[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1872 Introduced in House (IH)]

  1st Session
                                H. R. 1872

 To amend the Public Health Service Act to revise and extend programs 
  established pursuant to the Ryan White Comprehensive AIDS Resources 
                         Emergency Act of 1990.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 16, 1995

 Mr. Bilirakis (for himself, Mr. Waxman, Mr. Bliley, Mr. Dingell, Mr. 
  Hastert, Mr. Wyden, Mr. Upton, Mr. Manton, Mr. Klug, Mr. Towns, Mr. 
Greenwood, Mr. Studds, Mr. Bilbray, Mr. Brown of Ohio, Mr. Ganske, Ms. 
Furse, Mr. Moorhead, Mr. Deutsch, Mr. Rush, Ms. Eshoo, Mr. Stupak, Mr. 
  Gunderson, and Ms. Pelosi) introduced the following bill; which was 
                 referred to the Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to revise and extend programs 
  established pursuant to the Ryan White Comprehensive AIDS Resources 
                         Emergency Act of 1990.
    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 Act Amendments of 
1995''.

SEC. 2. REFERENCES.

    Whenever in this Act an amendment is expressed in terms of an 
amendment to a section or other provision, the reference shall be 
considered to be made to that section or other provision of the Public 
Health Service Act (42 U.S.C. 201 et seq.).

 TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

SEC. 101. ESTABLISHMENT OF PROGRAM OF GRANTS; DELAYED EFFECTIVE DATE 
              FOR MODIFICATIONS.

    (a) In General.--Effective October 1, 1996, section 2601 (42 U.S.C. 
300ff-11) is amended--
            (1) in subsection (a)--
                    (A) by striking ``subject to subsection (b)'' and 
                inserting ``subject to subsections (b) through (d)''; 
                and
                    (B) by striking ``metropolitan area'' and all that 
                follows and inserting the following: ``metropolitan 
                area for which there has been 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 syndrome for the most recent period 
                of five calendar years for which such data are 
                available.''; and
            (2) by adding at the end thereof the following subsections:
    ``(c) Requirement Regarding Population.--In the case of a 
metropolitan area that was not an eligible area under this part for 
fiscal year 1996, the Secretary may not make a grant under this section 
for the area unless the area has a population of 500,000 or more 
individuals. For purposes of eligibility under this part, the 
boundaries of each metropolitan area are the boundaries in effect for 
fiscal year 1994.
    ``(d) Continued Status as Eligible Area.--A metropolitan area that 
was an eligible area under this part for fiscal year 1996 is an 
eligible area for fiscal year 1997 and each subsequent fiscal year.''.
    (b) Conforming Amendment Regarding Definition of Eligible Area.--
Effective October 1, 1996, section 2607(1) (42 U.S.C. 300ff-17(1)) is 
amended by striking ``The term'' and all that follows and inserting the 
following: ``The term `eligible area' means a metropolitan area meeting 
the requirements of section 2601 that are applicable to the area.''.

SEC. 102. HIV HEALTH SERVICES PLANNING COUNCIL.

    (a) Establishment.--Section 2602(b)(1) (42 U.S.C. 300ff-12(b)(13)) 
is amended--
            (1) in subparagraph (A), by inserting before the semicolon 
        the following: ``, including federally qualified health 
        centers'';
            (2) in subparagraph (D), by inserting before the semicolon 
        the following: ``and providers of services regarding substance 
        abuse'';
            (3) in subparagraph (G), by inserting before the semicolon 
        the following: ``and historically underserved groups and 
        subpopulations'';
            (4) in subparagraph (I), by inserting before the semicolon 
        the following: ``, including the State medicaid agency and the 
        agency administering the program under part B'';
            (5) in subparagraph (J), by striking ``and'' after the 
        semicolon;
            (6) by striking subparagraph (K); and
            (7) by adding at the end the following subparagraphs:
                    ``(K) grantees under section 2671, or, if none are 
                operating in the area, representatives of organizations 
                in the area with a history of serving children, youth, 
                women, and families living with HIV; and
                    ``(L) grantees under other HIV-related Federal 
                programs.''.
    (b) Duties.--Section 2602(b)(3) (42 U.S.C. 300ff-12(b)(3)) is 
amended--
            (1) by striking ``The planning'' in the matter preceding 
        subparagraph (A) and all that follows through the semicolon at 
        the end of subparagraph (A) and inserting the following: ``The 
        planning council under paragraph (1) shall carry out the 
        following:
                    ``(A) Establish priorities for the allocation of 
                funds within the eligible area based on the following 
                factors:
                            ``(i) Documented needs of the HIV-infected 
                        population.
                            ``(ii) Cost and outcome effectiveness of 
                        proposed strategies and interventions, to the 
                        extent that such data are reasonably available.
                            ``(iii) Priorities of the HIV-infected 
                        communities for whom the services are intended.
                            ``(iv) Availability of other governmental 
                        and nongovernmental resources.'';
            (2) in subparagraph (B)--
                    (A) by striking ``develop'' and inserting 
                ``Develop''; and
                    (B) by striking ``; and'' and inserting a period;
            (3) in subparagraph (C)--
                    (A) by striking ``assess'' and inserting 
                ``Assess'';
                    (B) by striking ``rapidly''; and
                    (C) by inserting before the period the following: 
                ``, and assess the effectiveness, either directly or 
                through contractual arrangements, of the services 
                offered in meeting the identified needs''; and
            (4) by adding at the end the following subparagraphs:
                    ``(D) Participate in the development of the 
                statewide coordinated statement of need initiated by 
                the State health department.
                    ``(E) Obtain input on community needs through 
                conducting public meetings.''
    (c) General Provisions.--Section 2602(b) (42 U.S.C. 300ff-12(b)) is 
amended by adding at the end the following paragraph:
            ``(4) General provisions.--
                    ``(A) Composition of council.--The planning council 
                under paragraph (1) shall (in addition to requirements 
                under such paragraph) reflect in its composition the 
                demographics of the epidemic in the eligible area 
                involved, with particular consideration given to 
                disproportionately affected and historically 
                underserved groups and subpopulations. Nominations for 
                membership on the council shall be identified through 
                an open process, and candidates shall be selected based 
                on locally delineated and publicized criteria. Such 
                criteria shall include a conflict-of-interest standard 
                for each nominee.
                    ``(B) Certain restrictions.--The planning council 
                under paragraph (1) may not be directly involved in the 
                administration of a grant under section 2601(a). With 
                respect to compliance with the preceding sentence, the 
                planning council may not designate (or otherwise be 
                involved in the selection of) particular entities as 
                recipients of any of the amounts provided in the 
                grant.''.
SEC. 103. TYPE AND DISTRIBUTION OF GRANTS.

