[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 2489 Introduced in Senate (IS)]

103d CONGRESS
  2d Session
                                S. 2489

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

           September 30 (legislative day, September 12), 1994

    Mr. Kennedy (for himself, Mr. Hatch, Mr. Akaka, Mr. Biden, Mr. 
Bingaman, Mrs. Boxer, Mr. Bradley, Mr. Breaux, Mr. Bryan, Mr. Bumpers, 
Mr. Campbell, Mr. Chafee, Mr. D'Amato, Mr. Daschle, Mr. DeConcini, Mr. 
  Dodd, Mr. Durenberger, Mr. Feingold, Mrs. Feinstein, Mr. Glenn, Mr. 
Graham, Mr. Harkin, Mr. Hatfield, Mr. Inouye, Mr. Jeffords, Mr. Kerry, 
   Mr. Kohl, Mr. Leahy, Mr. Lieberman, Mr. Mack, Mr. Metzenbaum, Ms. 
 Mikulski, Mr. Mitchell, Ms. Moseley-Braun, Mr. Moynihan, Mrs. Murray, 
Mr. Packwood, Mr. Pell, Mr. Pryor, Mr. Reid, Mr. Riegle, Mr. Robb, Mr. 
   Sarbanes, Mr. Simon, Mr. Specter, Mr. Wellstone, and Mr. Wofford) 
introduced the following bill; which was read twice and referred to the 
                 Committee on Labor and Human Resources

_______________________________________________________________________

                                 A BILL


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

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ryan White CARE Reauthorization Act 
of 1994''.

SEC. 2. REFERENCES.

    Whenever in this Act an amendment is expressed in terms of an 
amendment to a section or other provision, the reference shall be 
considered to be made to a section or other provision of title XXVI of 
the Public Health Service Act (42 U.S.C. 300ff et seq.).

SEC. 3. AMENDMENTS.

