub-
section (b)(1)). 
"(B) The grant may be made only if the Secretary 
makes the following determinations: 
"(i) The applicant or other entity (as the case may 
be under subparagraph (A)) is appropriately qualified 
to conduct the project of research. An entity shall be 
considered to be so qualified if any research protocol 
of the entity has been recommended for funding under 
this Act pursuant to technical and scientific peer 
review through the National Institutes of Health. 
"(ii) The project of research is being conducted 
in accordance with a research protocol to which the 
Secretary gives priority regarding the prevention or 
treatment of HIV disease in women, infants, children, 
or youth, subject to paragraph (2). 
"(2) LIST OF RESEARCH PROTOCOLS.— 
"(A) IN GENERAL.—From among the research protocols 
described in paragraph (l)(B)(ii), the Secretary shall estab-
lish a list of research protocols that are appropriate for 
purposes of subsection (a)(1). Such list shall be established 
only £ifter consultation with public and private entities 
that conduct such research, and with providers of services 
under subsection (a) and recipients of such services. 
"(B) DISCRETION OF SECRETARY.—The Secretary 
may 
authorize the use, for purposes of subsection (a)(1), of a 
research protocol that is not included on the list under 
subparagraph (A). The Secretary may waive the require-
ment specified in paragraph (l)(B)(ii) in such circumstances 
as the Secretary determines to be appropriate. 
"(d) 
ADDITIONAL SERVICES FOR PATIENTS AND FAMILIES.—A 
grant under subsection (a) may be made only if the applicant 
for the grant agrees as follows: 
'(1) The applicant will provide for the case management 
of the patient involved and the family of the patient. 
"(2) The applicant will provide for the patient and the 
family of the patient— 
"(A) referrals for inpatient hospital services, treatment 
for substance abuse, and mental health services; and 
"(B) referrals for other social and support services, 
as appropriate. 
"(3) The applicant will provide the patient and the family 
of the patient with such transportation, child care, and other 
incidental services as may be necessary to enable the patient 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1361 
and the family to participate in the program estabhshed by 
the applicant pursuant to such subsection. 
"(e) COORDINATION WITH OTHER ENTITIES.—A grant under sub-
section (a) may be made only if the applicant 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 Social Security Act. 
"(2) The applicant will participate in the statewide coordi-
nated statement of need under part B (where it has been 
initiated by the public health agency responsible for administer-
ing grants under part B) and in revisions of such statement. 
"(f) APPLICATION.—A grant under subsection (a) may be made 
only if an application for the grant is submitted to the Secretary 
and the application is in such form, is made in such manner, 
and contains such agreements, assurances, and information as the 
Secretary determines to be necessary to carry out this section. 
"(g) COORDINATION WITH NATIONAL INSTITUTES OF HEALTH.— 
The Secretary shall develop £ind implement a plan that provides 
for the coordination of the activities of the National Institutes 
of Health with the activities carried out under this section. In 
carrying out the preceding sentence, the Secretary shall ensure 
that projects of research conducted or supported by such Institutes 
are made aware of applicants and grantees under subsection (a), 
shall require that the projects, as appropriate, enter into arrange-
ments for purposes of such subsection, and shall require that each 
project entering into such an arrangement inform the applicant 
or grantee under such subsection of the needs of the project for 
the participation of women, infants, children, and youth. 
"(h) ANNUAL REVIEW OF PROGRAMS; EVALUATIONS.-— 
"(1) REVIEW REGARDING ACCESS TO AND PARTICIPATION IN 
PROGRAMS.—With respect to a grant under subsection (a) for 
an entity for a fiscal year, the Secretary shall, not later than 
180 days after the end of the fiscal year, provide for the conduct 
and completion of a review of the operation during the year 
of the program carried out under such subsection by the entity. 
The purpose of such review shall be the development of rec-
ommendations, as appropriate, for improvements in the follow-
ing: 
"(A) Procedures used by the entity to 
allocate 
opportunities and services under subsection (a) among 
patients of the entity who are women, infants, children, 
or youth. 
"(B) Other procedures or policies of the entity regarding 
the participation of such individuals in such program. 
"(2) EVALUATIONS.—The Secretary shall, directly or through 
contracts with public and private entities, provide for evalua-
tions of programs canied out pursuant to subsection (a), 
"(i) TRAINING AND TECHNICAL ASSISTANCE.—Of the amoimts 
appropriated under subsection (j) for a fiscal year, the Secretary 
may use not more than five percent to provide, directly or through 
contracts with public and private entities (which may include 
grantees under subsection (a)), training and technical assistance 
to assist applicants and grantees under subsection (a) in complying 
with the requirements of this section. 
"(j) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there are authorized to be appropriated 
110 STAT. 1362 
PUBLIC LAW 104-146—MAY 20, 1996 
such sums as may be necessary for each of the fiscal years 1996 
through 2000.". 