    (a) Formula Grants Based on Relative Need of Areas.--Section 
2603(a) (42 U.S.C. 300ff-13(a)) is amended--
            (1) in paragraph (1)--
                    (A) in the second sentence, by inserting ``, 
                subject to paragraph (4)'' before the period; and
                    (B) by adding at the end the following sentence: 
                ``Grants under this paragraph for a fiscal year shall 
                be disbursed not later than 60 days after the date on 
                which amounts appropriated under section 2677 become 
                available for the fiscal year, subject to any waivers 
                under section 2605(d).'';
            (2) in paragraph (2), by amending the paragraph to read as 
        follows:
            ``(2) Allocations.--Of the amount available under section 
        2677 for a fiscal year for making grants under section 
        2601(a)--
                    ``(A) the Secretary shall reserve 50 percent for 
                making grants under paragraph (1) in amounts determined 
                in accordance with paragraph (3); and
                    ``(B) the Secretary shall, after compliance with 
                subparagraph (A), reserve such funds as may be 
                necessary to carry out paragraph (4).''; and
            (3) by adding at the end the following paragraph:
            ``(4) Maximum reduction in grant.--In the case of any 
        eligible area for which a grant under paragraph (1) was made 
        for fiscal year 1995, the Secretary, in making grants under 
        such paragraph for the area for the fiscal years 1996 through 
        2000, shall (subject to the extent of the amount available 
        under section 2677 for the fiscal year involved for making 
        grants under section 2601(a)) ensure that the amounts of the 
        grants do not, relative to such grant for the area for fiscal 
        year 1995, constitute a reduction of more than the following, 
        as applicable to the fiscal year involved:
                    ``(A) 1 percent, in the case of fiscal year 1996.
                    ``(B) 2 percent, in the case of fiscal year 1997.
                    ``(C) 3 percent, in the case of fiscal year 1998.
                    ``(D) 4 percent, in the case of fiscal year 1999.
                    ``(E) 5 percent, in the case of fiscal year 
                2000.''.
    (b) Supplemental Grants.--Section 2603(b) (42 U.S.C. 300ff-13(b)) 
is amended--
            (1) in paragraph (1)--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``Not later than'' and all that follows 
                through ``section 2605(b)--'' and inserting the 
                following: ``After allocating in accordance with 
                subsection (a) the amounts available under section 2677 
                for grants under section 2601(a) for a fiscal year, the 
                Secretary, in carrying out section 2601(a), shall from 
                the remaining amounts make grants to eligible areas 
                described in this paragraph. Such grants shall be 
                disbursed not later than 150 days after the date on 
                which amounts appropriated under section 2677 become 
                available for the fiscal year. An eligible area 
                described in this paragraph is an eligible area whose 
                application under section 2605(b)--'';
                    (B) in subparagraph (D), by striking ``and'' after 
                the semicolon;
                    (C) in subparagraph (E), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by adding at the end thereof the following 
                subparagraph:
                    ``(F) demonstrates the manner in which the proposed 
                services are consistent with the local needs assessment 
                and the statewide coordinated statement of need.''; and
            (2)(A) by redesignating paragraphs (2) through (4) as 
        paragraphs (3) through (5), respectively; and
            (B) by inserting after paragraph (1) the following 
        paragraph:
            ``(2) Priority.--
                    ``(A) Severe need.--In determining severe need in 
                accordance with paragraph (1)(B), the Secretary shall 
                give priority consideration in awarding grants under 
                this subsection to eligible areas that (in addition to 
                complying with paragraph (1)) demonstrate a more severe 
                need based on the prevalence in the eligible area of--
                            ``(i) sexually transmitted diseases, 
                        substance abuse, tuberculosis, severe mental 
                        illness, or other conditions determined 
                        relevant by the Secretary, which significantly 
                        affect the impact of HIV disease;
                            ``(ii) subpopulations with HIV disease that 
                        were previously unknown in such area; or
                            ``(iii) homelessness.
                    ``(B) Prevalence.--In determining prevalence of 
                conditions under subparagraph (A), the Secretary shall 
                use data on the prevalence of the conditions described 
                in such subparagraph among individuals with HIV disease 
                (except that, in the case of an eligible area for which 
                such data are not available, the Secretary shall use 
                data on the prevalences of the conditions in the 
                general population of such area).''.
    (c) Additional Requirements for Grants.--Section 2603 (42 U.S.C. 
300ff-13) is amended by adding at the end the following subsection:
    ``(c) Compliance With Priorities of HIV Planning Council.--
Notwithstanding any other provision of this part, the Secretary, in 
carrying out section 2601(a), may not make any grant under subsection 
(a) or (b) to an eligible area unless the application submitted by such 
area under section 2605 for the grant involved demonstrates that the 
grants made under subsections (a) and (b) to the area for the preceding 
fiscal year (if any) were expended in accordance with the priorities 
applicable to such year that were established, pursuant to section 
2602(b)(3)(A), by the planning council serving the area.''.