    (a) Establishment of Grant Program.--Section 2601 (42 U.S.C. 300ff-
11) is amended by adding at the end thereof the following new 
subsection:
    ``(c) Population of Eligible Areas.--The Secretary may not make a 
grant to an eligible area under subsection (a) after the date of 
enactment of this subsection unless the area has a population of at 
least 500,000 individuals, except that this subsection shall not apply 
to areas that are eligible as of March 31, 1994. For purposes of 
eligibility under this title, the boundaries of each metropolitan area 
shall be those in effect in fiscal year 1994.''.
    (b) Emergency Relief for Areas With Substantial Need for 
Services.--
            (1) Health services planning council.--Subsection (b) of 
        section 2602 (42 U.S.C. 300ff-12(b)) is amended--
                    (A) in paragraph (1), by striking ``include'' and 
                all that follows through the end thereof, and inserting 
                ``be reflective of the demographics of the HIV epidemic 
                in the eligible area involved, with particular 
                consideration given to disproportionately affected and 
                historically underserved groups.'';
                    (B) in paragraph (2), by adding at the end thereof 
                the following new subparagraph:
                    ``(C) Chairperson.--A planning council may not be 
                chaired solely by an employee of the grantee.'';
                    (C) in paragraph (3)--
                            (i) by striking ``and'' at the end of 
                        subparagraph (B);
                            (ii) by striking the period at the end of 
                        subparagraph (C) and inserting ``, and at the 
                        discretion of the planning council, assess the 
                        effectiveness, either directly or through 
                        contractual arrangements, of the services 
                        offered in meeting the identified needs; and''; 
                        and
                            (iii) by adding at the end thereof the 
                        following new subparagraph:
                    ``(D) participate in the development of the 
                Statewide coordinated statement of need initiated by 
                the State health department.'';
                    (D) by redesignating paragraphs (2) and (3) as 
                paragraphs (3) and (4), respectively; and
                    (E) by inserting after paragraph (1), the following 
                new paragraph:
            ``(2) Representation.--The HIV health services planning 
        council shall include representatives of--
                    ``(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 of 
                color, women, and gay and bisexual men;
                    ``(H) individuals with HIV or AIDS;
                    ``(I) nonelected community leaders;
                    ``(J) State government (including the State 
                medicaid agency);
                    ``(K) grantees under subpart II of part C;
                    ``(L) grantees under section 2671, or, if none are 
                operating in the area, pediatric, youth, and women's 
                service organizations operating in the area; and
                    ``(M) grantees under other Federal HIV programs.''.
            (2) Distribution of grants.--Section 2603 (42 U.S.C. 300ff-
        13) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (2)--
                                    (I)  by  striking  ``Not  later 
                                than--'' and all that follows through 
                                ``the Secretary shall'' and inserting 
                                the following: ``Not later than 60 days 
                                after an appropriation becomes 
                                available to carry out this part for 
                                each of the fiscal years 1996 through 
                                2000, the Secretary shall''; and
                                    (II) by inserting ``or the 
                                provisions of subsection (a)(3)(D)'' 
                                after ``section 2605(c)'';
                            (ii) in paragraph (3)(A)(ii)--
                                    (I) by striking ``product of 3'' in 
                                subclause (I), and inserting ``product 
                                of 9''; and
                                    (II) by striking ``equal to the 
                                product'' in subclause (II), and 
                                inserting ``amount equal to twice the 
                                product'';
                            (iii) in paragraph (3)(B)(i), by striking 
                        ``cumulative number of cases'' and inserting 
                        ``for the 10 years prior to the fiscal year in 
                        question'';
                            (iv) in paragraph (3)(C)--
                                    (I) by striking ``cumulative 
                                cases'' in clause (i), and inserting 
                                ``the number of cases reported and 
                                confirmed for the 10 years prior to the 
                                fiscal year in question''; and
                                    (II) by striking ``cumulative such 
                                cases'' in clause (ii), and inserting 
                                ``the number of cases reported and 
                                confirmed for the 10 years prior to the 
                                fiscal year in question''; and
                            (v) by adding at the end of paragraph (3), 
                        the following new subparagraph:
                    ``(D) Minimum amount.--No eligible area shall 
                receive an amount less than that awarded under 
                subsection (a) to such area in fiscal year 1995, except 
                for cause, as determined by the Secretary based on a 
                finding of fraud or an egregious violation by the 
                grantee of the provisions of this Act.''; and
                    (B) in subsection (b)(1)--
                            (i) by striking ``and'' at the end of 
                        subparagraph (D);
                            (ii) by striking the period at the end of 
                        subparagraph (E) and inserting a 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 Statewide coordinated 
                statement of need.''.
            (3) Use of amounts.--Section 2604 (42 U.S.C. 300ff-14) is 
        amended--
                    (A) in subsection (b)(1)(A), by inserting 
                ``treatment education and prophylactic treatment for 
                opportunistic infections,'' after ``treatment 
                services,''; and
                    (B) in subsection (e) by striking ``reporting, and 
                program oversight functions'' and inserting 
                ``reporting, and the assessment of program 
                effectiveness''.
            (4) Application.--Section 2605(a) (42 U.S.C. 300ff-15(a)) 
        is amended--
                    (A) in paragraph (1)(B), by striking ``1-year 
                period'' and all that follows through ``eligible area'' 
                and inserting ``preceding fiscal year'';
                    (B) in paragraph (4), by striking ``and'' at the 
                end thereof;
                    (C) in paragraph (5), by striking the period at the 
                end thereof and inserting ``; and''; and
                    (D) 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 
        process where it has been initiated by the State, and ensure 
        that the services provided under the comprehensive plan are 
        consistent with the Statewide coordinated statement of need.''.