(f) EVALUATIONS AND REPORTS.—Section 2674 (42 U.S.C. 300ff-
74) is amended— 
(1) in subsection (b)— 
(A) in the matter preceding paragraph (1), by striking 
"not later than 1 year" and all that follows through "title," 
and inserting the following: "not later than October 1, 
1996,"; 
(B) by striking paragraphs (1) through (3) and inserting 
the following paragraph: 
"(1) evaluating the programs carried out under this title; 
and"; and 
(C) by redesignating paragraph (4) as paragraph (2); 
and 
(2) by adding at the end the following subsection: 
"(d) ALLOCATION OF FUNDS.—The Secretary shall carry out 
this section with amounts available under section 241. Such 
amounts are in addition to any other amoiuits that are available 
to the Secretary for such purpose.". 
(g) DEMONSTRATION AND TRAINING.— 
(1) IN GENERAL.—Title XXVI is amended by adding at 
the end, the following new part: 
"PART F—DEMONSTRATION AND TRAINING 
__ 
"Subpart I—Special Projects of National 
Significance 
42 use 300fF- 
«SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE. 
"(a) IN GENERAL.—Of the amoimt appropriated under each 
of parts A, B, C, £ind D 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 special projects of national significance 
program to award direct grants to public and nonprofit private 
entities including community-based organizations to fund special 
programs for the care and treatment of individuals with HIV dis-
ease. 
"(b) GRANTS.—The Secretary shall award grants under sub-
section (a) based on— 
"(1) the need to assess tiie effectiveness of a particular 
model for the care and treatment of individuals with HIV 
disease; 
"(2) the innovative nature of the proposed activity; and 
"(3) the potential replicability of the proposed activity in 
other similar localities or nationally. 
"(c) SPECIAL PROJECTS.—Special projects of national significance 
shall include the development and assessment of innovative service 
delivery models that are designed to— 
"(1) address the needs of special populations; 
"(2) assist in the development of essential community-based 
service delivery infi"astructure; and 
"(3) ensure the ongoing availability of services for Native 
American communities to enable such communities to care 
for Native Americans with HIV disease. 
PUBLIC L.\W 104-146—MAY 20, 1996 
110 STAT. 1363 
"(d) SPECIAL POPULATIONS.—Special projects of national signifi-
cance may include the delivery of HIV health care and support 
services to traditionally underserved populations 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 development of model 
approaches to delivering HIV care and support services including— 
"(1) programs that support family-based care networks and 
programs that build organizational capacity critical to the deliv-
ery of care in minority communities; 
"(2) programs designed to prepare AIDS service organiza-
tions and grantees under this title for operation within the 
changing health care environment; and 
"(3) programs designed to integrate the delivery of mental 
health and substance abuse treatment with HIV services. 
"(f) 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 applicant agrees to participate in the 
ongoing revision process of such statement of need. 
"(g) REPLICATION.—The Secretary shall make 
information 
concerning successful models developed under this part available 
to grantees under this title for the purpose of coordination, replica-
tion, and integration. To facilitate efforts under this subsection, 
the Secretary may provide for peer-based technical assistance from 
grantees funded under this part.". 
(2) REPEAL.—Subsection (a) of section 2618 (42 U.S.C. 
300fF-28(a)) is repealed, 
(h) HIV/AIDS COMMUNITIES, SCHOOLS, CENTERS.— 
(1) NEW PART.—Part F of title XXVI (as added by subsection 
(e)) is further amended by adding at the end, the following 
new subpart: 
"Subpart II—AIDS Education and Training 
Centers 
"SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.". 
42 USC SOOff-
(2) AMENDMENTS.—Section 776 (42 U.S.C. 294n) is amend- ^^^' 
ed— 
(A) by striking the section heading; and 
(B) in subsection (a)(1)— 
(i) by striking subparagraphs (B) and (C); 
(ii) by redesignating subparagraphs (A) and (D) 
as subparagraphs (B) and (C), respectively; 
(iii) by inserting before subparagraph (B) (as so 
redesignated) the following new subparagraph: 
"(A) training health personnel, including practitioners 
in title XXVI programs and other community providers, 
in the diagnosis, treatment, and prevention of HIV infection 
and disease, including the prevention of the perinatal trans-
110 STAT. 1364 
PUBLIC LAW 104-146—MAY 20, 1996 
mission of the disease and including measures for the 
prevention and treatment of opportunistic infections;"; and 
(iv) in subparagraph (B) (as so redesignated) by 
adding "and" £ifter the semicolon. 
(3) TRANSFER.—Section 776 (42 U.S.C. 294n) (as amended 
42USC300ff- 
by paragraph (2)) is amended by transferring such section 
111- 
to section 2692 (as added by paragraph (1)). 