SEC. 104. USE OF AMOUNTS.

    Section 2604 (42 U.S.C. 300ff-14) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (1)(A), by striking ``including 
                case management and comprehensive treatment services, 
                for individuals'' and inserting the following: 
                ``including HIV-related comprehensive treatment 
                services (including treatment education and measures 
                for the prevention and treatment of opportunistic 
                infections), case management, and substance abuse 
                treatment and mental health treatment, for 
                individuals'';
                    (B) in paragraph (2)(A)--
                            (i) by inserting after ``nonprofit private 
                        entities,'' the following: ``, or private for-
                        profit entities if such entities are the only 
                        available provider of quality HIV care in the 
                        area,'' ; and
                            (ii) by striking ``and homeless health 
                        centers'' and inserting ``homeless health 
                        centers, substance abuse treatment programs, 
                        and mental health programs''; and
                    (C) by adding at the end the following paragraph:
            ``(3) Priority for women, infants and children.--For the 
        purpose of providing health and support services to infants, 
        children, and women with HIV disease, the chief elected 
        official of an eligible area shall use, of the grants made for 
        the area under section 2601(a) for a fiscal year, not less than 
        the percentage constituted by the ratio of the population in 
        such area of infants, children, and women with HIV disease to 
        the general population in such area of individuals with such 
        disease, or 15 percent, whichever is less. In expending the 
        funds reserved under the preceding sentence for a fiscal year, 
        the chief elected official shall give priority to providing, 
        for pregnant women, measures to prevent the perinatal 
        transmission of HIV.''; and
            (2) in subsection (e), by adding at the end thereof the 
        following sentence: ``In the case of entities 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).''.

SEC. 105. APPLICATION.

    Section 2605 (42 U.S.C. 300ff-15) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)(B), by striking ``1-year 
                period'' and all that follows through ``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 
                paragraph:
            ``(6) that the applicant will participate in the process 
        for the statewide coordinated statement of need (where it has 
        been initiated by the State), and will ensure that the services 
        provided under the comprehensive plan are consistent with such 
        statement.'';
            (2) in subsection (b)--
                    (A) in the subsection heading, by striking 
                ``Additional''; and
                    (B) in the matter preceding paragraph (1), by 
                striking ``additional'';
            (3) by redesignating subsections (c) and (d) as subsections 
        (d) and (e), respectively; and
            (4) by inserting after subsection (b), the following 
        subsection:
    ``(c) Single Application.--Upon the request of the chief elected 
official of an eligible area, the Secretary shall authorize the 
official to submit a single application through which the official 
simultaneously requests a grant pursuant to subsection (a) of section 
2603 and a grant pursuant to subsection (b) of such section. The 
Secretary may establish such criteria for carrying out this subsection 
as the Secretary determines to be appropriate.''.

SEC. 106. TECHNICAL ASSISTANCE; PLANNING GRANTS.

    Section 2606 (42 U.S.C. 300ff-16) is amended--
            (1) by inserting before ``The Administrator'' the 
        following: ``(a) In General.--'';
            (2) by striking ``may, beginning'' and all that follows 
        through ``title,'' and inserting ``(referred to in this section 
        as the `Administrator') shall''; and
            (3) by adding at the end the following subsection:
    ``(b) Planning Grants Regarding Initial Eligibility for Grants.--
            ``(1) Advance payments on first-year formula grants.--With 
        respect to a fiscal year (referred to in this subsection as the 
        `planning year'), if a metropolitan area has not previously 
        received a grant under section 2601 and the Administrator 
        reasonably projects that the area will be eligible for such a 
        grant for the subsequent fiscal year, the Administrator may 
        make a grant for the planning year for the purpose of assisting 
        the area in preparing for the responsibilities of the area in 
        carrying out activities under this part.
            ``(2) Requirements.--
                    ``(A) In general.--A grant under paragraph (1) for 
                a planning year shall be made directly to the chief 
                elected official of the city or urban county that 
                administers the public health agency to which section 
                2602(a)(1) is projected to apply for purposes of such 
                paragraph. The grant may not be made in an amount 
                exceeding $75,000.
                    ``(B) Offsetting reduction in first formula 
                grant.--In the case of a metropolitan area that has 
                received a grant under paragraph (1) for a planning 
                year, the first grant made pursuant to section 2603(a) 
                for such area shall be reduced by an amount equal to 
                the amount of the grant under such paragraph for the 
                planning year. With respect to amounts resulting from 
                reductions under the preceding sentence for a fiscal 
                year, the Secretary shall use such amounts to make 
                grants under section 2603(a) for the fiscal year, 
                subject to ensuring that none of such amounts are 
                provided to any metropolitan area for which such a 
                reduction was made for the fiscal year.
            ``(3) Funding.--Of the amounts available under section 2677 
        for a fiscal year for carrying out this part, the Administrator 
        may reserve not more than 1 percent for making grants under 
        paragraph (1).''.