            (5) Technical assistance.--Section 2606 (42 U.S.C. 300ff-
        16) is amended--
                    (A) by striking ``may'' and inserting ``shall'';
                    (B) by inserting after ``technical assistance'' the 
                following: ``, including peer based assistance 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 projected to be 
                eligible for funding under section 2601 in the 
                following fiscal year. Not to exceed 1 percent of the 
                amount appropriated for a fiscal year under section 
                2608 may be used to carry out this section.''.
            (6) Authorization of appropriations.--Section 2608 (42 
        U.S.C. 300ff-18) is amended by striking ``$275,000,000'' and 
        all that follows through the end of the section, and inserting 
        ``such sums as may be necessary in each of the fiscal years 
        1996, 1997, 1998, 1999, and 2000.''.
    (b) Care Grant Program.--
            (1) Infants and women.--Subsection (b) of section 2612 (42 
        U.S.C. 300ff-22) is amended to read as follows:
    ``(b) Infants and Women.--For each State in which the infants, 
children, adolescents, and women comprise greater than 10 percent of 
the AIDS cases reported to and confirmed by the Centers for Disease 
Control and Prevention for the 2 most recent fiscal years in such 
State, not less than 15 percent of funds allocated under this part 
shall be used to provide health and support services to infants, 
children, women, and families with HIV disease. With respect to a State 
in which infants, children, youth, and women comprise less than 10 
percent of AIDS cases reported to and confirmed by the Centers for 
Disease Control and Prevention for the 2 most recent fiscal years in 
such State, planning activities under part B in such State shall assess 
unmet needs and address the service needs of such populations in their 
applications.''.
            (2) HIV care consortia.--Section 2613 (42 U.S.C. 300ff-23) 
        is amended--
                    (A) in subsection (a)(2)(A), by inserting 
                ``prophylactic treatment for opportunistic infections, 
                treatment education,'' after ``monitoring,'';
                    (B) in subsection (c)--
                            (i) in subparagraph (C) of paragraph (1), 
                        by inserting before ``care'' ``and youth 
                        centered''; and
                            (ii) in paragraph (2)--
                                    (I) in clause (ii) of subparagraph 
                                (A), by striking ``served; and'' and 
                                inserting ``served;'';
                                    (II) in subparagraph (B), by 
                                striking the period at the end and 
                                inserting ``; and''; and
                                    (III) by adding after subparagraph 
                                (B), the following new subparagraph:
                    ``(C) representatives of organizations with a 
                history of serving children, youth, and women and 
                operating in the community to be served.''; and
                    (C) in subsection (d) to read as follows:
    ``(d) Definition.--As used in this part, the terms `family centered 
care' and `youth centered care' mean the system of services described 
in this section that is targeted specifically to the special needs of 
infants, children (including those orphaned by the AIDS epidemic), 
youth, women, and families. Family centered and youth centered care 
shall be based on a partnership among parents, extended family members, 
children and youth, professionals, and the community designed to ensure 
an integrated, coordinated, culturally sensitive, and community-based 
continuum of care.''.
            (3) Provision of treatments.--Section 2616 (42 U.S.C. 
        300ff-26) is amended by striking subsection (c) and inserting 
        the following new subsections:
    ``(c) Standards for Treatment Programs.--In carrying out this 
section, the Secretary shall--
            ``(1) review the current status of State drug reimbursement 
        programs and assess barriers to the expended availability of 
        prophylactic treatments for opportunistic infections (including 
        active tuberculosis); and
            ``(2) establish, in consultation with States, providers, 
        and affected communities, a recommended minimum formulary .
In carrying out paragraph (2), the Secretary shall identify those 
treatments in the recommended minimum formulary that are for the 
prevention of opportunistic infections (including the prevention of 
active tuberculosis).
    ``(d) State Duties.--
            ``(1) In general.--In implementing subsection (a), States 
        shall document the progress made in making treatments described 
        in subsection (c)(2) available to individuals eligible for 
        assistance under this section, and to develop plans to 
        implement fully the recommended minimum formulary.
            ``(2) Other mechanisms for providing treatments.--In 
        meeting the standards of the recommended minimum formulary 
        developed under subsection (c), a State may identify other 
        mechanisms such as consortia and public programs for providing 
        such treatments to individuals with HIV.''.
            (4) State application.--Section 2617(b) (42 U.S.C. 300ff-
        27(b)) is amended--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A), by striking 
                        ``and'' at the end thereof; and
                            (ii) by adding at the end thereof the 
                        following new subparagraph:
                    ``(C) a description of how the allocation and 
                utilization of resources are consistent with the 
                Statewide coordinated statement of need (including the 
                needs of children, adolescents, and women) developed in 
                partnership with other grantees in the State that 
                receive funding under this title;'';
                    (B) by redesignating paragraph (3) as paragraph 
                (4); and
                    (C) by inserting after paragraph (2), the following 
                new paragraph:
            ``(3) the public health agency administering the grant for 
        the State shall convene a meeting at least annually of 
        representatives of grantees funded under this title (including 
        HIV health services planning councils, early intervention 
        programs, children, youth and family service projects, special 
        projects of national significance, and HIV care consortia) and 
        other providers (including federally qualified health centers) 
        and public agency representatives within the State currently 
        delivering HIV services to affected communities for the purpose 
        of developing a Statewide coordinated statement of need. The 
        State shall not be required to finance attendance at such 
        meetings.''.
            (5) Distribution of funds.--Section 2618 (42 U.S.C. 300ff-
        28) is amended--
                    (A) by striking subsection (a);
                    (B) by redesignating subsections (b), (c), (d), and 
                (e) as subsections (a), (b), (c), and (d), 
                respectively;
                    (C) by amending subsection (a), as so redesignated, 
                to read as follows:
    ``(a) Amount of Grant.--
            ``(1) Minimum allotment.--
                    ``(A) In general.--Subject to the amount made 
                available pursuant to section 2620, the amount of a 
                grant to be made under this part for each of the 50 
                States, the District of Columbia, and Puerto Rico, 
                shall be the greater of--
                            ``(i) $250,000; and