(4) AUTHORIZATION OF APPROPRIATIONS.—Section 2692 (as 
42USC300ff- 
added by paragraph (1)) is amended by adding at the end 
111- 
thereof the following new subsection: 
"(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated to carry out this section, such sums as may 
be necessary for each of the fiscal years 1996 through 2000.". 
SEC. 4. 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 paragraph to an eligible area shall be 
made in an amount equal to the product o
f
— 
"(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 eligible area to the sum 
of the respective distribution factors for all eligible 
gireas. 
"(B) DISTRIBUTION FACTOR.—For purposes of subpara-
graph (A)(ii), the term 'distribution factor' means an 
amount equal to the estimated number of living cases 
of acquired immune deficiency syndrome in the eligible 
area involved, as determined under subparagraph (C). 
"(C) ESTIMATE OF LIVING CASES.—The amount deter-
mined in this subparagraph is an amount equal to the 
product o
f
— 
"(i) the number of cases of acquired immune defi-
ciency syndrome in the eligible area during each year 
in the most recent 120-month period for which data 
are available with respect to all eligible areas, as 
indicated by the number of such cases reported to 
and confirmed by the Director of the Centers for Dis-
ease Control and Prevention 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; 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1365 
"(IX) the ninth year during such period, .57; 
and 
"(X) the tenth year during such period, .88. 
The yearly percentage described in subparagraph (ii) shall 
be updated biennially by the Secretary, after consultation 
with the Centers for Disease Control and Prevention. The 
first such update shall occur prior to the determination 
of grant awards under this part for fiscal year 1998. 
"(D) 
UNEXPENDED FUNDS.—The Secretary may, 
in 
determining the amount of a grant for a fiscal year under 
this paragraph, adjust the grant amount to reflect the 
amount of unexptjnded £ind uncanceled grant funds remain-
ing 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.". 
SEC. 5. AMOUNT OF CARE GRANTS. 
Paragraphs (1) and (2) of section 2618(b) (42 U.S.C. 300ff-
28(b) (1) and (2)) are amended to read as follows: 
"(1) 
MINIMUM 
^^LLOTMENT.—Subject to the extent of 
amounts made available under section 2677, the amount of 
a grant to be made under this part for— 
"(A) each of the several States and the District of 
Columbia for a fiscal year shall be the greater o
f
— 
"(i)(I) with respect to a State or District that has 
less than 90 living cases of acquired immune deficiency 
syndrome, as determined under paragraph (2)(D), 
$100,000; or 
"(II) with respect to a State or District that has 
90 or more living cases of acquired immune deficiency 
syndrome, as determined under paragraph (2)(D), 
$250,000; 
"(ii) an amount determined under paragraph (2); 
and 
"(B) each territory of the United States, as defined 
in paragraph (3), shall be an amount determined under 
paragraph (2). 
"(2) DETERMINATION.— 
"(A) FORMULA.—The amount referred to in paragraph 
(l)(A)(ii) for a State suid paragraph (1)(B) for a territory 
of the United States shall be the product of— 
"(i) an amount equal to the amount appropriated 
under section 2677 for the fiscal year involved for 
grants under part B, subject to subparagraph (H); and 
"(ii) the percentage constituted by the sum of— 
"(I) the product of .80 and the ratio of the 
State distribution factor for the State or territory 
(as determined under subsection (B)) to the sum 
of the respective State distribution factors for all 
States or territories; and 
"(II) the product of .20 and the ratio of the 
non-EMA distribution factor for the State or terri-
tory (as determined under subparagraph (O) to 
the sum of the respective distribution factors for 
all States or territories. 
110 STAT. 1366 
PUBLIC LAW 104-146—MAY 20, 1996 
"(B) STATE DISTRIBUTION FACTOR.—For purposes of 
subparagraph (A)(ii)(I), the term 'State distribution factor' 
means an amount equal to the estimated number of Hving 
cases of acquired immune deficiency syndrome in the 
eligible area involved, as determined under subparagraph 
(D). 
"(C) NoN-EMA DISTRIBUTION FACTOR.—For purposes of 
subparagraph (A)(ii)(II), the term *non-ema distribution fac-
tor' means an amount equal to the sum of— 
"(i) the estimated number of living cases of 
acquired immune deficiency syndrome in the State or 
territory involved, as determined under subparagraph 
(D); less 
"(ii) the estimated number of living cases of 
acquired immune deficiency syndrome in such State 
or territory that are within an eligible area (as deter-
mined imder part A). 
"(D) ESTIMATE OF LIVING CASES.—The amount deter-
mined in this subparagraph is an amount equal to the 
product of— 
"(i) the number of cases of acquired immune defi-
ciency syndrome in the State or territory during each 
year in the most recent 120-month period for which 
data are available with respect to all States and terri-
tories, as indicated by the number of such cases 
reported to and confirmed by the Director of the Cen-
ters for Disease Control and Prevention for each year 
during such period; and 
"(ii) with respect to each of the first through the 
tenth year during such period, the amount referred 
to in section 2603(aX3)(C)(ii). 