                      TITLE II--CARE GRANT PROGRAM

SEC. 201. GENERAL USE OF GRANTS.

    Section 2612 (42 U.S.C. 300ff-22) is amended to read as follows:

``SEC. 2612. GENERAL USE OF GRANTS.

    (a) In General.--A State may use amounts provided under grants made 
under this part for the following:
            ``(1) To provide the services described in section 
        2604(b)(1) for individuals with HIV disease.
            ``(2) To provide to such individuals treatments that in 
        accordance with section 2616 have been determined to prolong 
        life or prevent serious deterioration of health.
            ``(3) To provide home- and community-based care services 
        for such individuals in accordance with section 2614.
            ``(4) To provide assistance to assure the continuity of 
        health insurance coverage for such individuals in accordance 
        with section 2615.
            ``(5) To establish and operate consortia under section 2613 
        within areas most affected by HIV disease, which consortia 
        shall be designed to provide a comprehensive continuum of care 
        to individuals and families with such disease in accordance 
        with such section.
    ``(b) Priority for Women, Infants and Children.--For the purpose of 
providing health and support services to infants, children, and women 
with HIV disease, a State shall use, of the funds allocated under this 
part to the State for a fiscal year, not less than the percentage 
constituted by the ratio of the population in the State of infants, 
children, and women with HIV disease to the general population in the 
State of individuals with such disease, or 15 percent, whichever is 
less. In expending the funds reserved under the preceding sentence for 
a fiscal year, the State shall give priority to providing, for pregnant 
women, measures to prevent the perinatal transmission of HIV.''.

SEC. 202. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

    Section 2613 (42 U.S.C. 300ff-23) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by inserting ``(or 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
                    (B) in paragraph (2)(A)--
                            (i) by inserting ``substance abuse 
                        treatment, mental health treatment,'' after 
                        ``nursing,''; and
                            (ii) by inserting after ``monitoring,'' the 
                        following: ``measures for the prevention and 
                        treatment of opportunistic infections, 
                        treatment education for patients (provided in 
                        the context of health care delivery),'' ; and
            (2) in subsection (c)(2)--
                    (A) in clause (ii) of subparagraph (A), by striking 
                ``and'' after the semicolon;
                    (B) in subparagraph (B), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding after subparagraph (B) the following 
                subparagraph:
                    ``(C) grantees under section 2671, or, if none are 
                operating in the area, representatives in the area of 
                organizations with a history of serving children, 
                youth, women, and families living with HIV.''.

SEC. 203. PROVISION OF TREATMENTS.

    Section 2616(a) (42 U.S.C. 300ff-26(a)) is amended--
            (1) by striking ``may use amounts'' and inserting ``shall 
        use a portion of the amounts'';
            (2) by striking ``section 2612(a)(4)'' and inserting 
        ``section 2612(a)(2)''; and
            (3) by inserting before the period the following: ``, 
        including measures for the prevention and treatment of 
        opportunistic infections''.

SEC. 204. STATE APPLICATION.

    Section 2617(b)(2) (42 U.S.C. 300ff-27(b)(2)) is amended--
            (1) in subparagraph (A), by striking ``and'' after the 
        semicolon; and
            (2) in subparagraph (B), by striking ``and'' after the 
        semicolon; and
            (3) by adding at the end thereof the following 
        subparagraphs:
                    ``(C) a description of the activities carried out 
                by the State under section 2616; and
                    ``(D) a description of how the allocation and 
                utilization of resources are consistent with a 
                statewide coordinated statement of need, developed in 
                partnership with other grantees in the State that 
                receive funding under this title and after consultation 
                with individuals receiving services under this part.''.

SEC. 205. ALLOCATION OF ASSISTANCE BY STATES; PLANNING, EVALUATION, AND 
              ADMINISTRATION.

    Section 2618(c) (42 U.S.C. 300ff-28(c)) is amended--
            (1) by striking paragraph (1);
            (2) by redesignating paragraphs (2) through (5) as 
        paragraphs (1) through (4), respectively; and
            (3) in paragraph (3) (as so redesignated), by adding at the 
        end the following sentences: ``In the case of entities to which 
        the State allocates amounts received by the State under the 
        grant (including 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). For purposes of the preceding sentence, the costs of 
        establishing and operating consortia under section 2613 shall 
        be considered administrative expenses.''.

SEC. 206. TECHNICAL ASSISTANCE.