                            ``(ii) an amount determined under paragraph 
                        (2).
                    ``(B) Virgin islands.--The United States Virgin 
                Islands shall be eligible for an allotment under 
                subparagraph (A) if the Secretary certifies that the 
                Virgin Islands has a program in place to effectively 
                utilize additional resources provided under such 
                allotment.
                    ``(C) Supplemental enhancement grants.--
                            ``(i) In general.--The Secretary shall 
                        award supplemental grants to eligible entities 
                        to enhance community-based care, treatment, and 
                        supportive services through the development and 
                        operation of consortia and innovative 
                        approaches.
                            ``(ii) Eligibility.--A State shall be 
                        eligible for--
                                    ``(I) a tier I supplemental grant 
                                in the amount of $500,000 if the number 
                                of AIDS cases (in the State) reported 
                                to and confirmed by the Centers for 
                                Disease Control and Prevention total 
                                not less than 1500 cases for the 10 
                                years prior to the fiscal year for 
                                which the grant is to be awarded and 
                                the State does not contain a 
                                metropolitan area whose chief elected 
                                official is a grantee for funding under 
                                part A; or
                                    ``(II) a tier II supplemental grant 
                                in the amount of $250,000 if the number 
                                of AIDS cases (in the State) reported 
                                to and confirmed by the Centers for 
                                Disease Control and Prevention total 
                                less than 1500 cases for the 10 years 
                                prior to the fiscal year for which the 
                                grant is to be awarded and the State 
                                does not contain a metropolitan area 
                                whose chief elected official is a 
                                grantee under part A and whose formula 
                                grant exceeds the minimum allotment 
                                described in subparagraph (A)(i).
                            ``(iii) Reduction.--A State that receives a 
                        grant under clause (ii)(I), or which would have 
                        been eligible to receive such a grant in fiscal 
                        year 1995, that subsequently contains a 
                        metropolitan area that becomes eligible for 
                        funding under part A, shall be subject to a 2-
                        year phased reduction in the amount of the 
                        grant under clause (ii)(I) as follows:
                                    ``(I) With respect to the first 
                                year in which the metropolitan area 
                                receives funds under part A, the State 
                                would receive $500,000 under clause 
                                (ii)(I).
                                    ``(II) With respect to the second 
                                year in which the metropolitan area 
                                receives funds under part A, the State 
                                would receive $250,000 under clause 
                                (ii)(I).
                                    ``(III) The State would not be 
                                eligible for funds under this 
                                subparagraph in years subsequent to the 
                                year described in subclause (II).
                            ``(iv) Terms.--All terms and conditions 
                        contained under subsections (b) and (c) of 
                        section 2617 shall apply to funds received 
                        under this subsection.
            ``(2) Determination.--
                    ``(A) Formula.--The amount referred to in paragraph 
                (1)(A) shall be the product of--
                            ``(i) an amount equal to the amount 
                        appropriated under section 2620 for the fiscal 
                        year involved less the amount needed to carry 
                        out subparagraph (B); and
                            ``(ii) the ratio of the distribution factor 
                        for the State or territory to the sum of the 
                        distribution factors for all the States or 
                        territories.
                    ``(B) Distribution factor.--As used in subparagraph 
                (A), the term `distribution factor' means the product 
                of--
                            ``(i) the number of cases of acquired 
                        immune deficiency syndrome in the State or 
                        territory, as indicated by the number of cases 
                        reported to and confirmed by the Centers for 
                        Disease Control and Prevention 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 income 
                                of individuals in the United States 
                                (including territories); to
                                    ``(II) the average per capita 
                                income of individuals in the State or 
                                territory.'';
                    (D) in subsection (b), as so redesignated--
                            (i) by amending paragraphs (3) and (4) to 
                        read as follows:
            ``(3) Planning and evaluations.--Subject to paragraph (5), 
        a State may not use more than 10 percent of amounts received 
        under a grant awarded under this part for planning and 
        evaluation activities.
            ``(4) Administration.--Subject to paragraph (5), a State 
        may not use more than 10 percent of amounts received under a 
        grant awarded under this part for administration, accounting, 
        reporting, and program oversight functions.'';
                            (ii) by redesignating paragraph (5) as 
                        paragraph (6); and
                            (iii) by inserting after paragraph (4), the 
                        following new paragraph (5):
            ``(5) Limitation on use of funds.--A State may not use more 
        than a total of 15 percent of amounts received under a grant 
        awarded under this part for the purposes described in 
        paragraphs (3) and (4).''
            (6) Technical assistance.--Section 2619 (42 U.S.C. 300ff-
        29) is amended--
                    (A) by striking ``may'' and inserting ``shall''; 
                and
                    (B) by inserting before the period the following: 
                ``, including technical assistance for the development 
                and implementation of Statewide coordinated statements 
                of need''.
            (7) Authorization of appropriations.--Section 2620 (42 
        U.S.C. 300ff-30), by striking ``$275,000,000'' and all that 
        follows through the end of the section, and inserting ``such 
        sums as may be necessary in each of the fiscal years 1996, 
        1997, 1998, 1999, and 2000.''.
            (8) Grievance procedures and coordination.--Part B of title 
        XXVI (42 U.S.C. 300ff-21) is amended by adding at the end 
        thereof the following new sections:

``SEC. 2621. GRIEVANCE PROCEDURES.

    ``Not later than 90 days after the date of enactment of this 
section, the Administration, in consultation with affected parties, 
shall establish grievance procedures, specific to each part of this 
title, to address allegations of egregious violations of each such part 
or the intent of the provisions of each such part. Such procedures 
shall include an appropriate enforcement mechanism.

``SEC. 2622. COORDINATION.

    ``The Secretary shall ensure that the Health 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 Federal HIV programs in order to 
facilitate the development of a complete continuum of HIV-related 
services for individuals with HIV disease and those at risk of such 
disease. The Secretary shall periodically prepare and submit to the 
relevant committees of Congress a report concerning such coordination 
efforts at the Federal, State, and local levels as well as the 
existence of Federal barriers to HIV program integration.''.
    (c) Early Intervention Services.--
            (1) Authorization of appropriations.--Section 2655 (42 
        U.S.C. 300ff-55) is amended by striking ``$75,000,000'' and all 
        that follows through the end of the section, and inserting 
        ``such sums as may be necessary in each of the fiscal years 
        1996, 1997, 1998, 1999, and 2000.''.
            (2) Required agreements.--Section 2664(g) (42 U.S.C. 300ff-
        64(g)) is amended--
                    (A) in paragraph (2), by striking ``and'' at the 
                end thereof;
                    (B) in paragraph (3)--
                            (i) by striking ``5 percent'' and inserting 
                        ``10 percent including planning, evaluation and 
                        technical assistance''; 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.''.
    (d) General Provisions.--Section 2671 (42 U.S.C. 300ff-71) is 
amended--
            (1) by amending the title to read as follows:

``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR 
              CHILDREN, YOUTH, WOMEN, AND FAMILIES.'';