"(E) PUERTO RICO, VIRGIN ISLANDS, GUAM.—For pur-
poses of subparagraph (D), the cost index for Puerto Rico, 
the Virgin Islands, and (xuam shall be 1.0. 
"(F) UNEXPENDED FUNDS.—The Secretary may, in 
determining the amount of a grant for a fiscal year under 
this subsection, adjust the grant amount to reflect the 
amoiint of unexpended and uncanceled grant funds remain-
ing 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. 
"(G) LIMITATION.— 
"(i) IN GENERAL.—The Secretary shall ensure that 
the amoimt of a grant awarded to a State or territory 
for a fiscal year under this part is equal to not less 
than— 
"(I) with respect to fiscal year 1996, 100 per-
cent; 
"(II) with respect to fiscal year 1997, 99 per-
cent; 
"(III) with respect to fiscal year 1998, 98 per-
cent; 
"(IV) with respect to fiscal year 1999, 96.5 
percent; and 
"(V) with respect to fiscal year 2000, 95 per-
cent; 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1367 
of the amount such State or territory received for fiscal 
year 1995 under this part. In administering this 
subparagraph, the Secretary shall, with respect to 
States that will receive grants in amounts that exceed 
the amounts that such States received under this part 
in fiscal year 1995, proportionally reduce such amounts 
to ensure compliance with this subparagraph. In mak-
ing such reductions, the Secret£u*y shall ensure that 
no such State receives less than that State received 
for fiscal year 1995. 
"(ii) RATABLE REDUCTION.—If the amount appro-
priated under section 2677 and available for allocation 
under this part is less than the amount appropriated 
and available under this part for fiscal year 1995, 
the limitation contained in clause (i) shall be reduced 
by a percentage equal to the percentage of the reduc-
tion in such amounts appropriated and available. 
"(H) 
APPROPRIATIONS 
FOR TREATMENT 
DRUG 
PRO-
GRAM.—^With respect to the fiscal year involved, if under 
section 2677 an appropriations Act provides an amount 
exclusively for carrying out section 2616, the portion of 
such amount allocated to a State shall be the product 
of— 
"(i) 100 percent of such amount; and 
"(ii) the percentage constituted by the ratio of the 
State distribution factor for the State (as determined 
under subparagraph (B)) to the sum of the State dis-
tribution factors for all States.". 
SEC. 6. CONSOLroATION OF AUTHORIZATIONS OF APPROPRIATIONS. 
(a) IN GENERAL.—Part D of title XXVI (42 U.S.C. 300ff'-71) 
is amended by adding at the end thereof the following new section: 
"SEC. 2677. AUTHORIZATION OF APPROPRIATIONS. 
42 USC 300ff-77. 
"(a) IN GENERAL.—Subject to subsection (b), there are author-
ized to be appropriated to make grants under parts A and B, 
such sums as may be necessary for each of the fiscal years 1996 
through 2000. 
"(b) DEVELOPMENT OF METHODOLOGY.— 
"(1) IN GENERAL.—^With respect to each of the fiscal years 
1997 through 2000, the Secretary shall develop and implement 
a methodology for adjusting the percentages allocated to part 
A and part B to account for grants to new eligible areas under 
part A and other relevEint factors. Not later than July 1, 1996, Reports, 
the Secretary shall prepare and submit to the appropriate 
committees of Congress a report regarding the findings with 
respect to the methodology developed under this paragraph. 
"(2) FAILURE TO IMPLEMENT.—If the Secretary determines 
that such a methodology under paragraph (1) cannot be devel-
oped, there are authorized to be appropriated— 
"(A) such sums as may be necessary to carry out part 
A for each of the fiscal years 1997 through 2000; and 
"(B) such sums as may be necessary to carry out part 
B for each of the fiscal years 1997 through 2000.". 
(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 (42 U.S.C. 300ff'-13)— 
110 STAT. 1368 
PUBLIC LAW 104-146—MAY 20, 1996 
(A) in subsection (a)(2), by striking "2608" and insert-
ing "2677"; and 
(B) in subsection (b)(1), by striking "2608" and insert-
ing "2677"; 
(2) in section 2605(c)(1) (42 U.S.C. 300ff-15(c)(l)) is amend-
ed by striking "2608" and inserting "2677"; and 
(3) in section 2618 (42 U.S.C. 300ff-28)— 
(A) in subsection (a)(1), is amended by striking "2620" 
and inserting "2677"; and 
(B) in subsection (b)(1), is amended by striking "2620" 
and inserting "2677". 
SEC. 7. PERINATAL TRANSMISSION OF HIV DISEASE. 