    Section 2619 (42 U.S.C. 300ff-29) is amended by inserting before 
the period the following: ``, including technical assistance for the 
development and implementation of statewide coordinated statements of 
need''.

                 TITLE III--EARLY INTERVENTION SERVICES

SEC. 301. ESTABLISHMENT OF PROGRAM.

    Section 2651(b) (42 U.S.C. 300ff-51(b)) is amended--
            (1) in paragraph (1), by inserting before the 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''; 
        and
            (2) in paragraph (4), by inserting after ``nonprofit 
        private entities'' the following: ``(or private for-profit 
        entities, if such entities are the only available providers of 
        quality HIV care in the area)''.

SEC. 302. MINIMUM QUALIFICATIONS OF GRANTEES.

    Section 2652(b)(1)(B) (42 U.S.C. 300ff-52(b)(1)(B)) is amended by 
inserting after ``nonprofit private entity'' the following: ``(or a 
private for-profit entity, if such an entity is the only available 
provider of quality HIV care in the area)''.

SEC. 303. MISCELLANEOUS PROVISIONS; PLANNING AND DEVELOPMENT GRANTS.

    Section 2654 (42 U.S.C. 300ff-54) is amended by adding at the end 
thereof the following 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 of 
        enabling such entities to provide early intervention services.
            ``(2) Requirement.--The Secretary may award a grant to an 
        entity under paragraph (1) only 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 
        HIV primary care services in rural or underserved communities.
            ``(4) Limitation.--Not to exceed 1 percent of the amount 
        appropriated for a fiscal year under section 2655 may be used 
        to carry out this section.''.

SEC. 304. ADDITIONAL REQUIRED AGREEMENTS.

    Section 2664(a)(1) (42 U.S.C. 300ff-64(a)(1)) is amended--
            (1) in subparagraph (A), by striking ``and'' after the 
        semicolon;
            (2) in subparagraph (B), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following subparagraph:
                    ``(C) evidence that the proposed program is 
                consistent with the statewide coordinated statement of 
                need and that the applicant will participate in the 
                ongoing revision of such statement of need.''.

SEC. 305. AUTHORIZATION OF APPROPRIATIONS.

    Section 2655 (42 U.S.C. 300ff-55) is amended by striking 
``$75,000,000'' and all that follows and inserting ``such sums as may 
be necessary for each of the fiscal years 1996 through 2000.''.
                      TITLE IV--GENERAL PROVISIONS

SEC. 401. GRANTS REGARDING CLINICAL RESEARCH AND WOMEN, INFANTS, AND 
              CHILDREN.