            (2) in subsection (a)--
                    (A) by striking ``demonstration'';
                    (B) by striking ``and the Director'' and inserting 
                ``, in coordination with the Director'';
                    (C) by striking paragraph (1), and inserting the 
                following new paragraph:
            ``(1) supporting, at the health facilities of such 
        entities, access to and linkages with clinical research on 
        therapies for pediatric patients, youth, and women with HIV 
        disease, and special initiatives related to clinical research 
        and care findings;''; and
                    (D) by amending paragraph (2) to read as follows:
            ``(2) providing and coordinating outpatient health care 
        services and systems of care, directly or through contractual 
        arrangements, to children, youth, and women and their 
        families.'';
            (3) in subsection (c)--
                    (A) in paragraph (1), to read as follows:
            ``(1) Linkages to research.--The Secretary may not make a 
        grant to an applicant under subsection (a) unless the applicant 
        enters into an agreement with an appropriately qualified entity 
        with expertise in biomedical or behavioral research to enhance 
        voluntary access to research.''; and
                    (B) in paragraph (2)--
                            (i) by inserting after ``through the'' the 
                        following: ``Director of the Administrator of 
                        the Health Resources and Services 
                        Administration, and in coordination with the'';
                            (ii) in subparagraph (A), by striking ``; 
                        and'' and inserting a semicolon;
                            (iii) in subparagraph (B), by striking the 
                        period at the end and inserting ``; and''; and
                            (iv) by inserting after subparagraph (B), 
                        the following new subparagraph:
                    ``(C) may provide training and technical assistance 
                including peer-based assistance through the Health 
                Resources and Services Administration.'';
            (4) in subsections (d), (e), and (f), by striking 
        ``pediatric patient'' each place such term appears and 
        inserting ``children and youth'';
            (5) in subsection (f), by inserting before the period the 
        following: ``, including coordination and access to child 
        welfare services, support services, kinship care services, and 
        other appropriate services for orphans of the AIDS epidemic.'';
            (6) in subsection (h), to read as follows:
    ``(h) Coordination.--The Secretary may not make a grant under 
subsection (c) unless the applicant submits evidence that the proposed 
program is consistent with the Statewide coordinated statement of need 
and the applicant agrees to annually participate in the ongoing 
revision process of such statement of need.''; and
            (7) in subsection (j), by striking ``$20,000,000'' and all 
        that follows through the end of the section, and inserting 
        ``such sums as may be necessary in each of the fiscal years 
        1996, 1997, 1998, 1999, and 2000.''.
    (e) Special Projects of National Significance.--Title XXVI is 
amended by adding at the end, the following new part:

          ``PART F--SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE

``SEC. 2701. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

    ``(a) In General.--Of the amount appropriated under each of parts 
A, B, and C of this title for each fiscal year, the Secretary shall use 
the greater of $20,000,000 or 3 percent of such amount appropriated 
under each such part, but not to exceed $25,000,000, to administer a 
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 disease.
    ``(b) Grants.--The Secretary shall award grants under subsection 
(a) based on--
            ``(1) the need to assess the effectiveness of a particular 
        model for the care and treatment of 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 
may include the development and assessment of innovative service 
delivery models that are designed to--
            ``(1) address the needs of special populations; and
            ``(2) assist in the development of essential community-
        based service delivery infrastructure.
    ``(d) Special Populations.--Special projects of national 
significance 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 
        critical to the delivery of care in minority communities;
            ``(2) programs that build organizational capacity in 
        disenfranchised communities;
            ``(3) programs designed to prepare AIDS service 
        organizations and grantees under this title for operation 
        within the changing health care environment; and
            ``(4) programs designed to integrate the delivery of mental 
        health and substance abuse treatment with HIV services.
    ``(f) Distribution of Funds.--Fifty percent of the funds made 
available under this section shall be provided to geographic areas that 
are not eligible for funds under section 2603 except that existing 
grantees shall continue to receive funding for the length of the 
project period.
    ``(g) Coordination.--The Secretary may not make a grant under this 
section unless the applicant submits evidence that the proposed program 
is consistent with the Statewide coordinated statement of need, and the 
applicant agrees to participate in the ongoing revision process of such 
statement of need.
    ``(h) Replication.--The Secretary shall make information concerning 
successful models developed under this part available to grantees under 
this title for the purpose of coordination, replication, and 
integration. To facilitate efforts under this subsection, the Secretary 
may provide for peer-based technical assistance from grantees funded 
under this part.''.

SEC. 4. EFFECTIVE DATE.

    (a) In General.--Except as provided in subsection (b), this Act, 
and the amendments made by this Act, shall become effective on October 
1, 1995.
    (b) Eligible Areas.--The amendments made by subsections (a) and 
(b)(4)(A) of section 3 become effective on the date of enactment of 
this Act.
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