42 use 300fr-33 
(a) FINDINGS.—The Congress finds as follows: 
note. 
^ 
(1) Research studies and statewide clinical experiences 
have demonstrated that administration of anti-retroviral medi-
cation during pregnancy can significantly reduce the trans-
mission of the human immunodeficiency virus (commonly 
known as HIV) from an infected mother to her baby. 
(2) The Centers for Disease Control and Prevention have 
recommended that all pregnant women receive HIV counseling; 
voluntary, confidential HIV testing; gind appropriate medical 
treatment (including anti-retroviral therapy) and support serv-
ices. 
(3) The provision of such testing without access to such 
counseling, treatment, and services will not improve the health 
of the woman or the child. 
(4) The provision of such counseling, testing, treatment, 
and services can reduce the number of pediatric cases of 
acquired immune deficiency s3nidrome, can improve access to 
and provision of medical care for the woman, and can provide 
opportunities for counseling to reduce transmission among 
adults, and fi-om mother to child. 
(5) The provision of such counseling, testing, treatment, 
and services can reduce the overall cost of pediatric cases 
of acquired immune deficiency s5Tidrome. 
(6) The cancellation or limitation of health insurance or 
other health coverage on the basis of HIV status should be 
impermissible under applicable law. Such cancellation or limita-
tion could result in disincentives for appropriate counseling, 
testing, treatment, and services. 
(7) For the reasons specified in paragraphs (1) through 
( 6 ) -
(A) routine HIV counseling and voluntary testing of 
pregnant women should become the standard of care; and 
(B) the relevant medical organizations as well as public 
health officials should issue guidelines making such coun-
seling and testing the standard of care. 
(b) ADDITIONAL REQUIREMENTS FOR GRANTS.—Part B of title 
XXVI (42 U.S.C. 300ff-21 et seq.) is amended— 
(1) by inserting after the part heading the following: 
"Subpart I—General Grant Provisions"; 
42 use 300ff-2l. 
(2) in section 2611(a), by adding at the end the following 
sentence: "The authority of the Secretary to provide grants 
under part B is subject to section 2626(e)(2) (relating to the 
decrease in perinatal transmission of HIV disease)."; and 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1369 
(3) by adding at the end thereof the following new subpart: 
"Subpart II—Provisions Concerning Pregnancy 
and Perinatal Transmission of HIV 
"SEC. 2625. CDC GUmELINES FOR PREGNANT WOMEN. 
42 USC 300ff-33 
"(a) REQUIREMENT.—Notwithstanding any other provision of Certification. 
law, a State shall, not later than 120 days after the date of enact-
ment of this subpart, certify to the Secretary that such State has 
in effect regulations or measures to adopt the guidelines issued 
by the Centers for Disease Control and Prevention concerning rec-
ommendations for humgin immunodeficiency virus counseling and 
voluntary testing for pregnant women. 
"(b) NONCOMPLIANCE.—If a State does not provide the certifi-
cation required under subsection (a) within the 120-day period 
described in such subsection, such State shall not be eligible to 
receive assistance for HIV counseling and testing under this section 
until such certification is provided. 
"(c) ADDITIONAL FUNDS REGARDING WOMEN AND INFANTS.— 
"(1) IN GENERAL.—If a State provides the certification 
required in subsection (a) gmd is receiving funds under part 
B for a fiscal year, the Secretary may (from the amounts 
available pursuant to paragraph (2)) make a grant to the State 
for the fiscal year for the following purposes: 
"(A) Making available to pregnant women appropriate 
counseling on HIV disease. 
"(B) Making available outreach efforts to pregnant 
women at high risk of HIV who are not currently receiving 
prenatal care. 
"(C) Making available to such women voluntary HIV 
testing for such disease. 
"(D) Offsetting other State costs associated with the 
implementation of this section and subsections (a) and 
(b) of section 2626. 
"(E) Offsetting 
State 
costs 
associated 
with 
the 
implementation of mandatory newborn testing in accord-
ance with this title or at an earlier date than is required 
by this title. 
"(2) FUNDING.—For purposes of carr/ing out this sub-
section, there are authorized to be appropriated $10,000,000 
for each of the fiscal years 1996 through 2000. Amounts made 
available under section 2677 for carrying out this part are 
not available for carrying out this section unless otherwise 
authorized. 
"(3) PRIORITY.—In awarding grants under this subsection 
the Secretary shall give priority to States that have the greatest 
proportion of HIV seroprevalance among child bearing women 
using the most recent data available as determined by the 
Centers for Disease Control and Prevention. 
"SEC. 2626. PERINATAL TRANSMISSION OF HIV DISEASE; CONTINGENT 42 USC 300ff-34. 
REQUIREMENT REGARDING STATE GRANTS UNDER THIS 
PART. 