    (a) In General.--Section 2671 (42 U.S.C. 300ff-71) is amended--
            (1) in subsection (a), by amending the subsection to read 
        as follows:
    ``(a) In General.--
            ``(1) Program of grants.--The Secretary, acting through the 
        Administrator of the 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 purpose of--
                    ``(A) providing through such entities, in 
                accordance with this section, opportunities for women, 
                infants, and children to participate as subjects in 
                research of potential clinical benefit to individuals 
                with HIV disease; and
                    ``(B) providing to women, infants, and children 
                health care on an outpatient basis.
            ``(2) Provisions regarding participation in research.--With 
        respect to the projects of research with which an applicant 
        under paragraph (1) is concerned, the Secretary may not make a 
        grant under such paragraph to the applicant unless the 
        following conditions are met:
                    ``(A) The applicant agrees to make reasonable 
                efforts--
                            ``(i) to identify the needs of the projects 
                        for women, infants, and children to participate 
                        as subjects in the projects;
                            ``(ii) to identify which of the patients of 
                        the applicant are women, infants, and children 
                        who would be appropriate subjects in the 
                        projects; and
                            ``(iii) to offer women, infants, and 
                        children the opportunity to so participate (as 
                        appropriate), including the provision of 
                        services under subsection (f).
                    ``(B) The applicant agrees that the applicant, and 
                the projects of research, will comply with accepted 
                standards of protection for human subjects (including 
                the provision of written informed consent) who 
                participate as subjects in clinical research.
                    ``(C) For the second or subsequent fiscal year for 
                which a grant under such paragraph is sought by the 
                applicant, the Secretary has determined that--
                            ``(i) a significant number of women, 
                        infants, and children who are patients of the 
                        applicant are participating in the projects 
                        (except to the extent this clause is waived 
                        under subsection (k)); and
                            ``(ii) the applicant, and the projects of 
                        research, have complied with the standards 
                        referred to in subparagraph (B).
            ``(3) Prohibition.--Receipt of services by a patient shall 
        not be conditioned upon the consent of the patient to 
        participate in research.
            ``(4) Consideration by secretary of certain 
        circumstances.--In administering the requirement of paragraph 
        (2)(C)(i), the Secretary shall take into account circumstances 
        in which a grantee under paragraph (1) is temporarily unable to 
        comply with the requirement for reasons beyond the control of 
        the grantee, and shall in such circumstances provide to the 
        grantee a reasonable period of opportunity in which to 
        reestablish compliance with the requirement.'';
            (2) in subsection (c), by amending the subsection to read 
        as follows:
    ``(c) Provisions Regarding Conduct of Research.--With respect to 
eligibility for a grant under subsection (a):
            ``(1) A project of research for which subjects are sought 
        pursuant to such subsection may be 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.
            ``(2) The grant may not be made unless the Secretary makes 
        the following determinations:
                    ``(A) The applicant or other entity (as the case 
                may be under paragraph (1)) is appropriately qualified 
                to conduct the project of research.
                    ``(B) The project of research is being conducted in 
                accordance with a research protocol to which the 
                Secretary gives priority regarding the prevention and 
                treatment of HIV disease in women, infants, and 
                children. After consultation with public and private 
                entities that conduct such research, and with providers 
                of services under this section and recipients of such 
                services, the Secretary shall establish a list of such 
                protocols that are appropriate for purposes of this 
                section. The Secretary may give priority under this 
                subparagraph to a research protocol that is not on such 
                list.'';
            (3) by striking subsection (i);
            (4) by redesignating subsections (g) and (h) as subsections 
        (h) and (i), respectively;
            (5) by inserting after subsection (f) the following 
        subsection:
    ``(g) Additional Provisions.--The Secretary may not make a grant 
under subsection (a) unless 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 
        coordinated statement of need under part B and in revisions of 
        such statement.'';
            (6) by redesignating subsection (j) as subsection (m); and
            (7) by inserting before subsection (m) (as so redesignated) 
        the following subsections:
    ``(j) Coordination With National Institutes of Health.--The 
Secretary shall develop and 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 this section, and shall require that the 
projects, as appropriate, enter into arrangements for purposes of this 
section.
    ``(k) Temporary Waiver Regarding Significant Participation.--
            ``(1) In general.--In the case of an applicant under 
        subsection (a) who received a grant under this section for 
        fiscal year 1995, the Secretary may, subject to paragraph (2), 
        provide to the applicant a waiver of the requirement of 
        subsection (a)(2)(C)(i) if the Secretary determines that the 
        applicant is making reasonable progress toward meeting the 
        requirement.
            ``(2) Termination of authority for waivers.--The Secretary 
        may not provide any waiver under paragraph (1) on or after 
        October 1, 1998. Any such waiver provided prior to such date 
        terminates on such date, or on such earlier date as the 
        Secretary may specify.
    ``(l) Training and Technical Assistance.--Of the amounts 
appropriated under subsection (m) for a fiscal year, the Secretary may 
use not more than five percent to provide training and technical 
assistance to assist applicants and grantees under subsection (a) in 
complying with the requirements of this section.''.
    (b) Conforming Amendments.--Section 2671 (42 U.S.C. 300ff-71) is 
amended--
            (1) in the heading for the section, by striking 
        ``demonstration'' and all that follows and inserting ``grants 
        regarding clinical research and women, infants, and 
        children.'';
            (2) in subsection (b), by striking ``pediatric patients and 
        pregnant women'' and inserting ``women, infants, and 
        children''; and
            (3) in each of subsections (d) through (f), by striking 
        ``pediatric''.
    (c) Authorization of Appropriations.--Section 2671 (42 U.S.C. 
300ff-71) is amended in subsection (m) (as redesignated by subsection 
(a)(6)) by striking ``there are'' and all that follows and inserting 
the following: ``there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 1996 through 2000.''.
SEC. 402. PROJECTS OF NATIONAL SIGNIFICANCE.

    (a) In General.--Part D of title XXVI (42 U.S.C. 300ff-71 et seq.) 
is amended by inserting after section 2673 the following section:

``SEC. 2673A. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE.

    ``(a) In General.--The Secretary shall make grants to public and 
nonprofit private entities (including nonprofit private community-based 
organizations) for the purpose of carrying out demonstration projects 
that provide for the care and treatment of individuals with HIV 
disease, and that--
            ``(1) assess the effectiveness of particular models for the 
        care and treatment of individuals with such disease;
            ``(2) are of an innovative nature; and
            ``(3) have the potential to be replicated in similar 
        localities, or nationally.
    ``(b) Certain Projects.--Demonstration projects under subsection 
(a) shall include the development and assessment of innovative models 
for the delivery of HIV services that are designed--
            ``(1) to address the needs of special populations 
        (including individuals and families with HIV disease living in 
        rural communities, adolescents with HIV disease, Native 
        American individuals and families with HIV disease, homeless 
        individuals and families with HIV disease, hemophiliacs with 
        HIV disease, and incarcerated individuals with HIV disease); 
        and
            ``(2) to ensure the ongoing availability of services for 
        Native American communities to enable such communities to care 
        for Native Americans with HIV disease.
    ``(c) Coordination.--The Secretary may not make a grant under this 
section unless the applicant submits evidence that the proposed program 
is consistent with the applicable statewide coordinated statement of 
need under part B, and the applicant agrees to participate in the 
ongoing revision process of such statement of need.
    ``(d) Replication.--The Secretary shall make information concerning 
successful models developed under this section available to grantees 
under this title for the purpose of coordination, replication, and 
integration.
    ``(e) Funding; Allocation of Amounts.--
            ``(1) In general.--Of the amounts available under this 
        title for a fiscal year for each program specified in paragraph 
        (2), the Secretary shall reserve 3 percent for making grants 
        under subsection (a).
            ``(2) Relevant programs.--The programs referred to in 
        subsection (a) are the program under part A, the program under 
        part B, the program under part C, the program under section 
        2671, the program under section 2672, and the program under 
        section 2673.''.
    (b) Striking of Related Provision.--Section 2618 (42 U.S.C. 300ff-
28) is amended striking subsection (a).