"(a) ANNUAL DETERMINATION OF REPORTED CASES.—A State 
shall annually determine the rate of reported cases of AIDS as 
a result of perinatal transmission among residents of the State. 
29-194 O - 96 - 19 : QL 3 Part 2 
110 STAT. 1370 
PUBLIC LAW 104-146—MAY 20, 1996 
"(b) CAUSES OF PERINATAL TRANSMISSION.—In determining the 
rate under subsection (a), a State shall also determine the possible 
causes of perinatal transmission. Such causes may include— 
"(1) the inadequate provision within the State of prenatal 
counseling and testing in accordance with the guidelines issued 
by the Centers for Disease Control and Prevention; 
"(2) the inadequate provision or utilization within the State 
of appropriate therapy or failure of such therapy to reduce 
perinatal transmission of HIV, including— 
"(A) that therapy is not available, accessible or offered 
to mothers; or 
"(B) that available therapy is offered but not accepted 
by mothers; or 
"(3) other factors (which may include the lack of prenatal 
care) determined relevant by the State. 
"(c) CDC REPORTING SYSTEM.—Not later than 4 months after 
the date of enactment of this subpart, the Director of the Centers 
for Disease Control and Prevention shall develop and implement 
a system to be used by States to comply with the requirements 
Gmdelines. 
of subsections (a) and (b). The Director shall issue guidelines to 
ensure that the data collected is statistically valid. 
Federal Register, 
"(d) DETERMINATION BY SECRETARY.—^Not later t h a n 180 days 
publication. 
after the expiration of the 18-month period beginning on the date 
on which the system is implemented under subsection (c), the 
Secretary shall publish in the Federal Register a determination 
of whether it has become a routine practice in the provision of 
health care in the United States to carry out each of the activities 
described in paragraphs (1) through (5) of section 2627. In making 
the determination, the Secretary shall consult with the States and 
with other public or private entities that have knowledge or exper-
tise relevant to the determination. 
"(e) CONTINGENT APPLICABILITY.— 
"(1) IN GENERAL.—^If the determination published in the 
Federal Register under subsection (d) is that (for purposes 
of such subsection) the activities involved have become routine 
practices, paragraph (2) shall apply on and after the expiration 
of the 18-month period beginning on the date on which the 
determination is so published. 
"(2) REQUIREMENT.—Subject to subsection (f), the Secretary 
shall not make a grant under part B to a State unless the 
State meets not less than one of the following requirements: 
"(A) A 50 percent reduction (or a comparable measure 
for States with less than 10 cases) in the rate of new 
cases of AIDS (recognizing that AIDS is a suboptimal proxy 
for tracking HIV in infants and was selected because such 
data is universally available) as a result of perinatal trans-
mission as compared to the rate of such cases reported 
in 1993 (a State may use HIV data if such data is avail-
able). 
"(B) At least 95 percent of women in the State who 
have received at least two prenatal visits (consultations) 
prior to 34 weeks gestation with a health care provider 
or provider group have been tested for the human 
immunodeficiency virus. 
"(C) The State has in effect, in statute or through 
regulations, the requirements specified in paragraphs (1) 
through (5) of section 2627. 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1371 
"(f) 
LIMITATION REGARDING AVAILABILITY OF FUNDS.—With 
respect to an activity described in any of paragraphs (1) through 
(5) of section 2627, the requirements estabUshed by a State under 
this section apply for purposes of this section only to the extent 
that the following sources of funds are available for earring out 
the activity: 
"(1) Federal funds provided to the State in grants under 
part B or under section 2625, or through other Federal sources 
under which payments for routine HIV testing, counseling or 
treatment are an eligible use. 
"(2) Funds that the State or private entities have elected 
to provide, including through entering into contracts under 
which health benefits are provided. This section does not 
require any entity to expend non-Federal funds. 
"SEC. 2627. TESTING OF PREGNANT WOMEN AND NEWBORN INFANTS. 
42 USC 300ff-35. 
"An activity or requirement described in this section is any 
of the following: 
"(1) In the case of newborn infants who are born in the 
State and whose biological mothers have not undergone pre-
natal testing for HIV disease, that each such infant undergo 
testing for such disease. 
"(2) That the results of such testing of a newborn infant 
be promptly disclosed in accordance with the following, as 
applicable to the infant involved: 
"(A) To the biological mother of the infant (without 
regard to whether she is the legal guardian of the infant). 
"(B) If the State is the legal guardian of the infant: 
"(i) To the appropriate official of the State agency 
with responsibility for the care of the infant. 
"(ii) To the appropriate official of each authorized 
agency providing assistance in the placement of the 
infant. 
"(iii) If the authorized agency is giving significant 
consideration to approving an individual as a foster 
parent of the infant, to the prospective foster parent. 
"(iv) If the authorized agency is giving significant 
consideration to approving an individual as an adoptive 
parent of the infant, to the prospective adoptive parent. 