SEC. 403. SPECIAL TRAINING PROJECTS.

    (a) Transfer of Program.--The Public Health Service Act (42 U.S.C. 
201 et seq.) is amended--
            (1) by transferring section 776 from the current placement 
        of the section;
            (2) by redesignating the section as section 2673B; and
            (3) by inserting the section after section 2673A (as added 
        by section 402).
    (b) Modifications.--Section 2673B (as transferred and redesignated 
by subsection (a)) is amended--
            (1) in subsection (a)(1)--
                    (A) by striking subparagraphs (B) and (C);
                    (B) by redesignating subparagraphs (A) and (D) as 
                subparagraphs (B) and (C), respectively;
                    (C) by inserting before subparagraph (B) (as so 
                redesignated) the following subparagraph:
                    ``(A) training health personnel, including 
                practitioners in programs under this title and other 
                community providers, in the diagnosis, treatment, and 
                prevention of HIV disease, including the prevention of 
                the perinatal transmission of the disease and including 
                measures for the prevention and treatment of 
                opportunistic infections;'';
                    (D) in subparagraph (B) (as so redesignated), by 
                adding ``and'' after the semicolon; and
                    (E) in subparagraph (C) (as so redesignated), by 
                striking ``curricula and'';
            (2) by striking subsection (c) and redesignating subsection 
        (d) as subsection (c); and
            (3) in subsection (c) (as so redesignated), by amending the 
        subsection to read as follows:
    ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 1996 through 2000.''.
SEC. 404. 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:
    ``(c) Allocation of Funds.--The Secretary shall carry out this 
section with amounts available under section 241. Such amounts are in 
addition to any other amounts that are available to the Secretary for 
such purpose.''.

SEC. 405. COORDINATION OF PROGRAM.

    Section 2675 of the Public Health Service Act (42 U.S.C. 300ff-75) 
is amended by adding at the end the following subsection:
    ``(d) Annual Report.--Not later than October 1, 1996, and annually 
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 programs.''.

                     TITLE V--ADDITIONAL PROVISIONS

SEC. 501. AMOUNT OF EMERGENCY RELIEF GRANTS.

    Paragraph (3) of section 2603(a) (42 U.S.C. 300ff-13(a)(3)) is 
amended to read as follows:
            ``(3) Amount of grant.--
                    ``(A) In general.--Subject to the extent of amounts 
                made available in appropriations Acts, a grant made for 
                purposes of this paragraph to an eligible area shall be 
                made in an amount equal to the product of--
                            ``(i) an amount equal to the amount 
                        available for distribution under paragraph (2) 
                        for the fiscal year involved; and
                            ``(ii) the percentage constituted by the 
                        ratio of the distribution factor for the 
                        eligible area to the sum of the respective 
                        distribution factors for all eligible areas.
                    ``(B) Distribution factor.--For purposes of 
                subparagraph (A)(ii), the term `distribution factor' 
                means the product of--
                            ``(i) an amount equal to the estimated 
                        number of living cases of acquired immune 
                        deficiency syndrome in the eligible area 
                        involved, as determined under subparagraph (C); 
                        and
                            ``(ii) the cost index for the eligible area 
                        involved, as determined under subparagraph (D).
                    ``(C) Estimate of living cases.--The amount 
                determined in this subparagraph is an amount equal to 
                the product of--
                            ``(i) the number of cases of acquired 
                        immune deficiency syndrome in the eligible area 
                        during each year in the most recent 120-month 
                        period for which data are 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 
                        Disease 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;
                                    ``(IX) the ninth year during such 
                                period, .57; and
                                    ``(X) the tenth year during such 
                                period, .88.
                    ``(D) Cost index.--The amount determined in this 
                subparagraph is an amount equal to the sum of--
                            ``(i) the product of--
                                    ``(I) the average hospital wage 
                                index reported by hospitals in the 
                                eligible area involved under section 
                                1886(d)(3)(E) of the Social Security 
                                Act for the 3-year period immediately 
                                preceding the year for which the grant 
                                is being awarded; and
                                    ``(II) .70; and
                            ``(ii) .30.
                    ``(E) Unexpended funds.--The 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 unexpended and uncanceled grant 
                funds remaining at the end of the fiscal year preceding 
                the year for which the grant determination is to be 
                made. The amount of any such unexpended funds shall be 
                determined using the financial status report of the 
                grantee.
                    ``(F) Puerto rico, virgin islands, guam.--For 
                purposes of subparagraph (D), the cost index for an 
                eligible area within Puerto Rico, the Virgin Islands, 
                or Guam shall be 1.0.''.

SEC. 502. AMOUNT OF CARE GRANTS.

    Section 2618 (42 U.S.C. 300ff-28), as amended by section 402(b), is 
amended by striking subsection (b) and inserting the following 
subsections:
    ``(a) Amount of Grant.--
            ``(1) In general.--Subject to subsection (b) (relating to 
        minimum grants), the amount of a grant under this part for a 
        State for a fiscal year shall be the sum of--
                    ``(A) the amount determined for the State under 
                paragraph (2); and
                    ``(B) the amount determined for the State under 
                paragraph (4) (if applicable).
            ``(2) Principal formula grants.--For purposes of paragraph 
        (1)(A), the amount determined under this paragraph for a State 
        for a fiscal year shall be the product of--
                    ``(A) the amount available under section 2677 for 
                carrying out this part, less the reservation of funds 
                made in paragraph (4)(A) and less any other applicable 
                reservation of funds authorized or required in this 
                title (which amount is subject to subsection (b)); and
                    ``(B) the percentage constituted by the ratio of--
                            ``(i) the distribution factor for the 
                        State; to
                            ``(ii) the sum of the distribution factors 
                        for all States.
            ``(3) Distribution factor for principal formula grants.--
        For purposes of paragraph (2)(B), the term ``distribution 
        factor'' means the following, as applicable:
                    ``(A) In the case of each of the 50 States, the 
                product of--
                            ``(i) the number of cases of acquired 
                        immune deficiency syndrome in the State, as 
                        indicated by the number of cases reported to 
                        and confirmed by the Secretary for the 2 most 
                        recent fiscal years for which such data are 
                        available; and
                            ``(ii) the cube root of the ratio (based on 
                        the most recent available data) of--
                                    ``(I) the average per capita income 
                                of individuals in the United States 
                                (including the territories); to
                                    ``(II) the average per capita 
                                income of individuals in the State.
                    ``(B) In the case of a territory of the United 
                States, the number of additional cases of such syndrome 
                in the specific territory, as indicated by the number 
                of cases reported to and confirmed by the Secretary for 
                the 2 most recent fiscal years for which such data is 
                available.
            ``(4) Supplemental amounts for certain states.--For 
        purposes of paragraph (1)(B), an amount shall be determined 
        under this paragraph for each State that does not contain any 
        metropolitan area whose chief elected official received a grant 
        under part A for fiscal year 1996. The amount determined under 
        this paragraph for such a State for a fiscal year shall be the 
        product of--
                    ``(A) an amount equal to 7 percent of the amount 
                available under section 2677 for carrying out this part 
                for the fiscal year (subject to subsection (b)); and
                    ``(B) the percentage constituted by the ratio of--
                            ``(i) the number of cases of acquired 
                        immune deficiency syndrome in the State (as 
                        determined under paragraph (3)(A)(i)); to
                            ``(ii) the sum of the respective numbers 
                        determined under clause (i) for each State to 
                        which this paragraph applies.
            ``(5) Definitions.--For purposes of this subsection and 
        subsection (b):
                    ``(A) The term `State' means each of the 50 States, 
                the District of Columbia, and the Commonwealth of 
                Puerto Rico.
                    ``(B) The term `territory of the United States' 
                means the Virgin Islands, Guam, American Samoa, the 
                Commonwealth of the Northern Mariana Islands, and the 
                Republic of the Marshall Islands.
    ``(b) Minimum Amount of Grant.--
            ``(1) In general.--Subject to the extent of the amounts 
        specified in paragraphs (2)(A) and (4)(A) of subsection (a), a 
        grant under this part for a State for a fiscal year shall be 
        the greater of--
                    ``(A) the amount determined for the State under 
                subsection (a); and
                    ``(B) the amount applicable under paragraph (2) to 
                the State.
            ``(2) Applicable amount.--For purposes of paragraph (1)(B), 
        the amount applicable under this paragraph for a fiscal year is 
        the following:
                    ``(A) In the case of each of the 50 States and the 
                District of Columbia--
                            ``(i) $100,000, if the State or District 
                        has less than 90 cases of acquired immune 
                        deficiency syndrome (as determined under 
                        subsection (a)(3)(A)(i)); and
                            ``(ii) $250,000, if the State or District 
                        has 90 or more such cases (as so determined).
                    ``(B) In the case of each of the territories of the 
                United States, $0.0.''.

SEC. 503. CONSOLIDATION 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 section:

``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) In General.--For the purpose of carrying out parts A and B, 
there are authorized to be appropriated such sums as may be necessary 
for each of the fiscal years 1996 through 2000. Subject to section 
2673A and to subsection (b), of the amount appropriated under this 
section for a fiscal year, the Secretary shall make available 64 
percent of such amount to carry out part A and 36 percent of such 
amount to carry out part B.
    ``(b) Development of Methodology.--With respect to each of the 
fiscal years 1997 through 2000, the Secretary may develop and implement 
a methodology for adjusting the percentages referred to in subsection 
(a).''.
    (b) Repeals.--Sections 2608 and 2620 (42 U.S.C. 300ff-18 and 300ff-
30) are repealed.
    (c) Conforming Amendments.--Title XXVI is amended--
            (1) in section 2603(b)(1), by striking ``2608'' and 
        inserting ``2677'';
            (2) in section 2605(c)(1), by striking ``2608'' and 
        inserting ``2677''; and
            (3) in section 2618--
                    (A) in subsection (a)(1), by striking ``2620'' and 
                inserting ``2677''; and
                    (B) in subsection (b)(1), by striking ``2620'' and 
                inserting ``2677''.

                        TITLE VI--EFFECTIVE DATE

SEC. 601. EFFECTIVE DATE.

  Except as provided in section 101, this Act takes effect October 1, 
1995.
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