"(C) If neither the biological mother nor the State 
is the legal guardian of the infant, to another legal guardian 
of the infant. 
"(D) To the child's health care provider. 
"(3) That, in the case of prenatal testing for HIV disease 
that is conducted in the State, the results of such testing 
be promptly disclosed to the pregnant woman involved. 
"(4) That, in disclosing the test results to an individual 
under paragraph (2) or (3), appropriate counseling on the 
himian immunodeficiency virus be made available to the 
individual (except in the case of a disclosure to an official 
of a State or an authorized agency). 
"(5) With respect to State insurance laws, that such laws 
require— 
"(A) that, if health insurance is in effect for an individ-
ual, the insurer involved may not (without the consent 
of the individual) discontinue the insurance, or alter the 
terms of the insurance (except as provided in subparagraph 
110 STAT. 1372 
PUBLIC LAW 104-146—MAY 20, 1996 
(O), solely on the basis that the individual is infected 
with HIV disease or solely on the basis that the individual 
has been tested for the disease or its manifestation; 
"(B) that subparagraph (A) does not apply to an individ-
ual who, in appl3dng for the health insurance involved, 
knowingly misrepresented the HIV status of the individual; 
and 
"(C) that subparagraph (A) does not apply to any 
reasonable alteration in the terms of health insurance for 
an individual with HIV disease that would have been made 
if the individual had a serious disease other than HIV 
disease. 
For purposes of this subparagraph, a statute or regulation 
shall be deemed to regulate insurance for purposes of this 
paragraph only to the extent that such statute or regulation 
is treated as regulating insurance for purposes of section 
514(b)(2) of the Employee Retirement Income Security Act of 
1974. 
42 use 300ff-36. 
"SEC. 2628. REPORT BY THE INSTITUTE OF MEDICINE. 
"(a) IN GENERAL.—The Secretary shall request that the 
Institute of Medicine of the National Academy of Sciences conduct 
an evaluation of the extent to which State efforts have been effective 
in reducing the perinatal transmission of the human immuno 
deficiency virus, and an analysis of the existing barriers to the 
further reduction in such transmission. 
"(b) REPORT TO CONGRESS.—The Secretary shall ensure that, 
not later than 2 years after the date of enactment of this section, 
the evaluation and analysis described in subsection (a) is completed 
and a report summarizing the results of such evaluation and analy-
sis is prepared by the Institute of Medicine and submitted to the 
appropriate committees of Congress together with the recommenda-
tions of the Institute. 
42 use 300ff-37. 
42 use 300ff-
27a. 
"SEC. 2629. STATE HIV TESTING PROGRAMS ESTABLISHED PRIOR TO 
OR AFTER ENACTMENT. 
"Nothing in this subpart shall be construed to disqualify a 
State from receiving grants under this title if such State has estab-
lished at any time prior to or after the date of enactment of 
this subpart a program of mandatory HIV testing.". 
SEC. 8. SPOUSAL NOTIFICATION. 
(a) IN GENERAL.—The Secretary of Health and Human Services 
shall not make a grant under part B of title XXVI of the Public 
Health Service Act (42 U.S.C. 300ff-21 et seq.) to any State unless 
such State takes administrative or legislative action to require 
that a good faith effort be made to notify a spouse of a known 
HIV-infected patient that such spouse may have been exposed to 
the human immunodeficiency virus and should seek testing. 
(b) DEFINITIONS.—For purposes of this section: 
(1) SPOUSE.—The term "spouse" means any individual who 
is the marriage partner of an HIV-infected patient, or who 
has been the marriage partner of that patient at any time 
within the 10-year period prior to the diagnosis of HIV infection. 
(2) 
HIV-INFECTED 
PATIENT.—The 
term 
"HIV-infected 
patient" means any individual who has been diagnosed to be 
infected with the human immunodeficiency virus. 
PUBLIC LAW 104-146—MAY 20, 1996 
110 STAT. 1373 
(3) STATE.—The term "State" means any of the 50 States, 
the District of Columbia, or any territory of the United States. 
SEC. 9. OPTIONAL PARTICIPATION OF FEDERAL EMPLOYEES IN AIDS 5 USC 4103 note 
TRAINING PROGRAMS. 
(a) IN GENERAL.—^Notwithstanding any other provision of law, 
a Federal employee may not be required to attend or participate 
in an AIDS or HIV training program if such employee refuses 
to consent to such attendance or participation, except for training 
necessary to protect the health and safety of the Federal employee 
and the individuals served by such employees. An employer may 
not retaliate in any manner against such an employee because 
of the refusal of such employee to consent to such attendance 
or participation. 
(b) DEFINITION.—^As used in subsection (a), the term "Federal 
employee" has the same meaning given the term "employee" in 
section 2105 of title 5, United States Code, and such term shall 
include members of the armed forces. 
SEC. 10. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES. 
Part D of title XXVI of the Public Health Service Act (42 
U.S.C. 300ff-71) as amended by section 6, is further amended 
by adding at the end thereof the following new section: 
"SEC. 2678. PROmBITION ON PROMOTION OF CERTAIN ACTIVITIES. 42 USC 300ff-78. 
"None of the funds authorized under this title shall be used 
to fund AIDS programs, or to develop materials, designed to promote 
or encourage, directly, intravenous drug use or sexual activity, 
whether homosexual or heterosexual. Funds authorized under this 
title may be used to provide medical treatment and support services 
for individuals with HIV.". 
SEC. 11. LIMITATION ON APPROPRIATIONS. 
Notwithstanding any other provision of law, the total amovmts 
of Federal funds expended in any fiscal year for AIDS and HIV 
activities may not exceed the total amounts expended in such fiscal 
year for activities related to cancer. 
SEC. 12. ADDITIONAL PROVISIONS. 
(a) DEFINITIONS.—Section 2676(4) (42 U.S.C. 300ff-76(4)) is 
amended by inserting "funeral-service practitioners," after "emer-
gency medical technicians,". 
(b) MISCELLANEOUS AMENDMENT.—Section 1201(a) (42 U.S.C. 
300d(a)) is amended in the matter preceding paragraph (1) by 
striking "The Secretary," and all that follows through "shall," and 
inserting "The Secretary shall,". 
(c) TECHNICAL CORRECTIONS.—Title XXVI (42 U.S.C. 300ff-
11 et seq.) is amended— 
(1) in section 2601(a), by inserting "section" before "2604"; 42 USC 300ff-ll. 
(2) in section 2603(b)(4)(B), by striking "an expedited 
42 USC 300ff-l3. 
grants" and inserting "an expedited grant"; 
(3) in section 2617(b)(3)(B)(iv), by inserting "section" before 
42 USC 300ff-27. 
"2615"; 
(4) in section 2647— 
42 USC 300ff-47. 
(A) in subsection (a)(1), by inserting "to" before "HIV"; 
(B) in subsection (c), by striking "section 2601" and 
inserting "section 2641"; and 
(C) in subsection (d)— 
42 USC 3
0
0
C
C 
note. 
110 STAT. 1374 
PUBLIC LAW 104-146—MAY 20, 1996 
42 use 300ff-48. 
42 use 300ff-49. 
42 use 300ff-51. 
42 use 300ff-76. 
42 use 300ff-84. 
42 use 300ff-ll 
note. 
(i) in the matter preceding paragraph (1), by strik-
ing "section 2601" and inserting "section 2641"; and 
(ii) in paragraph (1), by striking "has in place" 
and inserting "will have in place"; 
(5) in section 2648— 
(A) by converting the heading for the section to boldface 
type; and 
(B) by redesignating the second subsection (g) as sub-
section (h); 
(6) in section 2649— 
(A) in subsection (b)(1), by striking "subsection (a) of; 
and 
(B) in subsection (c)(1), by striking "this subsection" 
and inserting "subsection"; 
(7) in section 2651— 
(A) in subsection (b)(3)(B), by striking "facility" and 
inserting "facilities"; and 
(B) in subsection (c), by striking "exist" and inserting 
"exists"; 
(8) in section 2676— 
(A) in paragraph (2), by striking "section" and all that 
follows through "by the" and inserting "section 2686 by 
the"; and 
(B) in paragraph (10), by striking "673(a)" and insert-
ing "673(2)"; 
(9) in part E, by converting the headings for subparts 
I and II to RoniEin typeface; and 
(10) in section 2684(b), in the matter preceding paragraph 
(1), by striking "section 2682(d)(2)" and inserting "section 
2683(d)(2)". 
SEC. 13. 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, 1996. 
(b) EXCEPTION.—^The amendments made by sections 3(a), 5, 
6, and 7 of this Act to sections 2601(c), 2601(d), 2603(a), 2618(b), 
2626, 2677, and 2691 of the Public Health Service Act, shall become 
effective on the date of enactment of this Act. 
Approved May 20, 1996. 
LEGISLATIVE HISTORY—S. 641 (H.R. 1872): 
HOUSE REPORTS: Nos. 104-245 accompanying H.R. 1872 (Comm. on Commerce) 
and 104-545 (Comm. of Conference). 
SENATE REPORTS: No. 104-25 (Comm. on Labor and Human Resources). 
CONGRESSIONAL RECORD: 
Vol. 141 (1995): July 21, 26, 27, considered and passed Senate. 
Sept. 18, H.R. 1872 considered and passed House; S. 641, 
amended, passed in lieu. 
Vol. 142 (1996): May 1, House agreed to conference report. 
May 2, Senate agreed to conference report. 
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 32 (1996): 
May 20, Presidential remarks and statement.